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MaiTai - F&E 3
Fluid and Electrolyte Lecture 3
31
Nursing
Not Applicable
09/13/2010

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Term
Purpose of Parental Fluid Therapy
Definition
-Maintenance Needs
NPO
-Replace Abnormal Fluid Losses
Suctioning, Vomiting, Diarrhea
-Correct Electrolytes Disturbances
Hypokalemia, Hyponatremia
-Provide Drug Therapy
Prophylaxis, Infection
Term
Advantages of IV administration of Drug Therapy
Definition
-Drug circulates rapidly
-Easier to maintain constant blood levels
-Patient that cannot accept drugs by GI tract
-Patient unable to swallow
Term
Water and Electrolyte Solutions
Definition
Types of IV are categorized according to its concentration (tonicity) & pH to plasma
Term
Isotonic Solutions
Definition
same concentration as plasma
0.9% saline
Term
Hypotonic solution
Definition
lower concentration than plasma

-moves water into the cell to expand them
-excessive use can cause water intoxication
-0.45% saline (1/2 normal saline)
Term
Hypertonic solution
Definition
higher concentration than plasma

-used to correct fluid, electrolyte, & acid-base imbalances by moving water out of the body's cell & into the blood stream
Term
Selection of vascular access device
Definition
-Short peripheral catheters
-midarm/midline catheters
-central infusion devices
-nonTunneled percutaneous catheter
-Tunneled central catheter
-Implanted venous access ports
-Dialysis catheters
Term
Short peripheral catheters
Definition
26 (smallest) to 14 (large bore) gauge
26-24 used for older & pediatric pts
20 most commonly used
18 surgery
16-14 high risk procedures

Best practices:
-place in upper extremities
-use in non-dominant arm
-avoid choosing a site in the joint reflexion

Allowed to stay in place for 72-96h then replaced
Term
Midarm/Midline catheter
Definition
-6-8 inches in the antecubital fossa
-used for therapies lasting from 1-4 weeks
Term
Central infusion devices
Definition
-Peripherally inserted central catheter (PICC)
-18-29in, into antecubital fossa
-Tips of the catheter sits in the SVC & placement is verified by X-Ray

Used for:
-drugs that need to be quickly diluted
-Chemotherapy
-lengthly courses of antibiotics
-parenteral nutrition
Term
Nontunneled percutaneous catheter
Definition
place either at the subclavian or internal jugular

short term used
Term
Tunneled Central catheter
Definition
Portion of the catheter is placed subcutaneously

long term use
Term
Implanted Venous Access Ports
Definition
Surgically implanted placed in the upper chest or extremities
Term
Dialysis Catheters
Definition
-used for hemodialysis or a phersis procedure
-may be tunnelled for long term use or nontunneled for short term
-used for management for renal failure
Term
Rationale for selecting a central venous access device (CVAD)
Definition
-There is a higher blood flow volume in a central venous site
-superior vena cava 2000mL/m
-subclavian 800mL/m
-cephalic and basilic vein of upper arm 40-95mL/m
-Hypertonic solution needs to be administered into an area with high blood flow in order to immediately dilute
-A medication can be very irritating to the vessel may be given via CVAD
Such as: 50% glucose (TPN - Total parenteral nutrition) or 5-10% glucose give via peripheral site (PPN - peripheral parenteral nutrition)
Term
Rationale for determining IV flow rate
Definition
-Type of solution: solution may be irritating- give slower or dilute more
-Patient reaction: pt may c/o pain
-Fluid Deficit: higher rates if pt has good cardiac & renal function to prevent fluid overload
-Body size
-Age
Term
Standard of Care
Definition
-Assess IV site to the bag q1h
-Inspect site for redness, swelling, hardness & pain
-Check tubing for kinks
-Change peripheral IV sites every 72-96hrs
-Change primary tubing every 72hrs
-Change fluid containers every 24hrs
-Change dressing if it becomes loose, wet or soiled or when the catheter is removed.
Term
Local complications
Definition
-Infiltration
-Phlebitis
-Thrombosis/Thrombophlebitis
-Ecchymosis & Hematoma
-Infection at the IV site
Term
Infiltration
Definition
leakage of IV fluid into the extravascular tissue

s&s: edema at the IV site
NIs: stop the infusion & discontinue the IV, elevate extremity , apply cold compresses
Term
Phlebitis
Definition
Inflammation of the vein

s&s: pain, redness at the site, palpable hard like cord along the vein
NIs: discontinue the IV, warm compresses

Use intravenous nurses society phlebitis scale to document
Term
Thrombosis/Thrombophlebitis
Definition
blood clot inside the vein

s&s: slowed or stopped infusion, swollen extremity, tenderness&redness
NI's stop infusion & discontinue the IV, cold compresses, elevate. For thrombophlebitis: apply cold initially then warm compresses
Term
Ecchymosis & Hematoma
Definition
&secchymosis is from blood infiltrating into the surrounding tissue.

s: swelling, then bruising & pain
NIs: apply proper pressure when removing IV, treatment is the same as for infiltration.
Term
Infection at the IV site
Definition
localized redness & hardness at site

s&s: site is red, swollen, warm, pt c/o tenderness
NIs: clean exit site with alcohol, cover with sterile dressing
Term
Systemic complications
Definition
-Circulatory overload
-catheter embolism
-air embolism
Term
Circulatory overload
Definition
infusing fluids at a rate greater than the pt can accommodate

s&s: decrease amount of solution in the IV bad
-moist breath sounds (crackles)
-increased BP
NIs: slow rate down to KVO, raise the HOB, and call MD.
Term
Catheter Embolism
Definition
caused by a piece of the catheter breaking off & free floating in the vein

s&s: Decreased BP, pain along the vein, pulse becomes weak and thready
NIs: remove catheter, apply tourniquet high on the limb
Term
Air embolism
Definition
air is introduced into the central venous system during catheter insertion.

s&s: hypoxia, hypotension, respiratory distress, cyanosis, dyspnea, cough, changes in cardiac & neurological status, lightheadness
NIs: clamp catheter immediately, place pt in Trendelenburg's position on left side, head down, call MD, ABG's, ECG, administer 02 tape all connectors
Term
Parenteral Nutrition
Definition
supplying nutritional requirements by vein
Term
Partial nutritional support
Definition
is administered by peripheral vein (peripheral parenteral nutrition - PPN) that is less then 10% dextrose
Term
Total Parenteral Nutrition (TPN)
Definition
10% dextrose & administer via CVC

NIs: gradually increase as tolerated and taper when discontinuing therapy
-ongoing assessment of CVC site
-following hospital policy for dressing changes
-Change bag & tubing every q24h
-pt. may be allergic to fat or protein assess for side effects nausea, exhaustion, diarrhea
-assess for:
-hyperglycemia: fatigue, thirst, polyuria
-hyperosmolar, hyperglycemic, non-ketotic syndrome (HHNS): increase blood sugar, dehydration, increase serum osmolarity, somnolence (prolonged drowsiness, sleepiness), seizure and coma
Term
Enteral tube feeding
Definition
consume adequate nutrients even though GI tract is functioning

administered through the GI tract using a tube
-NG, G-Tube, J-tube

Characteristics of formula:
-formulas differ in osmolarity
-protein and CHO sources
-fat content
-caloric density

NIs:-administer formulas at room temp.
-adjust flow rate - start slow
-administer free water with feeding
-change delivery system q24h
-auscultate lung and bowel sounds

Assess:
-Type of feeding being administered
-Lab Values
-Hydration status
-I&O - diarrhea
-skin turgor
-tongue & mucous membrane
-thirst
-daily weight
-lung sounds
-sensory (mental awareness)
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