• Water in the body varies with what three factors?
• What does whole blood contain? RBC,WBC,
Age, body fat, sex
• What percent of the body is water? 60%
• Where are body fluids located? Intracellular,
extracellular
• What is extracellular subdivided into? Interstitial
and intravascular
• Who has higher fluid content? Infants 70 to 80%,
more vulnerable to fluid deficit
• Why do elderly have decrease fluid content?
Decreased mean body mass
• Name the three types of transport? Define?
Diffusion- movement of gas/liquid molecules from a
area of higher concentration to lesser thru a
selective permeable membrane (CO2 & O2,
perspiration, sweat glands). Osmosis – passage of a
solvent thru a membrane from a solution of lesser
solute to one of greater solute (venous/capillary).
Filtration- fluids flow from an area of greater
pressure across a membrane to an area of low
pressure (hydrostatic-arterial capillary bed to
interstitial)
• What organs maintains fluid composition? Kidneys,
lungs, heart, adrenal glands, parathyroid glands,
hypothalamus
• What is the rule of gains and losses? Input is = to
output
• What are other ways fluids are regulated by the
body? Thirst, output by kidney-skin-lungs-GI tract,
regulation – cellular NA/K+ pump-capillary level-
kidney filtration, Hormonal – Pituitary-hypothalmus-
adrenal-parathyroid glands, BP controls, osmolality,
lymphatics.
• What should be included in an assessment with a
patient with fluid and electrolyte imbalances?
Significant history that would be an indication
(disease, medications, diet, adequate I&O’s,
abnormal loss of fluid or intake), inspection of face
(pinched look, sunken eyes)-thirst changes-
decreased tearing and salivation-tongue turgor-JVD-
appearance and temperature of skin- edema-
pulmonary edema- neuromuscular irritability
( Chvostek’s sign/Trousseau’s sign) – other (changes
in sensation, behavior, energy)
• What hemodynamic signs should you monitor? Body
temperature, Pulse, respirations, BP, CVP,
Pulmonary Artery Pressures, Pulmonary wedge
pressures, urine specific gravity (1.003-1.035), I&O,
body weight
• What labs should you monitor? Anion Gap
(metabolic acidosis), lactate (tissue
hyperperfusion), Albumin (fluid shift to
interstitial/edema), BUN (reduced renal blood flow),
Creatinine (renal disease), HCT (RBC in Plasma),
Glucose (increase diuresis/fvd), serum osmolality
(280to 295 serum NA concentration), Ammonia
(decreased K+-alkalosis), phosphate (intracellular
ion/calcium relationship), carbon dioxide (total
bicarbonate and carbonic acid in venous blood), K+
(acid based), NA (bodies H2O status), CA (pH,
cellular), Magnesium (intracellular), Chloride
(excessive saline, alkalosis)
• What maintenance fluids contain undissolved
particles, such as protein, sugar, and starch
molecules too big to pass thru capillary walls?
Colloids draw fluids from interstitial & intracellular
spaces to increase intravascular volume. Used for
volume expansion when crystalloids are inadequate
to treat hypovolemic shock, hemorrhage or third
spacing. Example- Albumin 5% (isotonic) or 25%
concentration
Platelets, Plasma Must be given with in 24 hours,
degrades with storage. Treat blood loss
• Whole blood is broken down into what types of
units? RBC’s (increase RBC mass and oxygen
carrying capacity possibly causing fluid overload),
Platelets, FFP
• How fast should RBC’s be transfused? Infuse over 1-
2 hours no more than 4, need a 20 gauge needle,
consent, monitor for reaction, monitor patients with
poor ejection fraction closely for fluid overload, may
give diuretic in between units, type and cross
match will be drawn prior, to be checked with
another RN.
• What is Fresh Frozen Plasma give? Used for clotting
factors contains albumins, globulins, antibodies, &
other plasma proteins.
• Name colloids that are pharmaceutical plasma
expanders? Hespan –volume expanding,
Hetastarch – treat intravascular volume loss,
Dextran – increase intravascular volume, Mannitol-
increase plasma volume producing osmotic diuresis
treating ICP
• What solutions closely mimic the bodies
extracellullar fluid? Crystalloid. Expand both
extracellular fluid volume.
• How do you measure fluid volume status?
Tonicity/osmolality (controls fluid between
compartments) - measures number of solutes in a
solution – move from lower concentration to higher
concentration of solutes
• What fluids have the same tonicity as plasma
(ECF)? Isotonic - .9ns, D5W, LR for fluid loss due to
vomiting & diarrhea, waiting for blood, expand
circulating volume. Watch for excess.
• What types of fluids help restore hemeostasis?
Hypotonic - .45%, lower concentration of particles
than plasma to treat patient in hyperosmolality
state. Has less salt more H20 for patients who have
NA restriction, to much can cause intravascular
depletion, hyptension, cellular edema and tissue
damage. Hypertonic – concentrated D5W or 3%or
5% NACl, greater tonicity than fluid in the
extracellular compartment, use in extreme caution,
treat hypoosmolality, high in sodium concentration,
treat patients to correct hypoglycemia or provide
calories. Draws fluids from intracellular to
extracellar compartments causing cells to shrink
relieving cellular edema. Increase risk of volulme
overload. Monitor BS/ urine output, electrolytes.
• What are nursing interventions fro patients
receiving fluids? Meticulous I&O’s, DW, monitor lab
values discussed earlier, acid-base, serum lactate,
vital sign trends, skin integrity, warm solution to
prevent hypthermia
• What are complications a patient may have?
Volume overload, electrolyte disturbances,
coagulopathy, heart failure, pulmonary edema,
interstitial edema, allergic reaction
• Assessment-
•
History- dietary intake, elimination (diarrhea, urine
output), medications OTC/prescribed, weight
changes, heat exposure, thirst or excessive
drinking, disorders (diabetes, renal, Cushing,
Addison, cardiac), changes in mental status.
• Physical- Hydration- Normal SG 1,015, moist mucus
membranes/eyes, alert, = I & O, good skin turgor.
Assess skin turgor, dryness (eyes, nose, mucus
membranes), accurate I & O, weight changes,
behavioral and neurological changes (excites
 neurological function), wound drainage, gastric or
intestinal drainage, blood loss, drainage of body
secretions, neuromuscular (muscle tone, strength,
movement, coordination, tremors), GI peristalsis,
cardiac changes, changes from baseline
assessment.
• Psychosocial- depressed, eating disorders, alcohol &
drug abuse.
• Diagnostic- (memorize lab results, you will be
expected to know them for all your exams)
• Electrolytes K+ 3.5 to 5.5 meq/l, magnesium 1.5-
2.5 meq/l, NA 135-145 meq/l, Ca+ 9-11 total, Ca+
ionized 4.5-5.5mg/dl, phosphorus 2.8-4.5mg/dl
Potassium imbalance life threatening.
• BUN 10-30mg/dl measurement of liver and kidney
function.
• Creatinine 0.20- 1.0 mg/dl (measurement of renal
excretion only, better test of renal function)
• Glucose- fasting 70-120
• Osmolality 275-295, indicates concentration of
solutes in a in blood and urine. Used to measure
fluid.
• Hgb and HCT Male-13.5-18/40-54 Female 12-16/38-
47
• Urine pH and specific gravity- 4-8/1.003-1.030