Nursing Interventions for Hypervolemia

Physical Assessment of Hypervolemia

• Pitting edema, non-pitting edema, weeping, pulmonary edema, dyspnea, jugular vein distention, weight gain of 1 kg (2.2 lbs)
• Lab results: HCT below 30, BUN below 10

Nursing Interventions for Hypervolemia

• Monitor daily weights, sodium restriction, I/O, administer diuretics, assess lung sounds, monitor for dyspnea
• Position for comfort

Purpose of IV Therapy

• Maintain or replace body fluids
• Restore acid-base or electrolyte balance
• Medication administration
• Provide nutrition (PN)

Peripheral Catheters

• Butterfly catheters and quick catheters

Saline Locks

• Used to maintain IV access

Pro & Con of Peripheral IV

• Pro: Easy to access, easy to insert, RN skill
• Con: Easily dislodged, interferes with mobility, risk of infection

Vascular Access Devices

• PICC Line: Peripherally-inserted central catheter
  • Indications: long-term antibiotics, TPN, vesicant medications
• Subcutaneous Port:
  • Pro: Deliver large volumes, deliver vesicant solutions, long-lasting
  • Con: Additional training, expensive, systemic risk of injection

IV Complications

• Infiltration: Edema, pain, decreased IV flow rate, pale color, cool, no blood return
• Extravasation: Infiltration of vesicant into subcutaneous tissue, tissue damage, tissue necrosis
• Thrombophlebitis: Blood clot formation at end of catheter, pain, redness, warmth, decreased IV flow rate
• Phlebitis: Inflammation of vein, pain, redness, warmth, edema
• Circulatory Overload: Cause: Excess fluid in vascular system. S/S: HTN, SOB, Cyanosis, Crackles. TX: Reduce IV Flow Rate, Notify MD, Monitor VS, Diuretics
• Air Embolism: Cause: Air into vascular system leads to vascular collapse. S/S: Hypotension, Tachycardia, Weak Pulse, Coughing. TX: Left side, Trendelenburg position, Notify MD

Infusion Pumps

• Used to deliver IV fluids at a constant rate

Clinical Validation

• Station 1: Identify tubing, state drop factor
• Station 2: Measure remaining fluid, change IV bag
• Station 3: Assess IV site, discontinue IV
• Assess IV site, identify local complications: Infiltration, extravasation, thrombophlebitis

Potassium

• Source: Muscle contraction, cardiac tissue response, acid-base balance
• Normal range: 3.5-5.0 mEq/L

Hypokalemia

• Causes: NPO, diuretics, N/V, diarrhea
• Nerve and muscle cells are less excitable
• K+ level less than 3.5 mEq/L

Hyperkalemia

• 5 mEq/L

• Causes: Kidney disease, medications
• Ask if the serum level is accurate

Fluid and Electrolyte Objectives

• Describe processes that regulate fluid distribution, extracellular fluid volume, and body fluid osmolality.
• Identify common fluid and electrolyte imbalances.
• Apply the nursing process when caring for patients with fluid and electrolyte imbalances.
• Discuss purposes of IV therapy.
• Describe equipment used for administration of IV fluids.
• Differentiate various IV tubing and the drip rate each delivers.
• Describe local and systemic complications of IV fluid therapy.
• Compare advantages and disadvantages of peripheral and central IV sites.
• Describe the role of the nurse in assessing and maintaining an IV infusion.
• Demonstrate how to assess, change and discontinue intravenous solutions.

Thinking Points

• What electrolytes are important for homeostasis?
• What could affect a patient's safety with an IV?
• What sterile principles are important to remember in IV therapy?

Media Resources

• Changing intravenous tubing and fluids
• Discontinuing intravenous therapy
• Troubleshooting intravenous infusions
• Using an infusion pump

Clinical Validations

• Change an IV bag (hang new IV bag)
• Determine fluid level in IV bags
• Identify various IV tubing types and their components
• Assess IV site, identifying local complications
• Discontinue an IV infusion

Fluid Compartments

• Intracellular: 2/3 of body fluids
• Extracellular: 1/3 of body fluids
  • Interstitial
  • Intravascular (Plasma)
  • Transcellular

Goal of Fluid Compartments

• Homeostasis: Balance of fluids throughout the body

Osmolality

• Concentration
• Normal range in humans: 285-295 mOsm/kg
• Largely controlled by sodium
• Hypertonic: Higher osmolality
• Isotonic: Same tonicity as blood
• Hypotonic: Lower osmolality

Osmolality vs Osmolarity

• Both are units of measurement
• Consider them

Patients with Fluid Imbalances

• Consider patients with fluid imbalances

Fluid Volume Deficit

• Hypovolemia
• Extracellular problem
• Cause: Hemorrhage or third spacing
  • Shock

Fluid Volume Deficit (Continued)

• Causes: Severe vomiting and diarrhea
• Dehydration
• Intracellular problem

Physical Assessment of Dehydration

• Daily weights, I/O, dry mucus membrane, postural hypotension, tachycardia, thready pulse, tenting skin turgor, confusion, irritability, oliguria

Lab Results with Dehydration

• HCT elevated (>50%), BUN elevated (>25 mg/100mL), NA elevated (>145)

Nursing Interventions for Dehydration

• Give oral or IV fluids as ordered
• Monitor lab results
• Check vital signs, orientation
• Skin and oral care

Fluid Volume Excess

• Hypervolemia
• Overhydration
• Circulatory overload
• Extracellular volume excess

Hypervolemia: Who's at Risk?

• Heart failure, kidney failure
• Excess sodium intake, ages 9-18, pregnant women need more

Causes of Hypocalcemia

• Malnutrition, Vitamin D deficiency (renal disease), malabsorption, chronic diarrhea, pancreatitis

Hypocalcemia Indicators

• Paresthesias, increased deep tendon reflexes (DTRs), Chvostek sign, Trousseau signs, cardiac dysrhythmias- VTach
• Remember: Calcium is a calming agent on neuromuscular tissue, a deficit will lead to excitability

Chronic Hypocalcemia Management

• Give calcium carbonate orally with food, calcium citrate absorbed with or without food
• Encourage gentle walking, weight-bearing exercise for chronic issue

Acute Hypocalcemia Management

• Give IV calcium
• Calcium is a vesicant
• Monitor ECG

Hypercalcemia

• 10.5 mg/dL

• Causes: Hyperparathyroidism, cancer, milk-alkali syndrome

Hypercalcemia Indicators

• Bradycardia, fatigue/ confusion, decreased deep tendon reflexes, constipation
• Remember: Calcium is a calming agent, an excess will lead to depression of responses

Hypercalcemia Management

• Decrease calcium intake
• Push oral fluids to dilute and excret calcium
• Handle gently to prevent fractures
• Dialysis if necessary

This quiz covers the physical assessment of hypervolemia, including clinical signs and laboratory results. Additionally, it explores nursing interventions like monitoring weights and administering diuretics, as well as the purpose and types of IV therapy. Test your knowledge on peripheral catheters and vascular access devices.