Fundamental Nursing Chapter 16 Fluid and Chemical Balance - PowerPoint PPT Presentation

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Fundamental Nursing Chapter 16 Fluid and Chemical Balance

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Title: Fundamental Nursing Chapter 16 Fluid and Chemical Balance


1
Fundamental NursingChapter 16 Fluid and
Chemical Balance
Inst. Dr. Ashraf El - Jedi
2
Infusion Monitoring and Maintenance
  • Regulating the Infusion Rate
  • The nurse is responsible for calculating,
    regulating, and maintaining the rate of infusion
    according to the physician's order. If an
    infusion device is used, the electronic equipment
    is programmed in milliliters per hour. If the
    solution is infused without an electronic
    infusion device (i.e., by gravity), the rate is
    calculated in drops (gtt) per minute. Formulas
    for calculating infusion rates are provided in
    Box 16-5.

3
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4
Assessing for Complications
  • Complications associated with the infusion of IV
    solutions (Table 16-7) are circulatory overload
    (intravascular volume that becomes excessive),
    infiltration (escape of IV fluid into the
    tissue), phlebitis (inflammation of a vein),
    thrombus formation (stationary blood clot),
    pulmonary embolus (blood clot that travels to the
    lung), infection (growth of microorganisms at the
    site or within the blood stream), and air
    embolism (bubble of air traveling within the
    vascular system).

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6
Caring for the Site
  • Because the venipuncture is a type of wound, it
    is important to inspect the site routinely. The
    nurse documents its appearance in the client's
    record. A common practice is to change the
    dressing over the venipuncture site every 24 to
    72 hours

7
Replacing Equipment
  • Solutions are replaced when they finish infusing
    or every 24 hours, whichever occurs first (Skill
    16-4). IV tubing is changed every 72 hours,
    depending on agency policy, with some exceptions.

8
Blood Administration
  • Blood is collected, stored, and checked for
    safety and compatibility before it is
    administered as a transfusion.

9
Blood Collection and Storage
  • Blood donors are screened to ensure they are
    healthy and will not be endangered by the
    temporary loss in blood volume. Refrigerated
    blood can be stored for 21 to 35 days, after
    which it is discarded.

10
Blood Safety
  • Once collected, the donated blood is tested for
    syphilis, hepatitis, and human immunodeficiency
    virus (HIV) antibodies to exclude administering
    blood that may transmit these blood-borne
    diseases.

11
Blood Compatibility
  • Antigens determine the characteristic blood
    groupA, B, AB, and Oand Rh factor. Rh positive
    means the protein is present Rh negative means
    the protein is absent.

12
  • Before donated blood is administered, the blood
    of the potential recipient is typed and mixed, or
    cross-matched, with a sample of the stored blood
    to determine whether the two are compatible. To
    avoid an incompatibility reaction, it is best to
    administer the same blood group and Rh factor.

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14
Blood Transfusion
  • Before administering blood, the nurse obtains and
    documents the client's vital signs to provide a
    baseline for comparison should the client have a
    transfusion reaction.

15
Blood Transfusion Equipment
  • Catheter or Needle Gauge
  • it generally is infused through a 16- to
    20-gaugepreferably an 18-gaugecatheter or
    needle.

16
  • Blood Transfusion Tubing
  • Blood is administered through tubing referred to
    as a Y-set (Fig. 16-20).
  • The normal saline always is administered before
    the blood is hung and follows after the blood has
    been infused. It also is used during the infusion
    if the client has a transfusion reaction

17
Figure 16-20 Blood transfusion tubing.
18
Transfusion Reactions
  • Serious transfusion reactions generally occur
    within the first 5 to 15 minutes of the infusion,
    so the nurse usually remains with the client
    during this critical time

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21
Total Parenteral Nutrition
  • Total parenteral nutrition (TPN hypertonic
    solution of nutrients designed to meet almost all
    caloric and nutritional needs) is preferred for
    clients who are severely malnourished or may not
    be able to consume food or liquids for a long
    period.

22
  • Because TPN solutions are extremely concentrated,
    they must be delivered to an area where they are
    diluted in a fairly large volume of blood. This
    excludes peripheral veins. TPN solutions are
    infused through a catheter inserted into the
    subclavian or jugular vein the tip terminates in
    the superior vena cava. This type of a catheter
    is referred to as a central venous catheter (Fig.
    16-21)

23
Figure 16-21 Central venous catheter inserted
into the subclavian vein and threaded into the
superior vena cava.
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