FLUIDS AND

ELECTROLYTES
Dr. Rhodora C. Bernal
Body fluids consist of water, electrolytes,
blood plasma and component cells,
proteins, and other soluble particles called
solutes.
FLUIDS AND ELECTROLYTES
 40% to 60% of the average adult’s weight is
composed of water

Who is having higher proportion of BW as water

75% to 80% water
 Outside the cell

within the cells of the body

MAINTAINING FLUID AND ELECTROLYTE BALANCE

Play a major role in

from the pituitary gland
controlling all types of
regulates the osmotic
balance
ADH pressure of
extracellular fluid by
regulating the amount
of water reabsorbed
by the kidney
Through the secretion of
aldosterone, the adrenal glands
also aid in controlling extracellular
fluid volume by regulating the
amount of sodium reabsorbed by
the kidneys
RENIN ANGIOTENSIN ALDOSTERONE SYSTEM (RAAS)
 Fluid
Balance
MOVEMENT OF BODY FLUIDS AND ELECTROLYTES

Filtration
fluid and solutes move
together across a
membrane from one
compartment to another

Active Transport
 I
M
F B
L A
U L
I A
D N Fluid Volume Deficit

C
Fluid Volume Excess
E
S
 FLUID VOLUME DEFICIT

❑ occurs when loss of fluid is greater than fluid input

❑ Common causes of fluid volume deficit are diarrhea,
vomiting, excessive sweating, fever, and poor oral fluid
intake
 FLUID VOLUME DEFICIT
HIGH RISK:
❑ Older adults
❑ Infants and children
❑ Patients with chronic diseases such as diabetes
mellitus and kidney disease
❑ Patients taking diuretics and other medications that
cause increased urine output
❑ Individuals who exercise or work outdoors in hot
weather
 FLUID VOLUME DEFICIT
SYMPTOMS OF DEHYDRATION (ADULT)
❑ Feeling very thirsty
❑ Dry mouth
❑ Headache
❑ Dry skin
❑ Urinating and sweating less than usual
❑ Dark, concentrated urine
❑ Feeling tired
❑ Changes in mental status
❑ Dizziness due to decreased blood pressure
❑ Elevated heart rate
 FLUID VOLUME DEFICIT
SYMPTOMS OF DEHYDRATION (ADULT)
❑ Feeling very thirsty
❑ Dry mouth
❑ Headache
❑ Dry skin
❑ Urinating and sweating less than usual
❑ Dark, concentrated urine
❑ Feeling tired
❑ Changes in mental status
❑ Dizziness due to decreased blood pressure
❑ Elevated heart rate
 FLUID VOLUME DEFICIT
ADDITIONAL SYMPTOMS OF DEHYDRATION
(INFANTS AND YOUNG CHILDREN)

❑ Crying without tears

❑ No wet diapers for three hours or more
❑ Being unusually sleepy or drowsy
❑ Irritability
❑ Eyes that look sunken and sunken fontanel
FLUID VOLUME DEFICIT
FLUID VOLUME EXCESS
❑ occurs when there is increased fluid retained in the
intravascular compartment

❑ HIGH RISK
❑ Heart Failure
❑ Kidney Failure
❑ Cirrhosis
❑ Pregnancy
FLUID VOLUME EXCESS
SIGNS AND SYMPTOMS

❑ pitting edema
❑ ascites
❑ dyspnea
❑ crackles from fluid in the lungs.
FLUID VOLUME EXCESS

Treatment

❑ depends on the cause of the fluid retention

❑ Sodium and fluids are typically restricted
❑ diuretics are often prescribed to eliminate the
excess fluid.
 MANAGEMENT

❑ enteral fluid and electrolytes replacement

❑ fluid intake modifications
❑ dietary changes
❑ oral electrolyte supplements
❑ parenteral fluid and electrolyte replacement
INTRAVENOUS SOLUTIONS - ISOTONIC
❑ IVF that have a similar concentration of dissolved particles as
blood.
❑ used for patients with fluid volume deficit (also called
hypovolemia) to raise their blood pressure.

❑ 0.9% Normal Saline (0.9% NaCl)

❑ Plain Normal Saline Solutions (PNSS)

❑ Lactated Ringer’s Solution (PLR) 5% Dextrose in Water (D5W)

 Type IV Solution Uses Nursing Considerations
Fluid resuscitation for
hemorrhaging, severe
vomiting, diarrhea, GI Monitor closely for
0.9% Normal Saline (0.9%
Isotonic suctioning losses, wound hypervolemia, especially with
NaCl)
drainage, mild heart failure or renal failure.
hyponatremia, or blood
transfusions.
Fluid resuscitation, GI Should not be used if serum pH
tract fluid losses, burns, is greater than 7.5 because it
Lactated Ringer’s Solution
Isotonic traumas, or metabolic will worsen alkalosis. May
(LR)
acidosis. Often used elevate potassium levels if used
during surgery. with renal failure.
Should not be used for fluid
resuscitation because after
5% Dextrose in Water Provides free water to
dextrose is metabolized, it
(D5W) *starts as isotonic help renal excretion of
becomes hypotonic and
Isotonic and then changes to solutes, hypernatremia,
leaves the intravascular space,
hypotonic when dextrose is and some dextrose
causing brain swelling. Used to
metabolized supplementation.
dilute plasma electrolyte
concentrations.
INTRAVENOUS SOLUTIONS - HYPOTONIC

❑ have a lower concentration of dissolved

solutes than blood.
❑ hypotonic fluids are used to treat
cellular dehydration.

0.45% NaCl
Type IV Solution Uses Nursing Considerations

Monitor closely for hypovolemia,

hypotension, or confusion due to fluid
Used to treat intracellular
shifting into the intracellular space, which
0.45% Sodium dehydration and
can be life-threatening. Avoid use in
Hypotonic Chloride (0.45% hypernatremia and to
patients with liver disease, trauma, and
NaCl) provide fluid for renal
burns to prevent hypovolemia from
excretion of solutes.
worsening. Monitor closely for cerebral
edema.

Monitor closely for hypovolemia,

Provides free water to hypotension, or confusion due to fluid
promote renal excretion shifting out of the intravascular space,
5% Dextrose in of solutes and treat which can be life-threatening. Avoid use
Hypotonic
Water (D5W) hypernatremia, as well in patients with liver disease, trauma, and
as some dextrose burns to prevent hypovolemia from
supplementation. worsening. Monitor closely for cerebral
edema.
 Type IV Solution Uses Nursing Considerations

Monitor closely for hypervolemia,

hypernatremia, and associated respiratory
Used to treat severe
3% Sodium Chloride (3% distress. Do not use it with patients experiencing
Hypertonic hyponatremia and
NaCl) heart failure, renal failure, or conditions caused
cerebral edema.
by cellular dehydration because it will worsen
these conditions.

Monitor closely for hypervolemia,

hypernatremia, and associated respiratory
5% Dextrose and 0.45% Used to treat severe
distress. Do not use it with patients experiencing
Hypertonic Sodium Chloride hyponatremia and
heart failure, renal failure, or conditions caused
(D50.45% NaCl) cerebral edema.
by cellular dehydration because it will worsen
these conditions.

Monitor closely for hypervolemia,

hypernatremia, and associated respiratory
Used to treat severe
5% Dextrose and Lactated distress. Do not use it with patients experiencing
Hypertonic hyponatremia and
Ringer’s (D5LR)D10 heart failure, renal failure, or conditions caused
cerebral edema.
by cellular dehydration because it will worsen
these conditions.
 administration of water,
nutrients, electrolytes, blood
products and medications
❑ fluid replacement

❑ dehydration

❑ malnutrition

❑ electrolyte imbalance
❑ hyperalimentation

❑rapid delivery is required

❑ drug is irritating to the tissues

❑ drug needs to be administered

over a specified period of time
INTRAVENOUS FLUIDS

 Parenteral nutrition
 Administration of drugs
 Transfusion of blood or blood components
EQUIPMENT FOR IV INFUSION

IV Solution
Package of Tubing
Drop Chamber/Drip Chamber
 located at the site of the entrance of the
tubing into the container of intravenous
solution
allow to count the number of drops per
minute that the client is receiving (flow
rate)
 Roll Valve Clamp or clip
connected to tubing and can be manipulated to
increase or decrease the flow rate
 Access ports
 used to infuse secondary medications and to
administer IV push medications. These may also be
referred to as “Y ports.”
INTRAVENOUS PIGGYBACK (IVPB)

administering medicines through a port in an

existing IV line
used to administer small amounts of medication
along with the IV solution
INTRAVENOUS FLUIDS COMPUTATION

 Manufacturer Drip Factor

 Abbott- 15 drops per ml.

 Baxter- Trevenol- 10 drops per ml.
 Cutter- 20 drops per ml.
 IVAC- 20 drops per ml.
 McGraw- 15 drops per ml.
 INTRAVENOUS FLUID

▪ drops per minute

Total amount of volume in ml X Drop Factor

No. of Hours 60 min/hr
 INTRAVENOUS FLUID

▪ number of hours

Total amount of volume in ml X Drop Factor

gtts per minute 60 min/hr
 INTRAVENOUS FLUID

▪ cc per hour

Total amount of volume in ml

no. of hours
 STEPS IN IV INFUSION
◼ Gather supplies needed
◼ IV fluid
◼ primary tubing
◼ tubing change label
◼ alcohol pads/scrub hubs.
◼ Verify the provider order with the medication
administration record (eMAR/MAR).
 STEPS IN IV INFUSION
◼ Perform the first check of the twelve rights of medication
administration while withdrawing the IV fluids from the
medication dispensing unit
◼ Check expiration date and verify patient allergies

◼ Remove the IV solution from the packaging and gently

apply pressure to the bag while inspecting for tears or

leaks.
 STEPS IN IV INFUSION
◼ Check the color and clarity of the solution.
◼ Perform the second check of the twelve rights of
medication administration.
◼ Enter the patient room and greet the patient.
❑ Perform safety steps
❑ Perform hand hygiene.
❑ Check the room for transmission-based precautions
❑ Introduce yourself, your role, the purpose of your visit,
and an estimate of the time it will take.
❑ Confirm patient ID using two patient identifiers (e.g.,
name and date of birth).
❑ Explain the process to the patient and ask if they have
any questions.
❑ Be organized and systematic.
❑ Use appropriate listening and questioning skills.
❑ Listen and attend to patient cues.
❑ Ensure the patient’s privacy and dignity
❑ Assess ABCs.
 Perform the third medication check of the twelve
rights of medication administration at the patient’s
bedside.
 Remove the primary IV tubing from the packaging. If
administering IV fluid by gravity, note the drip factor
on the package and calculate drops/min. Perform the
necessary calculations for the infusion rate.
 Move the roller clamp so that it is halfway up the
tubing and clamp it.
 Remove the cover from the tubing port on the bag of
IV fluid.
 Remove the cap from the insertion spike on the
tubing. While maintaining sterility, insert the spike
into the tubing port of the bag of IV fluid.
 Squeeze the drip chamber two or three times to fill the
chamber halfway.
 Loosen the cap from the end of the IV tubing and open
the clamp to prime the tubing over the sink:
 If using multiple port tubing, invert the ports to prime
them and to prevent air accumulation in line.
 If the solution is an antibiotic, take care to not waste
solution while priming the tubing to ensure the
patient receives the correct dosage.
 Once primed, clamp the IV tubing and check the entire
length of the tubing for air bubbles. Tap the tubing gently
to remove any air.
 Replace or tighten the cap on the end of the tubing.
 Label the primary IV fluid bag with the date and time.
Place the tubing label on the tubing near the drip
chamber.
 Assessthe patient’s venipuncture site for signs and
symptoms of vein irritation or infiltration. Do not
proceed with administering fluids at this site if there are
any concerns.
 Vigorously cleanse the catheter cap on the patient’s IV
port with an alcohol pad/scrub hub (or the agency
required cleansing agent) for at least five seconds and
allow it to dry.
 Assess IV site patency according to agency policy. Purge a
prefilled normal saline syringe of air. Attach the syringe
onto the the saline lock cap. Undo the clamp on the
extension tubing. Inject 3 to 5 mL of normal saline using
a turbulent stop-start technique. If resistance is felt, do
not force the flush and do not proceed with IV solution
administration; follow up according to agency policy.
 Remove the syringe from the IV cap and then clamp the
extension tubing.
 Vigorously cleanse the catheter cap on the patient’s IV
port with an alcohol pad/scrub hub (or the agency
required cleansing agent) for at least five seconds and
allow it to dry.
❑ Remove the protective cap from the end of the primary
tubing and attach it to the IV port while maintaining
sterility.
❑ Move the slide clamp on the saline lock to open the
tubing.
❑ Set the infusion rate based on the provider order:
❑ For infusion pump: Set volume to be infused and rate
(ml/hr) to be administered.
❑ For gravity: Calculate drop per minute.
❑ Assess the patient’s IV site for signs and symptoms of vein
irritation or infiltration after infusion begins.

❑ Secure the tubing to the patient’s arm.

❑ Assist the patient to a comfortable position, ask if they

have any questions, and thank them for their time.
❑ Ensure safety measures when leaving the room:
❑ CALL LIGHT: Within reach
❑ BED: Low and locked (in lowest position and brakes
on)
❑ SIDE RAILS: Secured
❑ TABLE: Within reach
❑ ROOM: Risk-free for falls (scan room and clear any
obstacles)
❑ Perform hand hygiene.
❑ Document the procedure and related assessment
findings.
❑ Report any concerns according to agency policy.
❑ Include IV fluids on patient’s input/output
documentation.
 COMPLICATIONS FROM
IV THERAPY
• INFILTRATION
occurs when the tip of the catheter slips out of the
vein. The catheter passes through the wall of the
vein, or the blood vessel wall allows part of the fluid
to infuse into the surrounding tissue, resulting in the
leakage of IV fluids into the surrounding tissue.
Infiltration may cause pain, swelling, and skin that is
cool to the touch.
 COMPLICATIONS FROM
IV THERAPY
PHLEBITIS inflammation of a vein
 COMPLICATIONS FROM
IV THERAPY

CIRCULATORY OVERLOAD
AIR EMBOLISM
CATHETER EMBOLISM
SYSTEMIC INFECTION
COMPLICATIONS FROM
IV THERAPY
INFECTION OF VENIPUNCTURE
 COMPLICATIONS FROM
IV THERAPY

SPEEDSHOCK
ALLERGIC REACTION
PULMONARY CONGESTION