• Is contained within the cells.
• Essential for cell function and metabolism, it accounts for approximately 40% of body weight.

• Is outside the cells.
• Carries water, electrolytes, nutrients, and oxygen to the cells and removes the waste products of cellular metabolism.
• Accounts for 20% of body weight. ECF exists in three main locations
• Interstitial fluid- lies in the spaces between the body cells. excess fluid within the interstitial space is called edema.
• intravascular fluid- is the plasma within the blod. Its main function is to transport blood cells.
• Transcellular fluid- includes specialized fluids, such as cerebrospinal, pleural, peritoneal, and synovial fluid; and digestive juices.

Solutes that readily dissolve (e.g., electrolytes).

Larger molecules that do not dissolve readily (e.g., proteins).

The concentration of solutes providing pressure in body fluid

• Refers to the number of particles of solute per kilogram of water and is expressed as milliosmoles per kilogram (mOsm/kg).
• Sodium is the greatest determinant of serum osmolality, and potassium is the greatest determinant of intracellular osmolality.

A passive process by which molecules of a solute move through a cell membrane from an area of higher concentration to an area of lower concentration.

The movement of both water and smaller particles from an area of high pressure to one of low pressure.

The force created by fluid within a closed system; it is responsible for normal circulation of blood.

Represents the net pressures that move fluid and solutes.

• Eight to ten 8-ounce glasses of water which provide 1920 to 2400 mL of fluid.
• Women: 2700 mL
• Men: 3700 mL

Measurable and perceived (e.g., urine, diarrhea, ostomy, and gastric drainage)

• Loss that we do not perceive and that is not eastly measured.
• It occurs primarily by diffusion and evaporation through the skin, but also from the lungs, and accounts for about 900 mL per day.
• Increases with open wounds, burns, or other breaks in the protective layer of the skin.

• Pressure sensors in the vascular system stimulate or inhibit the release of ADH from the pituitary gland.
• ADH causes the kidneys to retain fluid.
• ADH is also produced in response to a rise in serum osmolality, fever, pain, stress, and some opioids.

• When extracellular (i.e., intravascular) fluid volume is decreased, receptors in the glomeruli respond to the decreased perfusion of the kidneys by releasing renin.
• Renin is an enzyme responsible for the chain of reaction that converts angiotensin to angiotensin II.
• Angiotensin II acts on the nephrons to retain sodium and water and directs the adrenal cortex to release aldosterone.

• When aldosterone is released, it stimulates the distal tubules of the kidneys to reabsorb sodium and excrete potassium.
• Sodium reabsorption results in passive reabsorption of water, thereby increasing plasma volume and improving kidney perfusion.
• When fluid excess is present, renin is not released, and this process stops.

• Affects fluid volume by influencing cardiac output. An increase in thyroid hormone causes an increase in cardiac output, thereby increasing glomerular filtration rate and urine output.

are important in renal and cardiovascular regulation of fluid maintenance.

• Is the discharge of sodium through urine.
• BNP is actually released from both the brain and the right atrium

• Major cation in the ECF
• Normal serum level= 135-145mEq/L
• Function:
• Regulates fluid volume
• Helps maintain blood volume
• Interacts with calcium to maintain muscle contraction
• Stimulates conduction of nerve impulses
• Regulation:
• Moves by active transport across cell membranes.
• Regulated by aldosterone and ADH levels.
• Reabsorbed and excreted through the kidneys.
• Minimal loss through perspiration and feces.
• Low sodium may be caused by excess water intake.
• Sources:
• Table salt, soy sauce, cured pork, cheese, milk, processed foods, canned products, and foods preserved with salt.
• A healthy adult between the ages of 19 and 50 should consume 1.5 grams of sodium and 2.3 grams of chloride each day (3.8 grams of salt) to replace daily losses and maintain serum blood levels.
• Should not exceed 5.8 grams per day.
• Patients who have blood pressure raising effects of salt are advised to limit salt to 2.0 g/day.

• Major cation in the ICF
• Normal serum level= 3.5-5 mEq/L
• Function:
• Maintains ICF osmolality
• Regulates conduction of cardiac rhythm
• Transmits electrical impulses in multiple body systems
• Assists with acid-base balance
• Regulation
• Regulated by aldosterone
• Excreted and conserved through the kidneys
• Lost through vomiting and diarrhea
• Loss triggered by many diuretics
• Sources
• Common food sources include bananas, oranges, apricots, figs, dates, carrots, potatoes, tomatoes, spinach, dairy products, and meats.
• Recommended that adults consume at least 4.7 grams or potassium per day.

• Buffers almost 90% of metabolic processes in the ECF.
• Blood and tissue fluid depend on this buffer.
• Usual ratio of NaHCO3 to H2CO3 is 20:1.

• Helps regulate acid-base balance in intracellular fluids.
• Converts alkaline sodium phosphate to acid sodium phosphate

• Plasma prosteins and globin portion of hemoglobin (in red blood cells) contain chemical groups that can either combine with or free up hydrogen ions.
• This system helps buffer intracellular fluid and plasma to maintain pH balance.

• Lungs are the second line of defense to restore normal pH.
• They control the body's carbonic acid supply via carbon dioxide retention or removal.
• When the serum pH is too acidic (pH is low), the lungs remove carbon dioxide through rapid, deep breathing.
• If the serum pH is too alkaline (pH is high), the lungs try to conserve carbon dioxide through shallow respirations
• This system works with the carbonic acid-sodium bicarbonate buffer system to maintain the 20:1 ratio of base to acid.

• The last line of defense is the kidneys, which regulate the concentration of plasma bicarbonate.
• They can neutralize more acid or base than either the respiratory system or the shemical buffers.
• If the serum pH is too acidic, the kidneys conserve additional bicarbonate to neutralize the acid.
• If the serum pH is too alkaline, the kidneys excrete additional bicarbonate to lower the amount of base and thereby decrease th pH.
• The kidneys also buffer pH by forming acids and ammonium (a base).
• Renal system is very slow, may take up to 3 days to return the pH to normal limits.
• This process is known as compensation.
• The pH returns to normal, but the carbon dioxide or bicarbonate level is abnormal.

an emergency condition in which severe blood and fluid loss make the heart unable to pump enough blood to the body. This type of shock can cause many organs to stop working.

• Water is pulled from the interstitial spaces and the ICF into the vascular system, resulting in dry skin and mucous membranes, decreased skin and tongue turgor, decreased urine output, and flat neck veins.
• Patients complain of muscle weakness, fatigue, and feeling warm.
•  Temperature in creases because the body is less able to cool itself through perspiration.
• 5% loss is clinically significant, 8% loss is severe, and a sudden 15% loss is usually fatal.
• A patient with fluid volume deficit usually has elevated blood urea nitrogen (BUN)-to-creatinine ratio and elevated hematocrit.
• Both values increase because there is less water in proportion to the solid substances being measured.
• Specific gravity of the urine increases as the kidneys attempt to conserve water, resulting in more concentrated urine.

• Fluid volume excess can result from excessive salt intake, disease affecting kidney or liver funtion, ot poor pumping action of the heart.
• Blood pressure is elevated, pulse is bounding, and respirations are increased and shallow. The neck veins may become distended
• Edema is present, and the skin is pale and cool.
• Urine output becomes dilute, and volume increases. The patient rapidly gains weight.
• In severe fluid overload, the patient develops moist crackles in the lungs, dyspnea, and ascites.
• Hemodilution causes BUN, hematocrit, and the specific gracity of the urine to decrease.

• Are used to monitor acid-base balance.
• ABG analysis measures pH, partial pressure of oxygen (Po2), partial pressure of carbon dioxide (Pco2), saturation of oxygen (Sao2), and bicarbonate (HCO3-) level.
• Acid-base balance is reflected by the pH, Pco2, and HCO2 values.

• Neutral pH is 7.4
• Changes in the Pco2 represent changes in acid: respiratory.
• Changes HCO3- represent changes in base: metabolic disorders
• Normal Pco2 is 35 to 45 mm Hg
• Normal HCO3- is 22 to 26 mEq/L

• Each Kg is equivalent to 2.2 lb
• 1 kg = 1 liter (1000 mL)
• 2.2 lb = 1 liter (1000 mL)

• Is a measure of the solute concentration of the blood.
• Sodium is the greatest determinant of serum osmolality
• Mey be directly measured with venous blood or estimated by doubling the serum sodium level.
• A rise in serum osmolality indicates fluid volume deficit; a decrease indicates fluid volume excess.
• Changes in serum osmolality usually indicate alterations in sodium levels

Clients at risk for fluid volume excess due to congestive heart failure (CHF) must be closely monitored when they receive isotonic fluid replacement, because they may easily develop fluid overload.

• A polyurethane or Teflon catheter is threaded over a metal stylet (needle).
• In most cases, the plastic catheter is less than 7.5 cm (3in.) in length.
• This type of access device is ideal for brief therapy.
• You cannot give irritating or hyperosmolar solutions through this type of catheter because it may cause severe damage to the vein.

• Is similar to over-the-needle catheter; however, the polyurethane or Teflon catheter lies inside the metal needle.
• After you advance the catheter into the vein, you withdraw the needle.

• Also called a scalp vein needle or wing tipped catheter, a butterfly needle is a short, beveled metal needle with flexible plastic flaps attached to the shaft.
• These needles are commonly used for intermittent or short-term therapy for children and infants or for single-dose medications and drawing blood.
• Because the inflexible metal needle remains in the vein, a butterfly needle is more likely to infiltrate (damage the vein and allow fluid to leak into the interstitial spaces) than a plastic catheter.

• A peripherally inserted flexible IV catheter, typically inserted into the antecubital fossa and then advanced into the larger vessels of the upper arm for greater hemodilution.
• It is 15 cm (6in.) long, so it can be used for a longer period of time than a shorter, over-the-needle catheter.
• May remain in place for as long as 49 days, although the median length of use is 7 days.
• Cannot administer highly osmolar and irritating solutions through this catheter.

• Also called a saline lock, and sometimes a heparin lock.
• Establishes a venous route as a precautionary measure for clients whose condition may change rapidly or who may require intermittent infusion therapy.

An intravenous line inserted into a major vein. Typically, the subclavian or internal jugular vein is used.

• PICCs are long, soft, flexible catheters inserted at the antecubital fossa through the basilic or cephalic vein of the arm.
• PICC lines are most commonly used for prolonged IV antibiotic therapy, parenteral nutrition, and chemotherapy.
• Is intended for intermediate to long-term use and does not need to be replaced unless the site appears infected or the catheter is no longer patent.

• Nontunneled CVCs are inserted by a physician, specially trained nurse practitioner, or physician assisstant through the skin into the jugular, subclavian, and occasionally, femoral veins. They are sutured in place.
• Often referred to as single, double, triple or quadruple-lumen catheters.
• Intended for shorter use than a PICC line (less than 6 weeks); however, guidelines advise that nontunneled CVADs not be routinely replaced.
• Blood can be drawn from a nuntunneled CVAD for diagnostic studies.
• If parenteral nutrition or blood is running in a port, you cannot use that same port for blood draws.
• Can also be used to measure central venous pressure (CVP).
• CVP measurements offer information on volume status, with a low reading indicating hypovolemia and a high reading, hypervolemia.

• Intended for long-term use.
• The catheter is inserted by a surgeon through a 7.5- to 15-cm (3- to 6-in.) subcutaneous tunnel in the chest wall and then into the jugular or subclavian vein.
• The catheter can either be sutured in place, with the sutures removed when fibrosis has developed around the catheter, or secured with an IV securing device, such as StatLock.
• Because they are tunneled through the skin rather than through a vein, the risk of infection is less than with PICCs or nontunneled central lines.

• Devices made of a radiopaque silicone catheter and a plastic or stainless steel injection port with a self-sealing silicone-rubber septum.
• The catheter may be tunneled or untunneled to a completely implanted subcutaneous reservoir (port) in the upper chest.
• Implanted ports are placed by surgeons and only specially trained nurses are allowed to access an implanted port because of the risk of infiltration into the tissue if the needle placement is not correct.
• Implanted ports are also intended for long-term use.
• Blood pressures and blood draws should be avoided in the extremity of the side of the chest where the implanted port has been placed.

• Designed for immediate access (within seconds) and short-term use (less than 24 hours), intraosseous (IO) access devices are used to administer fluids when a peripheral catheter cannot be inserted or when a central line insertion is not advisable, but especially in emergency situations.
• IOs are placed into the matrix of a bone.The most commen access site is the proximal tibia in both children and adults.

Identifies possible minor antigens that will affect the compatibility of the donor blood in the recipient.

• Allergic- Allergy to blood being infused
• Signs and Symptoms- Flushing, itching, wheezing, urticaria (hives); anaphylaxis, if severe
• Nursing responsibilities- Stop the transfusion; Replace with a saline infusion; Notify the physician immediately; Administer prescribed antihistamine
• Bacterial- Contamination of the blood
• Signs and Symptoms- Fever, chills, vomiting, diarrhea, hypertension
• Nursing Responsibilities- Stop the transfusion; Replace with a saline infusion; Notify the physician; Administer antibiotics as ordered; Treat symptoms
• Febrile- Temperature elevation due to sensitivity to WBCs, plasma proteins, or platelets
• Signs and Symptoms- Fever, chills, warm, flushed skin, aches
• Nursing Responsibilities- Stop the transfusion; Replace with a saline infusion; Notify the physician; Treat symptoms
• Hemolytic reactions- Destruction of RBSs as a result of infusing incompatible blood; occurs in 1 in 600,00 transfusions
• Signs and Symptoms- Fever, chills, dyspnea, chest pain, tachycardia, hypotension; can be fatal.
• Nursing responsibilities- Stop the transfusion immediately; Replace with a saline infusion; Notify the physician immediately; Send the remaining blood, including tubing and filter; a sample of venous blood; and the first voided urine to the lab for analysis; Treat shock.
• Circulatory overload- Administering too great a volume or too rapidly
• Signs and Symptoms- Persistent cough, crackles, hypertension, distended neck veins.
• Nursing Responsibilities- Slow or stop the transfusion; Monitor vital signs; Place the client upright; Notify the physician.

• Na+<135 mEq/L
• Common causes- Diuretics; GI fluid loss; Adrenal insufficiency; Excessive intake of hypotonic solutions, such as water or D5W IV fluids.
• Signs and Symptoms- Anorexia, nausea, and vomiting; Weakness; Lethargy; Confusion; Muscle cramps; Seizures.
• Treatment- Monitor I&O; Monitor sodium level; Increase oral sodium intake; Administer IV saline infusion and take seizure precaustions, if severe.

• Na+ >145 mEq/L
• Common Causes- Excessive sodium intake; Water deprivation; Increased water loss through profuse sweating, heat stroke, or diabetes insipidus; Administration of hypertonic tube feeding.
• Signs and Symptoms- Thirst; Elevated temperature; Dry mouth and sticky mucous membranes; If sever: Hallucinations, Irritability, Lethargy, Seizures.
• Treatments- Monitor I&O; Monitor sodium level; Monitor vital signs and level of consciousness; Restrict sodium in the diet; Beware of hidden sodium in foods and medications; Increase water intake; Administer IV solutions that do not contain sodium.

• K+ <3.5 mEq/L
• Common causes- Diuretics; GI fluid loss through vomiting, gastric suction, or diarrhea; Steroid asministration; Hyperaldosteronism; Anorexia or bulimia.
• Signs and Symptoms- Fatigue; Anorexia, nausea, and vomiting; Muscle weakness; Decreased GI motility; Dysrhythmias; Paresthesia; Flat T wave on ECG; Increased sensitivity to digitalis.
• Treatment- Monitor I&O; Monitor potassium level; If the client is taking digoxin, monitor pulse and observe for toxicity; Encourage intake of foods rich in potassium; Administer potassium supplements (note IV supplements must be well diluted and administered into a central vein slowly.)

• K+ >5.0 mEq/L
• Common causes- Renal failure; Potassium-sparing diuretics; Hypoaldosteronism; High potassium intake coupled with renal insufficiency; Acidosis; Major trauma; Hemolyzed serum sample produces pseudohyperkalemia.
• Signs and symptoms- Muscle weakness; Dysrhythmias; Flaccid paralysis; Intestinal colic; Tall T waves on ECG.
• Treatment- Monitor I&O; Monitor potassium level; Caution about potassium-rich food intake in patients with elevated creatinine levels.