2.3 Nutrition, Fluid Balance, Electrolytes, Acid Base Imbalance

Question 1

Describe the nutritional assessments that identify the need for nutritional supplements

Answer 1

Anthropometric measurements:
Height
Weight
Body Mass Index:
-ideal 18.5-24.5
-healthy
-overweight 25-30
-obese 30+

Question 2

Explain the significance of the abnormal findings for TOTAL PROTEIN

Answer 2

If your total protein level is low, you may have a liver or kidney problem, or it may be that protein isn’t being digested or absorbed properly. A high total protein level could indicate dehydration or a certain type of cancer, such as multiple myeloma, that causes protein to accumulate abnormally

Question 3

Explain the significance of the abnormal findings for ALBUMIN

Answer 3

Lower-than-normal level of serum albumin may be a sign of:
Kidney diseases
Liver disease (for example, hepatitis, or cirrhosis that may cause ascites)

Increased blood albumin may be due to:
Dehydration
High protein diet
Having a tourniquet on for a long time when giving a blood sample

Question 4

Explain the significance of the abnormal findings for GLOBULIN

Answer 4

Low globulin levels can be a sign of liver or kidney disease.

High levels may indicate infection, inflammatory disease or immune disorders. However, abnormal results may be due to certain medications, dehydration, or other factors

Question 5

Explain the significance of the abnormal findings for A/G RATIO

Answer 5

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Question 6

Identify assessment findings used to determine the route of nutritional supplementation

Answer 6

Enteral Nutrition:
Used with patient’s who have a functional GI tract
Cancer, critical illness, neurological/muscular disorders, GI disorders, resp failure with prolonged intubation, inadequate oral intake.

Parenteral Nutrition:
Used with patient’s who has a non-functional GI tract
GI surgery, obstruction, extended bowel rest

Question 7

Identify changes in bowel sounds that are expected with the stressed patient and nursing implications of changes in peristalsis

Answer 7

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Question 8

Describe the procedure for changing a CVC dressing

Answer 8

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Question 9

Describe the rationale for parenteral administration of lipids and nursing implications related to lipid administration

Answer 9

Fat emulsion (lipids) may be added
Provides essential fatty acids and additional calories
Monitor for fat overload syndrome
-fever
-elevated tri
-clotting problems
-multisystem failure

Question 10

Identify solutions that may only be administered via central vein

Answer 10

TPN

Question 11

Explain the guidelines for administration of parenteral fluids

Answer 11

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Question 12

Compare the rational for the use of the major types of parenteral solutions and discuss the rate of administering fluids.

Answer 12

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Question 13

Describe how to determine the caloric value of intravenous solutions

Answer 13

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Question 14

Identify the significance of abnormal findings for the following components of the Comprehensive Profile lab test including nursing responsibilities
ALKALINE PHOSPHATASE

Answer 14

Alkaline Phosphatase:

Nursing:

Question 15

Identify the significance of abnormal findings for the following components of the Comprehensive Profile lab test including nursing responsibilities
AST (SGOT)

Answer 15

AST (AGOT):

Nursing:

Question 16

Identify the significance of abnormal findings for the following components of the Comprehensive Profile lab test including nursing responsibilities
BILIRUBINE, TOTAL

Answer 16

Total Bilirubin:

Nursing:

Question 17

Identify the significance of abnormal findings for the following components of the Comprehensive Profile lab test including nursing responsibilities
BUN

Answer 17

BUN 5-20 mg/dl:
Indication of renal failure/insufficiency/injury
Low= malnourished, low in protein
High= dehydration

Nursing

Question 18

Identify the significance of abnormal findings for the following components of the Comprehensive Profile lab test including nursing responsibilities
CREATININE

Answer 18

Creatinine 0.6-1.2 mg/dl:
Indication of renal failure/insufficiency/injury
Low= malnourished, low in protein
High= renal function

Nursing:

Question 19

Identify the significance of abnormal findings for the following components of the Comprehensive Profile lab test including nursing responsibilities
GLUCOSE

Answer 19

Glucose 60-100 mg/dl:
Direct measurement of glucose, evaluation of DM pt’s
Low= starvation, hypothyroidism, hypopituitarism
High= DM, diuretic therapy, chronic renal failure

Nursing:

Question 20

Identify the significance of abnormal findings for the following components of the Comprehensive Profile lab test including nursing responsibilities
POTASSIUM (K)
SODIUM (NA)
CHLORIDE
CALCIUM

Answer 20

**SEE LEARNING PACKET PG 48-53

Question 21

Identify the significance of abnormal findings for the following components of the Comprehensive Profile lab test including nursing responsibilities
TOTAL PROTEIN

Answer 21

Total Protein:
Measures total protein in blood including albumin and globulin
Keeps fluid within the vascular spaces due to osmotic pressure.

Low protein: fluid leaks out of vascular spaces into interstitial spaces causing edema.

Nursing:

Question 22

Identify components of the “basic kidney profile” and explain the significance of abnormal findings for each of the components

Answer 22

Basic Kidney Profile:
Your kidney numbers include 2 tests: ACR (Albumin to Creatinine Ratio) and GFR (glomerular filtration rate). GFR is a measure of kidney function and is performed through a blood test. Your GFR will determine what stage of kidney disease you have

Question 23

Review foods and substances high in sodium

Answer 23

Foods high in sodium:
Smoked, cured, salted or canned meat, fish or poultry including bacon, cold cuts, ham, frankfurters, sausage, sardines, caviar and anchovies.
Frozen breaded meats and dinners, such as burritos and pizza.
Canned entrees, such as ravioli, spam and chili.
Salted nuts.
Beans canned with salt added

Question 24

Review foods and substances high in potassium

Answer 24

Foods high in potassium:
Leafy greens, beans, nuts, dairy foods, and starchy vegetables like winter squash are rich sources.
Dried fruits (raisins, apricots)
Beans, lentils.
Potatoes.
Winter squash (acorn, butternut)
Spinach, broccoli.
Beet greens.
Avocado.
Bananas.

Question 25

``` Review s/s and treatment for HYPO/HYPERNATREMIA HYPO/HYPERKALEMIA HYPO/HYPERCHLOREMIA HYPO/HYPERCALCEMIA HYPO/HYPER MAGNESIA ```

Answer 25

**SEE LEARNING PACKET PG 48-53

Question 26

What should be taught to patients regarding electrolyte disturbances

Answer 26

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Question 27

IV solutions and rates are appropriate. If not, identify the appropriate solution and rate. Mrs. Golden, age 65, has a history of severe CHF and was admitted for treatment of sepsis and dehydration. Her BP is 70/40; pulse 110, weak and thready. He orders 0.45% saline at 75 ml/hr

Answer 27

Mrs. Golden: 0.45 saline is a hypotonic solution and is not appropriate for this patient. The patient needs total volume replacement, which would require an isotonic solution instead. She needs volume resuscitation due to the sepsis and dehydration with low BP and tachycardia, but you would need to monitor closely as she is at risk for fluid volume overload if her heart function is poor. LR would not be the isotonic fluid of choice due to her potential for compromised liver (can't metabolize the lactate) and kidney function (can't have the K+ in the solution). You could expect 0.9 normal saline for the IV solution for this patient

Question 28

IV solutions and rates are appropriate. If not, identify the appropriate solution and rate Mrs. Kelly is a 35-year-old patient who recently underwent abdominal surgery. Her N.G. is draining 1500 ml per shift, and her serum pH is 7.60. The Dr. order is Ringers Lactate @ 150 ml/hr

Answer 28

Mrs. Kelly: Ringers Lactate at 150ml/hr is not appropriate for this patient. The lactate in the IV solution will cause further alkalosis because the liver converts lactate to bicarbonate. This patient needs a hypertonic IV solution in order to shift fluid out of the cells and into the ECF. She would likely need K+ replacement due to the large amount of drainage from the NG. You could expect D5.45 normal saline +KCL for this patient

Question 29

IV solutions and rates are appropriate. If not, identify the appropriate solution and rate Mr. Donatelli, age 40, is a hypertensive patient who has been on thiazide diuretic therapy. His skin and mucous membranes are dry, and he complains of a headache. His BP is 200/120. The order is for 5% dextrose in 0.45 Saline at 25 ml/hr

Answer 29

Mr. Donatelli: D5.45 normal saline is not appropriate for this patient as it is a hypertonic IV solution which would cause cellular dehydration and further increase BP. This patient needs a hypotonic solution to carefully correct the cellular dehydration caused by the diuretic, as well as replacement of K+. You could expect 0.45 normal saline +KCL for this patient and the rate would be increased above 25ml/h

Question 30

IV solutions and rates are appropriate. If not, identify the appropriate solution and rate Mr. Jefferson is a 55-year-old patient in ESRD who is admitted with nausea and vomiting. The order is 1000 ml D5 in Ringers Lactate every eight hours

Answer 30

Mr. Jefferson: D5LR is a hypertonic IV solution and is not appropriate for this patient. A patient with end-stage renal disease cannot handle this solution that would dehydrate the cells, and it would provide electrolytes (from the LR) and the kidneys could not handle more K+ in particular. The patient has nausea and vomiting and needs isotonic fluid replacement. You could expect 0.9 normal saline for this patient at a decreased rate.

Question 31

Review the body's bicarbonate: carbonic acid (HCO3:H2CO3), buffering mechanism

Answer 31

Buffers are substances that prevent major changes in pH by removing or releasing hydrogen irons When excess acid is present in body fluid, buffers BIND with hydrogen ions to minimize the change in pH If body fluids become too basic/alkaline buffers RELEASE hydrogen ions restoring the pH Bicarbonate is a weak base: when an acid combines with bicarbonate, the pH changes only slightly Carbonic acid is a weak acid: when a base is added to the system, it combines with carbonic acid and pH remains within range

Question 32

Discuss the normal ratio between bicarbonate and carbonic acid

Answer 32

Normal ratio 20-1: 20 parts bicarbonate 1 part carbonic acid If this ratio is maintained the pH remain within the 7.35-7.45 range

Question 33

Identify the 3 compensatory mechanisms in an acid-base disturbance

Answer 33

Kidneys and lungs

Question 34

Compare and contrast the cause, s/s, and nursing implications for Acidosis: metabolic and respiratory

Answer 34

Acidosis Metabolic Causes: Overproduction of H+ from ketoacidosis from DKA, starvation or alcoholism; lactic acidosis; severe infection Excessive ingestion of H+ from ASA toxicity, NS resuscitation Inadequate renal function Abnormal alkali losses from diarrhea, prolonged vomiting, ileostomy, intestinal fistulas or suctioning Compensatory Mechanism: Lungs increase respiratory rate and depth NI: Treat underlying cause NaHCO3 IV Lactated Ringers Safety measure r/t decreased LOC Monitor I/O, VS, potassium telemetry Acidosis Respiratory Causes: Reduced surface area of lung from reduces gas exchange, PE, CHF, pneumonia, atelectasis, lung cancer, COPD Obstruction of airways from COPD, bronchitis, asthma Anything that decrease respiratory effort, respiratory center depression, drugs, tumors, immobility, reduced LoC, neuromuscular disease (MS, MD) Compensatory Mechanism: Kidneys excrete H+ and save HCO3 NI: Treat underlying cause Extreme caution with sedative/opiates Improve ventilation: turn, cough and deep breathing, inspirex, elevate HOB, ventilator/airway management Safety measures t/t decreased LOC

Question 35

Compare and contrast the cause, s/s, and nursing implications for Alkalosis: metabolic and respiratory

Answer 35

``` Alkalosis Metabolic Causes: Excessive loss of H+ from vomiting, gastric suctioning, potassium loss, fistulas, diuretics Excessive ingestion HCO3, antacids, NaHCO3 Compensatory Mechanism: Lungs decrease respiratory rate and depth NI: Treat underlying cause Treat hypochloremia/hypokalemia Ca gluconate Seizure precautions Monitor VS, telemetry, I/O, K, Cl, Ca ``` ``` Alkalosis Respiratory Causes: Overstimulation of respiratory center from fever, early ASA toxicity, CNS disease or intracranial surgery/tumors Hyperventilation from anxiety, pain, aggressive vent settings Compensatory Mechanism: Kidneys excrete HCO3 and save H+ NI: Treat underlying cause Rebreather mask Coach breathing Treat hypochloremia/hypokalemia Seizure precautions ```

Question 36

# Define and give the normal ranges for the following: a. pH - b. pO2 - c. pCO2 - d. HCO3 - e. O2 saturation -

Answer 36

a. pH - 7.35-7.45 b. pO2 - 80-100 (<80 hypoxemia) c. pCO2 (respiratory) - 45-35 d. HCO3 (bicarb) - 22-26 e. O2 saturation - 96-100%

Question 37

Enteral Therapy NASOGASTRIC and OROGASTRIC tube types:

Answer 37

Nasogastric (Levine, Salem) Stomach tubes used to decompress or remove stomach contents. Used short-term for feedings… they become stiff in the presence of HCl acid HOB at 30 degrees Increased aspiration risk

Question 38

Enteral Therapy WEIGHTED Tubes types:

Answer 38

``` Weighted Tubes (Keofeed, Cortrak) Smaller tube (5, 8, 10 Fr) inserted thru the nose into the stomach that migrates into the jejunum due to peristalsis Decrease aspiration risk Med and feedings ```

Question 39

Enteral Therapy GASTROSTOMY tube types:

Answer 39

Gastrostomy (PEG), surgically placed. Allows use of gut as holding pouch. High fat foods leave stomach slowly causing patient to feel full longer. Discourages eating of table food. **know which tube your patient has

Question 40

Enteral Therapy JEJUNOSTOMY tube type:

Answer 40

Jejunostomy (K-Tube) Small tube (looks like IV tubing) surgically placed into the small bowel. Tube within a tube. Too much pressure used for clearing will cause entire tube to collapse **know which tube your patient has

Question 41

Small intestine is an alkaline environment. What do you NOT put down a J-tube or K-tube?

Answer 41

Potassium: causes diarrhea, gas and irritation Cranberry juice (other citrus juices): irritate the mucosa Question an antacid order for J or K tube The above can be administered via G or NG tubes with stomach placement

Question 42

Causes of diarrhea with tube feedings?

Answer 42

Feeding that is too fast, too much or too strong Antibiotics given within 2 wks are the greatest offender Other med: K+, antacids, digitalis preparations Milk products Stress Surgical interventions Contaminated products/unclean equipment

Question 43

Nursing interventions for tube feeding

Answer 43

1. Accurate I/O 2. Daily weight until stable, then 3x / wk. 3. Accu check q 6 hrs. 4. Assess bowel sounds, nares, stools q shift 5. Change bag and tubing q 24 hrs. 6. Check placement before each feeding and q shift 7. Check residual before each feeding and every shift and follow doctors’ orders and/or policy if large amount obtained. 8. Flush with 20ml warm water before and after all meds. 9. Stop feeding ½ hr. before meals. 10. Stop feeding if patient vomits. 11. Communicate with the dietician on how a patient is tolerating feedings, adjustment in rates or formula.

Question 44

Nutritional components

Answer 44

Basal Metabolic Rate: energy needed at rest for life sustaining, breathing, temp control, body circulation, energy need to do general things Resting energy expenditure: resting metabolic rate, consumed over 24 hour period, routine maintenance Vitamins and Minerals: essential for metabolism Water: 60-70% of body weight, ***30mL/kg of water intake 24 hour Fats: calorie dense nutrients, good and bad Carbohydrates: main source of energy Calories: energy we get from food, 2000-3000 men, 1600-2400 women Proteins: energy, 1 protein=4 kcal, blood clotting, fluid regulation, acid/base, regulating proteins. Albumin is protein. ***0.8g/kg of protein for healthy individual

Question 45

Identify the significance of abnormal findings for the following components of the Comprehensive Profile lab test including nursing responsibilities SERUM ALBUMIN

Answer 45

Serum Albumin 3.2-4.5g/dl: Primary protein in blood High= dehydration Low= malnutrition, <2.8g/dl

Question 46

Identify the significance of abnormal findings for the following components of the Comprehensive Profile lab test including nursing responsibilities PRE-ALBUMIN

Answer 46

Pre-albumin 15-36mg/dl: Precursor to albumin, a transport protein Shorter 1/2 life than albumin More accurate indication of malnutrition for acutely ill patients and liver function High= nephrotic syndrome Low= malnutrition, liver damage

Question 47

Identify the significance of abnormal findings for the following components of the Comprehensive Profile lab test including nursing responsibilities TRANSFERRIN

Answer 47

Transferrin: A protein that transports dietary iron from the gut to storage cells in body Iron dextran infusions may be used if low Low= anemia, B12 def, malnutrition

Question 48

Identify the significance of abnormal findings for the following components of the Comprehensive Profile lab test including nursing responsibilities HEMAGLOBIN

Answer 48

Hemoglobin: Protein that carried O2 bound to RBC Low (no bleeding)= malnutrition Low (bleeding)= anemia, bleeding, transfusion?

Question 49

Complications of Malnutrition

Answer 49

Cardiovascular: leaky capillary membranes= edema= low cardiac output Endocrine: intolerance to heat and cold Gastrointestinal: anorexia, vomiting, diarrhea, malabsorption, impaired protein synthesis Immunologic: infection risk, skin breakdown, poor wound healing, dry flaky skin Integumentary: reduced muscle mass, activity intolerance, weak, fall risk Musculoskeletal: weakness Neurologic: confusion Psych-social: substance abuse Respiratory: general weakness which limit lung compacity, pneumonia Hepatic: not absorbing protein, impaired liver

Question 50

Risks associated with ENTERAL FEEDING Complications? Nursing implications?

Answer 50

Aspiration: HOB at 30 degrees, stop tube feeding before turning or lowering HOB, check for aspiration/residual Fluid and electrolyte imbalance: risk for potassium/sodium/chloride/calcium abnormalities, watch lab values, dehydration, fluid overload, I/O GI intolerance: stress causes sympathetic nervous system which decrease peristalsis, N/V, bloating, bowel assessment, diarrhea, often on PPI to reduce acid in gut. Feeding starts slow Hyperglycemia: high blood sugars, required BS checks regularly Refeeding syndrome: life threatening, check electrolytes (must be in balance), reduced phosphorus= acute respiratory failure, reduced magnesium= neuromuscular symptoms, reduced potassium= cardiac muscle fatality

Question 51

Parenteral nutrition: feeding by IV

Answer 51

When oral nutrition or enteral nutrition is not enough to meet nutritional needs When the gut requires complete rest Intravenous administration of amino acids, vitamins, minerals, electrolytes, dextrose May add fat emulsion (lipids): provides essential fatty acids and addition calories, monitor for fat overload syndrome= fever, increase triglycerides, clotting problems, multisystem failure Specific orders are placed based on individual needs Order is place by provider Routes: Peripheral Parenteral Nutrition Total Parenteral Nutrition

Question 52

Routes of Parenteral Nutrition

Answer 52

``` Peripheral Parenteral Nutrition (PPN): Typically short term Peripheral IV Lower in dextrose concentration (<10%) May be able to handle some oral/enteral nutrition ``` Total Parenteral Nutrition (TPN): Long term use Central line access due to dextrose level Higher dextrose content which is hypertonic solution Requires close monitoring of fluid balance and serum electrolytes

Question 53

Risk associated wit Parental Nutrition

Answer 53

Infection: infection at site, sterile dressing. High levels of dextrose is grounds for bacterial growth. Fluid/Electrolytes Imbalance: monitor labs, I/O, weight Hyperglycemia: increased risk r/t dextrose, do not abruptly stopped PPN or TPN Psych-social: reduced oral stimulation, mouth care, eating/drinking is social event

Question 54

Central Intravenous Therapy general info

Answer 54

Vascular access devices that are placed into the central circulation PICC Line: placed by specialty nurse, usually in the basilic vein runs up to heart, tip of catheter rests inferior/superior vena cava and right atrium. Long term, lots of volume can be pumped into patient. TPN administration Midline: usually in basilic vein, tip of catheter stops mid way up vein. NOT A CENTRAL LINE, PPN only

Question 55

Central Venous Catheters (CVC) general info

Answer 55

Non-tunneled catheter: place in internal jugular Tunneled catheter: placed subclavian TPN feeding X-ray to verify placement Placed by provider Can use femoral CVC but higher risk of infection

Question 56

Port-a-Cath (port)

Answer 56

``` Port-a-Cath (port): 1+ years Sterile technique Implanted Tip of catheter is in superior vena cava ```

Question 57

Nursing Implications for Central Line Care

Answer 57

``` Risks associated with insertion: Pneumothorax Air embolism Central line assoc. bloodstream infection Thrombophlebitis DVT ``` ``` General care: Sterile dressing Trained staff to access Blood draws Maintenance of unused ports ```

Question 58

Air embolism

Answer 58

``` Air embolism: Very rare S/S: SOB Chest pain Low BP High HR Reduced LOC Stroke like symptoms ``` Intervention: Place on left lateral decubitus position, possibly with slight Trendelenberg unless contraindicated. The rationale for this position is to trap the air in the left ventricle until it can be reabsorbed, and prevent it from traveling to the lungs

Question 59

Intracellular Fluid, Interstitial Fluid and Plasma info and what is in it

Answer 59

``` Intracellular Fluid (ICF): This is the fluid inside of the cell Containing: K+ Mg+ PO4 (phosphorus) Glucose Oxygen ``` Extracellular fluid: This is the fluid that fluid outside of cell which includes: Plasma: This is the fluid in the vascular spaces (arteries, veins, capillaries) Interstitial Fluid (IF): Fluid that floats around between all the cells Containing: Na+ Cl HCO3 (bicarb) Plasma: This is the fluid in the vascular spaces (arteries, veins, capillaries)

Question 60

Hydrostatic pressure?

Answer 60

Hydrostatic pressure: The force of intravascular fluid pushing outward moving fluid from capillaries into the interstitial space -strongest at arterial end -CHF causes increased hydrostatic pressure -traumatic injuries cause vasodilation and increase capillary permeability

Question 61

Oncotic Pressure?

Answer 61

Oncotic pressure: Inward pulling force caused by blood proteins (albumin) to move fluid from the interstitial space back into the capillaries -strongest at the venous end -albumin is water magnet (little to no albumin in the vascular space means H2O moves into the interstitial spaces and leads to edema) -decreased plasma protein and serum albumin means decreased oncotic pressure

Question 62

Lymphatic system regarding extra fluid

Answer 62

The lymphatic system is the back up if extra fluid leaks out of the capillaries. The extra fluid should shift into the lymphatic system and returned to the heart for re-circulation. Lymphatic obstruction will lead to decreased absorption of fluid causing edema.

Question 63

Osmolality | Osmoles/Weight

Answer 63

Osmolality = Osmoles/Weight Dependent on Na+ concentration Normal Na+ 135-145 Normal serum osmolality 280-300 mOsm/kg H20 Osmo value is approx. double your Na+ so if Na+ is low your osmolality will be low. And the revers affect

Question 64

Fluid Shifting: Osmolarity | ISOTONIC SOLUTION

Answer 64

Isotonic Solution: Solution that has the same solute concentration as another solution. There is no net movement of water particles and the overall concentration on both sides of the cell membrane remain constant Equal in, equal out Inside cell: 20% solute concentration (80% water) Outside cell: 20% solute concentration (80% water)

Question 65

Fluid Shifting: Osmolarity | HYPERTONIC SOLUTION AND ASSESSMENT

Answer 65

Hypertonic Solution: Solution that has a HIGHER solute concentration than another solution. Water particles will move out of the cell causing crenation (shriveling, notched) Inside cell: 20% solute concentration (80% water) Outside cell: 40% solute concentration (W60% water) Water moves out of the cell **Water follows salt= dehydration of the cell **Water follows Na+ because Na+ stays where it is. Reminder, K+ slightly permeable across membranes and will move unlike Na+ ``` Hypertonic solutions assessments: Cardiac function Renal function Pulmonary edema Fluid overload Heart failure I/O Labs Weights ```

Question 66

Fluid Shifting: Osmolarity | HYPOTONIC SOLUTION AND ASSESSMENT

Answer 66

Hypotonic Solution: Solution that has a LOWER solute concentration than another solution. Water particles will move into the cell, causing the cell to expand and eventually lyse (breakdown). Inside cell: 20% solute concentration (80% water) Outside cell: 10% solute concentration (90% water) **Water follows salt= expanding the cell **Water follows Na+ because Na+ stays where it is. Reminder, K+ slightly permeable across membranes and will move unlike Na+

Question 67

Intravenous Solutions | ISOTONIC

Answer 67

Isotonic: 0.9% NaCl (NS) Lactated Ringer's D5W (5% dextrose in water) **Isotonic in the bag but turns to hypotonic in the patient due to metabolizing the dextrose

Question 68

Intravenous Solutions | HYPOTONIC

Answer 68

Hypotonic: 0.45% NaCl (1/2 NS) Pulls water INTO cell= volume replacement Used on patient's who are dehydrated Caution with patient's - HF - cardiovascular issues - ICP - edema

Question 69

Intravenous Solutions | HYPERTONIC

Answer 69

Hypertonic: Pulls fluid OUT of cell Must have proper kidney and heart function D5NS (5% dextrose in 0.9% NS): patient's with SIADH, cerebral edema, increased ICP D5.45NaCl (5% dextrose in 0.45% NaCl): patient's with DKA, often used post-op D5LR (5% dextrose in lactated ringer's): 3% saline

Question 70

Fluid and Electrolytes Pearls

Answer 70

Telemetry is always used K+ and Mg+ are buddies, they often go together and Ca+ tags along Na+ and H2O are buddies, water follows sodium Never give K+ IV push, must be on pump High K+ = acidosis Low K+ = alkalosis Ca+ and Mg+ think muscles, skeletal and heart Ca+ and Mg+ act like sedatives, sedated if you have too much and opposite if you don't have enough Na+ affects brain with imbalances, CNS changes Na+ should be correctly slowly, otherwise cerebral edema can occur High K+, are kidneys working? Or is it medication Ca+ and Phos have an inverse relationship ADH released = AD H2O to the body, retained fluid, not excreted through urine. Low Ca+ means look at the albumin