chapter 30 - week 2 Flashcards
total body water comopsition
Total body water
Composed of:
Intracellular fluid: 67%
Interstitial fluid: 25%
Plasma volume: 8%
60% of adult human body is water.
intravascular fluid
Fluid inside blood vessels
extravascular fluid
Fluid outside blood vessels
Lymph, cerebrospinal fluid
extravascular volume
Plasma
Interstitial fluid: fluid in space between cells, tissues, and organs
extracellular volume
Interstitial fluid
Intracellular fluid
what is the pressure that plasma proteins exert
contstant osmotic pressure
colloid osmotic pressure
normally 24 mm. Hg
what is the pressure interstitial fluid exerts
hydrostatic pressure
noramlly 17 mm Hg
crystalloids
- Solutions containing fluids and electrolytes that are normally found in the body
- Do not contain proteins (colloids)
- No risk for viral transmission, anaphylaxis, or alteration in coagulation profile
what are crsytalloids used for
- Better for treating dehydration rather than expanding plasma volume
Used as maintenance fluids to: - Compensate for insensible fluid losses
- Replace fluids
- Manage specific fluid and electrolyte disturbances
- Promote urinary flow
crystalloid types
- Normal saline (NS): 0.9% sodium chloride is isotonic; 0.45% “half-normal” is hypotonic)
- 3.3% dextrose and 0.3% NS (two thirds and one third) (isotonic)
- Hypertonic saline (3% sodium chloride)
- Lactated Ringer’s solution (isotonic)
- Dextrose 5% in water (D5W) (isotonic)
- D5W and 0.45% NS (hypertonic)
- Plasma-Lyte (isotonic)
crystalloi indictations
Indications include:
* Acute liver failure
* Acute nephrosis
* Adult respiratory distress syndrome
* Burns
* Cardiopulmonary bypass
* Hypoproteinemia
* Hemodialysis
* Deep vein thrombosis (reduction of risk)
* Shock
crystalloid adverse effects
- Adverse effects
- May cause edema, especially peripheral or pulmonary
- May dilute plasma proteins, reducing colloid oncotic pressure
- Effects may be short-lived
- Prolonged infusions may worsen alkalosis or acidosis
colloid
Protein substances
Increase colloid oncotic pressure
Move fluid from interstitial compartment to plasma compartment (when plasma protein levels are low)
* Albumin 5% and 25% (from human donors)
* Dextran 40 or 70 (available in sodium chloride and 5% dextrose)
* Hetastarch (synthetic)
colloid adverse effects
- Usually safe
- May cause altered coagulation, resulting in bleeding
- Have no clotting factors or oxygen-carrying capacity
- Rarely, dextran therapy causes anaphylaxis or kidney failure.
albumin
colloids:
Natural protein that is normally produced by the liver
Responsible for generating approximately 70% of colloid oncotic pressure
Sterile solution of serum albumin that is prepared from pooled blood, plasma, serum, or placentas obtained from healthy human donors
Pasteurized to destroy any contaminants
blood products
The only class of fluids that are able to carry oxygen
Increase tissue oxygenation
Increase plasma volume
Most expensive and least available fluid because they require human donors
blood products action
- Increase colloid osmotic pressure and plasma volume
- Pull fluid from extravascular space into intravascular space (plasma expanders)
- Red blood cell products also carry oxygen.
- Derived from human donors and thus have all the benefits (and hazards) of human blood products
blood products indications
Cryoprecipitate and plasma protein factors
* Management of acute bleeding (greater than 50% slow blood loss or 20% acutely)
Fresh frozen plasma
* Increase clotting factor levels in patients with demonstrated deficiency
Packed red blood cells
* To increase oxygen-carrying capacity in patients with anemia, in patients with substantial hemoglobin deficits, and in patients who have lost up to 25% of their total blood volume
Whole blood
* Same as for packed red blood cells except that whole blood is more beneficial in cases of extreme (greater than 25%) loss of blood volume, because whole blood also contains plasma
Contains plasma proteins, which help draw fluid back into blood vessels from surrounding tissues
blood products adverese effects
- Incompatibility with recipient’s immune system
- Cross-match testing
- Transfusion reaction
- Anaphylaxis
- Transmission of pathogens to recipient (hepatitis, human immunodeficiency virus)
electrolytes
Principal ECF electrolytes
* Sodium cations (Na+)
* Chloride anions (Cl−)
Principal intracellular fluid electrolyte
* Potassium cation (K+)
Others
* Calcium, magnesium, phosphorus
potassium obtained from foods
Bananas, oranges, apricots, dates, raisins, broccoli, green beans, potatoes, tomatoes, meats, fish, wheat bread, and legumes.
potassium
- Most abundant positively charged (cationic) electrolyte inside cells
- 95% of body’s potassium is intracellular.
- Potassium content outside of cells ranges from 3.5 to 5 mmol/L.
- Potassium levels are critical to normal body function.
hyperkalemia
Hyperkalemia: excessive serum potassium;
serum potassium level over 5.5 mmol/L
* Potassium supplements
* Angiotensin-converting enzyme inhibitors
* Kidney failure
* Excessive loss from cells
* Potassium-sparing diuretics
* Burns
* Trauma
* Metabolic acidosis
* Infections
hypokalemia
Hypokalemia: deficiency of potassium; serum potassium level less than 3.5 mmol/L
Excessive potassium loss (rather than poor dietary intake)
* Alkalosis
* Corticosteroids
* Diarrhea
* Ketoacidosis
* Hyperaldosteronism
* Increased secretion of mineralocorticoids
* Burns
* Thiazide, thiazide-like, and loop diuretics
* Vomiting
* Malabsorption
* Others
what is potassium responsible for?
- Muscle contraction
- Transmission of nerve impulses
- Regulation of heartbeat
- Maintenance of acid–base balance
- Isotonicity
- Electrodynamic characteristics of the cell
potassoim indications
Main indication
* Treatment or prevention of potassium depletion when dietary means are inadequate
Other therapeutic uses
* Stop irregular heartbeats
* Management of tachydysrhythmias that can occur after cardiac surgery
potassium adverse effects
Oral preparations
* Diarrhea, nausea, vomiting, gastrointestinal bleeding, ulceration
IV administration
* Pain at injection site
* Phlebitis
Excessive administration
* Hyperkalemia
* Toxic effects
* Cardiac arrest
hyperkalemia manifestations
Muscle weakness, paresthesia, paralysis, cardiac rhythm irregularities (leading to possible ventricular fibrillation and cardiac arrest)
treatment of severe hyperkalemia
- IV sodium bicarbonate, calcium gluconate or calcium chloride, dextrose with insulin
- Sodium polystyrene sulphonate (Kayexalate®) or hemodialysis to remove excess potassium
sodium
- Most abundant positively charged electrolyte outside cells
- Normal concentration outside cells is 135 to 145 mmol/L
- Maintained through dietary intake of sodium chloride: Salt, fish, meats, foods flavoured or preserved with salt
hyponatremia
Hyponatremia: sodium loss or deficiency; serum levels below 135 mmol/L
Symptoms
* Lethargy, stomach cramps, hypotension, vomiting, diarrhea, seizures
* Causes
* Some of the same conditions that cause hypokalemia
* Also, excessive perspiration (during hot weather or physical work), prolonged diarrhea or vomiting, kidney disorders, and adrenocortical impairment
hypernatremia
Hypernatremia: sodium excess; serum levels over 145 mmol/L
Symptoms
* Water retention (edema), hypertension
* Red, flushed skin; dry, sticky mucous membranes; increased thirst; elevated temperature; decreased or absent urinary output
* Causes
* Poor kidney excretion stemming from kidney malfunction; inadequate water consumption and dehydration
sodiums is responsbile for…
Sodium is responsible for:
* Control of water distribution
* Fluid and electrolyte balance
* Osmotic pressure of body fluids
* Participation in acid–base balance
sodoim indications
Main indication
* Sodium depletion when dietary measures are inadequate (treatment or prevention)
Mild
* Treated with oral sodium chloride or fluid restriction or both
Severe
* Treated with IV NS or lactated Ringer’s solution
soidum adverse effects
Adverse effects
Oral administration
* Nausea, vomiting, cramps
IV administration
* Venous phlebitis
nursing implications before electrotyle therapy
- Assess baseline fluid volume and electrolyte status.
- Assess baseline vital signs.
- Assess skin, mucous membranes, daily weights, and input and output.
- Before giving potassium, assess electrocardiogram.
- Assess for contraindications to therapy.
- Assess transfusion history.
- Establish venous access as needed.
- Administer colloids slowly.
- For blood products, follow administration procedures closely.
Oral forms of potassium
* Must be diluted in either water or fruit juice (100 to 250 mL) and taken with food or immediately after meals to minimize gastrointestinal distress or irritation and to prevent too rapid absorption
* Monitor reports of nausea, vomiting, gastrointestinal pain, and gastrointestinal bleeding.
nursing implications monitring electrolyte therpay
Monitor therapeutic response.
* Normal laboratory values: Red blood cells, white blood cells, electrolyte levels
* Improved fluid volume status
* Increased tolerance to activities
Watch for adverse effects
* Monitor for fluid overload and possible heart failure.
* Monitor closely for signs of transfusion reactions.
* Monitor serum electrolyte levels during therapy.
* Monitor infusion rate, appearance of fluid or solution, and infusion site.
* Observe for infiltration and other complications of IV therapy.
Parenteral infusions of potassium must be monitored closely.
* IV potassium must not be given at a rate faster than 10 mmol/hr to patients who are not on cardiac monitors. For critically ill patients on cardiac monitors, rates of 20 mmol/hr may be used.
* Never give as an IV bolus or undiluted
