electrolytes Flashcards
*Greater osmolarity then plasma
*Water moves OUT of the cells & into the intravascular compartment
*Cells SHRINK
D5 NS (5% Dextrose in 0.9% saline)
D5 ½ NS (5% Dextrose in 0.45% saline)
D5 LR (5% Dextrose in Lactated Ringer’s)
*Provision of calories as part of parenteral nutrition.
*Do not administer to client at risk for fluid volume excess.
*Nursing Assessment - Risk for fluid volume excess: blood pressure, lung sounds, serum sodium levels
-Packed red blood cells and whole blood
hypertonic
*Less osmolarity than plasma
*Water moves INTO the cells & out of the intravascular space
*Cells SWELL & possibly burst
-0.45% Sodium Chloride (NaCl)
*“half normal saline”
*1/2 NS
*Maintenance solution
*Nursing Assessment: Mental Status Changes - may indicate cerebral edema
*D5W is isotonic until dextrose is metabolized in the body - becomes free water (hypotonic)
hypotonic
consists of fluid intake and absorption, fluid distribution, fluid output
fluid balance
Movement of fluid among its various compartments.
fluid distribution
*Drinking and foods
*Thirst and habit
fluid intake
*Normally via skin, lungs, GI tract, kidneys
*Abnormally via vomiting, wound drainage, hemorrhage
sensible is measurable like through urine and feces and insensible is not measurable like through the lungs
fluid output
Dextrose in Water 5%
*D5W
*Glucose is quickly used up
*After glucose is used up, it becomes free water (hypotonic)
*Common “KVO” fluid
*Often compatible with meds
*Usually isotonic only in the container.when the concentration of two solutions is the same
Normal Saline
0.9% NaCl
Compatible with most medications
The only fluid to be given with blood
Excessive administration can raise serum Na level
Lactated Ringer’s
Lactated Ringer’s, Ringer’s solution
Often used in surgery patients to expand circulating volume from blood loss
Used to treat loss from burns & lower GI
Rescue Fluids-given in emergency situations/trauma as vascular replacement for hypovolemic shock
Dextrose in Water 5%
*D5W
*Glucose is quickly used up
*After glucose is used up, it becomes free water (hypotonic)
*Common “KVO” fluid
*Often compatible with meds
*Usually isotonic only in the container.
isotonic
excess
*ECV deficit
*Hypovolemia means decreased
vascular volume and often is
used when discussing ECV
deficit.
extracellular fluid volume (ECV)
*Shift of fluid into transcellular compartment (interstitial space, peritoneal cavity-ascites, bowel, joint cavities, pleural space
*Fluid trapped
*Decreased body weight does not occur
*Fluid loss cannot be measured
third-spacing of fluid
*Full, bounding pulses
*Hypertension
*Distended neck veins (JVD)
*Rapid weight gain best indicator of fluid overload
*Shortness of breath
*Moist Crackles on auscultation (“wet lungs”)
*Peripheral Edema (may be pitting)
*DLC - seizure
- Restrict fluid & Na intake as ordered
- TED hose/compression stockings
- Encourage rest periods
- Assess skin breakdown/change position
- Monitor I/O
- Assess for worsening FVE
- Educate self-monitoring of weight & I/O
fluid volume excess
loss of both water and electrolytes from the extracellular fluid; also called hypovolemia
*Fluid replacement is key.
*Administer oral fluids as indicated.
*Administer IV fluids as ordered.
*I and O, hourly outputs
*Daily weights
*Monitor vital signs
*Assess skin turgor
*Assess labs (urine specific gravity)
*Monitor during rehydration: pulse , blood pressure, urine output
fluid volume deficit
-Weight
-Skin turgor
-Pitting edema
-Skin for moisture
-Venous filling
-Neck veins in supine position with head elevated 45 degrees
-Tongue
-Eyeball palpation
-Eye position
-Lung sounds
-Blood pressure
hydration assessment
*Maintain/correct fluid imbalance
*Maintain/correct electrolyte or acid-base imbalance
*Expand vascular space
*Provide nutrition
intravenous (IV)
*Blood component therapy = IV administration of whole blood or blood component
*-Ensure patient knows reason for transfusion
*-Informed consent
*-Pretransfusion assessment
*-Verify blood product
*-20 G or larger
*-NS !!!!
*Type and cross
*Use proper equipment
*2 Nurses Check!!
*Baseline Assessment
*Initiate slowly
*Continuous Monitoring
*If suspected adverse reaction, stop transfusion immediately
blood replacement
*Stop the transfusion
*Disconnect the Blood at the site near patient
*Change tubing and start infusion of NS only
*Notify provider
*Frequent Vital signs per protocol
*Prepare to administer Antihistamines, Corticosteroids, vasopressors
*Label all tubing and send to lab
transfusion reaction
