Fluid and Electrolyte Balance: Part 3

Question 1

PRBCs

Answer 1

Packed red blood cells

Plasma & platelets removed

Question 2

Can give platelets if patient is experiencing….

Answer 2

Disseminated intravascular coagulation

Question 3

Blood and blood products: maximum rate of infusion

Answer 3

4 hours per unit (not in emergencies)

Question 4

Whole blood

Answer 4

Include platelets, fluid, etc

Question 5

What drug should you give simultaneously with whole blood?

Answer 5

Loops to prevent circulatory overload

Question 6

Sodium

Answer 6

Major cation in ECF

Question 7

Normal plasma sodium level

Answer 7

135-145 mEq/L

Question 8

Sodium plays a major role in…

Answer 8

Volume balance and plasma osmolarity

Question 9

Hyponatremia is caused by..

Answer 9

Vomiting, diarrhea, NG suctioning, burns, diabetes insipidus

Question 10

Treatment of hyponatremia

Answer 10

Oral replacement, 0.9% sodium chloride IV

Question 11

Why is 0.9% sodium chloride given for hyponatremia?

Answer 11

Has more sodium than we need even though it is isotonic

Question 12

Hypernatremia is caused by….

Answer 12

Excessive oral intake, hypertonic IV or tube feedings, Cushing’s syndrome

Question 13

Treatment of hypernatremia

Answer 13

Sodium restriction

Hypotonic IV fluids

Question 14

Potassium is required for…

Answer 14

Nerve impulse conduction & electrical excitability of muscles

Question 15

Potassium is regulated by..

Answer 15

The kidneys

Question 16

Extracellular (blood) K+ normal potassium values

Answer 16

4 - 5 mEq/L

Question 17

Hypokalemia

Answer 17

<3.5 mEq/L

Question 18

Hyperkalemia

Answer 18

> 5mEq/L

Question 19

Hypokalemia causes

Answer 19

Thiazide and loop diuretics, inadequate K+ intake, alkalosis, vomiting diarrhea, laxatives

Question 20

Consequences of hypokalemia

Answer 20

Skeletal muscle weakness, cardiac dysrhythmias, intestinal ileus, digoxin toxicity

Question 21

Treatment of hypokalemia

Answer 21

K+ replacement PO or IV (NEVER pushed)

Question 22

K+ replacement contraindications

Answer 22

Renal insufficiency, use with K+ sparing diuretics

Question 23

Hyperkalemia: >9mEq/L =

Answer 23

Cardiac arrest

Question 24

Hyperkalemia causes …

Answer 24

Elevated T wave, prolonged PR interval, confusion, anxiety, dyspnea, numbness / tingling hands, feet and lips

Question 25

Hyperkalemia treatment

Answer 25

Stop all K + sources, food, meds and lower extracellular K+ levels

Question 26

Ways to decrease extracellular K+ levels

Answer 26

Calcium salts (calcium gluconate), insulin & glucose, Na+ bicarb if acidotic, oral or rectal sodium polystryene sulfonate or dialysis

Question 27

Modes of delivery (tube placement)

Answer 27

Nasogastric (NG), nasoduodenal, nasojejunal, PEG tube (esophagus, stomach, jejunum)

Question 28

Enteral nutrition

Answer 28

Into the GI (Has to have a functioning gut)

Question 29

Parenteral nutrition

Answer 29

Bypassing stomach and goes straight into blood

Question 30

Administration schedule options

Answer 30

Continuous Intermittent Bolus

Question 31

Methods of administration (nutrition)

Answer 31

Syringe Gravity drip Pump

Question 32

Nutritional components in nutrition therapy

Answer 32

Amino acids, carbohydrates, fats, electrolytes, vitamins and trace elements

Question 33

Complications of enteral therapy

Answer 33

``` Aspiration Pneumonitis Diarrhea, vomiting Insufficient gastric emptying GI bleeding Hyperglycemia Electrolyte imbalances Fatty acid deficiency Aspiration pneumonia ```

Question 34

How to prevent aspiration

Answer 34

Sit patient up

Question 35

Parenteral nutrition therapy purpose

Answer 35

Conserve and restore lean body mass, promote wound healing

Question 36

Parenteral nutrition therapy routes

Answer 36

Peripheral IV short term | Central venous catheter --> 10 days, hypertonic solutions

Question 37

Components of parenteral nutrition therapy

Answer 37

Amino acids, dextrose, fats, carbohydrates, electrolytes and trace elements

Question 38

Complications of TPN

Answer 38

Fluid overload, dehydration, increased BUN, glucose intolerance, hyperlipidemia allergy, catheter related complication (pneumothorax, phlebitis, thrombosis)

Question 39

TPN

Answer 39

Parenteral nutrition therapy

Question 40

What to monitor daily with TPN

Answer 40

Daily weight, blood and urine chemistries, I&O