Fluid and electrolytes

Question 1

T/F: Crystalloids contains proteins

Answer 1

false

Question 2

Pros of crystalloids

Answer 2

no risk for viral transmission, anaphylaxis, alteration in coagulation profile

Question 3

Crystalloids indication

Answer 3

Dehydration, fluid loss, electrolyte disturbance, promote urinary flow

others: acute liver failure, acute nephrosis, respiratory distress, burns, cardiopulmonary bypass, hypoproteinemia, DVT, shock

Question 4

T/f: Crystalloids are used to expand plasma vol

Answer 4

false

Question 5

Crystalloids examples

Answer 5

• NS: 0.9% sodium chloride (isotonic), 0.45% half normal (hypotonic)
  -3.3% dextrose and 0.3% NS (isotonic)
• lact ringers sol (isotonic)
  -dextrose 5% in water (isotonic)
  -D5W and o.45% NS (hypertonic)
  -3% sodium chloride (hypertonic saline)

Question 6

Crystalloids adverse effects

Answer 6

-Edema
-diluted plasma protein = decreased colloid oncotic pressure

Question 7

Adverse effects of crystalloid from long term use

Answer 7

alkalosis, acidosis

Question 8

Colloids examples

Answer 8

-albumin 5% and 25% (from human donors)
-dextran 40 or 70 (available in sodium chloride and 5% dextrose)
-hetastarch

Question 9

Colloids adverse effects

Answer 9

altered coagulation & bleeding

Question 10

Cons of colloids

Answer 10

no clotting factors or oxygen carrying capacity; bleeding risk

Question 11

Pros of dextran therapy

Answer 11

rare anaphylaxis or kidney failure

Question 12

Pros of Blood products

Answer 12

only one carrying oxygen, increase tissue oxygenation, increase plasma vol

Question 13

Cons of blood products

Answer 13

most expensive and least available, risk of reactions to fluid; require human donors

Question 14

Type of blood products

Answer 14

-cryoprecipitate and plasma protein factors
-Fresh frozen plasma
-Packed RBC
-Whole blood

Question 15

cryoprecipitate and plasma protein factors indication

Answer 15

management of acute bleeding (> 50% slow blood loss or 20% acutely)

Question 16

Fresh frozen plasma indication

Answer 16

increasing clotting factors for pts with deficiency

Question 17

Packed RBC indications

Answer 17

increase oxygen carrying capacity in anemia, hemoglobin deficits, < 25% total blood vol loss

Question 17

Whole blood indication

Answer 17

> 25% loss of total blood vol

Question 18

Blood products adverse effects

Answer 18

incompatibility with recipients immune system, transfusion reaction, anaphylaxis, pathogen transmission (hepatitis, HIV)

Question 19

Principal ECF electrolyte

Answer 19

Na

Question 20

Principal ICF electr

Answer 20

K

Question 21

normal potassium range

Answer 21

3.5-5 mmol/L

Question 22

high potassium foods

Answer 22

bananda, orange, apricots, dates, raisins, broccoli, green beans, potatoes, tomatoes, meats, fish, wheat breads, legume

Question 23

Hyperkalemia causes

Answer 23

K supplements
ACE inhibitors
kidney failure
K sparing diuretics
burns, trauma, infections, metabolic acidosis

Question 24

Hyperkalemia range

Answer 24

> 5 mmol/L

Question 25

hypokalemia range

Answer 25

< 3.5 mmol/L

Question 26

hypokalemia causes

Answer 26

alkalosis, ketoacidosis, hyperaldosteronism corticosteroids diarrhea, emesis burns thiazide, thiazide-like, loop diuetics malabsorption

Question 27

Effect of hypokalemia in digoxin therapy

Answer 27

digoxin therapy leading to ventricular dysrhythmias*

Question 28

K indication

Answer 28

low K, stop irregular heartbeats, manage tachydysrhythmias after cardiac surgery

Question 29

K adverse effects

Answer 29

PO: diarrhea, nausea, emesi, GI bleeding, ulcer IV: pain at injection site, phlebitis Excessive admin: hyperkalemia, toxicity, cardiac arrest

Question 30

Hyperkalemia s/s

Answer 30

muscle weakness, parenthesis, paralysis, cardiac rhythm irregularities (may lead to ventricular fib, cardiac arrest)

Question 31

Severe hyperkalemia treatment

Answer 31

IV sodium bicarb sodium polystyrene sulphonate hemodialysis

Question 32

Sodium normal range

Answer 32

135-145 mmol/L

Question 33

hyponatremia range

Answer 33

< 135 mmol/L

Question 34

hyponatremia s/s

Answer 34

lethargy, stomach cramps, hypotension, emesis, diarrhea, seizures

Question 35

hyponatremia causes

Answer 35

excessive perspiration (hot weather, physical work) prolonged diarrhea, emesis kidney disorders adrenocortical impairment

Question 36

hypernatremia range

Answer 36

> 145 mmol/L

Question 37

hypernatremia s/s

Answer 37

edema, hypertension, red;flushed skin, sticky mucous membranes, increased thirst, increased temp, decreased or absent urinary output

Question 38

hypernatremia causes

Answer 38

poor kidney excretion (kidney dysfunction) poor water intake, dehydration

Question 39

Mild sodium treatment

Answer 39

fluid restriction PO sodium chloride

Question 40

severe sodium treatment

Answer 40

IV NS or Lact Ringers

Question 41

sodium adverse effects

Answer 41

PO: nausea, emesis, cramps IV: venous phlebitis

Question 42

Type of diagnostic to do before potassium admin

Answer 42

ECG

Question 43

IV potassium rate

Answer 43

should not be faster than 10 mmol/ hr for pts not on cardiac monitors - critically ill pts on cardiac monitors: less than 20 mmol/hr

Question 44

What should you not do when giving IV potassium

Answer 44

never give as an IV bolus or undiluted

Question 45

how to prep oral potassium

Answer 45

dilute in water or fruit juice (100-250 mL)

Question 46

how to minimize GI upset & prevent too rapid absorption when taking oral potassium

Answer 46

take with food or immediately after meals

Question 47

S/S to report when taking oral potassium

Answer 47

nausea, emesis, GI pain, GI bleeding

Question 48

T/F: colloids are admin slowly

Answer 48

True