Fluid & Blood Therapy

Question 1

What are 2 isotonic solutions used for fluid resuscitation

Answer 1

Lactated Ringer’s and 0.9% Sodium Chloride

Question 2

giving too much isotonic saline has the potential to _____

Answer 2

to increase sodium and chloride levels

Isotonic saline (0.9% NaCl), ornormal saline,has a sodium concentration (154 mEq/L) slightly higher than that of plasma (135 to 145 mEq/L) and a chloride concentration (154 mEq/L) significantly higher than the plasma chloride level (96 to 106 mEq/L).

Question 3

What is in LR

Answer 3

Lactated Ringer’s solution contains sodium, potassium, chloride, calcium, and lactate (the precursor of bicarbonate) in about the same concentrations as ECF. This makes it the ideal fluid in certain situations, such as surgery, burns, or GI fluid losses. Patients with liver dysfunction, hyperkalemia, and severe hypovolemia should not receive lactated Ringer’s because they have a decreased ability to convert the lactate to bicarbonate.

Question 4

What fluid is isotonic in the bag and hypotonic in the body?

Answer 4

D5W is isotonic in the bag, but is hypotonic in the body. It is mainly given used to treat hypernatremia. Although 5% dextrose in water is technically an isotonic solution, the dextrose quickly metabolizes. The net result is the administration of hypotonic free water with equal expansion of ECF and ICF.

Question 5

What is a normal Hgb level in a female?

Answer 5

12-16 g/dL

Question 6

What is a normal Hgb level in a male?

Answer 6

14-18 g/dL

Question 7

What are Hgb labs used for?

Answer 7

Measurement of gas-carrying capacity of the red blood cell (RBC)
Elevated: Associated w/ polycythemia( too many RBCs, The excess red blood cells cause the blood to increase in volume and thicken, keeping it from flowing easily), hemoconcentrated states (posture affects concentration of blood so that it doesn’t accurately reflect lab values) (2° dehydration)
Decreased: Associated w/ anemia, hemorrhage, hemodilution states (2° fluid volume excess)

Question 8

Normal Hct range for a female?

Answer 8

37-47%

Question 9

Normal Hct range for a male?

Answer 9

42-52%

Question 10

What are Hgb labs used for?

Answer 10

Measure of packed cell volume of RBCs expressed as a percentage of the total volume
Generally 3x hemoglobin

Question 11

What is a normal Plt level (M/F)

Answer 11

150,000 – 400,000/µL

Question 12

What are Plt labs used for?

Answer 12

Number of platelets available to maintain platelet clotting functions
Does not measure quality of platelet function

Question 13

When would you consider a packed RBC transfusion for a patient?

Answer 13

hemoglobin < 10 g/dL. Most patients will receive a transfusion at a hemoglobin of 7 to 8 g/dL

Question 14

T/F: If a pt is actively bleeding, platelets are usually transfused to keep platelet counts above 50,000/µL.

Answer 14

T

Question 15

Define thrombocytopenia

Answer 15

a condition that occurs when the platelet count in your blood is too low

Patients are usually transfused prior to the procedure to increase the level to at least 50,000/µL.

Question 16

T/F: Patients with platelet levels below 10,000/µL are usually transfused to prevent spontaneous bleeding.

Answer 16

T

Question 17

What blood type is a universal recipient

Answer 17

AB positive

Question 18

What are the clinical manifestations of transfusion reactions

Answer 18

Most frequent
Fever
Chills
Pruritus or urticaria
Other
Shortness of breath
Red urine
High fever
Loss of consciousness
Anaphylactic shock

Question 19

What are the clinical interventions a nurse should do if they suspect a transfusion reaction?

Answer 19

Asses

IV clamps on and transfusion stopped

Disconnect blood tubing and save for lab eval

Reconnect NS with new tubing

Monitor vital signs, O2 sat, urine output, and lung sounds. Document

Notify MD