Fluid Therapy Flashcards
What are some causes of Fluid Volume Deficit?
Abnormal loss of body fluids (diarrhea, fistula drainage, hemorrhage, polyuria), inadequate intake, or fluid shift from plasma to interstitial fluid.
What would you do from a nurse’s perspective for Fluid Volume Deficit?
Correct underlying cause and replace water and any needed electrolytes.
What are common fluids administered for Fluid Volume Deficit?
- Lactated Ringers
- 0.9 Sodium Chloride
- Packed Red Blood Cells when due to blood loss
What is something to be be worried about when administering fluid for someone with Fluid Volume Deficit?
Monitor for signs of fluid volume excess during volume repletion.
What are causes of Fluid Volume Excess?
Excessive fluid intake, abnormal retention of fluids (heart/renal failure), or shift form interstitial space into plasma fluid.
What are some nursing considerations when it comes to Fluid Volume Excess?
Correct underlying cause, diuretics, fluid restriction, and sodium restriction
What are some things that nurses should assess for dealing with Fluid Balance?
- Jugular Vein Distention
- Dyspnea, cough, moist crackles
- Increased RR
- Neuro Changes
- Skin turgor
What are some nursing interventions for Fluid Balance?
- Strict I/O
- Daily weight
- Vital signs
- Skin care
Which is more important, strict I/O, or daily weights?
Daily weights are going to be most important, because they can account for insensible loss.
*It is important to get a weight that is important. When taking weights, compare to day before.
White Blood Cells (WBC)
4,000- 11,000 uL
-Total number of leukocytes
Elevated:
-associated with infection, inflammation, tissue injury/death, malignancies (leukemia and lymphoma)
Decreased:
-Associate with bone marrow depression, severe/chronic illness, some types of leukemia
Hemoglobin (Hgb)
(female) 11.7- 16 g/dL
(male) 13.2- 17.3 g/dL
GENERAL: 12-17 g/dL
-measurement of gas carrying capacity of red blood cells
Elevated:
-Associated with polycythemia, hemoconcentrated states (dehydration)
Decreased: associated with anemia, hemorrhage, demodilution states (fluid volume excess)
Hematocrit (Hct)
(female) 35-47%
(male) 39-50%
- measurement of packed cell volume of RBCs expressed as a percentage of the total volume
- generally 3x hemoglobin
Platelet
150,000- 400,000 uL
- Number of platelets available to maintain platelet clotting functions
- Does not measure quality of platelet FUNCTION
Where are blood group antigens found?
They are found only on RBC membranes
(True/False) Presence of absence of blood group antigens (AB) is the basis for the four blood types.
True
Rh is based on what antigen?
The D antigen
Rh negative people (have/don’t have) the D antigen
Do NOT have
Each person has _____ in the serum, that interact with A or B antigens.
Antibodies
What blood types is considered the universal donor?
O negative
What blood type is considered the universal recipient?
AB+
Why would you use plasma, as opposed to WBC?
For clotting factors
Packed Red Blood Cells
Volume: 250-310 ml
Description: Prepared from whole blood with 85-90% of the plasma removed
Expected Response: One unit of packed red blood cells should increase a 70kg recipient’s Hgb by one g/dL, Htc by 3 g/dL
Complications: Infectious diseases, alloimmunizations, and transfusion reactions. Massive transfusions may precipitate hypothermia, coagulation disorders, citrate, and/or ammonia intoxication.
Fresh Frozen Plasma
Volume: 225-250
Description: Several different ways to manufacture. Contains all coagulation proteins.
Indications: Deficit of multiple plasma coagulation factors. liver disease associated with hemostatic deficit, DIC, thrombotic thrombocytopenia, purpora
Expected Response: Hemostatis and/or improvement in coagulation parameters
Complications: Infectious disease, volume overload, allergic and febrile transfusion reactions
Platelets (Pooled and Pheresis)
Volume: Variable; 30-60 mL/unit. At VCUHS, adult standard dose is 4 units
Description:
-pooled: prepared form fresh, whole blood (multiple donors)
-pheresis: single-donor obtained from plateletpheresis
Indications: Thrombocytopenia (low platelet count) with bleeding; platelet dysfunction
Expected Response: Increase platelet count 30,000-50,000/ mm3 in average 30kg adult
Complications: Frequent platelet transfusions may compromise future ability to control bleeding (via alloimmunization), infectious diseases, transfusion reactions (allergic and febrile)
Cryoprecipitate
Volume: 10-20 ml
Description: Concentrated factor VIII fibrinogen, factor XIII and Von Willebrand factor prepared from one unit of Fresh Frozen Plasma
Indications: Factor deficiencies, uremic platelet dysfunction
Expected Response: Hemostasis and/or improvement in coagulation parameters
Complications: Infectious diseases, transfusion reaction (febrile/allergic)
What kinds of patient teaching do you give someone who is receiving a blood product?
- Purpose
- Sign/Symptom of a Reaction
What is important to take before administering blood products?
Baseline VS
It is important to start blood transfusion within _____ of blood arriving on unit
30 minutes
When giving blood products, remain with patient for ____ after administering blood products, then ____.
Remain with them for at least 15 minutes, then recheck VS
When administering blood products to adults, it is important to use a ____ gauge or larger.
20 gauge
What is the adult dose for packed red blood cells
1 unit
Response:
Hemoglobin- 1 g/dL
Hematocrit- 3 g/dL
- When blood loss is greater than 30%
- Need to increase O2 carrying capacity
- Hb is less than 8 g/dL
When do you give platelets?
- Plt is less than 10-20,000 uL
- Plt is less than 50,000 with bleeding or invasive procedure
- Plt is less than 100,000 with invasive procedure
- Plt dysfunction with bleeding
What is the adult dose for plasma?
2-4 units
What is the response of plasma?
- Decrease in PT/INR
- Replace coagulation factor
- Due to ABO incompatibility
- Antibodies in recipient’s plasma attach to antigens on transfused RBCs, causing hemolysis
Acute Hemolytic
Reaction between transfused antileukocyte antibodies and recipients leukocytes, causing pulmonary inflammation and capillary leak
Transfusion-Related Acute Lung Injury (TRALI)
What should a nurse to for a mild allergic reaction to a blood product?
Administer antihistamines, resume transfusion if improved within 30 minutes
How would you react to a mild/severe allergic reaction to a blood product?
Administer antihistamines, epinephrine, vasopressors, and corticosteroids as needed.
How to react to acute hemolytic transfusion
Treat shock with vasopressors; maintain airway; administer fluids and diuretics; monitor for acute renal failure
How to react to TRALI
Respiratory support! Most will be resolved within 24-96 hours.
What is the first step when you notice a transfusion reaction taking place?
STOP TRANSFUSION!
After you stop transfusion, what is the next step when you notice a transfusion reaction?
Maintain 0.9 Sodium Chloride
