Fluids Flashcards
Which type of fluid is given with blood
normal saline (9%)
hyper/iso/hypo tonic: d5 in water
iso -> hypo tonic
hyper/iso/hypotonic: d5 1/2 normal saline
hypertonic
hyper/iso/hypotonic: normal saline
isotonic
hyper/iso/hypotonic: d5 in normal saline
hypertonic
hyper/iso/hypotonic: lactated ringer’s
isotonic
Use for Packed Red Blood Cells
blood loss
Use for fresh frozen plasma
trauma, burns, shock, bleeding/clotting disorders
Use for platelets
thrombocytopenia
Use for cryoprecipitate
used for clients with hereditary disorders that lead to inadequate clotting
What is cryoprecipitate derived from?
plasma
type and crossmatch
determining blood type and Rh factor
universal donor blood type
o neg
universal recipient blood type
AB positive
t/f: a consent must be obtained before administration of any blood type
true
Signs of a transfusion reaction
fever/chills, altered BP, dyspnea, allergic reaction
loss of body water but electrolytes remain consistent
dehydration
loss of both fluid and electrolytes
fluid volume deficit
meds that decrease thirst sensation
benzos and SSRIs
fluid volume deficit s/s
- hypotension
- tachy
- orthostatic hypotension
- decreased urine output
- flat neck veins
- weak pulse
dehydration lab tests
↑ serum osmolarity ↑ creatinine ↑ BUN ↑ urine specific gravity ↑ electrolytes (because more concentration)
What causes a reduced colloid oncotic pressure
Reduced levels of albumin
What does protein do for fluid balance
Keeps fluid in the intravascular space
What happens to the fluid when there is a reduced colloid oncotic space?
Third spacing (edema)
Causes of increased hydrostatic pressure
elevated BP, fluid overload, decreased cardiac output
causes of decreased colloid oncotic pressure
malnutrition, liver failure, nephrosis
causes of blockage or removal of lymph nodes
mastectomy, lymphoma
causes of increased capillary permeability
allergies, septic shock [endotoxin], pulmonary edema
How can someone have a fluid volume deficit if they have too much fluid somewhere?
fluid compartments need a certain amount of fluid to operate smoothly
s/s of fluid volume excess
(can be caused by hypertonic solutions)
weight gain of more than 0.5 kg/day, hypertension, bounding pulse, jugular vein distention, dyspnea, crackles, orthopnea
Fluid volume excess treatment - medication class
furosemide, spironolactone, bumetanide, hydrochlorothiazide
functions of electrolytes **
- maintaining balance of water in the body
- balancing blood pH
- moving nutrients into the cells
- moving wastes out of the cells
- maintaining proper function of the body’s muscles, heart, brain
Potassium normal range
3.5-5 mEq/L
sodium normal range
135-145 mEq/Le
calcium normal range
Serum: 8.9-10.5 mg/dL
Ionized: 4.5-5.6 mg/dL
magnesium normal range
- 8-2.3 mg/dL
1. 3-2.1 mEq/L
hypokalemia s/s
cardiac arrhythmias, constipation, fatigue
respiratory paralysis, paralytic ileus, tetany, hypotension, rhabdo, life threatening arrhythmias
diuretics, metabolic alkalosis, chronic kidney disease, folic acid deficiency, gastrointestinal losses
can all cause…
hypokalemia
How should you give potassium
ONLY given IV through a slowwwww infusion (burning feeling in vein)
hypokalemia on diuretics: what change to make
switch to spironolactone
acute renal failure, dehydration, diabetes, burns, acidosis, blood transfusion
are all causes of…
hyperkalemia
s/s of hyperkalemia
- nausea, vomiting, muscle aches, weakness, dysrhythmias,
- paralysis, heart failure, death
Severe vomiting/diarrhea, drinking excess water, excess alcohol intake, thiazide diuretics, liver/heart disease
are all causes of…
hyponatremia
when are hypertonic IV fluids used for hyponatremia
cerebral edema
t/f: it’s important to improve sodium levels rapidly to avoid permanent damage
false: shift slowly to avoid rapid changes in neurological cells
dehydration (incl from mild/moderate vomiting) and consumption of high sodium items can cause
hypernatremia
What can cause cerebral edema with treatment of hypernatremia
if sodium is lowered too quickly
inadequate vitamin D, decreased estrogen production, hypoparathyroidism, renal disease, low albumin levels, stimulant laxatives, chronic steroid use, proton pump inhibitors
can all cause…
hypocalcemia
Positive Chvostek and Trousseau signs indicate
hypocalcemia
s/s of hypocalcemia
chest pain, dysrhythmias, renal calculi, numbness and tingling, muscle cramping, confusion, osteopenia, dental problems
is ionized or serum calcium more accurate
ionized (but serum is faster)
cancer, hyperarathyroidism, vitamin D toxicity, TUMS can all cause…
hypercalcemia
s/s of hypercalcemia
- constipation, abd pain, nausea, vomiting
- confusion, coma, death
- renal failure, arrhythmias
Crohn’s or celiac, diarrhea, pancreatitis, t2dm, hypokalemia/hypocalcemia, decreased intake, increased renal excretion can all cause…
hypomagnesemia
hypomagnesemia s/s
- Decreased appetite, fatigue, nausea, weakness
- Muscle cramps, numbness and tingling, seizures, tetany, and personality changes
treatment for hypomagnesemia
- oral or IV magnesium
- treat hypokalemia and hypocalcemia first
- educate clients on foods high in magnesium
kidney disease, acidosis, hypothyroidism, trauma, medications that increase dwell time of food in the intestines, laxatives or antacids that contain magnesium all cause…
hypermagnesemia
s/s of hypermagnesemia
- dizziness, nausea, weakness, confusion
- blurred vision, headache, bladder paralysis, bradycardia, reduced respiratory rate, loss of deep tendon reflexes, death
hypermagnesemia treatment
- calcium to help with heart problems
- intravenous saline with diuretics
- dialysis in severe cases
sources of potassium
fruits, vegetables, orange juice, tomato juice
sources of calcium
dairy, dark green vegetables, sardines, salmon, oysters, tofu
sources of magnesium
nuts, egg yolk, milk, whole grain cereals, bananas, citrus fruit, dark green vegetables, legumes, seafood, chocolate
sources of phosphorus
dairy products, meats, fish, bran and wheat cereals, nuts
The nurse is caring for a client that has a Potassium level of 3.0 mEq/L. Which medication would the nurse expect to administer?
Potassium chloride (normal range: 3.5-5 mEq/L)
The nurse is caring for a client with edema. Which lab value would the nurse prioritize on the lab results in relation to edema?
albumin
The nurse is preparing to administer 0.45% sodium chloride to a client. Which description best matches what will happen to fluid with administration of 0.45% sodium chloride?
fluid will move from the intravascular space to the interstitial space
