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fluids and blood products Flashcards

1
Q

what percent of adults is water? infants?

A

60% adults
80% infants
total body water (TBW)

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2
Q

what are the compartments of TBW and their percentages

A
  1. intracellular fluid (67%)
  2. extracellular fluid (33%)
    2a. interstitial fluid (25% of ECF)
    2b. plasma (8% of ECF)
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3
Q

do iv fluids directly change ECF or ICF

A

IV fluids directly change ECF which indirectly affect ICF

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4
Q

compartments of ECF

A

interstitial fluid (electrolytes)
blood (plasma and cells)
- plasma (electrolytes)
- plasma proteins
- RBCs
- platelets
- WBCs

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5
Q

how is distribution of fluid in ECF (between plasma and IF) determined

A

bulk flow (starling forces)

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6
Q

what are the 2 main pressures in bulk flow

A

hydrostatic pressure (blood pressure): out
colloid osmotic pressure (from plasma proteins): in

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7
Q

causes of water imbalance on the body

A

retention (edema, hypertension - diuretics)
dehydration (fixed with IV fluids)

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8
Q

reasons for IV fluid administration

A
  • dehydration
  • electrolyte imbalances
  • blood compartment deficiencies
  • nutrition
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9
Q

3 types of IV fluids

A
  • crystalloids
  • colloids
  • blood and blood products
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10
Q

crystalloids

A

water + small fully dissolved molecules
- electrolytes (Na, K, Cl)
- molecules (glucose, lactate)

no proteins or large molecules

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11
Q

what does saline consist of

A

sodium chloride

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12
Q

what is normal saline

A

the same concentration of sodium chloride as in the body (~154 mmol/L)
- 0.9% sodium chloride
- 0.9gNaCl/100mL

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13
Q

what is normosol

A

NaCl, K, more things in it, more closely mimics. ECF composition (expensive)

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14
Q

half normal saline

A

0.45% sodium chloride (hypotonic)

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15
Q

what is normal cell osmolarity

A

300mOsm/L

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16
Q

isotonic solution

A

IF = 300mOsm/L (fluid not moving)

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17
Q

hypotonic solution

A

IF = 290 mOsm/L (water follows concentration gradient and enters cell, cell swells)

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18
Q

hypertonic solution

A

IF = 330 mOsm/L (water leaves cell, cell shrinks)

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19
Q

crystalloids examples

A
  • normal saline (0.9%NaCl)
  • half NS (0.45% NaCl)
  • hypertonic saline (3% NaCl)
  • lactated ringer’s
  • normosol/plasmalyte
  • D5W, dextrose 5% in water (300 mOsm/L, give water with glucose, body uses the glucose and leaves the water so it acts like a hypotonic solution)
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20
Q

uses of crystalloids

A

treating dehydration
- from volume loss (diarrhea, vomiting
maintain fluids
- compensate for fluid loss (NS)
- replace fluids (NS)
- manage specific fluid and electrolyte disturbances (ringer’s lactate)
- promote urinary flow (NS)
- expand plasma volume (3% NaCl)

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21
Q

isotonic loss

A

lose water and particles (less volume but same concentration)
- normal saline given (isotonic fluid)
- ex) blood loss, vomit, diarrhea

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22
Q

hypotonic loss

A

lose more water than particles (less volume and more concentrated ECF)
- hypotonic solution given to balance hypertonic ECF (half normal saline)
- hypertonic contraction
- ex) sweating

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23
Q

crystalloids indications

A
  • acute liver failure
  • acute nephrosis
  • burns
  • hypovolemic shock
  • renal dialysis
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24
Q

crystalloids adverse effects

A
  • edema (peripheral or pulmonary - fluid overload too quickly, fluid in interstitial spaces out of blood)
  • may dilute plasma proteins (long term use)
  • effects may be short lived
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25
Q

what do colloids do

A

enhance colloid osmotic pressure
- move fluid from interstitial compartment to plasma compartment
- plasma volume expanders (restore BP)
- initiate diuresis (ex. remove ascites in pt with portal hypertension)

colloids stay in blood (too big to leave capillaries)
hypertonic crystalloids can also be plasma volume expanders

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26
Q

colloids examples

A
  • dextran 40 or 70 (big glucose polymers)
  • hetastarch/hydroxyethyl starch
  • modified gelatin
  • albumin (from human donors)
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27
Q

colloid indications

A
  • trauma
  • burns
  • sepsis
  • hypovolemic shock
28
Q

colloid adverse effects

A

usually safe
- concerns in renal failure
- may cause altered coagulation
- lowered oxygen-carrying capacity

29
Q

blood and blood product examples

A
  • whole blood
  • RBC products (carry O2)
  • platelets
  • increase of other blood products (ex. clotting factors from plasma)
  • plasma

blood products can be given in NS
require human donors

30
Q

indications of packed RBC and whole blood

A

to increase oxygen carrying capacity
- anemia
- substantial hemoglobin deficits
- blood loss >25%

31
Q

indications of fresh frozen plasma (FPP)

A

increase clotting factor levels in clients with demonstrated deficiency
- coagulation disorder
- ex. disseminated intravascular coagulation (DIC)

32
Q

what is cryoprecipitate and plasma protein factors

A

not straight plasma but a part of it (more specific to pt needs)
- ex. fibrinogen, factor VIII, prothrombin complex concentrates
- indication ex. hemophilia

33
Q

blood product adverse effects

A
  • transfusion reaction (blood type and crossmatch)
  • transmission of pathogens to recipient (hep b&c, HIV)
34
Q

client care

A
  • administer colloids slowly
  • monitor for fluid overload and possible heart failure
  • monitor for signs of transfusion reactions
35
Q

crystalloids advantages

A

few side effects, low cost, wide availability

36
Q

crystalloids disadvantages

A

short duration of action, may cause edema

37
Q

colloids advantages

A

longer duration of action, less fluid required to correct hypovolemia

38
Q

colloids disadvantages

A

higher cost, may cause volume overload, may interfere with clotting, risk of anaphylactic shock

39
Q

principal ECF electrolytes

A

sodium (Na) and chloride (Cl)

40
Q

principal ICF electrolyte

A

potassium (K)

41
Q

other electrolytes common in body

A

calcium, magnesium, phosphorus

42
Q

what is potassium responsible for

A
  • skeletal muscle contraction
  • transmission of nerve impulses
  • regulation of heartbeat
  • maintenance of acid-base balance
43
Q

normal ECF level

A

3.5-5 mmol/L

44
Q

foods high in potassium

A

fruit, fish, vegetables, poultry, meats, dairy products

45
Q

excess dietary potassium is excreted with?

A

the kidneys

46
Q

what is hypokalemia

A

potassium deficiency
- <3.5 mmol/L
- not usually dietary but from
- excessive potassium loss

47
Q

hypokalemia causes

A
  • loop & thiazide diuretics
  • vomiting
  • diarrhea
48
Q

hypokalemia adverse effects

A
  • muscle weakness/ lethargy
  • cardiac dysrhythmias (irregular pulse)
  • paralytic ileus (decrease in bowel motility)
49
Q

hypokalemia treatment/prevention

A
  • diet
  • oral preparations/supplements (harsh on GI tract: diarrhea, nausea, vomiting, GI bleeding, ulceration - sustained tablet release better)
  • IV administration (pain at injection site, phlebitis, must be at a slow rate)
50
Q

hyperkalemia

A

excessive serum K levels
>5 mmol/L

51
Q

hyperkalemia causes

A
  • potassium sparing diuretics
  • ACE inhibitors (RAAS)
52
Q

hyperkalemia adverse effects

A
  • cardiac dysrhythmias (possible v fib and cardiac arrest)
  • muscle weakness/paralysis
  • paresthesia (tingling)
53
Q

hyperkalemia treatment

A
  • Iv sodium bicarbonate, calcium salts, dextrose with insulin (insul encourages cells to take up potassium)
  • hemodialysis
54
Q

client care for K administration

A

monitor parenteral infusions closely
- rate shouldn’t exceed 10 mmol/L
- never give as IV bolus or undiluted

oral forms of K should be diluted in H2O or juice to minimize GI irritation

55
Q

normal blood concentrations of Na

A

135-145 mmol/L

56
Q

food high in Na

A

salt, fish, meats, foods flavoured or preserved with salt

57
Q

what is Na responsible for

A
  • control of water distribution
  • fluid and electrolyte balance
  • osmotic pressure of body fluids
  • participant is acid-base balance
58
Q

hyponatremia

A

sodium loss or deficiency
<135 mmol/L

59
Q

hyponatremia symptoms

A

lethargy, stomach cramps, hypotension, vomiting, diarrhea, seizures

60
Q

hyponatremia causes

A
  • loop & thiazide diuretics
  • prolonged diarrhea or vomiting
  • renal disorders
61
Q

hypernatremia

A

sodium excess
>145 mmol/L

62
Q

hypernatremia symptoms

A
  • edema
  • hypertension
  • red, flushed skin
  • dry, sticky mucous membranes
  • increased thirst
  • increased temperature
  • decreased urine output
63
Q

hypernatremia causes

A
  • kidney malfunction
  • inadequate water consumption or dehydration
64
Q

hypernatremia treatment/preventions

A
  • diet
  • mild: oral sodium chloride and/or fluid restriction
  • severe: IV NS or lactated ringers
65
Q

therapeutic response to electrolyte imbalance treatment

A
  • normal lab values (RBC, WBC, Hgb, Hct, electrolytes)
  • improved fluid volume status
  • increased tolerance to activities

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