fluids and blood products Flashcards
what percent of adults is water? infants?
60% adults
80% infants
total body water (TBW)
what are the compartments of TBW and their percentages
- intracellular fluid (67%)
- extracellular fluid (33%)
2a. interstitial fluid (25% of ECF)
2b. plasma (8% of ECF)
do iv fluids directly change ECF or ICF
IV fluids directly change ECF which indirectly affect ICF
compartments of ECF
interstitial fluid (electrolytes)
blood (plasma and cells)
- plasma (electrolytes)
- plasma proteins
- RBCs
- platelets
- WBCs
how is distribution of fluid in ECF (between plasma and IF) determined
bulk flow (starling forces)
what are the 2 main pressures in bulk flow
hydrostatic pressure (blood pressure): out
colloid osmotic pressure (from plasma proteins): in
causes of water imbalance on the body
retention (edema, hypertension - diuretics)
dehydration (fixed with IV fluids)
reasons for IV fluid administration
- dehydration
- electrolyte imbalances
- blood compartment deficiencies
- nutrition
3 types of IV fluids
- crystalloids
- colloids
- blood and blood products
crystalloids
water + small fully dissolved molecules
- electrolytes (Na, K, Cl)
- molecules (glucose, lactate)
no proteins or large molecules
what does saline consist of
sodium chloride
what is normal saline
the same concentration of sodium chloride as in the body (~154 mmol/L)
- 0.9% sodium chloride
- 0.9gNaCl/100mL
what is normosol
NaCl, K, more things in it, more closely mimics. ECF composition (expensive)
half normal saline
0.45% sodium chloride (hypotonic)
what is normal cell osmolarity
300mOsm/L
isotonic solution
IF = 300mOsm/L (fluid not moving)
hypotonic solution
IF = 290 mOsm/L (water follows concentration gradient and enters cell, cell swells)
hypertonic solution
IF = 330 mOsm/L (water leaves cell, cell shrinks)
crystalloids examples
- 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)
uses of crystalloids
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)
isotonic loss
lose water and particles (less volume but same concentration)
- normal saline given (isotonic fluid)
- ex) blood loss, vomit, diarrhea
hypotonic loss
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
crystalloids indications
- acute liver failure
- acute nephrosis
- burns
- hypovolemic shock
- renal dialysis
crystalloids adverse effects
- 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
what do colloids do
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
colloids examples
- dextran 40 or 70 (big glucose polymers)
- hetastarch/hydroxyethyl starch
- modified gelatin
- albumin (from human donors)
colloid indications
- trauma
- burns
- sepsis
- hypovolemic shock
colloid adverse effects
usually safe
- concerns in renal failure
- may cause altered coagulation
- lowered oxygen-carrying capacity
blood and blood product examples
- 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
indications of packed RBC and whole blood
to increase oxygen carrying capacity
- anemia
- substantial hemoglobin deficits
- blood loss >25%
indications of fresh frozen plasma (FPP)
increase clotting factor levels in clients with demonstrated deficiency
- coagulation disorder
- ex. disseminated intravascular coagulation (DIC)
what is cryoprecipitate and plasma protein factors
not straight plasma but a part of it (more specific to pt needs)
- ex. fibrinogen, factor VIII, prothrombin complex concentrates
- indication ex. hemophilia
blood product adverse effects
- transfusion reaction (blood type and crossmatch)
- transmission of pathogens to recipient (hep b&c, HIV)
client care
- administer colloids slowly
- monitor for fluid overload and possible heart failure
- monitor for signs of transfusion reactions
crystalloids advantages
few side effects, low cost, wide availability
crystalloids disadvantages
short duration of action, may cause edema
colloids advantages
longer duration of action, less fluid required to correct hypovolemia
colloids disadvantages
higher cost, may cause volume overload, may interfere with clotting, risk of anaphylactic shock
principal ECF electrolytes
sodium (Na) and chloride (Cl)
principal ICF electrolyte
potassium (K)
other electrolytes common in body
calcium, magnesium, phosphorus
what is potassium responsible for
- skeletal muscle contraction
- transmission of nerve impulses
- regulation of heartbeat
- maintenance of acid-base balance
normal ECF level
3.5-5 mmol/L
foods high in potassium
fruit, fish, vegetables, poultry, meats, dairy products
excess dietary potassium is excreted with?
the kidneys
what is hypokalemia
potassium deficiency
- <3.5 mmol/L
- not usually dietary but from
- excessive potassium loss
hypokalemia causes
- loop & thiazide diuretics
- vomiting
- diarrhea
hypokalemia adverse effects
- muscle weakness/ lethargy
- cardiac dysrhythmias (irregular pulse)
- paralytic ileus (decrease in bowel motility)
hypokalemia treatment/prevention
- 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)
hyperkalemia
excessive serum K levels
>5 mmol/L
hyperkalemia causes
- potassium sparing diuretics
- ACE inhibitors (RAAS)
hyperkalemia adverse effects
- cardiac dysrhythmias (possible v fib and cardiac arrest)
- muscle weakness/paralysis
- paresthesia (tingling)
hyperkalemia treatment
- Iv sodium bicarbonate, calcium salts, dextrose with insulin (insul encourages cells to take up potassium)
- hemodialysis
client care for K administration
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
normal blood concentrations of Na
135-145 mmol/L
food high in Na
salt, fish, meats, foods flavoured or preserved with salt
what is Na responsible for
- control of water distribution
- fluid and electrolyte balance
- osmotic pressure of body fluids
- participant is acid-base balance
hyponatremia
sodium loss or deficiency
<135 mmol/L
hyponatremia symptoms
lethargy, stomach cramps, hypotension, vomiting, diarrhea, seizures
hyponatremia causes
- loop & thiazide diuretics
- prolonged diarrhea or vomiting
- renal disorders
hypernatremia
sodium excess
>145 mmol/L
hypernatremia symptoms
- edema
- hypertension
- red, flushed skin
- dry, sticky mucous membranes
- increased thirst
- increased temperature
- decreased urine output
hypernatremia causes
- kidney malfunction
- inadequate water consumption or dehydration
hypernatremia treatment/preventions
- diet
- mild: oral sodium chloride and/or fluid restriction
- severe: IV NS or lactated ringers
therapeutic response to electrolyte imbalance treatment
- normal lab values (RBC, WBC, Hgb, Hct, electrolytes)
- improved fluid volume status
- increased tolerance to activities
