Fluids, Electrolytes, And Parenteral Therapy Flashcards
Electrolyte
Electrically charged substance essential to the normal functioning of cells
Equal-analgesic conversion
A chart to compare doses of opioids against one another to maintain the same level of pain control
Fluid overload
Condición on which the body’s fluid requirements are met and the administration of fluid occurs at a rate that is greater than the rate at which the body can use or eliminate fluid, aka circulatory overload
Infiltrations
Collection of fluid onto tissue
Lock (saline or heparin)
An IV access line that isn’t attached to a running bag of fluid, the equipment consisting of an adapter and tubing introduced to the venous circulatory system
Normal saline
Solution of 0.9% sodium chloride and water, which is the proportion of salt and water normally circulation in body fluid
Total parenteral nutrition
Complex admixture of nutrients combined in a single container and administered to the body by an IV route
IV replacement solutions are used for the following
As a parenteral source if electrolytes, calories, or water for hydration, to facilitate nutrition and maintain electrolyte balance when the patient can’t eat, as a method to deliver drugs when a less invasive method isn’t suitable because of drug pharmacokinetics or patient status
Which arm is chosen for IV access
Nondominant arm and most distal point on arm (larger, more proximal veins need to be selected)
What to ask patient before IV therapy
About previous IV therapy, if a procedure has been done and if they have been told not to have an IV or venipuncture done on the affected side
When to use larger gauge needles for IV
When lots of fluid or blood products are anticipated
When to use indwelling devices
When a longer duration is anticipated compared to a few doses
What is tubing selection dictated by
Whether the IV will run continuously or occasional access over the period of day
What to do before inserting needle
Place a tourniquet above selected vein, and tighten so that venous blood flow is blocked, but arterial blood flow isn’t, and pull skin taut and insert needle at a low angle to the skin (blood should immediately flow into syringe)
3 methods of given fluids do and electrolytes IV
Direct IV push, intermittent infusion, continuous infusion
When to use a lock
Direct IV or intermittent transfusion
What is lock
The cannula that stays in the vein, an adapter and small tubing that is used
Advantages of a lock
Allows for a dose to be gained directly into a vein without having to maintain an existing transfusion and gives patient the ability to move
How to maintain the patency of a lock
A solution of saline or dilute heparin may be ordered for injection into the heparin lock before and after the administration (lock flush)
What does the flush solution do in a lock flush
Prevents small clots from obstructing the cannula of the IV administration
Lactated Ringer’s solution is used for (LR)
Burns, trauma, OB procedures where significant blood loss occurs
Normal saline solution is used for
Compatible with blood products, patients with kidney disease or HF
Half normal saline is used for
Hyponatremia or excessive edema
Plasma-Lyte A is used for
In place of LR, is compatible with blood products
Dextrose in water use
Dehydration to reduce potassium or sodium blood levels
Difference between an infusion pump and an infusion controller
Infusion pump adds pressure to the infusion and an infusion controller doesn’t
With parenteral administration, monitor for
Signs of infiltration
Signs of infiltration include
Edema or redness at the site
How is IV flow rate obtained
Counting the number of drops in the drip chamber
What is drop factor
Number of drops per mL
1st method of finding number of drops per minute
Total amount of solution divided by number of hours= mL per hour, then divide mL per hour by 60, and then multiply that by drop factor to get # or drops per minute
Method 2 to determine number of drops per minute
Take total amount of solution and divide by number of hours to get mL per hour, and then multiply that by drop factor, to get number of drops per minute
Method 3 to get drops per minute
Take drop factor divided by 60, and multiply by total hourly volume to get drops per min
Amount of fluid that causes fluid overload depends on
Patients cardiac status, and adequacy of renal function
Signs of fluid overload
Headache, weakness, blurred vision, behavioral changes (confusion, disorientation, delirium, drowsiness), weight gain, isolated muscle twitching, hyponatremia, rapid breathing, wheezing, coughing, rise in BP, distended neck veins, elevated central venous pressure, convulsions,
Steps to convert opiate meds
Determine the total dose of pain meds given during last 24 hours, using the chart, find the drug and convert it to an equivalent dose, then reduce 50% for elders/kidney impairment, 25-50% if good pain control, and don’t reduce if uncontrolled pain, then determine appropriate time intervals and divide up amount over 1 day
Major electrolytes In intercellular fluid
Potassium and magnesium
Major electrolytes in extracellular fluid
Sodium and calcium
Electrolyte imbalance can occur from
Vomiting, surgery, diagnostic tests, or drug administration
Potassium is necessary for
Transmission of impulses, contraction of smooth, cardiac, and skeletal muscles,
Causes of hypokalemia
Marked loss of GI fluids (vomiting, diarrhea, nasogastric suction, draining intestinal fistulas), diabetic acidosis, marked diuresis, severe malnutrition, use of a potassium depleting diuretics, excess antidiuretic hormone, and excessive urination
Magnesium plays an important role in
the transmission of nerve impulses, and in the activity of many enzyme reactions, such as carb metabolism, and is used in the prevention and control of seizures of obstetric patients with pregnancy induced hypertension
Potassium side effects
Nausea, vomiting, diarrhea, and abdominal pain and phlebitis, with IV administration
Potassium contraindications
People at risk for hyperkalemia (those with renal failure, oliguria, azotemia, anuria, severe hemolytic reactions, untreated Addison disease, acute dehydration, heat cramp, and those with hyperkalemia
Potassium precautions
Renal impairment, adrenal insufficiency, heart disease, metabolic acidosis, or prolonged and severe diarrhea
Potassium interactions
Prolonged sus with ACE inhibitors can result in an elevated serum potassium level and potassium sparing diuretics and salt substitutes can produce severe hyperkalemia, and increased risk of digoxin toxicity
Magnesium side effects
Most likely related to overdose and include flushing, sweating, hypotension, depressed reflexes, muscle weakness,respiratory failure, and circulatory collapse
Magnesium contraindications
Heart block, myocardial damage and in women with PIH during the 2 hours before delivery
Magnesium pregnancy cat
A
Magnesium precautions
Renal function impairment,
Magnesium interactions
When used with alcohol, antidepressants, antipsychotics, barbiturates, hypnotics, general anesthetics, and opioids, an increase in CNS depression can occur. Prolonged respiratory depression when administered with neuromuscular blocking drugs can occur. When used with digoxin, heart block can occur
Sodium is important for
Maintaining acid base balance, and normal heart action and the regulation of osmotic pressure in body cells,
Causes of hyponatremia
Excessive diaphoresis, severe vomiting or diarrhea, excessive diuresis, diuretic use, wound drainage, and draining intestinal fistulas
Calcium is important for
The functioning of nerves and muscles, the clotting of blood, the building of bones and teeth
Hypocalcemia can be seen in people with
Parathyroid disease or after accidental removal of the parathyroid glands during surgery of the thyroid gland
Calcium can be given during
Hypocalcemia, cardiopulmonary resuscitation, esp after open heart surgery and when epinephrine fails to improve weak or ineffective myocardial contractions. Can also be used as adjunct therapy of insect bites or sings to reduce muscle cramping (black widow or spider bites)
Hypocalcemia signs
Hyperactive reflexes, carpopedal spasm, perioral paresthesias, positive trousseau sign, positive Chvostek sign, muscle twitching, muscle cramps, tetany, laryngospasm, cardiac arrhythmia, nausea, vomiting, anxiety, confusion, emotional lability, convulsions
Hypercalcemia signs
Anorexia, nausea, vomiting, lethargy, bone tenderness or pain, polyuria, polydipsia, dehydration, muscle weakness and atrophy, stupor, coma, ardían arrest
Hypoamgnesemia signs
Leg and foot cramps, hypertension, tachycardia, neuromuscular irritability, tremor, hyperactive deep tendon reflexes, confusion, disorientation, visual or auditory hallucinations, painful paresthesias, positive trousseau sign, positive Chvostek sign, convulsions
Hypermagnesemia signs
Lethargy, drowsiness, impaired respiration, flushing, sweating, hypotension, weak to absent deep tendon reflexes
Hypokalemia signs
Anorexia, nausea, vomiting, depression, confusion, delayed or impaired thought process, drowsiness, abdominal distention, decreased bowel sounds, paralytic ileus, muscle weakness or fatigue, flaccid paralysis, absent or diminished deep tendon reflexes, weak and irregular pulse, paresthesias, leg cramps, electrocardiograph changes
Hyperkalemia signs
Irritability, anxiety, listlessness, mental confusion, nausea, diarrhea, abdominal distress, GI hyperactivity, paresthesias, weakness and heaviness of the legs, flaccid paralysis, hypotension, cardiac arrhythmia, electrocardiograph changes
Hyponatremia signs
Cold and clammy skin, decreased skin turgor, apprehension, confusion, irritability, anxiety, hypotension, postural hypotension, tachycardia, headache, tremors, convulsions, abdominal cramps, nausea, vomiting and diarrhea
Hypernatremia signs
Fever, hot and dry skin, dry and sticky mucous membranes, rough and dry tongue, edema, weight gain, intense thirst, excitement, restlessness, agitation, oliguria or anuria
Oral electrolyte solutions include
A carbohydrate and varios electrolytes
Oral electrolyte solutions use
Replace lost electrolytes and fluids in conditions such as severe vomiting or diarrhea
Sodium side effects
Excessive oral use can cause nausea and vomiting
Sodium contraindications
Hypernatremia and fluid retention, and when the administration of sodium or chloride can be detrimental
Sodium precautions
Surgical patients, circulatory insufficiency, hypoproteinemia, urinary tract obstruction, HF, edema, or renal impairment
Sodium precautions
Pregnancy (cat C) and lactation
Calcium side effects
Irritation of the vein, metallic or chalky taste, and heat waves. Rapid IV administration can cause bradycardia, vasodilation, decreased blood pressure arrhythmia and cardiac arrest. Oral administration can cause GI disturbances
Calcium chloride Side effects
Peripheral vasodilation, temporary fall in blood pressure, and a local burning
Blood plasma is
The liquid part of blood containing water, sugar, electrolytes, fats, gases, proteins, bile pigment and clotting factors. Plasma doesn’t require to be matched
IV plasma use
Increase blood volume when severe hemorrhage occurs and it’s necessary to partially restore blood volume while waiting for whole blood to be cross matched or when plasma soon has been lost as may be seen in severe burns
Albumin fraction of human blood does What
Acts to maintain plasma colloid osmotic pressure and as a carrier of intermediate metabolites in the transport and exchange of tissue products. Critical in regulating to volume of circulating blood
Plasma protein factors use
Treat hypovolemic shock that occurs as a result of burns, trauma, surgery and infections or in conditions when shock isn’t present, but likely to occur
Plasma protein fractions Side effects
Rare, but nausea, chills, fever, urticaria, and hypotensive episodes can occur
Plasma proteins contraindications
History of allergic reactions to albumin, severe anemia, cardiac failure, in the presence of normal or increased intravascular volume and in patients with cardiopulmonary bypass
Plasma protein fractions precautions
In shock, dehydrated, and in those with HF or hepatic or renal failure, pregnancy (cat C) and lactation
Plasma protein factors interactions
Try not to combine with any other solutions
Plasma expanders use
Expand plasma volume when shock is caused by burns, hemorrhage, surgery, and other trauma or for prophylaxis of venous thrombosis and thromboembolism
Plasma expanders for shock considerations
Plasma expanders aren’t a substitute for whole blood or plasma, but are emergency measures until the other substances can be used
Hetastarch side effects
Vomiting, a mild temperature elevation, itching and allergic reactions
Hetastarch allergic reactions signs
Wheezing, swelling around the eyes, and urticaria
Plasma expanders side effects
Mild cutaneous eruptions, generalized urticaria, hypotension, nausea, vomiting, headache, dyspnea, fever, tightness of the chest, bronchospasm, wheezing and rarely, anaphylactic shock
TPN mixture may include
Proteins (amino acids), fats, glucose, electrolytes, vitamins, minerals, and sterile water
Products used to meet the IV nutritional requirements of the patient
Protein substrates (amino acids) energy substrates (dextrose and fat emulsions), fluids, electrolytes, and trace minerals
TPN use
Prevent nitrogen and weight loss or to treat negative nitrogen balance when oral, gastronomy, or jejunostomy route can’t be used, GI absorption of protein is impaired by obstruction, inflammatory disease or antineoplastic therapy prevents normal GI functioning, bowel rest is needed, metabolic requirements for protein are significantly needed, morbidity and mortality may be reduced by replacing amino acids lost from tissue breakdown and when tube feeding alone can’t provide adequate nutrition
When does a state of negative nitrogen balance occur
When a patient’s intake of protein nutrients is significantly less than is required by the body to meet energy expenditures
Negative nitrogen balance can cause
Weight loss and muscle wasting
Peripheral TPN administration and use
Relatively short periods (5-7 days) and used When central venous route isn’t possible
When is TPN through a central vein indicated
To promote protein synthesis in patients who are severely hyperacatabolic or depleted of nutrients or who require long term parenteral nutrition
How is TPN delivered
Infusion pump
If an infusion of TPN is given too rapidly, what can occur
Hyperglycemia, glycosuria, mental confusion and loss of consciousness
Complications of TPN include
Bacterial infection, sepsis, embolism, metabolic problems and hemothorax or pneumothorax
IV fat emulsión use
Prevention and treatment of essential fatty acid deficiency and provides non protein calories in those receiving TPN when calorie requirements cant be met by glucose, usually in extended periods (more than 5 days)
IV Fat emulsion considerations
No more than 60% of caloric intake should come from fat emulsion, with carbs and amino acids making up the remaining 40%
Fat emulsion side effects
Sepsis caused by administration of equipment and thrombophlebitis caused by venous irritation from concurrently andonistering hypertonic solutions. Dyspnea, cyanosis, hyperlipidemia, hypercoagulability, nausea, vomiting, headache, flushing, increased body temperature, sweating, sleepiness, chest and back pain, slight pressure over eyes and dizziness can occur
IV fat emulsions contraindications
Conditions that interfere it’s normal fat metabolism (acute pancreatitis) and in those allergic to eggs
IV fat emulsions precautions
Severe liver impairment, pulmonary disease, anemia, blood coagulation disorders, pregnancy (cat C) and lactation
Fat emulsion interactions
Generally, shouldn’t be combined with any other solutions or drugs except when combined in TPN
Alkalinizing and acidifying Drugs use
Correct an acid base imbalance in blood
Metabolic acidosis
Decrease in the blood pH caused by an excess of hydrogen ions in the extracullular fluid (treated with alkalinizing drugs)
Metabolic alkalosis
Increase in the blood pH caused by excess of bicarbonate in the extracellular fluid (treated with acidifying drugs)
sodium Bicarbonate MOA
Separates in the blood an the bicarbonate Functions as a buffer to decrease the hydrogen ion concentration and reside the blood pH
Alkalinizing Drugs use
Treat metabolic acidosis ant to increase blood pH
Metabolic acidosis can be seen in which diseases
Severe shock, diabetic acidosis, severe diarrhea, extracorporeal circulation of blood, severe renal disease, and cardiac arrest
Oral sodium bicarbonate use
Gastric and urinary alkalizer, and can be useful in treating severe diarrhea accompanied by bicarbonate loss
Oral bicarbonate side effects
Excessive use can cause nausea, vomiting, systemic alkalosis
Bicarbonate contraindications
In patients losing chloride by continuous GI suction or through vomiting, in patients with metabolic or respiratory alkalosis, hypocalcemia, renal failure, or severe abdominal pain of unknown cause, and in those with sodium restricted diets
Bicarbonate precautions
HF, renal impairment and those receiving glucocorticoid therapy, pregnancy (cat C)
Bicarbonate interactions
Decreased absorption of ketoconazole, increased blood levels of quinidine, flecainide, of sympathomimetics, increased risk of crystslluria with flouroquinolones, decreased effects of lithium, methotrexate, chlorpropamide, salicylate,and tetracyclines. Not administered within 2 hours of enteric coated drugs
Ammonium chloride use
Lowers blood pH by being metabolized first into urea 5en to hydrochloride acid, which is further metabolized into hydrogen ions to acidity the blood
Ammonium chloride side effects
Metabolic acidosis and loss of electrolytes (esp potassium)
Ammonium chloride interactions
Spironolactone can increase systemic acidosis
Magnesium elderly considerations
Elderly may need reduced dosage of Magnesium due to reduced renal function
What should be tested before each dose of magnesium
Knee jerk reflex p, and if reflex is absent or slowed, dose is withheld
What to observe the patient for in the first 30 mins of infusion of a fat solution
Diffiucalty breathing, flushing, nausea, vomiting, or signs of allergy
Fluid overload elderly considerations
Elderly at greater is because of the increased incidence of cardiac disípese and decreased renal function
Alkalinizing Drugs es
Bicarbonate and tromethamine
Acidifying Drugs ex
Ammonium chloride
