IV Fluid, Blood and blood products Flashcards
How must we monitor Parenteral infusions of potassium? What is the normal concentration of plasma sodium outside of the cell?
must be monitored closely
Rate should not exceed 10 mmol/hour
NEVER give as an IV bolus or undiluted
Oral forms of potassium
must be diluted in water or fruit juice to minimize GI distress or irritation
monitor for complaints of nausea, vomiting, GI pain, or GI bleeding
135 to 145 mmol/L
During Treatment or prevention of sodium depletion when dietary measures are inadequate what must we monitor? How do we treat it ?
What theraptuic responses do we monitor?
Mild sodium loss:
Treated with oral sodium chloride and/or fluid restriction
Severe sodium loss :
IV normal saline or lactated Ringer’s solution
Monitor serum electrolyte levels during therapy
Normal lab values
RBCs, WBC, Hgb and Hct, electrolyte levels
Improved fluid volume status
Increased tolerance to activities
Monitor for adverse effects
Example of colloids?
Dextran 40 or 70 (BIG glucose polymers)
Hetastarch / hydroxyethyl starch (HES)
synthetic, derived from cornstarch
albumin (from human donors)
Colloid vs crystalloids?
big debate of which one is better = no evidence confirming the superiority of the other
Client Care for colloids, fluid overload, and transfusions?
-Administer colloids slowly
-Monitor for fluid overload and possible heart failure
-Monitor closely for signs of transfusion reactions
Adverse effects for blood products?
-Transfusion reaction
-Blood type and cross-match
-Transmission of pathogens to recipient (hepatitis B & C, HIV)
What do colloids do?
*plasma volume expanders”
restore BP
initiate diuresis eg removal ascites in patients with portal hypertension
-Have a much narrow usage then crystaloids
Blood Products: Indications of use? What are they packed with?
-Packed RBCs and whole blood
Used during:
-To increase oxygen-carrying capacity
-anemia
-substantial hemoglobin deficits
-blood loss >25% of total blood volume
What is Hypernatremia? What causes it? What are the symptoms?
sodium excess
serum levels >145 mmol/L
Symptoms
edema, hypertension
red, flushed skin; dry, sticky mucous membranes, increased thirst, elevated temperature, decreased urine output
Causes
kidney malfunction
inadequate water consumption and dehydration
What fluids to give?
What is Hyponatremia? SYmptoms? Causes?
sodium loss or deficiency
serum levels <135 mmol/L
Symptoms
lethargy, stomach cramps, hypotension, vomiting, diarrhea, seizures
Causes
Same causes as hypokalemia
prolonged diarrhea or vomiting, or renal disorders
Crystalloids: Adverse Effects?
Edema - peripheral or pulmonary
Fluid overload:
-Receiving fluids quicker than you are excreting it
Leads to fluid build up in lungs = difficulty breathing
May dilute plasma proteins:
Not ideal, especially with fibrinogen = blood clotting factor within plasma
Diluted = prolonged clotting = bleeds for longer
Colloids: Indications of use?
Trauma
Burns
Sepsis
Hypovolaemic shock
Plasma Volume Expansion
What is D5W? What is it used for?
glucose for energy production/ATP production
What do Principal ICF electrolyte contain?
Potassium (K+)
Others
Calcium, magnesium, phosphorus
what are Cryoprecipitate and plasma protein factors (PPF)? What do they allow for?
fibrinogen, Factor VIII, prothrombin complex concentrates
allows for separate factors to be administered based on what the patient requires – also used to help with hemophilia
Colloids: Adverse effects and disadvantages?
-More expensive
-Usually safe concerns in renal failure
Disadvantages:
-may cause altered coagulation – due to diluting of fibrinogen
-bleeding
-no oxygen-carrying capacity
What are Principal ECF electrolytes?
Sodium (NA+)
Chloride (Cl-)
Crystalloids: Indications of use?
*Huge blood loss that cause low blood pressure = very low tissue perfusion
Acute liver failure
Acute nephrosis
Burns
Hypovolemic shock
What is hyperklamia? How do we treat it? What can cause it?
-excessive serum potassium level >5 mmol/L
-Treatment
IV sodium bicarbonate, calcium salts, dextrose with insulin
Sodium polystyrene sulfonate (Kayexalate) or hemodialysis to remove excess potassium
Most commonly caused by K+ sparing diuretics
What do Crystalloids contain? What don’t they contain?
Contain water plus:
electrolytes (eg Na+, K+, Cl-)
small molecules (eg glucose, lactate)
Do NOT contain proteins/large molecules (colloids)
Causes of dehydration?
Vomiting, diarrhea
Isotonic volume loss = no concentration is lost, just the volume of fluid is lost
Blood loss, sweat
What is Fresh frozen plasma (FFP)? What is it used for?
-last longer than whole blood as it an be frozen
Used to:
-Increase clotting factor levels in clients with demonstrated deficiency = coagulation disorder
eg disseminated intravascular coagulation (DIC)
