Lilley Ch. 29 Flashcards
IV Fluids
-purposes: maintenance, when oral intake is not adequate. replacement, when losses have occured
Crystalloids
- better for treating dehydration-distributed faster into the compartments than colloids
- used to compensate for fluid loss, replace fluid loss, manage and replace electrolyte imbalances, promote urinary flow
- EX: NS, D5W, D10W, LR
Colloids
- stay in vascular space and increase osmotic pressure
- Includes: Human plasma products (albumin, fresh frozen plasma, blood, cryoprecipitate)
Semisynthetics (dextran and starches, [Hespan]) - used to treat conditions that require plasma volume expansion (shock, burns)
- less likely to cause edema and have a longer duration of action
Hypotonic Crystalloids
- more h2o than electrolytes (pure water lyses RBCS) (osmolality of 250 mOsm/kg)
- used when patients with hypernatremia (0.45% NaCl) as a maintenance fluid but not used as a replacement fluid (bolus) b/c could cause a shift in ECF and lower BP
- half normal saline (0.45% NaCl). quarter normal saline (0.225% NaCl), 2.5% dextrose in water
Hypotonic crystalloids (contraindications)
- never give to patients who are at risk for increased ICP/cerebral edema
- patients with liver disease, trauma or burns due to potential for depletion of intravascular fluid volume
- monitor for changes in mentation
Isotonic Crystalloids
- similar concentration of water and electrolytes to plasma (250-375 mOsm/L)
- expands only ECF
- no net loss or gain from ICF
- ideal to replace ECF volume deficit
- 0.9% NaCl, Lactated Ringer’s
5% Dextrose in Water (D5W)
- isotonic
- free water without electrolytes
- provides 170 cal/L
- used to replace water losses, treat hypernatremia, prevent ketosis
Normal Saline (NS or NSS)
- isotonic
- more NaCl than ECF
- expands intravascular volume (preferred fluid for immediate response) and replaces ECF fluid loss
- compatible with most meds.
- only solution used with blood
- contains no free water, calories, or other electrolytes
- can cause intravascular fluid overload and hyperchloremic acidosis
Lactated Ringer’s Solution
-isotonic
- similar in composition to plasma except contains no Mg. contains Na, Cl, Ca, and lactate
- expands ECF: treats burns, hypovolemia and GI lossess, used in surgerys
- Contraindicated with hyperkalemia, liver dysfunction and severe hypovolemia, because these patients have a decreased ability to convert lactate to bicarbonate
- no free water or calories
Hypertonic crystalloids
- initally expands and raises the osmolality of ECF
- causes fluid to move from the interstitial spaces and cells into the veins
- requires monitoring of: BP, lung sounds, serum sodium levels
- 3% NaCl, 10% dextrose in water (D10W)
D10W
- hypertonic glucose solution
- provides 340 kcal/L
- provides free water but no electrolytes
- highest concentration of dextrose that can be administered through a peripheral line.
Colloids
- stay in vascular space and increase osmotic pressure
- AKA: volume expanders or plasma expanders
- include: human plasma products (albumin, fresh frozen plasma, blood) semisynthetics (dextran and starches, [Hespan])
- used to treat conditions that require plasma volume expansion: shock, burns
- less likely to cause edema and have a longer duration of action
Dextrans
- synthetic complex sugar solution
- metabolizes slowly so it remains in the vascular system for a prolonged period but not as long as the colloids
- pulls additional fluid into the intravascular space
Hydroxylethyl starches
- Hespan
- synthetic colloids that work similarly to dextran to expand plasma volume
Packed RBCs
- Packed RBCs have the advantage of giving the patient primarily RBCs rather than RBCs and fluid volume. - Although packed RBCs have a decreased plasma volume, they will increase the oncotic pressure and pull fluid into the intravascular space.
- use of whole blood may cause circulatory overload, particularly in patients who are susceptible to complications from excess circulating volume (e.g., heart failure).
- To prevent manifestations of fluid volume excess, loop diuretics may be administered with blood
Cryoprecipitate
- Cryoprecipitated Antihemophilic Facotr (AKA: Cyro)
- portion of plasma
- rich in clotting factors
- fibrinogen, Factor 8, Factor 13, von willebrand factor
Albumin
- natural protein that is normally produced by the liver
- responsible for generating approximatley 70% of the COP
- sterile solution of serum albumin that is prepared from pooled blood, plasma, serum, or placentas obtained from healthy human donors
- pasteurized to destroy any contaminants
Cryoprecipitate and Plasma Protein (Uses)
management of acute bleeding
Fresh frozen plasma (uses)
increase clotting factor levels
Packed RBCs (Uses)
increase o2 carrying capacity in patients with anemia or in patients with substatial hemoglobin deficiits or patients with up to 25% total blood volume loss
Whole blood (uses)
used for the same reasons as PRBCs except that whole blood is more beneficial in cases of extreme loss of blood volume (greater than 25%) because it also contains plasma
Administration of Blood Products
- Transfusion Reactions:
TRALI: Transfusion related acute lung injury
TACO: Transfusion associated circulatory overload - Could cause transmission of pathogens to recipients
- Blood is only compatible with Normal Saline
- Monitor for fluid overload
- Vital signs taken before administration, when blood is started, every 15 minutes x 4 and every hour, and at completion
- Stay with the patient for the first 15 minutes at least
Supplies for blood transfusion
- 0.9% normal saline
- y type blood tubing with filter
Signs and Symptoms of Adverse Reaction to Transfusion
- temperature rises
- urticaria
- chills
- pruritus
- flank pain
- palpitations/tachycardia
- flushing
- nausea
- sudden agitation, anxiety or dread
- hypertension/hypotension
- jaundice
- respiratory distress
- sudden bleeding
- cardiopulmonary arrest
- chest pain
Transfusion Reaction Steps
- STOP transfusion immediatley and switch to NS
- assess and stabalize the patient
- notify physician
- notify the blood bank (prepare to collect blood and urine sample)
- keep unit of blood, tubing, all product tags and copy of the transfusion reaction form to give to the blood bank
