lilley ch 29 (fluid and electrolytes)

Question 1

normal urine osmolality range

Answer 1

100-1300 mOsm/kg

Question 2

normal plasma osmolality range

Answer 2

280-295 mOsm/kg

Question 3

3 types of crystalloids

Answer 3

isotonic
hypotonic
hypertonic

Question 4

Fluids with the same osmolality as the surrounding cells

Answer 4

isotonic

Question 5

examples of isotonic crystalloids (3)

Answer 5

LR
D5W
0.9% NS

Question 6

Solutions that are less concentrated than in the cells (less electrolytes)
-fluid moves out of vein and into tissues and cells

Answer 6

hypotonic

Question 7

examples of hypotonic crystalloids (2)

Answer 7

0. 45% NaCl

0. 33% NaCl

Question 8

Fluids that are more concentrated than in the cells

-fluid moves from interstitial spaces into cells

Answer 8

hypertonic

Question 9

examples of hypertonic crystalloids (2)

Answer 9

3% NaCl

D10W

Question 10

“stays where I put it”

Answer 10

isotonic

Question 11

“enters the vessel”

Answer 11

hypertonic

Question 12

“into the cell”

Answer 12

hypotonic

Question 13

-Solutions containing fluids and electrolytes that are normally found in the body
-don’t contain proteins
-less expensive
-No risk for viral transmission,
anaphylaxis, or alteration in
coagulation profile

Answer 13

crystalloids

Question 14

what is the best indicated use for crystalloids

Answer 14

dehydration and maintenance fluids

Question 15

contraindications of crystalloids (2)

Answer 15

drug allergy

hypervolemia

Question 16

adverse effects of crystalloids (5)

Answer 16

• may cause edema
• may dilute plasma proteins
• large volumes required to be effective
• effects may be short-lived
• prolonged infusions may worsen alkalosis/acidosis

Question 17

what is the only solution that can be given with blood

Answer 17

0.9% NS

Question 18

in which patients should you use NS with caution (2)

Answer 18

cardiac disease

renal disease

Question 19

isotonic crystalloid:

• does not provide free water or calories
• used to treat hypovolemia, burns, GI fluid losses

Answer 19

LR

Question 20

in which patients would the use of LR be contraindicated (4)

Answer 20

• alkalosis
• lactic acidosis
• liver disease
• caution with renal patients

Question 21

isotonic crystalloid:

• initially isotonic then hypotonic
• does not provide electrolytes, but provides some calories
• great for treating hypernatremia

Answer 21

D5W

Question 22

when should you not use D5W (2)

Answer 22

• cerebral edema

- resuscitation

Question 23

what patients would benefit from hypotonic crystalloids (2)

Answer 23

• diabetic ketoacidosis

- hyperglycemia

Question 24

when should you not use hypotonic crystalloids (4)

Answer 24

• cerebral edema
• liver disease
• trauma
• burns

Question 25

what is D50W used for

Answer 25

hypoglycemia (rapid IV bolus)

Question 26

when would hypertonic crystalloids be useful (3)

Answer 26

- severe hyponatremia - head injuries - when calories are needed with TPN

Question 27

``` type of fluid: -contain molecules too large to pass through capillary walls ("volume expanders") -require less volume -longer duration of action ```

Answer 27

colloids

Question 28

5 types colloids

Answer 28

- albumin 5% and 25% - dextran 40, 70, 75 - whole blood - packed red blood cells - fresh frozen plasma

Question 29

when are colloids useful (2)

Answer 29

shock | burns

Question 30

adverse effects colloids (2)

Answer 30

- may alter coagulation | - dextran therapy may cause anaphylaxis or renal failure

Question 31

4 contraindications of dextran

Answer 31

- hypersensitivity - heart failure - renal insufficiency - extreme dehydration

Question 32

type of fluid: - improves oxygenation - increases colloid osmotic pressure and plasma volume - expensive - least available

Answer 32

blood

Question 33

blood product: | Increase clotting factor levels in patients with demonstrated deficiency

Answer 33

fresh frozen plasma

Question 34

blood product: used to increase oxygen-carrying capacity in patients with anemia, in patients with substantial hemoglobin deficits, and in patients who have lost up to 25% of their total blood volume

Answer 34

packed red blood cells

Question 35

blood product: more beneficial in cases of extreme (greater than 25%) loss of blood volume because whole blood also contains plasma proteins

Answer 35

whole blood

Question 36

disadvantages of using blood products (3)

Answer 36

- possible anaphylaxis - possible transfusion reaction - possible transmission of pathogens to pt

Question 37

when is the most likely time for a blood transfusion reaction to occur

Answer 37

first 15 minutes of transfusion

Question 38

4 important S+S of blood transfusion reactions

Answer 38

- temp rise of 1C above baseline - hives - chills - pruritis

Question 39

what is the order of operations if you suspect a blood transfusion reaction (4 steps)

Answer 39

- stop transfusion and switch to normal saline - assess and stabilize patient - tell doctor - tell blood bank

Question 40

3 types of blood transfusion reactions

Answer 40

1. allergic: hives, itching 2. febrile: fever, chills, fast heartrate and breathing 3. hemolytic: chest pain, chills, fever, low bp, increased resp rate