lilley ch 29 (fluid and electrolytes) Flashcards
normal urine osmolality range
100-1300 mOsm/kg
normal plasma osmolality range
280-295 mOsm/kg
3 types of crystalloids
isotonic
hypotonic
hypertonic
Fluids with the same osmolality as the surrounding cells
isotonic
examples of isotonic crystalloids (3)
LR
D5W
0.9% NS
Solutions that are less concentrated than in the cells (less electrolytes)
-fluid moves out of vein and into tissues and cells
hypotonic
examples of hypotonic crystalloids (2)
- 45% NaCl
0. 33% NaCl
Fluids that are more concentrated than in the cells
-fluid moves from interstitial spaces into cells
hypertonic
examples of hypertonic crystalloids (2)
3% NaCl
D10W
“stays where I put it”
isotonic
“enters the vessel”
hypertonic
“into the cell”
hypotonic
-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
crystalloids
what is the best indicated use for crystalloids
dehydration and maintenance fluids
contraindications of crystalloids (2)
drug allergy
hypervolemia
adverse effects of crystalloids (5)
- may cause edema
- may dilute plasma proteins
- large volumes required to be effective
- effects may be short-lived
- prolonged infusions may worsen alkalosis/acidosis
what is the only solution that can be given with blood
0.9% NS
in which patients should you use NS with caution (2)
cardiac disease
renal disease
isotonic crystalloid:
- does not provide free water or calories
- used to treat hypovolemia, burns, GI fluid losses
LR
in which patients would the use of LR be contraindicated (4)
- alkalosis
- lactic acidosis
- liver disease
- caution with renal patients
isotonic crystalloid:
- initially isotonic then hypotonic
- does not provide electrolytes, but provides some calories
- great for treating hypernatremia
D5W
when should you not use D5W (2)
- cerebral edema
- resuscitation
what patients would benefit from hypotonic crystalloids (2)
- diabetic ketoacidosis
- hyperglycemia
when should you not use hypotonic crystalloids (4)
- cerebral edema
- liver disease
- trauma
- burns
what is D50W used for
hypoglycemia (rapid IV bolus)
when would hypertonic crystalloids be useful (3)
- severe hyponatremia
- head injuries
- when calories are needed with TPN
type of fluid:
-contain molecules too large to pass through
capillary walls ("volume expanders")
-require less volume
-longer duration of actioncolloids
5 types colloids
- albumin 5% and 25%
- dextran 40, 70, 75
- whole blood
- packed red blood cells
- fresh frozen plasma
when are colloids useful (2)
shock
burns
adverse effects colloids (2)
- may alter coagulation
- dextran therapy may cause anaphylaxis or renal failure
4 contraindications of dextran
- hypersensitivity
- heart failure
- renal insufficiency
- extreme dehydration
type of fluid:
- improves oxygenation
- increases colloid osmotic pressure and plasma volume
- expensive
- least available
blood
blood product:
Increase clotting factor levels in patients with demonstrated deficiency
fresh frozen plasma
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
packed red blood cells
blood product:
more beneficial in cases of extreme (greater than 25%) loss of blood volume because whole blood also contains plasma proteins
whole blood
disadvantages of using blood products (3)
- possible anaphylaxis
- possible transfusion reaction
- possible transmission of pathogens to pt
when is the most likely time for a blood transfusion reaction to occur
first 15 minutes of transfusion
4 important S+S of blood transfusion reactions
- temp rise of 1C above baseline
- hives
- chills
- pruritis
what is the order of operations if you suspect a blood transfusion reaction (4 steps)
- stop transfusion and switch to normal saline
- assess and stabilize patient
- tell doctor
- tell blood bank
3 types of blood transfusion reactions
- allergic: hives, itching
- febrile: fever, chills, fast heartrate and breathing
- hemolytic: chest pain, chills, fever, low bp, increased resp rate
