Pharm week 3 Flashcards
blood capabilities
Carrying oxygen Clotting
Oncotic pressure
Cleanse plasma of harmful constituents by exchanges
water in body is made of
Intracellular fluid (ICF) Interstitial fluid (ISF) Plasma volume (PV)
Fluid inside blood vessels
Intravascular fluid (IVF)
Extravascular volume
ISF (interstitial fluid)
ICF (intracellular fluid)
Extracellular volume
Plasma
Interstitial fluid (ISF): fluid in space between cells, tissues, and organs
Plasma proteins exert constant osmotic pressure****
Colloid oncotic pressure (COP)
Normally 24 mm Hg
ISF exerts hydrostatic pressure (HP)
Normally 17 mm Hg
water lost through kidneys
Urine excretion accounts for 50% to 60% of total daily water loss
blood
Only class of fluids that are able to carry oxygen
Increase plasma volume
blood products can increase
Increase COP and PV
Pull fluid from extravascular space into intravascular space (plasma expanders)
we are looking to manage
Management of acute bleeding (greater than 50%
slow blood loss or 20% acutely). THEY would get plasma protein factors (PPF).
if we need to increase clotting factors, we use
Fresh frozen plasma (FFP)
adverse affects of transfusions
Incompatibility with recipient’s immune system
Transfusion reaction
Anaphylaxis
Transmission of pathogens to recipient (hepatitis, HIV)
PRBCs (packed RBCs)
PRBCs: for blood loss up to 25% of total blood volume
whole blood
for blood loss over 25% of total blood volume
colloids
Albumin 5% and 25% (from human donors)
Dextran 40, 70, or 75 (a glucose solution)
Hetastarch (synthetic, derived from cornstarch)
colloids
Superior to crystalloids in PV expansion, but more
expensive
colloids disadvantages
May cause altered coagulation, resulting in bleeding
Have no clotting factors or oxygen-carrying capacity
Few others
types of crystalloids
Hydrating solutions
Isotonic solutions
Maintenance solutions
Hypertonic solutions
crystalloids
Better for treating dehydration rather than
expanding plasma volume
crystalloids - Used as maintenance fluids to
Compensate for insensible fluid losses
Replace fluids
Manage specific fluid and electrolyte disturbances
Promote urinary flow
types of crytalloids
Normal saline (0.9% sodium chloride)
Half normal saline (0.45% sodium chloride)
Hypertonic saline (3% sodium chloride)
Lactated Ringer’s solution
D5W
Plasma-Lyte
indications for colloids
Acute liver failure
Acute nephrosis
Burns
Shock
Renal dialysis
Many other conditions
adverse effects of colloids
May cause edema, especially peripheral or pulmonary
May dilute plasma proteins, reducing COP
Effects may be short-lived
crystalloids don’t contain
proteins
if we need faster expansion
use colloids
if dehydrated and we need to rehydrate quickly
use crystalloids
sodium polystyrene sulfonate
kayexolate - for hyperkalemia
sodium levels
135 - 145
Hyponatremia symptoms ***
Lethargy, stomach cramps, hypotension, vomiting, diarrhea, seizures
Hypernatremia - symptoms
Water retention (edema), hypertension
Red, flushed skin; dry, sticky mucous membranes; increased
thirst; elevated temperature; decreased urine output
natremia - either way
Mild
Treated with oral sodium chloride and/or fluid restriction
Severe
Treated with intravenous normal saline or lactated Ringer’s
solution
side effect of sodium administration
Oral administration
Nausea, vomiting, cramps
IV administration
Venous phlebitis
potassium levels
3.5 - 5
foods high in potassium
Fruit and fruit juices (bananas, oranges, apricots, dates,
raisins, broccoli, green beans, potatoes, tomatoes),
meats, fish, wheat bread, and legumes
K+ is excreted
through kidneys - Impaired kidney function leads to higher serum levels,
possibly toxicity
Metabolic acidosis = you need what?
K+
hypokalemia causes
Alkalosis
Corticosteroids
Crash diets
Diarrhea
Ketoacidosis
Burns (burn patients can
have either hypokalemia
or hyperkalemia)
Loop and thiazide
diuretics
Vomiting
Malabsorption
Large amounts of licorice
consumption!
hypokalemia can lead to
digtoxicity if they’re on digoxin
K+ adverse effects
Oral preparations
Diarrhea, nausea, vomiting, GI bleeding, ulceration
IV administration
Pain at injection site
Phlebitis
Excessive administration
Hyperkalemia
toxic effects
Hyperkalemia
Muscle weakness, paresthesia, paralysis, cardiac rhythm
irregularities (leading to possible ventricular fibrillation
and cardiac arrest)
Treatment of severe hyperkalemia
IV sodium bicarbonate, calcium salts, dextrose with insulin
kayexolate
Ca normal range
4.5 to 5.5 mEq/L; 9 to 11 mg/dl;
mag range
1.5 to 2.5 mEq/L or 1.8 to 3 mg/dl
treatmetn for hypomagnesium ***
IV magnesium, calcium gluconate
chloride range
95 to 108 mEq/L
phosphorus
1.7 to 2.6 mEq/L
Before giving potassium
assess ECG
DO the fluid electroylte
match worksheet WILL BE ON EXAM
very important - Parenteral infusions of potassium must be monitored***
closely
Rate should not exceed 20 mEq/hour
NEVER give as an IV bolus or undiluted. must always be diluted.
oral form of K+
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
Administer colloids
slowly. Monitor for fluid overload and possible heart
failure
For blood products, follow administration
procedures closely
Monitor closely for signs of transfusion reactions
if not on heart monitor for hypokalemia no faster than
10 mEq/hr
hypercalcemia
flabby muscles
similar questions on tests
as slides
