IV Fluid, Blood and blood products

Question 1

How must we monitor Parenteral infusions of potassium? What is the normal concentration of plasma sodium outside of the cell?

Answer 1

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

Question 2

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?

Answer 2

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

Question 3

Example of colloids?

Answer 3

Dextran 40 or 70 (BIG glucose polymers)

Hetastarch / hydroxyethyl starch (HES)
synthetic, derived from cornstarch

albumin (from human donors)

Question 4

Colloid vs crystalloids?

Answer 4

big debate of which one is better = no evidence confirming the superiority of the other

Question 5

Client Care for colloids, fluid overload, and transfusions?

Answer 5

-Administer colloids slowly
-Monitor for fluid overload and possible heart failure
-Monitor closely for signs of transfusion reactions

Question 6

Adverse effects for blood products?

Answer 6

-Transfusion reaction
-Blood type and cross-match
-Transmission of pathogens to recipient (hepatitis B & C, HIV)

Question 7

What do colloids do?

Answer 7

*plasma volume expanders”
restore BP

initiate diuresis eg removal ascites in patients with portal hypertension

-Have a much narrow usage then crystaloids

Question 8

Blood Products: Indications of use? What are they packed with?

Answer 8

-Packed RBCs and whole blood

Used during:
-To increase oxygen-carrying capacity
-anemia
-substantial hemoglobin deficits
-blood loss >25% of total blood volume

Question 9

What is Hypernatremia? What causes it? What are the symptoms?

Answer 9

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?

Question 10

What is Hyponatremia? SYmptoms? Causes?

Answer 10

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

Question 11

Crystalloids: Adverse Effects?

Answer 11

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

Question 12

Colloids: Indications of use?

Answer 12

Trauma
Burns
Sepsis
Hypovolaemic shock
Plasma Volume Expansion

Question 13

What is D5W? What is it used for?

Answer 13

glucose for energy production/ATP production

Question 14

What do Principal ICF electrolyte contain?

Answer 14

Potassium (K+)
Others
Calcium, magnesium, phosphorus

Question 15

what are Cryoprecipitate and plasma protein factors (PPF)? What do they allow for?

Answer 15

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

Question 16

Colloids: Adverse effects and disadvantages?

Answer 16

-More expensive
-Usually safe concerns in renal failure

Disadvantages:
-may cause altered coagulation – due to diluting of fibrinogen
-bleeding
-no oxygen-carrying capacity

Question 17

What are Principal ECF electrolytes?

Answer 17

Sodium (NA+)
Chloride (Cl-)

Question 18

Crystalloids: Indications of use?

Answer 18

*Huge blood loss that cause low blood pressure = very low tissue perfusion

Acute liver failure
Acute nephrosis
Burns
Hypovolemic shock

Question 19

What is hyperklamia? How do we treat it? What can cause it?

Answer 19

-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

Question 20

What do Crystalloids contain? What don’t they contain?

Answer 20

Contain water plus:
electrolytes (eg Na+, K+, Cl-)
small molecules (eg glucose, lactate)

Do NOT contain proteins/large molecules (colloids)

Question 21

Causes of dehydration?

Answer 21

Vomiting, diarrhea
Isotonic volume loss = no concentration is lost, just the volume of fluid is lost
Blood loss, sweat

Question 22

What is Fresh frozen plasma (FFP)? What is it used for?

Answer 22

-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)