chapter 30 - week 2

Question 1

total body water comopsition

Answer 1

Total body water
Composed of:
Intracellular fluid: 67%
Interstitial fluid: 25%
Plasma volume: 8%
60% of adult human body is water.

Question 2

intravascular fluid

Answer 2

Fluid inside blood vessels

Question 3

extravascular fluid

Answer 3

Fluid outside blood vessels
Lymph, cerebrospinal fluid

Question 4

extravascular volume

Answer 4

Plasma
Interstitial fluid: fluid in space between cells, tissues, and organs

Question 5

extracellular volume

Answer 5

Interstitial fluid
Intracellular fluid

Question 6

what is the pressure that plasma proteins exert

Answer 6

contstant osmotic pressure
colloid osmotic pressure
normally 24 mm. Hg

Question 7

what is the pressure interstitial fluid exerts

Answer 7

hydrostatic pressure
noramlly 17 mm Hg

Question 8

crystalloids

Answer 8

• Solutions containing fluids and electrolytes that are normally found in the body
• Do not contain proteins (colloids)
• No risk for viral transmission, anaphylaxis, or alteration in coagulation profile

Question 9

what are crsytalloids used for

Answer 9

• Better for treating dehydration rather than expanding plasma volume
  Used as maintenance fluids to:
• Compensate for insensible fluid losses
• Replace fluids
• Manage specific fluid and electrolyte disturbances
• Promote urinary flow

Question 10

crystalloid types

Answer 10

• Normal saline (NS): 0.9% sodium chloride is isotonic; 0.45% “half-normal” is hypotonic)
• 3.3% dextrose and 0.3% NS (two thirds and one third) (isotonic)
• Hypertonic saline (3% sodium chloride)
• Lactated Ringer’s solution (isotonic)
• Dextrose 5% in water (D5W) (isotonic)
• D5W and 0.45% NS (hypertonic)
• Plasma-Lyte (isotonic)

Question 11

crystalloi indictations

Answer 11

Indications include:
* Acute liver failure
* Acute nephrosis
* Adult respiratory distress syndrome
* Burns
* Cardiopulmonary bypass
* Hypoproteinemia
* Hemodialysis
* Deep vein thrombosis (reduction of risk)
* Shock

Question 12

crystalloid adverse effects

Answer 12

• Adverse effects
• May cause edema, especially peripheral or pulmonary
• May dilute plasma proteins, reducing colloid oncotic pressure
• Effects may be short-lived
• Prolonged infusions may worsen alkalosis or acidosis

Question 13

colloid

Answer 13

Protein substances
Increase colloid oncotic pressure
Move fluid from interstitial compartment to plasma compartment (when plasma protein levels are low)
* Albumin 5% and 25% (from human donors)
* Dextran 40 or 70 (available in sodium chloride and 5% dextrose)
* Hetastarch (synthetic)

Question 14

colloid adverse effects

Answer 14

• Usually safe
• May cause altered coagulation, resulting in bleeding
• Have no clotting factors or oxygen-carrying capacity
• Rarely, dextran therapy causes anaphylaxis or kidney failure.

Question 15

albumin

colloids:

Answer 15

Natural protein that is normally produced by the liver
Responsible for generating approximately 70% of colloid oncotic pressure
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

Question 16

blood products

Answer 16

The only class of fluids that are able to carry oxygen
Increase tissue oxygenation
Increase plasma volume
Most expensive and least available fluid because they require human donors

Question 17

blood products action

Answer 17

• Increase colloid osmotic pressure and plasma volume
• Pull fluid from extravascular space into intravascular space (plasma expanders)
• Red blood cell products also carry oxygen.
• Derived from human donors and thus have all the benefits (and hazards) of human blood products

Question 18

blood products indications

Answer 18

Cryoprecipitate and plasma protein factors
* Management of acute bleeding (greater than 50% slow blood loss or 20% acutely)

Fresh frozen plasma
* Increase clotting factor levels in patients with demonstrated deficiency

Packed red blood cells
* 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

Whole blood
* Same as for packed red blood cells except that whole blood is more beneficial in cases of extreme (greater than 25%) loss of blood volume, because whole blood also contains plasma
Contains plasma proteins, which help draw fluid back into blood vessels from surrounding tissues

Question 19

blood products adverese effects

Answer 19

• Incompatibility with recipient’s immune system
• Cross-match testing
• Transfusion reaction
• Anaphylaxis
• Transmission of pathogens to recipient (hepatitis, human immunodeficiency virus)

Question 20

electrolytes

Answer 20

Principal ECF electrolytes
* Sodium cations (Na+)
* Chloride anions (Cl−)

Principal intracellular fluid electrolyte
* Potassium cation (K+)

Others
* Calcium, magnesium, phosphorus

Question 21

potassium obtained from foods

Answer 21

Bananas, oranges, apricots, dates, raisins, broccoli, green beans, potatoes, tomatoes, meats, fish, wheat bread, and legumes.

Question 22

potassium

Answer 22

• Most abundant positively charged (cationic) electrolyte inside cells
• 95% of body’s potassium is intracellular.
• Potassium content outside of cells ranges from 3.5 to 5 mmol/L.
• Potassium levels are critical to normal body function.

Question 23

hyperkalemia

Answer 23

Hyperkalemia: excessive serum potassium;
serum potassium level over 5.5 mmol/L
* Potassium supplements
* Angiotensin-converting enzyme inhibitors
* Kidney failure
* Excessive loss from cells
* Potassium-sparing diuretics
* Burns
* Trauma
* Metabolic acidosis
* Infections

Question 24

hypokalemia

Answer 24

Hypokalemia: deficiency of potassium; serum potassium level less than 3.5 mmol/L
Excessive potassium loss (rather than poor dietary intake)
* Alkalosis
* Corticosteroids
* Diarrhea
* Ketoacidosis
* Hyperaldosteronism
* Increased secretion of mineralocorticoids
* Burns
* Thiazide, thiazide-like, and loop diuretics
* Vomiting
* Malabsorption
* Others

Question 25

what is potassium responsible for?

Answer 25

* Muscle contraction * Transmission of nerve impulses * Regulation of heartbeat * Maintenance of acid–base balance * Isotonicity * Electrodynamic characteristics of the cell

Question 26

potassoim indications

Answer 26

Main indication * Treatment or prevention of potassium depletion when dietary means are inadequate Other therapeutic uses * Stop irregular heartbeats * Management of tachydysrhythmias that can occur after cardiac surgery

Question 27

potassium adverse effects

Answer 27

Oral preparations * Diarrhea, nausea, vomiting, gastrointestinal bleeding, ulceration IV administration * Pain at injection site * Phlebitis Excessive administration * Hyperkalemia * Toxic effects * Cardiac arrest

Question 28

hyperkalemia manifestations

Answer 28

Muscle weakness, paresthesia, paralysis, cardiac rhythm irregularities (leading to possible ventricular fibrillation and cardiac arrest)

Question 29

treatment of severe hyperkalemia

Answer 29

* IV sodium bicarbonate, calcium gluconate or calcium chloride, dextrose with insulin * Sodium polystyrene sulphonate (Kayexalate®) or hemodialysis to remove excess potassium

Question 30

sodium

Answer 30

* Most abundant positively charged electrolyte outside cells * Normal concentration outside cells is 135 to 145 mmol/L * Maintained through dietary intake of sodium chloride: Salt, fish, meats, foods flavoured or preserved with salt

Question 31

hyponatremia

Answer 31

Hyponatremia: sodium loss or deficiency; serum levels below 135 mmol/L Symptoms * Lethargy, stomach cramps, hypotension, vomiting, diarrhea, seizures * Causes * Some of the same conditions that cause hypokalemia * Also, excessive perspiration (during hot weather or physical work), prolonged diarrhea or vomiting, kidney disorders, and adrenocortical impairment

Question 32

hypernatremia

Answer 32

Hypernatremia: sodium excess; serum levels over 145 mmol/L Symptoms * Water retention (edema), hypertension * Red, flushed skin; dry, sticky mucous membranes; increased thirst; elevated temperature; decreased or absent urinary output * Causes * Poor kidney excretion stemming from kidney malfunction; inadequate water consumption and dehydration

Question 33

sodiums is responsbile for...

Answer 33

Sodium is responsible for: * Control of water distribution * Fluid and electrolyte balance * Osmotic pressure of body fluids * Participation in acid–base balance

Question 34

sodoim indications

Answer 34

Main indication * Sodium depletion when dietary measures are inadequate (treatment or prevention) Mild * Treated with oral sodium chloride or fluid restriction or both Severe * Treated with IV NS or lactated Ringer’s solution

Question 35

soidum adverse effects

Answer 35

Adverse effects Oral administration * Nausea, vomiting, cramps IV administration * Venous phlebitis

Question 36

nursing implications before electrotyle therapy

Answer 36

* Assess baseline fluid volume and electrolyte status. * Assess baseline vital signs. * Assess skin, mucous membranes, daily weights, and input and output. * Before giving potassium, assess electrocardiogram. * Assess for contraindications to therapy. * Assess transfusion history. * Establish venous access as needed. * Administer colloids slowly. * For blood products, follow administration procedures closely. Oral forms of potassium * Must be diluted in either water or fruit juice (100 to 250 mL) and taken with food or immediately after meals to minimize gastrointestinal distress or irritation and to prevent too rapid absorption * Monitor reports of nausea, vomiting, gastrointestinal pain, and gastrointestinal bleeding.

Question 37

nursing implications monitring electrolyte therpay

Answer 37

Monitor therapeutic response. * Normal laboratory values: Red blood cells, white blood cells, electrolyte levels * Improved fluid volume status * Increased tolerance to activities Watch for adverse effects * Monitor for fluid overload and possible heart failure. * Monitor closely for signs of transfusion reactions. * Monitor serum electrolyte levels during therapy. * Monitor infusion rate, appearance of fluid or solution, and infusion site. * Observe for infiltration and other complications of IV therapy. Parenteral infusions of potassium must be monitored closely. * IV potassium must not be given at a rate faster than 10 mmol/hr to patients who are not on cardiac monitors. For critically ill patients on cardiac monitors, rates of 20 mmol/hr may be used. * Never give as an IV bolus or undiluted