normal potassium level
3.5-5 mEq/L
hyperkalemia
N/V; diarrhea; cardia arrhythmias
hypokalemia
anorexia; nausea; lethargy; muscle weakness; mental confusion
CAIs used to treat:
glaucoma, edema, and high altitude sickness
crystalloids
solutions containing fluids and electrolytes that are normally found in the body
(NO proteins)
crystalloid treatment
for dehydration but not expand plasma volume
compensates for insensible fluid loss; replace fluids; menage specific fluid and electrolyte disturbances; promote urinary flow
examples of crystalloids
Normal Saline (0.9% NaCl) half normal saline (0.45%NaCl) hypertonic saline (3% NaCl) Lactated ringers D5W
adverse effects of crystalloids
edema (esp. peripheral & pulmonary); may dilute plasma protein; may worsen alkalosis or acidosis
colloids
protein substances to increase colloid osmotic pressure (COP)
action of colloids
move fluid from interstitial compartment to plasma compartment (when plasma protein levels are low)
example of colloids
Albumin 5% and 25% (from human donors)
Dextran 40, 70, 75 (glucose solution)
Hetastarch (synthetic, derived from cornstarch)
adverse effects of colloids
usually safe
many cause altered coagulation, resulting in bleeding; have NO clotting factors or oxygen-carrying capacity
warning with dextran
rarely causes anaphylaxis or renal failure
blood products
must be able to carry oxygen
increase tissue oxygenation
increase plasma volume
how do blood products increase colloid osmotic pressure (COP) and plasma volume
pull fluid from extracellular space into intravascular place (plasma expanders); RBC products also carry oxygen; increase body’s supply of various products (such as clotting factors, hemoglobin)
fresh frozen plasma (FFP)
increase clotting factor levels in patients with deficiency
cryoprecipitate and plasma protein factors (PPF)
management of acute bleeding
greater than 50% slow blood loss or 20% acutely
packed red blood cells (PBRCs)
to increase oxygen-carrying capacity in patients with anemia, in pt with substantial hemoglobin deficits, and in patients who have lost unto 25% of their total blood volume
whole blood
same as PBRCs, 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
A patient is taken to the trauma unit after a motorcycle accident. It is estimated that he has lost 30% of his blood volume and his is hypovolemic shock. The nurse anticipates a transfusion with which blood product?
whole blood
extracellular fluid electrolytes
sodium cations
chloride anions
intracellular electrolytes
potassium
early signs of hypokalemia
anorexia, low BP, confusion, lethargy, muscle cramps/weakness, nausea
late signs of hypokalemia
increased HR, neuropathy, paralytic ileus, alkalosis
normal sodium level
135-145 mEq/L
hyponatremia symptoms
causes of hyponatremia
same as hypokalemia; also executives perspiration, prolonged diarrhea or vomiting, or renal disorders
hypernatremia symptoms
> 145 mEq/L
edema, hypertension, red, flushed, skin; dry, sticky mucous membranes (mouth); increased thirst; elevated temp; decreased urine output
causes of hypernatremia
poor renal excretion stemming from kidney malfunction; inadequate water consumption and dehydration
sodium is responsible for:
control of water distribution
F&E balance
osmotic pressure of body fluids
participation in acid-base balance