Crystalloid
Indications for use of a Crystalloid
What are: Acute liver failure
Acute nephrosis
Adult respiratory distress syndrome
Burns
Cardiopulmonary bypass
Hypoproteinemia
Renal dialysis
Reduction of the risk for deep vein thrombosis
Shock
These types of colloids move fluid from interstitial compartment to plasma compartment (when plasma protein levels are low)
Albumin 5% and 25% (from human donors)
Dextran 40, 70, or 75 (a glucose solution)
Hetastarch (synthetic, derived from cornstarch)
Requires human donors and are the only fluids that carry oxygen.
What are blood products
The four positively charged ions vs. the three negatively charged ions
What are sodium, potassium, calcium, and magnesium vs. chloride, phosphate, and bicarbonate
It is recommended to utilize electrocardiograms for safe monitoring with this medication.
What is potassium?
IV potassium must not be given at a rate faster than 10 mEq/hour to patients who are not on cardiac monitors. For critically ill patients on cardiac monitors, rates of 20 mEq/hour or more may be used.
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, and GI bleeding
The 5 types of crystalloids
What are:
Normal saline (NS; 0.9% sodium chloride)
Half NS (0.45% sodium chloride)
Hypertonic saline (3% sodium chloride)
Lactated Ringer’s solution
Dextrose 5% in water (D5W)
Used to treat wide variety of conditions when patient requires plasma volume expansion
Shock
Burns
What are the indicated uses of a colloid
Cryoprecipitate and plasma protein factors
Management of acute bleeding (greater than 50% slow blood loss or 20% acutely)
Fresh-frozen plasma (FFP)
Increase clotting factor levels in patients with demonstrated deficiency
Packed red blood cells (PRBCs)
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 PRBCs 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
What are the indications for each type of blood product
The three systems that regulate electrolytes
Renin-angiotensin-aldosterone system
Antidiuretic hormone system
Sympathetic nervous system
The only product safe to administer with blood.
What is 0.9% Sodium Chloride
Peripheral and pulmonary edema
What is an adverse effect of a crystalloid.
Fluids move to this space (intravascular or extravascular) to balance the isotonic pressure.
What is intravascular space
The blood product that would be used for a patient taken to the trauma unit after a motorcycle accident that has lost 30% of his blood volume and is in hypovolemic shock.
What is whole blood
Alkalosis
Corticosteroids
Diarrhea
Ketoacidosis
Laxative misuse
Hyperaldosteronism
Increased secretion of mineralocorticoids
Burns
Thiazide, thiazide-like, and loop diuretics
Vomiting
Malabsorption
What are reasons for excessive potassium loss?
IV sodium bicarbonate, calcium gluconate or calcium chloride, dextrose with insulin
Sodium polystyrene sulfonate (Kayexalate)
What are the treatment interventions for hyperkalemia
Concentrations
0.9%: physiologically normal concentration of sodium chloride (isotonic), and it is referred to as NS.
0.45% (“half-normal”)
0.25% (“quarter-normal”)
3% (hypertonic saline)
5% (hypertonic saline)
What is Sodium Chloride
Natural protein that is normally produced by the liver
Responsible for generating approximately 70% of the COP
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
What is Albumin
Incompatibility with recipient’s immune system
Crossmatch testing
Transfusion reaction
Anaphylaxis
Transmission of pathogens to recipient (hepatitis, human immunodeficiency virus)
What are the adverse effects of blood products
Potassium supplements
ACE inhibitors
Renal failure
Excessive loss from cells
Potassium-sparing diuretics
Burns
Trauma
Metabolic acidosis
Infections
What are causes of hyperkalemia?
Lethargy, stomach cramps, hypotension, vomiting, diarrhea, seizures
What are the symptoms the nurse should assess with hyponatremia
Same causes as hypokalemia; also excessive perspiration (during hot weather or physical work), prolonged diarrhea or vomiting, or renal disorders
Hypernatremia: sodium excess; serum levels over 145 mEq/L
Symptoms
Water retention (edema), hypertension
Red, flushed skin; dry, sticky mucous membranes; increased thirst; elevated temperature; decreased urine output
Causes
Poor renal excretion stemming from kidney malfunction; inadequate water consumption and dehydration
Intravenous (IV) therapy is ordered for a patient with a serum sodium of 150 mEq/L. The nurse should give this colloid to prevent further hypernatremia
What is 0.45% NS
Hypertonic saline injections (3% and 5%) are contraindicated in the presence of increased, normal, or only slightly decreased sodium concentrations. Conversely, infusing very low hypotonic saline (0.25% NaCl) is not recommended because it can cause hemolysis of the red blood cells
Solution of glucose
Actions similar to those of human albumin in that it expands the plasma volume by drawing fluid from the interstitial space to the intravascular space
Contraindications:
Hypersensitivity
HF
Renal insufficiency
Extreme dehydration
What is Dextran
The necessary tubing for administering blood products
What is Y-tubing
List at least three adverse effects of Potassium
What are:
Oral preparations
Diarrhea, nausea, vomiting, GI bleeding, ulceration
IV administration
Pain at injection site
Phlebitis
Rate of administration
Excessive administration
Hyperkalemia
Toxic effects
A patient with a serum potassium of 6.0 mEq/L is ordered polystyrene sulfonate (Kayexalate) via the nasogastric tube. This additive should be included with the Kayexalate administration?
What is water