Fluid and Electrolytes
What IV soulution will you use when you are giving a pt blood?
NORMAL SALINE SOLUTION, DO NOT USE DEXTROSE OR LACTATED RINGERS
How long should a blood transfusion last?
-- 2 to 4 hours
What should the nurse do if there is a suspected transfusion reaction?
--STOP THE INFUSION IMMEDIATELY, NOTIFY PRIMARY PROVIDE, AND FOLLOW THE AGENCY'S TRANSFUSION REACTION STANDARD
When giving a blood transfusion would you expect to see a transfusion reaction?
-- Within the first 15 minutes
Once you receive a unit of blood for transfusion, how long do you have to start the transfusion?
-- INFUSION MUST BE STARTED WITHIN 30 MINUTES OF LEAVING BLOOD BANK, BLOOD MUS BE COMPLETELY INFUSED WITHIN 4 HOURS
When would you expect to use an isotonic IV?
-- Dehydration from N/V
How do you tx Hyponatremia?
-- Oral
-- Normal saline IV
-- Lactated Ringer IV for sodium replacement
-- sometimes you can give pt a coke-cola
How do you tx hypernatremia?
--S/S's: H/A, Muscle aches, Seizures
-- Increase fluid intake
-- Restrict dietary intake of sodium
--IV D5W
What is an isotonic solution?
-- Water flows both ways equally
-- Osmotic pressure is equal. NA+ loss=H20 loss
--Hypertonic: water flows out of the cell and cell shrinks
-- Hypotonic: Water flows into cell and cell grows
How do you tx hyperkalemia?
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-- > than 5.5 mEq
-- Kayexalate (Sodium polystyrene sulfonate)
-- NEVER GIVE WITH SORBITOL (COLONIC NECROSIS)
-- CAUTIOUSLY IV
How do you administer Potassium?
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--Hypokalemia <3.5 mEq
-Oral
- CAUTIOUSLY IV
- ALWAYS DILUTE!!!!! (NEVER IVP)
- 10 mEq/hr (UNMONITORER)
--Hyperkalemia >5.5 mEq
-- Kayexalate (sodium polystyrene sulfonate), NEVER GIVE WITH SORBITOL (COLONIC NECROSIS)
-- CAUTIOUSLY IV
Why do pts become hyponatremic?
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-- Diuretics, V/D, Congestive HF, Renal and liver disease
-- TERMINOLOGY:
-Hyponatremia: common electrolyte abnormality, that can range from an asymptomatic condition to a life-threatening condition. Can occur with hypovolemic or hypervolemic or euvolemic states.
How do you tx Hypokalemia?
(If you get this question correct, 100 more points will added)!
-- Give potassium, begin oral supplements first
-- Low sodium, high potassium diet
-- Potassium chloride through IV, administered slowly
-- CAUTIOUSLY IV
-- ALWAYS DILUTE!!! (NEVER IVP)
-- 10 mEq/h (unmonitorer)
What are examples of Colloid solutions?
-- Albumin (Human) USP, 25% solution, FLEXBUMIN 25%
-- Destran 40
-- 6% Hetastarch
--Examples of crystalloid solutions:
-- 0.9% Sodium chloride injection USP (Normal saline)
-- Lactated ringers injection USP
How do colloids affect the oncotic pressure and what happens to water when you use them?
-- Displace water molecules, thus creating a relative water molecule deficit with water molecules moving back into the circulatory system within the lower venous pressure end of capillaries
When do we give blood products?
-- If you lose blood or have poor blood components, giving blood products replace lost things (Anemia)
-- ADMINISTER WITH NORMAL SALINE ONLY!
--Fresh frozen plasma (FFP): Increase clotting factors
-- Packed Red blood cells (PRBC): Increase oxygen carrying capacity, increase intravascular volume
-- Whole blood: Oxygen-carrying capacity is best, less likely to cause cardiac fluid overload
What are the S/S's that a pt is have a transfusion reaction?
-- Respirator (Dyspnea, Rales (lung sounds), Pulmonary edema)
-- Cardiovascular (Tachycardia, Hypotension, JVD)
-- Others (Fever, Flank pain, Dermatitis)
-- Pruritis: itchy skin
What are S/S's of hypokalemia?
-- Less than 3.5 mEq potassium
-- Muscle weakness, Constipation, Irregular pulse rate, Overall feeling of lethargy
-- Decreased cardiac output
-- GI motility