F&E 4th Semester
Card Set Information
F&E 4th Semester
F&E 4th Semester
Timeframe to transfuse blood or blood products?
Within 4 hours to the floor
Name teh hypertonic fluids
D5 in .33% NS
D5% in .45% NS
D5 in 0.9% NS
Name the isotonic fluids
What isotonic solution has K+ in it?
Name the hhypotonic solutions
What are colloids used for?
Protein solutions are used for
Used to treat hyponatremia when serum sodium <115
Fluid used that is good for volume replacement
Fluid most like plasma in the body
Good fluid to use after trauma or surgery
Fluid good with K+ replacement
D5 (becareful of DM)
Fluid used to jump start kidneys
Can cause hypotnsion and allergic reactions with use
Funtions like plasma protens to maintain oncotic pressure
Restore body proteins
plasma volume expander
How is albumin administered?
Slowly, or pulmonary vasculoature fluid retention can result
Can be used instead of plasma nad albumin to replace body protein
Useful in correcting hypovolemai in early shock and increasing cardiac output
Plasma voume expander that can affect blood clotting. 2 concentrations. 40 70, 70 can cause severe dehydration
% of plasma in whole bblood
What meds do you give before blood products?
Benedryl and aspirin
surgically implanted central line
Central lines need x ray confirmation when?
After insertion and BEFORE
Sites of insertion for central lines
Superior vena cava (internal jugular or R/L subclavian vein, inferior vena cava accessed from femoral vein.
Who inserts a central line?
Complications of central lines:
Who can insert a PICC?
RN - specially trained
PICC confirmation of placement
If hypertonic infultrates, what compress?
If hypotonic infultrates, what compress?
If isotonic infultrates, what compress?
D5 delivered , >3000ml, what can happen?
water intoxication, dextrose metabolized, water is all that is left.
What do you monitor if pt is receiving fluids?
How long to leave in a primary line?
72 hours, longer with order
antibiotics,vancomycin, cypro, big need needle/small ein can cause
Stop fluid- warm/moist ccompress
Fully compensated respiratory acidosis
Fully compensated respiratory alkalosis
Fully compensated metabolic acidosis
Fully compensated metabolic alkalosis
Respiratory acidosis partially compensated
Respiratory alkalosis partially compensated
Partially compenstated metabolic acidosis
Partially compenstated metabolic alkalosis
works with K+ and ca+ to maintain neuromuscular irritability and nerve conduction
Regulates acid base balance
what maintains Na+ balance?
kidneys, neural and hormal mediators
Causes of hypertonic alterations
Causes of hypotonic alterations
Isotonic deficit is...
a proportional loss of water and electrolytes
Signs of isotonic deficit
wght loss, dry skin and mucous membranes, decreased urin output and s.s of hypovolemia
Urin specific gravity during isotonic deficit
Divorced from phosphorus
care when giving milk...why?
phosphorus and calcium both inside
what causes isotonic excess?
too much IV NS, or oversecretion of aldosterone with renal retntion of water and sodium
S/S of isotonic excess
wght gain, neck ven distention, increased BP, increase pulse, hypervolemia, decreased hematorcrib ant plast protein concentrations. High output urin, decreasec concentration
Late s/s of excess (isotonic excess)
Edema and CHF
HHypertonic alterations, water in or out of cell
Out, cells dehydrated.
What IV solution for hypertonic alteration
Deficit in free water results in
excess of aldosterone can cause
cushings syndrome can cause
what can cause oversecreation of aldosterone
adrenal gland tumor
What is increaed with fever or respirtory infections?
Increased sodeium secondary to water loss
DI can cause
Diarrhea can cause
greater water loss in relation to sodium
decredased free water intake can cause
S/S of hypertonic hypernatremia
Drym ucous membranes
low jugular venous pressure
Evaluation findings of hypertonic hypernatremia
Increased sodium serum and specific gravity >1.030, hematocrit and plasma protein level
Treatment of hypertonic hypernatremia
D5% in water until sodium returns to normal
Appropriate term for hypertonic alterations caused by water deficit
How is water lost in water deficit hypertonic alterations
s/s of water deficit
dry skin and mucous membranes
skin turgor may be normal
treatment of dehydration
When IV therepy is used d5% in water...pure water can cause lysis
Both ICF volume and ECF volume increase with
Free water excess
s/s of hypervolemia and water intoxication with cerebral and pulmonary edema occur
Free water excess
Does water move in or out of cell in hyponatremia
Behavioral and neruo changes
lethargy and confusion
seizures and coma
Decreased urin specific gravity with hyper or hyponatremia
treatment of hyponatremia
restrict water intakee with dilutional hyponatremia
Confusion and convulsions
hypotonic aleration from water excess
weakness, nausea, muscle twitching headache and weight gain
hypotonic alteration from water excess
treatment of hypotonic water excess
Restrict fluids for 24 hours, if no convusions IV hypertonic sodium chlorides with severe s/s
alkalosis and K+
wahat can alter K+ levels
Catecholamines (epinepherine, norepinepherine), alpha and beta adrenergics....sudden increase can be fatal
insulin can be used to
muscle weakness, neromuscular irritability, tingling of lips and fingers, restlessness, intestinal cramping and diarrhea, severe: loss of muscle tone, paralysis
T waves changed, slow heart rate, prolonged PR interval and widened QRS complex, v fib, cardiac arrrest
hyperkalemia level is
causes of hyperkalemia
renal disease, massive trauma, insulin deficeincy, addison's disease, use of K+ salt sub., metabolic acidosis
holds onto K+
Hold dig if <
tx of hyperkalemia
calcium gluconate, adminsiter insuine, sodium bicarb (due to acidosis), adminst: Kayexalate (binds K+ in poop)
how is calcium lost?
Urin and feces
hypocalcemia caused by
Decreased PTH, vit D, renal dysf, electolyte influences
confusion and parasthesia around the mouth and digits
hand feet spasms, hyperreflexia, anxiety tentancy and convusions
Chvostek and Trousseau
tx of hypocalcemia
: Tums, increase phosphorus in diet
: IV 10% calcium gluconate diluted in 5% dextrose water (D5W)
do not dilute calcium in what?
common cause of hypercalcemia
hyperparathyroidism, breat, prostate, cervica, GI , ovariun cancer, excess Vit D,
depressions, signs of heart block , ekg changes, deep pain over boney areas, flank pain
tx for acute illness for hypercalcemia
normal saline to help kidneys excrete
makes calcium go back INTO the bone
#1 causwe of hypophosphatemia
promotes excretion of phoshate, causing hypophosphatemia
magnesium and alunim antacids can cuasee
respiratory alkalosis can cause what electrolyte imbalance
neruso irregularities, weakness and tremors, hematologic, possible hypoxia and cardiopulmonary abnormalities, weak pulses, abnormal serum levs, hyperventilation
tx of hypophosphatemia
oral or iv supplememnts
hyperphosphatemai is primarily related to
low calcium levels
tx of hyperphosphatemia
aluminum hydroxide and hemodialysis
magnesium is regulated by
fx of magnesium
neruomus excitability, cardiac contractions (aids others), influences utilization of K+, Ca+ protein
loop and thiazide diuretics can cause
malnutrition is the number one cause of
clinical manifestations of hypomagnesemia are similar to
LIFE THREATENING CARDIAC ARRYTHMIA
hypermagnesemia caused by
magnesium containing antacids, renal failure
Too much mag, does what?
depresses skeletal muscle contraction and nerve function
N/V, muscle weakness, hypotension, bradycardia, respiratory depression, loss of DTrs, flushing
prolonged QT interval
tx of hypermagnesemia
tx off underlying causeand by IV saline or calcium salts, dialysis