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Timeframe to transfuse blood or blood products?
Within 4 hours to the floor
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Name teh hypertonic fluids
- 3% NS
- D5 in .33% NS
- D5% in .45% NS
- D5 in 0.9% NS
- D5LR
-
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What isotonic solution has K+ in it?
LR
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Name the hhypotonic solutions
0.45% NS
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What are colloids used for?
Blood loss/burns
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Protein solutions are used for
Wound healing
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Used to treat hyponatremia when serum sodium <115
3% NS
-
Fluid used that is good for volume replacement
0.9% NS
-
Fluid most like plasma in the body
LR
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Good fluid to use after trauma or surgery
LR
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Fluid good with K+ replacement
D5 (becareful of DM)
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Fluid used to jump start kidneys
0.45% NaCl
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Can cause hypotnsion and allergic reactions with use
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Funtions like plasma protens to maintain oncotic pressure
Colloid solutions
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Restore body proteins
Albumin
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plasma volume expander
Albumin
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How is albumin administered?
Slowly, or pulmonary vasculoature fluid retention can result
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Can be used instead of plasma nad albumin to replace body protein
Plamanate
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Useful in correcting hypovolemai in early shock and increasing cardiac output
Dextran
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Plasma voume expander that can affect blood clotting. 2 concentrations. 40 70, 70 can cause severe dehydration
Dextran
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% of plasma in whole bblood
55
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What meds do you give before blood products?
Benedryl and aspirin
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IVAD
surgically implanted central line
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Central lines need x ray confirmation when?
After insertion and BEFORE
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Sites of insertion for central lines
Superior vena cava (internal jugular or R/L subclavian vein, inferior vena cava accessed from femoral vein.
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Who inserts a central line?
MD
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Complications of central lines:
- -Pneumothorax
- -Air embolism
- -infection
- -phlebitis
- -thrombus formation-
- -bleeding
- -cardiac dysrhythmias
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Who can insert a PICC?
RN - specially trained
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PICC confirmation of placement
Xray
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If hypertonic infultrates, what compress?
Cool
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If hypotonic infultrates, what compress?
warm
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If isotonic infultrates, what compress?
warm
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D5 delivered , >3000ml, what can happen?
water intoxication, dextrose metabolized, water is all that is left.
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What do you monitor if pt is receiving fluids?
output
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How long to leave in a primary line?
72 hours, longer with order
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Phlebitis
- antibiotics,vancomycin, cypro, big need needle/small ein can cause
- Stop fluid- warm/moist ccompress
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7.35
Increased C02
Increased HC03
Fully compensated respiratory acidosis
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7.41
decreased C02
decreased HC03
Fully compensated respiratory alkalosis
-
7.39
Decreased C02
Decreased PC03
Fully compensated metabolic acidosis
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7.43
Increased CO2
Increased PC03
Fully compensated metabolic alkalosis
-
7.3 pH
C02 55
PC03 20
Respiratory acidosis partially compensated
-
7.48
C02 30
HC03 20
Respiratory alkalosis partially compensated
-
Decreased pH
Decreased C02
Decreased HC03
Partially compenstated metabolic acidosis
-
Increased pH
Increased C02
Increased PC03
Partially compenstated metabolic alkalosis
-
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works with K+ and ca+ to maintain neuromuscular irritability and nerve conduction
Na+
-
Regulates acid base balance
Na+
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what maintains Na+ balance?
kidneys, neural and hormal mediators
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Causes of hypertonic alterations
- Hypernatremia
- Water Deficit
- Hyperchloremai
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Causes of hypotonic alterations
- Hyponatremia
- Water excess
- Hypochloremia
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Isotonic deficit is...
a proportional loss of water and electrolytes
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Signs of isotonic deficit
wght loss, dry skin and mucous membranes, decreased urin output and s.s of hypovolemia
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Urin specific gravity during isotonic deficit
High
-
-
Divorced from phosphorus
calcium
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care when giving milk...why?
phosphorus and calcium both inside
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what causes isotonic excess?
too much IV NS, or oversecretion of aldosterone with renal retntion of water and sodium
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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
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Late s/s of excess (isotonic excess)
Edema and CHF
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HHypertonic alterations, water in or out of cell
Out, cells dehydrated.
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What IV solution for hypertonic alteration
Hypotnotic
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Deficit in free water results in
- hypovolemia
- hyperchloremia
-
excess of aldosterone can cause
hypernatremia
-
cushings syndrome can cause
hypernatremia
-
what can cause oversecreation of aldosterone
adrenal gland tumor
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What is increaed with fever or respirtory infections?
Increased sodeium secondary to water loss
-
DI can cause
hypernatremia
-
Diarrhea can cause
greater water loss in relation to sodium
-
decredased free water intake can cause
hypernatremia
-
S/S of hypertonic hypernatremia
- Convulstions
- Pulmonary edema
- Thirst
- Fever
- Drym ucous membranes
- hypotension
- tachycardia
- low jugular venous pressure
- restlessness
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Evaluation findings of hypertonic hypernatremia
Increased sodium serum and specific gravity >1.030, hematocrit and plasma protein level
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Treatment of hypertonic hypernatremia
D5% in water until sodium returns to normal
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Appropriate term for hypertonic alterations caused by water deficit
Dehydration
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How is water lost in water deficit hypertonic alterations
- urine
- sweat
- feces
- insensible losses
-
s/s of water deficit
- thirst
- dry skin and mucous membranes
- elevated temp
- weight loss
- concentrated urin
- skin turgor may be normal
-
treatment of dehydration
- give water
- 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
into cell
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Behavioral and neruo changes
hyponatremia
-
lethargy and confusion
hyponatremia
-
apprehension
hyponatremia
-
seizures and coma
hyponatremia
-
Decreased urin specific gravity with hyper or hyponatremia
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
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alkalosis and K+
hypokalemia
-
wahat can alter K+ levels
Catecholamines (epinepherine, norepinepherine), alpha and beta adrenergics....sudden increase can be fatal
-
insulin can be used to
correct hyperkalemia
-
muscle weakness, neromuscular irritability, tingling of lips and fingers, restlessness, intestinal cramping and diarrhea, severe: loss of muscle tone, paralysis
hyperkalemia
-
T waves changed, slow heart rate, prolonged PR interval and widened QRS complex, v fib, cardiac arrrest
Hyperkalemia
-
hyperkalemia level is
>5.5
-
causes of hyperkalemia
renal disease, massive trauma, insulin deficeincy, addison's disease, use of K+ salt sub., metabolic acidosis
-
spiralactone
holds onto K+
-
-
tx of hyperkalemia
calcium gluconate, adminsiter insuine, sodium bicarb (due to acidosis), adminst: Kayexalate (binds K+ in poop)
-
ECG hypokalemia
- sinus brady
- AV block
- U waves
-
neuromuscular decrease
hypokalemia
-
paralytic ileus
hypokalemia
-
-
how is calcium lost?
Urin and feces
-
hypocalcemia caused by
Decreased PTH, vit D, renal dysf, electolyte influences
-
circumoral numbness
hypocalcemia
-
confusion and parasthesia around the mouth and digits
hypocalcemia
-
hand feet spasms, hyperreflexia, anxiety tentancy and convusions
hypocalcemia
-
Chvostek and Trousseau
hypocalcemia
-
tx of hypocalcemia
- Non severe: Tums, increase phosphorus in diet
- Severe: IV 10% calcium gluconate diluted in 5% dextrose water (D5W)
-
do not dilute calcium in what?
0.9% NaCL
-
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
hypercalcemia
-
kidney stones
hypercalcemia
-
tx for acute illness for hypercalcemia
normal saline to help kidneys excrete
-
calcitonin
makes calcium go back INTO the bone
-
#1 causwe of hypophosphatemia
alcoholism
-
hyperparathyroidism
promotes excretion of phoshate, causing hypophosphatemia
-
magnesium and alunim antacids can cuasee
hypophosphatemia
-
respiratory alkalosis can cause what electrolyte imbalance
hypophosphatemia
-
neruso irregularities, weakness and tremors, hematologic, possible hypoxia and cardiopulmonary abnormalities, weak pulses, abnormal serum levs, hyperventilation
Hypophosphatemia
-
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
kidneys
-
fx of magnesium
neruomus excitability, cardiac contractions (aids others), influences utilization of K+, Ca+ protein
-
loop and thiazide diuretics can cause
hypomagnesemia
-
malnutrition is the number one cause of
hypomagnesemia
-
clinical manifestations of hypomagnesemia are similar to
hypocalcemia
-
LIFE THREATENING CARDIAC ARRYTHMIA
hypomagnesemia
-
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
hypermagnesimia
-
prolonged QT interval
hypermagnesemia
-
tx of hypermagnesemia
tx off underlying causeand by IV saline or calcium salts, dialysis
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