No albumin is given later, initial volume replacement should be .9% Saline
Do we give albumin as an initial volume replacement?
It views it as not having it. Example, if you lose 200ml of fluid into the third space the body no longer counts it as volume.
How does the body view "Third Spacing"?
Intestinal obstruction, Severe pancreatits, Peritonitis, Major venous obstruction, capillary leak syndrome, and BURNS, Compartment syndrome secondary to a fracture
What problems cause Third Spacing?
Air humidity (people in a higher humidity and higher temps are more vulnerable to heat emergencies than someone in high temps with no humidity.)
What environmental situation affects your insensible loss?
They keep close watch on labs during feeds to calculate the next bag of TPN
How is TPN use calculated?
A crystalloid that contains lactate ions (K, HCO3, Mg, Ca) and resembles body fluids
What is Ringers Lactate?
To infuse blood, good for dehydration, fluid replacement, and low sodium situations
What are saline solutions good for?
In cardiac, renal or pulmonary patients. Continue to check lung sounds and assess for edema as to not cause fluid overload
When do we use caution with saline solutions?
When 1 liter of NSS is given , 250cc will stay in the intervascular space. To return 1000cc to the space you must infuse 4 liters
What ration does .9% saline infuse at?
This is called crystalloid resuscitation
If a patient responds to NSS fluids when hypovolumea what kind of resuscitation is this?
Diabetes insipidus, osmotic diarrhea
What kind of loses are from total body water? (all compartments of the body)
Secretory diarrhea, ascites, edema, burns, isotonic dehydration, cloreah, Third Spacing
What are some extracellular fluid loses?
Poor skin turgor, sunken eyeballs, weight change, hemodynamic effects (vital signs)
What are signs of extracellular depletion?
Always IV (Can be straight or diluted with NSS or DW, Rate of infusion depends on situation)
How do we give 25% Albumin?
0.9% saline does not diffuse/change across compartments
Does 0.9% saline diffuse across compartments?
0.45% saline will behave; half like water and half like saline
Does half saline diffuse across compartments?
Albumin Solution(5%) is yellow, given 100-250cc, and stays in the intravascular space. Salpore Albumin is used to make sure there is no saline in that bag.
What should I know about albumin?
People who initially lost volume will not receive it. The first step is usually to get blood work back and to administer saline. Will NOT see it during the recitation phase of the initial emergency care phase.
When will the patient receive albumin?
It is fluid that has been sequestered in a body compartment that is not in equilibrium with the ECF.
What is third spacing?
A truly devastating injury that causes several problems within the body. It can cause respiratory problems. It can cause swelling in the extremities because fluid cannot come back.
What can burns cause?
Fever, perspiration, acid base balance play a role but the big factor would be humidity in the air. The moisture in the air would determine how much you would sweat off and also affect respiratory rate.
What would be a variable for a person to lose more or less fluid?
It is Total Parental Nutrition which is given through one of the large veins. Each bag is based on the patient's blood work during the bag before it. They are constantly adjusting to each of the electrolytes. This is an expensive procedure. (Central Line Only)
What is TPN?
It is a 1000cc bag or 500cc of normal IV fluid. It contains lactase ions, potassium, bicarbonate, magnesium, calcium.
What is ringer's lactate?
It can cause life threatening hyperkalemia very fast.
What happens if you give ringer's lactate to someone with renal failure?
It would cause hypoatremia.
What happens if you give hypotonic IV solutions (Half saline or quarter saline) to someone who had volume depletion (Example: Fresh post-op or bleed during an accident) ?
Normal saline has no calories and it is typical given with blood products
Does normal saline have calories?
Patients with CHF and pulmonary edema because the sodium in the saline would hold onto the water in the body. Keep listening to the patients lungs and check for edema.
Which patients should not receive saline?
If you infuse a liter of 0.9% saline into someone who is volume depleted and only 250cc will stay in the intravascular space and the rest will be excreted. To have the patient retain a total of 1000cc, the nurse must infuse 4L of that saline.
If you infuse a liter of 0.9% saline into someone who is volume depleted, how many liters will you need if only 250 is absorbed?
What is it called if you give someone 8L of saline to resuscitate (non-protein containing solutions)?