Exam 1 - Burn Pharm, Fluids (3.7)

intracellular and extracellular fluids
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intracellular and extracellular fluids
Image: intracellular and extracellular fluids
ICF = 40%
Prevalent cation is K+
Prevalent anion is PO43-

ECF = 20%
Prevalent cation is Na+
Prevalent anion is Cl-
intracellular (ICF) vs. extracellular (ECF) -- body weight % and electrolytes
1. check compatibility before giving 2 meds through same line
2. check for precipitate (if present, STOP administering)
3. verify compatibility w/ ALL components of infusion

4. blood products & TPN should NOT be combined with anything in a single line
purpose of fluid therapy:
1. Provide fluids when PO intake is not possible
2. Maintain normal electrolyte balances
3. Replace fluids and electrolytes
4. Provide glucose as energy source
5. Provide access for administration of medication
6. Administer blood products
7. Maintain urine output
8. Emergency access

list 4 nursing implications for compatibility of fluids
colloids = volume/vascular expanders and hemodynamic support

crystalloids = electrolyte solutions consisting of water and crystals (maintenance fluids)
explain colloids vs. crystalloids
colloids (volume expanders)

•Man-made
Starches, dextrans, gelatins

•Naturally occurring
Albumin, ffp

•More expensive, resource dependent, and ethics
•Outcomes are not better than crystalloids
Used to increase the blood volume following severe losses of either blood or plasma
Crystalloids (electrolyte solutions)

Common solutions:
•D5w
•1/2NS and Normal Saline
•0.45% and 0.9% naCl solution
•Lactated ringer's (Contains sodium, chloride, potassium, calcium, and lactate)
•used to correct body fluid and electrolyte deficit
•Maintenance
NL = 280-295 mosm/Kg

diffusion = high to low movement to balance
osmolarity = total concentration of all solute particles in a solution

normal serum osmolarity? explain diffusion?
the osmotic pressure (pulling force)
The greater the osmolarity of a solution, the greater the
Solution with lower osmolarity (hypoosmolar) than serum

- LESS concentrated than cells
- fluid (water) will shift INTO cells to balance (and out of vascular space)
- cells swell
hypotonic solutions <280

explain...
solution with osmolarity equal to serum

- equal in osmolarity to cell interior
- neutral fluid movement
- no change in cell
isotonic solutions between 280-295

explain...
Solution with *higher osmolarity (hyperosmolar) than serum* - MORE concentrated than cells - fluid (water) will shift OUT of cells to balance (and into vascular space) - cells shrink (dehydrate cell)*hypertonic* solutions >295 explain...Hypertonic, isotonic, hypotonic solutions- 0.45% NS - 0.33% saline - D5Wlist 3 *hypotonic* fluids3. hypernatremia 4. 20 meq/l of K+ 5. cellular dehydration -- fluid goes into cell increased ICP/risk and/or third spacing risk*hypotonic* solutions: 1. Replace on-going losses of water and electrolytes under normal physiologic conditions (pt expected to have NO oral intake for long time) 3. Used to "dilute" plasma - particularly in ____________ 4. if NPO >24 hours, need to add ____________ 5. Treats ___________ Contraindicated in who????water intoxication, cellular swelling fluid replacement in shock*5% dextrose in water (D5W)* = isotonic but is rapidly metabolized Becomes *hypotonic* leading to _________ and __________ -- do NOT use in high volumes, and should NOT be used for _____________- 0.9% normal saline - D5W - Lactated ringerslist 3 *isotonic* fluidsexcessive vomiting, diarrhea, severe volume loss*isotonic* solutions: 1. Expands both intracellular and extracellular volume 2. Used commonly for: __________, __________, __________ **different fluids are indicated depending on the body fluid being lostSIADH (syndrome of inappropriate antidiuretic hormone), hyponatremia*0.9% normal saline (NS)* = most WIDELY used IV fluid (b/c serum sodium imbalances are very common) post op patients and critical ill patients are at risk for ___________ and thus __________0.9% SALINE (NS) •THE MOST COMMON ELECTROLYTE DISORDER IN HOSPITALIZED PATIENTS RELATES TO SERUM SODIUM - EITHER HYPONATREMIA OR HYPERNATREMIA​IS THE MOST WIDELY USED IV FLUID IN HOSPITALIZED PATIENTS.​expands ECF, post-op patients (and for *fluid resuscitation of burn victims*)*lactated ringers (LR)* = more similar to plasma than NS has less NaCl, but has K, Ca, PO43-, lactate (metabolized to HCO3)​ -- used to __________ and for __________1. fluid deficient shock 2. replace lost blood -- (resembles electrolyte composition of human plasma) 3. normal saline (NS)*resuscitation measures* w/ isotonic fluids 1. *NS* is fluid of choice for _____________ 2. *LR* solution is a good choice when the goal is to _____________ 3. _____________ must be used when administering *blood products*- 3% Saline - D5NS - D5LRlist 3 *hypertonic* fluidsshrink or drastic increase in sodium is needed 1. *Increased ICP* -- Mannitol refractory ICP, Cerebral edema 2. *Severe hyponatremia* -- Na <115 with neurologic symptoms*hypertonic* solutions: Indicated when cells need to _____________ -- 2 examples?5 days or longer, IV routeIf NPO for ____________, parenteral nutrition via the ______ route may be indicated -- contains amino acids, lipids, protein, carbohydrates, electrolytes , vitamins, trace metals, minerals, and fluids if gut works, use enteral feeding (through NG or G tube)PARENTERAL NUTRITIONIS A FORM OF NUTRITIONAL SUPPORT THAT SUPPLIES PROTEIN, CARBOHYDRATE, FAT, ELECTROLYTES , VITAMINS, MINERALS, AND FLUIDS VIA THE IV ROUTE TO MEET THE METABOLIC FUNCTIONING OF THE BODY.1. *cannot tolerate enteral nutrition* -- paralytic ileus, intestinal obstruction, persistent vomiting 2. *hyper metabolic status* -- burns, cancer 3. *risk of malnutrition* -- recent weight loss of > 10%, NPO for > 5 days, and preoperative for severely depleted clientslist 3 people who may get *parenteral nutrition*1. 24 hours 2. central line turn TPN off for 5 minutes, flush with 20mL NS, take labsTPN solution is developed based off the day's labs 1. solution and tubing are only good for ________ 2. prefer a __________ how do you draw labs w/ TPN via central line?