Exam 2 Blueprint - Fluids, Electrolytes, Blood Products PDF

**[Fluids, Electrolytes, Blood Product Administration]** **[Fluids]** Know the categories of fluids and what that category *means; how does that fluid behave? Does it pull fluid out? Does it keep fluid the same? Does it put fluid back into the cell?* 1. **Isotonic Fluids** - **Meaning**:...

**[Fluids, Electrolytes, Blood Product Administration]** **[Fluids]** Know the categories of fluids and what that category *means; how does that fluid behave? Does it pull fluid out? Does it keep fluid the same? Does it put fluid back into the cell?* 1. **Isotonic Fluids** - **Meaning**: These fluids have the same osmolarity as blood plasma, so there's no significant movement of water in or out of the cells. They primarily expand the extracellular fluid (ECF) volume. - **Behavior**: Maintains fluid balance; doesn't pull fluid into cells or out of cells. Ideal for expanding blood volume without causing cellular fluid shifts. - **Common Isotonic IV Fluids**: - **0.9% Sodium Chloride (Normal Saline)**: Used for fluid resuscitation, shock, and blood transfusions. - **Lactated Ringer's (LR)**: Has additional electrolytes; used in surgery, trauma, and burns. - **D5W (5% Dextrose in Water)**: Initially isotonic, but becomes hypotonic as dextrose is metabolized; suitable for patients needing hydration without sodium. 2. **Hypotonic Fluids** - **Meaning**: Hypotonic fluids have a lower osmolarity than blood plasma, leading to water moving into cells. - **Behavior**: Causes cells to swell by pulling fluid into them, which is helpful for intracellular dehydration. - **Common Hypotonic IV Fluids**: - **0.45% Sodium Chloride (Half Normal Saline)**: Used for patients with dehydration and hypernatremia (high sodium levels). - **0.33% Sodium Chloride**: Also used to hydrate cells, generally for conditions requiring slow rehydration. 3. **Hypertonic Fluids** - **Meaning**: Hypertonic fluids have a higher osmolarity than blood plasma, causing water to move out of cells. - **Behavior**: Pulls water out of cells, reducing cellular edema and expanding extracellular volume. - **Common Hypertonic IV Fluids**: - **3% Sodium Chloride**: Used in critical situations to treat hyponatremia (low sodium) and cerebral edema. - **5% Sodium Chloride**: Also used in severe hyponatremia; should be administered cautiously. - **D5 in 0.9% Sodium Chloride**: Provides extra calories and expands extracellular fluid. **Choosing IV Fluids Based on Patient Signs and Symptoms** - **Isotonic Fluids**: Ideal for patients needing blood volume expansion without changing cell size. Used for: - Hypovolemia (e.g., dehydration, bleeding) - Shock or trauma - Postoperative fluid replacement - **Hypotonic Fluids**: Suitable for patients who need cellular hydration, such as those with: - Hypernatremia (high sodium levels) - Cellular dehydration (e.g., in diabetic ketoacidosis after initial resuscitation with isotonic fluids) - **Hypertonic Fluids**: Used to treat specific critical conditions where it's necessary to pull fluid out of cells, including: - Severe hyponatremia (e.g., when sodium levels are dangerously low) - Cerebral edema (e.g., in traumatic brain injury to reduce brain swelling) **[Electrolytes]** A table of vitamins Description automatically generated Understand the RAAS Cycle; what is the purpose of the RAAS Cycle? ** Purpose: Regulates blood pressure and fluid balance.** ** Process:** - **Trigger: Low blood pressure or sodium levels.** - **Renin Release: Kidneys release renin.** - **Angiotensin Conversion: Renin activates angiotensin I, which converts to angiotensin II (a potent vasoconstrictor).** - **Aldosterone Release: Angiotensin II triggers the release of aldosterone from adrenal glands, increasing sodium and water reabsorption in the kidneys, which raises blood pressure.** Know these hormones, where they are excreted from, and what the normal functioning is: **[ Aldosterone]** - **[Excreted From: Adrenal cortex (the outer layer of the adrenal glands, which sit on top of the kidneys).]** - **[Function: Regulates sodium and potassium balance and helps control blood pressure.]** - **[Normal Function:]** - **[When sodium levels are low or blood pressure drops, aldosterone is released.]** - **[It acts on the kidneys to increase sodium reabsorption and potassium excretion, which indirectly leads to water retention.]** - **[This helps increase blood volume and, consequently, blood pressure.]** **[ ADH (Antidiuretic Hormone, also known as Vasopressin)]** - **[Excreted From: Hypothalamus (produced) and released from the posterior pituitary gland.]** - **[Function: Regulates water balance by controlling the amount of water reabsorbed in the kidneys.]** - **[Normal Function:]** - **[Released in response to high blood osmolality (e.g., dehydration) or low blood volume.]** - **[ADH increases water reabsorption in the kidney's collecting ducts, which dilutes blood plasma and increases blood volume.]** - **[This action helps to lower blood osmolality and increase blood pressure.]** **[ Renin]** - **[Excreted From: Kidneys, specifically the juxtaglomerular cells.]** - **[Function: Initiates the Renin-Angiotensin-Aldosterone System (RAAS) to regulate blood pressure and electrolyte balance.]** - **[Normal Function:]** - **[Released when there's low blood pressure, low blood sodium, or decreased kidney perfusion.]** - **[Renin converts angiotensinogen (from the liver) into angiotensin I, which is then converted to angiotensin II (a potent vasoconstrictor) in the lungs.]** - **[Angiotensin II stimulates aldosterone release, increases blood pressure through vasoconstriction, and promotes sodium and water reabsorption.]** **[Blood product administration]** - Supplies that the RN needs - Do you need a consent form? - Whom cannot receive blood products? - Tubing used for blood products - What IV solution is used for blood products? - How many RNs are needed for blood transfusion? - What are the transfusion reaction types and what occurs within each? - Be able to identify what blood a person can and cannot receive dependent on what their blood type is. For example, if I'm O- blood, what types of blood can I receive? What can I not receive? - How often does the RN need to get vital signs during a blood transfusion? - What is the RN to do if they suspect a transfusion reaction?  **Supplies Needed** - Blood administration set with a filter (special tubing) - 0.9% Sodium Chloride (Normal Saline) for priming the line - IV pump - Personal protective equipment (PPE) for infection control - Blood warmer (if required) - Vital signs equipment for frequent monitoring  **Consent Form** - Yes, a signed consent form is typically required for blood transfusions, as they carry potential risks. This should be obtained by the physician, and the RN confirms that consent is on file before administering blood.  **Who Cannot Receive Blood Products** - **Jehovah\'s Witnesses**: Many members refuse blood transfusions based on religious beliefs. - **Patients with a History of Severe Reactions**: Those with a history of severe transfusion reactions, such as anaphylaxis, may require special considerations, such as using premedications or irradiated blood products. - **Patients with Certain Conditions**: Patients with some autoimmune conditions may have specific restrictions or require extra precautions.  **Tubing Used for Blood Products** - Blood administration tubing is used, which has a built-in filter to trap clots and debris. It is specifically designed for transfusions and is usually Y-shaped, allowing saline to be connected alongside the blood product.  **IV Solution Used for Blood Products** - **0.9% Sodium Chloride (Normal Saline)**: This is the only solution compatible with blood products. Dextrose or other solutions can cause red blood cell hemolysis and should be avoided.  **Number of RNs Required** - Two RNs are needed to verify the blood product and patient information to ensure safety and accuracy before beginning the transfusion.  **Transfusion Reaction Types** - **Febrile Non-Hemolytic Reaction**: Caused by antibodies reacting to donor white cells. Symptoms: fever, chills. It's common but usually mild. - **Allergic Reaction**: Ranges from mild (itching, hives) to severe (anaphylaxis). Caused by allergic reaction to donor plasma proteins. - **Acute Hemolytic Reaction**: Occurs when there is ABO incompatibility. Symptoms: fever, chills, low back pain, hypotension, and dark urine. It is severe and can be fatal. - **Transfusion-Related Acute Lung Injury (TRALI)**: Caused by donor antibodies reacting with recipient leukocytes, leading to pulmonary edema. Symptoms: respiratory distress, hypoxia, pulmonary infiltrates on X-ray. - **Transfusion-Associated Circulatory Overload (TACO)**: Fluid overload causing symptoms like dyspnea, hypertension, and pulmonary edema. Often seen in patients with cardiac or renal issues.  **Blood Type Compatibility** - **O-** (universal donor): Can only receive **O-** blood. - **O+**: Can receive **O+** and **O-** blood. - **A-**: Can receive **A-** and **O-** blood. - **A+**: Can receive **A+, A-, O+,** and **O-** blood. - **B-**: Can receive **B-** and **O-** blood. - **B+**: Can receive **B+, B-, O+,** and **O-** blood. - **AB-**: Can receive **AB-, A-, B-,** and **O-** blood. - **AB+** (universal recipient): Can receive any blood type.  **Vital Sign Monitoring During a Blood Transfusion** - **Baseline**: Before starting the transfusion. - **15 Minutes After Starting**: The initial 15 minutes are critical for monitoring for adverse reactions. - **Hourly**: Check vitals hourly during the transfusion. - **Completion**: Check vitals once more after the transfusion ends.  **RN Actions for Suspected Transfusion Reaction** - **Stop the Transfusion Immediately**. - **Maintain IV Access** with normal saline using new tubing. - **Notify the Provider** and the blood bank. - **Monitor Vital Signs** closely. - **Collect Blood Samples** and send the blood product and tubing to the blood bank if instructed. - **Document** all findings and interventions thoroughly. **[Acid/Base Imbalance ]** **Understand each type of acid-base imbalance, including:** **1. Respiratory Alkalosis** - **Cause**: Low CO₂ levels due to hyperventilation (breathing too fast or deeply). - **Signs & Symptoms**: - **Common Symptoms**: Dizziness, light-headedness, numbness, and tingling in fingers and toes, muscle cramps, and sometimes confusion. - **Why These Symptoms Occur**: Hyperventilation reduces CO₂, leading to decreased carbonic acid and a rise in blood pH (alkalosis), which affects the nervous system and blood flow. - **Compensatory Signs**: - Kidneys retain H⁺ and excrete HCO₃⁻ over hours to days to try to normalize the pH. - **Predisposing Conditions**: - Anxiety, panic attacks - Fever or pain - Pulmonary embolism or pneumonia - Pregnancy (due to increased respiratory drive) - **Medications That May Cause Respiratory Alkalosis**: - Early stages of salicylate (aspirin) toxicity, which initially increases respiratory rate. - **Treatment/Interventions**: - Encourage slow, controlled breathing (using a paper bag for controlled rebreathing in acute cases). - Treat underlying causes (e.g., manage anxiety or fever). - Consider sedation for severe cases of anxiety-induced hyperventilation. **2. Respiratory Acidosis** - **Cause**: High CO₂ levels due to hypoventilation (inadequate breathing). - **Signs & Symptoms**: - **Common Symptoms**: Headache, confusion, drowsiness, and, in severe cases, stupor or coma. - **Why These Symptoms Occur**: Accumulated CO₂ causes an increase in carbonic acid, lowering blood pH (acidosis). Excess CO₂ also dilates cerebral blood vessels, which can increase intracranial pressure. - **Compensatory Signs**: - Kidneys begin to excrete H⁺ and retain HCO₃⁻, but compensation takes time (hours to days). - **Predisposing Conditions**: - Chronic obstructive pulmonary disease (COPD), asthma - Respiratory muscle weakness or paralysis (e.g., from Guillain-Barré syndrome) - Central nervous system depression due to trauma or drugs - **Medications That May Cause Respiratory Acidosis**: - Opioids, benzodiazepines, and other CNS depressants that reduce respiratory drive. - **Treatment/Interventions**: - Support ventilation (e.g., BiPAP or mechanical ventilation in severe cases). - Administer reversal agents if the cause is opioid overdose (e.g., naloxone). - Treat underlying lung or respiratory conditions. **3. Metabolic Acidosis** - **Cause**: Loss of bicarbonate (HCO₃⁻) or accumulation of acid. - **Signs & Symptoms**: - **Common Symptoms**: Rapid, deep breathing (Kussmaul respirations), fatigue, confusion, nausea, and sometimes hypotension. - **Why These Symptoms Occur**: Increased acid in the blood decreases pH, and the body tries to compensate by exhaling CO₂ quickly (Kussmaul breathing) to increase pH. - **Compensatory Signs**: - Lungs increase the rate and depth of breathing to "blow off" CO₂ and raise pH. - **Predisposing Conditions**: - Diabetic ketoacidosis (DKA) in uncontrolled diabetes - Chronic kidney disease or renal failure (reduced ability to excrete acid) - Severe diarrhea (loss of bicarbonate) - **Medications That May Cause Metabolic Acidosis**: - Metformin in patients with kidney impairment (can cause lactic acidosis) - Advanced salicylate (aspirin) toxicity - **Treatment/Interventions**: - Treat the underlying cause (e.g., insulin and fluids for DKA). - Administer sodium bicarbonate for severe acidosis (usually if pH \ 7.45**, the patient has **alkalosis**. **Step 3: Identify the Primary Problem (Respiratory or Metabolic)** - Look at **PaCO₂** and **HCO₃⁻** to determine the source: **Respiratory Imbalance** - If **PaCO₂** is abnormal and matches the pH trend (high PaCO₂ with low pH = acidosis, or low PaCO₂ with high pH = alkalosis), it indicates a **respiratory cause**. - **High PaCO₂ (\>45 mmHg)** = Respiratory Acidosis - **Low PaCO₂ (\