Electrolyte imbalance.ppt
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Intravenous Fluids
Management of clients with Fluid and Electrolyte Disturbances
Advantage• Preferred route for
administering fluids, electrolytes and drugs in emergency
Disadvantage• Drug and solution
incompatibility• Adverse reactions• Infections• complicstion
Management of clients with Fluid and Electrolyte Disturbances
Crystalloids• Solutions with small
molecules that flow easily from the bloodstream into the cells and tissues
• Isotonic• Hypotonic• hypertonic
Colloids• Act as plasma expanders• Always hypertonic; pulls
fluid from cells into the bloodstream
• Requires close monitoring for signs and symptoms of hypervolemia
• Albumin• Plasma protein fraction• Dextran
Management of clients with Fluid and Electrolyte Disturbances
Types of IVF according to tonicity
• Isotonic solutions• Hypotonic solutions• Hypertonic Solutions
Management of clients with Fluid and Electrolyte Disturbances
Isotonic solutions
• Osmolality: 250-300 mOsm/kg• Have a concentration of dissolved particles or
tonicity equal to the intracellular fluid.• Osmotic pressure is therefore the same inside
and outside the cells, so they neither shrink nor swell with fluid movement.
• Eg. D5W, PNSS, PLR
Management of clients with Fluid and Electrolyte Disturbances
Intravenous Fluids: IsotonicSolution Uses Special Considerations
D5W Fluid lossdehydration
- Solution is isotonic initially; becomes hypotonic when dextrose is metabolized- Don’t use for resuscitation- Use cautiously in renal or cardiac disease- doesn’t provide enough daily calories for prolonged use
PNSS Shock, Hyponatremia, Resuscitation, BT, DKA, Hypercalcemia, Metabolic Alkalosis
- don’t use in patient’s with heart failure, edema, hypernatremia
LR Dehydration, burn, Lower GIT fluid loss, acute blood loss, hypovolemia d/t 3rd space shifting, mild metabolic acidosis, salicylate overdose
- No magnesium- Don’t use in patients with renal failure or with liver disease
Management of clients with Fluid and Electrolyte Disturbances
Hypotonic Solutions
• Osmolality: < 250 mOsm/kg• Have tonicity less than the ICF, so osmotic
pressure draws water into the cells from the ECF
• It makes the cell swell• Contraindicated: Increase ICP, Liver Dse, burn,
trauma• Ex. Half-normal saline, 0.33% NaCL, D2.5W
Management of clients with Fluid and Electrolyte Disturbances
Intravenous Fluids: Hypotonic
Solution Uses Special Considerations.45% NaCL(half-
normal saline
solution)
Water replacementDKA after initial NSS and before dextrose solutionHypertonic dehydrationNa and CL depletionGastric fluid loss from vomiting of NGT lavage
-Use cautiously; can cause Cardiovascular collapse or increase ICP-Don’t use in patients with liver disease, trauma or burns
Management of clients with Fluid and Electrolyte Disturbances
Hypertonic Solution
• Osmolality: >300mOsm/kg• Tonicity is greater than that of ICF, so osmotic
pressure is unequal inside and outside the cell• It draws fluid from the intracellular space
causing the cells to shrink and extracellular space to expand.
• Contraindication/Caution: DKA, cardiac or renal disease
Management of clients with Fluid and Electrolyte Disturbances
Intravenous Fluids: HypertonicSolution Uses Special ConsiderationsD5NSS Hypotonic dehydration
Temporary treatment of circulatory insufficiency and shock if plasma expanders aren’t available
- Don’t use in patients with cardiac or renal disease
D10W Water replacementConditions in which some nutrition with glucose is required
Monitor serum glucose
Management of clients with Fluid and Electrolyte Disturbances
Delivery methods• Potential IV site:
metacarpal, cephalic, basilic, median cubital, greater saphenous veins
• Choose the right site• Needle size matters:
the higher the size, the smaller the diameter of the needle
Management of clients with Fluid and Electrolyte Disturbances
Complications of IV therapy
• Infiltration• Infection• Phlebitis• Thrombophlebitis• extravasation
Management of clients with Fluid and Electrolyte Disturbances
Infiltration
• Fluid leaks from the vein into surrounding tissue• Occurs when the access device dislodges from the vein
coolness at the site pain swelling leaking lack of blood return
• Management: Stop the infusionremove IV catheterelevate the extremityapply warm compress
Management of clients with Fluid and Electrolyte Disturbances
Go Small to prevent infiltration
• Use the smallest catheter• Avoid placement in joint areas• Anchor the catheter in place
Management of clients with Fluid and Electrolyte Disturbances
Infection
• The primary barrier to infection is puncturedPurulent drainage at the site tendernessErythemaWarmth or hardness on palpationSystemic: fever, chills, inc. WBC
Management of clients with Fluid and Electrolyte Disturbances
Monitoring vital signs is vital
• Check vital signs and notify the physician• Swab the site for culture• Remove the catheter as ordered• Maintain aseptic technique
Management of clients with Fluid and Electrolyte Disturbances
Phlebitis and thrombophlebitis
• Phlebitis is the inflammation of veins• Thrombophlebitis is an irritation of the vein
with the formation of a clot and usually more painful than phlebitis
painrednessSwelling or induration at the siteRed line streaking along the veinFeverSluggish flow of the solution
Management of clients with Fluid and Electrolyte Disturbances
Prevention begins with big veins
• Remove the IV• Monitor vital signs• Notify the physician• Apply warm soaks at the site • Choose large veins and change the catheter
every 72 hours to prevent this complication
Management of clients with Fluid and Electrolyte Disturbances
Extravasation
• Similar to infiltration• This results when medications (dopamine,
calcium solutions, and chemo drugs) seep through veins and produce blistering and eventually necrosis.
Initially: discomfort and burning sensation at the siteSkin tightnessblanchingLack of blood return
Management of clients with Fluid and Electrolyte Disturbances
Review the policy
• Stop the infusions• Notify the doctor• Apply ice early and warm soaks later• Elevate the extremities• Assess the circulation and nerve function of
the limb• When giving drugs that may extravasate,
know the hospital’s policyManagement of clients with Fluid and
Electrolyte Disturbances
Severed catheter• Occurs when a piece of catheter becomes dislodged
and is set free in the veinPain at the fragment siteDecreased BPcyanosisLoss of consciousnessWeak and rapid pulse
• ManagementApply tourniquet above the site of painNotify the physician immediatelyMonitor the patient Avoid reinserting a needle through its plastic catheter once the
needle has been withdrawnManagement of clients with Fluid and
Electrolyte Disturbances
Allergic reactionRed streak extending up the armRash itchingWatery eyes and nosewheezing
• ManagementStopping the IVF immediatelyNotify the physician immediatelyMonitor the patient Giving oxygen and medication as ordered
Management of clients with Fluid and Electrolyte Disturbances
Air embolism• Occurs when air enters the vein
decrease in blood pressure increase in PRrespiratory distress increase ICPLoss of consciousness
• ManagementNotify the physician and clamp the IVPlace the patient on his left side and lower his headMonitor VS and administer oxygenTo avoid serious complication, prime all tubing completely,
and tighten all connections securelyManagement of clients with Fluid and
Electrolyte Disturbances
Speed shock• Occurs when IV solutions or medications are given
too rapidlyFacial flushingIrregular pulseSevere headacheDecrease blood pressureLoss of consciousness and cardiac arrest
• Managementclamp the IV and Notify the physician immediatelyMonitor VS and administer oxygen administer medication as orderedInfusion control device can prevent this complication
Management of clients with Fluid and Electrolyte Disturbances
Fluid overload• Happens gradually or suddenly, depending on how well the
patient’s circulatory system can accommodate the fluid. Neck vein distentionPuffy eyelidsEdemaWeigh gainIncreased BPIncreased RRSOB, cough and crackles
• ManagementSlow the IV rate, notify the physician and monitor VSKeep the patient warm, keep the head of bed elevatedGive oxygen and other medication (diuretic) as order
Management of clients with Fluid and Electrolyte Disturbances
Blood Products and
Blood TransfusionManagement of clients with Fluid and
Electrolyte Disturbances
Blood Transfusion
• Restores blood volume, correct deficiencies in the blood’s oxygen carrying capacity and its coagulation components, or replace WBC in patients who need them
• Nurses need to be knowledgeable about the various blood products available to safely transfuse blood to their patients
Management of clients with Fluid and Electrolyte Disturbances
Compatibility
• Blood contains various antigens that affect how compatible one person’s blood is with another’s.
• The antigen include: ABO blood group, Rh factor and Human Leukocyte Antigen(HLA) blood group
Management of clients with Fluid and Electrolyte Disturbances
ABOs of typing blood
• Identifies two antigens on RBC--- A and B– A person has both A and B antigens (type AB)
only one antigen (type A or type B)or neither (type O) • A antigen has anti-B antibodies floating freely in the plasma• B antigen has anti A antibodies floating freely in the plasma
Type AB – universal recipients Type O – universal donors Ideally transfusion should be done using the
same type of blood as the patient
Management of clients with Fluid and Electrolyte Disturbances
Blood-type compatibilityRecipient’s blood type
Compatible donor type
A A, OB B, O
AB A, B, AB, OO O
Management of clients with Fluid and Electrolyte Disturbances
Rhesus (Rh) factor
• About 85% of US population in Rh-positive, which means possessing Rh antigen, an antigen found on the membrane of RBC
• Rh negative people may develop Rh antibody if exposed to Rh positive blood– 1st exposure: sensitization– 2nd exposure: fatal hemolytic reaction (can occur
during transfusion or pregnancy)
Management of clients with Fluid and Electrolyte Disturbances
Management of clients with Fluid and Electrolyte Disturbances
Fixing an Rh problem
• If an Rh negative patient is exposed to Rh-positive blood, an injection of Rh0(D) immune globulin can be given within 72 hours of exposure.
• Rh0(D) immune globulin inhibits antibody formation
• Common preparation include: RhoGAM
Management of clients with Fluid and Electrolyte Disturbances
Human Leukocyte Antigen (HLA)
• Located on the surface of circulating platelets, WBC and most tissue cells
• Responsible for febrile reactions in patients receiving a transfusion that contains platelets from several donors
• In that instance antigen-antibody reaction causes platelet destruction
• As a result, patient becomes less responsive to platelet transfusion
Management of clients with Fluid and Electrolyte Disturbances
Types of Blood products
• Fresh Whole blood»Used unless the patient has loss more
than 25% of total blood volume.»Used to treat hemorrhage, trauma, or
major burns» Should be avoided if fluid overload is
presentABO compatibility and Rh matching
Management of clients with Fluid and Electrolyte Disturbances
Types of Blood products
• Packed RBC» Prepared by removing about 90% of the
plasma surrounding the cells and adding an anticoagulant preservative
» Helps in restoring or maintaining the oxygen carrying capacity of the blood in patients with anemic conditions or can correct blood losses during or after surgery
» ABO compatibility and Rh matching
Management of clients with Fluid and Electrolyte Disturbances
Types of Blood products
• WBC»Rarely indicated; however they may be
used to treat gram-negative sepsis or progressive soft tissue infection that’s unresponsive to microbial.
HLA compatibility and Rh matching
Management of clients with Fluid and Electrolyte Disturbances
Types of Blood products
• Fresh Frozen Plasma (FFP)» Prepared by separating the plasma from the
RBCs and freezing it within 6 hours of collection
» Used to treat hemorrhage, expand plasma volume, correct undetermined coagulation factor deficiencies, replace specific clotting factors and correct factor deficiencies resulting from liver disease
Rh matchingManagement of clients with Fluid and
Electrolyte Disturbances
Types of Blood products
• Cryoprecipitate (factor VIII)» Insoluble portion of plasma recovered from
FFP» Used to treat hypofibrigenemia, factor VIII
deficiency (antihemophilic factor), hemophilia A, DIC
Management of clients with Fluid and Electrolyte Disturbances
Types of Blood products
• Albumin» Extracted in plasma and contains globulin
and other proteins» Used for patients who have acute liver
failure, burns, trauma or who have had surgery as well as for neonates with hemolytic disease when crystalloids prove ineffective
Management of clients with Fluid and Electrolyte Disturbances
Types of Blood products
• Platelet» Used for patients who have platelet
dysfunction or thrombocytopeniaRh matching
Management of clients with Fluid and Electrolyte Disturbances
Blood transfusion procedure
Before starting BT: Informed consent, explain the procedureCultural considerationVS (notify physician if febrile) If receiving other medication, it should not be mix with
blood productsDoctor’s order regarding BT to prevent errorsTriple check the patient’s identity (right transfusion at the right time)
If with previous transfusion
Management of clients with Fluid and Electrolyte Disturbances
How to avoid BT errors
• Match the patient’s name, medical record numberm ABO, Rh status, blood bank identification numbers with the label on the blood bag
• Check expiration date• Have the other nurse verify the information• Sign the blood slip, filling the required data. The blood slip will
prove useful if the patient develops an adverse effect• Double-check the doctor’s order • Be sure that the blood was typed and cross-matched within
the last 48hoursManagement of clients with Fluid and
Electrolyte Disturbances
Blood transfusion procedureDuring BT: Maintain sterile technique Observe standard institutional policies and standard precautions Flush with NSS before and after infusing blood products Infuse blood products through at least an 18G or 20G IV catheter Transfuse blood using a Y-type IV administration set with filter and
infuse the blood over 2 to 4 hours When starting the transfusion, remain with the patient and
observe carefully for first 15 minutes Use a pressure bag or specialized infusion pump to administer
blood more rapidly, if needed
Management of clients with Fluid and Electrolyte Disturbances
• When giving platelet concentrate, it should be transfused over 15 minutes
• Check platelet count 1 hour after the transfusion ends
Management of clients with Fluid and Electrolyte Disturbances
Blood transfusion procedureAfter BT: Monitor patient’s status Watch for signs of fluid overload, especially in elderly patients Obtain laboratory test Document:
Patients identificationIdentification of blood products, including date of expirationVS before, during and after BTDate, time, type, amount and duration of transfusionAdverse reaction and actions takenPatient response, including laboratory resultsAssessment after transfusionPatient teaching
Management of clients with Fluid and Electrolyte Disturbances
Blood transfusion reaction…
Management of clients with Fluid and Electrolyte Disturbances
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