1
Q
Reasons to give IV fluid to Pt’s
A
- NPO
- Hypovolemia
- Dehydration
- Certain Medications – certain dye’s for angiograms
2
Q
Where is most fluid located?
A
In the cells
3
Q
Oncotic Pressure
A
Pressure that a protein will exert to pull fluids towards them
4
Q
Hydrostatic pressure
A
Pressure that pulls fluid out and puts it into the interstitial space
5
Q
Normal Osmolality in blood
A
275 - 295 mOsm/kg
6
Q
Hypertonic IV fluid
-Does what?
A
- Water moves from interstitial space to plasma
7
Q
Hypotonic IV fluid
-does what?
A
- Water moves from plasma to interstitial space
8
Q
Isotonic IV fluid
-Does what?
A
- No fluid shift
2. Don’t give to someone with with HTN
9
Q
0.9 normal Saline and Lactated Ringer
A
Isotonic Solution
-Stays in the vessel
10
Q
D5.9
A
- Hypertonic Solution
- Fluid is going to leave cell and interstitial space into the plasma
- Cells will shrink from loss of fluid
11
Q
D5W
A
- Hypotonic solution
2. Fluid will move out of plasma and into interstitial and cellular space.
12
Q
Crystalloids
A
- Contain Electrolytes (Lactated ringer, Saline)
- Used to replace fluids and promote urine output
- Compartment entered depends on tonicity of IV fluid
13
Q
Colloids
A
- Molecules to large to easily cross capillary membrane
- Stays in IV space
- Rapidly expand plasma volume - Draw water from intracellular fluid and interstitial spaces into plasma
- –ULTIMATE Hypertonic solution
14
Q
Diuretics
-Used for
A
- High potassium
- Kidney failure (Don’t work when kidneys have failed)
- Fluid overload
15
Q
Pharmacotherapy considerations for Renal Failure
-Adjustments
A
- Reduce medications because they are excreted in the kidneys
- Call pharmacy to properly adjust the dose
16
Q
Pharmacotherapy considerations for Renal Failure
-Labs and tests to see Renal Failure
A
- GFR
- Creatinine clearance
- BUN
- Urine output 30ml/hr test
- Person w/ kidney failure will have high potassium levels
- Calcium will be low and phosphorus will be high
- Sodium can be low
- Early signs of renal failure is HTN
17
Q
Sings of liver failure
A
- Person w/ kidney failure will have high potassium levels
- Calcium will be low and phosphorus will be high
- Sodium can be low
- Early signs of renal failure is HTN
18
Q
Loop diuretics
-Examples
A
- Lasix
2. Bumex
19
Q
Thiazide type diuretics
-Examples
A
- Hydrochlorothiazide
2. Metolazone (Zaroxolyn)
20
Q
Potassium sparing diuretics
-Examples
A
- Triamterene (Dyrenium)
2. Spirolactone (Aldactone)
21
Q
Combination of diuretics
-Examples
A
- Maxide
2. Diazide
22
Q
Diuretic Uses
A
- Hypertension
- Hyperkalemia
- CHF
- Fluid Overload
- Primary Aldosteronism
23
Q
Diuretic Contraindications
A
- Electrolyte depletion (especially potassium)
- Pregnancy
- Anuria or progressive oliguria
- Anuria is <400 ml/24hr - Hypokalemia (Loop and thiazide) (check lab electrolytes)
- Hyperkalemia (w/ K+ sparing)
- Renal dysfunction
24
Q
Prednisone (glucocorticoid)
-Interaction
A
Prednisone decreases potassium
Also can decrease calcium and magnesium
25
Hypokalemia and Digoxin
Hypokalemia can cause digoxin toxicity
26
Hyperkalemia and ACE inhibitor & ARB
don't give together.
27
Diuretic
| -Drug interactions
1. ACE Inhibitors
2. NSAID's
- Can decrease the effectiveness of diuretics and ACE inhibitors
3. Digoxin Toxicity (with hypokalemia)
4. Corticosteroids (K will decrease)
28
Digoxin Toxicity
| -Signs
1. Light halo's
2. Visual disturbances
3. Severe N/V
29
Diuretics
| -Adverse Effects
1. Hypotension
2. Electrolyte Imbalance
3. Hearing Changes (LASIX) **TEXT
4. Photosensitivity (hydrochlorothyozide) --turns urine blue **TEST
5. Dehydration -- If BUN is high but everything is normal cut back on diuretics.
30
Hydrochlorothyozides
1. turns urine blue
| 2. Photosensitivity
31
Lasix
| -Implications
Can cause uric acid levels and gout
32
Hydrochlorothyozide
| -Implications
Limit Sun Exposure
33
Lasix IV push
| -How fast does it work?
1. 5 minutes to take effect
34
Diuretics
| -How to know they are working
1. Lowered BP
2. Potassium levels are good
3. CHF is good
4. They are urinating
35
Antispasmodics
1. Parasympatholitic action to relax bladder muscle and increase holding capacity
36
Antispasmodics
| -Examples
1. Urispas
37
Antispasmodics
| -Contraindications
1. Narrow-angle glaucoma
2. myasthenia gravis
3. CAD
4. GI bleeding or issues w/ motility
38
Antispasmodics
| -Pyridium (phenazopyridine)
1. Pyridium turns the urine blood orange and it stains.
| 2. Anesthetic effect on the urinary mucosa
39
Antispasmodics
| -Used for
1. Dysuria
2. Urgency
3. Nocturia
4. Pain
5. Frequency
6. Relief after transurethral surgery // Neurogenic bladder
40
Antispasmodics
| -Adverse effects
1. Headache, dizziness, restlessness
2. N/V, dry mouth
3. Heart palpitations and tachycardia
4. Urinary retention
41
Antispasmodics
| -Implications
1. Watch for GI distress cause anti-cholinergic slow digestive process
2. Watch symptoms of liver and kidney damage
3. Urine can stain while on Pyridium
4. Watch I/O
42
ACE Inhibitors
| -Overview
1. Causes dry cough
2. Increases potassium
3. Contraindicated with renal stenosis
4. Don't use with pregnancy
43
Phosphate-Binding Agent
1. Corrects the calcium/phosphorus imbalance from renal failure
2. Binds w/ phosphorus in the GI tract
44
Phosphate-Binding Agent
| -When to give
1. Give right before meal time
45
Phosphate-Binding Agent
| -Contraindication
1. Hypercalcemia
| 2. Hypophosphatemia
46
Potassium
| -can it be given IV push?
potassium cannot be given IV push.
It is never safe to push potassium
47
Cation-Exchange Resin
1. It will give a sodium molecule and take away a potassium molecule
2. Works in the stomach as well as the intestine (oral and enema)
48
Cation-Exchange Resin
| -Contraindications
1. Potassium is exchanged for Sodium so fluid follows sodium.
2. HTN
3. CHF
4. Marked Edema
49
Cation-Exchange Resin
| -Interactions
1. Cation-donating antacids/laxatives
50
Cation-Exchange Resin
| -Adverse Effects
1. Hypokalemia
2. Hypocalcemia
3. Hypomagnesemia
1, 2, and 3 work together / if one goes down, look at the others
4. Sodium retention
