HCD MOD D

• Crystalloids


  Salts that dissolve readily into true solutions
• Crystalloids


  • Used to manage balance through the tonicity of the solution
  • IV solutions that contain electrolytes and other agents that mimic the body's ECF are used to replace depleted fluid and promote urine output
• Crystalloid drug examples


  • 5% dextrose & water
  • Normal saline
  • Lactated ringers
  • 5% dextrose and ½ normal saline
• Crystalloids


  Water with electrolytes that form a solution that can pass through semipermeable membrane
• Colloids


  Substances such as large protein molecules that do not readily dissolve into true solutions
• Colloids


  • Expands volume= albumin is key example
  • Expands the ECF volume through replacement of proteins, starches, or other large molecules
• Colloid drug examples


  • Serum albumin
  • Dextran 40
• Blood products


  • Plasma
  • Cryoprecipitate
  • RBC
  • WBC
  • Platelets
• Tonicity


  Describes the osmolarity of a solution relative to plasma
• Isotonic


  • A solution that has the same osmolality as bodily fluids
  • Isotonic solutions do not result in any movement across the membrane through osmosis or diffusion
• Isotonic solutions


  • Indicated for patients with hypotensive and hypovolemic states (decreased urine output, tachycardia, decreased CVP)
  • Patients require volume expansion
• Isotonic solution examples


  • 0.9% NS
  • Lactated Ringers
  • D5W
  • D5 0.225% NaCl
• Hypotonic


  • Shifts fluid out of the intravascular compartment, hydrating the cells and interstitial compartment
  • Osmolarity is lower than serum osmolarity
  • Hypotonic solutions cause fluid to move into the cells
• Hypotonic solutions


  • Indicated for patients with dehydration or hypernatremia
• Hypotonic solution examples


  • 0.45% NaCl (NS)
  • D5 0.45% NS
  • 2.5% dextrose
• When to use hypotonic solutions

  • If there is a need to administer water to patient
  • Cells are dehydrated
  • Maintenance fluids (not volume replacement!!!)
• Caution: Hypotonic solutions may cause cardiovascular collapse due to decrease in vascular blood volume
• Do not administer hypotonic solutions to clients at risk for third spacing, increased intracranial pressure (head injuries), liver disease, trauma or burn patients
• Hypertonic


  • Draws fluid into intravascular compartment from the cells and interstitial compartment
  • Osmolarity is higher than serum osmolarity
  • Hypertonic fluids pull fluid from the cells into the vascular space
• When to use hypertonic solutions


  • Increase intravascular fluid volume
  • Pull fluid out of other compartments
  • Treat hyponatremia
  • Hypertonic + mannitol= reduce intracranial pressure
• Hypertonic solution examples


  • 3% sodium chloride
  • D5NS
  • D5LRS
  • D5 0.45% NaCl
  • Mannitol
• Fluid volume overload signs and symptoms: swelling (edema), high blood pressure, shortness of breath, rapid weight gain, full, bounding pulses, ascites, crackles in the lungs
• Fluid volume deficit signs and symptoms: altered LOC, weight loss, concentrated urine (low urine output), dry mucous membranes, weak pulse, tachycardia, fatigue, thirst
• Cardiac Output


  1. 8 L/min
• Cardiac Index


  2.5-4 L/min
• Heart Rate


  60-100 BPM
• Stroke Volume


  60-120 mL/min
• Mean Arterial Pressure (MAP)

  • 70-90 mmHg
  • Greater than 105 mmHg indicates hypertension or vasoconstriction
• Preload


  • Right side- CVP(RA): 2-5/6
  • Left side- wedge (PCWP/PAOP): 5-12
• Afterload


  • (right) PVR: 150-250
  • (left) SVR: 900-1400
• Contractility


  L side- LSWDI: 35-85
• Pulmonary pressures


  • PAS 20-30 (systolic)
  • PAD 10 (diastolic)
• Preload management


  1. Decreased: volume; add vasoconstrictors

  2. Increased: diuretics; vasodilators
• Afterload management


  1. Decreased: vasoconstrictors; volume

  2. Increased: vasodilators; Ca channel blockers, beta blockers
• Contractility management


  Decreased and increased: positive inotrope
• Heart rate management


  1. Decreased: Ca channel blockers, beta blockers

  2. Increased: atropine
• Clinical manifestations of low cardiac output

  • Palpitations
  • Dizziness or syncope
  • Pallor
  • Diaphoresis
  • Altered mentation
  • Hypotension
  • Angina

  
• 2nd degree AV block type 1 (Wenckebach)


  Priority intervention: Nothing- watch
• 2nd degree AV block type 2


  Priority intervention: Pacemaker
• 3rd degree AV block

  Priority intervention: Pacemaker