Download Roach: Introductory Clinical Pharmacology

Introduction to Clinical
Pharmacology
Chapter 54Fluids, Electrolytes,
and Parenteral Therapy
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Solutions Used In The Management Of
Body Fluids
• Blood plasma
• Plasma protein fractions
• Protein substrates
• Plasma expanders
• Intravenous (IV) replacement fluids
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Types of Intravenous Administration
• IV push
• Intermittent
• Continuous
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Nursing Alert
• Monitor IV site for infiltration
– Edema
– Redness at site
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Fluid Overload
• Aka circulatory overload
• Body’s fluid requirements are met, administration of fluid
occurs at a rate that is greater than the rate at which the
body can use or eliminate the fluid
– s/s
• Distended neck veins
• Headache
• convulsions
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Electrolyte imbalance
• Imbalances occur from vomiting, surgery, Dx tests or
drug administration
• A pt. taking a diuretic is able to maintain fluid balance by
an adequate oral intake of water
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Intracellular electrolytes
• Potassium (K+)
– Transmission of impulses
• Magnesium (Mg++)
– Used to prevent and control seizures in
obstetric patients with PIH
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Extracellular Electrolytes: Actions and
Uses
• Calcium (Ca++)
– Blood clotting
• Sodium (Na+)
– Hyponatremia-causes include severe v/d
• Combined electrolyte solutions
– IV solutions
– Oral electrolyte solutions
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Electrolytes: Adverse Reactions
• Reactions to calcium (Ca++):
– Rapid IV administration result in:
•Bradycardia; Vasodilation; Decreased
blood pressure; Cardiac arrhythmias;
Cardiac arrest
– Oral administration result in GI
disturbances
– Administration of calcium chloride:
Peripheral vasodilation; Temporary fall in
blood pressure; Local burning
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Electrolytes: Adverse Reactions (cont’d)
• Reactions to magnesium (Mg++):
– Flushing; Sweating; Hypotension
– Depressed reflexes; Muscle weakness;
Respiratory failure; Circulatory collapse
• Reactions to potassium (K+):
– Nausea; Vomiting; Diarrhea; Abdominal
pain; Phlebitis
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Electrolytes: Contraindications,
Precautions, and Interactions
• Calcium (Ca++):
– Contraindicated in patients with
hypercalcemia or ventricular fibrillation
– Used cautiously in patients with cardiac
disease
– When calcium is administered: Effect of
atenolol is decreased, decreases beta
blockade
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Electrolytes: Contraindications,
Precautions, and Interactions (cont’d)
• Potassium (K+):
– Contraindicated in patients: At risk for
Hyperkalemia; Renal failure; Oliguria;
Azotemia; Anuria; Hemolytic reactions;
Untreated Addison’s disease; Acute
dehydration; Heat cramps
– Used cautiously in patients with renal
impairment, heart disease, metabolic acidosis,
prolonged diarrhea, potassium sparing diuretics
and salt substitutes used with potassium can
produce severe hyperkalemia
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Electrolytes: Contraindications,
Precautions, and Interactions (cont’d)
• Sodium (Na+):
– Contraindicated in patients with
hypernatremia, fluid retention
– Used cautiously in: Surgical patients;
Those with circulatory insufficiency;
Hypoproteinemia; Urinary tract
obstruction; Congestive heart failure;
Edema; Renal impairment; Pregnancy
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Blood Products and Expanders: Actions and
Uses
• Blood Plasma-increases blood volume during severe
hemorrhage. while waiting for whole blood to be
typed and crossmatched or when plasma alone has
been lost
• Plasma Protein Fractions-the albumin fraction of
human blood acts to maintain plasma colloid
osmotic pressure and as a carrier of intermediate
metabolites in the transport and exchange of tissue
products, regulates blood volume from shock
• Plasma Expanders-Ex. Dextran 40; expand plasma
volume during shock caused by burns, hemorrhage,
surgery, and other trauma or for prophylaxis of
venous thrombosis and thromboembolism.
– Other plasma expanders may result in urticaria,
wheezing
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Blood Products and Expanders: Adverse
Reactions
• Blood Plasma-Fluid overload: Body’s fluid
requirements met; Caused by amount of fluid and
rate of administration of fluid; Depends on cardiac
status and adequacy of renal function
• Plasma Protein Fractions-Reactions to plasma
protein fractions: Urticaria; Hypotensive episodes
• Plasma Expanders-Urticaria; Hypotension; Dyspnea;
Bronchospasm; Wheezing; Anaphylactic shock
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Blood Products and Expanders:
Contraindications, Precautions and Interactions
• Plasma Protein Fractions-Contraindicated
– In patients with allergic reactions to
albumin, anemia, cardiac failure
– Presence of normal or increased
intravascular volume
– On cardiopulmonary bypass
– Used cautiously in patients: In shock or
dehydrated; Congestive cardiac heart
failure; Hepatic or renal failure
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Blood Products and Expanders:
Contraindications, Precautions and Interactions
• Plasma expanders-Contraindicated in
patients with hypersensitivity to solution and
bleeding disorders, cardiac failure, renal
failure with oliguria, anuria
– Used cautiously in patients with renal
disease, CHF, pulmonary edema, bleeding
disorders
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Total Parenteral Nutrition
• IV nutrition usually through central line
• IV Fat emulsions are used cautiously in those with
pulmonary disease
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Alkalinizing and Acidifying drugs: Action
and Uses
• Alkalinizing drug: Bicarbonate (HCO3–):
– Acid-base balance of body
Used to treat metabolic acidosis, to increase
blood pH
• Acidifying drug: Ammonium chloride:
– Lowers pH by metabolism of drug into
urea, then hydrochloric acid, further
metabolized to hydrogen ions to acidify
blood
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Alkalinizing and Acidifying drugs:
Adverse Reactions
• Excessive use of bicarbonate:
– Nausea; Vomiting; Pain; Discomfort;
Symptoms of indigestion; Gas
– Prolonged use of oral sodium bicarbonate
result in systemic alkalosis
• Adverse reactions to ammonium chloride:
– Include metabolic acidosis and loss of
electrolytes
• Ammonium chloride and spironolactone:
– Increase systemic acidosis
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Alkalinizing and Acidifying drugs:
Contraindications, Precautions, and
Interactions
• Contraindicated in patients losing chloride, with
metabolic or respiratory alkalosis, hypocalcemia,
renal failure, abdominal pain, on sodium-restricted
diets
• Used cautiously in patients with CHF or renal
impairment and with glucocorticoid therapy
• Administering bicarbonate causes: Increased levels
of quinidine, flecainide, sympathomimetics,
increased risk of crystalluria with fluoroquinolones
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Ammonia Chloride
• Lowers blood pH
• Adverse reactions include metabolic acidosis
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Nursing Process: Assessment
• Preadministration assessment:
– Assess patient for signs of electrolyte
imbalance before administering electrolyte,
electrolyte salt, combined electrolyte
solution
– Obtain vital signs to provide database
• Ongoing assessment:
– Inspect needle site for extravasation or infiltration, if
these are noticed-restart the infusion in another vein
(tissue necrosis)
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Nursing Process: Assessment (cont’d)
• Ongoing assessment (cont’d):
– Potassium: Observe signs of hyperkalemia
– Magnesium: Obtain patient’s blood pressure,
pulse, respiratory rate before drug is
administered
– Sodium: Observe patient during, after
administration for signs of hypernatremia
– Calcium
•Monitor BP, P, RR q 30 minutes until
condition stabilized
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Nursing Process: Nursing Diagnoses
• Excess Fluid Volume
• Deficient Fluid Volume
• Imbalanced Nutrition: Less than body
requirements
• Risk for Injury
• Disturbed Thought Process
• Risk for Decreased Cardiac Ouput
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Nursing Process: Planning
• Expected outcomes
– Optimal response to therapy
– Prevention of fluid overload
– Correction of fluid volume deficit
– Improved oral nutrition
– Understanding of the administration
procedure
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Nursing Process: Implementation
• Promoting an optimal response to therapy:
– Administering calcium: Warm the solution to
body temperature before administration
– Administering potassium: Advise patient
that liquid potassium solutions have salty
taste
– Administering magnesium: Observe patient
for signs of hypermagnesemia
– Administering Bicarbonate: Give oral sodium
bicarbonate tablets with full glass of water;
powdered form is dissolved in glass of water
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Nursing Process: Implementation
(cont’d)
• Educating the patient and family:
– Explain the reasons for IV solutions and
administration
– Emphasis the importance of notifying nurse
if there is a problem with the IV site or IV
administration
– Understands adherence to prescribed dosage
schedule
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Nursing Process: Evaluation
• The therapeutic effect of the drug is achieved
• Patient maintains adequate fluid volume
• Patient maintains adequate nutritional status
• No evidence of injury
• Orientation and mentation remain intact
• Cardiac output is maintained
• The patient and family demonstrate an
understanding of the drug regimen
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