NU 314: IV fluids, electrolytes, blood products & lipid lowering agents

What percentage of the body is water?

Approximately 50-70%

What are the two main types of body fluids?

Intracellular fluid (ICF) and Extracellular fluid (ECF)

What does osmolality refer to?

The concentration of solute particles in body fluids.

What is tonicity?

How concentrated an IV fluid is compared to body fluid.

What is an isotonic IV fluid?

A fluid with the same concentration as body fluids, e.g., 0.9% NaCl.

What happens to cells in a hypotonic solution?

Water moves into cells, causing them to swell.

What is the effect of hypertonic solutions on cells?

Water moves out of cells into ECF, causing cells to shrink.

What are crystalloids?

Solutions containing water and electrolytes that maintain osmotic gradient.

What are common uses for crystalloids?

Maintenance fluids, volume replacement, and managing fluid & electrolyte disturbances.

What is a major disadvantage of crystalloids?

They may cause edema due to fluid shifting.

What are colloids?

Solutions containing large protein or starch molecules that do not easily cross capillary walls.

When are colloids used?

When plasma volume expansion is needed, such as in shock or burns.

What is a key advantage of colloids over crystalloids?

Colloids have a longer duration of effect.

What are blood products used for?

To carry oxygen and increase plasma volume.

What are packed red blood cells (PRBCs) indicated for?

To improve oxygen-carrying capacity in symptomatic anemia and blood loss.

What is the purpose of fresh frozen plasma (FFP)?

To increase clotting factor levels in deficiency states.

What is the risk associated with blood transfusions?

Incompatibility with the recipient's immune system, leading to transfusion reactions.

What are the normal lab values for sodium (Na⁺)?

135-145 mEq/L

What is hypokalemia?

A condition where potassium (K⁺) levels are less than 3.5 mEq/L.

What are common causes of hypokalemia?

Diuretics, GI losses, alkalosis, excessive insulin, inadequate intake.

What are the clinical signs of hypokalemia?

Weakness, cramps, constipation, arrhythmias, and flattened T waves.

What is the treatment for hypokalemia?

Potassium replacement, often with KCl.

What are the adverse effects of oral potassium replacement?

Nausea, vomiting, diarrhea, GI bleeding, and ulceration.

What is the risk associated with IV potassium administration?

Pain at the site and phlebitis.

What is the role of platelets in blood products?

To prevent/treat hemorrhage in thrombocytopenic patients.

What does cryoprecipitate contain?

Fibrinogen and clotting factors, used for acute bleeding.

What is the primary function of electrolytes in the body?

To maintain fluid balance and support various physiological functions.

What is the normal range for potassium (K⁺)?

3.5-5.0 mEq/L

What is the primary oral form of potassium replacement?

KCl (Potassium Chloride)

What are common adverse effects of oral potassium replacement?

Nausea/Vomiting, diarrhea, GI bleeding, ulceration

What is the maximum peripheral IV rate for potassium administration?

≤ 10 mEq/hr

What condition is defined as K⁺ > 5.5 mEq/L?

Hyperkalemia

What are the symptoms of hyperkalemia?

Peaked T waves, widened QRS, dysrhythmias, muscle weakness, paresthesias

What is the treatment for severe hyperkalemia?

IV sodium bicarbonate, IV calcium gluconate, IV insulin + dextrose, sodium polystyrene sulfonate (Kayexalate), hemodialysis

What is the definition of hyponatremia?

Na⁺ < 135 mEq/L

What are common causes of hyponatremia?

Excess free water, GI losses, SIADH, CHF, renal failure

What is the treatment principle for hyponatremia?

SLOW correction to avoid osmotic demyelination

What is the definition of hypernatremia?

Na⁺ > 145 mEq/L

What are the symptoms of hypernatremia?

Thirst, neurological changes (restlessness, agitation, seizures), dry mucous membranes

What is the primary cause of coronary artery disease (CAD)?

Progressive narrowing of coronary arteries due to atheromatous plaques

What are the unmodifiable risk factors for CAD?

Genetic predisposition, age, gender (male > premenopausal female)

What is the role of HMG-CoA reductase in cholesterol synthesis?

It is a liver enzyme that regulates the early, rate-limiting step in cholesterol synthesis.

What is the primary function of LDL cholesterol?

Delivers cholesterol to tissues and is associated with atherosclerosis.

What is the function of HDL cholesterol?

Responsible for reverse cholesterol transport, carrying cholesterol from tissues to the liver.

What are the main classes of lipid-lowering agents?

HMG-CoA reductase inhibitors (statins), bile acid sequestrants, niacin, fibric acid derivatives, cholesterol absorption inhibitors.

What is the mechanism of action of statins?

Inhibit HMG-CoA reductase, decreasing cholesterol synthesis and increasing LDL receptor uptake.

What are the indications for statin therapy?

Hyperlipidemia, documented CAD, history of MI, stroke, TIA, PAD, stable angina, atherosclerosis.

What is the risk of excessive potassium administration?

Hyperkalemia and risk of cardiac arrest.

What should be monitored when administering Kayexalate?

Electrolytes and bowel function.

What is the treatment for chronic mild hyponatremia?

Oral NaCl.

What is a high-alert drug for treating severe symptomatic hyponatremia?

3% NaCl (hypertonic saline).

What is the effect of statins on HDL levels?

HDL increases slightly.

What are the effects of hyperlipidemia?

Increased lipids in blood from excess dietary fat or genetic alterations.

What is the potential cardiovascular benefit of statins beyond lipid lowering?

Stabilization of plaques and anti-inflammatory effects.

What are some common statin drugs?

Lovastatin (Mevacor), Pravastatin (Pravachol), Simvastatin (Zocor), Atorvastatin (Lipitor), Fluvastatin (Lescol), Rosuvastatin (Crestor), Pitavastatin (Livalo)

What is the primary effect of statins?

Lower LDL and triglycerides; increase HDL

When are statins typically dosed?

Once daily at night

What does H M G C R stand for in relation to statin adverse effects?

Hepatotoxicity, Myopathy, GI upset, Cataracts, Rhabdomyolysis

What is rhabdomyolysis?

Breakdown of skeletal muscle fibers that can lead to acute renal failure

What are some contraindications for statin use?

Allergy, active liver disease, significant alcohol use, pregnancy & breastfeeding, concurrent grapefruit juice

What nursing implications should be considered for statins?

Max effect occurs in 6-8 weeks; administer with food; emphasize adherence; monitor muscle symptoms and liver function tests

What are bile acid sequestrants?

Second-line lipid-lowering agents that bind bile acids in the intestine

Name examples of bile acid sequestrants.

Cholestyramine (Questran), Colestipol (Colestid), Colesevelam (Welchol)

What is the mechanism of action for bile acid sequestrants?

They bind bile acids, leading to decreased LDL levels as the liver uses more cholesterol to make new bile acids

What are common adverse effects of bile acid sequestrants?

GI effects like constipation, nausea, bloating, and decreased absorption of fat-soluble vitamins

What is niacin and its role in lipid lowering?

Vitamin B₃ that lowers triglycerides and LDL while increasing HDL

What are common side effects of niacin?

GI upset, increased serum uric acid, intense cutaneous flushing

What is the mechanism of action for Ezetimibe (Zetia)?

Inhibits absorption of cholesterol and related sterols from the small intestine

What are PCSK9 inhibitors?

Drugs that increase the number of LDL receptors, dramatically lowering LDL cholesterol

Name two examples of PCSK9 inhibitors.

Alirocumab (Praluent) and Evolocumab (Repatha)

What are the common adverse effects of PCSK9 inhibitors?

Diarrhea, increased liver function tests, influenza-like illness, hypersensitivity reactions

What is the dosing frequency for Alirocumab?

Subcutaneous injection every 2-4 weeks

What is the significance of timing when taking bile acid sequestrants with other medications?

All other medications must be taken 1 hour before or 4-6 hours after bile acid sequestrants

What should be monitored when a patient is on niacin?

Monitor for gout symptoms and uric acid levels

What is the effect of statins on cholesterol synthesis?

They inhibit cholesterol synthesis primarily during the night when the liver synthesizes most cholesterol

What is the recommended action if a patient experiences muscle soreness while on statins?

Assess for new muscle pain, tenderness, weakness, and check CK levels

What should patients be educated about regarding grapefruit juice and statins?

Grapefruit juice can increase statin levels and lead to toxicity

What is the role of Cholestyramine in treating pruritus?

It binds bile salts and can be used to treat pruritus in partial biliary obstruction

What is the primary indication for using bile acid sequestrants?

To reduce serum cholesterol and LDL in primary hypercholesterolemia

What is the effect of niacin on triglycerides?

It decreases triglyceride levels

What is the primary mechanism by which statins lower cholesterol?

By inhibiting HMG-CoA reductase, which is involved in cholesterol synthesis