Colloids:
Variation in the choice of colloid for intraoperative fluid management happens to be the case in every institution. Albumin has been solely favoured for the maintenance of colloid osmotic pressure in infants and neonates . The most frequently used plasma expander in this population. (150)
Albumin Several advantages of Albumin in neonate include being the main preserver of the colloid osmotic pressure in plasma (75 %), it is an important binding site for certain metabolites (e.g., bilirubin), free fatty acids and drugs. (151) Albumin has been characterized with a reduction in oedema and inspired oxygen concentration requirements in ventilator-dependent hypoalbuminemic preterm infants, compared with
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Therefore constant assessment of blood loss must be estimated by weighing blood soaked sponges, recording blood and fluid losses using calibrated miniaturized suction bottles and visual estimation of blood lost on surgical drapes. Factors determining allowable blood loss are estimated blood volume, haematocrit value, cardiopulmonary and general medical condition and risk versus benefit of transfusion. (162) Whenever blood is ordered for a neonate in small volumes, it is usually received in a syringe (50 ml) which cannot be transfused using the standard blood set. Infusion pumps are commonly used to transfuse the blood received in syringe aliquots for accurate rate‑ and volume‑controlled administration, crucially during surgery. (164)
Fresh Frozen plasma (FFP): It is administered to replace clotting factors lost during massive blood transfusion, for disseminated intravascular coagulopathy and for congenital clotting factor deficit. Patients with known clotting factor deficits will likely require transfusion of FFP before blood loss exceeds one blood volume. In comparison, healthy patients who don’t have coagulation factor deficits at the beginning of surgery do not necessarily require FFP until blood loss exceeds 1 and probably 1.5 blood volumes. (6) Platelets: Dilution during massive blood loss must be avoided or complications such as thrombocytopenia as a result
To understand whether the actions carried out was rational or whether it did more harm or good, it is necessary to review the development of RDS in a preterm baby.
After surgery, Mr. Baker is taken to a room on the medical-surgical floor. He has an IV infusing at 125 ml/hr, a PCA pump, and a nasogastric tube connected to low suction. He is receiving oxygen through a nasal cannula.
The patient’s vital signs have stabilized, with HR in the 70s, BP is in the 120s/60s, regular RR and 37.6o Celsius temperature. Graft site wound bed is pink with tissue granulation noted. The learner is expected to prepare the patient for discharge. This SCE prepares the learner for the following items of the NCLEX-RN test format:
541). Interventions should be rendered continuously, promptly and appropriately as it can cause life-threatening complications (Holt 2009, p. 26). Apparently, the patient is stable, but continuous assessment and management should be done to avoid recurrences of untoward signs andsymptoms and prevent potential complications. Firstly, continuous assessment and vital signs should be done and these include blood pressure, cardiac rate, respiration, venous distention and skin turgor to assess possible occurrence of fluid overload as a result of rapid administration of large fluid that is often needed to treat the patient with DKA (Smeltzer & Bare 2004 p. 1185). Aside from this, documentation of fluid intake and output should be monitored and documented to assess for circulatory overload and renal function (Holt 2009, p. 61). Significantly, it is integral in the provision of continuous care that nurses reassess the factors that may have contribute or led to DKA, and educate the patient and his family about strategies to prevent its recurrences (Smeltzer & Bare 2004 p. 1186; Lemone, Burke & Bauldoff 2011, p. 551).
Furthermore, prompt infusion of antimicrobial agents ought to be priority and this may require extra vascular access ports (Dellinger, et al., 2008). Early goal-directed resuscitation has confirmed to improved survival for emergency department patients presenting with septic shock in a randomized, controlled, single-center study. Resuscitation lessen 28-day death rate (Dellinger, et al., 2008). In a reviewed conducted by Dellinger, et al., (2012) advocated administering one litre of crystalloid or 300-500ml of colloid more than 30 minutes, to accomplish a central venous pressure (CVP) of 8 mm Hg to 12 mm Hg. Volumes ought to be increased if there are huge indications of hypoperfusion (Dellinger, 2014).
Along with potential biomarkers, research has focused on how to best treat patients with sepsis and septic shock. The current recommendations include giving IV antibiotics within 1 hour of recognition of sepsis and a minimum of 30 mL/kg of IV crystalloid fluid within the first three hours (15). This is followed by frequent reassessment and further fluid administration based off of the hemodynamic status of the patient (15). While the guidelines are widely used by practicing physicians, there are concerns about the aggressive fluid resuscitation (16-17). Some researchers are suggesting the use of ultrasound imaging techniques to help monitor the volume status of patients
She has an ostomy. She was fresh from surgery yesterday, so they gave her pain meds to manage the pain. When I first walked into the room, I learned that she was making snore-liking sounds when she was breathing. From what I have learned, it is called rhonchi. She had many secretions going on. What I was concerned of was how much oxygen she was getting in. I looked at her last vital signs and found that she was had a 92 percent o2 sat level. I was also concerned about her aspirating. Therefore, we had to make sure her HOB 30-45 degrees. I made sure the side rails were up x3 because of fall precaution. She was comfortable most of the time but I taught her but the risk for pressure sores. She understood the need turn frequently to prevent pressure sores. Later I looked in her labs and found that her hemoglobin at 7.1. She was a candidate for blood transfusion. The nurse was teaching me how blood transfusions are done. Before they give her blood, they have to get her last vital signs. We were consistently checking her vitals as we were giving her a blood transfusion. After giving her blood, we had to monitor her and her vital signs for any transfusion reaction. The symptoms of transfusion reaction is shortness of breath and depressed vital signs. Later we found that her oxygen level was at a 93 percent. Afterwards, I looked into her chart and found that he had an XRAY done, which revealed
I am also part of a Wayne State IRB approved clinical research study titled “Application of a Microfluidic Flow-Based Thrombosis Assay for Postoperative Pediatric Cardiac Surgery Patients (MTA-POCS)”, and Dr. Hines is the principal investigator for this research. I am also involved in another IRB approved clinical research titled “ Acute Renal injury following Acute Brain Injury”. My role is to collect and analyze the data from the
Intravenous (IV) fluids were bolusing; however, when blood pressure was only obtainable manually and revealed that her blood pressure was 74/34, the decision was made to send the patient to the intensive care unit (ICU). There, coagulation studies revealed an elevated PT, PTT, D-dimer, and a decreased fibrinogen count. She received a peripherally inserted central catheter (PICC), a transfusion of two units of packed red blood cells (PRBCs), as well as cryoprecipitate therapy during her treatment in the ICU.
The method used was double blind randomized control study, the neonates were placed into either the experimental or control group by computer. The study was conducted by registered nurses who all had at least two years of experience in the NICU as a staff nurse. The nurse obtaining the study data remained blind to whether the patient received the intervention of sucrose or not, by stepping out of the room while the patients primary nurse opened up an envelope containing information if the patient was to receive 0.5mL of sucrose or not. The primary nurse would then administer the sucrose if indicated prior to the nurse collecting data for the study would return. The sucrose was administered between one and three minutes prior to the arterial puncture procedure. Every neonate was swaddled for the procedure and a pacifier was held in place lightly while the arterial puncture was performed. The nurse investigator would obtain the NIPS score, heart rate, and oxygen saturation, after the needle was inserted and then one minute after completion of the procedure. Milazzo, et al. (2011), found that the average gestation of the neonate in this study was 33.8 weeks and there was no difference in age of gestation for the experimental or control groups. The NIPS score was found to be between zero and three
Kleinpell, Aitken, and Achorr 2013, recommend that crystalloids solutions, such as normal saline and lactated ringers, or albumin, should be the fluids of choice when initiating fluid resuscitation. Their recommendation is based on a study trial that was conducted to evaluate the effectiveness of artificial colloids. The results indicated no survival benefits when using artificial colloids comparing to crystalloids (Kleinpell, Aitken, and Achorr 2013).
In a publication of the Stanford University School of Medicine, held an article entitled “Against the Flow—What’s Behind the Decline in Blood Transfusions?” The author of that article, Sarah C. P. Williams, stated: “Over the past decade, a growing body of research has revealed that in hospitals around the world, donated blood is used more often, and in larger quantities, than is needed to help patients—both in operating rooms and hospital
Lastly, in case of an emergency hemorrhagic episode science has advance to the point to decrease blood transfusions to the minimum with help of medications like:
Sepsis should be to be considered a medical emergency and treatment should begin the minute a patient presents with symptoms. Treatment options may begin with applying oxygen to the patient. Providing oxygen to the patient can ensure the body has enough oxygen in its system to perfuse vital organs. Treating patients with intravenous fluids can not only hydrate the patient but help to bring up a patient’s blood pressure than make be low due to the sepsis. Intravenous fluids such as normal saline (a crystalloid fluids) are usually the fluid of choice when treating sepsis. Another group of fluids that may be administered are colloid solutions. Colloids solutions include albumin and dextran. Albumin can replace lost fluid and help restore blood volume. Is a plasma volume expander that can assist in treating hypovolemia? When patients have an unstable or low blood pressure it can lead to shock. “A 2006 study showed that the risk of death from sepsis increases by 7.6% with every hour that passes before treatment begins’ (Kumar, 2006, p.251).
It is also important to keep accurate record of Liam’s fluid balance chart, and assess Liam’s capillary refill, skin turgor, fontanel condition and mucous membranes every shift, as they provide information about the infant’s hydration status (Axton & Fugate 2009). Urine analysis may be performed to provide information on hydration status and/or determine if Liam has urine tract infection (UTI) (Axton & Fugate 2009; Crisp, Taylor, Douglas, & Rebeiro, 2013). Management of dehydration would be one of nursing interventions if urine sample shows a high urine specific gravity, and antibiotics would be administered if a bacterium is detected in the urine sample (Axton & Fugate 2009). Feeding ability should be assessed in order to determine the route of fluid intake (i.e. oral, nasogastric or intravenous fluids) (PMH, 2013).