CNUR 305 EXAM Questions With Answers
Guaranteed Pass
Common indications for blood transfusion
•Surgical blood loss
•Trauma/injury
•Anemia
•Gastro-intestinal bleeding
•Cancer
•Organ dysfunction
•Infections
•Bleeding disorders
Components of Blood/blood products
Each donation of whole blood is separated into 4 components:
•Red blood Cells
•Plasma
•Platelets
•Cryoprecipitate
What Lab values could indicate the need for each of these products:
•Red blood Cells: HG/HCT vrs NA and Albulmin
•Plasma: INR, PT aPTT
•Platelets: Platelet needs such as bleeding or drugs (Low Molecular weight Heparin)
•Albumin: Albimin lab: Not usual for volume replacement unless from nephrologist. Usual for
Burns and liver disease.
Dehydration and fluid overload affect hgb, hct- number of red blood cells, heparin rather than
LMW heparin- stop for 15 min, drastic change in levels
Platelets- septic shock- antibiotics and fluid
Albumin- major puller, decrease diet and blood loss
RBC: 4.2-5.4 x1012/L Female 4.7-6.1 x1012/L Male
HgB: 120-160g/L Female 140-180g/L Male
Platelets: 150 - 400 x 109/L
PT: 11-12.5 seconds
aPTT: 30-40 seconds
,PTT: 60-70 seconds
Albumin: 35-50g/L
Treatment for fluid volume deficits
Main strategy is to identify and control source of fluid loss. Replace by oral, enteral, or IV
dependent on the severity of the deficit and acuity of the patient. Treatment with isotonic
solutions is key in management.
Patient is getting better if: gaining weight or has stabilized,Urine output is increasing, I & O are
balanced, Mucous membranes are moist, LOC intact, VS normal and Labs are normalizing:
Crystalloids are predominately based on a solution of sterile water with added electrolytes to
approximate the mineral content of human plasma (i.e. N/S, ringers lactate)
Colloids are often based on crystalloid solutions, thus containing water and electrolytes, but
have the added component of a colloidal substance that does not freely diffuse across a
semipermeable membrane. (i.e. pentastarch, dextran, albumin, etc.)For albumin the colloid is
albumin
No clear consensus if colloids vs crystalloids is better for volume resuscitation.
Sodium
Range 135 -145 mmol/L
Responsible for water balance
Required for normal transmission of impulses across muscle and nerve cells through sodium-
potassium pump mechanism
Role in maintaining acid-base balance
Changes in sodium levels alter water balance
Can increase acidity
Hypernatremia:
Water loss (dehydration)or sodium gain (hypertonic saline administration, adrenal tumor
causing increased aldosterone)
Primary prevention is thirst
First indicator is urine output- damage, increased urea and creatinine
Can lead to seizures or coma
Hypernatremia Treatment:
IV fluids (iso tonic)
Treat the underlying cause (DKA)
Hyponatremia:
Water excess (dilutional hyponatremia) or losses of Na containing fluids (too much NS)
,Usual issue is dilutional hyponatremia
Can lead to seizures and coma
Hyponatremia Treatment:
Fluid Restriction
If the risk is severe then hypertonic solutions are used (3% Sodium Chloride
Intravascular- in pipes, pull more water in if too much sodium= dehydration
Surgery- NS contributed to high levels of sodium, resistance to push against
I/O, foleys
Too quick of an overcorrection can result in seizures, coma, and death (etc.). Therefore, only
extreme measures are corrected quickly if the risk of seizures, coma, and death (etc.) are
present.
Creatinine
End product of muscle metabolism
Filtered in the glomerulus
Not reabsorbed in the tubules
Male - 53-106 mcmol/L
Female - 44-97 mcmol/L
Elevated creatinine shows kidney damage while low shows possible overhydration.
•High levels of creatinine usually mean low glomerular filtration rate.
•Urine output- poor, urea and creatinine may be in range- out of range= kidney damage
•Write out one liners, write assessment out before and then go in and check, and adjust
•Distance running- increase muscles, Advil, rhabdo, dark urine
Urea
End-product of protein metabolism
Filtered in the glomerulus
Eliminated in the urine
↑ BUN ↓glomerular function
Impacted by muscle mass
Normal Urea - 3.6-7.1 mmol/L
BUN to Creatinine Ratio:
Normal BUN to Creatinine ratio:
•10:1 to 15:1
, Osmolality
•Amount of concentration of solute in body water
•Reflects hydration
•Used as approximation of extracellular fluid status
•Normal range:
•Serum: 280-300 mOsm/kg
•Urine: 100-1300mmol/KG
•Sodium is main contributor in serum
•Urea is main component in urine
•Indicator of renal function
•When the renal function is normal the serum and urine osmolarity go the same direction (one
rises and the other rises). If there is impairment then then the urine osmolarity can become
more concentrated (higher) than the blood).
•Anuria is less than 100ml/day
•Oliguira is less than 500ml in 24 hours so if someone is in this face this is an expected amount
of urine and we are hoping to improve it or maybe the damage is already done and we are
happy with the little amount of urine we have!
Parenteral Nutrition
•The administration of nutrients through a vascular access device.
•Indicated as a substitute for oral/enteral feedings
•A sterile, chemical, hypertonic solution
•An intricate combination of protein, carbohydrates, fat, minerals, and electrolytes
•Individualized
•Can be a short or long term therapy
Used in the setting of GI dysfunction or patient's who are severely catabolic
PN should be reserved and initiated only after the first 7 days of hospitalization when enteral
nutrition is not available
Patient's unique requirements- based greatly on patient's weight, ideal body weight, current
blood work, liver function, kidney function, degree of stress and fluid requirements
Indicators for PN
•Any contraindication to enteral feeding
•Severe diarrhea and vomiting
•Complicated abdominal surgeries or trauma
•GI disease:
•Obstruction
Guaranteed Pass
Common indications for blood transfusion
•Surgical blood loss
•Trauma/injury
•Anemia
•Gastro-intestinal bleeding
•Cancer
•Organ dysfunction
•Infections
•Bleeding disorders
Components of Blood/blood products
Each donation of whole blood is separated into 4 components:
•Red blood Cells
•Plasma
•Platelets
•Cryoprecipitate
What Lab values could indicate the need for each of these products:
•Red blood Cells: HG/HCT vrs NA and Albulmin
•Plasma: INR, PT aPTT
•Platelets: Platelet needs such as bleeding or drugs (Low Molecular weight Heparin)
•Albumin: Albimin lab: Not usual for volume replacement unless from nephrologist. Usual for
Burns and liver disease.
Dehydration and fluid overload affect hgb, hct- number of red blood cells, heparin rather than
LMW heparin- stop for 15 min, drastic change in levels
Platelets- septic shock- antibiotics and fluid
Albumin- major puller, decrease diet and blood loss
RBC: 4.2-5.4 x1012/L Female 4.7-6.1 x1012/L Male
HgB: 120-160g/L Female 140-180g/L Male
Platelets: 150 - 400 x 109/L
PT: 11-12.5 seconds
aPTT: 30-40 seconds
,PTT: 60-70 seconds
Albumin: 35-50g/L
Treatment for fluid volume deficits
Main strategy is to identify and control source of fluid loss. Replace by oral, enteral, or IV
dependent on the severity of the deficit and acuity of the patient. Treatment with isotonic
solutions is key in management.
Patient is getting better if: gaining weight or has stabilized,Urine output is increasing, I & O are
balanced, Mucous membranes are moist, LOC intact, VS normal and Labs are normalizing:
Crystalloids are predominately based on a solution of sterile water with added electrolytes to
approximate the mineral content of human plasma (i.e. N/S, ringers lactate)
Colloids are often based on crystalloid solutions, thus containing water and electrolytes, but
have the added component of a colloidal substance that does not freely diffuse across a
semipermeable membrane. (i.e. pentastarch, dextran, albumin, etc.)For albumin the colloid is
albumin
No clear consensus if colloids vs crystalloids is better for volume resuscitation.
Sodium
Range 135 -145 mmol/L
Responsible for water balance
Required for normal transmission of impulses across muscle and nerve cells through sodium-
potassium pump mechanism
Role in maintaining acid-base balance
Changes in sodium levels alter water balance
Can increase acidity
Hypernatremia:
Water loss (dehydration)or sodium gain (hypertonic saline administration, adrenal tumor
causing increased aldosterone)
Primary prevention is thirst
First indicator is urine output- damage, increased urea and creatinine
Can lead to seizures or coma
Hypernatremia Treatment:
IV fluids (iso tonic)
Treat the underlying cause (DKA)
Hyponatremia:
Water excess (dilutional hyponatremia) or losses of Na containing fluids (too much NS)
,Usual issue is dilutional hyponatremia
Can lead to seizures and coma
Hyponatremia Treatment:
Fluid Restriction
If the risk is severe then hypertonic solutions are used (3% Sodium Chloride
Intravascular- in pipes, pull more water in if too much sodium= dehydration
Surgery- NS contributed to high levels of sodium, resistance to push against
I/O, foleys
Too quick of an overcorrection can result in seizures, coma, and death (etc.). Therefore, only
extreme measures are corrected quickly if the risk of seizures, coma, and death (etc.) are
present.
Creatinine
End product of muscle metabolism
Filtered in the glomerulus
Not reabsorbed in the tubules
Male - 53-106 mcmol/L
Female - 44-97 mcmol/L
Elevated creatinine shows kidney damage while low shows possible overhydration.
•High levels of creatinine usually mean low glomerular filtration rate.
•Urine output- poor, urea and creatinine may be in range- out of range= kidney damage
•Write out one liners, write assessment out before and then go in and check, and adjust
•Distance running- increase muscles, Advil, rhabdo, dark urine
Urea
End-product of protein metabolism
Filtered in the glomerulus
Eliminated in the urine
↑ BUN ↓glomerular function
Impacted by muscle mass
Normal Urea - 3.6-7.1 mmol/L
BUN to Creatinine Ratio:
Normal BUN to Creatinine ratio:
•10:1 to 15:1
, Osmolality
•Amount of concentration of solute in body water
•Reflects hydration
•Used as approximation of extracellular fluid status
•Normal range:
•Serum: 280-300 mOsm/kg
•Urine: 100-1300mmol/KG
•Sodium is main contributor in serum
•Urea is main component in urine
•Indicator of renal function
•When the renal function is normal the serum and urine osmolarity go the same direction (one
rises and the other rises). If there is impairment then then the urine osmolarity can become
more concentrated (higher) than the blood).
•Anuria is less than 100ml/day
•Oliguira is less than 500ml in 24 hours so if someone is in this face this is an expected amount
of urine and we are hoping to improve it or maybe the damage is already done and we are
happy with the little amount of urine we have!
Parenteral Nutrition
•The administration of nutrients through a vascular access device.
•Indicated as a substitute for oral/enteral feedings
•A sterile, chemical, hypertonic solution
•An intricate combination of protein, carbohydrates, fat, minerals, and electrolytes
•Individualized
•Can be a short or long term therapy
Used in the setting of GI dysfunction or patient's who are severely catabolic
PN should be reserved and initiated only after the first 7 days of hospitalization when enteral
nutrition is not available
Patient's unique requirements- based greatly on patient's weight, ideal body weight, current
blood work, liver function, kidney function, degree of stress and fluid requirements
Indicators for PN
•Any contraindication to enteral feeding
•Severe diarrhea and vomiting
•Complicated abdominal surgeries or trauma
•GI disease:
•Obstruction
