Admission order/IV Fluids Flashcards
What is the purpose of admission orders?
outline initial tx plan for pts entering medical facility for specialized care (means of communication)
If a pt plans to stay more than 2 midnights, you say they are? if not overnight stay?
a. inpatient
b. outpatient
What does observation admissions mean?
expected to stay only one midnight to observe progress
*can transition to inpatient
What is the difference between hospice care and home health?
a. hospice - palliative care with hospice at end of life
b. HH - needs skilled care at home
What does ADC VANDALISM stand for?
Admit
Diagnosis
Condition
Vitals
Activity
Nursing
Diet
Allergies
Lab and Diagnostics
IV fluids
Specialists/Consultations
Medication Monitoring
What should the admit specify?
- service
- attending doc
- unit
- cardiac monitoring - y/n
What pts are admitted to ICU?
- Patients requiring, or likely to require, advanced respiratory support
- Patients requiring support of two or more organ systems
- Patients with chronic impairment of one or more organ systems who also require support for an acute reversible failure of another organ.
What should you not list under diangosis?
- signs/symptoms
*list primary dx (even if only working dx)
When rounding on your first pt, you note that VS are good and they do not appear to have any life threatening duress. You note this pt to be:
stable
When rounding on your second pt, you note that BP is a little eveated, and pain scale is 6/10. They do not appear to have any life threatening duress. You note this pt to be:
fair
*implies the patient is experiencing a condition whereby they are not doing well and will need monitoring. It may be due to pain issues or other mild circumstances with minimal impairment of patient safety. Some would use “Ill-appearing” as an equivalent.
You note your third patient as “guarded”. What did you mean?
- a need to be monitored closely
- VS possibly labile
- mentation could be altered
- could be in“Toxic” category (ex. sepsis)
Where do you send critical pts?
ICU
*are potentially unstable or hx of being unstable
Your final pt of the day is a 65 y/o with stage four colon cancer. She is having significant dyspnea, and extreme bradycardia. They have decided to stop curative treatment, and have been placed in palliative care. You qualify this pt as?
expectant - likely to die within 72 hrs
(goal is sx control)
How often do you check VS?
4-8 hours typically
Define the following:
- Up ad lib
- Bedrest with assistance
- Bathroom privileges
- Bedrest
- Up ad lib- as the patient wants to get up, usually without help
- Bedrest with assistance- the patient stays in bed and only gets up with help
- Bathroom privileges- the patient can get up to the bathroom unassisted. “with help” can be added.
- Bedrest- should not get up at all
What are examples of diet orders?
- Regular
- Carbohydrate Consistent (diabetics)
- Clear liquid (pre-procedure pts; broth, jello, coffee)
- Full liquid (helps transition to reg diet; includes ice cream, soups)
- NPO (nothing by mouth; ex. pre-operation)
What does Dr. Tyler say is the most important feature of an Admissions order?
Medications
What is the goal of IV fluid therapy?
indicated to achieve or maintain fluid and electrolyte balance, replace or supplement needed blood components, provide nutrients, and administer medications.
What are the body water compartments and distributions?
How do illness/injury affect fluid/electrolyte balance?
- Non-specific metabolic responses to stress
- directly attributable to specific organ, system dysfunction, or the effects of drugs/IV therapies used to treat
- due to very restricted recent food intake or malnutrition.
What are the five Rs to fluid replacement?
What are the tonicity classificaitions of the following?
- NS, Lactated Ringer’s, D5W (+/-)
- 1/2 NS, D5W (+/-)
- 3% NaCl, D10W, D5 1/2 NS, D5NS, D5LR
- Isotonic
- Hypotonic
- Hypertonic
How much water does the average person require per day? Na and K?
- 25-30ml/kg of water
- 1mmol/kg of Na+ and K+
4 y/o male presents with N/V and diarrhea. You suscpect gastroenteritis, and start IV therapy. What are you correcting with your tx?
- dehydation (most common reason for IV therapy in kids)
- in this siutation, also hang IV ABs
Define age/weight for these stages:
- Infancy
- Toddler
- Preschool
- School-aged
- Infancy: birth to 12 months and 3-6 kg weight
- Toddler: 1-2 years and 6-12 kg weight
- Preschool: 4-6 years and 12-15 kg weight
- School-aged: 6-12 years and 16-35 kg weight
What is the Holliday-Segar Method?
- First 10kg = 100ml per kg in 24 hrs
- Second 10kg = 50ml per kg in 24hrs
- Other kg (or remaining kg) = 20ml per kg in 24 hrs.
What is the best way to calculate volume loss in kids?
- compare normal wt with current wt
*Replace half of fluid volume replacement dose in 8 hours, the rest over the subsequent 16 hours with ongoing monitoring
What clinical and lab values can be used to assess volume depletion in adults?
- BP
- JVP
- Urine [Na]
- Urine output
Most pts are treated with what type of saline?
isotonic or half isotonic
Exceptions:
- hypernatremia –> hypotonic
- hyponatremia –> hyper or isontonic
- blood loss –> isotonic or blood
- hypokalemia or metabolic acidosis –> maybe add K or bicarb
What is a concern with isotonic saline? D5W? Lactated ringer’s?
- metabolic acidosis with aggressive resuscitation
- electrolyte shifts due to hypotonicity after inital response phase
- increase embolic formation in midst of PRBC transfusion
Using the Holliday-Segar Method calculate the maintenance fluid to be given to a pt. weighing 22kg
