Dehydration - Stress Flashcards
What does the mnemonic BUFALO relate to in treatment of sepsis?
B = blood cultures
U = urine measurement
F = fluid challenge
A = antibiotics
L = lactate
O = oxygen
In the sepsis 6 is antibiotics. Should patients be given broad or narrow spectrum IV antibiotics?
- broad spectrum
When performing a fluid challenge in a patient with sepsis, how much fluid should they be challenged with?
1 - 10mg/kg
2 - 30ml/kg
3 - 3ml/kg
4 - 50ml/kg
2 - 30ml/kg
- purpose is to increase intravascular pressure
When performing a fluid challenge in a patient with sepsis, they should be challenged with 30ml/kg of fluids. Generally, how quickly should this be delivered?
1 - 500ml over 15-20 minutes
2 - 500ml/10 minutes
3 - 3L/hour
4 - 1L over 15-20 minutes
1 - 500ml over 15-20 minutes
- 250ml over 30minutes if patient is frail
There are 2 types of fluids patients can be given, colloids and crystalloids. Which of the 2 will remain in the vasculature of the patient?
- colloids due to large molecular weight particles
- too big to diffuse across normal endothelium so they remain in the blood
Colloids are IV fluids where almost 100% remains in the intravascular space. Although not given very often, they can be prescribed for high protein losses. They generally contain albumin (20 or 4.5%) or dextrose. Of the conditions below, which would generally receive colloids?
1 - mother giving birth
2 - burn victim
3 - internal haemorrhage
4 - transplant
2 - burn victim
- the body loses skin, connective tissue and even muscle containing high protein
- the body tries to compensate and therefore needs a lot of protein to heal
What is a crystalloid solution?
1 - aqueous solution alone
2 - aqueous solution containing mineral salts and small molecules
3 - aqueous solution containing proteins
4 - aqueous solution containing dextrose
2 - aqueous solution containing mineral salts and small molecules
Crystalloid fluid is used as normal saline, which is the most common fluid given to patients. Normal saline contains Na+ and Cl-. What are the normal concentrations of Na+ and Cl- in normal saline?
1 - Na+ = 154 mmol/L and Cl- = 54 mmol/L
2 - Na+ = 124 mmol/L and Cl- = 104 mmol/L
3 - Na+ = 54 mmol/L and Cl- = 154 mmol/L
4 - Na+ = 154 mmol/L and Cl- = 154 mmol/L
4 - Na+ = 154 mmol/L and Cl- = 154 mmol/L
- normal Na+ in blood = 154 mmol/L
- normal Na+ in blood = 96-106 mmol/L
When prescribing a patient a crystalloid solution roughly how much of the fluid will remain in the intravascular and interstitial fluids?
1 - intravascular = 25% and interstitial = 75%
2 - intravascular = 75% and interstitial = 25%
3 - intravascular = 50% and interstitial = 50%
4 - intravascular = 80% and interstitial = 20%
2 - intravascular = 75% and interstitial = 25%
- due to small molecular size the fluid moves across endothelium
Why is taking a detailed history important in a patient who is suspected of being hypovolemic?
- ask them about normal fluid intake
Which of the following is not a measure of outgoing fluid?
1 - urine measurement
2 - stool output
3 - vomiting
4 - tears
5 - sweat
4 - tears
In relation to recording fluid levels, why is it important that medication is recorded accurately?
- often given as an IV so will be contained in saline
- diuretics are important for fluid output
In cases of shock and/or dehydration what happens to capillary refill time?
- becomes slower
- not as much blood flow and cold so takes longer
In cases of shock and/or dehydration what happens to skin turgor (skins elasticity)?
- decreases
- does not return to normal as quickly
In cases of shock and/or dehydration what happens to mucus membranes?
- become dry
- can see this in tongue and eyes
In cases of shock and/or dehydration are patients likely to experience oedema?
- yes
- generally in ankles and sacrum due to gravity and bed rest
In cases of shock and/or dehydration what can happen to a patients pulse rate and volume?
- pulse rate increases as less blood
- pulse volume will be reduced as less blood
Haematocrit is a measure of the blood. What is haematocrit?
1 - volume of blood volume made up of WBCs
2 - protein in the RBCs
3 - protein in the WBCs
4 - volume of blood volume made up of RBCs
4 - volume of blood volume made up of RBCs
Haemoglobin is a measure of the blood. What is haematocrit?
1 - volume of blood volume made up of WBCs
2 - protein in the RBCs
3 - protein in the WBCs
4 - volume of blood volume made up of RBCs
2 - protein in the RBCs
- carries O2 to tissues
What happens to the urea:creatanine ratio during times of stress and/or dehydration?
- increases
- sign kidneys are not working properly
What is the formula for calculating serum osmolality?
1 - (2xNa) + (2xK) + Glucose + Urea
2 - (Na) + (2xK) + Glucose
3 - (2xNa) + (K) + Glucose + Urea
4 - (2xNa) + (2xK) + Urea
1 - (2xNa) + (2xK) + Glucose + Urea
We can calculate serum osmolality using the following equation: (2xNa) + (2xK) + Glucose + Urea. What happens to osmolality during stress and/or dehydration?
- increases
- fluid levels drop and electrolyte content increases
In a patient who is dehydrated and/or who’s body is under stress, why can a chest X-ray be useful?
- respiratory and cardiac defects are often the primary site of inflammation and sepsis
- fluid leaks through endothelium into the lungs
Normal saline is a fluid given to patients when they need to increase their fluid levels. What does it mean for it to be normal saline?
1 - composition is the same as plasma fluids
2 - osmolality is the same as the human plasma
3 - when given IV it will not cause RBCs to rupture
3 - when given IV it will not cause RBCs to rupture
