Exam 1 Flashcards
Intracellular water volume is how much of body weight and found mostly where?
2/3, and mostly found in muscle mass
What is your total body water?
50-80%
Extracellular water is how much of body weight and where is it mostly found?
20%, and mostly found in CV system and interstitial spaces
Plasma is what percentage of extracellular fluid and how much of blood volume?
25% of extracellular, and 50% of blood volume
Blood volume is how much of your total body weight?
approx 8% (15% arterial and 85%venous)
Formula for male blood volume?
75ml/kg
Formula for female blood volume?
65ml/kg
Formula for neonate blood volume?
85ml/kg
Formula for preemie blood volume?
90ml/kg
How does body water differ from males, females, elderly, and newborns?
Male-60% water, Female-50%, elderly-45-55%, newborn-75-80%
What are the major components in intracellular?
K+, Mg, Phos, proteins
Major components of extracellular fluid?
Na+, Ca++, Cl-, HCO3, Glucose
What is orthostatic BP?
systolic bp decrease 20mmHg or more from supine to standing or sitting. Indicative of 6-8% volume deficit
What are compensatory responses to intravascular deficit (orthostatic hypotension)?
increase in HR but not if beta blocked
How much intravascular volume loss is need to cause a decrease in arterial BP?
30%
Lab signs of hypovolemia
Increased Hct, metabolic acidosis, urine specific gravity 1.010, urine osmolality >450
NPO fluid calculation is What?
1st: 10kg= 4ml/kg/hr, next: 10kg= 2ml/kg/hr, each kg over 20kg 1ml/kg/hr. (quick way= (weight + 40 ml)x hrs NPO)
What is needed to obtain informed consent?
Make sure patient understands: 1. type of surgery being done, 2. Understand anesthetic type, risks and questions about anesthesia, 3. Explain possible complications and document
When reviewing chart make sure surgical consent is signed by whom?
(Adult non-emergent)-Patient or legal guardian
(Emergency)- closest relative or surgeon
(under 18)- signed by parent or closest legal guardian
Old anesthetic records are helpful why?
can give info on past difficult anesthetics and intubations
What other allergy is associated with an allergy to Avocado, Bananas, Chestnuts?
Latex
If anaphylaxis occurs intra-operatively and no source can be identified what could be a possible source?
Latex
What Meds should you continue prior to surgery?
4-As DHGTI- Antihypertensives, Antianginal, Anticonvulsants, Asthma, Digitalis, Hormones, GERD, Thyroid, Insulin (for insulin see pg. ….)
What is Malignant Hyperthermia?
genetic inability to breakdown succinalcholate & anesthesia which causes increases in Temp, Ca++ release, contractions, CO2, HR, acidosis, Rhabdo
Treatment for Malignant Hyperthermia?
Dantrolene
If patient has taken steroids in last 6 months what med should be given?
Hydrocortisone 100mg q6hr
Up to what time can a patient have black coffee before sugery?
2hrs (clear liquid as long as no creamer)
Up to what time can a patient have any food they want before surgery?
up to 8hrs
Up to what time can a patient have light meal or for baby infant formula/non-human milk before sugery?
up to 6 hrs
Infants can have breast milk up to what time before surgery?
4hr
What lab should be done on all women under 50?
Serum or urine HCG (pregnancy)
Abnormal blood chemistry such as electrolytes are most common in what patient populations?
Chronic diuretic therapy, cardiac history, renal disease, diabetic
In assessment of patient preparing for emergent surgery what key evaluations should be made?
- last oral intake (always presume full stomach), 2. get type and cross and is blood available, 3. Check/get IV access or lines, 4. Allergies, 5. Pertinent med hx and system review
If child is scheduled for non-urgent surgery and has upper respiratory infection what should you do?
- If severe symptoms postpone 4 weeks
- If case under general anesthesia consider risk factors and risk/benefit (avoid ETT, consider LMA, hydrate, humidify, anticholinergics?)
What are the goals of general anesthesia?
Amnesia, analgesia, skeletal muscle relaxation, and control of SNS responses
What is the gold standard for local anesthetics?
bupivacaine last 2-3 hrs
Describe the ASA classification system?
P1= normal healthy pt. P2= pt with mild systemic disease P3= pt with severe systemic disease or multiple mild disease P4= disease is constant threat to life P5= Moribund pt. not expect to survive without surg P6= brain dead organ donation E = emergency qualifier and can be added to each class
Major intracellular and extracellular cations?
- intracellular- Na+
- extracellular- K+
What labs would be indicators of possible hypovolemia?
increase hematocrit
metabolic acidosis
urine specific gravity 1.010 (normal 1.010-1.025)
urine osmolality >450
Absorption of irrigation solutions during TURP’s or endometrial ablations can lead to what?
hyponatremia
What is the treatment for hyponatremia?
Hypertonic Saline, correct underlying problem (abandon surgery), restrict fluids, increased H2O loss (diuretics if hypervolemic).
What happens with K+ levels with each 10mmHg decrease in PCO2?
They decrease approx 0.5mEq/l (K+ high with acidosis and decreases with alkalosis)
What is the treatment for hyperkalemia?
IV calcium 1gm
Alkalosis (hyperventilate, IV NaHCO3)
Albuterol 5mg/3cc saline q20min
Glucose 25gm followed by 10-15units reg insulin