Exam #2: Parenteral Fluid Therapy Flashcards
What are the three TYPES of IVF?
- Crystalloids
- Colloids
- Blood/Blood Products
What is the most commonly used type of IVF?
Crystalloids
What are the four types of Crystalloid IVFs we discussed?
- Isotonic
- Hypertonic
- Hypotonic
- D5W
What is the main osmotically active particle in Crystalloids?
SODIUM
What are the three types of Isotonic Crystalloids, and what are they used to treat (2)?
Dehydration, Hypovolemia
- 0.9% NS
- LR
- Plasma-Lyte
What are the four components of LR?
- Na+
- Cl-
- K+
- Ca2+
Which type of IVF is most physiologic to the normal body?
Plasma-Lyte
- Type of Crystalloid
How does sodium content in Hypertonic and Hypotonic Crystalloids compare to Isotonic?
- Hypertonic: MORE Na+ than body is used to
- Hypotonic: LESS Na+ than body is used to
What is the primary type of Hypertonic Crystalloids, and what is it used to treat?
Life-threatening hyponatremia with water retention
- 3% NS
With which TYPE of IVF should you caution rapid correction could cause central pontin myelinolysis (CPM), osmotic demyelination?
Hypertonic Crystalloid
What two complications should you be cautious of with using Hypertonic Crystalloid?
- Central pontin myelinolysis (CPM)
- Osmotic demyelination
With which ROUTE of IVF should you caution rapid correction could cause central pontin myelinolysis (CPM), osmotic demyelination?
Replacement
What two complications should you be cautious of when administering Replacement IVF?
- Central pontin myelinolysis (CPM)
- Osmotic demyelination
What are the two types of Hypotonic Crystalloids, and what are they used to treat?
Maintenance Fluids (long- term NPO)
- 0.5 NS
- 0.25 NS
What should Hypotonic Crystalloids NOT be used to treat, and why?
NOT dehydration/hypovolemia
- Can’t replace volume deficit
What is D5W, and what is it used to treat?
Hyperglycemia
- 5% dextrose in water
What substances do Colloids contain?
High-molecular weight substances that do NOT migrate easily across capillary walls
When are Colloids used, and in what two types of patients specifically?
When Crystalloids cannot treat low plasma volume due to low osmotic pressure
- Burn patients
- Peritonitis
What are the three types of Colloids, and which is MOST commonly used?
- Albumin Preparations = MOST common
- Dextran
- Hetastarch (Hydroxyethyl Starch)
What are the two types of Albumin Preparations, and what are they used to treat?
Edematous patients to move fluid into vascular space/blood
- 5% Albumin
- 25% Albumin
When are Albumin Preparations most useful, and in what four types of patients specifically?
Useful if Albumin is <2.5 mg/dL
- Liver disease
- Peritonitis
- Burns
- Surgical patients
What are the three types of Blood/Blood Products?
- PRBCs (Packed Red Blood Cells)
- Platelets
- FFPs (Fresh Frozen Plasma)
What are PRBCs always combined with, and why?
Combination with Crystalloids
- Expand intravascular volume
What is the use of PRBCs, and why would this be necessary (2)?
Blood transfusions
- Due to GI bleed or severe anemia
What are the two uses of Platelets?
- Thrombocytopenia
- Impaired platelet function
What are the two uses of FFPs?
- Major bleeding complications from Warfarin
- Vitamin K Deficiency
What are the three WAYS/FORMS (i.e. forms) by which you can give IVF?
- Bolus
- Maintenance
- Replacement
What four types of IVF can be given in Bolus form?
- NS
- LR
- Plasma-Lyte
- PRBCs
Under what condition would a Bolus be used, and what might cause this (2)?
Hypovolemia
- Dehydration
- Acute blood loss
In what two patient types should Bolus use be cautioned?
- HF
- Renal disease
Under what condition would Maintenance be used, and what might cause this?
To maintain ongoing loss of water/electrolytes
- Patients are not eating or drinking normally (ex. NPO for surgery)
What is the primary form of Maintenance given to patients?
D5/0.5 NS with 20 meq KCl
What type of calculation is used to evaluate Maintenance for a normal adult patient?
“kg Method”
- Uses body weight to determine water needs
WHY is the “kg Method” adjusted for children?
Children require LESS Na+ than adults
How should K+ be administered (form/way)? How should it NOT be administered?
Give K+ ONLY as Maintenance
- Do NOT give as Bolus
Under what condition would Replacement be used?
Correct existing water/electrolyte deficits
What three things can be monitored to evaluate the effectiveness of Replacement IVT?
- Vital signs
- UO
- Symptoms/clinical presentation
What type of calculation is used to evaluate Replacement for a surgical patient?
“Parkland Formula”
What two types of calculation are used to evaluate Replacement for a burn patient?
- “Parkland Formula”
- “Rule of Nines”
What is the most common type of Parenteral Nutrition? What is the other type (more rare)?
Total Parenteral Nutrition (TPN)
- Peripheral Parenteral Nutrition (PPN) rarely used
What are the five indications for use of TPN?
- Need for bowel rest
- Small bowel obstruction
- Complete bowel obstruction
- Inflammatory bowel disease
- Pre-existing nutritional deprivation
What is the specific route of entry for TPN, and what two complications is this used to avoid (ROUTE specific)?
SVC (central)
Avoids peripheral…
- Thrombophlebitis
- Vein intimal damage
What are the two general complications associated with TPN?
- Metabolic/electrolyte abnormalities
- Catheter-related complications
What are the four catheter-related complications associated with TPN?
- Air embolism
- PTX
- DVT (due to catheter)
- Infection
