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Advanced Health Assessment Unit 2 > Fluid > Flashcards

Fluid Flashcards

1
Q

How do you calculate Total Body Water (TBW)?

A

0.6 x body weight

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2
Q

How do age, gender, and obesity affect Total Body Water?

A

Decreases with Age
Higher in men vs women
Decreases with Obesity

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3
Q

Total Body Water is ____ to lean body mass.

A

Proportional

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4
Q

Total Body Water is ____ to obesity

A

Inverse

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5
Q

Normal Blood Volumes

A

Adult Male: 75
Adult Female: 70
School age child: 75
Infant: 80
Neonate: 85

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6
Q

What are the components of the ECF?

A

Interstitial (3/4), Intravascular (plasma - 1/4) and Transcellular fluid (portion of TBW that is contained within epithelial lined spaces - minimal)

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7
Q

ECF is ___ of TBW

A

1/3

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8
Q

ICF is ___ of TBW

A

2/3

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9
Q

Water moves across a semipermeable membrane from more dilute to more concentrated. Ensures appropriate concentration of fluid/electrolytes across compartments

A

Osmosis

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10
Q

Based on the amount of solute in a liter of solution (Na, K, BUN, glucose)

A

Osmolarity

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11
Q

Normal Osmolarity

A

285-295 mOsm/kg

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12
Q

Pressure across a semipermeable membrane exerted by a solute-containing solution
-Plasma osmotic pressure = 28 mmHg (Protein 19 mmHg)

A

Osmotic Pressure

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13
Q

Has a “pull” effect
-Proteins are the only dissolved substance that do not readily diffuse through the capillary membrane.

A

Plasma Oncotic Pressure

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14
Q

Hydrostatic Fluid Pressure (movement from areas of high to low pressure) is balanced by Colloid Osmotic Pressure-Oncotic (proteins being impermeable)

A

Starling’s Law of Capillary Filtration

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15
Q

Movement OUT of capillaries occurs at the _____ end

A

Arterial

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16
Q

Movement INTO capillaries occurs at the _____ end

A

Venous

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17
Q

Has an osmotic pressure lower than body fluids; fluid goes into the cell (can lead to lysis)

A

Hypotonic

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18
Q

Has an osmotic pressure that is the same as body fluids; equal movement in/out

A

Isotonic

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19
Q

Has an osmotic pressure greater than body fluids; fluid moves out of the cell

A

Hypertonic

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20
Q

Most common isotonic fluid given in the OR.
-Cannot give w/ blood d/t Ca+
-Caution with metabolic or respiratory alkalosis → already increased levels of bicarb/lactate
-Caution with severe hepatic failure → impaired utilization of lactate may lead to accumulation
-Caution with severe renal failure → risk of hyperkalemia (low risk because only 4 mEq of K per L)

A

Lactated Ringers

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21
Q

An isotonic fluid, works well with maintaining a normal environment
-More expensive; does not contain Ca+ so okay with blood

A

Plasmalyte

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22
Q

Compared to plasma, it has a lower pH, higher osmolarity, and higher chloride content.
-With excessive admin (>2-3L) can lead to → hyperchloremic metabolic acidosis – days to resolve in pts with renal failure

A

Normal Saline

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23
Q

Contains 513 mEq/L of Na & Cl with an osmolarity of 1025 mOsm/L.
-Risk of hypernatremia, hyperchloremia, & cellular dehydration
-Consider giving through a central line & gradually administered to achieve Na of 145-155 mEq/L
-Uses: severe symptomatic hyponatremia, fluid resuscitation, increased ICP

A

Hypertonic Saline (3%)

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24
Q

You should increase the Na by no more than ____ due to the risk of cerebellar pontine demyelination

A

10-20 mEq/L/24 horus

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25
Q

Really a hypotonic solution as the dextrose is rapidly metabolized. Results in free water.
-Used as a metabolic substrate for neonates (monitor BG) and Diabetics (used with insulin gtt)

A

D5W

26
Q

Plasmapheresis & pasteurized
-Not associated with anaphylaxis, infection, or coagulopathy

A

Albumin

27
Q

Salt poor; pulls water intravascularly, unpredictable effects
-Less dilute

A

25% Albumin

28
Q

Used in OR, but requires an intact capillary membrane to stay in the intravascular space (for about 16 hours). Considered isotonic to plasma

A

5% Albumin

29
Q

Has a dilutional effect on coagulation factors, direct inhibition of clot factors (reduction in platelet aggregation), binds to Factor 8, VWF, and fibrinogen, FDA Black Box Warning! (not to use in critically ill patients…increased risk of mortality & renal failure)

A

Hetastarch

30
Q

What are the advantages of Crystalloids?

A

Inexpensive, promotes UOP, restores 3rd space losses.
-Used most often for initial resuscitation

31
Q

Disadvantages of Crystalloids?

A

Dilutes plasma proteins, reduces capillary osmotic pressure, possible peripheral edema and pulmonary edema, and has a transient effect

32
Q

Advantages of Colloids?

A

Sustained impact on plasma volume, smaller volume needed for fluid resuscitation, less peripheral edema, more rapid onset, useful in conditions of vascular permeability

33
Q

Disadvantages of Colloids?

A

Coagulopathies, anaphylaxis potential, Ca can bind to proteins, potential for renal failure & altered immune response, and osmotic diuresis

34
Q

Patients who have been NPO, taken a bowel prep, or have chronic diuretics or chronic renal failure are at risk of?

A

Hypovolemia

35
Q

Why are chronically hypertensive patients at risk for hypovolemia?

A

Relative hypovolemia occurs because, hypertensive patients have constriction of their blood vessels, so fluid within them is minimal. When they get anesthesia, they vasodilate, and lose what little fluid they had in their blood vessels.

36
Q

Patients at risk for Fluid complications

A

-Trauma/Burns: fluid losses or shifts
-Sepsis: Vasodilation
-Liver Failure: dec plasma proteins
-Chronic GI losses (vomiting - replace with NS)
-Chronic Diarrhea (replace with LR)
-Anesthesia causes inc ADH (hold onto fluid)
-Evaporative losses due to mechanical ventilation; dec release of Atrial Natriuretic Factor (produces Na to help retain fluids)

37
Q

Supine hypotension, positive tilt test (increase HR by > 20 and decrease SBP by >20), oliguria, weak peripheral pulses, prerenal azotemia (BUN-Cr ratio >20), low urinary Na (body conserves Na if dec blood volume)

A

Evidence of Hypovolemia

38
Q

Minor Hypovolemia causes what metabolic disturbance?

A

Metabolic Alkalosis

39
Q

Major Hypovolemia causes what metabolic disturbance?

A

Metabolic Acidosis

40
Q

What are the goals of fluid therapy?

A

1) Provide adequate delivery of O2 to the tissues
2) Maintain environment (pH and electrolytes) necessary for proper function of cells and organs.

41
Q

Why is there a risk of overresuscitating patients in anesthesia?

A

Patients have an inc release of ADH and are holding onto water already

42
Q

What is the 4-2-1 rule?

A

For the first 10kg, 4mL/kg/hr
For the second 10kg, 2mL/kg/hr
For the remainder, 1mL/kg/hr

43
Q

How much do you add if patient has received a bowel prep?

A

Replace an additional 1L upfront, in the first 1-3 hours of surgery

44
Q

How do you account for NPO deficit in fluids?

A

hours NPO x hourly maintenance requirement replaced over the first 2-3 hours of the surgery

45
Q

Evaporative or 3rd Space Losses are based on potential tissue trauma. How do you account for these?

A

Minimal 0-2 mL/kg/hr (ex: cataract)
Moderate 2-4 mL/kg/hr (ex: laparoscopic)
Severe 4-8 mL/kg/hr (ex: intra abd)

46
Q

True surgical losses account for actual bleeding. How do you replace these based on crystalloid vs colloid?

A

Replace with crystalloid on a 3:1 basis (give 300mL fluid for 100mL blood loss)
Replace with colloid on a 1:1 basis (give 100 mL albumin for 100mL blood loss)

47
Q

How do you calculate estimated blood volume?

A

Estimated Blood Volume = typical blood volume x patient weight

48
Q

How do you calculate Allowable blood loss?

A

Allowable Blood Loss = EBV x (hct initial - hct final) / hct initial

49
Q

What does allowable blood loss tell you?

A

Gives you a starting point to know when they will lose enough blood to get to your lowest acceptable Hct.
-Indicates to you when you need to draw an H/H

50
Q

-Temperature (warm the fluids)
-pH (can lead to acidosis)
-RBC (stored RBC has a lower pH & 2,3-DPG-left shift. Mass transfusion can lead to low Ca & hyperkalemia)
-WBC (neutrophils activated)
-Platelets/Coagulation (decreased function)
-Albumin (can exacerbate third spacing)
-Inflammatory cytokines (increased by blood & colloids)

A

Variables affected by fluid administration

51
Q

Should not receive glucose containing solutions due to the risk of intracranial ischemia

A

Cerebral Edema/Neurosurgical patients

52
Q

Fluid restriction has been shown to decrease morbidity, but it’s complicated bc need more fluid for the other body systems (kidneys)

A

ARDS

53
Q

Should receive judicious fluids due to risk of 3rd spacing causing increased cardiac work (Diastolic HF)

A

CHF

54
Q

Patients should receive MINIMAL fluids, avoid blood products due to inflammatory response, and risk of postpneumonectomy pulmonary edema

A

Lung Resection

55
Q

Consider EARLY Colloid replacement. Replace paracentesis fluid >4L removed with Albumin.
-Risk of comorbidities: cerebral edema, hepatorenal syndrome, and electrolyte disturbances

A

Liver Failure

56
Q

BSA% burned x wt x 4 = total volume in 1st 24 hours
-Give ½ in first 8 hours, consider albumin after first 24 hours

A

Parkland Formula for Crystalloid fluid replacement in burn patients.

57
Q

These patients may experience transient intraoperative oliguria due to pressure on the abdomen from CO2. Causes dec blood flow to the kidneys. Don’t use UOP in these cases as a guide for fluid replacement.

A

Laparoscopy

58
Q

These patients require aggressive and early fluid replacement

A

Sepsis

59
Q

If not appropriately resuscitated, these patients can experience the lethal triad of acidosis, hypothermia, and coagulopathy

A

Massive Trauma

60
Q

These patients are at risk of LARGE fluid shifts leading to cardiopulmonary complications. Tumescent technique uses diluted lidocaine with epi in large volumes of saline.

A

Liposuction

61
Q

Hyperchloremic metabolic acidosis → exacerbated by NS admin (dilution of bicarb), acidosis contributes to decreased splanchnic blood flow (gut ischemia), and hyperchloremia contributes to renal vascular constriction
- If Anuric: judicious fluid because no way to get rid of it
-If Nephrotic syndrome: fluid replacement with albumin
-Plasmalyte vs LR vs NS: all are acceptable in reasonable quantities. (Dr. Mund usually gives LR unless hyperkalemia)

A

Renal Patients

Advanced Health Assessment Unit 2 (6 decks)

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