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Basic Principles N928 > Fluid and Blood Therapy > Flashcards

Fluid and Blood Therapy Flashcards

1
Q

Roles of Fluids in the Human Body

A

transport, temperature regulation, maintain internal environment

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2
Q

Transport

A

deliver oxygen and nutrients to cells and remove waste materials

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3
Q

Temperature and Regulation

A

blood circulation to the skin and sweating increase heat dissipation, helping to keep the body at a constant temperature

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4
Q

Maintain Internal Environment

A

body fluid properties are kept constant to maintain an efficient metabolism

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5
Q

Total Body Fluid composition

A

18% protein
60% water
16% fat
6% minerals etc

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6
Q

TBF composition of newborn

A

80%

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7
Q

TBF composition of toddler

A

70%

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8
Q

TBF composition of child

A

65%

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9
Q

TBF composition of Adult man

A

60%

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10
Q

TBF composition of adult woman

A

55%

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11
Q

TBF composition of seniors

A

50-55%

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12
Q

TBW compartments of females

A

45% solids

55% fluids

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13
Q

TBW compartments of males

A

40% solids

60% fluids

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14
Q

Fluids are composed of

A

2/3 intracellular fluid

1/3 extracellular fluid

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15
Q

Extracellular fluids is composed of

A

75% interstitial fluid

25% plasma

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16
Q

Calculate the amount of water in each compartment for a 100kg male

A 
TBW= 60%
ICF= 2/3 of TBW
ECF= 1/3 of TBW
Interstitial fluid 75% of ECF
Plasma 25% of ECF
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17
Q

Why is there more fluid in the interstitial compartment than the plasma?

A

plasma and proteins + reservoir

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18
Q

Electrolytes found in the ICF

A

Magnesium
Potassium
Phosphate
Proteins

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19
Q

Electrolytes in the ECF

A 
Chloride
sodium
calcium
bicarb
glucose
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20
Q

Cell membrane transport

A

no extra energy required
passive (simple facilitate)
osmosis

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21
Q

Passive diffusion is

A

simple or facilitate

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22
Q

Simple diffusion

A

doesn’t have a carrier

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23
Q

Facilitated diffusion

A

has a carrier

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24
Q

Osmosis is the

A

simple diffusion of water

from a high concentration of water to a low concentration of water across a semi permeable membrane

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25
Is the fluid inside the RBCs considered ICF or ECF?
ICF
26
Pc
capillary pressure hydrostatic pressure pushes on the capillary wall
27
Pi
interstitial fluid pressure | the push of fluid into the capillary
28
Pic
plasma colloid osmotic pressure | the pull into the capillary (albumin)
29
Pii
interstitial fluid colloid osmotic pressure | the release of fluid into the interstitial space
30
Osmolality
number of osmoles of solute in a kilogram of solvent
31
Osmolarity
number of osmoles of solute in a liter of solution
32
osmotic pressure
pressure needed to stop osmosis
33
osmotic pressure is dependent on
number of molecules | the size of the molecules does not affect the osmotic pressure
34
P=n/v
number of solutes, v= volume
35
osmole
the osmosis caused by a mole
36
millimole
molecular weight in milligrams
37
what unit do we use
mOsm
38
Mole
standard unit for measuring large quanities of very small atoms, molecules or particles
39
Avogardo's number
6.022x 10^23 | the number of atoms, molecules or particles in a mole is the same for all substances
40
omostic pressure depends
number of molecules not the mass
41
Calculate osmolality
2 x Na +glucose/18 +BUN/2.8
42
Normal Plasma Osmolality
290 mOsm/L
43
Homeostasis
Osm IVF =Osm ISF= Osm ICF= 290 mOsm/L
44
TOnicity
the ability of the combined effect of all the solutes to generate an osmotic driving force that causes water movement - only includes the effect osmoles
45
Hypertonic Solution
increased plasma osmolality above the normal level | >295mOsm/L
46
Isotonic Solution
normal plasma osmolality | 290mOsm/L
47
Hypotonic Solution
decreased plasma osmolality below the normal level | < 275mOsm/L
48
Sodium
most abundant electrolyte in ECF responsible for most of the osmotic activity of the osmotic activity of the ECF Gain of Na+--> gain of H20 Loss of Na+---> Loss of H20 ECF [Na] > ICF [Na+] d/t the NaK ATPase pump alterations in ECF [Na] greatly affects the movement of water across the cell membrane
49
Serum Na
Sernum Na ~ TBNa/TBW
50
Fluid Disorders
isotonic fluid disorders hypotonic fluid disorders hypertonic fluid disorders
51
Isotonic fluid disorders
isotonic loss of fluid | isotonic gain of flui
52
Hypotonic fluid disorders
hypertonic loss of Na gain of pure water hypotonic gain of Na
53
Hypertonic fluid disorders
hypotonic loss of Na loss of pure water hypertonic gain of Na hyperglycemia
54
isotonic loss or gain of fluid
no change to serum Na no osmotic gradient no water shift across membranes no change in ICF compartment
55
isotonic loss of fluid example
hemorrhage
56
Hemorrhage is
``` an ECF volume depletion Serum Na normal serum osmolality stays normal ICF normal Administer isotonic fluid ```
57
Isotonic gain of fluid example
excessive gain of isotonic fluid
58
Excessive gain of isotonic fluid
ECF volume overload ECF increase Serum na/osmolality/ICF= normal
59
hypotonic fluid disorders
plasma osmolality is low caused by low serum na osmotic gradient shifts water from ECF to ICF, ICF volume expansion cellular swelling
60
Hypertonic loss of Na examples
diuretics (loop, thiazide) addison's disease (decrease aldosterone) 21 hydrodxylase deficiency (decrease aldosterone)
61
Hypertonic loss of Na is
ECF volume depletion decrease in serum NA, decrease in TBNa/TBW Decreases ECF, Serum Na, Serum osmolality, increase in ICF
62
Gain of Pure water example
SIADH
63
Gain of Pure Water
``` decrease serum Na TBNa / increased TBW ECF increase Serum Na decrease Serum osmolality decrease ICF increase ```
64
Treatment of gaining of pure water
restrict water | treat underlying problem
65
Gain of hypotonic solution example
absorption of electrolyte- free irrigation solution (TURP or endometrial ablation)
66
Gain of hypotonic solution
decrease serum Na = TBNa/increase in TBW increase in ECF decrease in serum Na, osmolality increase in ICF
67
S/S of gain of hypotonic solution
seizures, pulmonary edema, difficulty ventilating, cerebral edema
68
Treatment of gain of hypotonic solution
diuresis | 3% NS
69
Hypotonic Gain of Na Example
Overload states | cirrhotic, nephrotic, CHF
70
Hypotonic Gain of Na
decrease serum Na= increase TBNa/increased TBW ECF increased decrease serum Na and serum osmolality increased ICF
71
S/S of hypotonic gain of NA
``` dependent pitting edema cavity effusions (ascites) SOB increase Body weight mental status changes ```
72
Treatment of hypotonic gain of Na
restrict salt and water | diuretic
73
Hypertonic Fluid Disorders
plasma osmolality is high caused by a high serum Na or glucose osmotic gradient water shifts from ICF to ECF ICF volume contracts (cell shrinks)
74
Hypotonic loss of Na examples
sweating, osmotic diarrhea, osmotic diuresis, vomiting
75
Hypotonic loss of Na
increase in serum Na= decrease in TBNa/decrease TBW ECF and ICF decrease Serum Na and Osmolality increase
76
S/S of hypotonic loss of Na
dry skin, mucuous membranes dizzy confusion mental status changes increase HR
77
Treatment of hypotonic loss of Na
administer isotonic fluid (to maintain BP) then switch to hypotonic fluid (0.45% NS)
78
Loss of Pure Water Example
Diabetes Insipidus | excessive water evaporation off the skin surface (fever, burns, insensible fluid loss)
79
Loss of Pure Water
increase serum Na = TBNa/decreased TBW ECF decreased ICF decreased Increase in Serum Na and osmolality
80
Loss of Pure water s/s
confusion, drowsiness mental status changes
81
Treatment of Pure water
administer water D5W | treat underlying problem
82
Hypertonic Gain of Na example
NaHCO3 infusion | infusion of hypertonic saline, antibiotics that contain Na, sodium modeling in hemodialysis
83
Hypertonic Gain of Na
increase ECF Decrease ICF Increase serum Na and osmolality
84
S/S in hypertonic gain of Na
mental status
85
Treatment of hypertonic gain of Na
stop the infusion
86
Hyperglycemia Example
``` Diabetic Ketoacidosis (type 1 DM) Hyperosmolar non-ketotic coma (type 2 DM) ```
87
Hyperglycemia
decrease serum Na = decrease TBna/ TBW decrease ECF and ICF decrease serum Na increase Osmolality
88
S/S of hyperglycemia
mental status changes | diabetic coma
89
Treatment of hyperglycemia
treat underlying cause
90
Alterations in Fluid Balance Preoperative
``` burns vomitting diarrhea fever gastric suction bowel prep ```
91
Alterations in Fluid Balance intraoperative
hemorrhage evaporative loss third spacing (manipulation of tissues) hypo-osmolar irrigation (TURP, endometrial ablation)
92
Alterations in Fluid balance anesthesia
vasodilation release of ADH increase evaporative loss from ventilation mobilization of third space fluids on POD #3
93
ADH
nonapeptide synthesized in hypothalamus released in response to stress MOA- reabsorption on the collecting ducts in kidneys causing water retention potential to offset the hypovolemic effect of fasting
94
Is urine output a valid indicator of perioperative volume status?
since UOP can be affected by multiple factors it is not a sensitive indicator of circulating blood volume recommendation- isolated low UO should not trigger fluid therapy and extensive diagonstic efforts
95
Goal Directed Fluid therapy
maximizing cardiac flow parameters as a surrogate for oxygen delivery improves outcomes
96
Primary objective of periop fluid therapy
maintenance of normovolemia in order to maintain adequate tissue perfusion
97
Fluid challenge
CO will usually increase in response to a fluid challenge
98
Traditional Method of Fluid therapy
calculate fluid requirements for | surgical loss deficit and maintenance
99
Hourly Maintenance Fluid Requirements
4 mg/kg/hr 0-10kg 2mg/kg/hr 11-20kg 1mg/kg/hr 21+ kg
100
NPO Deficit
hourly maintenance requirement x # of hours NPO
101
Minimal surgical loss additional fluid requirements
0-2ml/kg | short superficial procedure
102
Moderate surgical loss additional fluid requirements
uncomplicated intraabdominal or orthopedic procedure | 2-4ml/kg
103
severe surgical loss additional fluid requirement
prolonged highly invasive procedure | 4-8ml/kg
104
D5W
hypotonic solution has little place perioperatively cause free water intoxication adn hyponatremia additional calorie but also can cause hyperglycemia
105
Evaporative Loss and 3rd Space Loss
evaporative loss related directly to surface area of surgical wound and duration of exposure 3rd space loss is due to fluid shifts and intravascular volume deficit caused by re-distribution of fluids
106
Calculating 3rd Space (need to know)
type of procedure degree of exposure amount of surgical manipulation

Basic Principles N928 (10 decks)

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