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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
Q

Is the fluid inside the RBCs considered ICF or ECF?

A

ICF

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26
Q

Pc

A

capillary pressure
hydrostatic pressure
pushes on the capillary wall

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27
Q

Pi

A

interstitial fluid pressure

the push of fluid into the capillary

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28
Q

Pic

A

plasma colloid osmotic pressure

the pull into the capillary (albumin)

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29
Q

Pii

A

interstitial fluid colloid osmotic pressure

the release of fluid into the interstitial space

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30
Q

Osmolality

A

number of osmoles of solute in a kilogram of solvent

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31
Q

Osmolarity

A

number of osmoles of solute in a liter of solution

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32
Q

osmotic pressure

A

pressure needed to stop osmosis

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33
Q

osmotic pressure is dependent on

A

number of molecules

the size of the molecules does not affect the osmotic pressure

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34
Q

P=n/v

A

number of solutes, v= volume

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35
Q

osmole

A

the osmosis caused by a mole

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36
Q

millimole

A

molecular weight in milligrams

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37
Q

what unit do we use

A

mOsm

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38
Q

Mole

A

standard unit for measuring large quanities of very small atoms, molecules or particles

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39
Q

Avogardo’s number

A

6.022x 10^23

the number of atoms, molecules or particles in a mole is the same for all substances

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40
Q

omostic pressure depends

A

number of molecules not the mass

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41
Q

Calculate osmolality

A

2 x Na +glucose/18 +BUN/2.8

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42
Q

Normal Plasma Osmolality

A

290 mOsm/L

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43
Q

Homeostasis

A

Osm IVF =Osm ISF= Osm ICF= 290 mOsm/L

44
Q

TOnicity

A

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
Q

Hypertonic Solution

A

increased plasma osmolality above the normal level

>295mOsm/L

46
Q

Isotonic Solution

A

normal plasma osmolality

290mOsm/L

47
Q

Hypotonic Solution

A

decreased plasma osmolality below the normal level

< 275mOsm/L

48
Q

Sodium

A

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
Q

Serum Na

A

Sernum Na ~ TBNa/TBW

50
Q

Fluid Disorders

A

isotonic fluid disorders
hypotonic fluid disorders
hypertonic fluid disorders

51
Q

Isotonic fluid disorders

A

isotonic loss of fluid

isotonic gain of flui

52
Q

Hypotonic fluid disorders

A

hypertonic loss of Na
gain of pure water
hypotonic gain of Na

53
Q

Hypertonic fluid disorders

A

hypotonic loss of Na
loss of pure water
hypertonic gain of Na
hyperglycemia

54
Q

isotonic loss or gain of fluid

A

no change to serum Na
no osmotic gradient
no water shift across membranes
no change in ICF compartment

55
Q

isotonic loss of fluid example

A

hemorrhage

56
Q

Hemorrhage is

A 
an ECF volume depletion
Serum Na normal
serum osmolality stays normal 
ICF normal
Administer isotonic fluid
57
Q

Isotonic gain of fluid example

A

excessive gain of isotonic fluid

58
Q

Excessive gain of isotonic fluid

A

ECF volume overload
ECF increase
Serum na/osmolality/ICF= normal

59
Q

hypotonic fluid disorders

A

plasma osmolality is low caused by low serum na
osmotic gradient shifts water from ECF to ICF, ICF volume expansion
cellular swelling

60
Q

Hypertonic loss of Na examples

A

diuretics (loop, thiazide)
addison’s disease (decrease aldosterone)
21 hydrodxylase deficiency (decrease aldosterone)

61
Q

Hypertonic loss of Na is

A

ECF volume depletion
decrease in serum NA, decrease in TBNa/TBW
Decreases ECF, Serum Na, Serum osmolality, increase in ICF

62
Q

Gain of Pure water example

A

SIADH

63
Q

Gain of Pure Water

A 
decrease serum Na
TBNa / increased TBW
ECF increase
Serum Na decrease
Serum osmolality decrease
ICF increase
64
Q

Treatment of gaining of pure water

A

restrict water

treat underlying problem

65
Q

Gain of hypotonic solution example

A

absorption of electrolyte- free irrigation solution (TURP or endometrial ablation)

66
Q

Gain of hypotonic solution

A

decrease serum Na = TBNa/increase in TBW
increase in ECF
decrease in serum Na, osmolality
increase in ICF

67
Q

S/S of gain of hypotonic solution

A

seizures, pulmonary edema, difficulty ventilating, cerebral edema

68
Q

Treatment of gain of hypotonic solution

A

diuresis

3% NS

69
Q

Hypotonic Gain of Na Example

A

Overload states

cirrhotic, nephrotic, CHF

70
Q

Hypotonic Gain of Na

A

decrease serum Na= increase TBNa/increased TBW
ECF increased
decrease serum Na and serum osmolality
increased ICF

71
Q

S/S of hypotonic gain of NA

A 
dependent pitting edema
cavity effusions (ascites)
SOB
increase Body weight
mental status changes
72
Q

Treatment of hypotonic gain of Na

A

restrict salt and water

diuretic

73
Q

Hypertonic Fluid Disorders

A

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
Q

Hypotonic loss of Na examples

A

sweating, osmotic diarrhea, osmotic diuresis, vomiting

75
Q

Hypotonic loss of Na

A

increase in serum Na= decrease in TBNa/decrease TBW
ECF and ICF decrease
Serum Na and Osmolality increase

76
Q

S/S of hypotonic loss of Na

A

dry skin, mucuous membranes
dizzy confusion
mental status changes
increase HR

77
Q

Treatment of hypotonic loss of Na

A

administer isotonic fluid (to maintain BP) then switch to hypotonic fluid (0.45% NS)

78
Q

Loss of Pure Water Example

A

Diabetes Insipidus

excessive water evaporation off the skin surface (fever, burns, insensible fluid loss)

79
Q

Loss of Pure Water

A

increase serum Na = TBNa/decreased TBW
ECF decreased ICF decreased
Increase in Serum Na and osmolality

80
Q

Loss of Pure water s/s

A

confusion, drowsiness mental status changes

81
Q

Treatment of Pure water

A

administer water D5W

treat underlying problem

82
Q

Hypertonic Gain of Na example

A

NaHCO3 infusion

infusion of hypertonic saline, antibiotics that contain Na, sodium modeling in hemodialysis

83
Q

Hypertonic Gain of Na

A

increase ECF
Decrease ICF
Increase serum Na and osmolality

84
Q

S/S in hypertonic gain of Na

A

mental status

85
Q

Treatment of hypertonic gain of Na

A

stop the infusion

86
Q

Hyperglycemia Example

A 
Diabetic Ketoacidosis (type 1 DM)
Hyperosmolar non-ketotic coma (type 2 DM)
87
Q

Hyperglycemia

A

decrease serum Na = decrease TBna/ TBW
decrease ECF and ICF
decrease serum Na
increase Osmolality

88
Q

S/S of hyperglycemia

A

mental status changes

diabetic coma

89
Q

Treatment of hyperglycemia

A

treat underlying cause

90
Q

Alterations in Fluid Balance Preoperative

A 
burns
vomitting
diarrhea
fever
gastric suction
bowel prep
91
Q

Alterations in Fluid Balance intraoperative

A

hemorrhage
evaporative loss
third spacing (manipulation of tissues)
hypo-osmolar irrigation (TURP, endometrial ablation)

92
Q

Alterations in Fluid balance anesthesia

A

vasodilation
release of ADH
increase evaporative loss from ventilation
mobilization of third space fluids on POD #3

93
Q

ADH

A

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
Q

Is urine output a valid indicator of perioperative volume status?

A

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
Q

Goal Directed Fluid therapy

A

maximizing cardiac flow parameters as a surrogate for oxygen delivery improves outcomes

96
Q

Primary objective of periop fluid therapy

A

maintenance of normovolemia in order to maintain adequate tissue perfusion

97
Q

Fluid challenge

A

CO will usually increase in response to a fluid challenge

98
Q

Traditional Method of Fluid therapy

A

calculate fluid requirements for

surgical loss deficit and maintenance

99
Q

Hourly Maintenance Fluid Requirements

A

4 mg/kg/hr 0-10kg
2mg/kg/hr 11-20kg
1mg/kg/hr 21+ kg

100
Q

NPO Deficit

A

hourly maintenance requirement x # of hours NPO

101
Q

Minimal surgical loss additional fluid requirements

A

0-2ml/kg

short superficial procedure

102
Q

Moderate surgical loss additional fluid requirements

A

uncomplicated intraabdominal or orthopedic procedure

2-4ml/kg

103
Q

severe surgical loss additional fluid requirement

A

prolonged highly invasive procedure

4-8ml/kg

104
Q

D5W

A

hypotonic solution
has little place perioperatively
cause free water intoxication adn hyponatremia
additional calorie but also can cause hyperglycemia

105
Q

Evaporative Loss and 3rd Space Loss

A

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
Q

Calculating 3rd Space (need to know)

A

type of procedure
degree of exposure
amount of surgical manipulation

Basic Principles N928 (10 decks)

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