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Therapy 3 > Fluid and Fluid Disorders > Flashcards

Fluid and Fluid Disorders Flashcards

1
Q

What is the relation of TBW to body fat?

A

As fat increases, TBW percent decreases

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2
Q

What is the IBW calculation for males and females?

A

Males = 50 + 2.3 (ht in inches - 60)

Females = 45.5 + 2.3 (ht in inches - 60)

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3
Q

What ratio is Intracellular fluid/extracellular fluid?

A 
ICF = 2/3
ECF = 1/3
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4
Q

ICF is rich in what electrolytes?

A

Potassium
Magnesium
Phosphates
Proteins

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5
Q

ECF is rich in what electrolytes?

A

Sodium
Chloride
Bicarbonate

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6
Q

What are the two fluid sub-compartments of the ECF compartment?

A

Interstitial fluid (fluid space between the cells) 3/4

Intravascular (plasma, blood vessel compartments) 1/4

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7
Q

What are the tools to assess fluid balance?

A 
Blood Pressure
Arterial Catheter (ART line)
Pulmonary Artery Catheters
Central Venous Catheters
Physical Exam
Monitoring I/O's
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8
Q

What type of depletion is Intravascular depletion?

A

It is a type of extracellular fluid depletion

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9
Q

What is a quick indicator for intravascular fluid loss?

A

Checking for an increase in the BUN/Scr ratio (> 20:1)

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10
Q

What are the causes of intravascular depletions?

A 
Acute hemorrhage
Dieresis
Burns
GI losses (vomiting, diarrhea)
Adrenal insufficiency
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11
Q

What are the internal redistributions of intravascular depletion?

A

Septic shock
Anaphylactic shock
Abdominal Ascites (common in liver disease)

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12
Q

What is the characteristics of TBW depletion?

A

Characterized by a loss of hypotonic fluid from ALL body compartments (2/3 ICF and 1/3 ECF)

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13
Q

What are the signs and symptoms of TBW depletion?

A

CNS disturbances (mental status)
Excessive thirst
Dry mucous membranes
Decreases skin turgor
Elevated serum sodium and plasma osmolality
Concentrated urine (dark)
Acute weight loss (loss of one liter ~ loss of 2 pounds of body weight

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14
Q

What are the causes of TBW depletion?

A 
Lack of sufficient oral intake
Excessive insensible losses (fever, hot weather)
Diabetes Insipidus
Uncontrolled DM
Failure of kidney urine-conc. mechanisms
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15
Q

What is the maintenance calculation for adult fluid requirements?

A

1500 mL + 20 mL for each kg over 20kg’s

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16
Q

What is the TBW deficit calculation?

A

Water deficit = normal TBW - present TBW

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17
Q

What is considered a normal sodium concentration?

A

140 mEq/L

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18
Q

What are the the three therapeutic fluids used?

A

Crystalloid solutions
Colloid solutions
Oxygen-Carrying resuscitation solutions

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19
Q

What do hypertonic solutions do to the cell?

A

Hypertonic solutions draw water out of the cell and int the ECF

20
Q

What do hypotonic solutions do to the cell?

A

Hypotonic solutions pull water into cells from the ECF

21
Q

What is the TBW calculation?

A

TBW = wt (kg) x 0.6

22
Q

What are the most common crystalloid solutions?

A

Normal, half-normal, and hypertonic Saline
Ringers solution
Lacerated ringers solution

23
Q

What is one important use of hypertonic saline?

A

Hypertonic saline is used to lower intracranial pressure

24
Q

What do lactated ringer solutions replace?

A 
Sodium
Chloride
Lactate
Potassium
Calcium
25
Q

What are cautions of using lactated ringer solutions?

A

Large volumes of LR lead to metabolic alkalosis (caution in hepatic dysfunction)

Never use in liver diseased patients (caused lactic acidosis)

26
Q

What electrolytes does Ringers Solution contain?

A

Sodium
Chloride
Calcium
Potassium

27
Q

What is the caution with D5W in NS?

A

Caution in cardiac or renal patients because of HF and pulmonary edema

28
Q

What is the sodium and chloride content of NS?

A

154 mEq/L each

29
Q

What are the colloidal solutions?

A

Albumin 5% or 25%
Dextrans
Hetastarch
Fresh frozen plasma

30
Q

What is the MOA of colloidal solutions?

A

They increase plasma osmotic pressure and effectively move fluid from the interstitial compartment to the plasma compartment.

31
Q

When do you NOT use HES

A

In critically ill patients (sepsis)

In patients with renal or liver dysfunction

32
Q

What are HES indications?

A

Treatment and prophylaxis of hypovolemia

33
Q

In patients demonstrating signs of impaired tissue perfusion, the standard therapy is…

A

Normal Saline administered briskly (150-500 mL/hr) until S/add of impaired tissue perfusion have minimized or disappeared.

34
Q

In patients demonstrating elevated plasma osmolality and serum sodium concentrations, use

A

Hypotonic solutions: 1/2 NS, D5 1/2 NS

35
Q

Never use hypertonic or colloidal solutions in…

A

TBW depletion

36
Q

What are conditions that may predispose patients to fluid overload?

A

Renal failure
Cardiac failure
Hepatic failure
Elderly

Replenish cautiously!

37
Q

What are examples of excessive intake?

A 
Excessive IV fluid
Blood/plasma use
Hypertonic fluids
Excess dietary sodium
Colloid use
Water intoxication
Remobilization of edema
38
Q

What are some examples of inadequate output?

A 
CHF
Cirrhosis
Nephrotic syndrome 
Hyperaldoseronism
Low dietary protein
Steroid use
39
Q

What are examples of fluid deficits?

A

Inadequate replacement: poor oral intake, inadequate IV fluids

Excessive Loss: GI losses, renal, metabolic, skin, third spacing

40
Q

D5W uses…

A

Fluid loss
Dehydration
Hypernatremia

41
Q

NS uses…

A 
Shock
Hyponatremia blood transfusions
Resuscitation
Fluid challenges
Diabetic ketoacidosis
42
Q

Lactated Ringer uses…

A 
Dehydration 
Burns
Lower GI fluid loss
Acute blood loss
Hypovolemia due to third spacing
43
Q

1/2 NS uses…

A

Water replacement
DKA
Gastric fluid loss from NG or vomiting

44
Q

D5 1/2 NS uses…

A

Later in DKA therapy

45
Q

D5 in NS uses…

A

Temp. treatment for shock if plasma expanders aren’t available
Addisons crisis

46
Q

D10W uses…

A

Water replacement.

Conditions where some nutrition with glucose is required.

47
Q

3% saline uses…

A

Treatment of severe symptomatic hyponatremia.

Traumatic brain injury.

Therapy 3 (12 decks)

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