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Phase 2 - General Surgery Placement > Fluid and Nutrition Management > Flashcards

Fluid and Nutrition Management Flashcards

1
Q

what are the three common reasons for fluids to be prescribed?

A

resuscitation
maintenance
replacement

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2
Q

what is the distribution of fluid between extracellular and intracellular?

A

extracellular - 1/3

intracellular - 2/3

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3
Q

what is the distribution of fluid between the extracellular vascular and interstitial compartments?

A

vascular - 1/4

interstitial - 3/4

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4
Q

what is the absolute distribution of fluid in the vascular compartment?

A

1/12th or about 8%

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5
Q

why is it important that fluid remain in the intravascular compartment?

A

in order to increase intravascular volume and increase tissue perfusion rate

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6
Q

why is it important to give and monitor fluids in a NBM patient?

A

because majority of our fluid intake is oral and this needs to be replaced

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7
Q

what are the signs and symptoms of a dehydrated patient?

A
  • dry mucous membranes
  • reduced skin turgor
  • low urine output
  • hypotension
  • tachycardia
  • increased capillary refill time
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8
Q

what are the signs and symptoms of a fluid overloaded patient?

A
  • raised JVP
  • peripheral or sacral oedema
  • pulmonary oedema
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9
Q

what is the recommended daily water requirement?

A

25 ml/kg/day

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10
Q

what is the recommended daily sodium requirement?

A

1.0 mmol/kg/day

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11
Q

what is the recommended daily potassium requirement?

A

1.0 mmol/kg/day

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12
Q

what is the recommended daily glucose requirement?

A

50 g/day

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13
Q

what are the two kinds of intravenous fluids?

A

crystalloids and colloids

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14
Q

how do colloid fluids work?

A

they have large proteins in the fluid, increasing the oncotic pressure keeping the fluid in the vascular compartment

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15
Q

what are the three common crystalloid fluids?

A
  • 0.9% saline (normal saline)
  • 5% dextrose
  • Hartmann’s solution
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16
Q

what are the contents of normal saline?

A

water, sodium, and chloride

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17
Q

true or false: normal saline is isotonic

A

true

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18
Q

which compartments does normal saline distribute into?

A

it is isotonic so stays in the extracellular compartment

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19
Q

what percentage of normal saline stays in the intravascular space?

A

25%

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20
Q

true or false: normal saline can be used in resuscitation

A

true

it can be used in both maintenance and resuscitation

21
Q

what is hyperchloraemic acidosis?

A

when too much saline is given in fluid maintenance leading to an excess of chloride ions in the plasma

22
Q

what are the contents of 5% dextrose solution?

A

water and dextrose

23
Q

is 5% dextrose solution hypotonic or hypertonic?

A

hypotonic

24
Q

what happens to the dextrose in 5% dextrose solution?

A

it is immediately taken up by the cells, leaving the water behind

25
Q

how does the water distribute itself in 5% dextrose solution and how much remains in the vascular space?

A

it distributes itself evenly across all compartments, leaving only 8% in the vascular space

26
Q

when can 5% dextrose solution be used?

A

it can only be used in fluid maintenance as it maintains hydration without giving an excess of electrolytes

27
Q

why is it useful to give a NBM patient 5% dextrose solution?

A

as they have no other intake of glucose and need some form of energy

28
Q

what are the contents of Hartmann’s solution?

A

water, sodium, chloride, potassium, lactate, calcium

29
Q

true or false: Hartmann’s solution is isotonic

A

true

30
Q

what compartments does Hartmann’s solution distribute into?

A

it stays in the extravascular compartment, with 25% remaining intravascularly

31
Q

when is Hartmann’s solution given?

A

it can be used for maintenance and resuscitation

32
Q

why would someone use Hartmann’s over 0.9% saline?

A

because Hartmann’s is considered more physiologically accurate due to the other electrolytes present

33
Q

what measurement is considered a reduced urine output?

A

< 0.5ml/kg/hour

34
Q

how is a patient with reduced urine output managed?

A
  • measure urine output
  • check if they are in retention or if they have a blocked catheter
  • be given a fluid challenge
35
Q

what is a fluid challenge?

A

250-500mls given over 15-30 minutes to prevent hypovolaemia

36
Q

true or false: malnourished patients make bad surgical candidates

A

true

they are at increased risk of surgical complications such as reduced wound healing and infection

37
Q

what does surgery do to the body’s metabolism?

A

the physiological stress results in a hyper metabolic state with a catabolic response

38
Q

what is the indication for giving oral nutritional supplements (ONS)?

A

if the patient is unable to eat sufficient calories

39
Q

what is the indication for giving a nasogastric tube (NGT)?

A

if the patient is unable to take sufficient calories orally or has a dysfunctional swallow

40
Q

what is the indication for gastrostomy feeding (PEG/RIG)?

A

if the patient’s oesophagus is blocked or dysfunctional

41
Q

what is the indication for jejunal feeding (jejunostomy)?

A

if the patient’s stomach is inaccessible or if there is an outflow obstruction

42
Q

what is the indication for parenteral nutrition?

A

if the patient’s jejunum is inaccessible or if they have intestinal failure

43
Q

when would treating malnutrition not be considered a reason to delay surgery?

A

if the underlying cause for malnutrition is being treated in the surgery (e.g. someone with active Crohn’s disease)

44
Q

true or false: patient should wait post-op before eating again

A

false

early post-operative feeding has been shown to reduce post-operative complications

45
Q

what is the recommended daily intake of sodium?

A

1-2mmol/kg/day

46
Q

what is the recommended daily intake of potassium?

A

1mmol/kg/day

47
Q

what is the recommended daily intake of glucose?

A

50g/day

48
Q

what is the recommended daily intake of water?

A

25-30ml/kg/day

Phase 2 - General Surgery Placement (14 decks)

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