Fluid Balance

Question 1

What is transcellular fluid?

Answer 1

Fluid in CSF, eyes, synovial joints

Question 2

If a burn patient has a low serum albumin, what would you expect to happen to their fluid status?

Answer 2

Burn: tissue damage- albumin escapes blood vessel and causes edema

Hypovolemia

Question 3

First Spacing
Second spacing
Third spacing

Answer 3

1: normal distribution in ICF and ECF
2: abnormal accumulation in interstitial fluid- edema
3: fluid trapped where it is difficult or impossible to return to cells or blood vessels-ascites

Question 4

What do the following symptoms indicate:
Slow cap. refill
Confusion
Cold/clammy skin
Postural hypotension, high pulse, low CVP
Thirst, dry mucous membranes
Low urine output, weakness, dizzy
weight loss

Answer 4

Hypovolemia

Question 5

How will the following labs reflect hypovolemia?
Urine specific gravity
Blood Urea Nitrogen
Hct to Hgb ratio
RBCs

Answer 5

All will be elevated

Question 6

What do the following symptoms indicate?
Bounding pulse, high BP/CVP
Confusion, headache, lethargy
Dyspnea, crackles, pulm. edema
Edema
JVD
Muscle spasms
Polyuria
S3 Heart sound
Seizures, coma
WEIGHT GAIN

Answer 6

Hypervolemia

Question 7

The average fluid maintenance rate is ____-____ mL/day

Answer 7

2,000-3,000

Question 8

Blood is only compatible with ____
What are the following blood products given for?
Whole blood
PRBCs
Platelets
FFP
Cryoprecipitate

Answer 8

0.9% NS

Whole blood: >25% blood loss, trauma

PRBCs: anema, Hgb <7, <25% blood loss

Platelets, FFB, Cryoprecipitate: clotting disorders

Question 9

Explain TRALI and TACO

Answer 9

TRALI: Transfusion related acute lung injury

TACO: transfusion associated circulatory overload

Question 10

What are the steps if you recognize a transfusion reaction?

Answer 10

Stop the transfusion, switch line to NS to maintain line

Assess/stabilize patient

Notify physician

Notify blood bank- collect blood and urine samples

Keep all supplies used to give back to the blood bank

Question 11

What kind of fluid would you give to a patient with N/V/D x3days, with a serum Na of 138?

3% NS
0.9% NS
0.45% NS

Answer 11

0.9% NS
-isotonic- they need fluid replacement
-sodium is within range (135-145)

Question 12

What kind of fluid would you give to a patient with cerebral edema?

Answer 12

Hypertonic- cells need to shrink

Question 13

What kind of fluid would you give to a patient w/ a lack of fluid intake during cancer treatment and a serum Na of 150?

Answer 13

Hypotonic- need fluid replacement and something to lower the Na
(135-145 norm, 150 is high)