Fluid balance in times of stress Flashcards

1
Q

What does the mnemonic BUFALO relate to in treatment of sepsis?

A

B = blood cultures
U = urine measurement
F = fluid challenge
A = antibiotics
L = lactate
O = oxygen

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2
Q

In the sepsis 6 is antibiotics. Should patients be given broad or narrow spectrum IV antibiotics?

A
  • broad spectrum
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3
Q

When performing a fluid challenge in a patient with sepsis, how much fluid should they be challenged with?

1 - 10mg/kg
2 - 30ml/kg
3 - 3ml/kg
4 - 50ml/kg

A

2 - 30ml/kg

  • purpose is to increase intravascular pressure
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4
Q

When performing a fluid challenge in a patient with sepsis, they should be challenged with 30ml/kg of fluids. Generally, how quickly should this be delivered?

1 - 500ml over 15-20 minutes
2 - 500ml/10 minutes
3 - 3L/hour
4 - 1L over 15-20 minutes

A

1 - 500ml over 15-20 minutes

  • 250ml over 30minutes if patient is frail
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5
Q

There are 2 types of fluids patients can be given, colloids and crystalloids. Which of the 2 will remain in the vasculature of the patient?

A
  • colloids due to large molecular weight particles
  • too big to diffuse across normal endothelium so they remain in the blood
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6
Q

Colloids are IV fluids where almost 100% remains in the intravascular space. Although not given very often, they can be prescribed for high protein losses. They generally contain albumin (20 or 4.5%) or dextrose. Of the conditions below, which would generally receive colloids?

1 - mother giving birth
2 - burn victim
3 - internal haemorrhage
4 - transplant

A

2 - burn victim

  • the body loses skin, connective tissue and even muscle containing high protein
  • the body tries to compensate and therefore needs a lot of protein to heal
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7
Q

What is a crystalloid solution?

1 - aqueous solution alone
2 - aqueous solution containing mineral salts and small molecules
3 - aqueous solution containing proteins
4 - aqueous solution containing dextrose

A

2 - aqueous solution containing mineral salts and small molecules

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8
Q

Crystalloid fluid is used as normal saline, which is the most common fluid given to patients. Normal saline contains Na+ and Cl-. What are the normal concentrations of Na+ and Cl- in normal saline?

1 - Na+ = 154 mmol/L and Cl- = 54 mmol/L
2 - Na+ = 124 mmol/L and Cl- = 104 mmol/L
3 - Na+ = 54 mmol/L and Cl- = 154 mmol/L
4 - Na+ = 154 mmol/L and Cl- = 154 mmol/L

A

4 - Na+ = 154 mmol/L and Cl- = 154 mmol/L

  • normal Na+ in blood = 154 mmol/L
  • normal Na+ in blood = 96-106 mmol/L
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9
Q

When prescribing a patient a crystalloid solution roughly how much of the fluid will remain in the intravascular and interstitial fluids?

1 - intravascular = 25% and interstitial = 75%
2 - intravascular = 75% and interstitial = 25%
3 - intravascular = 50% and interstitial = 50%
4 - intravascular = 80% and interstitial = 20%

A

1 - intravascular = 25% and interstitial = 75%

  • due to small molecular size the fluid moves across endothelium and into the interstitial space
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10
Q

Why is taking a detailed history important in a patient who is suspected of being hypovolemic?

A
  • ask them about normal fluid intake
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11
Q

Which of the following is not a measure of outgoing fluid?

1 - urine measurement
2 - stool output
3 - vomiting
4 - tears
5 - sweat

A

4 - tears

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12
Q

In relation to recording fluid levels, why is it important that medication is recorded accurately?

A
  • often given as an IV so will be contained in saline
  • diuretics are important for fluid output
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13
Q

In cases of shock and/or dehydration what happens to capillary refill time?

A
  • becomes slower
  • not as much blood flow and cold so takes longer
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14
Q

In cases of shock and/or dehydration what happens to skin turgor (skins elasticity)?

A
  • decreases
  • does not return to normal as quickly
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15
Q

In cases of shock and/or dehydration what happens to mucus membranes?

A
  • become dry
  • can see this in tongue and eyes
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16
Q

In cases of shock and/or dehydration are patients likely to experience oedema?

A
  • yes
  • generally in ankles and sacrum due to gravity and bed rest
17
Q

In cases of shock and/or dehydration what can happen to a patients pulse rate and volume?

A
  • pulse rate increases as less blood
  • pulse volume will be reduced as less blood
18
Q

Haematocrit is a measure of the blood. What is haematocrit?

1 - volume of blood volume made up of WBCs
2 - protein in the RBCs
3 - protein in the WBCs
4 - volume of blood volume made up of RBCs

A

4 - volume of blood volume made up of RBCs

19
Q

Haemoglobin is a measure of the blood. What is haemoglobin?

1 - volume of blood volume made up of WBCs
2 - protein in the RBCs
3 - protein in the WBCs
4 - volume of blood volume made up of RBCs

A

2 - protein in the RBCs

  • carries O2 to tissues
20
Q

What happens to the urea:creatanine ratio during times of stress and/or dehydration?

A
  • increases
  • may be increased levels but kidney should filter them out of the body
  • sign kidneys are not working properly
21
Q

What is the formula for calculating serum osmolality?

1 - (2xNa) + (2xK) + Glucose + Urea
2 - (Na) + (2xK) + Glucose
3 - (2xNa) + (K) + Glucose + Urea
4 - (2xNa) + (2xK) + Urea

A

1 - (2xNa) + (2xK) + Glucose + Urea

22
Q

We can calculate serum osmolality using the following equation: (2xNa) + (2xK) + Glucose + Urea. What happens to osmolality during stress and/or dehydration?

A
  • increases
  • fluid levels drop and electrolyte content increases
23
Q

In a patient who is dehydrated and/or who’s body is under stress, why can a chest X-ray be useful?

A
  • respiratory and cardiac defects are often the primary site of inflammation and sepsis
  • fluid leaks through endothelium into the lungs
24
Q

Normal saline is a fluid given to patients when they need to increase their fluid levels. What does it mean for it to be normal saline?

1 - composition is the same as plasma fluids
2 - osmolality is the same as the human plasma
3 - when given IV it will not cause RBCs to rupture

A

3 - when given IV it will not cause RBCs to rupture

25
Q

Normal saline is a fluid given to patients when they need to increase their fluid levels. It is 0.9% saline including which of the following?

1 - Na+ and Cl- = both 154mmol/L
2 - Na+ = 154mmol/L and glucose 277mmol/L
3 - Na+ and K+ = both 154mmol/L
4 - Na+ = 131 and K+ = 5mmol/L

A

1 - Na+ and Cl- = both 154mmol/L

  • Na+
26
Q

Normal saline is a fluid given to patients when they need to increase their fluid levels. It is 0.9% saline including Na+ and Cl- both at 154mmol/L. What can happen if a patient is given too much of the normal saline alone?

1 - become hyponatremic, hyperchloremia and metabolic acidosis follows
2 - can become hyponatremic and metabolic alkalosis follows
3 - can become hypernatremic and metabolic alkalosis follows
4 - can become hypernatremic, hyperchloremia and metabolic acidosis follows

A

4 - can become hypernatremic, hyperchloremia and metabolic acidosis follows

  • pH of normal saline is 3.5-6.5
27
Q

Normal saline is a fluid given to patients when they need to increase their fluid levels. It is 0.9% saline including Na+ and Cl- both at 154mmol/L. If a patient is given too much of the normal saline alone they can develop hypernatremic and metabolic acidosis follows. To stop this from happening patients are given 2L of normal saline with 1L of 5% glucose. Why is the glucose given alongside?

1 - glucose neutralises Na+ and Cl-
2 - glucose provides calories
3 - glucose provides calories and is metabolised into H2O
4 - glucose is metabolised into H2O

A

3 - glucose provides calories and is metabolised into H2O

  • the H2O neutralises the acidity of the normal saline
28
Q

Patients who need a fluid resuscitation will generally be given 2L of normal saline and 1L of 5% glucose. However, they will also need what else to be added?

1 - Ca2+
2 - K+
3 - HCO3-
4 - Mg+

A

2 - K+

  • varies depending on the trust protocol, but generally 20-40mmol/L
29
Q

In the picture is a case study of a patient who is presenting with right iliac pain. There are some things highlighted in red. What do the things in red indicate that the patient has?

1 - infection
2 - sepsis
3 - systemic inflammatory response (SIRS)
4 - septic shock

A

3 - systemic inflammatory response (SIRS)