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critical care > fluid & electrolytes (worksheet/basics) > Flashcards

fluid & electrolytes (worksheet/basics) Flashcards

1
Q

weight in oliguric phase of acute tubular necrosis

A

up

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2
Q

total fluid balance in oliguric phase of acute tubular necrosis

A

up

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3
Q

urine output in oliguric phase of acute tubular necrosis

A

down

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4
Q

urine osmolality in oliguric phase of acute tubular necrosis

A

up

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5
Q

serum BUN/creatinine in oliguric phase of acute tubular necrosis

A

up

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6
Q

serum osmolality in oliguric phase of acute tubular necrosis

A

down

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7
Q

how are urine output and osmolality related

A

inverse (if one is up, the other is down)

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8
Q

what should you think of serum osmolality as?

A

amount of salt

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9
Q

potential electrolyte imbalances in oliguric phase of acute tubular necrosis

A

hyperkalemia, hyponatremia, hypocalcemia, hyperphosphatemia

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10
Q

potential complications in oliguric phase of acute tubular necrosis

A

fluid overload!
cardiac arrythmia
CVP/wedge increased

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11
Q

treatment in oliguric phase of acute tubular necrosis

A

stop cause
maintain fluid balance
CRRT

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12
Q

weight in diuretic phase of acute tubular necrosis

A

down

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13
Q

total fluid balance in diuretic phase of acute tubular necrosis

A

down

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14
Q

urine output in diuretic phase of acute tubular necrosis

A

up

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15
Q

urine osmolality in diuretic phase of acute tubular necrosis

A

down

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16
Q

serum BUN/creatinine in diuretic phase of acute tubular necrosis

A

trend down / start normalizing

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17
Q

serum osmolality in diuretic phase of acute tubular necrosis

A

up

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18
Q

potential electrolyte imbalances in diuretic phase of acute tubular necrosis

A

hypernatremia!
hypokalemia

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19
Q

potential complications in diuretic phase of acute tubular necrosis

A

dehydration!
dysrhythmias

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20
Q

treatment in diuretic phase of acute tubular necrosis

A

hydration to replace loss
electrolytes

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21
Q

which F&E problems have the same characteristics?
(in terms of weight, urine output, etc.)

A

SIADH looms the same as oliguric phase of acute tubular necrosis
DI looks the same as diuretic phase of acute tubular necrosis

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22
Q

what to question when looking at phases of third spacing?

A

where is the fluid?

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23
Q

where is the fluid in phase 1 (loss) of third spacing

A

none in vascular spade, all in interstitial

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24
Q

weight in phase 1 (loss) of third spacing

A

up (in wrong place)

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25
Q

total fluid balance in phase 1 (loss) of third spacing

A

up

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26
Q

urine output in phase 1 (loss) of third spacing

A

down

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27
Q

urine osmolality in phase 1 (loss) of third spacing

A

up

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28
Q

serum BUN in phase 1 (loss) of third spacing

A

up

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29
Q

serum osmolality in phase 1 (loss) of third spacing

A

up

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30
Q

potential electrolyte imbalances in phase 1 (loss) of third spacing

A

hypernatremia
hyperkalemia

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31
Q

potential complications in phase 1 (loss) of third spacing

A

renal hypoperfusion, no fluid

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32
Q

treatment in phase 1 (loss) of third spacing

A

IV fluids
albumin! same as colloids

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33
Q

how does albumin help in phase 1 (loss) of third spacing

A

pulls from interstitial to vascular

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34
Q

weight in phase 2 (reabsorption) of third spacing

A

down (start urinating)

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35
Q

total fluid balance in phase 2 (reabsorption) of third spacing

A

down

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36
Q

urine output in phase 2 (reabsorption) of third spacing

A

up

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36
Q

urine osmolality in phase 2 (reabsorption) of third spacing

A

down

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37
Q

serum BUN in phase 2 (reabsorption) of third spacing

A

back to normal

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38
Q

serum osmolality in phase 2 (reabsorption) of third spacing

A

low or normal

39
Q

potential electrolyte imbalances in phase 2 (reabsorption) of third spacing

A

hypokalemia
sodium returning to normal or slightly low

40
Q

potential complications in phase 2 (reabsorption) of third spacing

A

vascular fluid overload!
pulmonary status concern

41
Q

treatment in phase 2 (reabsorption) of third spacing

A

assess for overload (dec. fluids/diuretics if so)
look at net balance to determine intake

42
Q

weight in SIADH

A

up

43
Q

total fluid balance in SIADH

A

up

44
Q

urine output in SIADH

A

down

45
Q

urine osmolality in SIADH

A

up

46
Q

serum osmolality in SIADH

A

down (only holding water, dilutes sodium)

47
Q

ADH relationship to salt and water

A

ADH only deals with water NOT SALT

48
Q

SIADH = ?

A

soaked inside
too much ADH

49
Q

potential electrolyte inbalances in SIADH

A

hyponatremia!!

50
Q

potential complications in SIADH

A

Sodium = Seizures!!!
Stop urinating
coma/death

51
Q

treatment in SIADH

A

fluid restriction
sodium replacement (hypertonic saline!)
demeclocycline (side effect interferes with ADH)
Stop fluids, give Salt

52
Q

what med has a side effect that interferes with ADH to help SIADH

A

demeclocycline

53
Q

DI = ?

A

dry inside
nothign to do with blood sugar!

54
Q

weight in diabetes insipidus (DI)

A

down

55
Q

total fluid balance in diabetes insipidus (DI)

A

down (peeing lots)

56
Q

urine output in diabetes insipidus (DI)

A

up

57
Q

urine osmolality in diabetes insipidus (DI)

A

down

58
Q

serum osmolality in diabetes insipidus (DI)

A

up

59
Q

potential electrolyte imbalances in diabetes insipidus (DI)

A

hypernatremia

60
Q

potential complications in diabetes insipidus (DI)

A

seizures, coma, death (sodium)

61
Q

treatment in diabetes insipidus (DI)

A

hypotonic fluids
vasopressin (same as ADH)
hydrochlorothiazide (only is caused by kidneys)

62
Q

what is a “quick fix” to maintain stability

A

CRRT

63
Q

heparin use in CRRT and probs

A

can be used in the circuit to prevent clots, can cause HIT -> watch platelets

64
Q

functions of the kidneys

A

1) eleimination of metabolic waste
2) BP regulation
3) erythrocyte production
4) vitamin D activation
5) acid/base balance

65
Q

what is GFR dependen on?

A

blood flow

66
Q

normal GFR?

A

125

67
Q

GFR levels of dec. kidney fxn and kidney failure

A

< 100 = dec. fxn
< 15 = failure

68
Q

which fluid compartment is accessed IV

A

extracellular fluid

69
Q

describe isotonic, hypertonic, and hypotonic fluids in relation to plasma

A

isotonic = same concentration as plasma
hypertonic = > plasma concentration
hypotonic = < plasma concentration

70
Q

isotonic crystalloids

A

0.9% NaCl
LR

71
Q

hypertonic crystalloids

A

3% NaCl (monitor close)
D5 NaCl (D5 normal)
D5 in LR (D5LR)
D5 0.45% NaCl (D5 half normal)

72
Q

hypotonic crystalloids

A

0.25% NaCl
0.45% NaCl

73
Q

examples of colloids

A

25% albumin
hetastarch
blood prodicts

74
Q

what do colloids do to fluid

A

pull fluid into intravascualr space

75
Q

Condition defined by:

decline in GFR
retention of products normally excreted
electrolyte imbalance
acid/base abnormality
fluid volume disruption

A

AKI

76
Q

normal BUN

A

10-20

77
Q

which AKI is any renal hypoperfusion from dec. cardiac output, hemorrhage, vasodilation, thrombosis, etc.

A

pre-renal AKI

78
Q

which AKI is any condition that produces ischemic or toxic insult directly at site of nephron

A

intra-renal AKI

79
Q

which AKI is any obstruction that hinders flow of urine after the kidney

A

post-renal AKI

80
Q

potential causes of post-renal AKI

A

kidney stones, catheter blockage, tumor

81
Q

which kind of acute tubular necrosis (ATN) results from prolonged hypoperfusion?

A

ischemic ATN

82
Q

which ATN results when concentration of nephrotoxin causes necrosis of tubular cells

A

nephrotoxic ATN

83
Q

potential causes of nephrotoxic ATN

A

vancomycin
aminoglycosides
zosyn
contrast dye

84
Q

what is important to prevent nephrooxic ATN?

A

monior peaks and troughs of risk meds

85
Q

which phase of ATN is period from initial insult until cell injury occurs, ischemia injury is evolving

A

onset phase

86
Q

which ATN phase results from necrotic cellular debris blocking formation of urine and removal of wastes

A

oliguric/anuric phase

87
Q

which phase of ATN is characterized by increase in GFR

A

diuretic phase

88
Q

main goal of AKI treatment

A

restore and maintain electrolye imbalance

89
Q

contraindications for hemodialysis

A

hemodynamic instability
inability to coagulate
lack of access

90
Q

what is used if dialysis is contraindicated?

A

CRRT

91
Q

why is CRRT better if hemodialysis is contraindicated?

A

filters smaller amount of blood over longer times

92
Q

what is the end result of the loss phase of third spacing?

A

fluid moves into interstitial space

93
Q

which DI is when posterior pituitary fails to release ADH?

A

central DI

94
Q

which DI is inability of kidney to respond to ADH

A

nephrogenic

critical care (23 decks)

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