Fluid Management

Question 1

______ IV fluids do not readily pass through a membrane (i.e., intravascular and extravascular [interstitial] fluid compartments)

Answer 1

Colloid

Colloids are solutions that contain large molecules and provide oncotic pressure in addition to volume expansion. Examples include protein solutions such as albumin and non-protein solutions such as Dextran and Hydroxyethyl Starch (HES)

Question 2

______ IV fluids pass readily through a membrane (i.e., intravascular and extravascular [interstitial] fluid compartments

Answer 2

Crystalloid

Crystalloids are solutions of salts and electrolytes used for volume expansion. Examples include NS, LR, D5W

Question 3

Define isotonic solution and give examples

Answer 3

Osmolality near that of plasma (>250 mOsm/L but <375 mOsm/L)

D5W (dextrose 5% water)

0.9% NaCl (NS)

Lactated Ringers

Question 4

Define hypotonic solution and give examples

Answer 4

Osmolality that is less than that of plasma (<250 mOsm/L)

0.45% NaCl (1/2 NS)

Question 5

Define hypertonic solution and give examples

Answer 5

Osmolality greater than that of plasma (>375 mOsm/L)

D10W (dextrose 10% water)

D5NS

D5LR

3% NaCl

Question 6

Define free water

Answer 6

Water not bound by macromolecules

When applied to IV fluids, will cause a shift of fluids into the cells (ICF) from the vascular space (ECF)

Question 7

How is maintenance hourly rate for IV fluids calculated?

Answer 7

[4 mL for 1-10 kg] + [2 mL for 11-30 kg] + [1 mL for each >30 kg]

Question 8

How is body water deficit calculated?

Answer 8

[(0.6 x weight (kg)) x (Na - 140)]/(140)

Question 9

What is contained in Lactated Ringers (LR)?

Answer 9

Na+
Cl-
HCO3-
K+
Ca+

Question 10

_______ solutions can be used for maintenance fluids or resuscitation.

______ fluids applies to situations when a pt is unable to drink or take in enough fluids to maintain physiologic needs.

Answer 10

Isotonic

Maintenance

Question 11

_____ solutions are the top choice for post-operative period, inability to swallow or protect airway from aspiration (facial trauma, acute CVA), burns, or intubation

Answer 11

Isotonic

Question 12

Fluid resuscitation includes dehydration, hypovolemia, or shock (any type). During fluid resuscitation, the goal is to keep fluids within the __________ space. Isotonic solutions are the best choice, with the preferred fluid being _______

Answer 12

Intravascular; NS

Question 13

During high volume resuscitation with NaCl, it is possible to overload the ____ and induce _________________

Answer 13

Cl-; hyperchloremic metabolic acidosis (NAGMA)

Question 14

T/F: while NS is the IV fluid of choice for resuscitation, LR may also be used for vascular expansion and electrolyte replacement

Answer 14

True

Question 15

When might use of hypertonic solutions be appropriate?

Answer 15

3% NS may be used with caution in extreme cases of hyponatremia (Na ~115)

Must be done slowly with frequent sodium monitoring

Question 16

3% NS may be used with caution in extreme cases of hyponatremia (Na ~115). This must be done slowly with frequent sodium monitoring. What are potential complications?

Answer 16

Osmotic demyelination syndrome (Locked-in syndrome)

Iatrogenic hypernatremia

Fluid overload

Question 17

______ solutions have an abundance of free water and do not stay in vascular space. They will move into ICF causing them to reach a lower osmolality (cell swelling)

Answer 17

Hypotonic

Question 18

In what situations are D5W and D10W used?

Answer 18

Used to treat hypoglycemia

While D5W is isotonic, the uptake of glucose leaves behind no solute, thus is often considered hypotonic and NOT used for resuscitation as it may cause fluid overload. Generally does not change the glucose concentration of the pt as it is assimilated into the cells.

However, in a diabetic pt it may not be assimilated and can cause hyperglycemia

Question 19

Differentiate 22, 20, 18, and 16 gauge needles by size and indications

Answer 19

22 gauge: 0.8 mm — children and older adults; slow infusions

20 gauge: 1.0 mm — crystalloid infusion for maintenance

18 gauge: 1.2 mm — fluid resuscitation or blood transfusion

16 gauge: 1.7 mm — fluid resuscitation or blood transfusion

Question 20

3 potential peripheral complications of IV therapy

Answer 20

Phlebitis

Infiltration

Extravasation

Question 21

Definition, signs and symptoms of phlebitis

Answer 21

Inflammation of a vein

Symptoms: pain, increased skin temp, redness

Signs: erythema, pain, red streak along vein, palpable venous cord, purulent drainage

Question 22

Definition, signs and symptoms of infiltration

Answer 22

Leakage of IV solution or medication into extravascular tissue

Symptoms: edema, pallor, decreased skin temp, and pain

Signs: skin blanched, tight/leaking, bruised, edema, pitting

Question 23

Definition, signs and symptoms of extravasation

Answer 23

IV catheter becomes dislodged and medication infuses into the tissues

Symptoms: pain, stinging, burning, swelling, redness at site

Signs: skin blanched, tight/leaking, bruised, edema, pitting

Question 24

Treatment for phlebitis

Answer 24

D/C IV line, moist warm compresses, monitor

Question 25

Treatment for infiltration

Answer 25

D/C IV line, elevate extremity, warm compresses may facilitate absorption of fluid

Question 26

Treatment for extravasation

Answer 26

D/C IV line, apply cool compresses, administer antidote if one exists

Question 27

What is a progress note?

Answer 27

Daily update of a hospitalized pt

Includes date and time, subjective (CC/HPI), objective (vitals, PE, new labs, new imaging), assessment (update of current problems, new problems), plan (tx changes, radiology or labs needed; discharge planning)

Question 28

Succinct document summarizing the major events of the hospital stay. Vital to provide outpatient provider with the most important info so that treatment plans can be identified and maintained; commonly includes consultants, procedures, condition, disposition, meds, and follow up instructions

Answer 28

Discharge summary

Question 29

Which IV fluid is commonly used in perioperative period?

Answer 29

LR