Fluid Management Flashcards
______ IV fluids do not readily pass through a membrane (i.e., intravascular and extravascular [interstitial] fluid compartments)
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)
______ IV fluids pass readily through a membrane (i.e., intravascular and extravascular [interstitial] fluid compartments
Crystalloid
Crystalloids are solutions of salts and electrolytes used for volume expansion. Examples include NS, LR, D5W
Define isotonic solution and give examples
Osmolality near that of plasma (>250 mOsm/L but <375 mOsm/L)
D5W (dextrose 5% water)
0.9% NaCl (NS)
Lactated Ringers
Define hypotonic solution and give examples
Osmolality that is less than that of plasma (<250 mOsm/L)
0.45% NaCl (1/2 NS)
Define hypertonic solution and give examples
Osmolality greater than that of plasma (>375 mOsm/L)
D10W (dextrose 10% water)
D5NS
D5LR
3% NaCl
Define free water
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)
How is maintenance hourly rate for IV fluids calculated?
[4 mL for 1-10 kg] + [2 mL for 11-30 kg] + [1 mL for each >30 kg]
How is body water deficit calculated?
[(0.6 x weight (kg)) x (Na - 140)]/(140)
What is contained in Lactated Ringers (LR)?
Na+ Cl- HCO3- K+ Ca+
_______ 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.
Isotonic
Maintenance
_____ solutions are the top choice for post-operative period, inability to swallow or protect airway from aspiration (facial trauma, acute CVA), burns, or intubation
Isotonic
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 _______
Intravascular; NS
During high volume resuscitation with NaCl, it is possible to overload the ____ and induce _________________
Cl-; hyperchloremic metabolic acidosis (NAGMA)
T/F: while NS is the IV fluid of choice for resuscitation, LR may also be used for vascular expansion and electrolyte replacement
True
When might use of hypertonic solutions be appropriate?
3% NS may be used with caution in extreme cases of hyponatremia (Na ~115)
Must be done slowly with frequent sodium monitoring
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?
Osmotic demyelination syndrome (Locked-in syndrome)
Iatrogenic hypernatremia
Fluid overload
______ 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)
Hypotonic
In what situations are D5W and D10W used?
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
Differentiate 22, 20, 18, and 16 gauge needles by size and indications
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
3 potential peripheral complications of IV therapy
Phlebitis
Infiltration
Extravasation
Definition, signs and symptoms of phlebitis
Inflammation of a vein
Symptoms: pain, increased skin temp, redness
Signs: erythema, pain, red streak along vein, palpable venous cord, purulent drainage
Definition, signs and symptoms of infiltration
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
Definition, signs and symptoms of extravasation
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
Treatment for phlebitis
D/C IV line, moist warm compresses, monitor
Treatment for infiltration
D/C IV line, elevate extremity, warm compresses may facilitate absorption of fluid
Treatment for extravasation
D/C IV line, apply cool compresses, administer antidote if one exists
What is a progress note?
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)
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
Discharge summary
Which IV fluid is commonly used in perioperative period?
LR
