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001 Respiratory Therapy > Fluid Management and Blood Replacement > Flashcards

Fluid Management and Blood Replacement Flashcards

1
Q

Fluids and Electroyltes

A

60% of the body wieght is fluid

This water based solution contains many different types of solutes

Many of these solutes are ions (charged particles) known as electrolytes

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2
Q

Compartment of Body Fluid

A

Intracellular and Extracellular Fluids

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3
Q

Intracellular Fluid

A

Intracellular (ICF) is about 67% of body fluids in adults but only about 50% in infants

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4
Q

Extracellular Fluid Compartments

A

Of the extracellular compartment, 1/4 is plasma and 3/4 is interstitial fluid

Interstitial Fluid (ISF): Which is around cells and in the lymph

Intra-vascular (IVF): Plasma componenet of the blood

Trans Cellular Fluid (TCF): Secreted by the epithelial cells (digestive fluids, CSF, intraocular fluid)

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5
Q

Fluid and Elcetrolytes in Extracellular Compartment

A

Fluids and electrolytes move freely between ISF and IVF — interstitium and blood

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6
Q

Extra Cellular Fluid and Blood Volume

A

Blood volume consists of both plasma volume (an extracellular compartment) and an intracellular volume (red and white cell volume)

Not all extracellular water is present as “liquid” water, but is rather bound to mucopolysaccharides in connective tissue.

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7
Q

Blood Volume in Males

A

approximately 7% of total body weight (70 ml/kg).

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8
Q

Blood Volume in Females

A

55-65 ml/kg

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9
Q

Blood Volume in Infants

A

8% (80 ml/kg)

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10
Q

What is the most important volume to consider in the care of surgical patient s

A

There is a rapidly equilibrating sub-compartment of extracellular fluid which is in equilibrium with the intravascular compartment

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11
Q

Electroyte Transport

A

Organs and systems (kidneys, hormones etc.) regulate electrolyte transport in all other regions

Passive transport: diffusion, filtration, osmosis

Active transport: requires energy (e.g. sodium / potassium pump)

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12
Q

Total Body Water

A

70-50% of body weight in males

As a percentage of body weight it will decrease with age

Men have higher TBW than women which tend to mean a greater amount of fat and less muscle mass in women

Obese individuals have less TBW than lean ones. This is because the percentage of TBW decreases in inverse proportion to the percentage of body fat.

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13
Q

What are the Main Purposes of IV Therapy

A

To replace fluids and/or nutrients rapidly

To sustain pts. that are unable to take nutrients orally

To administer drugs instantly to the pt. (vein to brain)

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14
Q

IV Therapy can be Classified Into

A

IV therapy can be further classified in regards to site (peripheral or central—e.g. subclavian)

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15
Q

Peripheral IV Sites

A

Forearm

Hands and feet

Veins of the head and scalp (kids)

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16
Q

IV Equitment

A

IV administration set

IV bag. (various solutions)

Extension tubing

Filters

Infusion pumps

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17
Q

Five Basic Types of IV Fluids

A

Sources of Free Water and Calories

Crystalloids

Colloids.

Blood and blood components

Hypertonic

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18
Q

IV Type-Sources of Free Water and Calories

A

D5W: could be hypo-iso-hypertonic

Aminosyn II: 3.5% with dextrose, hypertonic, added proteins, 345 calories per 500mL.

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19
Q

IV Type-Crystalloids

A

Used to help with fluid replacement and are less expensive compared to colloids so they are used more. Balanced electroylte composition and used to expand total extracellular volume

Normal Saline: Contain sodium and maybe some dextrose

Ringers Lactate: Contains all normal electrolytes

Dextrose 5%

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20
Q

IV Type-Colloids

A

Volume expanders, used to maintain serum osmolality

Dextran®, Albumin, Plasmanate®, Hetastarch®.

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21
Q

IV Type-Hypertonic

A

Hyperosmolar solutions

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22
Q

Fluid for Non ‘Class-E’ patients who come into OR

A

These patient will have nothing by mouth for the last 8 hours, they will loose fluids due to normal pathways as well some that are lost due to nature of the procedure

The will be some degree of maintenance and replacement of fluid needed, suggested is basal ongoing requirement plus any deficit

23
Q

Monitoring Fluids Requirements

A

Look at

Urine output

CVP

PCWP

Estimating blood loss

24
Q

Loss of Fluid also results in loss of…

A

Loss of fluids (esp. blood) also involves the loss of electrolytes, therefore any replacement fluids should contain the proper concentrations of electrolytes.

25
Q

Determining What Amount of Fluid You Need

A

Total need = basal need + pre-existing deficit + ongoing losses.

26
Q

rate of infusion for a normal patient who has no large water deficit is

A

4 mL/Kg/Hr for the first 10 Kg of body weight

2 mL/Kg/Hr for the next 10 Kg of body weight

1 mL/Kg/Hr for each additional Kg of body weight

Therefore a 65 kg pt will require:

(4*10) + (2*10) + (1*45) = 105 mL/Hr.

27
Q

Fluid Deficit

A

Remember that when a patient volume is depleted it is not only intravascular fluid but also extracellular, and intracellular fluid missing.

Thus a modestly volume depleted patient may actually 3-4L below normal TBW, nearly equal to a blood volume.

28
Q

Mild Fluid Deficit

A

Degree of Depletion: Minus 3-5%

Body Weight Depletion: 2-3.5L

Symptons: Dry mucous membrane, decreased urine output, thirst

29
Q

Severe Fluid Deficit

A

Degree of Depletion: Minus 11-15%

Body Weight Depletion: 7-10L

Symptons: Cool extremities, dry skin, stupor, hypotension

30
Q

Moderate Fluid Deficit

A

Degree of Depletion: Minus 7-10%

Body Weight Depletion: 5-7L

Symptons: Decrease skin tugour, Orthostasis

31
Q

The therapeutic use of blood or blood products in the operating room falls under three categories:

A

Replacement of lost blood cells.

Replenishment of plasma volume.

Correction of coagulopathies.

32
Q

Blood Transfusion-Replacement of Lost Blood Cells

A

Whole blood tranfusion is rarely used due to the arrival of blood borne pathogens

Patients can tolerate a 30% loss of blood just with the use oncotically balanced fluids

Packed red cells with albumin and saline is often used as a replacement for whole blood

33
Q

Blood Transfusion-Replenishment of Plasma Volume

A

The fluids used to replace lost volume can be colloidal or crystalloid. The difference is what compounds are used to bring the fluid up to proper blood osmotic values.

Colloids use large proteins like albumin.

Crystalloids use salt and / or sugar solutions.

34
Q

Blood Transfusion-Correction of Coagulopathies

A

Stored blood products can be used to correct problems with the coagulation process.

Stored plasma has all the plasma proteins except Factors V and VII. It can be used to reverse anti-coagulation therapy like Coumadin.

Fresh frozen plasma has everything in it.

Platelets or cryoprecipitated Factor VIII can be given separately to treat hypo-coagulation problems.

35
Q

Blood Transfusion Reactions

A

Febrile—-Allergic—-Hemolytic:

Serious reactions to blood products happen in about 3% of patients receiving them.

Reactions due to A-B-O incompatibility or Rh (+ -) incompatibility are potentially fatal.

Other reactions seem to be less serious or at least are treatable.

36
Q

Blood Transfusion Febrile Reactions

A

Transfusion related fever happens in 1 to 2% of all patients receiving blood products.

The possible mechanism is reaction to lysed red cells, reaction to white cells or to cytokines released by white cells or other proteins.

These febrile reactions can be prevented by using leukocyte poor red cells or ‘washed red cells’

37
Q

Blood Transfusion Allergic Reactions

A

Allergic reactions including rash (urticaria) occur as commonly as fever in blood transfusions. Treatment includes anti-histamines (Benadryl) given IV.

Bronchospasm, angio-neurogenic edema are rare events.

Anaphylaxis requires immediate action; stopping the transfusion, use of epinephrine, bronchodilators, antihistamine, steroids etc. and any other measures needed to maintain the circulatory system.

38
Q

Blood Transfusion Hemolytic Reactions

A

Problems with ABO or Rh compatibility will cause hemolysis of RBCs. The immediate consequences are renal failure and DIC.

Signs include: chills, fever, headache, paresthesia (tingling extremities), N&V, chest pain, increase HR, decrease BP.

Treatment:FiO2, bronchodilators, inotropes and vasopressors to support circulation, diuretics like mannitol to increase renal tubular flow and hopefully reduce the chance of kidney failure., attempt to Tx DIC.

Reaction could be delayed if the pt has been sensitized to the red cell antigens from a previous transfusion.

39
Q

Transfusion Problems

A

Dilutional Coagulopathies

Infection: HIV, Hepatitis, CJV, the next one?

Potassium intoxication: Too quick transfusion?

Citrate intoxication: Anti-coag preservative

Hypothermia: Use blood warmers

Acid-base abnormalities

TRALI: transfusion related acute lung injury

40
Q

Transfusion Relation Acute Lung Injury

A

Diffused alveolar damage, increase capillary permeability, non-cardiogenic pulmonary edema

May be due to repsonse to leukocyte antigens or neutrophils

More common in multiparous women possibly due to their exposure to different fetal blood varieties.

41
Q

Group Testing & Cross Matching

A

Identifying blood group (of the recipient & donor) involves testing for A, B type, and Rh antibodies and screening the serum for many (not all) of the irregular blood antibodies.

Cross matching implies checking the donor’s red cells and the recipient’s serum for compatibility.

A full cross match can take up to 1.5 hours whereas a quick match (less sensitive) can be done in 15-20 minutes.

In emergencies, if the patient’s blood type is known, that blood type can be given (e.g. Type A, Rh neg).

Hemolytic reaction occurrence is 1:1000 in the first time pt., down to about 1:100 in the multiple transfusion pt.

If there is no time for much of anything the pt. can be given type ‘O’ red cells with very little plasma and be relatively safe. O+ve is used in males or post-menopausal women and O –ve saved for potentially fertile women.

Identifying the patient prior to transfusion is mandatory.

42
Q

Autologous Blood Transfusion

A

A patient’s blood is collected and then used later for a scheduled event

This can even occur during the same procedure if blood loss is anticipated

43
Q

Blood Infusion Equipment

A

Whole blood or red cell preparations (high viscosity) should be given via an 18 gauge needle, disposable infusion set and a filter.

The calcium in Ringers’ Lactate will cause coagulation so it should not be used if it can come in contact with stored blood.

The filter will prevent clots and other debris from being transfused.

Blood pumps —- blood warmers are often used.

44
Q

Blood Bank

A

Area is responsible for the selection and preparation of appropriate, compatible blood components (red blood cells, platelets, and plasma) that are safe for transfusion into patients.

Blood products are also tested to be sure they are free from infectious diseases such as HIV and hepatitis viruses B and C.

This laboratory also evaluates transfusion reactions by diagnosing their cause, determining whether or not it is safe to proceed with a transfusion, and selecting further components that are safe for transfusing

The blood bank may have a donor service to draw units of blood for general use and for autologous transfusions (for elective-surgery patients who wish to donate their own blood before surgery so that it will be available to them if they need it).

45
Q

Types of Blood Tests

A

ABO Group and Rh Type

Type and Cross Match

Antibody Screening

Direct Coombs

46
Q

Purspose of ABO Group and Rh Type

Type and Cross Match

A

Establishes blood group (A, B, O) and Rh type (positive or negative) to ensure compatibility of transfused blood between donor and recipient

47
Q

Antibody Screening Test

A

Ensures that blood is safe for transfusion

48
Q

Direct Coombs Test

A

Tests for antibodies on surface of red blood cells in autoimmune hemolytic anemias, transfusion reaction, and erythroblastosis fetalis (newborn hemolytic disease)

49
Q

ABO System

A

Every person’s blood belongs to one of four ABO blood groups

Named for antigens on RBC membranes

Type A: antigen A on RBCs

Type B: antigen B on RBCs

Type AB: both antigens A and B on RBCs; known as universal recipient

Type O: neither antigen A nor B on RBCs; known as universal donor

50
Q

Rh System

A

Rh-positive: Rh antigen is present on the RBCs

Rh-negative: RBCs have no Rh antigen present

Anti-Rh antibodies are not normally present in blood; anti-Rh antibodies can appear in Rh-negative blood if it has come in contact with Rh-positive RBCs

The complement system hekps or “complements

51
Q

Complement System

A

Complement system helps or “complements” the ability of antibodies and phagocytic cells to clear pathogens from an organism

52
Q

What is the distribution of this fluid into various body compartments?

A

Two thirds of TBW is intracellular, 1/3 is extracellular

53
Q

Peripheral IV Needle Size

A

Peripheral IV therapy is accomplished through a cannula (needle) ranging in size from 14 gauge (huge) to 27 gauge (small)

54
Q

IV Flow Rates and Needle Size

A

Flow rate is inversely proportional to cannula size. That is, the higher the number of the needle, the less flow is possible.

Large bore needles are used for blood transfusion and high flow situations. Small bore needles must be used on neonates and children

001 Respiratory Therapy (53 decks)

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