Fluid Management (Kane) Final Exam Flashcards
What percentage of total body water (TBW) is found in the average adult?
A. 50%
B. 55%
C. 60%
D. 70%
C. 60%
Slide 2
Which of the following are true about water distribution in the body?
A. 60% of TBW in the average pediatric patient
B. High percentage of water in adipose tissue
C. Low percentage of water in adipose tissue
D. Found equally in all types of tissues
C. Low percentage of water in adipose tissue
Slide 2
Which fluid compartment includes plasma volume?
A. Intracellular
B. Interstitial
C. Intravascular
D. Transcellular
C. Intravascular
Slide 2
Which of the following is NOT included in the transcellular fluid compartment?
A. GI tract fluid
B. Urine
C. Plasma volume
D. CSF
C. Plasma volume
GI tract, urine, csf, joint fluid, aqueous humor, Pericardial fluid
Slide2
Which of the following are components of the extracellular fluid compartment? Select 3
A. Intracellular fluid
B. Interstitial fluid
C. Intravascular fluid
D. Transcellular fluid
E. Cytoplasm
B. Interstitial fluid
C. Intravascular fluid
D. Transcellular fluid
Slide 2
The intersitial compartment includes _______ and ______________ fluid around cells.
A. lymphatics; protein-poor
B. intracellular; plasma;
C. lymphatics; plasma
D. intracellular; protein-poor
A. lymphatics; protein-poor
Slide 2
What is the direction of solute movement in diffusion?
A. Low to high concentration
B. High to low concentration
C. Random movement
D. No movement
B. High to low concentration
Solute particles fill solvent
Slide 3
Which ion is the primary extracellular cation?
A. Potassium (K)
B. Calcium (Ca)
C. Sodium (Na)
D. Magnesium (Mg)
C. Sodium (Na)
slide 3
Which ion is the primary intracellular cation?
A. Sodium (Na)
B. Potassium (K)
C. Calcium (Ca)
D. Magnesium (Mg)
B. Potassium (K)
Slide 3
The speed of diffusion is proportional to _______ .
A. distance
B. distance squared
C. time squared
D. volume
B. distance squared
Slide 3
Which of the following are types of solutes involved in diffusion? Select 3
A. Glucose
B. Proteins
C. Electrolytes
D. Water
E. Lipids
A. Glucose
B. Proteins
C. Electrolytes
Slide 3
Which of the following are true about diffusion? Select 2
A. Can relate to electrical gradients
B. Moves from low to high concentration
C. Can occur across permeable membranes
D. Does not relate to electrical gradients
E. Speed is proportional to distance cubed
A. Can relate to electrical gradients
C. Can occur across permeable membranes
As well as:
* Solute particles fill solvent
* High to low concentration
* Speed is proportional to distance squared*
Slide 3
What type of membrane is involved in osmosis?
A. Impermeable
B. Semipermeable
C. Permeable
D. Nonpermeable
B. Semipermeable
A semipermeable membrane separates pure water from water with dissolved solute
Osmosis Jones… 2001 throwback..
Slide 4
In osmosis, water diffuses from ____ concentration to ____ concentration solute.
A. low; high
B. high; low
C. equal; unequal
D. random; specific
A. low; high
Slide 4
What factor directly affects osmotic pressure?
A. Pressure
B. Solvent
C. Temperature
D. Gravity
C. Temperature
Slide 4
Which factors affect osmotic pressure? Select 2
A. Molecular weight
B. Number of molecules
C. Volume
D. Speed
B. Number of molecules
C. Volume (inversely affects pressure)
*P = nRT/V
Osmotic pressure is affected by temperature, number of molecules, volume
Slide 4
True or False
Osmotic pressure is the pressure that resists the movement of water through osmosis
True
Slide 4
What does osmolarity measure?
A. The number of osmotically active particles per liter of solutes
B. The number of osmotically active particles per liter of solvent
C. The number of osmotically active particles per gram of solvent
D. The number of osmotically inactive particles per liter of solvent
B. The number of osmotically active particles per liter of solvent
Kane - know the difference unless you are eating McDonalds
Slide 5
Which statements are true about osmolarity and its effects?
A. Higher osmolarity has higher pulling power
B. Lower osmolarity has higher pulling power
C. Osmolality is measured in particles per liter of solvent
D. Patient with higher serum glucose has lower osmolarity
A. Higher osmolarity has higher pulling power
Slide 5
Patient A has a serum glucose of 600 mg/dL, and Patient B has a serum glucose of 250 mg/dL. _______ has higher osmolarity because of the higher number of _______.
A. Patient A; particles
B. Patient B; particles
C. Patient A; cells
D. Patient B; cells
A. Patient A; particles
Slide 5
True or False
Osmolality refers to the number of osmotically active particles per liter of solvent.
False (The correct measurement is per kilogram of solvent)
Slide 6
The normal range of osmolality in the human body is _______ to _______ mOsm.
A. 260; 270
B. 270; 280
C. 280; 290
D. 290; 300
C. 280- 290
Slide 6
What is oncotic pressure?
A. The total pressure exerted by water in the body
B. The total osmotic pressure due to colloids
C. The total pressure exerted by electrolytes in the body
D. The total osmotic pressure exerted by glucose in the bloodstream
B. The component of total osmotic pressure due to colloids
Slide 7
What percentage of oncotic pressure is contributed by albumin?
A. 50-60%
B. 60-70%
C. 65-75%
D. 70-80%
C. 65-75%
Slide 7
Which of the following proteins contribute to oncotic pressure?
Select 3
A. Albumin
B. Globulins
C. Fibrin
D. Fibrinogen
E. Hemoglobin
F. Hematocrit
A. Albumin
B. Globulins
D. Fibrinogen
Slide 7
MATCHING
Match the Average Intake to our Average Output
Kane - in general what we intake is relatively equal to our output
Slide 8
What percentage of daily water loss is due to urinary secretion?
A. 30%
B. 40%
C. 50%
D. 60%
D. 60%
slide 9
What activates Atrial Natriuretic Peptide (ANP)?
A. Decreased fluid volume
B. Increased fluid volume
C. Increased potassium levels
D. Decreased sodium levels
B. Increased fluid volume
*↑ atrial stretch = ↑ renal excretion.
*
slide 9
Which hormone regulates renal H₂O excretion in response to plasma tonicity?
A. Aldosterone
B. Antidiuretic Hormone (ADH)
C. Atrial Natriuretic Peptide (ANP)
D. Renin
B. Antidiuretic Hormone (ADH)
slide 9
If sodium and fluid volume decrease, _______ is released, causing sodium and water conservation.
A. Atrial Natriuretic Peptide (ANP)
B. Antidiuretic Hormone (ADH)
C. Aldosterone
D. Renin
C. Aldosterone
regulates Sodium and Potassium levels
slide 9
Which sensors are involved in the regulation of overall fluid balance? Select 3
A. Osmoreceptors in the kidney
B. Low pressure baroreceptors
C. High pressure baroreceptors
D. Hypothalamic chemoreceptors
E. Hypothalamic osmoreceptors
B. Low pressure baroreceptors in large veins and right atrium
C. High pressure baroreceptors in the carotid sinus and aortic arch
E. Hypothalamic osmoreceptors
Slide 10
Where are high pressure baroreceptors located?
A. Large veins and right atrium
B. Hypothalamus
C. Carotid sinus and aortic arch
D. Lungs
C. Carotid sinus and aortic arch
Slide 10
Where are low pressure baroreceptors located?
A. Carotid sinus
B. Aortic arch
C. Large veins and right atrium
D. Hypothalamus
C. Large veins and right atrium
Slide 10
Triggers for maintaining fluid balance include increased _______ or _______ release.
A. thirst; aldosterone
B. hunger; ADH
C. thirst; ADH
D. hunger; aldosterone
C. thirst; ADH
Slide 10
Which of the following are compensatory mechanisms activated in response to acute disturbances in circulating volume? Select 3
A. Venoconstriction
B. Mobilization of venous reservoir
C. Increased urine production
D. Autotransfusion from ISF to plasma
E. Decreased heart rate
A. Venoconstriction -Platelet aggregation
B. Mobilization of venous reservoir -Blood is shunted to primary organs
D. Autotransfusion from ISF to plasma -We don’t need it extracellularly, we need circulating volume
Kane - compensation may happen in minutes to hours. At that hour mark that it takes to completely compensate, it only works if you are NOT losing any more volume.
If we continue to lose volume, that compensation with partly or totally delayed
Slide 11
What happens to cardiac output (CO) during acute disturbances in circulating volume?
A. It remains the same
B. It increases significantly
C. It decreases
D. It stabilizes
C. It decreases, leading to tachycardia and increased inotropy
Slide 11
True or False
During acute disturbances in circulating volume, reduced urine production is a compensatory mechanism to maintain circulating volume.
True
Slide 11
Which sensors are involved in the response to acute disturbances in circulating volume? Select 3
A. Low pressure baroreceptors
B. High pressure baroreceptors
C. Osmoreceptors
D. Chemoreceptors
E. Thermoreceptors
F. Mechanoreceptors
G. RAA axis
A. Low pressure baroreceptors
B. High pressure baroreceptors
G. RAA axis
Slide 11
Renin is released from _______ cells in the kidney and cleaves angiotensinogen to make _______ .
A. juxtaglomerular; angiotensin I
B. adrenal; angiotensin II
C. juxtaglomerular; angiotensin II
D. adrenal; vasopressin
A. juxtaglomerular; angiotensin I
Slide 12
Angiotensin I becomes Angiotensin II and causes _______ and _______ release.
A. vasoconstriction; aldosterone
B. vasodilation; renin
C. vasoconstriction; renin
D. water excretion; aldosterone
A. vasoconstriction; aldosterone
Slide 12
Aldosterone is released from the adrenal cortex and stimulates:
Select 2
A. Salt and water retention
B. Regulates potassium levels
C. Regulates
D. Salt and water excretion
A. Salt and water retention
B. Regulates potassium levels
Where sodium goes, water follows
Slide 12
In the absence of ongoing loss, how long does it take to restore volume through the RAA axis?
A. 1-2 hours
B. 12-72 hours
C. 4-8 weeks
D. 1-2 days
B. 12-72 hours
Slide 12
In the absence of ongoing loss, how long does it take for the RAA axis to restore RBC numbers through erythropoiesis?
A. 12-72 hours
B. 1-2 weeks
C. 4-8 weeks
D. 2-4 days
C. 4-8 weeks
Slide 12
Which intravenous fluid has an osmolarity closest to normal plasma osmolarity (280-290 mOsm)?
A. Normal Saline (NS)
B. Lactated Ringers (LR)
C. Plasmalyte A
D. D5
C. Plasmalyte A
*Plasmalyte is the closest to normal osmolarity (280-290)
Sodium and potassium is normal
Chloride is normal
*
Slide 14
Why is D5 considered a bad idea for fluid therapy?
A. It has high sodium content
B. It turns into free water
C. It has low potassium content
D. It causes vasoconstriction
B. It turns into free water
Slide 14
Which fluid is recommended for diabetic patients?
A. Lactated Ringers (LR)
B. D5
C. Normal Saline (NS)
D. Albumin 5%
C. Normal Saline (NS)
Slide 14
Which fluid is not recommended for patients with liver injury/failure?
A. Normal Saline (NS)
B. Lactated Ringers (LR)
C. Plasmalyte A
D. Hetastarch
B. Lactated Ringers (LR)
*Kane - NS, Plasmalyte is ok.
Lactated ringers is not good because of the high levels of Lactate in it
*
Slide 14
If Plasmalyte is not available what is the next fluid that is closest to normal osmolarity?
A. Normal Saline (NS)
B. Lactated Ringers (LR)
C. Albumbin
D. Hetastarch
B. Lactated Ringers (LR)
LR is close to osmolality
Electrolyte composition is close
Slide 14
Which of the following are examples of crystalloids? Select 4
A. Blood products
B. Normal Saline (0.9%)
C. Hypertonic Saline (3%)
D. Lactated Ringers
E. Dextrose Solutions
F. Albumin
B. Normal Saline (0.9%)
C. Hypertonic Saline (3%)
D. Lactated Ringers
E. Dextrose Solutions
Slide 15
What is the primary use of crystalloids in medical treatment?
A. Replacement of free water and vitamins
B. Replacement of free water and electrolytes
C. Replacement of free water and glucose
D. Replacement of free water and colloids
B. Replacement of free water and electrolytes
Slide 15
Which of the following statements about crystalloids are true?
Select 3
A. They are solutions of electrolytes in water
B. They are used for volume expansion
C. They are primarily used to provide essential vitamins
D. They are known for increasing blood pressure
E. They are often referred to as balanced solutions
A. They are solutions of electrolytes in water
B. They are used for volume expansion
E. They are often referred to as balanced solutions -*aka Isotonic…but not exactly, but they are close *
Slide 15
What percentage of crystalloids is distributed into the intravascular space 20 minutes after administration?
A. 30%
B. 50%
C. 70%
D. 90%
C. 70% is in the intravascular space (ECF)
slide 16
What happens to crystalloids 30 minutes after administration?
A. 30% remains intravascular
B. 50% remains intravascular
C. 50% is gone
D. 70% is gone
C. 50% is left in the intravascular space
Slide 16
Crystalloids can leak into interstitial components such as _______ , _______ , and _______ , leading to tissue edema.
A. blood vessels; soft tissues; gut
B. lung; gut; soft tissues
C. heart; liver; kidneys
D. muscles; lungs; soft tissues
B. lung; gut; soft tissues
Slide 16
True or False
Crystalloids can cause a hypercoagulable state due to the dilution of anticoagulant factors.
True
..could become hypocoaguable depending on what we have done with their anticoagulants
Slide 16
Normal Saline (0.9%) is commonly used and compatible with _______ , but it can dilute _______ and albumin in the plasma.
A. blood products; hematocrit (HCT)
B. electrolytes; glucose
C. blood products; proteins
D. medications; lipids
blood products; hematocrit (HCT)
Slide 17
What is a potential consequence of giving too much Normal Saline (0.9%)? Select 2
A. Decreased diuresis
B. Hypochloremic metabolic alkalosis
C. Hyperchloremic metabolic acidosis
D. Increased blood pressure
E. Hyperkalemia
C. Hyperchloremic metabolic acidosis
E. Hyperkalemia
Slide 17
What is a common issue with Normal Saline (0.9%) in critical care patients?
A. It leads to AKI and dialysis
B. It increases blood glucose levels
C. It stays entirely in the vascular system
D. It enhances diuresis
A. It leads to AKI and dialysis
RRT in critical care patients
Not staying in the vascular system and leaking out into the interstitium
Slide 17
Hypertonic Saline (3%) pulls water out of the ________ to the _______, including plasma, and is used to treat conditions such as _______ and increased ICP.
A. ECF; ICF; hyperkalemia
B. ICF; ECF; hypo-osmolar hyponatremia
C. plasma; ICF; hypernatremia
D. ECF; ICF; hypo-osmolar hyponatremia
B. ICF; ECF; hypo-osmolar hyponatremia
Slide 18
Hypertonic Saline (3%) is often given to treat which syndrome?
Select 2
A. Nephrotic syndrome
B. TUR syndrome
C. Metabolic syndrome
D. Cushing’s syndrome
E. Increased ICP
B. TUR syndrome -*most often given for this reason *
E. Increased ICP - Seen in the ICU more likely
Slide 18
What is a key difference between Lactated Ringers (LR) and Normal Saline (NS)?
A. LR has a higher osmolality than NS
B. LR has lower Na+ and Cl- concentrations than NS
C. LR has higher Na+ and Cl- concentrations than NS
D. LR is hypertonic compared to NS
B. LR has lower Na+ and Cl- concentrations than NS
This gives LR a much lower osmolarity than NS
Slide 19
Lactate in Lactated Ringers (LR) serves as a _______ , which is beneficial unless the patient has _______ .
A. source of glucose; diabetes
B. buffer; liver failure
C. diuretic; liver failure
D. buffer; hypocalcemia
B. buffer; liver failure due to the high lactate levels
AND it relies on hepatic metabolism
Slide 19
What is an advantage of Lactated Ringers (LR) over Normal Saline (NS) regarding water excretion?
A. LR retains more water in the body
B. LR excretes excess water faster than NS
C. LR suppresses diuresis
D. LR causes less water loss
B. LR excretes excess water faster than NS
Suppresses ADH secretion/allows diuresis
Slide 19
What is a primary use of Dextrose Solutions (D5’s)?
A. Suitable for volume expansion
B. Source of free water
C. Enhances electrolyte balance
D. Increases blood pressure
B. Source of free water
Slide 20
Why are Dextrose Solutions (D5’s) not suitable for volume expansion?
A. Water moves freely into the intravasculature
B. Water moves freely between all compartments
C. Water moves freely into the intracellular space
D. Water moves freely inot the intrastitial space
B. Water moves freely between all compartments
*Kane - Not really used in the OR – can turn into water – not really a benefit
*
Slide 20
In which situation could Dextrose Solutions (D5’s) be used?
A. For caloric intake in diabetics
B. To treat hyperkalemia
C. As a diuretic
D. To decrease blood glucose levels
A. For caloric intake in diabetics (10%)
Slide 20
True or false
Colloids are large molecules of a heterogeneous, non-crystalline substance
False
Colloids are large molecules of a homogeneous, non-crystalline substance
Slide 21
Colloids are usually dispersed in a _______ , typically a _______ .
A. solid medium; saline solution
B. aqueous medium; crystalloid solution
C. second substance; balanced crystalloid
D. second substance; dextrose solution
C. second substance; balanced crystalloid
Slide 21
Which of the following is true about colloid particles?
Select 2
A. They can be separated through filtration
B. They can be separated through centrifugation
C. They cannot be separated through filtration
D. They cannot be separated through centrifugation
C. They cannot be separated through filtration
D. They cannot be separated through centrifugation
Slide 21
Which of the following are examples of colloids?
Select 2
A. Human plasma derivatives
B. Synthetic colloids
C. Semisythetic colloids
D. Human non-crystalloid derivatives
A. Human plasma derivatives
C. Semisythetic colloids
Hetastarch, Hespan, albumin, fibrinogen
Slide 21
What is the effect of increased colloid osmotic pressure (COP) due to colloids?
A. Decreased potential plasma volume expansion
B. Increased potential plasma volume expansion
C. Increased potential intracellular fluid volume
D. Decreased potential blood viscosity
B. Increased potential plasma volume expansion
Slide 22
How do colloids cause hemodilution?
A. By pulling free fluid from the extracellular fluid (ECF) into the interstitium
B. By pulling free fluid from the interstitium into the intracellular fluid (ICF)
C. By pulling free fluid from the intracellular fluid (ICF) into the interstitium
D. By pulling free fluid from the interstitium into the extracellular fluid (ECF)
B. By pulling free fluid from the interstitium into the intracellular fluid (ICF)
Slide 22
Which of the following is a consequence of colloid administration on blood components? Select 2
A. Increased hematocrit (HCT) levels
B. Decreased plasma viscosity
C. Increased concentration in albumin particles
D. Inhibits RBC aggregation
E. Increases RBC aggregation
B. Decreased plasma viscosity
D. Inhibits RBC aggregation
*Dilute Hgb, HCT, RBC, Albumin particles *
Slide 22
What is a recommended dosage consideration when administering Hespan/Hetastarch?
A. There is no limit to how much can be given
B. Dosage should be limited to avoid affecting coagulation
C. Dosage should be increased quickly
D. Dosage should be based on patient’s age only
B. Dosage should be limited to avoid affecting coagulation
there is a limit to how much you give until you affect coags
If you suspect a problem with coags – give Albumin
Slide 22
Colloids have an uncertain effect on _______, __________, and __________ systems.
A. immune, coagulation, and renal
B. coagulation, renal and pulmonary
C. immune, coagulation, and muscular
D. coagulation, renal and cardiac
A. immune, coagulation, and renal
from additives, some side effects due to Hespan/hetastarch
Slide 22
What are Hydroxyethyl Starch (HES) molecules derived from?
A. Wheat or rice
B. Potato or maize
C. Barley or oats
D. Soy or maize
B. Potato or maize
Slide 23
What is the main polymer of Hydroxyethyl Starch (HES)?
A. Cellulose
B. Glycogen
C. Amylopectin
D. Amylodextrin
C. Amylopectin
SCIENCE!!!
Slide 23
The metabolism of Hydroxyethyl Starch (HES) is dependent on the _______ of molecules, which results in plasma volume effects lasting longer, with volume being _______ larger at 90 minutes.
A. molecular weight; 70-90%
B. molecular size ; 70-50%
C. serum sodium concentration; 60-70%
D. hemoglobin concentration; 70-80%
E. molecular weight; 70-80%
E. molecular weight; 70-80%
Plasma volume effects last longer
Kane - More bang for your buck to stay in the vascular system longer
Slide 23
What are some side effects d/t Hydroxyethyl Starch (HES) in relation to coagulopathy?
Select 2
A. Factor V
B. von Willebrand factor (vWF)
C. Factor VIII
D. Fibrinogen
E. Prothrombin
B. von Willebrand factor (vWF)
C. Factor VIII
Slide 23
Dextrans are _______ similar to starches and are produced by _______ .
A. branched polysaccharides; Leuconostoc mensenteroides
B. branched monosaccharides; Leuconostoc mesenteroides
C. branched proteins; Saccharomyces cerevisiae
D. branched polysaccharides; Leuconostoc pyogenes
A.* highly* branched polysaccharides; Leuconostoc mesenteroides
– similar to starches, stays in the intravascular space longer
Slide 24
How long do Dextrans stay in the intravascular space?
A. 1-2 hours
B. 3-5 hours
C. 6-12 hours
D. 24 hours
C. 6-12 hours
Slide 24
Dextran-40 is used for _______ surgery and has the effect of _______ Factor VIII, vWF factor, and platelet aggregation.
A. orthopedic; enhancing
B. cardiovascular; inhibiting
C. microvascular; inhibiting
D. vascular; enhancing
C. microvascular; inhibiting
Kane - good for reattaching fingers, reconstruction of breasts with flap surgeries to help with light anticoagulation with vessel reanastamosis
Slide 24
Human plasma are derivatives such as _______, _______ and immunoglobulin solution.
A. Albumin 5%; FFP
B. Dextrose; FFP
C. Lactated Ringer’s; FFP
D. Albumin 5%; Hetastarch
A. Albumin 5%; FFP
If you are bleeding, need a colloid and need coagulation factors you give FFP, don’t just give FFP willy nilly
Slide 25
Which conditions are indications for the use of human plasma derivatives to help with physologic colloid oncotic pressure?
Select 3
A. Trauma
B. Sepsis
C. Replacement following paracentesis
D. After minor blood loss in a TURP
E. During laparoscopic cholecystectomy
A. Trauma
B. Sepsis
C. Replacement following paracentesis
Volume replacement, lots of insensible loss along with real loss in “big belly” cases
Slide 25
Which of the following factors can contribute to preoperative fluid alterations? Select 4
A. Disordered Na+ distribution
B. Requirement for dialysis
C. Inflammation related redistribution
D. Chronic use of diuretics
E. Insensible losses
F. Diagnosis of hypertension
A. Disordered Na+ distribution
B. Requirement for dialysis
D. Chronic use of diuretics
F. Diagnosis of hypertension
*Kane - they may have come from dialysis and straight to the OR. They are in a negative balance and may have unstable K+ (fluid shifts still can occur and may not be accurate)**
Slide 26
Which of the following preoperative factors are associated with planned surgery? Select 4
A. Inflammation due to redistribution
B. Preop fasting
C. Autoregulatory Responses
D. Bowel prep
E. Nausea, vomiting, diarrhea
F. 3rd space redistribution
B. Preop fasting
D. Bowel prep
E. Nausea, vomiting, diarrhea (N,V,D) and/or suction
F. 3rd space redistribution
Slide 26
Which of the following intraoperative factors can lead to fluid alterations? Select 2
A. Insensible losses
B. Inflammation related redistribution
C. Chronic use of diuretics
D. Fasting
E. Vasoconstriction from pressors
A. Insensible losses
B. Inflammation related redistribution
Slide 26
Which of the following intraoperative factors can contribute to fluid alterations? Select 3
A. Vasodilation from anesthetics
B. Sympathetic blockade
C. 3rd Space redistribution
D. Diagnosis of hypertension
E. Autoregulatory responses
A. Vasodilation from anesthetics
B. Sympathetic blockade
E. Autoregulatory responses
Slide 26
True or false
Acute hemorrhage can cause fluid alterations in both the perioperative and intraoperative phases
TRUE
Slide 26
Which of the following are signs of hypovolemia?
Select 4
A. Tachycardia
B. Decreased pulse pressure
C. Hypertension
D. Increased capillary refill
E. Decreased capillary refill
F. Bradycardia
G. Hypotension
A. Tachycardia
B. Decreased pulse pressure
E. Decreased capillary refill
G. Hypotension
Slide 27
What percentage of volume must be lost to show signs of hypovolemia?
A. 10%
B. 15%
C. 25%
D. 30%
C. 25%
Slide 27
What factors can contribute to inadequate urine output?
Select 2
A. End-organ damage due to RAA
B. High cortisol levels due to stress
C. Proper positioning in reverse Trendelenburg
D. Low cortisol levels due to stress
A. Inadequate as end-organ due to RAA
B. High cortisol levels due to stress
Slide 27
Urine output can be inadequate due to _______ and _______ .
A. Increased cortisol levels; positioning in Trendelenburg
B. Decreased cortisol levels; positioned in reverse Trendelenburg positioning
C. Increased blood volume; proper Foley catheter positioning
D. Decreased blood pressure; increased urine output
A. Increased cortisol levels; positioning in Trendelenburg -*hard for the Urine to come out of the foley *
Slide 27
Assessements of low intravascular volume can be assessed by measuring:
Select 3
A. ETCO2
B. Lactate
C. RR
D. CVP
E. Mixed venous O2
B. Lactate
D. CVP
E. Mixed venous O2
Kane - in times of stress the venous system dilates and becomes distensible, might have the same amount of plasma volume, but the venous system is dilating and will go to other places
- what does acid/base look like?*
Slide 27
Which of the following is an effect of excessive crystalloid/colloid administration?
A. Increased capillary hydrostatic pressure
B. Decreased capillary hydrostatic pressure
C. Increased tissue oxygenation
D. Improved wound healing
A. Increased capillary hydrostatic pressure
Slide 28
Which of the following are consequences of excessive crystalloid/colloid administration? (Select 2)
A. Decreased capillary hydrostatic pressure
B. Excessive fluid development in lungs
C. Decreased gut motility
D. Increased tissue oxygenation
E. Improved wound healing
B. Excessive fluid development in lungs -pulmonary edema - happens way too often
C. Decreased gut motility
Slide 28
Which of the following are consequences of excessive crystalloid/colloid administration? Select 3
A. Reduced tissue oxygenation
B. Poor wound healing
C. Increased gut motility
D. Increased capillary hydrostatic pressure
E. Excessive fluid development in muscle
A. Reduced tissue oxygenation
B. Poor wound healing
E. Excessive fluid development in muscle - peripheral edema
Slide 28
True or false
Assessments of high intravascular volume can have hyper and hypocoagulopathy
True!
Slide 28
True or False
The 4-2-1 rule in fluid therapy only helps to calculate total fluid loss from NPO status
False it helps calculate total fluid defecit so we can accurately give fluid replacement
Includes:
*- NPO deficit
- Ongoing maintenance – for every hour in the OR – there is more of a deficit in fluid
- Anticipated surgical loss – Blood loss, insensible loss
*
Slide 29
Match the type of intake to the proper NPO duration
1 - B (Clear liquids - 2 hours) - can give Gatorade (carbohydrates)
2 - D (Breast milk - 4 hours)
3 - A (Infant formula - 6 hours)
4 - E (Light meal - 6 hours)
5 - C (Meat/fatty, fried foods - 8 hours)
Cancel case for cookie monster
Slide 30
What is the fluid rate for the first 10 kg of body weight in the classic 4-2-1 rule for the NPO/Maitenance?
A) 1 mL/kg/hr
B) 2 mL/kg/hr
C) 4 mL/kg/hr
D) 5 mL/kg/hr
C) 4 mL/kg/hr
Slide 31
What is the fluid rate for the second 10 kg of body weight in the classic 4-2-1 rule for NPO/Maitenance?
A) 1 mL/kg/hr
B) 2 mL/kg/hr
C) 4 mL/kg/hr
D) 5 mL/kg/hr
B) 2 mL/kg/hr
Slide 31
For the 4-2-1 rule what is the first step to calculate the NPO deficit?
A) Calculate the total deficit in mL
B) Change pounds to kilograms
C) Apply the 4-2-1 rule
D) Determine the fluid need per hour
Change pounds to kilograms
8 hours NPO; weights 176 pounds = 80kg
Slide 32
What is the 2nd step after converting weight to kilograms for calculating the NPO defecit?
A) Calculate the the fluid needed per minute
B) Determine the fluid need per hour
C) Change pounds to megatons
D) Calculate the total defecit
2 Calculate the 4-2-1 rule - 80kg total
B) Determine the fluid need per hour
4cc/kg 1st 10kg = 40ml
2cc/kg 2nd 10kg = 20ml
1cc/kg last 60kg = 60ml
Need is = 120ml/hour
Slide 32
What is the 3rd step after finding the total need of fluid per hour for the NPO defecit?
A) Calculate the the fluid needed per minute
B) Calculate the total insensible loss
C) Change pounds to kilograms
D) Calculate the total defecit
D) #3 calculate total deficit
8 hours NPO x 120ml/hr = 960 ml
Slide 32
How is the NPO deficit replaced during surgery?
A) 1/3 in the 1st hour, 1/3 in the 2nd hour, 1/3 in the 3rd hour
B) 1/2 in the 1st hour, 1/4 in the 2nd hour, 1/4 in the 3rd hour
C) 1/4 in the 1st hour, 1/2 in the 2nd hour, 1/4 in the 3rd hour
D) 1/4 in the 1st hour, 1/4 in the 2nd hour, 1/2 in the 3rd hour
B) 1/2 in the 1st hour
1/4 in the 2nd hour,
1/4 in the 3rd hour
Dividing up the calculated 960ml of total defecit
Slide 33
True or False
Surgeons are accurate in estimating blood loss.
False
How much blood does a lap sponge typically absorb?
A) 10 mL
B) 20 mL
C) 100 mL
D) 200 mL
C) 100 mL
Be aware of how much irrigation has been given..
Slide 37
What is the absorption capacity of a Raytech sponge?
A) 10 mL
B) 20 mL
C) 50 mL
D) 100 mL
B) 20 mL
Slide 37
How much blood does a 4x4 sponge typically absorb?
A) 5 mL
B) 10 mL
C) 20 mL
D) 50 mL
B) 10 mL
Slide 37
What is the range of minimal insensible evaporative/redistribution losses?
A) 0-1 mL/kg/hr
B) 0-2 mL/kg/hr
C) 1-2 mL/kg/hr
D) 1-3 mL/kg/hr
B) 0-2 mL/kg/hr
Slide 38
Moderate insensible evaporative/redistribution losses are classified within what range?
A) 1-3 mL/kg/hr
B) 2-4 mL/kg/hr
C) 3-5 mL/kg/hr
D) 4-6 mL/kg/hr
B) 2-4 mL/kg/hr
Slide 38
Severe insensible losses through evaporative/redistribution losses are classified within what range?
A) 3-5 mL/kg/hr
B) 4-6 mL/kg/hr
C) 4-8 mL/kg/hr
D) 5-7 mL/kg/hr
C) 4-8 mL/kg/hr
Slide 38
The Parkland formula is based on the Rule of 9’s and is adjusted for:
Select 2
A) Elderly patients
B) Pediatric patients
C) Obese patients
D) Middle aged adults
E) Overweight patients
B) Pediatric patients
C) Obese patients
Kane - if you have a lot of bad burns on the belly or where you carry your weight, that percentage may be more than 9%
Slide 39
In the Parkland formula, what is the percentage of total body surface area (TBSA) of 2nd/3rd degree burns that requires fluid resuscitation?
A) 10%
B) 15%
C) 20%
D) 25%
C) 20%
Slide 39
What is the Parkland formula for fluid resuscitation in burns?
A) 2mL/kg/%BSA burn
B) 4mL/kg/%BSA burn
C) 6mL/kg/%BSA burn
D) 8mL/kg/%BSA burn
B) 4mL/kg/%BSA burn
Fluid used is Lactated Ringers
4ml x 80kg x 40% of burned area = 12,800ml
Slide 39
According to the Parkland formula, how should the total fluid be replaced?
A) All in the first 8 hours
B) All in the first 16 hours
C) ½ over the first 8 hours, ½ over the next 16 hours
D) ¼ over the first 8 hours, ¾ over the next 16 hours
C) ½ over the first 8 hours, ½ over the next 16 hours
Slide 39
True or False
Goal Directed therapy is Keeping cardiac output (CO) at a level that delivers appropriate amounts of oxygen to the tissues
TRUE
Slide 40
Which of the following parameter is not considered super specific for fluid administration in goal-directed therapy?
A) SVO2
B) CO
C) CVP
D) SV
C) CVP
Slide 40
What does a decreasing lactate level indicate in goal-directed therapy?
A) Worsening of the patient’s condition
B) Successful resuscitation
C) Increased fluid needs
D) Decreased oxygen delivery
B) Successful resuscitation
Slide 40
Which of the following measures oxygen extraction in goal-directed therapy?
A) SVO2
B) TEE
C) SVV
D) CVP
E) CO
A) SVO2
Slide 40
Which of the following parameters are used to quantify LV cavity size/EF in fluid administration for goal-directed therapy?
A) Lactate levels
B) SVV
C) SWAN
D) TEE
E) SV
D) TEE
Slide 40
Which of the following parameters are used in fluid administration for goal-directed therapy?
Select 4
A) ANP
B) SVV
C) SWAN
D) TUR
E) SV
F) BUN
G) CO
B) SVV -stroke volume variance – determine are these patients hypovolemic or fluid responsive.
C) SWAN -use declining
E) SV
G) CO
Slide 40
According to studies, goal-directed therapy results in which of the following outcomes?
Select 2
A) Less AKI
B) Increased respiratory failure
C) Decreased wound infection
D) Increased mortality
E) Worsening fluid balance
A) Less AKI
C) Decreased wound infection
Studies: less aki, respiratory failure, wound infection, mortality
Slide 41
Goal-directed therapy on volume status allows you to do all of these except:
A) Increase fluid intake
B) Use vasopressors
C) Administer inotropes
D) Use diuretics
E) Use blood products
D) Use diuretics
Slide 41
What is the general maintenance rate of crystalloids in goal-directed therapy?
A) 1-3 mL/kg/hr
B) 3-5 mL/kg/hr
C) 5-7 mL/kg/hr
D) 7-9 mL/kg/hr
A) 1-3 mL/kg/hr
Kane - a lot less than what we were getting with the 4-2-1 rule
Slide 42
How much fluid is typically used in a fluid challenge to increase stroke volume (SV) in goal-directed therapy?
A) 100cc
B) 150cc
C) 200cc
D) 250cc
D) 250cc
Slide 42
In goal-directed therapy, how are colloids generally administered in relation to blood loss or blood products?
A) 1:1
B) 2:1
C) 1:2
D) 1:3
A) 1:1
Kane - if the fluid balnaces dont’ work instead of giving tons of crystalloids it switches to colloids with blood loss and blood products
Slide 42
Which physiological conditions can limit the accuracy of stroke volume variance (SVV) measurements?
Select 3
A) Low heart rate
B) Irregular heart beats
C) Increased abdominal pressure
D) High tidal volume mechanical ventilation
E) Normal thoracic pressure
A) Low heart rate
B) Irregular heart beats
C) Increased abdominal pressure
Slide 43
Which mechanical or procedural conditions can limit the accuracy of stroke volume variance (SVV) measurements?
Select 3
A) Thorax open
B) Normal lung compliance
C) Consistent heart rhythm
D) Mechanical ventilation with low tidal volume
E) Decreased abdominal pressure
F) Spontaneous breathing
A) Thorax open
D) Mechanical ventilation with low tidal volume
F) Spontaneous breathing
Slide 43
Acronym used for the Limits to Stroke Volume Variance
L.I.M.I.T.S.
Low hr/rr
Irregular heart beats
Mechanical ventilation (with low tidal volume)
Increased abdominal pressure
Thorax open
Spontaneous breathing
Slide 43
Which statements are true about systolic pressure variation (SPV) monitoring?
Select 2
A) It measures the difference between systolic and diastolic BP.
B) It calculates the max systolic pressure minus the minimal systolic pressure.
C) It is measured during one cycle of mechanical breath.
D) It monitors the variation of stroke volume in 30 seconds.
B) It calculates the max systolic pressure minus the minimal systolic pressure.
C) It is measured during one cycle of mechanical breath.
Slide 44
What does pulse pressure (PP) monitoring measure?
A) The variation of stroke volume in 30 seconds
B) The difference between systolic and diastolic BP
C) The max systolic pressure minus the minimal systolic pressure
D) The average systolic pressure during one cycle of mechanical breath
B) The difference between systolic and diastolic BP
Slide 44
What is the normal range for stroke volume variance (SVV)?
A) 5-10%
B) 10-15%
C) 15-20%
D) 20-25%
B) 10-15%
Slide 44
Which statements accurately describe stroke volume variance (SVV) monitoring?
Select 2
A) It measures the variation of SV in 30 seconds.
B) Normal SVV ranges from 15-25%.
C) It is used to calculate pulse pressure.
D) It indicates fluid responsiveness if the value is outside the normal range.
E) It calculates max systolic pressure minus minimal systolic pressure.
A) It measures the variation of SV in 30 seconds.
D) It indicates fluid responsiveness if the value is outside the normal range.
Slide4 44
