Fluid theraphy

Question 1

What is fluid concentration determined by?

Answer 1

The amount of substances contained in the fluid (solution)

Question 2

What is a solution?

Answer 2

A solute dissolved within a solvent

Question 3

What is a solute?

Answer 3

A solid portion of a solution

Question 4

What is a solvent?

Answer 4

Liquid portion of a solution

Question 5

What is an isotonic solution?

Answer 5

A solution with a concentration equal to plasma

Question 6

What is a hypertonic solution?

Answer 6

A solution with a concentration higher than plasma

Question 7

What is a hypotonic solution?

Answer 7

A solution with a concentration lower than plasma

Question 8

What are electrolytes?

Answer 8

Ions within a solution

Question 9

What is osmosis?

Answer 9

The movement of water across a semi-permeable membrane from a lower concentrated solution to a more highly concentrated solution, in order to equalise the concentrations.

Question 10

How is fluid moved within the body?

Answer 10

By hydrostatic pressure

Question 11

How is fluid lost in the body?

Answer 11

Via the interstitial spaces. The ‘osmotic draw’ brings fluid back into interstitial spaces via the interstitial spaces
Any excess fluid drains off into the lymphatic system

Question 12

How does water move in capillaries?

Answer 12

High capillary blood pressure - fluid and nutrients go into interstitial tissue - increased concentration of blood - fluid and waste drawn into capillary by osmosis

Question 13

How does water move in cells?

Answer 13

ECF and cytosol concentration need to be balanced (osmotic pressure within cell prevents excess fluid absorption) - Fluid and nutrients move into cells from ICF - fluid and waste is pushed out of cell to ICF - Fluid not absorbed into capillary taken to lymphatic system

Question 14

What problems can occur with water movement within cells?

Answer 14

Decreased plasma proteins or ineffective lymphatic drainage = oedema

Question 15

What happens when plasma osmolarity is increased?

Answer 15

Increase in plasma osmolarity is detected by osmoreceptors in hypothalamus which stimulates thirst

Question 16

What happens when plasma concentration is increased?

Answer 16

Increase in plasma concentration casues the activation of PPT which stimulates the anti-diruteic hormone which sitmualtes the distal convulted tubules which cause the resorption of water

Question 17

How is hydration maintained in the body?

Answer 17

The body feels thrist which causes the increase of plasma which stimulates thirst

Question 18

How is hydration assessed?

Answer 18

1% = slight loss in skin elastic, hair standing on end 
5%  = dry mucous membrane, slight decreased skin elastic, increased SG
7% = marked loss in skin elastic, increased SG, decreased urine output, sunken eyes, tachycardia, prolonged capillary refill time 
10% = skin tenting, sunken eyes, 3rd eyelid profusion, oliguria, weak pulse, anuria, prolonged CRT, shock, lethargy 
12% = depression, collapse, shock, morinund, death

Question 19

What is the normal urine output?

Answer 19

1-2ml/kg/hr

Question 20

What is the normal specific gravity in both dog and cat?

Answer 20

Dog - 1.015-1.045

Cat - 1.020-1.060

Question 21

What is the normal PCV in both dog and cat?

Answer 21

dog - 45%

Cat - 35%

Question 22

Describe pH within body

Answer 22

pH, number of H+ ions
Greater number, more acidic
Normal body pH = 7.4
Several mechanisms to maintain homeostasis

electrolytes affect pH
faecal volume/RR excreted via water vapour

Question 23

What is a pH imbalance?

Answer 23

Where pH blood becomes abnormal

Question 24

What is metabolic acidosis?

Answer 24

Where an acid state in the body occurs due to altered metabolism - unable to excrete acid or is losing excess alkali (causes increased acid)

Question 25

Give examples of causes of metabolic acidosis

Answer 25

Vomiting - brings up stomach acid then alkali. Due to decrease in alkali causing a relative acid increase
Diarrhoea - similar to vomiting
Renal failure - dysfunction in kidney, can’t excrete acid causing relative acid increase due to build up
Shock - decreased BP to kidney can’t function so same as renal failure occurs

Question 26

What is metabolic alkalois?

Answer 26

Where an alkaline state in the body occurs due to altered metabolism - losing excess acid (causing increased alkaline)

Question 27

Give examples of cause of metabolic alkalois

Answer 27

Vomiting stomach contents only - stomach acid lost, cause relative increase in alkaline
Over admin of bicarbonate - increases alkaline in the body

Question 28

What is respiratory acidosis?

Answer 28

Where an acid state in the body occurs in the body when respiratory system can’t excrete acid (increased acid)

Question 29

What can cause respiratory acidosis?

Answer 29

Repsiratory obstruction - can’t excrete acid, causes a build up of acid
Acute respiratory - can’t excrete acid, causes a build up of acid
Acute respiratory failure - breathing is stopped, cant excrete acid causing a build up
Hypoventilation - breathing slowed, causes build up of acid
Anaesthetic problems - wrong size circuit, causes acid build up due to restricted breathing

Question 30

What is respiratory alkalosis?

Answer 30

Where an alkaline state in the body occurs when respiratory system losses excess acid (increased alkaline)

Question 31

What can cause respiratory alkalosis?

Answer 31

Hyperventilation - heatstroke, loss of acid causes relative build up of alkaline
Pain, stress - increased respiration, build up of alkaline
Hyperthermia - increased respiration, build up of alkaline
Excessive IPPV

Question 32

What can cause fluid losses?

Answer 32

Urine
Diarrhoea
Vomit
Blood

Question 33

What are the types of fluid losses?

Answer 33

Water only - plasma becomes hypertonic, fluid moves from ICF to ECF by osmosis
Water + electrolytes - loss hypotonic or hypertonic, movement depends on tonicity of fluid, hypetonic dehydration - water only loss, hypotonic dehydration - fluid moves from ECF to ICF by osmosis, isotonic dehydration - no fluid movement
Blood - most serious, isotonic loss therefore no fluid movement
Plasma - increased PCV, loss of plasma proteins, proteins need to be replaced

Question 34

What should be considered before giving fluid therapy?

Answer 34

Amount of fluid required
Type of fluid required
Type of dehydration
pH of the body

Question 35

What are the categories of fluid?

Answer 35

Chrystalloids
Colloids
Blood/blood products

Question 36

Describe chrystalloids

Answer 36

Variety of solutions available
Used to retify fluid and electrolyte loss
Also to balance abnormal body pH

Question 37

Describe Colloids

Answer 37

A number of products available
Contain large molecules - create fluid shift from ICF to plasma
Do not provide any O2 carrying capacity - consider concurrent O2 admin

Question 38

Describe Blood/blood products

Answer 38

whole blood - haemorrhage, anaemia, haemolysis
plasma - burns, hypovolaemia
packed red cells - anaemia
Cryo-precipate - clotting /bleeding disorders

Question 39

DEscribe the management of a drip line

Answer 39

use unopened srelike materials
prepare aseptically
Insert catheter up to the hilf
Ensure catheter is taped in dry
Change catheters (every 48-72hrs)
Use heparinised saline to provide patent catheter
Check bag is right fluid, in date and clear
Check admin site for swelling, brusing, pain and perivascular fluid
Check line regularly for kinks, blockages and interference

Question 40

What patient monitoring occurs with a patient on fluid therapy?

Answer 40

check clinical signs for hydration level 
Monitor TPR and mm
Record urine output and SG
Monitor PCV
Monitor ongoing losses

Question 41

What does central venous pressure measure?

Answer 41

Measurement of blood pressure within a central vein

Not commonly used in practice

Question 42

What can overhydration cause?

Answer 42

causes patient to be ‘soggy’. water gets into aveloi causing soft, moist cough - pulmonary oedema
Dyspnoea, tachypnoea
Tachycardia, lethargy
runny nose, decreased PCV, increased urine output