Fluid Types

Question 1

What is osmolarity?

Answer 1

describes the concentration of dissolved particles (or solutes)

Question 2

Hypotonic solutes have a (higher, lower, same) osmolarity than the blood.

Answer 2

lower

Question 3

With hypotonic solutions, Osmosis causes water to move from _________ space to __________ space.

Answer 3

extracellular, intracellular (cell swells)

Question 4

What do hypotonic fluids do in relation to cells?

Answer 4

They dilute extracellular space and replenish the inside of the cell.

Question 5

A patient has hypernatremia. What type of fluids should you give and why?

Answer 5

Hypotonic because it will dilute the concentration of solutes.

Question 6

Hypotonic fluids can provide free water to help the _________ excrete waste and prevent ______________.

Answer 6

kidneys, dehydration

Question 7

Examples of hypotonic fluids

Answer 7

half normal saline
anything less than half normal saline
D5W

Question 8

What is special about D5W?

Answer 8

It starts out as an isotonic fluid but will become hypotonic within the body.

Question 9

Hypotonic fluids can lead to brain swelling. Why?

Answer 9

Because fluid is moving from the ECF to the ICF which leads to cell swelling.

Question 10

What should you monitor for when giving hypotonic fluids?

Answer 10

mental status changes
hypotension
hypovolemia
hyponatremia

Question 11

What type of patients are most sensitive to hypotonic fluids and why?

Answer 11

Patients who are fluid sensitive (like heart or renal failure patients) because they cannot handle the extra water.

Question 12

Hypertonic solutions have a (higher, lower, same) osmolarity than the blood.

Answer 12

higher

Question 13

With hypertonic fluids, osmosis will cause water to leave ___________ space.

Answer 13

intracellular (cell shrinks)

Question 14

Hypertonic fluids will (expand, shrink) extracellular space.

Answer 14

expand

Question 15

What kind of patients would benefit from hypertonic fluids?

Answer 15

hyponatremic
cerebral edema (brain swelling)

Question 16

Examples of hypertonic solutions

Answer 16

3% saline
D10W
D5NS
D5 1/2 NS

Question 17

What are 2 big reasons why should I use caution when administering hypertonic fluids?

Answer 17

can overload the extracellular space leading to pulmonary edema
can cause hypernatremia

Question 18

Isotonic solutes have a (higher, lower, same) osmolarity than the blood.

Answer 18

same

Question 19

Do isotonic solutions affect the size of the cell? Why or why not?

Answer 19

No because there is an equal transfer of water between the ECF and ICF.

Question 20

What will isotonic solutions expand?

Answer 20

the extracellular fluid volume (plasma)

Question 21

What are some reasons why you would want to administer isotonic fluids?

Answer 21

fluid loss in extracellular space
vomiting
diarrhea (need Na and Cl back)
hypovolemic shock
burns
prior surgery (will lose ECF)

Question 22

Examples of isotonic fluids

Answer 22

normal saline
LR
D5W (starts as isotonic but will change to hypotonic in the body)

Question 23

What does NS replace?

Answer 23

water, sodium, and chloride

Question 24

What is the only solution that can be administered with blood?

Answer 24

NS

Question 25

What should I monitor for when giving isotonic fluids?

Answer 25

- fluid overload (esp in those with heart or kidney failure) - BP - breathing/lung sounds - edema in extremities

Question 26

What does D5W replace?

Answer 26

water and dextrose

Question 27

What fluid would help with hypernatremia but would NOT be used for fluid resuscitation?

Answer 27

D5W

Question 28

What fluid starts out as isotonic but changes to hypotonic and why?

Answer 28

D5W because the dextrose is metabolized, so only water is left. This is hypotonic (has low osmolarity).

Question 29

What is in LR?

Answer 29

water, K, Na, Cl, Cal, and Lactate

Question 30

What does the lactate in LR help to increase blood pH?

Answer 30

lactate will convert to bicarb thus increasing your blood pH

Question 31

Who would you not want to give LR to?

Answer 31

a patient with liver disease (liver convert lactate to bicarb) or lactic acidosis (already has a high amount of lactate present)

Question 32

Name some colloid solutions

Answer 32

Natural - albumin, FFP (Frash Frozen Plasma) Synthetic - dextran, hydroxyethyl starches (HES), and gelatin

Question 33

Describe colloid solutions

Answer 33

- large molecules that stay in intravascular space longer - fast at expanding the intravascular space by pulling water into intravascular space - amount administered = amount lost

Question 34

What type of patient would you want to have colloid solutions?

Answer 34

patients with hypovolemic shock, severe burns, or severe bleeding, or low albumin levels

Question 35

Name crystalloid solutions

Answer 35

hypotonic, hypertonic, and isotonic solutions

Question 36

Describe crystalloid solutions

Answer 36

- small molecules that don't stay long in intravascular space - high amount of fluids needed = amount lost

Question 37

Risks of colloid solutions

Answer 37

- allergic reaction - coagulation problems - high cost

Question 38

Risks of crystalloid solutions

Answer 38

- edema/fluid overload

Question 39

__________ pressure pulls water through the capillary wall

Answer 39

Oncotic

Question 40

___________ pressure pushes water across the capillary wall.

Answer 40

Hydrostatic

Question 41

Hydrostatic pressure is created by the _________ _________.

Answer 41

heart's contractions

Question 42

Hydrostatic pressure is __________ at the arterial end of the capillary

Answer 42

highest

Question 43

Hydrostatic pressure is __________ at the venous end of the capillary

Answer 43

lowest

Question 44

What is ANP - Atrial Natriuretic Peptide?

Answer 44

a hormone released by heart cells due to atrial wall stretching

Question 45

What is BNP - Brain Natriuretic Peptide?

Answer 45

A hormone released by heart cells due to ventricle wall stretching

Question 46

What do ANP and BNP do in relation to the RAAS?

Answer 46

they work against angiotensin II and stop the effects of aldosterone, ADH, and renin. Which helps to prevent fluid volume overload