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Nayla Foundations Exam 5 > Fluids > Flashcards

Fluids Flashcards

1
Q

Why do we replace fluids

A

to maintain homeostasis

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2
Q

What is total body water

A

60% of total body weight
2/3 ICF, 1/3 ECF (of the ECF, 3/4 is interstitial, 1/4 is plasma)
Newborns have the most (80%)
In adults, M>W (more adipose= less water)

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3
Q

How do we remember fluid levels

A

TIE 60 40 20

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4
Q

What ions are intracellular

A

Potassium
PO4
protein
magnesium

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5
Q

What ions are extracellular

A

Sodium
Chloride
HCO3

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6
Q

What do we need to know about daily water balance

A

Input should equal output (Euvolemia)

Output is usual insensible loss (lungs, skin NOT sweat), sweat, feces, urine

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7
Q

What causes hypovolemia

A 
GI loss (vomit, bleeding, diarrhea) 
Renal loss (diuretics, diabetes insipidus) 
Skin loss 
Sequestered w/ loss (rhabdo, pancreatitis)
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8
Q

What are symptoms of Hypovolemia

A 
thirst 
decreased sweating/skin turgor
DMM
Oliguria (concentrated pee)
CNS depression 
weakness, muscle cramps 
Hypotension
Tachycardia
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9
Q

What is third spacing

A 
fluid in the interstitium (where it shouldn't be) 
AKA edema (ascites, burns, pleural effusion)
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10
Q

What is significant about third spacing

A

They can still be hypovolemic

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11
Q

What are the types of fluids

A 
Crystalloid (electrolytes, pass thru endothelial membrane, water follows) 
Colloid (lytes and org. molecules, don't pass endothelium, stay in intravascular space) 
Blood products (like colloids, stay in vascular space)
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12
Q

What is the most common fluid used

A

Crystalloid- it’s isotonic

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13
Q

What are types of crystalloids

A

Isotonic (name Na as normal cells): LR, 0.9% NS, plasma-lyte- distribute evenly thru ECF
Hypertonic (higher salt than our cells): 3% NS
Hypotonic (lower salt): 0.5%, 0.25% NS
Dextrose 5% in water (D5W)/ D5 1/2NS

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14
Q

What is in isotonic crystalloids

A

LR: lactate, K+, Ca, NaCl

plasma lyte: less Chloride to prevent acidosis (more physiologic)

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15
Q

What are Isotonic crystalloids used for

A

dehydration
hypovolemia
hypovolemic shock (CAN IV BOLUS)

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16
Q

What are hypertonic crystalloids used for

A

life threatening hyponatremia (causing seizure)

To decrease cerebral edema in neurosurg patients

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17
Q

Why do we need to be careful with hypertonic crystalloids

A

If administered too quickly can cause CPM

18
Q

What are hypotonic crystalloids used for

A

maintenance fluid- they distribute thru TBW so not good for replacing INTRAvascular fluid deficit, dehydration, or hypovolemia

19
Q

What is D5W used for

A

hypoglycemia
hypernatremia w/ free water deficit
(distributes like hypotonic- caution in DM patients)

20
Q

Colloids are basically

A

likely to expand vascular compartment- use them when crystalloids fail to sustain plasma volume 2/2 decreased osmotic pressure

21
Q

Who would colloids be beneficial in

A

burn pts
peritonitis (protein loss)
malnourished
(NOT for severe hypovolemia)

22
Q

What are the types of colloids

A

Albumin (5%, 25%)

Dextran and Hetastarch (not used a lot)

23
Q

When is albumin used

A

In edematous patients, to mobilize interstitial fluid (NOT if albumin >2.5 mg)
Liver disease
peritonitis
burns
3rd spacing
–AKA, we want to try to shift fluid to intravascular space from the interstitium

24
Q

What are blood products

A

Packed RBC*
platelets
FFP
cryoprecipitate

25
Q

What are packed RBC and when are they used

A

Made from whole blood, they stay in vascular space
Used for transfusion to increase oxygen to tissues (hemorrhage or severe anemia)
1 PRBC unit will increase Hgb by 1g

26
Q

What do patients need if they get packed RBC

A

Type and screen (blood type)

Type and cross (at time of transfusion to specifically check for a reaction)

27
Q

When are platelets used

A

to prevent or treat bleeding In patients with:
thrombocytopenia
bad platelet function (on ASA/plavix)

28
Q

What is FFP and when is it used

A

Has all factors of soluble coagulation system.
Used to correct major bleeding if patient is on warfarin OR hypokalemic
Also in hereditary angioedema

29
Q

What is the difference between FFP and vitamin K

A

FFP works right away but is only effective for a short time

Vitamin K takes a while to be effective but lasts way longer

30
Q

What is cryoprecipitate and when is it used

A

Thawed FFP and collect precipitate- has higher fibrinogen and factor 8, factor 10, and VWF
Use if low fibrinogen d/t massive hemorrhage, liver failure, or consumptive coagulopathy

31
Q

What is a bolus

A 
1 large amount (250mL-1L) 
isotonic crystalloids (2/2 hypovolemia) 
Packed RBC (2/2 massive hemorrhage)
32
Q

Who do we need to use caution in when giving a bolus

A

Heart Failure patients (may already be fluid overloaded)

33
Q

What are maintenance IV fluids

A

they account for ongoing water and electrolyte loss, under normal physiologic conditions (urine, feces, sweating, respirations)

  • we give them when patients are not eating or drinking normally, to maintain balance
  • NS, plasma lyte, LR, D5 1/2NS +/- 20mEq KCl
34
Q

How do we calculate rate at which to give maintenance fluids (adults)

A

based on the clinical scenario! usually:
1st 10kg= 100 mL/kg
2nd 10kg= 50 mL/kg
rest= 20 mL/kg
divide all by 24 hours and you get your average hourly infusion rate

35
Q

Most hourly infusion rates are

A

75 ml, 100 ml, 125 ml

if you get a weird number thru calculation, ROUND

36
Q

What can you add to maintenance IV fluids

A

K to treat hypokalemia (potassium is osmotically like Na)
BUT, you cant bolus potassium. so if you add K to 0.9% NS, you can no longer bolus
also, use caution with K in renal disease patients

37
Q

How are replacement IV fluids used

A

to correct existing water/electrolyte deficiency d/t pathologic conditions
must monitor vitals, UO, and clinical picture
use CAUTION if very hypo or hypernatremic (correcting too fast can lead to CPM)

38
Q

Who often needs replacement fluids

A

surgical patients (low UO, 3 spacing, blood loss, etc.)

39
Q

What is parkland formula (burn patients)

A 
total fluid needed in first hour= (% of 2-3 degree burn) x (kg) x 4mL
replace with LR! 
first 8 hr: 1/2 of total fluid 
8 hr: 1/4 of total 
8 hr: 1/4 of total
40
Q

What is the rule of 9’s

A 
Head: 9
Arms: 9 each
legs: 18 each
front torso: 18
back: 18
perineum: 1

Nayla Foundations Exam 5 (7 decks)

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