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Surgery > fluids > Flashcards

fluids Flashcards

1
Q

pathophys of thirst

A

hypothalamus responds to osmoreceptors that trigger thirst in response to hypertonic solution

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2
Q

fluid overload is commonly the result of these dz processes

A

heart failure
liver failure
renal failure
iatrogenic

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3
Q

fluid resuscitation vs maintenance

A

someone who is dry coming out of the OR
giving a bolus is resuscitation

maintenance is for NPO

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4
Q

how is lactate solution better from resuscitation

A

acidosis occurs form fluid loss and the lactate solution and lactate meatbolism counters this

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5
Q

normal fluid requirements-faily adult

A

2-3 l A DAY

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6
Q

Humans require how many ml of water for every square meter of surface area

how do you calculate body surface area

A

1500

height in cm x weight in kilos/3500

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7
Q

how many ml/hr of IV fluid does the average adult need

A

100-125 ml/hr to meet daily fluid requirements

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8
Q

daily fluid requirement equation for average adult

A

based on weight

1500ml of water for every square meter of surface area.

An average adult has a surface area of about 1.7 square meters. 1.7 x 1500 = 2.55 liters a day.

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9
Q

daily electrolyte requirements

Na
K
Glucose

A

Na: 1-2 mEq/kg (140)

K: .5-1 MeQ/KH( 70 MeQ)

Glucose: 500 kcal

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10
Q

28 yo male NPO for maintenance order

A

D5NS w/ 20 mEk KCL at 125 ml/hr

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11
Q

D5W

A

5% Dextrose (calories) in water

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12
Q

1/2 NS

A

.45% of Na in 1L

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13
Q

NS

A

NaCL

0.9grams of NaCl in 1 L

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14
Q

lactated ringer

A

electrolytes no calories

  • Used for fluid resuscitation after blood loss d/t trauma, surgery or burns
  • Used very routinely in the perioperative setting for
  • Can be used for fluid resuscitation and fluid maintenance
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15
Q

D5W in 1/2 NS

A

has calories

good maintenance fluid

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16
Q

Two main types of fluids

A

crystalloids (small solutes; can move a little freely)

and

colloids (big solutes; like blood).

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17
Q

crystalloids

A

administered as maintenance fluids nPO pts, used fro hypovolemic resuscitation in trauma

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18
Q

colloids

A

fluids that in addition to mineral salts also have large proteins

less likely than crystalloids to cause edema\
usually given 250ml of albumin

used for special populations and not administered very often

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19
Q

what do you need before administering colloids

A

need a type and cross match for compatibility

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20
Q

why don’t we use colloids

A

albumin expand volume better
less edema

but greater mortality

21
Q

in what patient population would we use colloid fluid

A

elderly who can’t tolerate high volume resuscitation
severe diarrhea with low serum albumin
nephrotic syndrome

22
Q

how to determine fluid needs PO

A

• As a general rule, it is safe to assume that a patient just leaving the OR is going to be down 1 to 2 liters of fluid.

maintenance for breast
for bigger cases, i.e., whipple will need resuscitation threapy too

should check urine output
blood tests
skin, BP, HR, RR, cap refill and lung sounds to determine fluid needs

also check CXR out of OR (looking for fluid accumulation)

always ask the anesthesiologist if there was a foley, what fluids where given, if there are JP drians

23
Q

when would JP drains be used PO

A

JP drains are used when there is an empty cavity to help remove fluid that automatically wants to fill old tissue space

24
Q

ideal pt

UO and labs

A

urine output is between 50-100 ml/hr

labs are within normal limits
Na 135-145
K 3.6-4.8
creatinine <1.2

25
Q

what does a dry pt look like

A 
NPO for a minute
elderly
DM
was having diarrhea or vomiting pre-op
tachy
weighs less  than pre OP

decreased skin turgor and low CVP

26
Q

what does an overloaded pt look like

A

hx of chf
FLUID INTAKE GREATER THAN OUTPUT
Raised CVP, lung crackles, weight is above pre ob

Na may be low
CXR=Pulm Edema

27
Q

treating perfect pt

A

if able to take PO heplock the IV when pt beings to eat

remove foley
check electrolytes fro 24 hrs -48 hrs

monitor for signs of fluid overload or fluid deficit while in house

28
Q

treating dry pt

A

give an initial isotonic fluid bolus 500-1000ml
use smaller amoutns in elderly

follow V/S UP BP

follow labs for electrolyte abnormalities

if you’re concerned about the pts fluid status consider placing a foley or keeping current foley to track urine output more closely

29
Q

tx for overloaded pt

A

Restrict fluid intake. If patient requires maintenance fluids, give 500ml over first 24 hours (20ml/hr).

•Consider diuretics (e.g., Lasix) if patient has signs of pulmonary edema. (crackles)

  • Follow electrolytes closely, and correct abnormalities.
  • Severe cases in the setting of renal failure may require dialysis.
30
Q

cations

A

Na+, K+, Mg+, Ca2+

31
Q

anions

A

Cl-, HCO3-, PO43- (and other phosphates), and negatively charged proteins.

32
Q

Concentration of a solution expressed as the total number of solute particles per kilogram.

A

osmolarity

33
Q

interstitial fluid accoutns for

A

[~9L, ~15% of body weight]

34
Q

intravascular fluid accounts for

A

[~5L, ~5% of body weight

35
Q

the spontaneous movement of molecules from areas of high concentration to areas of low concentration.

A

• Molecular diffusion

36
Q

what effects osmotic activity

A
  • The concentration of each solution (the greater the difference, the greater the osmotic pull).
  • Temperature.
  • Surface area to volume ratio.
  • The permeability of the membrane (if more permeable, water will diffuse faster than solutes).
37
Q

two types of osmoles

A

Effective osmoles, which DO NOT freely move across a membrane (e.g., electrolytes)

Ineffective osmoles, which DO freely move

38
Q

electrolytes are an example of effective or ineffective osmoles

A

Effective osmoles, which DO NOT freely move across a membrane

39
Q

give an example of ineffective osmoles

A

Ineffective osmoles, which DO freely move

(e.g., urea, ethanol, methanol).

40
Q

The concentration of a solution, minus ineffective osmoles, is called

A

The concentration of a solution, minus ineffective osmoles, is called tonicity.

41
Q

Isotonic ismols

A

270-300 mOsm/L

42
Q

hypertonic

A

> 300 mOsml/L

43
Q

Hypotonic ismols

A

<270 mOsm/L

44
Q

most of our body weight is intracellular or extracellular

A

intracellular

45
Q

Where do our fluids go?

A
  • 800-1500ml in urine
  • 0-250ml in stool
  • 600-900ml through skin and lungs
46
Q

The ______ triggers thirst with baroreceptors in response to hypovolemia.

A
  • The renin-angiotensin system triggers thirst with baroreceptors in response to hypovolemia.
  • Oropharyngeal dryness
  • Psychological factors
47
Q

increased fluid loss by system

A
  • GI: vomiting, diarrhea
  • Renal: diuresis
  • Vascular: hemorrhage
  • Skin: burns, fever
  • Lungs: tachypnea, mechanical ventilation
48
Q

daily fluid requirement equation for elderly

A

1500ml PLUS 10-15ml per kg over 20

49
Q

when you foley out indicate a fluid deficit

A

ins and outs indicate fluid deficit (less than 30ml an hr)

Surgery (18 decks)

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