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Surgery > IV Fluids > Flashcards

IV Fluids Flashcards

1
Q

Things to Consider with IV Fluids

A

Why an IV?
Know your patient: age, heart/lung/kidney problems
Watch for signs of dehydration
Monitor: weight, BP, HR, BMP, & urine output

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2
Q

Disorders of Volume in a Surgical Patient

A

Depletion

Excess

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3
Q

Disorders of Electrolyte Concentrations

A 
Sodium
Potassium
Chloride
Calcium
Magnesium
Phosphate
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4
Q

Sequelae of Inappropriate Fluid & Electrolyte Management

A 
Increased length of stay
Increased cost
Wound infection
Delayed wound healing
Anastomotic failure
Tachyarrhythmias
Cerebral edema, seizures, death
Pulmonary edema, CHF, renal failure
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5
Q

3 Things to Accomplish with IV Therapy

A

Maintenance therapy
Replacement therapy
Volume resuscitation

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6
Q

Reason for Maintenance Therapy

A

Patient not expected to eat or drink for a while

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7
Q

Reason for Replacement Therapy

A

Correct abnormalities in volume and/or electrolytes

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8
Q

Reasons for Volume Resuscitation

A

Hypotension

Hemorrhage

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9
Q

What does total body water depend on?

A

Age
Gender
Muscle mass
Fat

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10
Q

Total Body Water as a % of Weight Decreases in

A

Morbidly obese individuals
Elderly
People with low muscle mass due to disease or injury

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11
Q

How much of total body weight does the intracellular fluid hold?

A

2/3

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12
Q

How much of total body weight does the extracellular fluid hold?

A

1/3

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13
Q

What does the plasma portion of the ECF contain?

A

Main: Na+
Cations: K+, Ca++, Mg++
Anions: Cl-, HCO3-, proteins, sulfates, organic acids

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14
Q

What does the ICF contain?

A

Main: K+, Mg++
Anions: phosphates, sulfates, & proteins

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15
Q

What can flow freely among all of the compartments in the body?

A

Water

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16
Q

Normal Body Fluid Osmolarity

A

285 osmol/L

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17
Q

Types of Fluid Replacement Products

A

Crystalloids

Colloids

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18
Q

Types of Crystalloids

A

Dextrose in water
Saline
Combination
Ringer’s Lactate (physiologic)

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19
Q

Examples of Colloids

A 
Albumin
Dextran
Hetastarch
Blood
FFP
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20
Q

Define Crystalloid

A

Solution that contains small molecules & are able to pass through semi-permeable membranes

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21
Q

Define Colloid

A

Solutions that contain high molecular weight proteins or starch
Can not cross semi-permeable membranes
Remain in the intravascular space

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22
Q

When are colloids indicated?

A

Rapid hemodynamic equilibration is required

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23
Q

What is important when addressing a specific situation?

A

Composition of the solution

Rate of administration

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24
Q

Why are isotonic solutions given?

A

To expand the ECF volume

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25
Q

Why are hypotonic solutions given?

A

To reverse dehydration

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26
Q

Why are hypertonic solutions given?

A

To increase the ECF volume & decrease cellular swelling

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27
Q

Examples of Isotonic Fluids

A

Normal Saline
Ringer’s solution
Lactated Ringers

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28
Q

What does Ringer’s solution contain?

A

Sodium
Potassium
Calcium

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29
Q

What is missing from Ringer’s solution?

A 
Dextrose
Magnesium
Bicarbonate
Calories
Free water
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30
Q

What does Lactated Ringer’s contain?

A 
Sodium
Potassium
Calcium
Chloride
Lactate
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31
Q

What is missing from Lactated Ringer’s

A

Dextrose
Magnesium
Free water

32
Q

What is hypotonic solutions used for?

A

Prevent & treat cellular dehydration by providing free water to the cells

33
Q

Contraindications to Hypotonic Solutions

A

Acute brain injuries

34
Q

Why are hypotonic solutions contraindicated in acute brain injuries?

A

Cerebral cells are very sensitive to free water, absorbing it rapidly & leading to cerebral cellular edema

35
Q

Examples of Hypotonic Fluids

A

5% dextrose in water (D5W)
1/2 NS
1/4 NS

36
Q

D5W & the Body

A

Dextrose metabolized

Free water shifts from vessels to cells

37
Q

1/2 NS & 1/4 NS & the Body

A

Provide free water to cell as well as small amounts of sodium & chloride
Frequently used as maintenance therapy

38
Q

Adverse Effects of Normal Saline (NS)

A

Fluid overload
Metabolic acidosis
Hypernatremia

39
Q

Adverse Effects of Lactated Ringer’s

A

Fluid overload
Hyponatremia
Hyperkalemia

40
Q

Adverse Effect of D5W

A

Hyponatremia

41
Q

Clinical Types of Volume Deficit

A

Total body water
Extracellular
Intracellular

42
Q

Total Body Water Volume Deficit

A

Water loss

Ex: diabetes insipidus, osmotic diarrhea

43
Q

Extracellular Volume Deficit

A

Salt & water loss
GI tract losses
Third spacing

44
Q

Examples of Salt & Water Loss in Extracellular Volume Deficit

A

Secretory diarrhea
Ascites
Edema

45
Q

Examples of GI Tract Losses

A

Vomiting
Diarrhea
NG Sx
Enteric fistulas

46
Q

Intravascular Volume Deficit

A

Acute hemorrhage

47
Q

Define “Third Space”

A

Acute sequestration in a body compartment that is not in equilibrium with ECF

48
Q

Causes of Third Spacing

A 
Intestinal obstruction
Severe pancreatitis
Peritonitis
Major venous obstruction
Capillary leak syndrome
Sepsis
49
Q

Clinical Parameters to Help Judge Degree of Volume Loss

A 
Weight loss
BP
JVP
Urine sodium concentration
Urine output
HCT
50
Q

States of Increased Fluid Loss

A 
Fever
Burns
Sepsis
Gastric fistulas
Surgical drains
Other states of increased metabolic activity
51
Q

Clinical Findings of Extracellular Fluid Depletion

A 
Thirst
Decreased urine output
Weight loss
Drowsiness to coma
Decreased skin turgor
Dry mucous membranes
Sunken eyes
Tachycardia
Orthostatic hypotension progressing to hypotension
52
Q

Lab Findings in Extracellular Fluid Depletion

A

Increased HCT
Elevated BUN/Creatinine
Elevated urine sodium
Urine specific gravity >1.020

53
Q

Clinical Signs to Monitor in Extracellular Fluid Depletion

A

Hemodynamic parameters
Urine output
Daily weights
Daily labs: HCT, BMP

54
Q

Signs of HypOvolemia

A 
Orthostatic hypotension
Tachycardia
Flat neck veins
Decreased skin turgor
Dry mucosa
Supine hypotension
Oligouria
Organ failure
55
Q

Signs of HypERvolemia

A 
Hypertension
Tachycardia
Increased JVP
Gallop
Edema
Pleural effusion
Pulmonary edema
Ascites
Organ failure
56
Q

Management of Hypovolemic Shock

A

1-2 L of isotonic solution on rapid infusion

Continue until clinical signs begins to improve

57
Q

Type of Replacement Fluid in Hypovolemic Shock

A

Blood up to a HCT of 35%

Then crystalloid vs. colloid (need more crystalloid than colloid)

58
Q

Advantages of Albumin over an Isotonic Saline

A

More rapid volume expansion

Lesser risk of pulmonary edema due to dilutional hypoalbuminemia

59
Q

Disadvantages of Albumin over an Isotonic Solution

A

Cost

Not as readily available

60
Q

Why not hyperoncotic starches in treatment of hypovolemia?

A

Increased risk of acute kidney injury

Increased mmortality

61
Q

What should be given if a patient becomes acidotic on isotonic saline for the treatment of hypovolemia?

A

Add sodium bicarbonate to the infusate

62
Q

Treatment of Mild to Moderate Hypovolemia

A

Administer isotonic solution at a rate greater than the rate of continued fluid losses

63
Q

Continued Fluid Loss is the Sum of

A

Urine output
Insensible losses
Other fluid losses (GI)

64
Q

How much more fluid than fluid losses should be administered?

A

50-100 mL/hour

65
Q

What type of fluid should be used in hypernatremia?

A

Hypotonic solutions

66
Q

What type of fluids should be used in hyponatremia?

A

Isotonic solutions

Hypertonic solutions

67
Q

What type of fluid should be used in blood loss?

A

Isotonic solution

Blood products

68
Q

When would potassium or bicarbonate need to be added to the fluids?

A

Hypokalemia

Metabolic acidosis

69
Q

What are disorders of sodium regulated by?

A

Thirst
ADH
Renal water handling

70
Q

What is hypernatremia usually due to?

A

Water loss

71
Q

Management of Hypernatremia

A

Correct slowly: 10 mEq/L
IVF: hypotonic
Rate of infusion calculated using the Midas Formula

72
Q

Things to Consider When Determining how Much Fluid to Give

A

What is your starting point?
Expected losses?
Expected gains?

73
Q

What are expected losses?

A

Measureable: urine, GI
Insensible: sweat, exhaled, fever
Fever: increase by 100 mL/day/degree centigrade

74
Q

Who needs maintenance therapy?

A

Unable to eat or drink for a prolonged period of time
Preoperative period
Ventilated patients

75
Q

Goal of Maintenance Therapy

A

Maintain fluid & electrolyte balance

Provide good “nutrition”

76
Q

Monitoring for Maintenance Therapy

A

Baseline serum sodium
Baseline weight
Daily electrolytes

Surgery (20 decks)

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