Iv fluids and problems of FVE etc

Question 1

Conditions leading to fluid loss and assoc symptoms

Answer 1

• BLEEDING-tachycardia and HoTN
• BOWEL OBSTRUCTION-reduced perspiration and mucous secretions
• DIARRHEA-reduced urine output (oliguria)
• FEVER-dry skin and mucous membranes
• VOMITING-reduced lacrimal and salivary secretions

Question 2

crystalloids

Answer 2

• Fluids given by IV injection that supply water and sodium to maintain the osmotic gradient between extra and intravascular compartments.
• Crystalloids= a substance in a solution that diffuses through a semipermeable membrane

Question 3

what type of fluid should be used to expand plasma volume

Answer 3

o Because they work by osmosis, hypertonic saline (3% sodium chloride) is more efficient than normal saline (0.9% sodium chloride) for expanding the plasma volume (PV)

Question 4

do crystalloids contain proteins

Answer 4

no

Question 5

should crystalloids or colloids be used to treat hypovolemic shock and why

Answer 5

o Compared w distribution of colloids, crystalloids are distributed faster into the interstitial and intracellular compartments making crystalloids better for treating dehydration than for expanding the PV alone eg in hypovolemic shock

Question 6

indications for use of crystalloids

Answer 6

Indications
• Promote urine flow
• Used to compensate for insensible fluid loss, replace fluids when there are body fluid deficits and manage specific fluid and electrolyte disturbances

•	Indications: 
        acute liver failure
•	Acute nephrosis
•	Adult resp distress syndrome
•	Burns
•	Cardiopulmonary bypass
•	Hypoproteinemia
•	Reduction of the risk of DVT
•	Kidey dialysis
•	Shock

Question 7

death occurs when ___% of body water is lost

Answer 7

• Death often occurs when 20-25% of the total body water is lost

Question 8

wheres water lost from initially during dehydration

Answer 8

• During initial dehydration water is lost first from extracellular compartments

Question 9

t or f: crystalloids are contraindicated in hyponatremia and hypochloremia

Answer 9

F hyper is whn they shouldnt be used

Question 10

contraindications fro cystalloids

Answer 10

Contraindications:
• Allergy
• Hyervolemia
• Hypernatremia, hyperchloremia

Question 11

how would crystalloids affect acidosis or alkalosis

Answer 11

• Lg volumes are required for crystalloids to be effective which may worsen acidosis or alkalosis

Question 12

adverse effects of crystalloids

Answer 12

Adverse effects
• Because they don’t contain lg particles they don’t stay within the bood vessels and can leak out of the plasma into the tissues and cells
• Results in peripheral edema and pulmonary edema
• Crystalloids also reduce the COP by diluting the proteins in plasma
• May result in dec oxygen tension as theyve reduced the RBC conc
• Lg volumes are required for crystalloids to be effective which may worsen acidosis or alkalosis
• Short lived effects

Question 13

NaCl or what % is physiologically normal

Answer 13

0.9%

Question 14

how do colloids work

Answer 14

Mechanism of action and drug effects
• Sometimes called plasma expanders
• Naturally occurring (albumin, dextran or starches, gelatine)
• Usually contain combo of both small and lg particles
• The small particles are elim quickly and promote dieresis but the lg ones maint plasma volume

Question 15

how long can colloids maintain COP

Answer 15

• Can maintain COP for several hours (d/t lg particles)

Question 16

colloids or crystalloids
which is more likely to cause 
-bleeding
-edema
-lt plasma volume expansion
-st PV expansion

Answer 16

• Colloids are superior to crystalloids in their ability to expand the plasma volume
• Crystalloids are less likely to promote bleeding
• Crystalloids are more likely t cause edema because fo the larger volumes needed to achieve the desired clinical effect
• Crystalloids are better than colloids for short term plasma volume expansion

Question 17

colloid adverse effects

Answer 17

Adverse effects
•	Relatively safe
•	No )2 arrying capacity
•	Contain no clotting factors
•	Dilute
•	Impair platelet func
•	Rarely dextran therapy causes anaphylaxis or kidney failure

Question 18

crystalloids or colloids which is more compatible with other drugs

Answer 18

colloids. are used as medium for drug delivery

Question 19

mgmt of bleeding Less than or equal to 20% use

Answer 19

crystalloids

Question 20

• mgmt of bleeding 20-50% low loss

Answer 20

NONPROTEIN PLASMA EXPANDERS-DEXTRAN AND HETASTARCH

Question 21

mgmt of bleeding • Greater than 50% slow loss or 20% acute-

Answer 21

WHOLE BLOOD OR PACKED RBC AND OR FRESH FROZEN PLASMA AND PLASMA PROTEIN PPF AND FFP

Question 22

mgmt of bleeding

• Greater than or equal to 80% lost

Answer 22

• Greater than or equal to 80% lost=AS below BUT FOR EVERY 5 UNITS OF BLOOD GIVEN, ADMINISTER 1-2 UNITS FRESH FROZEN PLASMA AND 1-2 UNITS OF PLATELETS TO PREVENT HEMODILUTION OF CLOTTING FACTORS AND BLEEDING
• Greater than 50% slow loss or 20% acute-WHOLE BLOOD OR PACKED RBC AND OR FRESH FROZEN PLASMA AND PLASMA PROTEIN PPF AND FFP

Question 23

what type of drugs are blood products

Answer 23

• Biological drugs

Question 24

MOA blood products

Answer 24

• Inc COP and blood volume

* They pull fluid from the extravascular space to the intravascular space therefore theyre plasma expanders

Question 25

types of blood products and their indications

Answer 25

• Cryoprecipitate ad plasma protein fraction-to manage acute bleeding >50% blood loss slowly or 20% acutely
• Fresh frozen plsma-to inc clotting factor level in pts w demonstrated deficiency
• Packed RBC-to inc )2 carrying capacity in pts w anemia, in pts w substantial Hb deficits, and in pts whove lost up to 25% of their total blood volume
• Whole blood-same as packed RBCs except that whole blood is more beneficial in cases of extreme (>25%) loss of blood volume, since whole blood contains plasma it also contains more plasma proteins

Question 26

disadvantages of packed RBCs

Answer 26

• Disadvantages=high cost, limited shelf life, fluctuating availability, risk for virus transmission, allergic rxns and bleeding abn