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Unit 2 Clin Med Lab > L7: Parenteral fluid therapy > Flashcards

L7: Parenteral fluid therapy Flashcards

1
Q

Insensible water loss

A

lungs + non-sweating skin

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2
Q

Normal saline composition

A

.9% NaCl

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3
Q

Lactated ringers composition

A 
Lactate
K+
Ca++
NaCl
Bicarb
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4
Q

Plasma-lyte composition

A

NaCl (with less Cl)
Mg
K+

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5
Q

3 isotonic crystalloids

A

Normal Saline
Lactated ringers’s
Plasma-lyte

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6
Q

Isotonic crystalloids effect

A

distribute evenly through ECF

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7
Q

a crystalloid is

A

a solution that has sodium as the main osmotically active particle

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8
Q

Isotonic crystalloids are used for

A

Treatment of dehydration/hypovolemia

Preferred choice rapid correction of severe hypovolemia

IV boluses

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9
Q

Isotonic crystalloid for burns

A

Lactated ringers

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10
Q

“The most physiologic” isotonic crystalloid

A

Plasma-lyte

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11
Q

Hypertonic crystalloid composition

A

3% normal saline

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12
Q

Isotonic crystalloids preferred by internists

A

.9% normal saline

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13
Q

Isotonic crystalloids preferred by surgeons

A

LR

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14
Q

Uses for 3% normal saline (hypertonic)

A

Life threatening hyponatremia with significant water excess

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15
Q

Risk of 3% NS

A

USE CAUTIOUSLY: risk of central pontine myelinolysis

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16
Q

2 options for hypotonic crystalloids

A

.5 NS

.25 NS

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17
Q

D5W is used to treat

A

hypoglycemia

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18
Q

D5W composition

A

5% dextrose in water

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19
Q

3 fluids that distribute evenly through total body water

A

.5 NS
.25 NS
D5W

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20
Q

.5 NS/.25 NS are used for

A

maintenance fluids

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21
Q

.5 NS/.25 NS are n’t used for

A

Inadequate for replacing intravascular volume deficits: dehydration/hypovolemia

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22
Q

Caution with D5W

A

DM

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23
Q

Colloids are

A

solutions that contain high-molecular weight substances that do not migrate easily across capillary walls→ stay in vascular compartment→ expand vascular compartment

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24
Q

colloids may be

A

synthetic or human derived

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25
when are colloids used?
When crystalloids fail to sustain plasma volume due to low osmotic pressure: considerable protein loss from vascular space (burns, peritonitis)
26
when aren't colloids used?
No strong data to support use in managing severe hypovolemia
27
2 concentrations for albumin
5% | 25%
28
Albumin action
Mobilize interstitial fluid into vascular space
29
Albumin uses
``` Edema Liver disease Peritonitis Burns Surgical pts “Third-spacing” ```
30
When is albumin not useful
serum albumin >2.5
31
Albumin alternatives
Dextran 40 Dextran 70 Hydroxyethlyl Starch
32
Dextran
Synthetic glucose polymer which expands intravascular volume equal to the amount infused
33
Hydroxyehtlyl Starch
Glycogen-like synthetic molecule that expands intravascular volume greater than the amount infused
34
Dextran vs Hydroxyethyl starch
both expand intravascular volume Dextran: equal to amount infused Hydroxyethyl starch: greater than amount infused
35
RBCs are most similar to
colloids | stay in vascular space
36
PRBCs are used with _____ to ______
Crystalloids Expand intracellular volume
37
PRBCs uses
Blood transfusions: | Hemorrhage, severe anemia
38
Before using PRBCs
Must be typed and screened/crossed to determine blood type and antibodies
39
Platelets uses
Prevent or treat bleeding: Thrombocytopenia Impaired platelet function
40
Fresh frozen plasma uses
Correct major bleeding complications from warfarin and/or vitamin K deficiency
41
prothrombin complex concentrates (PCCs)
Better than fresh frozen plasma so I guess if you see both pick this?
42
Boluses are used to treat
Hypovolemia: dehydration or acute blood loss
43
Fluids used for bolus
NS LR Plasma-Lyte PRBCs
44
amount to bolus
250-1L
45
Who not to bolus
caution in heart failure
46
Maintenance fluids are for
Accounts for ongoing losses of water and electrolytes under normal physiologic conditions via urine, sweat, respirations, stool When patients are not eating/drinking normally
47
Maintenance fluids for adults:
D5/.5NS with 20 meq KCL
48
Maintenance fluids for peds:
D5/.25NS with 20 meq KCL
49
What's the deal with potassium
As osmotically active as sodium Caution when replacing K+ in patients with kidney disease Never bolus potassium-containing IVF
50
If you're giving maintenance fluids to a patient who is hypokalemic
you can add extra K+
51
1st 10 kg of maintenance fluids
100 ml/kg/day
52
2nd 10 kg of maintenance fluids
50 ml/kg/day
53
All weight >20 kg maintenance fluids
20 ml/kg/day
54
Replacement fluids
Corrects any existing water and electrolyte deficits caused by GI, urinary tract, skin, or blood losses, third-spacing
55
Which fluids are given for replacement fluids
Depends on electrolyte disturbances/fluids lost
56
What is cautioned for replacement fluids
avoid rapid correction in significantly hyponatremic or hypernatremic→ central pontine myelinolysis
57
For surgery patients, how are replacement fluids determined?
Use urine output and vital signs to determine amount of additional fluid needed
58
What should you do while giving replacement fluids?
Monitor vital signs, urine output, clinical picture to determine effectiveness
59
How much replacement fluid to give burn patients in first 24 hours
Percentage of 2nd/3rd degree burns x body weight (kg) x 4
60
How fast to give replacement fluids to a burn patients
½ during 1st 8 hours ¼ in 2nd 8 hours ¼ in 3rd 8 hours
61
Replacement fluid for burn patients
LR
62
Each arm is
9%
63
Head
9%
64
Anterior trunk
9%
65
Posterior trunk
9%
66
Each leg is
18%
67
Perinium
1%
68
why is central venous administration preferred in TPN
avoid intimal damage and thrombophlebitis due to osmolality of solution
69
TPN is for
nutrition when a patient needs it for longer than 1 week
70
How long can the body tolerate inadequate oral intake
1-2 weeks
71
Indications for TPN
Small bowel resection Complete bowel obstruction Inflammatory bowel disease → bowel rest may induce remission Pre-existing nutritional deprivation → unable to tolerate enteral Anticipated/actual inadequate energy intake by mouth → adults >7-10 days → peds >3-7 days Significant multisystem disease
72
What's inadequate oral intake requiring TPN for adults
longer than 7-10 days
73
What's inadequate oral intake requiring TPN for peds
longer than 3-7 days
74
What to monitor while giving TPN
Intake and output Daily weights Labs: Electrolytes, BUN, creatinine, glucose, calcium, magnesium, phosphate, LFTs, triglycerides
75
How often to take labs for inpatient TPN
daily/weekly
76
How often to take labs for outpatient TPN
Weekly/monthly
77
2 major groups for complications from TPN
Metabolic/electrolyte abnormalities Catheter-related
78
Catheter-related complications of TPN
``` Air embolism Pneumothorax Catheter-associated DVT Catheter infection Thrombophlebitis ```

Unit 2 Clin Med Lab (8 decks)

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