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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
Q

when are colloids used?

A

When crystalloids fail to sustain plasma volume due to low osmotic pressure: considerable protein loss from vascular space (burns, peritonitis)

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26
Q

when aren’t colloids used?

A

No strong data to support use in managing severe hypovolemia

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27
Q

2 concentrations for albumin

A

5%

25%

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28
Q

Albumin action

A

Mobilize interstitial fluid into vascular space

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29
Q

Albumin uses

A 
Edema
Liver disease
Peritonitis
Burns
Surgical pts 
“Third-spacing”
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30
Q

When is albumin not useful

A

serum albumin >2.5

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31
Q

Albumin alternatives

A

Dextran 40
Dextran 70
Hydroxyethlyl Starch

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32
Q

Dextran

A

Synthetic glucose polymer which expands intravascular volume equal to the amount infused

33
Q

Hydroxyehtlyl Starch

A

Glycogen-like synthetic molecule that expands intravascular volume greater than the amount infused

34
Q

Dextran vs Hydroxyethyl starch

A

both expand intravascular volume

Dextran: equal to amount infused
Hydroxyethyl starch: greater than amount infused

35
Q

RBCs are most similar to

A

colloids

stay in vascular space

36
Q

PRBCs are used with _____ to ______

A

Crystalloids

Expand intracellular volume

37
Q

PRBCs uses

A

Blood transfusions:

Hemorrhage, severe anemia

38
Q

Before using PRBCs

A

Must be typed and screened/crossed to determine blood type and antibodies

39
Q

Platelets uses

A

Prevent or treat bleeding:

Thrombocytopenia
Impaired platelet function

40
Q

Fresh frozen plasma uses

A

Correct major bleeding complications from warfarin and/or vitamin K deficiency

41
Q

prothrombin complex concentrates (PCCs)

A

Better than fresh frozen plasma so I guess if you see both pick this?

42
Q

Boluses are used to treat

A

Hypovolemia: dehydration or acute blood loss

43
Q

Fluids used for bolus

A

NS
LR
Plasma-Lyte PRBCs

44
Q

amount to bolus

A

250-1L

45
Q

Who not to bolus

A

caution in heart failure

46
Q

Maintenance fluids are for

A

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
Q

Maintenance fluids for adults:

A

D5/.5NS with 20 meq KCL

48
Q

Maintenance fluids for peds:

A

D5/.25NS with 20 meq KCL

49
Q

What’s the deal with potassium

A

As osmotically active as sodium

Caution when replacing K+ in patients with kidney disease

Never bolus potassium-containing IVF

50
Q

If you’re giving maintenance fluids to a patient who is hypokalemic

A

you can add extra K+

51
Q

1st 10 kg of maintenance fluids

A

100 ml/kg/day

52
Q

2nd 10 kg of maintenance fluids

A

50 ml/kg/day

53
Q

All weight >20 kg maintenance fluids

A

20 ml/kg/day

54
Q

Replacement fluids

A

Corrects any existing water and electrolyte deficits caused by GI, urinary tract, skin, or blood losses, third-spacing

55
Q

Which fluids are given for replacement fluids

A

Depends on electrolyte disturbances/fluids lost

56
Q

What is cautioned for replacement fluids

A

avoid rapid correction in significantly hyponatremic or hypernatremic→ central pontine myelinolysis

57
Q

For surgery patients, how are replacement fluids determined?

A

Use urine output and vital signs to determine amount of additional fluid needed

58
Q

What should you do while giving replacement fluids?

A

Monitor vital signs, urine output, clinical picture to determine effectiveness

59
Q

How much replacement fluid to give burn patients in first 24 hours

A

Percentage of 2nd/3rd degree burns x body weight (kg) x 4

60
Q

How fast to give replacement fluids to a burn patients

A

½ during 1st 8 hours
¼ in 2nd 8 hours
¼ in 3rd 8 hours

61
Q

Replacement fluid for burn patients

A

LR

62
Q

Each arm is

A

9%

63
Q

Head

A

9%

64
Q

Anterior trunk

A

9%

65
Q

Posterior trunk

A

9%

66
Q

Each leg is

A

18%

67
Q

Perinium

A

1%

68
Q

why is central venous administration preferred in TPN

A

avoid intimal damage and thrombophlebitis due to osmolality of solution

69
Q

TPN is for

A

nutrition when a patient needs it for longer than 1 week

70
Q

How long can the body tolerate inadequate oral intake

A

1-2 weeks

71
Q

Indications for TPN

A

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
Q

What’s inadequate oral intake requiring TPN for adults

A

longer than 7-10 days

73
Q

What’s inadequate oral intake requiring TPN for peds

A

longer than 3-7 days

74
Q

What to monitor while giving TPN

A

Intake and output

Daily weights

Labs:
Electrolytes, BUN, creatinine, glucose, calcium, magnesium, phosphate, LFTs, triglycerides

75
Q

How often to take labs for inpatient TPN

A

daily/weekly

76
Q

How often to take labs for outpatient TPN

A

Weekly/monthly

77
Q

2 major groups for complications from TPN

A

Metabolic/electrolyte abnormalities

Catheter-related

78
Q

Catheter-related complications of TPN

A 
Air embolism
Pneumothorax
Catheter-associated DVT
Catheter infection
Thrombophlebitis

Unit 2 Clin Med Lab (8 decks)

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