Lecture 1: Fluid Management Flashcards
What is the difference in contents and use of Crystalloids vs. Colloids?
- Crystalloids: solutions of salts and electrolytes used for volume expansion i.e., normal saline, lactated ringers, D5W
- Colloids: solutions that contain large molecules and provide oncotic pressure in addition to volume expansion i.e., albumin, dextrans, and HES
How to calculate the maintenence fluid (hourly rate) for infusion using patients weight in kg?
- 4 mL for 1-10kg
+
- 2 mL for 11-30kg
+
- 1 mL for each >30kg
How to calculate the body water deficit (liters) using the pt’s weight in kg?
- [(0.6 x weight (kg)) X (pt Na+ - 140)] / 140
- i.e., [(0.6 x 70kg) X (144-140)] / 140 = 1.2 L deficit
What are the components of D5W vs. D10W and are they hypo-, iso-, or hypertonic?
- D5W = isotonic solution with 50g glucose/L
- D10W = hypertonic solution with 100g glucose/L
What are the components of 0.45%, 0.9%, and 3% NaCl solutions and is each -iso, hypo-, or hypertonic?
- Each contains Na+ and Cl-
- 0.45% = hypotonic
- 0.9% = isotonic
- 3% = hypertonic
What are the components of lactate ringers and is it a iso-, hypo-, or hypertonic solution?
- Isotonic solution containing Na+, Cl-, and HCO3-
- Also contains some K+ and Ca2+; Ca2+ can bind some drugs reducing their bioavailability
- Ca2+ inactivates anticlotting solutions in blood products and is contraindicated
Which dextrose solution for infusion is generally used for hypoglycemic patients?
D5W
During high volume resuscitation with NaCl, it is possible to overload the Cl- and induce which acid-base disturbance?
Hyperchloremic metabolic acidosis (NAGMA)
A hypertonic solution of 3% NS may be used with caution in some cases of extreme hyponatremia (Na ~115) but must be done slowly w/ frequent monitoring due to possibility of what 3 complications?
- Osmotic demyelination syndrome (locked-in)
- Iatrogenic hypernatremia
- Fluid overload
Define free water as it relates to fluid management and what occurs with fluid shifts?
- Water not bound by macromolecules
- When applied to IV fluids, will cause a shift of fluids into cells (ICF) from the vascular space (ECF)
When would you use a 22, 20, 18, or 16 gauge IV needle?
- 22 gauge: children and older adults; slow infusions
- 20 gauge: crystalloid infusion for maintenance
- 18 and 16 gauge: fluid resuscitation or blood transfusion
What is treatment for phelbitis in pt with IV?
D/C IV line + moist warm compresses + monitor
How does infiltration vs. extravasation differ in terms of complications which may arise from IV therapy?
- Infiltration: leakage of IV solution or meds into extravascular tissue; edema, pallor, ↓ skin temp and pain
- Extravasation: IV catheter becomes disloged and meds infuse into tissues; pain, stinging, burning, swelling redness at site
What is the tx of infiltration as a complication of IV therapy?
D/C IV line + elevate extremity + warm compresses may facilitate absorption of fluid
What is the tx of extravasation as a complication of IV therapy?
D/C IV line + apply cool compresses + administer antidote if one exists
What are the 9 components of a discharge summary?
- Consultants: include doc name and specialties
- Procedures: dates
- Pertinent H&P detalis: brief summary of reason for admission, pertinent lab and imaging findings
- Course: brief summary of hospital course, tx’s and progress during stay
- Discharge: condition (good, fair, guarded, critical)
- Disposition: home, skilled nursing, nursing home, rehab center, etc..
- Medications: meds that need to be continued (dose, route, frequency, and duration if short term). List previous meds and whether they are continued.
- Instructions: activities, restrictions, diet, wound care
- Follow-up: who, when, and why
