Med Surg Exam 1 fluids

Question 1

1 liter =

Answer 1

2.2 lb. 1kg

Question 2

Infant fluid amount

Answer 2

70-80%

Question 3

Intracellular fluid

Extracellular fluid

Answer 3

40%

20%

Question 4

Thirst center

Answer 4

Hypothalmus

Question 5

Electrolytes Cations (positive)

Answer 5

NA 
K 
CA
Mag
H ions

Question 6

Electrolytes anions (negative)

Answer 6

Chloride
Bi carb
Phosphate sulfate
Proteinate ions

Question 7

Movement of fluids through capillary walls depends on?

Answer 7

Hydrostatic pressure(pressure on walls)
Osmotic pressure(exerted by protein in the plasma)
Direction of fluid depends on the difference between these 2.

Question 8

Passive transport

Answer 8

Osmosis
Diffusion
Filtration

Question 9

Active transport needs?

Answer 9

ATP

Question 10

Osmosis

Answer 10

Movement of fluid from an area of low solute to higher concentrations.

Question 11

Diffusion

Answer 11

Movement of solutes from an area of high concentration to lower.

Question 12

Filtration

Answer 12

Movement of water and solutes from an area of higher hydrostatic pressure to an area of lower hydro pressure.

Question 13

Active transport

Answer 13

Movement of fluids against the concentration gradient. From low to high. NA-K pump

Question 14

Loss of fluids. Sensible and insensible

Answer 14

Sensible- urine, diarrhea
Insensible-Skin(500 mL/day)
Bowels(100-200ml/day
Lungs(300-500 ML/day

Question 15

First spacing

Answer 15

Normal distribution

Question 16

Second spacing

Answer 16

Abnormal accumulation of interstitial tissue

Easily exchanged with ECF

Question 17

Third spacing

Answer 17

Fluid accumulation in the body not easily exchanged with ECF.
Can be from infection, burns, ascities, SBO, peritonitis, pleural effusions.

Question 18

Gerontological considerations for fluids

Answer 18

Hormonal changes(ADH)
Loss of sub q tissue
Reduced thirst
Do daily weights

Question 19

Dehydration

Answer 19

Refers to the loss of water alone with increased NA levels.

Question 20

Fluid volume deficit

Answer 20

Rapid weight loss, decreased skin turgor, oliguria, hypotension, rapid weak pulse, increased temp, cool and clammy skin, lassitude, thirst, nausea, muscle weakness, cramps. PC-hypovolemic shock.

Question 21

Fluid volume excess

Answer 21

Risk factors: HF, renal fail, cirrhosis.
Excess NA intake
S/S- edema, JVD, bad lung sounds,tachy, increased BP, increased CVP and pulse pressure, increased UO, SOB.
-restrict fluids, give diuretics.
PC- pulmonary edema, HTN, electrolyte imbalance, hypoxia, respiratory alkalosis.

Question 22

Maintaince fluids

Answer 22

1500ml /sq meter of body surface.
Mostly for NPO or under stress.
Minimizes ketone formation

Question 23

Replacement fluids

Answer 23

Usually D/C after 48 hours
Check renal function before starting.
Will probably need K

Question 24

Fluid restoration

Answer 24

Longer than 48 hours.
Strict I and O
Daily labs

Question 25

PICC removal

Answer 25

Slow short pulls

Question 26

Central Venus cath CVC

Answer 26

Short term-non tunneled

Long term-tunneled (removed by MD)

Question 27

Crystalloid fluids

Answer 27

Isotonic. Hyper, hypo
Solutes diffuse.
Give 3-4 times more than colloids (expanders)

Question 28

Expanders (colloids)

Answer 28

Blood, TPN,PPN,

Doesn’t dissolve.

Question 29

Hypotonic solution

Answer 29

<250
Hydrated cell by pullling h20 into cellular space from vascular space.
Can rob blood from cells.
Don’t give to TBI.

Question 30

Isotonic solution

Answer 30

Hydrates intravascular compartment, replaces volume without disrupting intracellular and interstitial volumes
250-375

Question 31

Hypertonic solution

Answer 31

> 375
Draws fluid out of intracellular space leading to increased intracellular volume both in the vascular and interstitial space.
Cell shrinks. Treatment of hypotonic dehydration, circulatory collapse, increased fluid shift from interstitial space to vascular space.
Watch for vein irritation, pulmonary edema, circulatory overload, increased glucose. Infuse slowly.

Question 32

Low albumin=

Answer 32

Edema

Alb pulls fluid of of tissues.

Question 33

Plasma expanders

Answer 33

Increase vascular volume.
Tx of shock from fluid loss.
Watch for circulatory overload, and hypersensitivity.
Don’t mix with meds.

Question 34

Osmolarity math

Answer 34

2 x NA + (glucose / 18) + (BUN / 2.8)

Question 35

Intrinsic infection control

Answer 35

Contamination already present in body

Question 36

If IV infiltrates than?

Answer 36

Pain, coolness, parlor

Question 37

Phlebitis

Answer 37

Pain, redness, edema, warmth.

Question 38

Line changes

Answer 38

72 hours

Question 39

Systemic overload fluids

Answer 39

Restless, cough, SOV, HTN, edema, rapid pulse, hypoxic.

Question 40

Air embolus

Answer 40

Give presser, fluids, o2, rapid weak pulse, palpations, confusion, anemia, decreased BP.

Question 41

Speed shock

Answer 41

Gave med too fast, vessel spasm.

Question 42

Hypervolemia

Answer 42

PC- pulmonary edema, HTN, electrolyte imbalance, hypoxemia, resp alk. JVD, bounding pulse.

Question 43

Hypovolemia

Answer 43

PC- shock, decreased BP, increased pulse, cool clammy skin, increased BUN.

Question 44

Fluid needs, math

Answer 44

1500 mL for 1st 20 kg of body weight.
20 ml for each kg of weight over 20 kg.
If pt weighs 100kg than: 100-20=80 (1500ml)
80 x 20=1600. 1500+1600= 3100 mL/day.

Question 45

Hypotonic solutions

Answer 45

<250 draw fluid into cells.

1/2 NS, D2.5H2O

Question 46

Isotonic solutions

Answer 46

250-375
Non fluid shift.
NS, D5H2O, LR

Question 47

Hypertonic solutions

Answer 47

> 375
Fluid shift out of ICF and into ECF. Cell shrinks.
D5 1/2 NS, D5 NS, D5 LR, D10 H2O
Give slow!

Question 48

MAP math

Answer 48

Double the diastolic +2 then + systolic

Divide all by 3