Nutrition and Fluids Flashcards
Most commonly used tube for nutritional intervention that is simple to insert and for short term use.
nasogastric tube (NG)
Tube that can also be used for enteral nutrition short term. Less risk of aspiration
nasojejunal tubes (NJ)
Tube that can be used for an extended period of time. Inserted through wall endoscopically/surgically.
percutaneous endoscopic gastrostomy (PEG)
Can follow the rapid infusion of feeds via jejunal tubes or rapid gastric bolus feeds. Sx include: faintness, palpitations, diaphoresis, pallor, tachycardia, hypoglycemia
dumping syndrome
Treatment for dumping syndrome
slow rate of feeding or change formula to one w/ more complex carbohydrates
Tonicity of solutions used for parenteral nutrition
hypertonic
Potential complication in surgical patients due to stress response with concurrent fluid/electrolyte therapy
volume overload
Fluids containing larger molecular weight particles with plasma oncotic pressures similar to normal plasma proteins
colloids
Examples of colloids
albumin, FFP, hetastarch, dextran
noting or pertaining to a solution containing the same salt concentration as blood
isotonic fluids
Examples of isotonic solutions
0.9% NS or lactated ringers
a solution of lower osmotic pressure than blood
hypotonic fluids
examples of hypotonic fluids
0.45% NaCl and D5 0.45% in NaCl
most osmotically active electrolyte in the body
sodium
easiest way to monitor net gain/loss of fluids
daily weights
tells you the patient has adequate water balance
normal serum sodium
obligate fluid loss of normal adults
1600 ml/day
Ideal fluid to use for maintenance therapy since the kidneys will regulate Na, K, and H20 retention
0.45% NaCl + 20 mEq KCl
Estimate of daily fluid requirements (from ALL sources) in adults without fever/sweats
1500ml + 20ml/kg for each kg >20
How much does water requirement increase for each degree of fever > 37C?
100-150 ml/day for each degree above 37C
Earliest sign of hypovolemia due to the kidneys conserving sodium and water
decreased urine Na (<25 mEq/L)
What is the BUN/Cr ratio with hypovolemia?
> 20:1
What is the initial cause of hypovolemia related to general anesthesia?
loss of vascular tone
Treatment for hypovolemia due to decreased intake of excess excretion while waiting for labs
0.45% NaCl
Treatment for hypovolemia due to decreased intake of excess excretion if serum Na > 145
0.25% NaCl
Treatment for hypovolemia due to decreased intake of excess excretion if serum Na < 138
0.9% NaCl (NS)
Minimum amount of urine that should be made per hr
30cc
Treatment for hypovolemia due to vomiting or diarrhea until labs are back
0.9% NaCl (NS)
Treatment for hypovolemia due to vomiting or diarrhea if serum Na > 145
0.45% NaCl
Treatment of hypovolemia due to hemorrhage until labs are back
bolus 1-2 liters 0.9% NS or LR through large bore IVs
How do you determine how much IV fluid to give burn victim?
4 x weight in kg x % TBSA burn. Give ½ of that volume in first 8 hours. Give other ½ in next 16 hours
What patient population are you most likely to see sodium deficit?
pediatrics
Maintenance fluid volume 24 hr period for kids <10kg
100mL/Kg
Maintenance fluid volume 24 hr period for kids 11-20kg
1000mL for first 10kg of body weight plus 50mL/kg for any increment of weight over 10kg
Maintenance fluid volume 24 hr period for kids 20-80kg
1500mL for first 20kg of body weight plus 20 mL/kg for any increment of weight over 20 kg
