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clin lab med exam 2 > Parenteral fluid therapy > Flashcards

Parenteral fluid therapy Flashcards

1
Q

body water accounts for what percentage of weight

A

60% of body weight

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2
Q

of total body water, how much is intracellular and how much is extracellular

A
  • ICF: 2/3
  • ECF: 1/3
    • ex: TBW = 40 L
      • ICF = 25L ; ECF = 15L
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3
Q

Of the ECF, how much is in interstitial and how much is in plasma

A
  • ECF = 15L
    • interstitial = 3/4 = 10L
    • plasma = 1/4 = 5L
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4
Q

What are the 3 different types of intravenous fluids

A
  1. Crystalloids: solutions that contain sodium
  2. Colloids: solutions that contain HMW substances that do not migrate easily across capillary walls
  3. Blood and blood products
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5
Q

What are the different types of Crystalloids

A
  • Isotonic Crystalloids: same salt concentration as normal cells of body and blood
  • Hypertonic Crystalloids: higher salt concentration than normal cells of body and blood
  • Hypotonic Crystalloids: lower salt concentration than normal cells of body and blood
  • other: D5W
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6
Q

What are the two types of Isotonic Crystalloids

A
  • Normal saline: 0.9% NaCl/NS
  • Lactated Ringer solution: contain lactate, K+, and Ca2+ in addition to NaCl
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7
Q

When are Isotonic Crystalloids used

A
  1. tx of dehydration/hypovolemia
  2. IV boluses
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8
Q

What is the only Hypertonic Crystalloids

A
  • 3% NS
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9
Q

When is the Hypertonic Crystalloid 3% NS indicated

A
  • life-threatening hyponatremia with significant water excess
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10
Q

Overly rapid correction of hyponatermia with 3% NS could lead to

A
  • osmotic demyelination - central pontine myelinolysis
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11
Q

List the 2 types of Hypotonic crystalloids

A
  • 0.5 NS (0.45% NaCl)
  • 0.25 NS
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12
Q

Hypotonic crystalloids distribute where

A

throughout the total body water

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13
Q

isotonic crystalloids distribute where

A

uniformly throughout the ECF space

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14
Q

function of Hypotonic crystalloids

A
  • used for maintenance fluid
  • **inadequeate for replacing intravascular volume deficits
    • not used for tx of dehydration/hypovolemia
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15
Q

Where does D5W distribute

A

distribute throughout the total body water

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16
Q

when is D5W (5% dextrose in water) used

A
  • tx hypoglycemia
    • use with caution in patients with DM
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17
Q

When are Colloids used

A
  • more likely to expand vascular compartment
  • used when crystalloids fail to sustain plasma volume due to low osmotic pressure
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18
Q

What are the most commonly used Colloids

A

albumin preparations

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19
Q

What are the 3 types of Colloids

A
  1. Albumin preparation
  2. Dextran
  3. Hydroxyethyl starch
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20
Q

what are the 2 types of albumin preparations

A
  • 5% albumin
  • 25% albumin
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21
Q

What are the 2 types of Dextran

A
  • Dextran 40
  • Dextran 70
22
Q

When are albumin preparations used

A
  • edematous patients to mobilize interstitial fluid into vascular space
    • not useful if pt’s serum albumin > 2.5 mg/dL
  • liver disease, peritonitis, burns, or surgical patients experiencing third spacing
23
Q

Function of Dextran

A
  • a synthetic glucose polymer which expands intravascular volume equal to the amount infused
24
Q

function of Hetastarch

A
  • a glycogen-like synthetic molecule that increases the vascular volume to an amount > or = to the volume infused
  • more frequently used intra-operatively
25
Q

List the 3 types of blood products

A
  1. packed red blood cells
  2. platelets
  3. fresh frozen plasma
26
Q

where do packed red blood cells distribute

A

remain entirely within the vascular space

27
Q

when are packed red blood cells used

A
  • used with crystalloids to expand intravascular volume
  • blood transfusions
    • hemorrhage, severe anemia
    • patients must be types and screened/crossed in order to determine blood type and antibodies prior to transfusion
28
Q

When are platelets given

A
  • used in patients with thrombocytopenia or impaired platelet function to prevent or treat bleeding
29
Q

when is fresh frozen plasma given

A
  • used to correct major bleeding complications in patients on warfarin and/or with vitamin K deficiency
30
Q

IVF can be given in what three amounts

A
  1. bolus
  2. maintenance
  3. replacement
31
Q

What type of IVF can be used for boluses

A
  • NS and LR: dehydration
  • Packed RBC: acute blood loss
32
Q

how much is given in a bolus

A

250 mL - 1 L bolus

33
Q

use cation when given boluses to people with

A

heart failure

34
Q

Function of Maintenance IVF

A
  • maintains/accounts for ongoing losses of water and electrolytes under normal physiological conditions via urine, sweat, respirations, and stool
  • used when patients are not eating or drinking normally
  • goal to provide water and electrolyte balance
35
Q

what IVF is normally used for Maintenance IVF

A
  • D5/0.5 NS with 20 meq KCl
36
Q

What is the Kg method for determining maintenance IVF for normal adult patients

A
  • for 1st 10 kg of body weight -> 100 ml/kg/day
  • for 2nd 10 kg of body weight -> 50 ml/kg/day
  • for weight >20 kg -> 20 ml/kg/day
  • divide the total of the above by 24 hours to determine hourly rate of infusion
37
Q

What is the Kg method for determining maintenance IVF for pediatric patients

A
  • weight < 10 kg -> 100 ml/kg
  • weight > 10 kg to 20 Kg -> 1000 ml for 1st 10 kg + 50 ml/kg for weight over 10 kg
  • weight > 20 kg to 80 kg -> 1500 ml for 1st 20 kg + 20 ml/kg for weight over 20 kg
  • divide total of the above by 24 hrs
  • *use 0.25 NS
38
Q

can a bolus containing potassium be given

39
Q

What is the function of Replacement IVF

A
  • corrects any existing water and electrolyte deficits caused by GI, urinary, skin, or blood losses of “third spacing”
  • monitor vital signs, urine output and clinical picture
40
Q

caution must be exercised when given replacement IVF to patients who are hypo or hypernatremic due to

A

could lead to osmotic demyelination - central pontine myelinolysis

41
Q

in addition to maintenance fluids, surgical patients need replacement of fluids lost from

A
  • urine output
  • blood loss
  • “third spacing”
42
Q

What is the Parkland formula

A
  • total fluid required during first 24 hours in burn victims
    • (percentage of 2nd and 3rd degree burns ) x (body weight in kg) x 4 mL
43
Q

what type of IVF is given to burn patient s

44
Q

what is the rule of nines

A
  • each arm = 9%
  • head = 9%
  • anterior and posterior trunk each = 18%
  • each leg = 18%
  • perineum = 1 %
45
Q

What are the two types of parenteral nutrition

A
  1. total parenteral nutrition (TPN)
  2. peripheral parenteral nutrition (PPN)
46
Q

when is total parenteral nutrition (TPN) indicated

A
  • small bowel resection or complete bowel resection
  • inflammatory bowel disease
  • anticipated or actual inadequate energy intake by mouth
  • significant multisystem disease
47
Q

route of entry of total parenteral nutrition (TPN)

A
  • requires central venous access via SVC
    • most common type of parenteral access
    • parenteral nutrition support is expected to be long-term (>7 days)
48
Q

route of entry for PPN

A
  • requires peripheral venous access
    • parenteral nutrition support is expected to be short term (< 7 days)
49
Q

What should be monitored when patient is on TPN

A
  • intake and output
  • daily weights
  • labs
    • electrolytes, BUN, creatinine, glucose, calcium, magnesium, phosphorous, LFT, triglycerides
50
Q

complications of total parenteral nutrition (TPN)

A
  • catheter related
    • air embolism
    • pneumothorax
    • DVT
    • catheter infecion
    • thrombophlebitis

clin lab med exam 2 (5 decks)

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