Parenteral fluid therapy Flashcards
(50 cards)
1
Q
body water accounts for what percentage of weight
A
60% of body weight
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
- ex: TBW = 40 L
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
4
Q
What are the 3 different types of intravenous fluids
A
- Crystalloids: solutions that contain sodium
- Colloids: solutions that contain HMW substances that do not migrate easily across capillary walls
- Blood and blood products
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
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
7
Q
When are Isotonic Crystalloids used
A
- tx of dehydration/hypovolemia
- IV boluses
8
Q
What is the only Hypertonic Crystalloids
A
- 3% NS
9
Q
When is the Hypertonic Crystalloid 3% NS indicated
A
- life-threatening hyponatremia with significant water excess
10
Q
Overly rapid correction of hyponatermia with 3% NS could lead to
A
- osmotic demyelination - central pontine myelinolysis
11
Q
List the 2 types of Hypotonic crystalloids
A
- 0.5 NS (0.45% NaCl)
- 0.25 NS
12
Q
Hypotonic crystalloids distribute where
A
throughout the total body water
13
Q
isotonic crystalloids distribute where
A
uniformly throughout the ECF space
14
Q
function of Hypotonic crystalloids
A
- used for maintenance fluid
- **inadequeate for replacing intravascular volume deficits
- not used for tx of dehydration/hypovolemia
15
Q
Where does D5W distribute
A
distribute throughout the total body water
16
Q
when is D5W (5% dextrose in water) used
A
- tx hypoglycemia
- use with caution in patients with DM
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
18
Q
What are the most commonly used Colloids
A
albumin preparations
19
Q
What are the 3 types of Colloids
A
- Albumin preparation
- Dextran
- Hydroxyethyl starch
20
Q
what are the 2 types of albumin preparations
A
- 5% albumin
- 25% albumin
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
List the 3 types of blood products
1. packed red blood cells
2. platelets
3. fresh frozen plasma
26
where do packed red blood cells distribute
remain entirely within the vascular space
27
when are packed red blood cells used
* 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
When are platelets given
* used in patients with thrombocytopenia or impaired platelet function to prevent or treat bleeding
29
when is fresh frozen plasma given
* used to correct major bleeding complications in patients on warfarin and/or with vitamin K deficiency
30
IVF can be given in what three amounts
1. bolus
2. maintenance
3. replacement
31
What type of IVF can be used for boluses
* **NS** and **LR**: dehydration
* **Packed RBC**: acute blood loss
32
how much is given in a bolus
250 mL - 1 L bolus
33
use cation when given boluses to people with
heart failure
34
Function of Maintenance IVF
* 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
what IVF is normally used for Maintenance IVF
* D5/0.5 NS with 20 meq KCl
36
What is the Kg method for determining maintenance IVF for normal adult patients
* 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
What is the Kg method for determining maintenance IVF for pediatric patients
* 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
can a bolus containing potassium be given
NO
39
What is the function of Replacement IVF
* 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
caution must be exercised when given replacement IVF to patients who are hypo or hypernatremic due to
could lead to osmotic demyelination - central pontine myelinolysis
41
in addition to maintenance fluids, surgical patients need replacement of fluids lost from
* urine output
* blood loss
* "third spacing"
42
What is the Parkland formula
* 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
what type of IVF is given to burn patient s
LR
44
what is the rule of nines
* each arm = 9%
* head = 9%
* anterior and posterior trunk each = 18%
* each leg = 18%
* perineum = 1 %
45
What are the two types of parenteral nutrition
1. total parenteral nutrition (TPN)
2. peripheral parenteral nutrition (PPN)
46
when is total parenteral nutrition (TPN) indicated
* small bowel resection or complete bowel resection
* inflammatory bowel disease
* anticipated or actual inadequate energy intake by mouth
* significant multisystem disease
47
route of entry of total parenteral nutrition (TPN)
* requires **central** venous access via SVC
* most common type of parenteral access
* parenteral nutrition support is expected to be long-term (\>7 days)
48
route of entry for PPN
* requires peripheral venous access
* parenteral nutrition support is expected to be short term (\< 7 days)
49
What should be monitored when patient is on TPN
* intake and output
* daily weights
* labs
* electrolytes, BUN, creatinine, glucose, calcium, magnesium, phosphorous, LFT, triglycerides
50
complications of total parenteral nutrition (TPN)
* catheter related
* air embolism
* pneumothorax
* DVT
* catheter infecion
* thrombophlebitis
