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Clin Med II - Exam 4 > Paulson - Intro to Fluids > Flashcards

Paulson - Intro to Fluids Flashcards

1
Q

water balance is determined by

A

water intake

water output

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2
Q

3 forms of water input

A

ingested water

water in food

water from oxidation

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3
Q

4 forms of water output

A

urine

skin

respiratory tract

stool

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4
Q

2 types of body water

A

intracellular

extracellular/intravascular

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5
Q

intracellular body water accounts for __ of total body water

extracellular/intravascular body water accounts for __ of total body water

A

intracellular: ⅔

extracellular/intravascular: ⅓

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6
Q

intravascular compartment is called __

intracellular compartment is called __

A

intravascular: first space
intracellular: second space

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7
Q

space where fluid doesn’t usually accumulate but may

A

third space

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8
Q

examples of third space (3)

A

pleural cavity

peritoneal cavity

edema in extracellular space

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9
Q

drugs are administered into __ space

and should distribute evenly to __ space

A

first

second

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10
Q

4 conditions that can cause third spacing

A

surgery

major trauma

burns

inflammation

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11
Q

fluid related implication of third spacing

A

fluid/lytes/meds not bioavailable

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12
Q

2 types of fluid therapy

A

maintenance

replacement

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13
Q

replacement of ongoing water losses of water and lytes under normal physiologic conditions (urine, sweat, respiration, stool)

A

maintenance therapy

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14
Q

correction of existing water and lyte deficits from GI, skin, urinary, bleeding, third spacing

A

replacement therapy

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15
Q

3 things that increase maintenance fluid requirements

A

tachypnea

fever

diuretics

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16
Q

3 reasons for hypovolemia in surgical pt’s

A

NPO pre/post surgery

blood loss

third spacing

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17
Q

steps to calculate maintenance therapy

A
  1. calculate body wt
  2. calculate fluid needed over 24 hr
  3. divide total ml by 24 hr for a ml/hr rate
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18
Q

calculation for fluid needed over 24 hr

A

100 ml/kg for frist 10 kg

50 ml/kg for second 10 kg

20 ml/kg for each kg over 20

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19
Q

most physiologic replacement in normal circumstances

A

D5½NS + 20 mEq K/L

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20
Q

what is the 4/2/1 rule for hourly rate of maintenance fluids

A

4 ml for kg 1-10

2 ml for kg 11-20

1 ml for each kg kg 21 or higher

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21
Q

3 ex of dehydration deficit to account for in maintenance fluid therapy

A

dry

tachycardic

shock

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22
Q

dry deficit accounts for __% loss

A

3

5% if < 5 yo

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23
Q

tachycardic deficit accounts for __% loss

A

6%

10% if < 5yo

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24
Q

shock deficit accounts for __ % loss

A

9%

15% if < 5 yo

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25
Q

3 indications of dry deficit

A

dry mm

dry tongue

poor turgor

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26
Q

steps to calculate dehydration deficit

A
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27
Q

if output losses from NGT, you can measure and replace

A

ml for ml

28
Q

NGT losses have high __ levels

A

Cl

29
Q

signs of volume overload (4)

A

jvd

lung crackles

edema

dyspnea

30
Q

tx for volume overload (3)

A

fluid restriction

diuretics

lower the rate

31
Q

types of IV fluids

A

plasma

ns

½ ns

rl (lactated ringers)

5%D

plasmalyte

gel

3% saline

5% alb

30% alb

32
Q

which type of IV fluid is meant to mimic human plasma

A

plasmalyte

33
Q

solute made of large proteins like albumin or other molecules that remain intravascular to draw water from cells to intravascular space

A

colloids

34
Q

caution w. colloids

A

cell dehydration

35
Q

fluid w. lytes as solute

A

crystalloids

36
Q

lytes in crystalloids (4)

A

Na

K

Ca

Cl

37
Q

classification of crystalloids (4)

A

isotonic

hypertonic

hypotonic

hypotonic/hypertonic

38
Q

isotonic crystalloids contain

A

the same amt of lytes as normal plasma

39
Q

hypertonic crystalloids contain

A

more lytes than body plasma

40
Q

hypotonic crystalloids contain

A

less lytes than body plasma

41
Q

isotonic crystalloid that has NaCl, KCl, CaCl, and Na lactate in sterile water

A

lactated ringers (LR)

42
Q

indications for LR

A

ml for ml replacement for blood loss:

trauma

surgery

burns

43
Q

type of fluid preferred if large volumes are needed for fluid resuscitation

A

LR

44
Q

type of fluid that counteracts acidosis

A

LR

45
Q

isotonic crystalloid that contains 0.9% NaCl in sterile water and approximates plasma

A

NS

46
Q

large volumes of ns can cause

A

hyperchloremic metabolic acidosis

47
Q

indications for NS (2)

A

flush wounds

administer w. blood products

48
Q

do NOT administer ns

A

long term

49
Q

type of fluid that contains 0.45% NaCl in water

A

½ NS

50
Q

½ NS is __tonic

A

hypo

51
Q

indication for ½ NS

A

hypernatremic pt who does not need extra glucose → DM

52
Q

indication for D5W (5% dex in water)

A

rehydrating pt who is hypernatremic

pt on Na restriction

53
Q

D5W is __tonic

A

hypo

54
Q

contraindication for D5W (2)

A

uncontrolled diabetic

hypokalemic

55
Q

what will free water do to a pt

A

kill them

56
Q

mc postoperative fluid

A

D5½NS

57
Q

indication for D5½NS

A

daily maintenance of body fluids for rehydration

58
Q

D5NS is __tonic

A

hyper

59
Q

D5NS replaces

A

fluid

sodium

Cl

60
Q

caution w. D5NS

A

volume overload → edema

61
Q

3% saline is __tonic

A

hyper

62
Q

indication for 3% saline

A

used cautiously for severe hyponatremia → common cause of hyponatremia is fluid overload

63
Q

50-100 ml bolus of 3% saline raises serum Na

A

2-3 mEq

→ may be repeated 1-2 times

64
Q

parameters for raising serum Na

A

not to exceed:

10-12 mEq/L in first 24 hr

18 mEq/L in first 48 hr

65
Q

fluid rate depends on (3)

A

severity of volume depletion

condition of pt

other dz’s

66
Q

how to determine success of fluid replacement (5)

A

urine output

bp/hr nl

mental status

capillary refill

frequent monitoring

67
Q

monitoring of fluid replacement should include (3)

A

physical appearance

frequent lab monitoring

vitals

Clin Med II - Exam 4 (20 decks)

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