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Pharmacology and Fluid Therapy > Principles of Fluid Therapy (LO7) > Flashcards

Principles of Fluid Therapy (LO7) Flashcards

1
Q

When giving fluid therapy to patients, always consider the following five questions:

A
  • Why am I giving fluids?
  • How will I give fluids?
  • What type of fluid will I use?
  • How much fluid?
  • How will I monitor?
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2
Q

Why am I giving fluids?

A

Your reasons for giving fluids may include:

  • Resuscitation
  • Deficit replacement
  • Ongoing losses
  • Maintenance
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3
Q

How will I give fluids?

A
  • Parenteral – Intravenous
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4
Q

What type of fluid will I use?

A
  • Normal Saline
  • Ringers Lactate
  • D5W or D10W
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5
Q

How much fluid should I give?

A
  • This will be based on your patient’s clinical presentation.
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6
Q

How will I monitor?

A
  • This will be accomplished through continuous reassessment of your patient and their vital signs.
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7
Q

Electrolytes

A

, circulate through the body and help to regulate everything from water levels in the body to cardiac activity and muscle contractions

  • Electrolytes can either have a negative or positive charge
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8
Q

The major electrolytes found in the body are:

A
  • Sodium
  • Potassium
  • Calcium
  • Magnesium
  • Bicarbonate
  • Chloride
  • Phosphorus
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9
Q

Sodium

A

the principle extracellular cation

required to help regulate the volume of total water as well as the distribution of water throughout the body

important for proper nerve and muscle function

If levels are high it can lead to edema, lethargy, and weakness

If the levels are low, it can result in pulmonary or cerebral edema

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10
Q

Potassium

A

the principle intracellular cation

establishing resting membrane potential

most dangerous of any electrolyte imbalance

too low can result in decreased skeletal muscle function, GI disturbances, and cardiac arrhythmia.

High levels lead to hyperstimulation of neural cell transmission which may lead to cardiac arrhythmias including cardiac arrest.

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11
Q

Calcium

A

the principle cation that is required for bone growth.

role in heart muscle function, muscle contraction, nerve transmission, and blood clotting.

Levels that are too low can result in skeletal muscle cramps, abdominal cramps, carpopedal spasms, hypotension, and vasoconstriction.

High levels can result in the patient displaying signs of skeletal muscle weakness, lethargy, ataxia (involuntary lack of coordination or muscle control), cardiac arrhythmia, vasodilation, and flushed skin.

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12
Q

Magnesium

A

the second most common intracellular cation.

It plays an important role in the metabolism of proteins and carbohydrates.

essential for normal neuromuscular activity, synaptic transmission, and myocardial function.

Low levels may result in the patient presenting with weakness, irritability, tetany, delirium, convulsions, confusion, anorexia, nausea, emesis, and cardiac arrhythmia.

High levels may result in the patient presenting with hypotension, muscular weakness, nausea, vomiting, and altered mental function.

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13
Q

Bicarbonate

A

the second most prevalent extracellular anion.

It is the primary buffer used in all circulating body fluids.

Bicarbonate levels determine acidosis or alkalosis in the body.

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14
Q

Chloride

A

the most prevalent anion in extracellular fluid and is strongly linked to sodium.
o if sodium is either retained or excreted the same action will occur with chloride.

contributes to the formation of stomach acids and helps to regulate fluid balance and pH.

Low levels may result in the patient presenting with muscle spasms, metabolic acidosis, shallow respiration, hypotension, and tetany.

High levels may result in the patient presenting with lethargy, weakness, metabolic acidosis, and rapid, deep breathing.

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15
Q

Phosphorus

A

important component in adenosine triphosphate (ATP), which is a source of energy for the body

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16
Q

Fluid and Electrolyte Movement

A
  • Water and electrolytes move within the body according to the principle of balance
  • When the concentration of charge or compounds are greater on one side of the cell membrane, a gradient is created
  • The tendency is for materials to move from areas of higher concentration to areas of lower concentration in an attempt to balance things out
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17
Q

There are different means of movement within the body:

A
  • Diffusion
  • Facilitated Diffusion
  • Osmosis
  • Active Transport
  • Filtration
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18
Q

Diffusion

A
  • the passive movement of solute from an area of higher concentration to an area of lower concentration.
  • If it is classed as simple diffusion, it occurs without the help of membrane transport proteins.
  • The movement of oxygen is classed as simple diffusion.
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19
Q

Facilitated Diffusion

A
  • Facilitated diffusion is a type of passive diffusion that requires assistance of an integral membrane protein to move a solute across the membrane when it is too highly charged to cross alone.
  • It can be either channel mediated facilitated diffusion as is with the movement of potassium or it may be carrier mediated facilitated diffusion as is with glucose across the plasma membrane.
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20
Q

Osmosis

A
  • Osmosis is a form of diffusion that involves the movement of water across a semipermeable membrane.
  • The water moves from the side with the lesser number of particles and greater concentration of water, to the side of the membrane with the greater number of particles and lesser concentration of water.
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21
Q

Active Transport

A
  • Active transport is not a passive process as it requires energy to occur.
  • When a solute must move against its concentration gradient (from lower to higher), they cannot do this alone.
  • The primary source of energy is adenosine triphosphate (ATP).
  • An example of active transport is the sodium-potassium pump.
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22
Q

Filtration

A
  • Filtration is the passage of materials through a membrane by a physical force such as gravity.
  • In the body filtration is also achieved by means of a physical pump, the heart, which effects the rate of filtration by effecting the pressure of the blood through the blood vessels.
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23
Q

Intravenous Solutions

A

When choosing the fluid to administer, it is important to know the type of fluid it is and the effect it has on the body.

There are 5 basic types of IV fluid:

  1. Isotonic
  2. Hypotonic
  3. Hypertonic
  4. Crystalloid
  5. Colloid
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24
Q

Isotonic Solution

A
  • has the same concentration of solute as serum and bodily fluids.
  • will not cause the cells to either swell or shrink
  • works by expanding the contents of intravascular space without shifting fluid to or from other compartments
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25
Q
  • Examples of isotonic solutions
A

normal saline and lactated ringers.

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26
Q

Hypotonic Solution

A
  • has a concentration of solute less than that of serum which results in a fluid shift
  • Since the concentration of solute is less than that of the interstitial fluid, hypotonic fluid placed in the intravascular space causes fluid to move from the vascular compartment into the interstitial compartment.
  • causes cells to swell and possibly burst.
  • work to hydrate the cells while depleting intravascular compartments.
  • should not be used for fluid replacement but rather to maintain a lifeline.
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27
Q

example of a hypotonic solution

A

D5W once administered

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28
Q

Hypertonic Solution

A
  • has a concentration of solute greater than that of serum which results in a fluid shift.
  • Since the concentration of solute is greater than that of the interstitial fluid, hypertonic solution placed in the intravascular space causes fluid to move from the interstitial and intracellular compartments to the vascular compartment.
  • causes cells to shrink and possibly collapse.
  • Hypertonic solutions work to help stabilize blood pressure, increase urine output, and reduce edema.
  • These types of fluid are rarely used prehospital.
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29
Q

An example of a hypertonic fluid

A

D5 in lactated ringers.

30
Q

Crystalloid Solutions

A
  • are dissolved crystals in water
  • have the ability to cross membranes and alter fluid levels so it makes them a good choice for prehospital patients that require fluid replacement.
  • When administering crystalloid solutions for fluid replacement it is important to remember the 3 to 1 rule.
  • For every 1 mL of fluid lost, the patient requires 3 mL of crystalloid solution because within one hour, two thirds of the fluid will leave the vascular space.
31
Q

Examples of crystalloid solutions

A

normal saline and lactated ringers

32
Q

Colloid Solutions

A
  • contain molecules that are too large to cross the capillary membranes and therefore remain in the vascular compartment.
  • high osmolarity.
  • fluid is drawn from interstitial compartments and intracellular compartments into vascular compartments.
  • it is important to closely monitor a patient receiving a colloid solution.
  • reducing edema while expanding the vascular compartment.
  • rarely administered prehospital.
33
Q

Examples of colloid solutions

A

albumin, dextran, and pentaspan

34
Q

Fluid Replacement Products

A 
•	Lactated Ringer’s 
•	Normal Saline 
•	5% Dextrose in Water (D5W) 
•	Colloids 
o	Dextran 
o	Pentaspan
35
Q

Lactated Ringer’s

  • classification
  • description
A

Classification
- Isotonic Crystalliod Solution

Description 
-	Sterile water with multiple electrolytes: 
o	Sodium (Na) - 130mEq/L. 
o	Potassium (K) - 4mEq/L. 
o	Calcium (Ca) - 30mEq/L. 
o	Chloride - 109mEq/L. 
o	Lactate - 28mEq/L.
36
Q

Lactated Ringer’s

  • indications
  • contraindications
  • precautions
A

Indications

  • This solution is indicated for use in adults and pediatric patients as a source of electrolytes, calories and water for hydration
  • Significant burns and hypovolemia.

Contraindications

  • DON’T USE: Heart failure, renal failure, or suspected hyperkalemia
  • pts with ;liver problems

Precautions
- Monitor closely for signs of circulatory overload

37
Q

Normal Saline

  • class
  • description
A

Classification
- Isotonic crystalloid

Description
- 0.9% Solution Sodium Chloride

38
Q

Normal Saline

  • indications
  • contraindications
A

Indications
- Hypovolemia, heat exhaustion/stroke, DKA

Contraindications
- Hypersensitivity, heart failure

39
Q

Normal Saline

-precautions

A
  • Use caution in patients with renal impairment to avoid volume overload
  • Use with Caution if signs of heart failure, CHF or crackles
  • Shock in peds manifested as:
    o Tachycardia - Poor skins signs - ALOC
    o Weak distal pulse - Delayed Cap Refill - Low Blood Pressure
40
Q

5% Dextrose in Water (D5W)

  • class
  • description
A

Classification
- isotonic solution

Description

  • 5% Dextrose Injection, USP solution is sterile and nonpyrogenic.
  • It is a parenteral solution containing dextrose in water for injection intended for intravenous administration.
  • Each 100 mL of 5% Dextrose Injection, USP, contains dextrose, hydrous 5 g in water for injection.
41
Q

5% Dextrose in Water (D5W)

  • indications
  • contraindications
  • precautions
A

Indications
- hypoglycaemia

Contraindications
- D5W should not be used as a fluid replacement for hypovolemic states
-hyperglycemia
Precautions

  • May produce venous irritation
42
Q

Pentaspan

  • class
  • description
A

Classification
- Colloid solution- plasma volume expander

Description
- (10% Pentastarch in 0.9% Sodium Chloride Injection)

43
Q

Pentaspan

  • indications
  • contraindications
A

Indications
- the management of shock due to hemorrhage, surgery, sepsis, burns or other trauma

Contraindications

  • patients with sepsis.
  • patients with severe liver disease
  • patients with known hypersensitivity to hydroxyethyl starch, or with bleeding disorders, or with congestive heart failure where volume overload is a potential problem
  • renal disease with oliguria or anuria not related to hypovolemia.
44
Q

Pentaspan

-precautions

A
  • Caution should be used when the risk of pulmonary edema and/or congestive heart failure is increased
  • Special care should be exercised in patients who have impaired renal clearance since this is the principal route by which pentastarch is eliminated
  • patients allergic to corn because such patients can also be allergic to PENTASPAN
  • possibility of circulatory overload
  • not a substitute for red blood cells or coagulation factors in plasma
45
Q

Dextran

  • class
  • description
A

Classification
- Colloid solution- plasma volume expander

Description
- 10% LMD in 0.9% Sodium Chloride Injection

46
Q

Dextran

  • indications
  • contraindications
A

Indications
- treat hypovolemia and/or hemorrhage from trauma, burns, surgeries, or other causes if ABO compatibility tests are not possible in time

Contraindication

  • patients with heart failure, as rapid administration may prove dangerous due to the plasma volume expansion effects, potentially leading to circulatory overload and acute decompensation
  • patients with untreated bleeding disorders
  • patients with underlying renal disease, failure to clear dextran can lead to worsening of renal function
  • include severe liver disease, preexisting edema, asthma, diabetes, epilepsy, and seizures
47
Q

Dextran

-Precautions

A
  • Hypersensitivity Reactions
  • Delayed Reactions
  • Increased Risk Of Toxicity In Patients With Underlying Conditions
48
Q

WHEN ARE Volume expanders USED

A

used when a patient has lost fluid as a result of hemorrhage, diarrhea, vomiting, heat exhaustion, or burns

49
Q

The most effective way to increase a patient’s intravascular fluid levels

A

administer colloid solutions

50
Q

PCP scope of practice, if volume expansion needs to occur

A

crystalloid fluid will need to be administered

51
Q

When administering a crystalloid solution to increase intravascular volume it is important to not only remember

A

the rule of 3:1 but also that crystalloid solution cannot carry oxygen

52
Q 
Vascular Access (Peripheral Intravenous) 
-purpose
A

Purpose
-Provides access to the circulation to administer drug therapy or fluids.

Equipment

  • PPE
  • Appropriate size catheter
  • Tourniquet
  • Swabs
  • Gauze
  • Tape
  • Drip
  • Set
  • IV bag with solution Sharp Container
53
Q

Vascular Access (Peripheral Intravenous) technique according to SCOP

A
  1. PPE
  2. Choice of insertion site:
  3. Procedure
    a. Explain the procedure, including why IV therapy is necessary.

b. Select the appropriate size cannula.
c. Prepare equipment and cannulation site.
d. Stabilize vein and insert needle bevel up.
e. Confirm IV placement by flashback and advance further into thevein. f. Advance catheter over the needle and into the vein.
g. Retract needle while stabilizing the vein.

54
Q

Vascular Access (Peripheral Intravenous) Choice of insertion site: according to SCOP

A
  1. General drug administration
    i. Small to medium gauge cannula (i.e. adult: 18 – 20 G, child: 22 – 24G).

ii. Best most distal available vein.
iii. Use non-dominant limb when possible. iv. Avoid joints.

  1. Likely need for fluid replacement
    i. Large gauge cannula sited in a large vein (i.e. adult: 16 – 18 G, child: 20 – 22 G).

ii. In significant trauma a 16 G cannula is sufficient to facilitate rapidfluid replacement.

  1. Difficult IV access/poor vein presentation
    i. Consider the lower limbs, or external jugular vein.

ii. Consider IO access (Note: a small gauge cannula provides more reliable access than
the IO route).

55
Q

Vascular Access (Peripheral Intravenous) Indications according to scop

A
  1. For volume expansion in patients with the clinical diagnosis of shock (hypovolemic, neurogenic or anaphylactic). Patients with suspected cardiogenic shock will have an intravenous initiated TKO, with OLMC required to establish the rate of flow for PCP and ICP.
  2. To obtain an intravenous route for administration of essential emergency drugs. Examples include, but not limited to the following circumstances:

a. Cardiac arrest.
b. Diabetic shock.
c. Anaphylactic shock.
d. Unconsciousness of unknown etiology or significanttrauma.

56
Q

Vascular Access (Peripheral Intravenous) contraindications according to scop

A
  1. Whenever possible avoid sites of burns, infection or localized cellulitis.
57
Q

Vascular Access (Peripheral Intravenous) precautions according to scop

A

Precautions
1. Because of the increased risk of phlebitis in IVs started in the pre-hospital scene, strict attention must be placed on an aseptic technique and secure taping of the IV.

  1. The following sites are not to be used for IV access:
    a. Lower limbs when pelvis, abdominal or thoracic trauma issuspected.

b. Distal to a complex limb injury.
c. Limb with a fistula present.
d. An area of phlebitis or cellulitis.
e. When a limb has potential or existing lymphedema (e.g. the same side as lymph node clearance).

58
Q

A peripheral intravenous saline lock may be used in those patients where

A

IV access has been obtained for the purpose of administering IV medications

59
Q

. A saline lock is not to be used for

A

patients who require or may require bolus IV fluid therapy for hypotension.

60
Q

Each dose of IV medication administered during a cardiac arrest

A

is followed by a bolus of IV fluid (to accelerate its entry to the central circulation) as follows:

a. Under the age of six years: 5 mL (including IO infusions)
b. Between six and twelve years: 10 mL
c. Over the age of 12 years: 20 mL

61
Q

The IVs should be established enroute unless:

A

a. There is delay in extrication of the patient.
b. Airway management during transportation will not allow for IV initiation.
c. In patients with “controlled hemorrhage” where ongoing blood loss will not be a problem.
d. Transport time of greater than 30 minutes in length.
e. Crystalloids will be the fluid administered. The decision as to which fluid will be utilized

62
Q
  • Solvent:

- Solute:

A
  • Solvent: the fluid that does the dissolving

- Solute: the dissolved particles contained in the solvent

63
Q

Dehydration

overhydration

A

dehydration
-define does inadequate total systematic fluid volume

overhydration
-when the body’s total systematic fluid volume increases

64
Q

Dehydration signs and symptoms

A

Signs and symptoms include decreased level of consciousness, orthostatic hypotension, tachypnea, dry mucous membranes, tachycardia, poor skin turgor, flushed dry skin

65
Q

dehydration causes

A

include diarrhea, vomiting, gastrointestinal drainage, haemorrhage and insufficient fluid or food intake

66
Q

overhydration signs and symptoms

A

include shortness of breath, puffy eyelids, edema, polyuria, moist crackles and acute weight gain

67
Q

overhydration causes

A

o Causes include monitored IV lines, kidney failure and prolonged hyporventilation

68
Q

intracellular fluid

A

-is the water contained inside the cells it normally accounts for 45% about 28 L of body weight

69
Q

Extra cellular fluid

A

The water outside the cells accounts for 15% of body weight about 14 L and is further divided into two types of fluids interstitial fluid and intravascular fluid

70
Q

interstitial fluid

A

The water bathing the sales accounts for approximately 10.5% of the body weight about 10 L

include special fluid collections such as cerebrospinal fluid and intraocular fluid

71
Q

Intravascular fluid

A

plasma

The water within the blood cells carry his red blood cells white blood cells and vital nutrients

Normally accounts for approximately 4.5% of body weight or 4 L

72
Q

tonicity

A

The concentration of a solution or ability to draw or give water

Pharmacology and Fluid Therapy (12 decks)

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