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My APA Anesthesia 1 > Quiz 4 > Flashcards

Quiz 4 Flashcards

1
Q

what percentage body weight is Total Body water

A

60% total body weight

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2
Q

what percentage body weight is Intracellular volume

A

40% total body weight

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3
Q

what percentage body weight is Extracellular volume

A

20% total body weight

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4
Q

what is extracellular fluid made up of? percentage?

A

Interstitial fluid volume (75% of ECV)

Plasma (intravascular) volume (25% of ECV)

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5
Q

TBW is _____ of a man’s weight

A

55%

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6
Q

TBW is _____ of a woman’s weight

A

45%

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7
Q

TBW is _____ of an infant’s weight

A

80%

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8
Q

__________ pump maintains the high concentration of K+ in ICF

A

Sodium-potassium

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9
Q

High concentration of what lytes intracellularly?

A

Potassium (primary cation)
Phosphate (primary anion)
Magnesium

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10
Q

High concentration of what lytes extracellularly?

A

Sodium (primary cation)

Chloride(primary anion)

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11
Q

What is main determinant of osmotic pressures?

A

Albumin

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12
Q

An expression of the number of osmoles of a solute in a liter of solution

A

Osmolarity

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13
Q

An expression of the number of osmoles of a solute in a kilogram of solvent

A

Osmolality

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14
Q

How a solution affects cell volume

For example – isotonic, hypertonic, hypotonic

A

Tonicity

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15
Q

Concentration disorder, Insufficient water present in relation to sodium levels

A

Dehydration

might have too much salt, or not enough water – fluid replacement specific too disorder

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16
Q

Loss of extracellular fluid
Absolute loss of fluid from the body
Reduced circulating volume

A

Hypovolemia

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17
Q

____ is the most abundant electrolyte in the ECF.

A

Na+

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18
Q

Most common electrolyte abnormality in hospitalized patients

A

hyponatremia

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19
Q

Clinical Manifestations of Hyponatremia

A 
Headache
Weakness
Coma
Confusion
Cerebral edema
Cramps
Agitation
Malaise
Anorexia 
Nausea/vomiting
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20
Q

Treatment of Hyponatremia

A

Fluid restriction

Administration of hypertonic saline and an osmotic or loop diuretic

!!!Correction of serum sodium levels too rapidly can result in neurologic damage and myelinolysis!!! Breaks down nerves and axons

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21
Q

Most common cause is water deficiency d/t:

A

Excessive loss

Inadequate intake

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22
Q

Clinical Manifestations of Hypernatremia

A 
Thirst
Hallucinations
Irritability
Renal insufficiency
Disorientation
Seizure
Hypervolemia
Intracranial bleeding
Polyuria or oliguria
Coma
Weakness
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23
Q

Treatment of Hypernatremia

A

Plasma sodium should be decreased by 1-2mEq/hr until the patient is clinically stable.

Correction of serum sodium to normal should gradually progress over a 24 hour time frame.

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24
Q

K+ Largely responsible for

A

resting membrane potential

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25
Q

The most common electrolyte abnormality encountered during clinical practice.

A

Hypokalemia

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26
Q

Hypokalemia causes

A 
Gastrointestinal losses
Poor dietary intake
Systemic alkalosis
Diabetic ketoacidosis
Diuretic therapy
Sympathetic nervous system stimulation
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27
Q

Clinical Manifestations of Hypokalemia

A 
ST-segment depression
Presence of U wave
Flattened or inverted T waves
Ventricular ectopy
Weakness ( respiratory muscle)
Decreased reflexes
Confusion
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28
Q

how fast can you run K+ in?

A

40 mEqs/hour

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29
Q

Clinical Manifestations of Hyperkalemia

A 
Tall, peaked and elevated T waves
Widened QRS complex
Prolonged PR interval
Flattened or absent P wave
ST segment depression
Cardiac arrest
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30
Q

Treatment of Hyperkalemia

A
  • Avoid adverse cardiac effects
  • Insulin and glucose to shift K+ into cells
  • IV calcium to antagonize cardiac effects of hyperkalemia
  • hyperventilate

(3 goals: 1. Stabilize cardiac membrane; 2. driving K from ECV to ICV; 3. remove K from body)

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31
Q

what is upper limit of potassium level for elective procedures?

A

5.5 mEq/L

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32
Q

Clinical Manifestations of Hypomagnesemia

A 
Flat T-waves
U-waves
Prolonged QT interval
Widened QRS
Atrial and Ventricular PVCs
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33
Q

Low Mag has inhibitory effect on ________ which alters the _______________.

A

NA-K-ATPase

resting membrane potential

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34
Q

Treatment of Hypomagnesemia

A
  • 1-2g over 5 minutes with EKG monitored

- Followed by continuous IV infusion 1-2g/hr

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35
Q

What moves Ca into bones?

A

Calcitonin

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36
Q

What moves Ca out of bones?

A

Parathyroid hormone

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37
Q

Clinical Manifestations of Hypercalcemia

A 
Hypertension
Heart block
Shortened QT interval
Dysrhythmias
Muscle weakness
Decreased deep tendon reflexes
Sedation
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38
Q

Factors influencing intraoperative fluid management

A

Patient’s perioperative fluid status – trauma, blood loss, ETOH pt, elderly, liver cirrhosis, bowel prep

Co-existing disease – CHF, liver Fx

Intra-operative fluid shifts

Intra-operative blood loss

Selection of appropriate fluids for replacement of intra-operative losses

39
Q

insensible loss?

A 
Water loss through:
Urine
Feces
Sweat
Respiratory tract

Correct insensible losses with 2ml/kg/hr of a crystalloid solution*

40
Q

Replacement of third space loss

A

Minimal trauma: 3-4 mL/kg/hr

Moderate trauma: 5-6 mL/kg/hr

Severe trauma: 7-8 mL/kg/hr

41
Q

Goals of Perioperative Goal-Directed Fluid Therapy (PGDT)

A

Minimize: oxygen demand

Optimize:
CO, Tissue oxygenation, capillary and macrovascular flow, oxygen and nutrient delivery, and end-organ perfusion

42
Q

PGDT Hemodynamic monitoring

A
  • Dilution techniques – CO with PAC
  • Plethysmography variability index
  • Stroke volume variation
  • Systolic pressure variation
  • Pulse pressure variation
  • Esophageal Doppler and Echocardiography
43
Q

PGDT Protocols

A
  • Baseline assessment of target hemodynamic measures
  • Administration of small fluid bolus (200-250 mL) to assess Frank-Starling curve
  • End-points identified and fluid given to maintain
44
Q

What fluids are Preferable in dehydration states (prolonged fasting, GI losses, polyuria, hypermetabolic conditions)

A

Crystalloids

45
Q

What can 0.9% NS negatively contribute to?

A

hyperchloremic metabolic acidosis (high doses)

46
Q

what is a major risk of 3% saline?

A

Intracellular dehydration

47
Q

Avoid high doses of what fluid in DM?

A

LR d/t Lactate metabolites are gluconeogenic

48
Q

Avoid combining what fluid with blood products?

A

LR d/t Calcium content

49
Q

Give how much crystalloid per how much blood loss?

A

3:1

50
Q

Give how much colloid per how much blood loss?

A

1:1

51
Q

Clinical assessment of intraoperative blood loss?

A
  • Tachycardia
  • Hypotension
  • Oliguria
  • Decrease CVP
  • Decrease mixed venous oxygen
  • Variation of systolic BP with respiratory cycle in mechanically ventilated patients (greater than 10mmHg)
52
Q

The primary indication for blood transfusion is to increase the ________________ of the blood.

A

oxygen carrying capacity

53
Q

Blood can be stored for ______ days?

A

21-35

54
Q

Blood is stored at a temperature of ?

A

1-6 C
or
33.8-42.8 F

(slows down the rate of glycolysis in red blood cells)

55
Q

how much hematocrit in a unit of PRBC?

A

70%

56
Q

Advantages of PRBC over whole blood?

A
  • Decreased potential for citrate toxicity

- Decreased risk of allergic reaction (related to decreased volume of plasma that is infused with PRBC’s)

57
Q

Administration of platelets during surgery is usually indicated for platelet counts less than _________?

A

50,000 cells/mm3

58
Q

The platelet count will increase by ______________ with each unit of platelets administered

A

5,000 to 10,000 cells/mm3

59
Q

Risk of platelet transfusion

A
  • Transmission of viral diseases.
  • Sensitization to human leukocyte antigens present on platelet cell membranes.
  • Bacterial infection in 1 of 12,000 transfusions.
  • Small risk of platelet-related sepsis.
60
Q

FFP contains ?

A
  • all plasma proteins
  • All coagulation factors except platelets
  • Includes factors V and VIII
61
Q

indication for FFP?

A

PT or PTT elevated AND bleeding

62
Q

Risks associated with FFP transfusion?

A
  • Sensitization to foreign proteins.
  • Transmission of viral diseases.
  • Allergic reactions
63
Q

Cryoprecipitate contains high concentrations of ?

A
  • Factor VIII
  • von Willebrand factor
  • Factor XIII
  • Fibrinogen
  • Fibronectin
64
Q

Thought to occur when antibodies in the recipient’s serum interact with antigens from the donor’s cells

A

Febrile transfusion reaction

65
Q

A febrile transfusion reaction is distinguished from a hemolytic transfusion reaction by evaluating the patient’s __________ for __________.

A

serum and urine

hemolysis

66
Q

treatment of febrile transfusion reaction?

A
  • slowing the rate

- administering antipyretics

67
Q

Allergic transfusion reaction s/s?

A
  • Pruritus
  • Urticaria
  • Occasional facial swelling
68
Q

Allergic transfusion reaction treatment?

A

IV antihistamine

Severe , blood should be discontinued - usually dt igA deficiency

69
Q

Differentiate between allergic reaction and hemolytic reaction by checking the _________ for ___________.

A

urine and plasma

free hemoglobin

70
Q

Which blood reaction? Transfused donor cells are attacked by the recipient’s antibody and compliment, resulting in intravascular hemolysis

A

Hemolytic blood reaction

71
Q

Which blood reaction? Occur due to presence of incompatible plasma proteins in the donor blood

A

Allergic reaction

72
Q

Hemolytic Transfusion Reaction S/S?

A 
Fever
Flushing
Chills
Chest pain
Hypotension
Hemoglobinuria
Nausea
Dyspnea
73
Q

All clinical signs of Hemolytic reaction are masked by anesthesia except _____________.

A

hemoglobinuria and hypotension

74
Q

how to diagnose hemolytic reaction?

A

direct antiglobulin test

75
Q

Treatment of Hemolytic Transfusion Reaction

A
  • Stop the transfusion!!!
  • Renal failure occurs as a result of precipitates in the renal tubules.
  • Prevent renal failure by maintaining urine output.
  • Maintain UOP at 100mL/hr through the administration of lactated Ringer’s solution and mannitol and/or furosemide
76
Q

Complications of blood therapy – Metabolic Abnormalities?

A
  • Increased levels of serum hydrogen and serum potassium.
  • Decreased 2,3-diphosphoglycerate levels.
  • Metabolic alkalosis
  • Hypocalcemia
77
Q

pH of a unit of blood is about ___ after collection and is ___ after being stored for 21 days.

A
  1. 1
  2. 9

(But somehow pt’s pH increases with blood admin)

78
Q

More significantly, blood products contain the preservative _____ that metabolizes to _______ upon transfusion. The increased _________ levels increase the arterial pH of the recipient, frequently causing metabolic alkalosis

A

citrate

bicarbonate

bicarbonate

79
Q

What does Decreased concentrations of 2,3-diphosphoglycerate do to the pt?

A

a shift of the oxyhemoglobin dissociation curve to the left and an increase in the affinity of Hgb for O2 - so tissue o2 can decrease

80
Q

Highest occurance of viral disease from blood products?

A

Cytomegalovirus

81
Q

concern for microaggregates?

A

Concern is that microaggregates will enter the recipient’s blood, accumulate in the lungs, cause vascular obstruction, and contribute to ARDS.

(use filter to decrease risk)

82
Q

goal temp for heated blood admin?

A

37-38 C

83
Q

treatment for DIC?

A

platelets

FFP

84
Q

define TRALI (transfusion-related acute lung injury)

A

Acute, noncardiogenic pulmonary edema associated with dyspnea and arterial hypoxemia that occurs within six hours of transfusion

85
Q

contraindications of intraoperative blood salvage?

A

Malignancy CA
Presence of blood-borne disease
Blood contaminated with bowel contents

86
Q

EBV Premi

A

95-100 ml/kg

87
Q

EBV Term

A

85-90 ml/kg

88
Q

EBV Up to 12 months

A

80 ml/kg

89
Q

EBV Adult male

A

70-75 ml/kg

90
Q

EBV Adult female

A

65-70 ml/kg

91
Q

EBV Obese

A

55 ml/kg

92
Q

Maintenence fluid calculations

A

1st 10 kg = 4 ml/kg/hr
2nd 10 kg = 2 ml/kg/hr
>20kg = 1ml/kg/hr

93
Q

Deficit =

A

maint x hours NPO

First half in first hour, 1/4 in 2nd, and 1/4 in 3rd hour

My APA Anesthesia 1 (8 decks)

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