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PCT3 > Test 1 > Flashcards

Test 1 Flashcards

1
Q

What are the purposes of IV fluid replacement?

A

To restore lost fluid vol from the intravascular, shock, to give medications, and to have access incase of electrolyte emergencies

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2
Q

Total body fluids=

A

60%

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3
Q

Intracellular fluid is = to

A

2/3 the fluid vol in the body and 40-45%

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4
Q

extracellular fluid is = to

A

15-20% of total body fluids
- intersitial= 75% of the ECF
- Plasma=25% of the ECF

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5
Q

infants fluid content make up = …%

A

70%

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6
Q

Why do water imbalances increase in the elderly and infant population?

A

due to decreased skeletal muscle mass, more adipose tissue make up, infants have a smaller system that is still developing.

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7
Q

what is Osmoregulation?

A

a mechanism that uses gradients and semi permeable membranes to balance movement of solutes.

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8
Q

what is diffusion?

A

when particles move across a cellular membrane from high to low concentration.

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9
Q

What is Active transport?

A

Process requires ATP to activate a Na/K+ pump to move solutes against the gradient.

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10
Q

What is osmosis?

A

The movement of water over semi permeable membranes to areas of high solute concentration

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11
Q

What is filtration and where is it done?

A

Filtration can occur in the vascular system or the nephrons in the kidneys.
the vascular system using hydrostatic pressure to push fluids out of veins and into capillaries & uses oncotic pressure to pull water back into the arteriole.

The nephrons in the kidneys filter solutes, water, waste products making 180 L of fluids a day making 1-2 L of urine.

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12
Q

what is RAAS and How does RAAS work?

A

Renin-Angiotensin-Aldosterone-System
- Kidneys sense decreased blood flow at the Juxtaglomulerus–> stimulates the releases of renin from the liver–> renin stimulates the release of angiotensinogen which is converted to ang2 by ACE from the lungs—> Agn2= active form and causes vasoconstriction in the periphery bv—>Aldosterone is stimulated by the Vasoc coaused by Ang2—> Ald acts on the kidneys to reabsorb Na+ and water

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13
Q

when there is too much solute and water loss the cell will…

A

shrink ( hypertonic)

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14
Q

When there is too much solvent and not enough solute the cell will…

A

Swell ( hypotonic)

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15
Q

What does ANP do?

A

Atrial naturetic hormone is stimulated by increased stretch of the atria. ANP causes +GFR and promotes excretion.

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16
Q

What populations is regular dehydration common in?

A

children and elderly

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17
Q

What causes dehydration?

A
  • fluid shift from the intracellular to extracellular–> interstitial –> vasculature
  • N/v/d, poisoning, Heat stroke, sepsis,
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18
Q

what are some s/s of dehydration?

A
  • alt LOA, thirst, dry mucous membranes, excessive skin turgor, lethargy, decreased urine output, Hypotension, Pale skin, orthostatic vitals
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19
Q

What causes over-hydration?

A

medication, fluid overload, urinary retention, too much fluid intake, kidney failure, chf, UTI

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20
Q

what are s/s of over hydration?

A

lung crackles, s/s or UTI, ascities, pulmonary and peripheral edema, SOB, weakness, lethargic, +bp,

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21
Q

What types of fluids can be used to replace fluid loss in the body?

A

crystalloids: ex: ringers lactate, 0.9%NaCl,
Blood products
colloids:

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22
Q

what does the 3:1 rule mean?

A

for every 1 unit vol lost it should be replaced with 3 unit vols of isotonic solution ( preferrably)

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23
Q

isotonic solutions of have a ph of what?

A

5.5

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24
Q

what are some common types of isotonic crystalloid?

A

ringers lactate
NS 0.9%
Dw5

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25
Q

what is the purpose of hypotonic Crystalloids?

A

to restore cellular hydration by diluting serums ex: 0.45% dex

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26
Q

what is the purpose of a hypertonic crystalloid solution?

A

regulates bp by way of Osmolarity, reduces edema
ex: 3%Nsm & mannitol

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27
Q

what fluid would be best used for a brain injured pt?

A

isotonic colloids, 0.9% NS

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28
Q

What fluids would be best for a multi system trauma pt?

A

Lactated ringers because of its more balanced solute concentration. this reduces the inflammatory response
- the liver will also convert the lactate into alkali to revert acidosis due to hypovolemia

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29
Q

what solution is not compatible with blood products?

A

Lactated ringers because it will cause clotting to occur in the blood

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30
Q

why is D5W a hypotonic solution?

A

b/c the cells will quickly uptake the glucose and cause the water to follow the glucose ( osmosis).

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31
Q

why is D5W no recommended for a brain injured pt?

A

Brain does not need insulin present to uptake glucose—> increased glucose in brain causing water to follow—> ++ ICP

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32
Q

Why would you use a hypertonic saline solution?

A
  • to treat 3rd space shock to bring fluids back into the icf
  • to reduce organ inflammation due to multi-system organ failure.
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33
Q

what are colloids?

A

Colloids have larger molecules in their solutions and expand the volume in the intravascular space in. reduces edema.

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34
Q

what must be working in the body before giving a colloid solution?

A

the kidneys to allow for excretion

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35
Q

how can you get blood products to your scene if you need it?

A

call for blood:
- must be trapped on scene with a hypovolemic pt whose condition is not improving after 20-40 cc/kg of NS
1) call bhp & ask for some one to bring products and escribe situation, physician/rn may responde, and only they can give the blood to the pt

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36
Q

When should you use a Micro drip set ( 60gtts)?

A

for peds or pt you need to closely monitor

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37
Q

when should you use a macro drip set ( 10gtts)

A

average set to use for average adult-elderly

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38
Q

when to use a buretrol?

A

for precise amounts and pt you need to monitor closelyy with fluids ex: peds/kidney failure

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39
Q

Pink catheter=

A

20 gauge, 60ml/min, 17 mins to infuse, for med admin

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40
Q

blue catheter=

A

22 gauge, 35ml/min, 29 mins to infuse, kids and elderly

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41
Q

green catheter=

A

18 gauge, 100ml/min= 10 mins, min standard for blood products/fluid

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42
Q

grey catheter=

A

16 gauge, 150ml/min, 7 mins to infuse, for trauma or blood loss

43
Q

orange catheter

A

14 gauge, 250 ml/min, 4 mins to infuse, trauma and blood loss

44
Q

what are some complications that can occur with giving fluids?

A

dislodged catheter, air embolism, catheter embolism, hemoglobin dilution.

45
Q

what types of hypo/hyper/isotonic solutions do we commonly use?

A

iso= NS 0.9%, Ringers lactate
hypo= D5w, 0.45% NS
hyper= Mannitol, D50w

46
Q

What size of IV bag would you use for fluid resuscitation?

A

1000ml for fluid replacement

47
Q

what should you look for when checking you IV bag?

A

clarity, right solution & size, no leaks, ports are sealed, no condensation, expiry date

48
Q

how would you adjust the rate of flow in IV tubing?

A

Roller clamp

49
Q

when cannulating a vein you should attempt ______ first then _______

A

distal then proximal

50
Q

What is an IO and who is it commonly used for?

A

intraosseous is a direct line to the bone marrow which allows for quick absorption in pt with no palpable veins or pediatric pt.

51
Q

what are the indications for Iv fluid directive?

A

actual or potential need for fluid therapy or IV medication.

52
Q

what are contraindications for IV cannulation? bolus?

A

-fracture proximal to the site
- fluid overload

53
Q

what are the conditions for cannulation and bolus?

A

cannulation= >/=2years
Bolus=>/= 2years, hypotensive

54
Q

what is your treatment for IV fluid maintenance?

A

for age 2-12, 15ml/min,
for >12= 30-60ml/min

55
Q

what is treatment for IV bolus

A

for: 2-12 years, 20ml/kg, reassessed every 100ml, up to 2000ml
for >12 years, 20ml/kg, reassess every 250ml, max of 2000ml

56
Q

if you have a pt that weighs 120 lbs what is their max fluid vol?

A

1080 ml

57
Q

When you spike an IV bag what should you do?

A

put tape on it with the date time spiked and initials,

58
Q

what areas should you avoid when looking to cannulate a vein?

A

edematous veins, fractures/potential fractures, AV fistulas, Same side of recent mastectomy, cellulitis

59
Q

how can you make veins more easy to cannulate?

A

heat, fist pumping, tapping site

60
Q

how many times can u attempt an IV?

A

2 times

61
Q

what are some factors that could affect the flow of an IV?

A

height of the bag, kink in the line, pt arm elevated, embolism, vasospasm

62
Q

when should you not initiate IV cannulation?

A

when on a high priority call and IV cannulation delays transport,

63
Q

How to discontinue IV and when would you?

A

close roller clamp, put pressure on the catheter and have a 2x2 ready for blood, pull out catheter and press firmly on site w 2x2 for 30sec-min.
- when pt refuses transport, pt withdraws of consent, dislodged catheter.

64
Q

whata re some local or systemic complications of an IV?

A

Local:
- infiltration: redness and fluid accumulation around the site thats non-vesicant ( not caused by IV meds/solution) or vesicant ( caused by meds/solution)
- infection: break in skin barrier
- extravasation: redness and fluid accumulation around the site thats vesicant ( caused by meds/fluids)
- phelblitis= inflamation of vein
vasospasm; contraction+relaxation
systemic:
- infection: spreads from local ex: sepsis
- catheter/air embolism
- nerve/tendon/ligament damage

65
Q

what is sepsis?

A

systemic infection that happens when bacteria/virus/fungus enters the blood stream.
s/s: hypotension, sweat, alt loa, hyperglycemic, fever, chills, weakness, tachycardia, malaise

66
Q

how can infection occur with an iv?

A

bacteria/fungus/viruses enter the skin through the site of cannulation via contaminated equipment.
s/s: pain, purulent exudate, redness, heat, discolouration, swelling

67
Q

what is phelblitus and what causes this?

A

Inflammation of the vein caused by longterm IV use.
- s/s: redness following up the vein, swelling of vein,
caused by having a catheter thats too long, movement of catheter, chemical irritants, occlusion

68
Q

what is fluid over load and what happens during it?

A

when too much fluids are administered to a pt. too much fluids in vasculature will cause fluid shift to the capillary system at the lungs and put pressure against the alveolus ( wheezing/dyspnea), this results in constriction or spasm of the capillary system which reduces the levels of gas exchanage that can occur ( pulmonary edema).
s/s: restlessness, wheezing, alt loa, cough, chest tightness, SOB, crackles, JVD,
tx: elevate head, slow IV tkvo, CPAP

69
Q

what is an air embolism and what are the associated s/s?

A

when air enters the vasculature through IV it can pass to the right atrium and occlude the pulmonary vessels
- 10ml of air =harmful
s/s: dizzy, alt loa, Tachycardia, sudden SOB, wheezing, coughing ( cardiac asthma)
give O2, sit upright,

70
Q

What is a catheter embolism and what are the s/s?

A

when a piece of the catheter breaks off and circulates the vasculature to the Right atrium and gets stuck in the pulmonary vessels
s/s: sudden chest pain, + same as air embolism
can lead to MI/PEA

71
Q

what is a vasovagal reaction?

A

vagus nerve innervates the heart beat, some people have a very sensitive vagal reaction and when they are scared or experience pain it can cause a delay in innervation of the heart to beat causing decreased CO–> low BP—> syncopal episode
s/s: anxiety, sob,

72
Q

how does the body lose fluids?

A

expiration, excretion, defecation, sweat

73
Q

what is hypovolemia and how can this occur?

A

when the body is depleted of fluids, can occur when there is a extenuating bleed, ++ urination w no fluid resus, ++V/D, burns, trauma
s/s: alt loa, hypotension, pale skin, tachycardia, skin turgor, restlessness, concentrated urine.

74
Q

what is hypervolemia and how can this occur?

A

when the body system is has too much fluid.
- due to increased intake, kidney failure, CHF, given too much fluids,

75
Q

what is euvolemia?

A

balanced fluid volume in the body.

76
Q

what are some pertinent Hx q to ask if pt is hyper/hypovolemic?

A

any blood loss, how much ater did you drink? how many times u went to bathroom?, any decreased urine output, any ++ N/V/D, meds….

77
Q

when to change the IV bag?

A

when there is 25ml left to avoid getting air in the line.

78
Q

What is important about Na+?

A

Major cation in the ECF. it helps with fluid vol and concentration, muscular function, nerve impulses, and is regulated by the Na/K+.

79
Q

What is important about Cl-

A

It is the primary anion in the ECF, it helps to maintain fluid levels, Na+ reabsorption in the kidneys, essential for the reabsorption of H+ ion buffer alkalosis, often lost through vomiting, excessive sweat, and excreted through urine.

80
Q

What is hyperkalemia and some s/s of it?

A

too much potassium. s/s: lethargy, Peaked T wave, bradycardia ( late s/s), paralysis, Heart block/failure ( >8meq)
etc.

81
Q

How can hyperkalemia be managed?

A

Loop diuretics in hospital, renal dialysis, NaHCO3, Insulin and D501

82
Q

what is hypokalemia and what are some s/s?

A

Too little K+, s/s: similar to hyperk+, st depression.

83
Q

Where do we get Ca2+ from and how is it regulated in the body?

A

food or vitamins. regulated by calcitonin, vitamin d, and Parathyroid hormone

84
Q

what does Ca2+ required to do in the body?

A

Impulse transmission, muscular contraction, blood clotting, enzymes function, normal conduction of the myocytes

85
Q

Hypocalcemia can be detected by these common signs…..

A

trousseau’s signs: carpopedal spasm that causes flexion of the wrist and fingers ( when you inflate bp cuff)

chvostel’s signs: ipsilateral contraction of the facial muscles that is visible when you tap the face.

86
Q

Magnesium is the @nd most common intracellular cation (t/f)

A

true

87
Q

what is Mg+ needed for in the body?

A

co-enzyem metabolism of proteins and carbs, DNA/protein synthesis, aids with muscular relaxation, aids ca2+ reabsorption

88
Q

What is shock and what are the different types of it?

A

When there is a disruption in normal perfusion of cells in the body which causes them to stop working. Hypovolemic, cardiogenic, distributive, and obstructive.

89
Q

What is hypovolemic shock and what causes it?

A
  • inadequate perfusion of cells due to decreased blood vol.
  • caused by trauma, hemmorage, burns, excessive v/d, dehydration etc.
90
Q

what is distributive shock and what causes it?

A

When the vasculature dilates and a greater volume is needed to fill the space. ex: anaphylaxis

91
Q

what is cardiogenic shock and what causes it?

A

Is when the heart fails as a pump to circulate adequate volume–> hypo perfusion ex: stemi/ arrhythmias

92
Q

What is obstructive shock and what causes it?

A

When there is an obstruction preventing blood flow–> hypo perfusion of cells–> shock. Ex: tumor

93
Q

What is the progression of shock and explain each level?

A

Compensated shock: When the heart rate increases to bump more blood to remain a normotension bp.
decompensated shock: Heart rate increases though the bp is no longer maintaining at normal levels. (reversible)
irreversible shock: the heart becomes bradycardic and pt is hypotensive–> unresponsive –> death

94
Q

what are some physiological considerations for shock?

A

age, gender, comorbidities, pregnancy, medications, the specific organs affected

95
Q

what does a shocky pt look like?

A

pale, cool, clammy, tachycardia, hypotension, altered LOA

96
Q

How do you find the shock index?

A

Hr/sbp= shock index
normal= 0.5-0.7
- 0.9–> predicted death

97
Q

how do you manage shock?

A
  • sufficent O2, give crystalloids ( pt needs blood), stop all external bleeds, keep warm, initiate iv access
98
Q

what is the trauma triad of death?

A

blood clotting problem–>acidic blood–>decreased cardiac performance–> decreased coagulation

99
Q

What kind of electrolyte imbalance has ST depression and a prominent U wave?

A

Hypokalemia

100
Q

What kind of electrolyte imbalance has a peaked T wave, wide complex, and flat PR?

A

hyperkalemia

101
Q

what are some causes of hyperkalemia?

A

tumor lysis, burns, acidosis

102
Q

what is a severe level of K+?

A

7.0meq abg

103
Q
A

PCT3 (13 decks)

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