Test 1 Flashcards
What are the purposes of IV fluid replacement?
To restore lost fluid vol from the intravascular, shock, to give medications, and to have access incase of electrolyte emergencies
Total body fluids=
60%
Intracellular fluid is = to
2/3 the fluid vol in the body and 40-45%
extracellular fluid is = to
15-20% of total body fluids
- intersitial= 75% of the ECF
- Plasma=25% of the ECF
infants fluid content make up = …%
70%
Why do water imbalances increase in the elderly and infant population?
due to decreased skeletal muscle mass, more adipose tissue make up, infants have a smaller system that is still developing.
what is Osmoregulation?
a mechanism that uses gradients and semi permeable membranes to balance movement of solutes.
what is diffusion?
when particles move across a cellular membrane from high to low concentration.
What is Active transport?
Process requires ATP to activate a Na/K+ pump to move solutes against the gradient.
What is osmosis?
The movement of water over semi permeable membranes to areas of high solute concentration
What is filtration and where is it done?
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.
what is RAAS and How does RAAS work?
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
when there is too much solute and water loss the cell will…
shrink ( hypertonic)
When there is too much solvent and not enough solute the cell will…
Swell ( hypotonic)
What does ANP do?
Atrial naturetic hormone is stimulated by increased stretch of the atria. ANP causes +GFR and promotes excretion.
What populations is regular dehydration common in?
children and elderly
What causes dehydration?
- fluid shift from the intracellular to extracellular–> interstitial –> vasculature
- N/v/d, poisoning, Heat stroke, sepsis,
what are some s/s of dehydration?
- alt LOA, thirst, dry mucous membranes, excessive skin turgor, lethargy, decreased urine output, Hypotension, Pale skin, orthostatic vitals
What causes over-hydration?
medication, fluid overload, urinary retention, too much fluid intake, kidney failure, chf, UTI
what are s/s of over hydration?
lung crackles, s/s or UTI, ascities, pulmonary and peripheral edema, SOB, weakness, lethargic, +bp,
What types of fluids can be used to replace fluid loss in the body?
crystalloids: ex: ringers lactate, 0.9%NaCl,
Blood products
colloids:
what does the 3:1 rule mean?
for every 1 unit vol lost it should be replaced with 3 unit vols of isotonic solution ( preferrably)
isotonic solutions of have a ph of what?
5.5
what are some common types of isotonic crystalloid?
ringers lactate
NS 0.9%
Dw5
what is the purpose of hypotonic Crystalloids?
to restore cellular hydration by diluting serums ex: 0.45% dex
what is the purpose of a hypertonic crystalloid solution?
regulates bp by way of Osmolarity, reduces edema
ex: 3%Nsm & mannitol
what fluid would be best used for a brain injured pt?
isotonic colloids, 0.9% NS
What fluids would be best for a multi system trauma pt?
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
what solution is not compatible with blood products?
Lactated ringers because it will cause clotting to occur in the blood
why is D5W a hypotonic solution?
b/c the cells will quickly uptake the glucose and cause the water to follow the glucose ( osmosis).
why is D5W no recommended for a brain injured pt?
Brain does not need insulin present to uptake glucose—> increased glucose in brain causing water to follow—> ++ ICP
Why would you use a hypertonic saline solution?
- to treat 3rd space shock to bring fluids back into the icf
- to reduce organ inflammation due to multi-system organ failure.
what are colloids?
Colloids have larger molecules in their solutions and expand the volume in the intravascular space in. reduces edema.
what must be working in the body before giving a colloid solution?
the kidneys to allow for excretion
how can you get blood products to your scene if you need it?
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
When should you use a Micro drip set ( 60gtts)?
for peds or pt you need to closely monitor
when should you use a macro drip set ( 10gtts)
average set to use for average adult-elderly
when to use a buretrol?
for precise amounts and pt you need to monitor closelyy with fluids ex: peds/kidney failure
Pink catheter=
20 gauge, 60ml/min, 17 mins to infuse, for med admin
blue catheter=
22 gauge, 35ml/min, 29 mins to infuse, kids and elderly
green catheter=
18 gauge, 100ml/min= 10 mins, min standard for blood products/fluid
grey catheter=
16 gauge, 150ml/min, 7 mins to infuse, for trauma or blood loss
orange catheter
14 gauge, 250 ml/min, 4 mins to infuse, trauma and blood loss
what are some complications that can occur with giving fluids?
dislodged catheter, air embolism, catheter embolism, hemoglobin dilution.
what types of hypo/hyper/isotonic solutions do we commonly use?
iso= NS 0.9%, Ringers lactate
hypo= D5w, 0.45% NS
hyper= Mannitol, D50w
What size of IV bag would you use for fluid resuscitation?
1000ml for fluid replacement
what should you look for when checking you IV bag?
clarity, right solution & size, no leaks, ports are sealed, no condensation, expiry date
how would you adjust the rate of flow in IV tubing?
Roller clamp
when cannulating a vein you should attempt ______ first then _______
distal then proximal
What is an IO and who is it commonly used for?
intraosseous is a direct line to the bone marrow which allows for quick absorption in pt with no palpable veins or pediatric pt.
what are the indications for Iv fluid directive?
actual or potential need for fluid therapy or IV medication.
what are contraindications for IV cannulation? bolus?
-fracture proximal to the site
- fluid overload
what are the conditions for cannulation and bolus?
cannulation= >/=2years
Bolus=>/= 2years, hypotensive
what is your treatment for IV fluid maintenance?
for age 2-12, 15ml/min,
for >12= 30-60ml/min
what is treatment for IV bolus
for: 2-12 years, 20ml/kg, reassessed every 100ml, up to 2000ml
for >12 years, 20ml/kg, reassess every 250ml, max of 2000ml
if you have a pt that weighs 120 lbs what is their max fluid vol?
1080 ml
When you spike an IV bag what should you do?
put tape on it with the date time spiked and initials,
what areas should you avoid when looking to cannulate a vein?
edematous veins, fractures/potential fractures, AV fistulas, Same side of recent mastectomy, cellulitis
how can you make veins more easy to cannulate?
heat, fist pumping, tapping site
how many times can u attempt an IV?
2 times
what are some factors that could affect the flow of an IV?
height of the bag, kink in the line, pt arm elevated, embolism, vasospasm
when should you not initiate IV cannulation?
when on a high priority call and IV cannulation delays transport,
How to discontinue IV and when would you?
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.
whata re some local or systemic complications of an IV?
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
what is sepsis?
systemic infection that happens when bacteria/virus/fungus enters the blood stream.
s/s: hypotension, sweat, alt loa, hyperglycemic, fever, chills, weakness, tachycardia, malaise
how can infection occur with an iv?
bacteria/fungus/viruses enter the skin through the site of cannulation via contaminated equipment.
s/s: pain, purulent exudate, redness, heat, discolouration, swelling
what is phelblitus and what causes this?
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
what is fluid over load and what happens during it?
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
what is an air embolism and what are the associated s/s?
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,
What is a catheter embolism and what are the s/s?
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
what is a vasovagal reaction?
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,
how does the body lose fluids?
expiration, excretion, defecation, sweat
what is hypovolemia and how can this occur?
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.
what is hypervolemia and how can this occur?
when the body system is has too much fluid.
- due to increased intake, kidney failure, CHF, given too much fluids,
what is euvolemia?
balanced fluid volume in the body.
what are some pertinent Hx q to ask if pt is hyper/hypovolemic?
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….
when to change the IV bag?
when there is 25ml left to avoid getting air in the line.
What is important about Na+?
Major cation in the ECF. it helps with fluid vol and concentration, muscular function, nerve impulses, and is regulated by the Na/K+.
What is important about Cl-
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.
What is hyperkalemia and some s/s of it?
too much potassium. s/s: lethargy, Peaked T wave, bradycardia ( late s/s), paralysis, Heart block/failure ( >8meq)
etc.
How can hyperkalemia be managed?
Loop diuretics in hospital, renal dialysis, NaHCO3, Insulin and D501
what is hypokalemia and what are some s/s?
Too little K+, s/s: similar to hyperk+, st depression.
Where do we get Ca2+ from and how is it regulated in the body?
food or vitamins. regulated by calcitonin, vitamin d, and Parathyroid hormone
what does Ca2+ required to do in the body?
Impulse transmission, muscular contraction, blood clotting, enzymes function, normal conduction of the myocytes
Hypocalcemia can be detected by these common signs…..
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.
Magnesium is the @nd most common intracellular cation (t/f)
true
what is Mg+ needed for in the body?
co-enzyem metabolism of proteins and carbs, DNA/protein synthesis, aids with muscular relaxation, aids ca2+ reabsorption
What is shock and what are the different types of it?
When there is a disruption in normal perfusion of cells in the body which causes them to stop working. Hypovolemic, cardiogenic, distributive, and obstructive.
What is hypovolemic shock and what causes it?
- inadequate perfusion of cells due to decreased blood vol.
- caused by trauma, hemmorage, burns, excessive v/d, dehydration etc.
what is distributive shock and what causes it?
When the vasculature dilates and a greater volume is needed to fill the space. ex: anaphylaxis
what is cardiogenic shock and what causes it?
Is when the heart fails as a pump to circulate adequate volume–> hypo perfusion ex: stemi/ arrhythmias
What is obstructive shock and what causes it?
When there is an obstruction preventing blood flow–> hypo perfusion of cells–> shock. Ex: tumor
What is the progression of shock and explain each level?
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
what are some physiological considerations for shock?
age, gender, comorbidities, pregnancy, medications, the specific organs affected
what does a shocky pt look like?
pale, cool, clammy, tachycardia, hypotension, altered LOA
How do you find the shock index?
Hr/sbp= shock index
normal= 0.5-0.7
- 0.9–> predicted death
how do you manage shock?
- sufficent O2, give crystalloids ( pt needs blood), stop all external bleeds, keep warm, initiate iv access
what is the trauma triad of death?
blood clotting problem–>acidic blood–>decreased cardiac performance–> decreased coagulation
What kind of electrolyte imbalance has ST depression and a prominent U wave?
Hypokalemia
What kind of electrolyte imbalance has a peaked T wave, wide complex, and flat PR?
hyperkalemia
what are some causes of hyperkalemia?
tumor lysis, burns, acidosis
what is a severe level of K+?
7.0meq abg
