Treatment with IVF Flashcards
1
Q
What are the types of fluids?
A
- Fresh Frozen Plasma
- Packed RBC’s
- Whole blood
- Crystalloids
A. IV Fluids - Colloids
2
Q
what are colloids?
A
- Albumin
- Dextran
- Hetastarch (HES)
- Mannitol (alcohol sugar/osmotic diuretic)
3
Q
What are the possible isotonic fluids?
A
- NS
2. RL
4
Q
What are the 1/2 isotonic fluids?
A
- 1/2 NS
5
Q
What are the electrolyte free solutions?
A
5% dextrose
10% dextrose
6
Q
What are the dextrose, electrolyte solutions?
A
- 5% DNS
- D5, 1/2 NS
- D5, 0.33% NaCl
- D5, 0.2% NaCl
7
Q
What are the ped maintenance fluids?
A
Isolyte P
8
Q
What are the IV crystalloids?
A
1. Isotonic A. NS, LR, (D5W) 2. Hypotonic A, ½ NS, ¼ NS, 2.5% DW, (D5W in body) 3. Hypertonic A. 3% NS, 5% NS, (D5 ½ NS, D5 NS, D5 LR)
9
Q
What happens to cells in hypotonic solutions?
A
- Fluid shift into cells
- Used for cellular hydration
- Watch for decreased BP d/t decreased blood volume
- Don’t use: low bp, increased ICP, stroke, neuro pt, liver, trauma, surgery, burns
10
Q
What happens to cells in hypertonic solutions?
A
- Fluid shifts out cells
- Used for: hypovolemia, vascular expansion, increase urine output, 3rd spacing, DKA
- Watch for hypervolemia, increased NaCl, extravasations, cellular
dehydration, hypergycemia - Not for use in: renal pts, cardiac pts, dehydration
11
Q
Where do crystalloid fluids diffuse into?
A
Crystalloids across the intravascular & extracellular only
12
Q
Where do colloids move into?
A
Most colloids across the intravascular compartment only
13
Q
What is isotonic solution?
A
- One that has same solute concentration as another solution
- Therefore, two equally concentrated fluids in adjacent compartments are in balance
- No net shift of fluid
14
Q
What are the isotonic solutions?
A
- Normal saline 0.9% NS
- Lactated Ringer’s
- D5W (dextrose 5% in water)
15
Q
What is NS used for?
A
- Volume replacement
A. Can accompany blood transfusion - Initial fluid replacement in DKA
- Shock
16
Q
When is NS contraindicated?
A
- CHF
- Edema
- Hypernatremia
17
Q
What is LR used for?
A
- Acute blood loss
- Burns
- Dehydration/hypovolemia
- Septic shock
- Lower GI tract fluid loss
18
Q
When is LR used cautiously?
A
- Renal failure patients
A. Can cause hyperkalemia - Liver disease
A. Patients can’t metabolize lactate
19
Q
What is D5W used for?
A
- Fluid loss & dehydration
- Hypernatremia
- Cardiac or renal patients
A. Monitor closely for fluid overload
B. Monitor glucose
20
Q
Define hypotonic solution
A
- Lower solute concentration than another solution
- If cell is placed in hypotonic solution, water diffuses into cell until equilibrium is reached
- Cell expands as water diffuses through membrane
21
Q
What are the hypotonic solutions? (Once inside the body)
A
- ½ Normal Saline (0.45% NS)
- D5W
- 0.25% NS
- D5 ½NS
- D5 ¼NS
22
Q
What are hypotonic solutions used for?
A
- Fluid maintenance
2. Hypertonic (hypernatremic) dehydration
23
Q
When are hypotonic solutions contraindicated?
A
- Cerebral edema
- Trauma
- Burns
24
Q
Define hypertonic solutions
A
- Solution w/ a higher solute concentration than another solution
- Draws water out of cells & into ECF
- Cells shrink, extracellular volume increases
25
What are hypertonic solutions?
1. D5 in ½ Normal Saline (D5 0.45% NS)
2. D5 in Normal Saline (D5 0.9% NS)
3. 3% NS
4. 5% NS
5. D5 LR
26
What is hypertonic solution D5 in ½ Normal Saline used for?
1. Prevents hypoglycemia & cerebral edema in DKA patients
A. Use only after initial Tx w/ NS
B. When glucose
27
What are hypertonic solutions used for?
1. Addisonian crisis
2. Hypotonic (hyponatremic) dehydration
3. SIADH
4. Cerebral edema
28
When are hypertonic solutions not indicated?
Cardiac or renal patients
29
Define colloids
High molecular weight (MW) substance that largely remains in the intravascular compartment
30
What is a natural colloid?
Albumin
31
What are artificial colloids?
1. Gelatin solution
2. Dextran solution
3. Hydroxyethyl starches (HES)
32
How long do the effects of albumin last?
Effect lasts 16 - 24 h
33
What are the indications for albumin?
1. Hypovolemic shock
2. Burns
3. Hypo-albuminemia
4. Following paracentesis
5. Cirrhosis (extracorporeal albumin dialysis)
6. After liver transplantation
7. Bacterial peritonitis
8. Acute lung injury
34
What are the advantages of albumin over synthetic colloids?
1. > degree of volume expansion
2. Less S/E
3. Pruritus, anaphylactoid reactions & coagulation abnormalities
35
What are the disadvantages to synthetic colloids?
1. More expensive
| 2. Release of inflammatory mediators in septic shock → ↑ ‘leakiness’ of vascular endothelium → edema
36
How long do dextrans last?
Effect lasts 6-12 h
37
What are the indications for dextrans?
1. Microsurgical re-implantations
| 2. Extracorporeal circulation during cardio-pulmonary bypass
38
What are the 2 forms of dextrans?
1. 6% solution
A. Avg molecular weight 70,000 (dextran 70)
2. 10% solution
A. Avg mol. weight of 40,000 (dextran 40, low-molecular-weight dextran)
39
How long do gelatins last?
Effect lasts 5 h
40
What are the indications for the use of gelatins?
1. Hypovolemia due to acute blood loss
| 2. Extracorporeal circulation – cardiopulmonary by-pass
41
How are gelatins formed?
1. Proteins formed when connective tissues of animals are boiled
A. Formed from hydrolysis of collagen
42
How long does the effect of HES last?
Effect lasts 8-12 h
43
How is HES formed?
1. Derivatives of amylopectin
| A. Starch compound resembling glycogen
44
What are the indications for HES?
Hemodynamic stabilizer
45
What are the advantages of HES?
1. Anti-inflammatory properties
| 2. Cost effective
