Blood and Fluid Management in Healthcare

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Questions and Answers

Which of the following is NOT a potential adverse effect associated with albumin administration?

Anaphylaxis

Fluid overload

Renal dysfunction (correct)

Infection

A patient is about to receive a unit of Packed Red Blood Cells (PRBCs). Which of the following considerations is NOT critical for administration?

Ensuring use of special filters and tubing

Verifying appropriate vascular access

Administering through the same IV line as medications (correct)

Confirming ABO and Rh compatibility

Why is informed consent required before administering blood products?

Blood products are analogous to human tissue transplants, necessitating consent. (correct)

Blood products are considered medications, requiring consent for use.

To comply with the regulatory requirements of blood banks.

Consent is only required for specific blood products, such as FFP.

Following the infusion of one unit of PRBC, how much would the expected hemoglobin increase?

10 g/L Signup and view all the answers

Which of the following statements accurately describes Fresh Frozen Plasma (FFP)?

Contains acellular blood components including clotting factors. Signup and view all the answers

Which of the following best describes the primary role of water in the body's thermoregulation?

It facilitates heat transfer through evaporation from skin and respiratory system. Signup and view all the answers

What is the primary difference between hydrostatic pressure and oncotic pressure in the context of fluid movement?

Hydrostatic pressure results from the pressure of blood on the capillary walls; oncotic pressure is due to protein concentration in plasma. Signup and view all the answers

If a cell is placed in a hypertonic solution, what is the expected net movement of water and the effect on the cell?

Water moves out of the cell, causing it to shrink or crenate. Signup and view all the answers

Which of the following properties of water make it ideal as a transport medium in the body?

Its polar nature and high solvency allows it to dissolve and carry various substances. Signup and view all the answers

Which of the following is NOT a direct function of water in the body?

Regulation of blood glucose levels. Signup and view all the answers

According to the content provided, what role does water play in the building of cell protoplasm?

Water's polarity helps facilitate the movement of precursor molecules to where they assemble as protoplasm. Signup and view all the answers

Which statement best differentiates diffusion from osmosis?

Osmosis is a specific case of diffusion, describing water movement, whereas diffusion describes the movement of any solute. Signup and view all the answers

Which crystalloid solution is considered physiologically hypotonic due to the rapid uptake of dextrose?

D5W Signup and view all the answers

Which intravenous fluid is characterized by a high sodium load and may cause hyperchloremic acidosis?

7.5% NaCl Signup and view all the answers

A patient with a clotting impairment needs intravenous fluids. Which of the following is the most important consideration?

Fluid type Signup and view all the answers

Which crystalloid solution has a pH closest to that of plasma?

Ringer’s Lactate Signup and view all the answers

Which of the following is NOT a primary function of crystalloid fluids?

Expanding plasma volume Signup and view all the answers

Which intravenous fluid is NOT suitable as a resuscitation fluid?

D5W Signup and view all the answers

A continuous infusion of which solution should be used carefully due to potential drug incompatibilities?

Ringer’s Lactate Signup and view all the answers

What is the approximate osmolarity of 0.9% Sodium Chloride?

308 mOsm Signup and view all the answers

A patient requires an intravenous solution. Which of these factors is NOT considered during the determination of the appropriate IV fluid?

Patient's dietary preferences Signup and view all the answers

Which property BEST differentiates crystalloid infusions from plasma-volume expanders?

Crystalloid infusions do not contain proteins (colloids), whereas plasma-volume expanders do. Signup and view all the answers

What is the primary rationale for using crystalloid infusions for maintenance fluids?

To compensate for insensible fluid losses and replace fluids. Signup and view all the answers

In which of the following situations is a crystalloid bolus MOST likely contraindicated?

Severe left ventricular dysfunction and suspected fluid overload. Signup and view all the answers

Why might Lactated Ringer’s solution be preferred over other crystalloid solutions in cases where large volumes of fluids may be administered?

Lactated Ringer’s solution has a better acid-base balance and does not produce hyperchloremic acidosis as readily. Signup and view all the answers

A patient is receiving a crystalloid infusion. Which of the following is a potential adverse effect related to its dilution of plasma proteins?

Decreased capillary oncotic pressure and increased risk of edema. Signup and view all the answers

How does the administration of crystalloid fluids impact a patient's hematocrit (Hct)?

Decreases the Hct due to dilutional effects. Signup and view all the answers

When is the use of crystalloid infusions in hemorrhagic shock considered a last resort?

When other methods to restore blood volume, such as blood transfusions, are not available or have failed. Signup and view all the answers

A patient is being administered crystalloid fluids at a rate of 75 mL/h. What type of fluid maintenance is being provided?

TKVO (To Keep Vein Open) infusion. Signup and view all the answers

What is the typical order of distribution of crystalloids administered, between extravascular and intravascular spaces?

2/3 extravascular, 1/3 intravascular Signup and view all the answers

What potential effect could crystalloid infusions have in a patient experiencing hypothermia?

Potentially worsen the hypothermia. Signup and view all the answers

What characteristic of hypertonic saline solutions makes them effective in increasing vascular volume?

They have a higher concentration of sodium, which pulls more volume into the vascular space. Signup and view all the answers

A hypertonic saline solution is typically defined as having a concentration greater than what percentage?

0.9% Signup and view all the answers

What is the primary difference between a 5% Albumin solution and a 25% Albumin solution regarding volume expansion?

The 25% solution leads to 2 to 4 times the volume expansion of the 5% solution. Signup and view all the answers

Why is a transfusion consent required prior to administering albumin?

Albumin is a blood product and carries a risk of transmission. Signup and view all the answers

Which of the following is NOT a characteristic of colloid solutions?

They contain electrolytes. Signup and view all the answers

What is the primary mechanism through which colloids such as albumin increase intravascular volume?

By pulling fluid from the extravascular space into the intravascular space. Signup and view all the answers

Which of the following is a contraindication for the use of colloids such as albumin?

CHF with evidence of volume overload. Signup and view all the answers

What is a significant precaution to keep in mind when administering albumin?

It can leak into the interstitium in cases of increased vascular permeability. Signup and view all the answers

While colloids are used in various shock states, what does new evidence suggest about their benefit in initial resuscitation compared to crystalloids?

New evidence shows no benefit from colloids over crystalloid in initial resuscitation. Signup and view all the answers

The effect of a 25% albumin solution used for volume expansion persists for how long?

16 - 24 hours. Signup and view all the answers

Study Notes

Fluid Therapy Overview

Fluid therapy is used to increase blood volume and organ/tissue perfusion.
Common indications include shock, burns, and severe dehydration.
Important factors to consider include the IV site, gauge, fluid type, flow rate, total body fluid volume (TBF), intravascular volume, oxygen, and clotting impairment.
Crystallloids and colloids are both used; crystallloids include 0.9% saline, 0.45%, 3%, 7.5% NaCl.
Ringer's solution is similar to plasma pH, contains a lactate buffer, and contains calcium.
Dextrose is a physiological hypotonic solution and is not a resuscitation fluid.
Hypertonic saline has a higher sodium concentration than 0.9% saline, often 3%, 5%, or 7%.

Fluid Composition

Intracellular fluid (ICF) is 2/3 of the total body fluid and extracellular fluid (ECF) is 1/3.
ECF is further divided into interstitial fluid (80%) and plasma (20%).
Intracellular fluid contains proteins, ATP, potassium, magnesium, and chloride.
Extracellular fluid contains proteins and sodium.

Water Movement

Diffusion is the random movement of molecules from high to low concentration.
Osmosis is the spontaneous movement of water across a semipermeable membrane from low to high solute concentration.
Water moves from hypotonic to hypertonic solutions.
Osmotic pressure is the pressure applied to stop water movement across a semipermeable membrane.
Hydrostatic pressure is the pressure exerted by a solution at equilibrium.
Oncotic pressure is the pressure that proteins exert on one side of the membrane; these large proteins can't cross the membrane causing water to cross.
The relationship between hydrostatic and oncotic pressure results in fluid moving in and out of blood vessels through filtration and reabsorption.

Fluid Therapy Objectives

Discuss the functions of water in the body.
Describe the different ways that water moves within the body.
Explain diffusion, osmosis, osmotic pressure, oncotic pressure, and hydrostatic pressure.
Provide details about body fluid compartments and fluid composition.
Identify the tonicity of various solutions.
Differentiate between crystallloid and colloid fluids, including indications, contraindications, precautions, does and adverse effects.
List and differentiate between the different blood and blood products. Provide indications for their use.
Discuss transfusion-related reactions.

Crystalloids

Crystalloids are fluids with dissolved electrolytes, are isotonic, and used to supply water and electrolytes. Indications for use include hypovolemia, maintaining fluids, and replacing fluids lost during insensible losses.
Precautions include their use with caution in patients with heart or kidney failure or electrolyte abnormalities. Potential adverse effects include fluid overload, edema, dilution of plasma proteins, and worsen or cause acidosis.
Crytsalloids are supplied in bags of 50, 100, 250, 500, and 1000 ml.
Examples include 0.9% saline, Ringer's solution, and dextrose.

Colloids

Colloids are fluids that remain intravascular and may draw fluid from the extracellular space.
Examples include albumin and starches; these are generally more expensive than crystallloids.
Colloids are used in fluid resuscitation; indications include drawing excess extravascular fluid into the intravascular space and replacing low albumin.
Potential adverse effects include allergy, CHF (congestive heart failure), and volume overload.

Blood and Blood Products

Blood products are considered human tissue transplants.
Consent is required before transfusion.
Blood products include packed red blood cells (PRBC), fresh frozen plasma (FFP), platelets, cryoprecipitate, and prothrombin complex concentrates (PCC).
Things to consider include vascular access, special filters and tubing, and incompatibility with medications; cross-matching should be done.
Important to note that each blood product has a different storage time and method of delivery.
Cryoprecipitate is made from FFP and contains fibrinogen, Factor VIII and XIII, and Von Willebrand Factor.
PCC contains factors II, VII, IX, X, and proteins.

Transfusion Reactions

Hemolysis occurs due to blood group incompatibility, causing hemolysis of red blood cells, fever, chills, back pain, dyspnea, hypotension, and hemoglobinuria.
Erythroblastosis fetalis occurs due to Rh incompatibility between mother and fetus, causing massive hemolysis in the fetus..
Transfusion-related lung injury (TRALI) is related to antibody or neutrophil-related immune response, with symptoms including fever, chills, urticaria, or full-blown anaphylaxis.
Transfusion-related circulatory overload (TACO) occurs due to poor heart function or rapid fluid administration, symptoms are dyspnea, hypertension and cyanosis, tachycardia, increased venous pressure and pulmonary edema.

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Description

This quiz addresses critical concepts regarding blood product administration, adverse effects of albumin, and the physiological roles of fluids in the body. Participants will be tested on topics such as informed consent, hemoglobin changes, and the properties of water relevant to thermoregulation and transport. Perfect for health professionals or students in medicine-related fields.