chapter 47 quiz 4 Fluid Management in Perioperative Phase

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What term is used to describe the range of neurohumoral and inflammatory changes induced by trauma or surgery in the perioperative phase?

Stress recovery

Electrolyte disturbance

Fluid balance

Stress response (correct)

Which organ dysfunction is associated with disordered Na+ distribution, leading to profound effects on extracellular fluid volume?

Hepatic dysfunction (correct)

Pancreatic dysfunction

Lung dysfunction

Muscle dysfunction

In what circumstance might patients depend on dialysis for fluid removal prior to surgery?

End-stage renal disease (correct)

Hypertension

Cardiac dysfunction

Diuretic treatment

How might chronic treatment with diuretics impact a patient's electrolyte balance preoperatively?

Result in electrolyte depletion Signup and view all the answers

What effect can overnight fasting have on a patient's normal blood volume ?

no changes in normal blood volume Signup and view all the answers

Which group of patients may have a volume-contracted circulation preoperatively, making them more susceptible to intraoperative hypovolemia?

Hypertensive patients Signup and view all the answers

What is the primary aim of the conservative responses invoked during absolute or relative hypovolemia?

To maintain circulating volume by retaining salt and water. Signup and view all the answers

Which of the following may lead to a systemic inflammatory response syndrome (SIRS) postoperatively?

Cardiopulmonary bypass. Signup and view all the answers

What allows gut bacterial endotoxin to translocate into the systemic circulation, triggering systemic inflammation?

Increased endothelial permeability. Signup and view all the answers

How does hypervolemia caused by excessive fluid infusion contribute to endothelial dysfunction?

By degrading the endothelial glycocalyx. Signup and view all the answers

What is one consequence of inflammation-related endothelial dysfunction?

Capillary leak syndrome leading to edema. Signup and view all the answers

Which hormone is primarily responsible for postoperative retention of water?

Antidiuretic hormone (ADH). Signup and view all the answers

What metabolic shift is mediated by catecholamine and cortisol release in response to tissue injury?

Muscle protein catabolism. Signup and view all the answers

What role does ADH play in maintaining fluid balance during the postoperative phase?

Stimulating water retention. Signup and view all the answers

Which response occurs when there's preservation of cardiac and brain perfusion during hypovolemia?

Peripheral tissue perfusion decline. Signup and view all the answers

What is the consequence of reduced plasma oncotic pressure related to inflammation?

Increased capillary filtration into interstitial space. Signup and view all the answers

What is the recommended duration for cessation of oral fluids before elective surgery in modern perioperative practice?

2 hours Signup and view all the answers

Which electrolyte is predominantly lost in excess gastric fluid loss from obstruction, vomiting, or nasogastric suction?

Na+ Signup and view all the answers

which Pathologic effect cause electrolyte disturbances without external signs of fluid loss?

fluid sequestration within the bowel lumen Signup and view all the answers

What may contribute to impaired functional matching of local O2 delivery with tissue O2 requirements during surgery?

Microcirculatory dysfunction Signup and view all the answers

What is a factor that influences intraoperative fluid balance by reducing cardiac preload and afterload?

Vasodilation Signup and view all the answers

What is a significant clinical manifestation of surgical blood loss?

Hypovolemia Signup and view all the answers

How can the stress response during the perioperative phase be detrimental to patients?

By being either exaggerated or prolonged Signup and view all the answers

Patients may enter the perioperative phase with established derangements of fluid and electrolyte balance. Hepatic, renal, and cardiac dysfunction are all associated with disordered Na+ distribution, which has profound secondary effects on ECF volume.

Renal dysfunction Signup and view all the answers

How can chronic diuretic treatment affect a patient's electrolyte balance preoperatively?

By leading to electrolyte depletion Signup and view all the answers

What is a critical consideration for patients with end-stage renal disease who depend on dialysis for fluid removal relative to surgery?

The timing of dialysis in relation to surgery Signup and view all the answers

What could help improve hemodynamics and lower serum creatinine in patients with excess fluid loss due to bowel preparation?

Increasing potassium supplementation with IV crystalloid Signup and view all the answers

Which electrolyte is most significantly lost in cases of large bowel losses such as diarrhea?

Potassium (K+) Signup and view all the answers

What effect can sympathetic blockade caused by central neuraxial blockade have on cardiac output?

Decrease cardiac output Signup and view all the answers

Intraoperative fluid therapy may not always be effective due to impaired functional matching of local O2 delivery with tissue O2 requirements caused by:

Microcirculatory dysfunction Signup and view all the answers

opening of anatomic compartments lead to evaporative fluid loss from mucosal surfaces during surgery.what is the minimum loss during laparotomy?

1 mL/kg/h Signup and view all the answers

Renal urine production suppression during surgery is related to perioperative Anti-Diuretic Hormone (ADH) secretion and effects of:

Positive-pressure ventilation Signup and view all the answers

Which scenario may result in a redistribution of fluid from the intravascular to the extracellular compartment during major surgery?

Inflammatory response Signup and view all the answers

What electrolyte is the least lost in cases of small bowel secretions ?

Potassium (K+) Signup and view all the answers

What may lead to impaired functional matching of local O2 delivery with tissue O2 requirements during surgery?

Microcirculatory dysfunction Signup and view all the answers

What directly leads to mucosal necrosis in situations of hypovolemia-induced shunting of blood from the mucosa?

Intestinal villi countercurrent blood supply Signup and view all the answers

Which response is aggravated by periods of hypotension and tissue hypoperfusion, leading to the potential aggravation of the inflammatory cascade?

Reactive O2 species release Signup and view all the answers

What is a key consequence of reduced plasma oncotic pressure related to inflammation?

Capillary leak syndrome Signup and view all the answers

What mechanism leads to edema in the lungs, bowel, and connective tissue as a result of inflammation-related endothelial dysfunction?

Endothelial large pores formation Signup and view all the answers

What contributes to the release of cardiac natriuretic peptides that can further degrade the endothelial glycocalyx?

Excessive fluid infusion Signup and view all the answers

Major surgery induces an inflammatory response that redistributes fluid from the intravascular to the extracellular compartment. when this is typically manifested?

manifests in the postoperative phase Signup and view all the answers

What is a common manifestation of hypovolemia in the perioperative phase?

Reduced pulse pressure and tachycardia Signup and view all the answers

Why may urine output not be a reliable measure of adequate end-organ perfusion postoperatively?

Postoperative reduction from ADH and RAA activation Signup and view all the answers

Which statement is true regarding CVP as a marker of central venous volume?

CVP may be normal or high in venoconstricted states with reduced vascular volume Signup and view all the answers

What should be considered when assessing intravascular volume in perioperative fluid therapy?

Conventional markers are not reliable when taken in isolation. Signup and view all the answers

What may not always accompany significant loss of blood volume in healthy patients ?

significant hemodynamic alterations Signup and view all the answers

What limitation is associated with using urine output as a measure of adequate end-organ perfusion?

Insensitivity to postoperative changes in circulating volume Signup and view all the answers

What may contribute to reduced tissue oxygenation with impaired healing?

excessive intravascular fluid Signup and view all the answers

How does positive fluid balance and weight gain in the early perioperative period impact postoperative morbidity?

Increases morbidity Signup and view all the answers

Which side effect may be attributed to the amount of fluid given to a patient in the perioperative period?

Hypocoagulability Signup and view all the answers

What is a potential effect of inadequate correction of salt and water overload in the perioperative period?

Reduced tissue oxygenation Signup and view all the answers

What is a consequence of postoperative ADH secretion regarding fluid balance?

Slower correction of salt and water overload Signup and view all the answers

Which parameter is considered a more useful marker when the relationship between right-heart and left-heart filling pressures is not reliable in the presence of cardiopulmonary pathologic processes?

CVP values over time Signup and view all the answers

Which technique identifies a mismatch between global O2 delivery and O2 usage at a whole organism level?

Mixed venous O2 saturation Signup and view all the answers

Which technique is based on the association between inadequate gut perfusion and mucosal hypercarbia and acidosis?

Gastric tonometry Signup and view all the answers

What physiological effect can excessive intravascular volume have on the body?

Edema in compliant tissues Signup and view all the answers

What is the primary goal of perioperative fluid administration?

Balancing between excessive and inadequate intravascular volume Signup and view all the answers

chapter 47 quiz 4 Fluid Management in Perioperative Phase

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Questions and Answers

What term is used to describe the range of neurohumoral and inflammatory changes induced by trauma or surgery in the perioperative phase?

Which organ dysfunction is associated with disordered Na+ distribution, leading to profound effects on extracellular fluid volume?

In what circumstance might patients depend on dialysis for fluid removal prior to surgery?

How might chronic treatment with diuretics impact a patient's electrolyte balance preoperatively?

What effect can overnight fasting have on a patient's normal blood volume ?

Which group of patients may have a volume-contracted circulation preoperatively, making them more susceptible to intraoperative hypovolemia?

What is the primary aim of the conservative responses invoked during absolute or relative hypovolemia?

Which of the following may lead to a systemic inflammatory response syndrome (SIRS) postoperatively?

What allows gut bacterial endotoxin to translocate into the systemic circulation, triggering systemic inflammation?

How does hypervolemia caused by excessive fluid infusion contribute to endothelial dysfunction?

What is one consequence of inflammation-related endothelial dysfunction?

Which hormone is primarily responsible for postoperative retention of water?

What metabolic shift is mediated by catecholamine and cortisol release in response to tissue injury?

What role does ADH play in maintaining fluid balance during the postoperative phase?

Which response occurs when there's preservation of cardiac and brain perfusion during hypovolemia?

What is the consequence of reduced plasma oncotic pressure related to inflammation?

What is the recommended duration for cessation of oral fluids before elective surgery in modern perioperative practice?

Which electrolyte is predominantly lost in excess gastric fluid loss from obstruction, vomiting, or nasogastric suction?

which Pathologic effect cause electrolyte disturbances without external signs of fluid loss?

What may contribute to impaired functional matching of local O2 delivery with tissue O2 requirements during surgery?

What is a factor that influences intraoperative fluid balance by reducing cardiac preload and afterload?

What is a significant clinical manifestation of surgical blood loss?

How can the stress response during the perioperative phase be detrimental to patients?

Patients may enter the perioperative phase with established derangements of fluid and electrolyte balance. Hepatic, renal, and cardiac dysfunction are all associated with disordered Na+ distribution, which has profound secondary effects on ECF volume.

How can chronic diuretic treatment affect a patient's electrolyte balance preoperatively?

What is a critical consideration for patients with end-stage renal disease who depend on dialysis for fluid removal relative to surgery?

What could help improve hemodynamics and lower serum creatinine in patients with excess fluid loss due to bowel preparation?

Which electrolyte is most significantly lost in cases of large bowel losses such as diarrhea?

What effect can sympathetic blockade caused by central neuraxial blockade have on cardiac output?

Intraoperative fluid therapy may not always be effective due to impaired functional matching of local O2 delivery with tissue O2 requirements caused by:

opening of anatomic compartments lead to evaporative fluid loss from mucosal surfaces during surgery.what is the minimum loss during laparotomy?

Renal urine production suppression during surgery is related to perioperative Anti-Diuretic Hormone (ADH) secretion and effects of:

Which scenario may result in a redistribution of fluid from the intravascular to the extracellular compartment during major surgery?

What electrolyte is the least lost in cases of small bowel secretions ?

What may lead to impaired functional matching of local O2 delivery with tissue O2 requirements during surgery?

What directly leads to mucosal necrosis in situations of hypovolemia-induced shunting of blood from the mucosa?

Which response is aggravated by periods of hypotension and tissue hypoperfusion, leading to the potential aggravation of the inflammatory cascade?

What is a key consequence of reduced plasma oncotic pressure related to inflammation?

What mechanism leads to edema in the lungs, bowel, and connective tissue as a result of inflammation-related endothelial dysfunction?

What contributes to the release of cardiac natriuretic peptides that can further degrade the endothelial glycocalyx?

Major surgery induces an inflammatory response that redistributes fluid from the intravascular to the extracellular compartment. when this is typically manifested?

What is a common manifestation of hypovolemia in the perioperative phase?

Why may urine output not be a reliable measure of adequate end-organ perfusion postoperatively?

Which statement is true regarding CVP as a marker of central venous volume?

What should be considered when assessing intravascular volume in perioperative fluid therapy?

What may not always accompany significant loss of blood volume in healthy patients ?

What limitation is associated with using urine output as a measure of adequate end-organ perfusion?

What may contribute to reduced tissue oxygenation with impaired healing?

How does positive fluid balance and weight gain in the early perioperative period impact postoperative morbidity?

Which side effect may be attributed to the amount of fluid given to a patient in the perioperative period?

What is a potential effect of inadequate correction of salt and water overload in the perioperative period?

What is a consequence of postoperative ADH secretion regarding fluid balance?

Which parameter is considered a more useful marker when the relationship between right-heart and left-heart filling pressures is not reliable in the presence of cardiopulmonary pathologic processes?

Which technique identifies a mismatch between global O2 delivery and O2 usage at a whole organism level?

Which technique is based on the association between inadequate gut perfusion and mucosal hypercarbia and acidosis?

What physiological effect can excessive intravascular volume have on the body?

What is the primary goal of perioperative fluid administration?

What physiological response may be exacerbated by modest hypovolemia in the context of the surgical stress response?

What is a potential consequence of hypervolemia in the perioperative setting?

What effect can hypovolemia have on global O2 delivery during surgery?

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