Fluid therapy 1&2
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Questions and Answers

What is the most common electrolyte disturbance due to fluid loss

  • Hyperkalemia
  • Hypokalemia
  • Hyponatremia (correct)
  • Hypernatremia

What is the most common cause of volume loss

  • Diuretics
  • Cerebral edema
  • Vomiting (correct)
  • Diarrhea (correct)

Other causes of volume loss are

  • Diuretics (correct)
  • Renal disease (correct)
  • Addison's disease (correct)
  • Cerebral edema (correct)

Clinical signs of hyponatremia

<p>Lethargy (A), Muscle weakness (B)</p> Signup and view all the answers

Changes in potassium are particularly serious because of the clinical signs that can be seen, for example:

<p>Bradycardia (B), Cardiac arrhythmias (C), Lethargy (D)</p> Signup and view all the answers

Serum levels begin to _____ when k+ is driven into the cells

<p>drop</p> Signup and view all the answers

Serum potassium will decrease only after a considerable loss of total body k+ loss, when serum potassium concentration is _____.

<p>&lt; 3.5 mEq/L (C)</p> Signup and view all the answers

Clinical signs of hypokalemia

<p>Muscle weakness (A), Hypoventilation (B), Hypotension (D)</p> Signup and view all the answers

Regarding abnormal serum concentrations of K+, which one is most commonly seen

<p>Hypokalemia (A)</p> Signup and view all the answers

Common causes of hypokalemia

<p>Anorexia (C), GI or Urinary losses (D)</p> Signup and view all the answers

Less commonly encountered abnormal serum concentration of K+ is

<p>Hyperkalemia (B)</p> Signup and view all the answers

Causes of hyperkalemia

<p>Urinary obstruction or Trauma to the renal system (ureter, bladder, etc) (A), Anuria or oliguria (C), Addisons disease (D)</p> Signup and view all the answers

K+ is normally excreted by the kidneys. Acidosis -> K+ being driven out of the cell which can cause which of the following

<p>Arrhythmia (B), Lethargy (C), Bradycardia (D)</p> Signup and view all the answers

Match the electrolyte with its primary function

<p>Water balance and volume within the ECF = Sodium Resting cell membrane potential = Potassium Osmolality and acid/base regulation = Chloride Acid/bae regulation and fluid pH = Bicarbonate</p> Signup and view all the answers

Match the electrolyte to its primary function

<p>Support, muscle contractions, hormone signaling, blood clotting, and nerve function = Calcium Primary component of ATP, energy source = Phosphorus Cofactor in many enzymatic processes = Magnesium</p> <ul> <li>= -</li> </ul> Signup and view all the answers

Match

<p>Movement of molecules; mores the electrolytes and proteins down the concentration gradient (high to low) = Diffusion Movement of water across the membrane = Osmosis Moves electrolytes or proteins against the concentration gradient = Active transport</p> <ul> <li>= -</li> </ul> Signup and view all the answers

What is the cell membrane and what is its function

<p>Semi-permeable membrane that restricts movement of electrons and proteins</p> Signup and view all the answers

The pumping of ____ against its concentration gradient is used for transmitting electrical signals within nerve cells

<p>sodium</p> Signup and view all the answers

Na+/K+ pump, generate action potentials that are responsible for

<p>Heart contraction (A), Nerve stimulation (B), Movement of muscles (C), Movement of limbs (D)</p> Signup and view all the answers

Osmoreceptors in the hypothalamus detect an increase in plasma concentration which stimulates thirst and the release of _____

<p>ADH</p> Signup and view all the answers

Causes the reabsorption of water

<p>ADH (D)</p> Signup and view all the answers

Match Renal hypoperfusion

<p>Stimulates the release of renin from the juxtaglomerular cells = 1 Renin acts of angiotensinogen in the plasma which converts to angiotensin I then angiotensin II = 2 Stimulates release of aldosterone from the adrenal cortex = 3 Promotes reabsorption of sodium from the DCT = 4</p> Signup and view all the answers

Fluid losses happen

<p>During periods of food and water restriction (B), When there are exaggerated sensible and insensible losses are present (C), During diseased states (D)</p> Signup and view all the answers

What is dehydration

<p>Net reduction in the free water content of the body (B), When fluid losses from the body exceed fluid intake (C)</p> Signup and view all the answers

Indications for use of fluid therapy (7)

<p>Maintenance of fluid volume, dehydration, shock, systemic disease, diuresis, hypoproteinemia, anesthesia</p> Signup and view all the answers

Assessment of fluid and electrolyte imbalance involves what 3 things

<p>History, physical exam, laboratory tests</p> Signup and view all the answers

Match the estimates of dehydration with the clinical signs

<p>5-6 = skin sly, doughy, inelastic 6-8 = skin inelastic, eyes slightly sunken in orbits 10-12 = marked increased skin turgor, eyes sunken, prolonged CRT, dry mm, early sings of shock 12-15 = all signs plus muscle weakness, collapse, shock, weak pulse, cool extremities, decreased urine production, increase in temperature, imminent death</p> Signup and view all the answers

A pound is a

<p>Pint (A), 500mL of fluid (D)</p> Signup and view all the answers

Fluid therapy can play a vital role in the stabilization and recovery of an ill patient. It is used in clinical medicine to: (5)

<p>Replace hydration deficits, maintain normal hydration status, replace electrolytes, nutrients, and serve as a vehicle for infusing certain IV drugs</p> Signup and view all the answers

Which of the following is accurate of crystalloids

<p>Water-based solutions containing electrolytes and non electrolytes that are permeable to the capillary membrane (B)</p> Signup and view all the answers

Colloids contain molecules that can cross cell membranes and enter all fluid compartments

<p>False (B)</p> Signup and view all the answers

Colloids remain in the intravascular space longer because the pressure is greater than in the tissue

<p>True (A)</p> Signup and view all the answers

Hetastarch can reduce the amount of crystalloids needed for volume resuscitation by 60-100%

<p>False (B)</p> Signup and view all the answers

Colloid properties remain active for approximately 24-48 hours.

<p>True (A)</p> Signup and view all the answers

Adverse effects of colloids

<p>Bleeding problems (C)</p> Signup and view all the answers

First choice for resuscitation

<p>Crystalloids (C)</p> Signup and view all the answers

Commonly used for rehydration and maintenance needs

<p>Crystalloids (B)</p> Signup and view all the answers

Lower osmotic pressure relative, which causes fluid shift into the cells, causing swelling of the cells

<p>Hypotonic crystalloids (C)</p> Signup and view all the answers

When dextrose is metabolized it results in a hypotonic solution

<p>True (A)</p> Signup and view all the answers

Similar osmotic pressure to the fluids of plasma and cell, the solutions evenly distribute in the extravascular space when given IV

<p>Isotonic crystalloids (B)</p> Signup and view all the answers

50% of isotonic fluid will remain in the intravascular space of the ECF after one hour

<p>False (B)</p> Signup and view all the answers

Which of the following is accurate of isotonic crystalloids

<p>Inexpensive, readily available and a good replacement fluid for dehydration (A), Good for resuscitation that need rapid volume expansion (B), Not good for maintenance because of their high Na+ and Chl- content with low K+ (D)</p> Signup and view all the answers

Most common example of an isotonic crystalloid

<p>Lactated Ringers Solution (B)</p> Signup and view all the answers

Do not use LRS while giving a blood transfusion because the fluids containing calcium may overcome the anticoagulant properties of citrate, resulting in coagulation of the blood

<p>True (A)</p> Signup and view all the answers

Have higher osmotic pressure which causes movement of water out of the cell

<p>Hypertonic crystalloids (D)</p> Signup and view all the answers

Which of the following are accurate of hypertonic crystalloids

<p>Used for rapid volume expansion (A), Draws fluids into the vascular compartment for rapid resuscitation (B), Used for treating head injuries, cerebral edema, or increase in intracranial pressure (D)</p> Signup and view all the answers

If using hypertonic solutions one must use caution and be vigilant of hypernatremia or increased bleeding

<p>True (A)</p> Signup and view all the answers

Which of the following can occur if hypertonic solutions are given too quickly

<p>Bradycardia (B), Hypotension (C), Bronchoconstriction and rapid shallow breathing (D)</p> Signup and view all the answers

Example of hypertonic solutions

<p>7% saline (A), 3% saline (D)</p> Signup and view all the answers

For transfusions, solutions such as 5% dextrose are hypotonic and may induce hemolysis

<p>True (A)</p> Signup and view all the answers

Which of the following is an example of colloid solutions

<p>Hetastarch (B), Vetastarch (C), Dextran (D)</p> Signup and view all the answers

Which of the following are examples of blood products

<p>Plasma (A), Albumin (B), Oxyglobin (C)</p> Signup and view all the answers

Maintenance solutions are used to replace fluid and/or electrolyte deficits

<p>False (B)</p> Signup and view all the answers

Which of the following is an example of replacement solutions

<p>LRS (A), Normosol R (B), Normal NaCL (C), Plasmalyte (D)</p> Signup and view all the answers

Maintenance solutions are used to maintain hydration and electrolyte levels within the body

<p>True (A)</p> Signup and view all the answers

It is rare that maintenance solutions contain dextrose

<p>False (B)</p> Signup and view all the answers

Which of the following is an example of a maintenance solution

<p>Normosol M with dextrose (B), Normosol M without dextrose (C), 2.5% dextrose % 0.45% saline (D)</p> Signup and view all the answers

Potassium (K+) is necessary for the maintenance of several body functions most notably electrical potential in muscles and nerves

<p>True (A)</p> Signup and view all the answers

Maximum rate of K+

<p>0.5mEq/kg/hr (C)</p> Signup and view all the answers

Volume of fluid and amount of electrolytes needed normally in a 24hr period is

<p>40-60mL/kg/day (D)</p> Signup and view all the answers

Dehydration correction comes with 3 requirements, #1 is the volume of fluid needed to ______ the patient

<p>Rehydrate</p> Signup and view all the answers

Dehydration correction comes with 3 requirements, #2 is the volume of fluid needed for ______ requirements

<p>Maintenance</p> Signup and view all the answers

Dehydration correction comes with 3 requirements, #3 is the volume of fluid needed to correct __________

<p>ongoing losses</p> Signup and view all the answers

Routes for fluid administration

<p>Oral (A), IV and SubQ (B), Intraperitoneal (C)</p> Signup and view all the answers

What are SubQ fluids used for

<p>Mild dehydration (A), Nonhospitalized patients (B)</p> Signup and view all the answers

When administering SubQ fluids the areas where the limbs join the trunk should be used

<p>False (B)</p> Signup and view all the answers

Do not give 5% dextrose SQ because it will cause necrosis

<p>True (A)</p> Signup and view all the answers

How long does it usually take for SubQ fluids to be absorbed

<p>6-8 hours (C)</p> Signup and view all the answers

Subcutaneous fluid administration cannot be used in animals that

<p>Require large replacement volumes (A), Are severely dehydrated or hypothermic (B)</p> Signup and view all the answers

Most common sites of IV catheter placement

<p>Medial femoral and saphenous veins (C), Cephalic vein (D)</p> Signup and view all the answers

Rate of fluid flow through the catheter is controlled by which of the following

<p>Patient blood pressure (B), Resistance in administration system (C), Pressure or height of fluid source (D)</p> Signup and view all the answers

How often should a catheter be flushed if its not being used

<p>4-6 hours (D)</p> Signup and view all the answers

Complications of IV catheterization include

<p>Phlebitis (A), Thrombosis (B), Infection (C), Air embolism (D)</p> Signup and view all the answers

What to monitor during fluid therapy

<p>Temperature (A), Cardiovascular system (B), Respiratory system (C), Urine output (D)</p> Signup and view all the answers

Signs of fluid overload

<p>Serous nasal discharge (A), Restlessness (B), Coughing (C), Hyperpnea (D)</p> Signup and view all the answers

Neonatal fluid replacement includes

<p>Multiple electrolyte solutions supplemented with 5% dextrose (D)</p> Signup and view all the answers

Fluid therapy in clinical situations - acute

<p>Hypovolemic patients (B), Rapid loss requires rapid replacement (C)</p> Signup and view all the answers

Fluid therapy in clinical situations - chronic

<p>Dehydrated but not seriously hypovolemic (A), Anemia (C), Replaced over 12-24 hours (D)</p> Signup and view all the answers

A number of diseases can affect the bodies ability to stay in equilibrium. Fluid is used:

<p>To correct dehydration deficit (A), To provide adequate perfusion to all tissues (B), For diuresis of endotoxins (C), To help prevent shock (D)</p> Signup and view all the answers

Clinical syndrome in which the peripheral blood flow is inadequate to return sufficient blood to the heart for normal function

<p>Shock (A)</p> Signup and view all the answers

What is the main treatment for all types of shock

<p>Fluid therapy (A)</p> Signup and view all the answers

Hypoproteinemia is when

<p>Total protein levels are less than 3.5g/dL (C)</p> Signup and view all the answers

When is it best to use colloids

<p>When total protein levels are less than 3.5g/dL (C)</p> Signup and view all the answers

Assists the body in eliminating substances that can be excreted by the kidneys (one word)

<p>Diuresis</p> Signup and view all the answers

Which of the following is an indication for the use of diuresis

<p>Renal failure (A), Liver failure (B), Diabetes (C), Electrolyte imbalances (D)</p> Signup and view all the answers

Which of the following is accurate of IV fluids during anesthesia

<p>Helps maintain homeostasis (B), Provides venous access for delivery of induction agent (C), Helps maintain venous access in case of emergency (D)</p> Signup and view all the answers

Study Notes

Electrolyte Disturbances

  • Hyponatremia is the most common electrolyte disturbance due to fluid loss.
  • Volume depletion is the most common cause of fluid loss.
  • Other causes of volume loss:
    • Gastrointestinal: vomiting, diarrhea, malabsorption
    • Renal: diuretics, diabetes insipidus
    • Skin: sweating, burns
    • Third spacing: ascites, pleural effusion
  • Clinical signs of hyponatremia:
    • Headache
    • Nausea and vomiting
    • Confusion
    • Lethargy
    • Seizures
    • Coma

Potassium Disturbances

  • Changes in potassium are particularly serious because of the clinical signs that can be seen.
  • Serum levels begin to decrease when K+ is driven into the cells.
  • Serum potassium will decrease only after a considerable loss of total body K+ loss, when serum potassium concentration is below 2.5 mEq/L.
  • Clinical signs of hypokalemia:
    • Muscle weakness
    • Fatigue
    • Constipation
    • Arrhythmias
    • Respiratory distress
  • Hypokalemia is the most commonly seen abnormal serum concentration of K+.
  • Common causes of hypokalemia:
    • Diuretics
    • Vomiting
    • Diarrhea
    • Renal insufficiency
  • Hyperkalemia is a less commonly encountered abnormal serum concentration of K+.
  • Causes of hyperkalemia:
    • Renal failure
    • Acidosis
    • Medications
    • Trauma
    • Rhabdomyolysis
  • K+ is normally excreted by the kidneys.
  • Acidosis -> K+ being driven out of the cell which can cause hyperkalemia.

Electrolyte Functions

  • Sodium (Na+) : Primary function is to maintain fluid balance and regulate blood pressure.
  • Potassium (K+) : Primary function is to maintain nerve and muscle function.
  • Calcium (Ca2+) : Primary function is to strengthen bones and teeth and regulate muscle contraction.
  • Magnesium (Mg2+) : Primary function is to support nerve and muscle function and regulate blood sugar.
  • Chloride (Cl-) : Primary function is to maintain fluid balance and acid-base balance.
  • Phosphorous (P) : Primary function is to build strong bones and teeth and produce energy in the body.

Cell Membrane & Action Potentials

  • The cell membrane is a thin, flexible barrier that surrounds all cells and controls what enters and exits the cell.
  • The pumping of Na+ against its concentration gradient is used for transmitting electrical signals within nerve cells.
  • Na+/K+ pump, generate action potentials that are responsible for nerve impulse transmission.

Osmoregulation

  • Osmoreceptors in the hypothalamus detect an increase in plasma concentration which stimulates thirst and the release of antidiuretic hormone (ADH).
  • Antidiuretic hormone (ADH) causes the reabsorption of water in the kidneys.

Renal Hypoperfusion & Fluid Losses

  • Renal hypoperfusion refers to decreased blood flow to the kidneys.
  • Fluid losses can occur through various routes, including:
    • Gi tract: vomiting, diarrhea
    • Skin: sweating, burns
  • Dehydration is a condition in which the body lacks sufficient water.
  • Clinical signs of dehydration:
    • Dry mouth
    • Thirst
    • Decreased urine output
    • Fatigue
    • Dizziness
    • Sunken eyes

Fluid Therapy

  • Indications for use of fluid therapy:
    • Dehydration
    • Volume depletion
    • Electrolyte imbalance
    • Shock
    • Trauma
    • Surgery
  • Assessment of fluid and electrolyte imbalance involves:
    • History and physical examination
    • Laboratory tests
    • Imaging studies

Dehydration Estimates

  • Estimates of dehydration with clinical signs:

    • 1-2% dehydration: Mild thirst
    • 3-5% dehydration: Moderate thirst, sunken eyes
    • 6-8% dehydration: Severe thirst, sunken eyes, lethargy
    • 9-12% dehydration: Critical dehydration, shock
  • A pound is a unit of weight, approximately equal to 0.45 kilograms.

Fluis Therapy Clinical Uses

  • Fluid therapy can play a vital role in the stabilization and recovery of an ill patient.
  • It is used in clinical medicine to:
    • Replace lost fluids and electrolytes
    • Maintain fluid balance
    • Improve blood pressure
    • Support organ function
    • Deliver medications

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