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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