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Questions and Answers

What happens to the mechanism of compensation in metabolic problems compared to respiratory problems?

  • The metabolic system can compensate for respiratory problems, but not the other way around.
  • The respiratory system compensates effectively for metabolic issues, but not vice versa. (correct)
  • Both systems can effectively compensate for both types of problems.
  • Neither system can compensate effectively for any problem.
  • What is the expected effect of deep anesthesia on carbon dioxide levels in the body?

  • It leads to immediate hyperventilation.
  • It increases the sensitivity of the hypothalamus to CO2.
  • Higher CO2 levels are required for the hypothalamus to register changes. (correct)
  • It has no effect on CO2 levels.
  • In the absence of reflex vasoconstriction under anesthesia, what condition is likely to occur in ventilation-perfusion (V-Q) matching?

  • High ventilation and low perfusion are common.
  • Normal ventilation and normal perfusion occur.
  • High perfusion and low ventilation are predominant. (correct)
  • Low ventilation and low perfusion predominates.
  • What indicates a compromised diffusion of oxygen in the body?

    <p>Normal CO2 levels with low oxygen levels.</p> Signup and view all the answers

    Which ion acts as a strong acid in the context of acid-base balance?

    <p>Cl-</p> Signup and view all the answers

    What is the normal range for sodium ion (Na+) concentration in the blood?

    <p>140-150 mmol/L</p> Signup and view all the answers

    What effect does fluid therapy have on blood pH levels?

    <p>It alters pH through changes to chloride levels.</p> Signup and view all the answers

    What complication can arise from dilution caused by fluid administration in hepatic-compromised patients?

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

    Which of the following is a characteristic of hypertonic saline?

    <p>Anti-inflammatory properties</p> Signup and view all the answers

    Which of the following conditions is NOT a contraindication for the use of hypertonic saline?

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

    What could be a reason for not using a specific type of fluid commonly in patients with hepatic dysfunction?

    <p>Only indicated for hepatic dysfunction</p> Signup and view all the answers

    What happens when you inject pure water into the bloodstream?

    <p>Causes RBC lysis</p> Signup and view all the answers

    What is the relationship between HCO3 and CO2 as it pertains to metabolic imbalance?

    <p>HCO3 directly increases with increasing CO2 levels.</p> Signup and view all the answers

    What immediate effect does administering hypotonic fluids have on the intracellular fluid (ICF) volume?

    <p>Increases ICF volume by allowing water to leave the extracellular fluid.</p> Signup and view all the answers

    In the context of fluid therapy, what is the primary purpose of administering isotonic solutions?

    <p>To raise blood pressure during hemorrhage without causing fluid shifts.</p> Signup and view all the answers

    What physiological change occurs due to dilated cardiomyopathy?

    <p>Compensatory tachycardia to maintain cardiac output.</p> Signup and view all the answers

    What is the primary action of hypoventilation in patients with hyperthyroidism during surgery?

    <p>Decreases oxygen delivery to tissues due to low ventilation.</p> Signup and view all the answers

    Which statement correctly describes the effect of ACE inhibitors in patients with cardiac disease?

    <p>They are contraindicated as they can exacerbate hypotension.</p> Signup and view all the answers

    What condition is indicated by an increase in HCO3 beyond 24 mmol/L?

    <p>Metabolic alkalosis, as indicated by the bicarbonate excess.</p> Signup and view all the answers

    Which intervention is recommended for patients with suspected cardiac disease before surgery?

    <p>Ensure hydration status, discontinue ACE-inhibitors, and assess vital signs.</p> Signup and view all the answers

    What is the primary concern following significant blood loss and subsequent administration of crystalloids?

    <p>They will only increase interstitial fluid volume without affecting the intravascular space.</p> Signup and view all the answers

    What effect does administering acepromazine have on blood pressure?

    <p>It decreases afterload, potentially lowering blood pressure.</p> Signup and view all the answers

    What are the potential complications associated with administering fluids to hepatic-compromised patients?

    <p>Complications include dilution leading to anemia, hypoproteinemia, coagulopathy, and edema.</p> Signup and view all the answers

    Why is hypertonic saline preferred in certain situations despite its short duration of action?

    <p>Hypertonic saline is favored because it causes no cellular edema and produces immediate increases in stroke volume, cardiac output, and blood pressure.</p> Signup and view all the answers

    Outline the contraindications for the use of hypertonic saline in patient management.

    <p>Contraindications include hypernatremia, cardiac dysfunction, dehydration, uncontrolled hemorrhage, coagulopathies, and pre-existing fluid deficit.</p> Signup and view all the answers

    What physiological response indicates a patient is a non-responder during peri-anesthetic fluid administration?

    <p>A non-responder indicates sufficient preload when a small amount of fluid causes no response in blood pressure or other hemodynamic parameters.</p> Signup and view all the answers

    What happens at the cellular level when pure water is injected into the bloodstream?

    <p>Injecting pure water causes osmosis, leading to the entry of water into erythrocytes, which results in RBC lysis.</p> Signup and view all the answers

    How does hypoventilation under anesthesia affect carbon dioxide levels in the body?

    <p>Hypoventilation causes an increase in carbon dioxide levels, as less CO2 is expelled from the body.</p> Signup and view all the answers

    What is the primary consequence of absent reflex vasoconstriction in the respiratory zones under anesthesia?

    <p>The absence of reflex vasoconstriction leads to low ventilation and high perfusion in the lungs.</p> Signup and view all the answers

    What role does bicarbonate (HCO3-) play in blood pH regulation?

    <p>Bicarbonate acts as a buffer to help maintain blood pH within a tightly controlled range.</p> Signup and view all the answers

    In the context of acid-base balance, how does chlorine (Cl-) function?

    <p>Chlorine acts as an acid in the acid-base balance, essential for maintaining proper physiological pH.</p> Signup and view all the answers

    Why is carbon dioxide considered more diffusible than oxygen in pulmonary conditions?

    <p>Carbon dioxide diffuses more easily due to its smaller molecular size and higher solubility in water.</p> Signup and view all the answers

    How does the normal range of potassium (K+) and calcium (Ca++) concentration influence cardiac function?

    <p>Potassium is tightly controlled to regulate heart rhythm, while calcium is crucial for cardiac contraction strength.</p> Signup and view all the answers

    Explain the relationship between sodium (Na+) concentration and blood pH.

    <p>Sodium primarily acts as a base, and its normal range contributes to maintaining a slightly alkaline blood pH.</p> Signup and view all the answers

    What is the relationship between metabolic acidosis and the increase in HCO3 in acute respiratory disorders?

    <p>An increase in HCO3 results in alkalosis, whereby a ΔCO2 of 10 corresponds to a ΔHCO3- of 1, indicating compensation in response to respiratory disorders.</p> Signup and view all the answers

    How does the administration of hypotonic fluids affect ICF volume?

    <p>Hypotonic fluids increase ICF volume by promoting water movement into cells due to osmotic gradients.</p> Signup and view all the answers

    What is the significance of understanding the osmolarity of intravenous fluids when treating dehydration?

    <p>The osmolarity of IV fluids must be similar to the body's fluids to prevent shifts of water that can lead to imbalances and complications.</p> Signup and view all the answers

    Explain the role of CaO2 in determining oxygen delivery to tissues.

    <p>CaO2, calculated as [Hg] x SaO2, directly influences oxygen delivery (DO2) as it dictates the amount of oxygen carried by the blood to tissues.</p> Signup and view all the answers

    What physiological changes occur in the heart due to dilated cardiomyopathy?

    <p>In dilated cardiomyopathy, ventricular dilation leads to decreased contractility, resulting in lowered stroke volume although cardiac output may be maintained by increased heart rate.</p> Signup and view all the answers

    How do fluid shifts affect osmolarity in patients receiving isotonic solutions?

    <p>Isotonic solutions do not change osmolarity because they match the body's fluid osmolarity, primarily increasing extracellular fluid volume without inducing shifts.</p> Signup and view all the answers

    What adverse effects can arise from the administration of acepromazine in patients with cardiac conditions?

    <p>Acepromazine can cause hypotension by reducing afterload, which can be detrimental in patients who require stable hemodynamics.</p> Signup and view all the answers

    What do changes in preload and afterload signify in managing mitral regurgitation?

    <p>In mitral regurgitation, management aims to reduce afterload and enhance contractility during systole to support effective heart function.</p> Signup and view all the answers

    What happens to blood gas parameters in diabetic ketoacidosis, and why is this significant?

    <p>In diabetic ketoacidosis, severe electrolyte imbalances and elevated ketones can alter blood gas parameters, emphasizing the need for rapid assessment and intervention.</p> Signup and view all the answers

    In the context of cardiac surgery, why is it important to manage patients with hyperthyroidism preoperatively?

    <p>Preoperative management of hyperthyroidism is crucial to limit stress, prevent hemodynamic instability, and mitigate risks of hypoventilation and hypotension during surgery.</p> Signup and view all the answers

    Study Notes

    Metabolic and Respiratory Concepts

    • Fixed acids removal via kidneys can lead to metabolic acidosis.
    • Respiratory system can compensate for metabolic issues, but metabolic system struggles with respiratory problems.
    • Anesthesia suppresses normal respiratory function, causing hypoventilation, with CO2 detection thresholds rising.
    • If O2 issues arise, it indicates compromised diffusion, as CO2 diffuses more easily than O2.
    • Hypoventilation is indicated by a PaCO2 > 40 mmHg.

    Ventilation-Perfusion (V-Q) Relationships

    • In-line with the heart: V = Q; below the heart: V < Q.
    • Local hypoxia triggers vasoconstriction; zones 3 disappear, with zone 2 predominating.
    • Under anesthesia, lack of reflex leads to low V-Q (low ventilation + high perfusion) and high V-Q (high ventilation + low perfusion).

    Acid-Base Balance

    • Key electrolytes in blood and their normal ranges (mmol/L):
      • Na+: 140-150 (acts as a base)
      • K+: 4-8 (tightly controlled)
      • Ca++: 1.8 (tightly controlled)
      • Cl-: 105-125 (acts as an acid)
      • HCO3-: 24
    • Blood pH slightly alkaline due to higher HCO3- levels compared to Cl-.
    • Carbonic acid (H2CO3) plays a limited role in pH control as levels remain tightly regulated.

    Bicarbonate and Metabolic Disorders

    • HCO3- serves as an indicator of metabolic imbalance but is interconnected with CO2 levels.
    • A ΔCO2 of 10 corresponds with a ΔHCO3- of 1, suggesting alkalosis when >24 mmol/L.
    • Conditions like diabetic ketoacidosis lead to electrolyte imbalances; insulin can cause osmotic diuresis, leading to hypovolemia.

    Cardiovascular Dynamics

    • DO2 (Oxygen delivery) calculation: DO2 = CO + CaO2; where CO = HR x SV and CaO2 = [Hg] x SaO2.
    • Mitral regurgitation treatment focuses on reducing afterload and increasing contractility.
    • Dilated cardiomyopathy is characterized by decreased contractility and preserved CO via increased heart rate; avoid bradycardia.
    • Hypertrophic cardiomyopathy leads to decreased CO and left atrial enlargement; tachycardia should be avoided.

    Anesthetic Management in Cardiac Disease

    • Acepromazine can decrease afterload; however, α-2 agonists lead to vasoconstriction.
    • Dobutamine can improve contractility in hypotensive patients.
    • Monitor hydration levels and blood pressure pre-anesthesia; avoid NSAIDs to reduce complications.
    • Surgical anesthetics typically cause hypotension, though hyperthyroid patients may experience related complications.

    Fluid Therapy Principles

    • Capillary endothelium allows small proteins and electrolytes to pass, while cellular membranes restrict free ion movement.
    • Osmolarity affects fluid distribution; isotonic solutions do not change osmolarity.
    • Hypotonic fluids increase intracellular fluid volume (ICF), while hypertonic fluids pull water from cells, potentially leading to dehydration.
    • Isotonic crystalloid fluids distribute evenly between the intravascular fluid (IVF) and interstitial fluid (ISF).

    Crystalloid Solutions

    • Crystalloids consist of small molecules and are available in various formulations (e.g., LRS, Normal Saline) for specific indications.
    • 5% Dextrose metabolizes rapidly, leading to water retention in IVF.
    • Lactate solutions can provide an alkaline effect, metabolizing H+ without inducing acidosis when oxygen is present.
    • Precautions during fluid therapy include avoiding edema, dilutional anemia, and managing electrolyte imbalances.

    Hypertonic Solutions

    • Hypertonic saline can increase stroke volume, cardiac output, and blood pressure short-term.
    • Contraindications include hypernatremia, dehydration, and coagulopathy.
    • Patient monitoring and fluid administration pacing are essential in anesthetic management.

    Metabolic and Respiratory Concepts

    • Fixed acids removal via kidneys can lead to metabolic acidosis.
    • Respiratory system can compensate for metabolic issues, but metabolic system struggles with respiratory problems.
    • Anesthesia suppresses normal respiratory function, causing hypoventilation, with CO2 detection thresholds rising.
    • If O2 issues arise, it indicates compromised diffusion, as CO2 diffuses more easily than O2.
    • Hypoventilation is indicated by a PaCO2 > 40 mmHg.

    Ventilation-Perfusion (V-Q) Relationships

    • In-line with the heart: V = Q; below the heart: V < Q.
    • Local hypoxia triggers vasoconstriction; zones 3 disappear, with zone 2 predominating.
    • Under anesthesia, lack of reflex leads to low V-Q (low ventilation + high perfusion) and high V-Q (high ventilation + low perfusion).

    Acid-Base Balance

    • Key electrolytes in blood and their normal ranges (mmol/L):
      • Na+: 140-150 (acts as a base)
      • K+: 4-8 (tightly controlled)
      • Ca++: 1.8 (tightly controlled)
      • Cl-: 105-125 (acts as an acid)
      • HCO3-: 24
    • Blood pH slightly alkaline due to higher HCO3- levels compared to Cl-.
    • Carbonic acid (H2CO3) plays a limited role in pH control as levels remain tightly regulated.

    Bicarbonate and Metabolic Disorders

    • HCO3- serves as an indicator of metabolic imbalance but is interconnected with CO2 levels.
    • A ΔCO2 of 10 corresponds with a ΔHCO3- of 1, suggesting alkalosis when >24 mmol/L.
    • Conditions like diabetic ketoacidosis lead to electrolyte imbalances; insulin can cause osmotic diuresis, leading to hypovolemia.

    Cardiovascular Dynamics

    • DO2 (Oxygen delivery) calculation: DO2 = CO + CaO2; where CO = HR x SV and CaO2 = [Hg] x SaO2.
    • Mitral regurgitation treatment focuses on reducing afterload and increasing contractility.
    • Dilated cardiomyopathy is characterized by decreased contractility and preserved CO via increased heart rate; avoid bradycardia.
    • Hypertrophic cardiomyopathy leads to decreased CO and left atrial enlargement; tachycardia should be avoided.

    Anesthetic Management in Cardiac Disease

    • Acepromazine can decrease afterload; however, α-2 agonists lead to vasoconstriction.
    • Dobutamine can improve contractility in hypotensive patients.
    • Monitor hydration levels and blood pressure pre-anesthesia; avoid NSAIDs to reduce complications.
    • Surgical anesthetics typically cause hypotension, though hyperthyroid patients may experience related complications.

    Fluid Therapy Principles

    • Capillary endothelium allows small proteins and electrolytes to pass, while cellular membranes restrict free ion movement.
    • Osmolarity affects fluid distribution; isotonic solutions do not change osmolarity.
    • Hypotonic fluids increase intracellular fluid volume (ICF), while hypertonic fluids pull water from cells, potentially leading to dehydration.
    • Isotonic crystalloid fluids distribute evenly between the intravascular fluid (IVF) and interstitial fluid (ISF).

    Crystalloid Solutions

    • Crystalloids consist of small molecules and are available in various formulations (e.g., LRS, Normal Saline) for specific indications.
    • 5% Dextrose metabolizes rapidly, leading to water retention in IVF.
    • Lactate solutions can provide an alkaline effect, metabolizing H+ without inducing acidosis when oxygen is present.
    • Precautions during fluid therapy include avoiding edema, dilutional anemia, and managing electrolyte imbalances.

    Hypertonic Solutions

    • Hypertonic saline can increase stroke volume, cardiac output, and blood pressure short-term.
    • Contraindications include hypernatremia, dehydration, and coagulopathy.
    • Patient monitoring and fluid administration pacing are essential in anesthetic management.

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    Description

    Test your understanding of metabolic and respiratory concepts related to acid-base balance, V-Q relationships, and renal function. This quiz covers critical principles like the impact of anesthesia on respiratory function and the dynamics of gas exchange. Enhance your knowledge on how these systems interrelate in health and disease.

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