Therapeutics - Fluids 2

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  1. Would you expect Intravascular depletion to occur slowly or quickly?
  2. Why do you need to aggressively and rapidly treat intravascular fluid depletion?
    It occurs rapidly and could result in loss of organ perfusion
  3. Intravascular depletion usually occurs due to loss of fluid, what is the composition of this fluid?
    Isotonic solution of Na and water
  4. Are major disturbances of plasma osmolality common?
  5. What are the major SYMPTOMS of decreased tissue perfusion?
    Dizziness, orthostatic hypotension, racing heart beat
  6. What are the SIGNS of decreased tissue perfusion?
    Tachycardia, decreased urine output and central venous pressure, Increased BUN/SCr hemoglobin, and hematocrit, hypovolemic shock
  7. What BUN/SCr ratio would indicate intravascular depletion?
    > 20:1
  8. What is hemocontrentration?
    Increased hematocrit
  9. What is oliguria?
    Decreased urine output
  10. What does PCWP stand for?
    Decreased central venous pressure
  11. What does CVP mean?
    Refers to the pressure in the right atrium and vena cava and indicates info about the blood volume, heart pump effectiveness and vascular tone
  12. What does a decreased CVP indicate?
    Decreased blood volume, drug induced vasodilation and sepsis induced vasodilation
  13. What does an increased CVP indicate?
    High blood volume, HF, vasoconstriction, mechanical ventilation
  14. How does Pulmonary artery wedge pressure compare in terms of accuracy to CVP?
    More accurate
  15. What is Pulmonary artery wedge pressure most useful for?
    Helpful in assessing fluid status in patients with confusing clinical pictures
  16. What is the main intention with giving fluid in hypovolemic shock?
    To maintain organ perfusion
  17. If you drew a blood sample for a lab on a dehydrated person, what might you expect to see that would indicated that they were dehydrated?
    BUN/SCr is very high, usually >20:1 and hemoglobin and hematocrit are very concentrated
  18. What is the mechanism for internal fluid depletion of intravascular stores?
    Redistribution of ECF from vascular to interstitium, e.g. septic shock, anaphylactic shock and abdominal ascites
  19. How does total body water depletion compare to ECF depletion?
    More gradual and chronic problem
  20. What is TBW depletion?
    Loss of HYPOtonic fluid from all body compartments
  21. Is ECF or TBW depletion primarily a disturbance of osmolality?
  22. Does TBW usually result in clinical signs of intravascular depletion?
  23. A person has symptoms of dehydration that occurred over a short period of time, would you suspect, TBW or ECF depletion?
  24. What are the signs of TBW depletion?
    Change in mental status, excessive thirst, dry mucus membranes, decreased turgor, high serum Na dn plasma osmolality, conc. urine and acute weight loss
  25. What are the common causes of TBW depletion?
    Lack of sufficient intakes, excessive insensible loss (fever, hot out), Diabetes insiidus, kidney issues, excessive osmotic diuresis
  26. What are common reasons that excessive osmotic diuresis occurs?
    Glycosuria, mannitol or high protein diet
  27. What group of patients are commonly admitted to the hospital because of total body water depletion secondary to lack of oral intake or extraordinary insensible losses?
    Long term care/Nursing home patients
  28. If a patient has both TBW and ECF depletion, which you suspect they acquired first?
    TBW 9 which lead to ECF depletion)
  29. If a patient has TBW and ECF depletion at once, what should be your first course of action?
    Maintain tissue perfusion
  30. If a patient has TBW and ECF depletion at once, and you have stabilized tissue perfusion, what would be your secondary goal?
    Replenish the ICF/correct osmolality
  31. How much maintenance/basal fluids does a neonate (1-10 kg) need?
  32. How much maintenance/basal fluids does a neonate (10-20 kg) need?
    1000mL + 50 mL for each kg over 10 kg
  33. How much maintenance/basal fluids does an adult need?
    1500mL + 20mL for each kg over 20 kg
  34. What is a normal hourly fluid rate for most adults?
    75-125mL per hour (~100mL/hr)
  35. How do you calculate TBW deficit?
    0.6 x LBW x [(present Na conc./140mEq/L )-1]
  36. How do you estimate total body water?
    By acute weight change
  37. Why is it important to realize exceptional losses of water from the system?
    To be able to offset them and avoid depletion
  38. When evaluating an exceptional loss of fluids, you need to account for both the amount and the _________ of the loss.
  39. What types of losses were given as examples of exceptional fluid losses in class?
    Fever, upper/lower GI losses, diuretics, renal disorders, third spacing and burns
  40. A patient has a fever, you would expect that they need how much more fluid in a day than a healthy patient?
    1-2 L
  41. What are the three types of therapeutic fluids?
    Crystalloid, Colloidal and Oxygen carry resuscitation solutions
  42. What are Crystalloid fluids?
    Solutions of mineral salts or other water-soluble molecules
  43. What are Colloidal fluids?
    Solutions that contain larger insoluble molecules, such as gelatin
  44. What are Oxygen carry resuscitation solutions?
    Blood products
  45. A fluid that is ~310 mEq/L is classified as having what type of tonicity?
  46. A fluid that is >376 mEq/L is classified as having what type of tonicity?
  47. A fluid that is < 250 mEq/L is classified as having what type of tonicity?
  48. 0.9% NaCl is classified as having what type of tonicity?
Card Set:
Therapeutics - Fluids 2
2014-02-07 17:42:27
Therapeutics Fluids
Therapeutics - Fluids 2
Therapeutics - Fluids 2
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