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Spring 2020 - APA Foundations 1 > Fluid and Body Therapy - Quiz 4 > Flashcards

Fluid and Body Therapy - Quiz 4 Flashcards

1
Q

How much of Total Body Weight is Water?

A

Water is 60% of TBW

40% Intracellular

20% Extracellular

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2
Q

What makes up the Extracellular Compartment?

A

75% Interstitial Volume

25% Plasma

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3
Q

What is the Total Body Water for Man, Woman, Baby?

A

Man: 55%

Woman: 45%

Baby: 80%

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4
Q

What is found in the Intracellular Fluid Compartment?

A

Potassium (K+), Phosphate (PO43-), & Magnesium (Mg)

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5
Q

What elements are found in the Extracellular Fluid Compartment?

A

Sodium (Na+) & Chloride (Cl)

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6
Q

What affects Fluid movement accross Compartments?

A

Membrane & Osmotic Properties

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7
Q

What is the main determinant of Osmotic Pressure?

A

Albumin

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8
Q

What is the difference between Osmolarity and Osmolality?

A

Osmolarity = # of osmoles in a Liter of Solution

Osmolality = # osmoles in a Kg of Solvent

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9
Q

Whats the difference between Hypovolemia and Dehydration?

A

Hypovolemia deals with actual fluid loss.

Dehydration deals with concentration in relation to water

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10
Q

What is Hypervolemia?

A

Excess fluid in an isotonic concentration

EX: CHF, Renal Failure

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11
Q

All gain/loss of sodium is accompanied by the gain/loss of what?

A

Water

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12
Q

What is the amount of Sodium in the ECV vs ICV?

A

Extraceullar: 140 mEq

Intracellular: 25 mEq (NaKATPase)

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13
Q

What are some causes of Hyponatremia?

A

Adrenal Insufficiancy

SIADH

CHF

Liver Failure

Renal Failure

Nephrotic Syndrome

Diuretics

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14
Q

What are some symptoms of Hyponatremia?

A

Neuro problems

Anorexia

N/V

Cramps & Weakness

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15
Q

How do you treat Hyponatremia

A

Restrict Fluids

Give 3% Hypertonic Fluid

Osmotic/Loop Diuretic

Correct Slowly or Brain Explodes (1-2 mEq/L per hour)

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16
Q

What is the most common cause of Hypernatremia?

A

Water Deficiency: Excessive loss or Inadequate Intake

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17
Q

What diseases can cause Hypernatremia?

A

Hyperaldosteronism

Diabetes Insipidus

Renal Dysfunction

Salt Intake

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18
Q

What are some symptoms of Hypernatremia?

A

Neuro Problems

Thirst

Hypervolemia

Polyuria or Oliguria

Renal Insufficiency

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19
Q

How do you treat Hypernatremia?

A

Replace Water Deficit

Correct Slowly (1-2 mEq/hr)

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20
Q

What is largely reponsible for Resting Membrane Potential?

A

Potassium

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21
Q

How is the amount of Potassium balanced by the body?

A

Potassium absorbed through GI and excreted by Kidneys

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22
Q

What are some things that cause Hypokalemia?

A

GI Loss

DKA

Diuretics

Poor Diet

Systemic Alkalosis

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23
Q

What are the CV effects of Hypokalemia?

A

ST Depression & U Wave

Flat T Waves

Ventricular Ectopy

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24
Q

What are the Neuromuscular effects of Hypokalemia?

A

Weakness

Decreased Reflexes

Confusion

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25
Q

How do you treat Hypokalemia in the OR?

A

Slow IV Potassium

Avoid Hyperventilation & Glucose

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26
Q

What are some causes of Hyperkalemia?

A

Renal Failure

Potassium-Sparing Diuretics

Giving Too Much K+ & Salt Substitutes

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27
Q

What are factors that alter Potassium Distribution?

A

Acidosis

Digoxin Toxicity

Insulin Deficiency

Tissue/Muscle Damage

Succinylcholine

Ace Inhbitors, ARBs, B-Blockers

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28
Q

How would Hyperkalemia look on an EKG?

A

Tall, Peaked T-Waves

Wide QRS

Prolonged PR Interval

Flat/Absent P-Wave

ST Depression

Cardiac Arrest

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29
Q

How do you treat Hyperkalemia?

A

Give Insulin + Glucose to shift K+ into cells

IV Calcium

Upper Limit of K+ is 5.5 mEq/L

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30
Q

Where is Magnesium stored in the body?

A

Muscle and Bones: 40-60%

Cells: 30%

Serum: 1%

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31
Q

Which organs regulate Magnesium?

A

Intestines & Kidney

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32
Q

What role does Magnesium play in the body?

A

Enzyme Reactions

Protein Synthesis

Neuromuscles

Na-K-ATPase

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33
Q

What causes Hypomagnesemia?

A

Poor Intake of Mag

TPN w/o Mag

Starvation

GI Losses

Chronic Alcoholism

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34
Q

What would Hypomagnesemia look like on an EKG?

A

Flat T-Waves

U-Waves

Prolonged QT Interval

Wide QRS

Atrial & Ventricular PVCs

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35
Q

How is Hypomagnesemia treated?

A

Give 1-2g Mag over 5 minutes

then

Continuous Infusion 1-2g/hr

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36
Q

What causes Hypermagnesemia?

A

(>2.5 mEq/L)

Giving too much Mag: Preeclampsia, Antacids, Laxatives

Renal Failure

Adrenal Insufficiency

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37
Q

Symptoms for Mag of 3-5 mEq/L

A

Flushing, N/V

38
Q

Symptoms for Mag of 4-7 mEq/L

A

Drowsiness, ↓Deep Tendon Reflex, Weakness

39
Q

Symptoms for Mag of 5-10 mEq/L

A

Hypotension

&

Bradycardia

40
Q

Symptoms for Mag of 7-10 mEq/L

A

Loss of Patellar Reflex

41
Q

Symptoms for Mag of 10 mEq/L

A

Respiratory Depression

42
Q

Symptoms for Mag of 10-15 mEq/L

A

Respiratory Paralysis, Coma

43
Q

A Magnesium level of >15 mEq/L causes what?

A

Cardiac Arrest

44
Q

How is Hypermagnesemia treated?

A

Stop giving Mag

Use Calcium if Bradycardic, Heart Block or Respiratory Depression

45
Q

Where is Calcium found in the body?

A

99% in Bones

46
Q

What are the functions of Calcium?

A

Bone Strength

Second Messenger of Cell Membrane

Muiscle contraction, Cardiac Muscles

47
Q

What causes Hypocalcemia?

A

Hypoparathyroidism

Malignancy

Chronic Renal Insufficiency

48
Q

Symptoms of Hypocalcemia

A

Cramps & Weakness

Chvostek

Trousseau

Seizure

Numbness/Tingling

49
Q

What are the CV effects of Hypocalcemia?

A

Dysrhythmias

Hypotension

Decreased Cardiac Contractility

50
Q

What are the Pulmonary Effects of Hypocalcemia?

A

Laryngospasm

Bronchospasm

Hypoventilation

51
Q

What causes Hypercalcemia?

A

Hyperparathyroidism

Malignancy

Immobility

52
Q

What are the CV effects of Hypercalcemia?

A

HTN

Heart Block

Short QT Interval

Dysrhthmias

53
Q

How is Hypercalcemia treated?

A

Treat underlying cause

Give Fluids

Give Loop Diuretics

54
Q

What kind of Fluid losses would you see Intra-Operatively?

A

Insensible Loss

Third Space Loss

Blood Loss

55
Q

What is Insensible Loss?

A

Water Loss via Urine, Feces, Sweat, & Lungs

Correct w/ 2mL/kg of Crystalloid

56
Q

How much fluid replacement is needed for Third Space loss?

A

Surgery Dependent

Minimal Trauma: 3-4mL/kg

Moderate Trauma: 5-6mL/kg

Severe Trauma: 7-8mL/kg

57
Q

What happens after the 3rd Post-Op day with Third Space Loss?

A

Fluid moves back from space to intravascular

Pts with Heart issues = P. Edema or Hypervolemia

58
Q

What is PeriOperative Goal-Directed Fluid Therapy?

A

Protocols for fluid managememt to minimize O2 demand and optimize Cardiac Output & Perfusion

59
Q

Crystalloids

A

Water + Electrolytes

May Dilute Plasma Proteins

Increases Intravascualr Volume

Risk for P. Edma

Can cause Hemodilution

60
Q

Which fluids do you avoid for Cerebral Risk Patients?

A

LR

61
Q

Which fluids contain calcium and has sodium lactate as a buffering agent?

A

LR

62
Q

Which fluid is Gluconeogenic, can cause alkalosis, and should be avoided along with citrate transfusion products?

A

LR

63
Q

Which fluids are the Most Isotonic balanced Salt Solutions that have no lactate buffers or calcium?

A

Plasmalyte, Normosol, and Isolyte

64
Q

What is the volume of Crystalloid used to replace IntraOperative Blood Loss?

A

3x the EBL

65
Q

When do you use Glucose Containing Solutions Intraoperatively?

A

Rarely - Only to prevent Hypoglycemia

66
Q

What are some Colloids that are used?

A

Albumin

Plasmanate

Hetastarch

Dextran

67
Q

Why are Colloids used?

A

Stays in Intravascular Space

Replaces blood 1:1

68
Q

What is the advantage of Colloids?

A

No Disease RIsk

69
Q

What are the Diasdvantages to Colloid use?

A

No O2 Carrying Capacity

No Coagulation Factors

Expensive

70
Q

Why isn’t Hetastarch used anymore?

A

Coagulapathy & Increased Mortality

71
Q

Why isn’t Dextran used?

A

Coagulopathy

Anaphylaxis

Unable to Crossmatch pt. after given

72
Q

What are some characteristics of Albumin?

A

Carries Proteins - Donnan Effect - Increases Osmolality

Anaphylaxis Risk

Pretreated to Kill Pathogens

73
Q

When do you use 5% Albumin vs 25% Albumin?

A

5% - Rapid Volume Expansion

25% - Hypoalbuminemia

74
Q

What are signs of IntraOp Blood Loss?

A

↑HR

↓BP

↓CVP

↓Mixed Venous O2

↓Urine Output

75
Q

What is the Primary reason for blood tranfusion?

A

Increase Oxygen Carrying Capacity

Give when Hb < 6g/dL

76
Q

When do you give Whole Blood instead of PRBCs?

A

Hemorrhage - Whole blood expands blood volume & red cell volume

77
Q

What Blood type do you give for Emergency Transfusions?

A

O-Negative

then switch to patient’s blood type

78
Q

What Preservatives are added to Donated Blood?

A

Phosphate - Buffer

Dextrose - Energy

Adenine - ATP

Citrate

79
Q

How long can blood be stored?

A

21-35 Days

80
Q

At what temperature is blood stored to prevent glycolysis?

A

1 - 6 C

81
Q

How much Hb is correct by 1 unit of PRBCs?

A

1g/DL per 1 unit of PRBCs

82
Q

Which fluids are avoided when transfusing blood?

A

Hypotonic solutions and fluids containing glucose or calcium

83
Q

When is giving Platelets indicated?

A

Platelet < 50,000

84
Q

How much is the Platelet count corrected per Unit given?

A

5000 - 10,000 per Platelet unit

85
Q

When is FFP indicated?

A

PT/PTT > 1 - 1.5x normal

Reverse Warfarin

Factor Deficiency

86
Q

When is Cryoprecipitate given?

A

Hemophilia A - Factor VIII deficiency

Von Willebrand Factor Deficiency

Fibrinogen Deficiency

87
Q

What is the most common Transfusion Reaction?

A

Febrile Reaction - when antibodies react w/ donor antigens

88
Q

What are some metabolic complications of blood therapy?

A

Hyperkalemia

Hypocalcemia

↓2,3-DPG

Alkalosis

89
Q

What happens to the patient’s pH after a blood transfusion?

A

Increase in pH

90
Q

What is Autologous Blood?

A

Retransfusion of patient’s own blood during significant surgical blood loss

Spring 2020 - APA Foundations 1 (10 decks)

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