Fluid Therapy Flashcards
(132 cards)
1
Q
What are the five routes for fluid therapy administration?
A
Oral, subcutaneous, intravenous, intraperitoneal and intraosseous.
2
Q
What does oral fluid therapy administration mean?
A
Through the mouth.
3
Q
What does subcutaneous fluid therapy administration mean?
A
Under the skin.
4
Q
What does intravenous fluid therapy administration mean?
A
Through the veins.
5
Q
What does intraperitoneal fluid therapy administration mean?
A
Through the abdominal cavity, not into any abdominal organs or vessels.
6
Q
What does intraosseous fluid therapy administration mean?
A
Through the bone.
7
Q
What does dehydration mean?
A
The loss of fluid from all over the body or loss of fluid in all body fluid compartments. True dehydration is only water loss, no electrolytes.
8
Q
What is does intra mean?
A
Inside
9
Q
What is does inter mean?
A
Between
10
Q
What is does extra mean?
A
Outside
11
Q
What is does vas(o) mean?
A
Vessels
12
Q
What is does intravascular mean?
A
Inside the vascular system
13
Q
What is does extravascular mean?
A
Everything outside the vascular system
14
Q
What is does intracellular mean?
A
Fluid inside the cells
15
Q
What is does extracellular mean?
A
Fluid outside cells
16
Q
What is does interstitial mean?
A
Fluid outside cells and outside vessels
17
Q
What is does transcellular mean?
A
Fluid elsewhere (usually lubricant fluid)
18
Q
How much of our body weight is made up of fluid?
A
60%. 66% of that is intracellular fluid and 33% of that fluid is extracellular (25% interstitual, 7% intravascular, <1% transcellular - CSF, joint, serous, eye).
19
Q
What are the three major electrolytes in body fluid?
A
Potassium, sodium and chloride.
20
Q
What fluid is potassium in?
A
It is the main cation in intracellular fluid.
21
Q
What fluid is sodium in?
A
It is the main cation in extracellular fluid.
22
Q
What are the three parts of extracellular fluid?
A
Interstitial, transcellular, intravascular.
23
Q
What is a solute?
A
A substance being disolved (e.g salt)
24
Q
What is a solvent?
A
The substance doing the disolving (e.g water)
25
What is a solution?
Solute + solvent dissolved.
26
What does permeable mean?
It allows things to pass through.
27
What is a semi permeable membrane?
A barrier that allows some things to pass through.
28
What is diffusion?
Spontaneous movement of substances
moving from a solution with high solute
concentration to a solution with low solute
concentration to balance the solutes on each
side. It stops when equilibrium is reached.
29
What is osmosis?
The solvent (water) moves from a solution
with low solute concentration to a solution
with high solute concentration, when
separated by a semi permeable membrane, to
balance concentration of solution.
30
What is important to remember about salt?
Salt sucks!
31
What is osmotic pressure?
It is pressure that stops water from doing osmosis. It stops osmosis from continually happening and it reaching a perfect balance. It can stop natural osmosis, but not artificial osmosis. The pressure needed to stop more water entering a region, osmotic pressure stops our veins leaking into the extracellular region.
32
What is sodium also known as?
Salt.
33
What electrolytes can the body control and not control levels of?
The body can control sodium levels in the body through things like the kidney filtration and absorption. However, the body cannot control its levels of potassium.
34
What does hypo mean?
Low
35
What does hyper mean?
High
36
What does vol mean?
Volume
37
What does haem mean?
Blood
38
What is hypovolaemia?
Low circulating blood volume (e.g shock, blood loss)
39
What is hypervolaemia?
Increased circulating blood volume (e.g overdose of fluid therapy)
40
What is hypotension?
Low blood pressure within the arteries
41
What is hypertension?
High blood pressure within the arteries
42
What is the fluid classification hypotonic made of?
Low sodium concentration. Lower number of particles in a solution compared to another solution , so exerts a lower osmotic pressure than body fluid.
43
What is the fluid classification isotonic made of?
Similar sodium concerntration to body. Same number of particles in both solutions, which means it is an equal osmotic pressure to body fluids. Has 0.9% sodium.
44
What is the fluid classification hypertonic made of?
High sodium concerntration. Higher number of particles in a solution compared to another solution, so exerts a higher osmotic pressure than bodt fluid. Has 7.2% sodium.
45
What is odema?
Tissue swelling
46
What causes hypervolaemia?
Giving too much fluid artificially.
47
What causes hypovolaemia?
Not having enough fluid. Can be from haemorrhage, severe dehydration, third space fluid loss (medial condition causing fluid leaks), burns, vomiting and diarrhoea.
48
What causes dehydration?
Not enough fluid in all fluid compartments.
49
What is an isotonic solution used for?
To replenish cells and tissues, hydrating the patient at a slow rate.
50
What is an hypertonic solution used for?
To rapidly expand the circulating blood volume by forcing fluids from the body into the intravascular system (from high salt concentration). It draws fluid from cells into interstitial space and then
some into intravascular space, can be used for reducing intracranial pressures, increasing circulation volume rapidly (must follow up with replacement crystalloid fluid to replace fluid in cells).
51
What is an hypotonic solution used for?
For true dehydration to replenish water, but cannot be given in large volumes. It's used for high sodium levels in the body. Using it is very rare.
52
What happens to red blood cells in a hypertonic solution?
Due to excess salt, the fluids get sucked out of the red blood cells and caused them to become dehydrated.
53
What happens to red blood cells in a hypotonic solution?
Due to excess fluids, it enters the red blood cell and fills it, once filled enough the red blood cell can burst.
54
What happens to red blood cells in a isotonic solution?
Blood cell sits in soloution without any damage as a isotonic solution matches the normal blood levels.
55
What are the two main indicators for fluid therapy?
Dehydration and hypovolaemia.
56
How is salt useful in fluid therapy?
Salt sucks in fluids. When salt is in the intravascular system; it can suck fluids from other fluid compartments into the blood. This is done as blood volume is prioritised when body fluids are low.
57
Why is blood important?
Blood is needed to carry oxygen around the body via the red blood cells. Without oxygen, an animal will quickly die.
58
What happens when fluid intake is high?
Kidneys produce more urine which creates more dilute urine.
59
What happens when fluid intake is low?
Kidneys will conserve water which creates mroe concentrated urine.
60
What is the balance of the body fluids?
What comes in, must come out so it's balanced.
61
What are three processes of the kidneys in urine production?
Filtration (small substances like plasma are
separated from large substances
like platelets, Red blood cells – and
returned to blood stream), reabsorption (reabsorption of ions, water and nutrients) and secretion seelectively secretes ions to maintain blood PH and
electrolytes).
62
How would we assess the need for fluid therapy in a patient?
History: food/water consumption, gastro loss, urination losses, general inability to drink (injury), illness, unavailability.
Physical exam: mucous membranes (moist or tacky) skin turgor, sunken eyes
Bodyweight changes - short term change
Packed cell volumes/total solids
Blood results of urea and creatinine
Specific gravity on urine
Heart rate/pulse quality
Lactate/lactic acid measurement
63
What are crystalliod fluids?
It passes freely out of the bloodstream, stays 30-40 minutes in the bloodstream. Some crystalloid fluids are isotonic, hypertonic and hypotonic solutions.
64
What are collid fluids?
It does not easily leave the bloodstream, they have a large molecular weight/size. They stay in the bloodstream for 2 hours. Some collid fluids are blood, plasma, and synthetic collids (Dextrons).
65
What is the process of hypovolaemic shock?
Hypotension, tachycardia, hypoperfusion
v
Compensatory response (vasoconstriction) HR ^ BP ^
Due to constriction there is more pressure and congestion. But due to constriction and less space, flow is better, but small vessels like fingers and toes are sacrificed for blood flow to organs. Improves pressure and heart rate.
v
Decompensatory response HR v BP v
Heart rate and blood pressure drops as heart fatigues and can't keep up with the compensatory response.
v
Hypovolaemic shock
v
Death
66
What is tachycardia?
Rapid heart rate
67
What is tachypnoea?
Rapid breathing
68
What is hypoperfusion?
Low flow of oxygen into the blood, low blood flow.
69
How should dehydration be treated?
Slow fluid administration, correct fluid deficit over 48 hours, monitor ongoing losses. monitor weight, PCV/TS
70
How should hypovolaemia be treated?
Rapid fluid administration, over 10-30 minutes, reassess constantly, decide if further fluid is required.
71
What is PVC?
Packed cell volume.
72
What is TS?
Total solids or proteins.
73
What are the oral fluid route advantages, disadvantages and complications?
Advantages:
Non-invasive, most natural, no special equipment required, no risk of infection, cheap
Disadvantages:
Not the most rapid administration, patient may not be able to drink required volume, patient may vomit, volume of fluid given isn't controlled
Complications:
Vomiting, not willing or able
74
What are the subcutaneous fluid route advantages, disadvantages and complications?
Advantages:
Minimal restraint, easy, quick administration, quite cheap, clien can be taught how
Disadvantages:
Slow absorption, can be uncomfortable
Complications:
Can slough skin, needs warm fluids for absorption
75
What are the intraperitoneal fluid route advantages, disadvantages and complications?
Advantages:
Quickly absorbed, easy on small patients, more utilized on small patients
Disadvantages:
Care of organs, slower absorption than IV
Complications:
Respiratory issues from pressure on diaphragm, organ damage
76
What are the intraosseous fluid route advantages, disadvantages and complications?
Advantages:
Quickly absorped, good option for small patients
Disadvantages:
Takes skill and knowledge, generally requires special equipment, painful to patient
Complications:
Infection, bone fracture, blocked needle
77
What are the intravenous fluid route advantages, disadvantages and complications?
Advantages:
Rapid administration, volume accurately measured, all types of fluids/meds can be used, large volumes rapidly absorbed, supports blood pressure directly
Disadvantages:
Requires equipment and skill, invasive to patient, risk of infection
Complications:
Infection, fluid overload
78
What are the clinical signs of fluid deficit?
Skin tugor is mildly poor, dry mucous membranes,
= mild dehydration= 5% less than it should be/depleated.
Tachycardia, weak pulses, no urine, cold extremities, slow CRT, tachy and pale muscous membranes.
= deficit = 10-15% less than it should be is dangerous.
Hypovolaemic shock can occur.
79
What is CRT?
Capillary refil time.
80
What are the surgical fluid rates for IV (isotonic crystalliod fluid)?
3ML/KG/HR
5ML/KG/HR
10ML/KG/HR
81
What is the maintence fluid rate for IV (isotonic crystalliod fluid)?
2ML/KG/HR
82
What are the shock fluid rates for IV (isotonic crystalliod fluid)?
90ML/KG BOLUS (dogs)
| 50-60ML/KG BOLUS (cats)
83
What is bolus?
Quickly pumping a large amount of fluid into a patient, doing a check and then adding more or stopping. It's like adding a bucket of water to a bathtub, checking if it's enough, if not adding more and so on. Maintainence IV would be like turning on a dripping tap into the bath tub.
84
What is important to keep checking when doing bolus on an animal?
Blood pressure, heart rate and pulse. Make sure they are going back to normal, if nor continue with bolus.
85
What does HR mean?
Heart rate
86
What does BP mean?
Blood pressure
87
What does BPM mean?
Beats per minute or breaths per minute
88
What is important to remember when putting a number into a pump machine?
The machine doesn't use decimal numbers, so rounding up or down to make whole numbers is important.
89
How often is bolus done each time and how much fluid is the maximum amount given?
Usually every 10-30 minutes, with a check of patient before adding another dose of bolus. 90ml for dogs, 50-60ml/kg for cats.
90
How can the amount of bolus given each time for an animal's weight?
To work it out you times the weight (ideal weight) by 10ml. So for a 5kg dog it would look like this:
5kg x 10ml = 50ml.
91
How can fluids be lost?
Sweat, panting/breathing, urination, diarrhoea, vomiting and bleeding
92
How can fluids be taken in vs how can they be administered?
They can be taken by drinking or absorption of it from food. They can be administered orally, subcutaneously, intravenously, intraperitoneally and inreosseously.
93
What electrolytes does intracellular fluid contain?
Potassium (K+) is the main cation and a little bit of Phosphate which is an anion
94
What electrolytes does intracellular fluid contain?
Sodium (Na+) is the main cation, chloride (Cl¯) is major anion
95
What role does sodium play in fluid balance?
It's very important for maintaining fluid balance in compartments, it is mostly in the extracellular space, kidneys can conserve or excrete soidum for the body when needed (also can be lost through sweat and faeces).
96
What role does potassium play in fluid balance?
Ir enters the cell easier than sodium and starts the sodium-potassium pump for cell exchange of these electrolytes, there's no way to conserve potassium (kidneys excrete it freely), itis needed for the normal function of cells.
97
What is the symbol for potassium?
K+
98
What is the symbol for chloride?
Cl¯
99
What is the symbol for sodium?
Na+
100
What does the body do when it's dehydrated?
Body will try to correct / compensate water balance (TISSUES – INTRAVASCULAR – THIRST – ORGAN DAMAGE). Water will be drawn into the intravascular compartment (maintaining circulation volume is priority), a hormone is released by kidney to stimulate thirst and reabsorb water (ADH). It does this to maintain blood volume for good blood pressure.
101
What does the body do when it's over hydrated?
The kidneys get backed up – unable to compensate for the excessive fluid, a hormone is released by kidneys to trigger reabsorption of sodium, the body moves fluid to other areas, dumping it into any spaces it can like the lungs which is dangerous, sodium is reabsorbed and kidneys keep secreting excess fluid until the fluid levels are normal again.
102
What are crystalloid fluids used for?
In high rates to treat hypovolaemia – sometimes with a colloid, in low rates to replace for dehydration (but short term - it doesn't stay long in the intravascular space).
103
What are colloid fluids used for?
Its large molecules that mostly stay in the intravascular space, to replace intravascular volume quickly (but must use caution, too much volume can cause volume overload).
104
How is maintence fluid per hour calculated?
What you need to know:
Animal's ideal weight.
Times the drip size by the weight by the hour. So for a 5kg dog that has a 2ml drip size, it would look like this:
5kg dog = 2ml/kg/hr = 2ml x 5kg x 1hr = 10ml/hr
105
How is maintence fluid per day calculated?
What you need to know:
Animal's ideal weight, and how many hours in a day (24). So for a 5kg dog, it would look like this:
50ml x 5kg = 250ml x 1 day
To work out per hour:
250ml ÷ 24hrs = 10.4ml/hr (10ml/hr)
106
What is a drop vs a ml?
```
Drop = a portion of liquid
ml = a set measure of volume
```
107
How is drop rate calculated?
What you need to know:
Animal's ideal weight, how many drops per ml the drip set has. So for a 12kg dog, it would look like this:
Get the ml to calculate with.
2ml/kg/hr x 12kg = 24ml/hr
20 drops make up 1 ml, how many drops in 24ml?
20 drops/ml x 24ml/hr = 480 drops/hr (same rate as 24ml/hr)
How many minutes in an hour? 60 minutes per hour.
480 drops/60min (same as 480 drops/hr)
So how many drops in a minute?
480 drops ÷ 60min = 8 drops per minute
How many seconds per minute? 60 seconds per minute (8 drops/60 sec)
8 drops ÷ 60 sec = 0.133 drops per sec.
Now it needs to be taken up ao it can be rounded up or down to a whole number that can be counted. Times the number by different values.
0. 133 drops x 7 sec = 0.931 drop/7 sec
0. 133 drops x 8 sec = 1.064 drop/8 sec
Now round it to get the final answer.
= 1 drop/7 sec
= 1 drop/8 sec
108
How is drop rate calculated in your head?
1 drop in a smaller amount of time is more accurate than one drop in a larger amount of time.
1. Convert ml to drops
2. Break hour into min
3. Break min into sec
4. How many seconds for a whole drop?
109
What is important to remember about animal size when choosing to use a drip or fluid pump?
Smaller animals need more accuracy, prefreably from a fluid pump. Smaller animals need more accuracy as there is much less room for error than with a bigger animal. If they need to be put on a drip, smaller animals need more accurate drip set, so something like a 60 drop per ml set that'll give them 1 drop every 9 seconds is best. Lower drop sets like 20 drop per ml ones that have 1 drop every 26 seconds aren't as accurate as counting the drops takes longer and has a higher chance of losing count.
110
What are the differences between enteral and parenteral fluid therapy routes?
Enteral: Oral-gastrointestinal
Parenteral: All other routes other than through the gastrointestinal system
111
What are the benefits of parenteral fluid therapy?
Good for animals who can't eat or drink
When replacing deficits, large volumes that an animal may not drink themselves can be given
It gives extra electrolytes and additives (IV), an animal wouldn't want to drink these themselves due to taste
It offers anesthesia fluid therapy support
112
What are problems that pumps, giving sets or catheters can have that need troubleshooting?
Drip chamber is full
Air bubbles in the line
Kink in the tubing
Backflow of blood into the line
113
What is a healthy PCV% for a dog and cat?
Dog: 35-55% (Greyhounds can be higher with 60-65%)
Cat: 30-45%
Anything below is worth investigating.
114
Why is sterility important on an IV needle site?
The skin is being punctured and this gives opportunity for bacteria to be dragged right into the
115
What is blood a great environment for?
Bacterial growth causing infections.
116
What should be put on record when placing an IV catheter on a patient?
Size of IV catheter
When it was placed (date)
Which vessel was used
Name of fluid
What fluid rate was started with
What time the fluid therapy was started at
117
What is important to never do when there are dried blood clots in an IV line?
Never push the clot back into the patient. It could go anywhere like the brain and be deadly.
118
Why is record keeping important?
It keeps records of the treatment but also serves as a way to communicate with other staff members so they know what is happening with the patient.
119
Why should an IV catheter be bandaged?
Protects the catheter from the environment and helps protect it from the patient. It doesn't help hold the catheter, the tape does that.
120
What are some commonly used IV catheter bandage materials?
Soffban, cohesive wrap and non-elastic tape.
121
What are some important considerations when putting a bandage onto an IV catheter?
No tension on the dressings (should be loose)
Soffban under all lines and plastic wrap to pad limb
Wrapping so the toes are out is the best choice so swelling can be seen
122
How often does IV bandages need to be re-wrapped?
Once daily.
123
Why should really sticky tape be used on an IV catheter and what should be used to take if off to avoid hurting the patient?
Extra stickiness helps hold it in place better and using alcohol to remove takes away the stickiness.
124
What should be inspected when re-wrapping an IV catheter?
Patency:
Flush catheter with hep/saline solution (conc. 1ml/1 litre) or just sterile saline
Check for no resistance and do not push
Can you feel the flush proximally?
Is the patient reacting to the flush? Pain? Irratation?
Is the fluid going subcutaneously?
Is the patient chewing it because of pain or discomfort?
• SWELLING– PROXIMAL AND DISTAL TO THE CATHETER
➢ PROXIMAL SWELLING = ‘BLOWN’ VESSEL – PATENCY?
➢ DISTAL SWELLING = TAPE/DRESSING TOO TIGHT
» RE WRAP/CUT TAPE
Swelling:
proximal and distal to the catheter
Proximal swelling = blown vessel, patency?
Distal swelling = tape or dressing too tight? Cut tape, rewrap dressing.
Check for redness, heat, irritation and discharge. These can be signs of infection.
If there are signs of infection, irritation or contamination of the catheter site, then the IV catheter may need to be removed.
125
How should IV tape that is too tight be cut?
Use blunt scissors that won't stab the patient. At the back of the limb push the scissors inbetween the tape and the skin, when the scissors are pulled out it creates a small gap. Cut where this gap is so the tape and not the skin is being cut. Once cut, the tape will open up a bit as the limb is able to get blood supply to the distal areas. Once cut, put a piece of tape on top of the cut area and re-wrap the bandage.
126
How long can a peripheral IV catheter in?
72 hours, but can be left longer if site looks okay.
| No longer than 5 days.
127
How do you troubleshoot a beeping fluid pump?
Always go from least to most invasive techniques when troubleshooting. Find the occlusion.
Giving set clamps closed?
IV catheter blocked?
Limb/vessel flow blocked?
128
What are some common additives in IV fluid bags?
Glucose and potassium chloride.
129
How should IV bags with additives be labelled?
Name of the additive
Quantity of the additive
Time and date added
Who added it
Should be a bright label stuck onto the fluid bag.
130
What is important to mointor during fluid therapy?
Make sure there is no fluid overload
Check for urine output and other losses
Check weight
Check IV site daily
Check lung sounds and respiration rates
131
What are some special considerations with fluid therapy?
Paediatric patients:
Renal function is different in puppies than adult dogs, they have less ability to concentrate urine. This causes a greater excretion of glucose, protein and less excretion of sodium. This causes a greater risk of fluid overload in puppies than adult dogs.
Renal insufficiency patients:
If they have reduced urine output, you need to watch out for fluid retention.
If they have excess urine output, then you need to watch out for them losing excess electrolytes and becoming dehydrated.
Cardiac conditions:
Fluids increase circulating volume, so heart may not be able to cope. There is a greater risk of fluid overload and heart fatigue or back up in the heart.
Anaemia:
Fluids will dilute PCV, but the same number of red blood cells are still there. Fluids can actually help if the anaemic patient if also dehydrated. More fluids gives more volume to the blood to it is able to get to tougher areas like toes much easier.
132
What are the signs of fluid overload?
wip
