fluids

Question 1

pathophys of thirst

Answer 1

hypothalamus responds to osmoreceptors that trigger thirst in response to hypertonic solution

Question 2

fluid overload is commonly the result of these dz processes

Answer 2

heart failure
liver failure
renal failure
iatrogenic

Question 3

fluid resuscitation vs maintenance

Answer 3

someone who is dry coming out of the OR
giving a bolus is resuscitation

maintenance is for NPO

Question 4

how is lactate solution better from resuscitation

Answer 4

acidosis occurs form fluid loss and the lactate solution and lactate meatbolism counters this

Question 5

normal fluid requirements-faily adult

Answer 5

2-3 l A DAY

Question 6

Humans require how many ml of water for every square meter of surface area

how do you calculate body surface area

Answer 6

1500

height in cm x weight in kilos/3500

Question 7

how many ml/hr of IV fluid does the average adult need

Answer 7

100-125 ml/hr to meet daily fluid requirements

Question 8

daily fluid requirement equation for average adult

Answer 8

based on weight

1500ml of water for every square meter of surface area.

An average adult has a surface area of about 1.7 square meters. 1.7 x 1500 = 2.55 liters a day.

Question 9

daily electrolyte requirements

Na
K
Glucose

Answer 9

Na: 1-2 mEq/kg (140)

K: .5-1 MeQ/KH( 70 MeQ)

Glucose: 500 kcal

Question 10

28 yo male NPO for maintenance order

Answer 10

D5NS w/ 20 mEk KCL at 125 ml/hr

Question 11

D5W

Answer 11

5% Dextrose (calories) in water

Question 12

1/2 NS

Answer 12

.45% of Na in 1L

Question 13

NS

Answer 13

NaCL

0.9grams of NaCl in 1 L

Question 14

lactated ringer

Answer 14

electrolytes no calories

• Used for fluid resuscitation after blood loss d/t trauma, surgery or burns
• Used very routinely in the perioperative setting for
• Can be used for fluid resuscitation and fluid maintenance

Question 15

D5W in 1/2 NS

Answer 15

has calories

good maintenance fluid

Question 16

Two main types of fluids

Answer 16

crystalloids (small solutes; can move a little freely)

and

colloids (big solutes; like blood).

Question 17

crystalloids

Answer 17

administered as maintenance fluids nPO pts, used fro hypovolemic resuscitation in trauma

Question 18

colloids

Answer 18

fluids that in addition to mineral salts also have large proteins

less likely than crystalloids to cause edema\
usually given 250ml of albumin

used for special populations and not administered very often

Question 19

what do you need before administering colloids

Answer 19

need a type and cross match for compatibility

Question 20

why don’t we use colloids

Answer 20

albumin expand volume better
less edema

but greater mortality

Question 21

in what patient population would we use colloid fluid

Answer 21

elderly who can’t tolerate high volume resuscitation
severe diarrhea with low serum albumin
nephrotic syndrome

Question 22

how to determine fluid needs PO

Answer 22

• As a general rule, it is safe to assume that a patient just leaving the OR is going to be down 1 to 2 liters of fluid.

maintenance for breast
for bigger cases, i.e., whipple will need resuscitation threapy too

should check urine output
blood tests
skin, BP, HR, RR, cap refill and lung sounds to determine fluid needs

also check CXR out of OR (looking for fluid accumulation)

always ask the anesthesiologist if there was a foley, what fluids where given, if there are JP drians

Question 23

when would JP drains be used PO

Answer 23

JP drains are used when there is an empty cavity to help remove fluid that automatically wants to fill old tissue space

Question 24

ideal pt

UO and labs

Answer 24

urine output is between 50-100 ml/hr

labs are within normal limits
Na 135-145
K 3.6-4.8
creatinine <1.2

Question 25

what does a dry pt look like

Answer 25

``` NPO for a minute elderly DM was having diarrhea or vomiting pre-op tachy weighs less than pre OP ``` decreased skin turgor and low CVP

Question 26

what does an overloaded pt look like

Answer 26

hx of chf FLUID INTAKE GREATER THAN OUTPUT Raised CVP, lung crackles, weight is above pre ob Na may be low CXR=Pulm Edema

Question 27

treating perfect pt

Answer 27

if able to take PO heplock the IV when pt beings to eat remove foley check electrolytes fro 24 hrs -48 hrs monitor for signs of fluid overload or fluid deficit while in house

Question 28

treating dry pt

Answer 28

give an initial isotonic fluid bolus 500-1000ml use smaller amoutns in elderly follow V/S UP BP follow labs for electrolyte abnormalities if you're concerned about the pts fluid status consider placing a foley or keeping current foley to track urine output more closely

Question 29

tx for overloaded pt

Answer 29

Restrict fluid intake. If patient requires maintenance fluids, give 500ml over first 24 hours (20ml/hr). •Consider diuretics (e.g., Lasix) if patient has signs of pulmonary edema. (crackles) * Follow electrolytes closely, and correct abnormalities. * Severe cases in the setting of renal failure may require dialysis.

Question 30

cations

Answer 30

Na+, K+, Mg+, Ca2+

Question 31

anions

Answer 31

Cl-, HCO3-, PO43- (and other phosphates), and negatively charged proteins.

Question 32

Concentration of a solution expressed as the total number of solute particles per kilogram.

Answer 32

osmolarity

Question 33

interstitial fluid accoutns for

Answer 33

[~9L, ~15% of body weight]

Question 34

intravascular fluid accounts for

Answer 34

[~5L, ~5% of body weight

Question 35

the spontaneous movement of molecules from areas of high concentration to areas of low concentration.

Answer 35

• Molecular diffusion

Question 36

what effects osmotic activity

Answer 36

* The concentration of each solution (the greater the difference, the greater the osmotic pull). * Temperature. * Surface area to volume ratio. * The permeability of the membrane (if more permeable, water will diffuse faster than solutes).

Question 37

two types of osmoles

Answer 37

Effective osmoles, which DO NOT freely move across a membrane (e.g., electrolytes) Ineffective osmoles, which DO freely move

Question 38

electrolytes are an example of effective or ineffective osmoles

Answer 38

Effective osmoles, which DO NOT freely move across a membrane

Question 39

give an example of ineffective osmoles

Answer 39

Ineffective osmoles, which DO freely move (e.g., urea, ethanol, methanol).

Question 40

The concentration of a solution, minus ineffective osmoles, is called

Answer 40

The concentration of a solution, minus ineffective osmoles, is called tonicity.

Question 41

Isotonic ismols

Answer 41

270-300 mOsm/L

Question 42

hypertonic

Answer 42

>300 mOsml/L

Question 43

Hypotonic ismols

Answer 43

<270 mOsm/L

Question 44

most of our body weight is intracellular or extracellular

Answer 44

intracellular

Question 45

Where do our fluids go?

Answer 45

* 800-1500ml in urine * 0-250ml in stool * 600-900ml through skin and lungs

Question 46

The ______ triggers thirst with baroreceptors in response to hypovolemia.

Answer 46

* The renin-angiotensin system triggers thirst with baroreceptors in response to hypovolemia. * Oropharyngeal dryness * Psychological factors

Question 47

increased fluid loss by system

Answer 47

* GI: vomiting, diarrhea * Renal: diuresis * Vascular: hemorrhage * Skin: burns, fever * Lungs: tachypnea, mechanical ventilation

Question 48

daily fluid requirement equation for elderly

Answer 48

1500ml PLUS 10-15ml per kg over 20

Question 49

when you foley out indicate a fluid deficit

Answer 49

ins and outs indicate fluid deficit (less than 30ml an hr)