Inpatient management Flashcards
(54 cards)
Why is fluid balance critical in inpatient management?
Fluid overload → increases interstitial fluid, impairing oxygen & nutrient diffusion, harming renal & lung function
Fluid deficit → reduces perfusion, promotes catabolism, insulin resistance & cellular stress
How can fluid balance be monitored?
Clinical signs of hydration & perfusion
- mucous membranes
- pulse rate & quality
- blood pressure
- peripheral oedema
- chest auscultation & lung ultrasound for pulmonary oedema
What are solutions for fluid imbalances?
Adjust fluid therapy rates, use diuretics if needed
What is oncotic pressure?
Pressure exerted by proteins (mainly albumin) in blood to keep fluid inside blood vessels
Also called Colloid Osmotic Pressure (COP)
What happens when albumin is low (hypoalbuminaemia)?
Less oncotic pressure → fluid leaks out of blood vessels into tissues (causing oedema)
At same time, this can lead to low blood volume (hypovolemia), worsening perfusion
What are the clinical signs of hypoalbuminaemia?
Because fluid leaks out of blood vessels, patients may show:
- Peripheral oedema
- Pulmonary oedema on auscultation/ultrasound
- Flat caudal vena cava → Suggests low blood volume (hypovolemia)
- Low blood pressure (hypotension)
- Poor pulses
How is low oncotic pressure/hypoalbuminaemia managed?
Increase protein intake (feeding tube may be needed)
Plasma transfusion for oncotic support
Avoid synthetic colloids (risk of acute kidney injury)
What are the most common electrolyte disturbances in critical illness and what clinical signs do they cause??
Hypokalemia (low potassium) due to reduced intake → Weakness, low head carriage, plantigrade stance
Sodium (losses or redistribution secondary to hyperglycaemia) → mentation disturbances, cerebral dehydration/swelling
Chloride (hand in hand with sodium or losses from GI → vomiting, symptoms associated with underlying disease
How are electrolyte disturbances monitored?
Electrolytes via blood/gas machine or biochem
How are electrolyte disturbances treated?
Supplementation with fluids
Where electrolytes are high - specific treatment approaches
What are the causes, respiratory responses, and clinical signs of acidosis?
Occurs when there is excess acid in body, classified into metabolic & respiratory acidosis
Metabolic – increased acid e.g. lactate, uraemia, ketones
Associated with increased RR & reduced PCO2
Respiratory – retained CO2 e.g. brainstem injury or respiratory paralysis (botulism/tetanus)
Associated with reduced RR & increased PCO2
What causes alkalosis, and how does it affect respiration?
Metabolic Alkalosis: Loss of acid (e.g., severe vomiting, pyloric foreign body). Causes reduced RR, increased PCO₂ & hypochloraemia
Respiratory Alkalosis: CO₂ loss from hyperventilation due to pain, stress, or fear
How are acid/base imbalances diagnosed?
pH measurement (blood gas machine)
PCO₂ levels (blood gas machine)
Respiratory rate (RR)
How are acid/base imbalances treated?
Hartmann’s (alkalinising) for acidosis
Saline (acidifying) for alkalosis
Treat underlying cause (e.g. pain)
Why is mentation monitoring important?
Indicates brain oxygenation, perfusion status & intracranial disease
Uses Modified Glasgow Coma Scale for standardisation
What are key cardiac abnormalities in critical patients?
Bradycardia → Check potassium levels
Arrhythmias (e.g., V-Tach) → Common in systemic disease
Poor contractility → Seen in sepsis, DCM, late-stage HCM
How are cardiac issues monitored and how are V-Tach & poor contractility treated?
ECG monitoring (intermittent or continuous)
POCUS (ultrasound) to assess contractility
Lidocaine for V-Tach, Pimobendan for poor contractility
What do different blood pressure patterns indicate?
Low systolic + diastolic BP (low total BP)→ Hypovolemia
Low diastolic BP (wide gap) → inappropriate vasodilation: Distributive shock (e.g. sepsis, SIRS)
Low systolic BP (small gap) → Poor cardiac contraction
What are systolic and diastolic pressure an indirect measure for?
Systolic pressure – indirect measurement of cardiac contraction force
Diastolic pressure – indirect measure of vascular tone
How do you treat blood pressure issues?
Treatment based on underlying cause
What are some possible causes of hypothermia?
Reduced energy conservation
- e.g. anaesthesia, wet, exposure
Reduced energy production
- e.g. starvation, metabolic exhaustion, hypoxia
What are some possible causes of hyperthermia?
Increased energy conservation
- e.g. BOAS, hot day, exercise
Increased energy production
- e.g. inflammation/infection –> pyrexia
Why should hypothermia be corrected slowly?
Rapid warming can cause metabolic mismatch, harming heart & brain
How can oxygen & ventilation be monitored?
Basic:
- MM colour, resp rate & effort, pulse oximetry, lung ultrasound
Advanced:
- Blood gas analysis (PaO₂, FiO₂/PaO₂ ratio)
