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My APA Anesthesia 1 > Quiz 4 > Flashcards

Quiz 4 Flashcards

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1
Q

what percentage body weight is Total Body water

A

60% total body weight

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2
Q

what percentage body weight is Intracellular volume

A

40% total body weight

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3
Q

what percentage body weight is Extracellular volume

A

20% total body weight

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4
Q

what is extracellular fluid made up of? percentage?

A

Interstitial fluid volume (75% of ECV)

Plasma (intravascular) volume (25% of ECV)

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5
Q

TBW is _____ of a man’s weight

A

55%

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6
Q

TBW is _____ of a woman’s weight

A

45%

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7
Q

TBW is _____ of an infant’s weight

A

80%

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8
Q

__________ pump maintains the high concentration of K+ in ICF

A

Sodium-potassium

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9
Q

High concentration of what lytes intracellularly?

A

Potassium (primary cation)
Phosphate (primary anion)
Magnesium

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10
Q

High concentration of what lytes extracellularly?

A

Sodium (primary cation)

Chloride(primary anion)

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11
Q

What is main determinant of osmotic pressures?

A

Albumin

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12
Q

An expression of the number of osmoles of a solute in a liter of solution

A

Osmolarity

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13
Q

An expression of the number of osmoles of a solute in a kilogram of solvent

A

Osmolality

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14
Q

How a solution affects cell volume

For example – isotonic, hypertonic, hypotonic

A

Tonicity

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15
Q

Concentration disorder, Insufficient water present in relation to sodium levels

A

Dehydration

might have too much salt, or not enough water – fluid replacement specific too disorder

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16
Q

Loss of extracellular fluid
Absolute loss of fluid from the body
Reduced circulating volume

A

Hypovolemia

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17
Q

____ is the most abundant electrolyte in the ECF.

A

Na+

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18
Q

Most common electrolyte abnormality in hospitalized patients

A

hyponatremia

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19
Q

Clinical Manifestations of Hyponatremia

A 
Headache
Weakness
Coma
Confusion
Cerebral edema
Cramps
Agitation
Malaise
Anorexia 
Nausea/vomiting
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20
Q

Treatment of Hyponatremia

A

Fluid restriction

Administration of hypertonic saline and an osmotic or loop diuretic

!!!Correction of serum sodium levels too rapidly can result in neurologic damage and myelinolysis!!! Breaks down nerves and axons

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21
Q

Most common cause is water deficiency d/t:

A

Excessive loss

Inadequate intake

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22
Q

Clinical Manifestations of Hypernatremia

A 
Thirst
Hallucinations
Irritability
Renal insufficiency
Disorientation
Seizure
Hypervolemia
Intracranial bleeding
Polyuria or oliguria
Coma
Weakness
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23
Q

Treatment of Hypernatremia

A

Plasma sodium should be decreased by 1-2mEq/hr until the patient is clinically stable.

Correction of serum sodium to normal should gradually progress over a 24 hour time frame.

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24
Q

K+ Largely responsible for

A

resting membrane potential

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25
The most common electrolyte abnormality encountered during clinical practice.
Hypokalemia
26
Hypokalemia causes
``` Gastrointestinal losses Poor dietary intake Systemic alkalosis Diabetic ketoacidosis Diuretic therapy Sympathetic nervous system stimulation ```
27
Clinical Manifestations of Hypokalemia
``` ST-segment depression Presence of U wave Flattened or inverted T waves Ventricular ectopy Weakness ( respiratory muscle) Decreased reflexes Confusion ```
28
how fast can you run K+ in?
40 mEqs/hour
29
Clinical Manifestations of Hyperkalemia
``` Tall, peaked and elevated T waves Widened QRS complex Prolonged PR interval Flattened or absent P wave ST segment depression Cardiac arrest ```
30
Treatment of Hyperkalemia
- Avoid adverse cardiac effects - Insulin and glucose to shift K+ into cells - IV calcium to antagonize cardiac effects of hyperkalemia - hyperventilate (3 goals: 1. Stabilize cardiac membrane; 2. driving K from ECV to ICV; 3. remove K from body)
31
what is upper limit of potassium level for elective procedures?
5.5 mEq/L
32
Clinical Manifestations of Hypomagnesemia
``` Flat T-waves U-waves Prolonged QT interval Widened QRS Atrial and Ventricular PVCs ```
33
Low Mag has inhibitory effect on ________ which alters the _______________.
NA-K-ATPase resting membrane potential
34
Treatment of Hypomagnesemia
- 1-2g over 5 minutes with EKG monitored | - Followed by continuous IV infusion 1-2g/hr
35
What moves Ca into bones?
Calcitonin
36
What moves Ca out of bones?
Parathyroid hormone
37
Clinical Manifestations of Hypercalcemia
``` Hypertension Heart block Shortened QT interval Dysrhythmias Muscle weakness Decreased deep tendon reflexes Sedation ```
38
Factors influencing intraoperative fluid management
Patient’s perioperative fluid status – trauma, blood loss, ETOH pt, elderly, liver cirrhosis, bowel prep Co-existing disease – CHF, liver Fx Intra-operative fluid shifts Intra-operative blood loss Selection of appropriate fluids for replacement of intra-operative losses
39
insensible loss?
``` Water loss through: Urine Feces Sweat Respiratory tract ``` Correct insensible losses with 2ml/kg/hr of a crystalloid solution*
40
Replacement of third space loss
Minimal trauma: 3-4 mL/kg/hr Moderate trauma: 5-6 mL/kg/hr Severe trauma: 7-8 mL/kg/hr
41
Goals of Perioperative Goal-Directed Fluid Therapy (PGDT)
Minimize: oxygen demand Optimize: CO, Tissue oxygenation, capillary and macrovascular flow, oxygen and nutrient delivery, and end-organ perfusion
42
PGDT Hemodynamic monitoring
- Dilution techniques – CO with PAC - Plethysmography variability index - Stroke volume variation - Systolic pressure variation - Pulse pressure variation - Esophageal Doppler and Echocardiography
43
PGDT Protocols
- Baseline assessment of target hemodynamic measures - Administration of small fluid bolus (200-250 mL) to assess Frank-Starling curve - End-points identified and fluid given to maintain
44
What fluids are Preferable in dehydration states (prolonged fasting, GI losses, polyuria, hypermetabolic conditions)
Crystalloids
45
What can 0.9% NS negatively contribute to?
hyperchloremic metabolic acidosis (high doses)
46
what is a major risk of 3% saline?
Intracellular dehydration
47
Avoid high doses of what fluid in DM?
LR d/t Lactate metabolites are gluconeogenic
48
Avoid combining what fluid with blood products?
LR d/t Calcium content
49
Give how much crystalloid per how much blood loss?
3:1
50
Give how much colloid per how much blood loss?
1:1
51
Clinical assessment of intraoperative blood loss?
- Tachycardia - Hypotension - Oliguria - Decrease CVP - Decrease mixed venous oxygen - Variation of systolic BP with respiratory cycle in mechanically ventilated patients (greater than 10mmHg)
52
The primary indication for blood transfusion is to increase the ________________ of the blood.
oxygen carrying capacity
53
Blood can be stored for ______ days?
21-35
54
Blood is stored at a temperature of ?
1-6 C or 33.8-42.8 F (slows down the rate of glycolysis in red blood cells)
55
how much hematocrit in a unit of PRBC?
70%
56
Advantages of PRBC over whole blood?
- Decreased potential for citrate toxicity | - Decreased risk of allergic reaction (related to decreased volume of plasma that is infused with PRBC’s)
57
Administration of platelets during surgery is usually indicated for platelet counts less than _________?
50,000 cells/mm3
58
The platelet count will increase by ______________ with each unit of platelets administered
5,000 to 10,000 cells/mm3
59
Risk of platelet transfusion
- Transmission of viral diseases. - Sensitization to human leukocyte antigens present on platelet cell membranes. - Bacterial infection in 1 of 12,000 transfusions. - Small risk of platelet-related sepsis.
60
FFP contains ?
- all plasma proteins - All coagulation factors except platelets - Includes factors V and VIII
61
indication for FFP?
PT or PTT elevated AND bleeding
62
Risks associated with FFP transfusion?
- Sensitization to foreign proteins. - Transmission of viral diseases. - Allergic reactions
63
Cryoprecipitate contains high concentrations of ?
- Factor VIII - von Willebrand factor - Factor XIII - Fibrinogen - Fibronectin
64
Thought to occur when antibodies in the recipient’s serum interact with antigens from the donor’s cells
Febrile transfusion reaction
65
A febrile transfusion reaction is distinguished from a hemolytic transfusion reaction by evaluating the patient’s __________ for __________.
serum and urine hemolysis
66
treatment of febrile transfusion reaction?
- slowing the rate | - administering antipyretics
67
Allergic transfusion reaction s/s?
- Pruritus - Urticaria - Occasional facial swelling
68
Allergic transfusion reaction treatment?
IV antihistamine | Severe , blood should be discontinued - usually dt igA deficiency
69
Differentiate between allergic reaction and hemolytic reaction by checking the _________ for ___________.
urine and plasma free hemoglobin
70
Which blood reaction? Transfused donor cells are attacked by the recipient’s antibody and compliment, resulting in intravascular hemolysis
Hemolytic blood reaction
71
Which blood reaction? Occur due to presence of incompatible plasma proteins in the donor blood
Allergic reaction
72
Hemolytic Transfusion Reaction S/S?
``` Fever Flushing Chills Chest pain Hypotension Hemoglobinuria Nausea Dyspnea ```
73
All clinical signs of Hemolytic reaction are masked by anesthesia except _____________.
hemoglobinuria and hypotension
74
how to diagnose hemolytic reaction?
direct antiglobulin test
75
Treatment of Hemolytic Transfusion Reaction
- Stop the transfusion!!! - Renal failure occurs as a result of precipitates in the renal tubules. - Prevent renal failure by maintaining urine output. - Maintain UOP at 100mL/hr through the administration of lactated Ringer’s solution and mannitol and/or furosemide
76
Complications of blood therapy – Metabolic Abnormalities?
- Increased levels of serum hydrogen and serum potassium. - Decreased 2,3-diphosphoglycerate levels. - Metabolic alkalosis - Hypocalcemia
77
pH of a unit of blood is about ___ after collection and is ___ after being stored for 21 days.
7. 1 6. 9 (But somehow pt's pH increases with blood admin)
78
More significantly, blood products contain the preservative _____ that metabolizes to _______ upon transfusion. The increased _________ levels increase the arterial pH of the recipient, frequently causing metabolic alkalosis
citrate bicarbonate bicarbonate
79
What does Decreased concentrations of 2,3-diphosphoglycerate do to the pt?
a shift of the oxyhemoglobin dissociation curve to the left and an increase in the affinity of Hgb for O2 - so tissue o2 can decrease
80
Highest occurance of viral disease from blood products?
Cytomegalovirus
81
concern for microaggregates?
Concern is that microaggregates will enter the recipient’s blood, accumulate in the lungs, cause vascular obstruction, and contribute to ARDS. (use filter to decrease risk)
82
goal temp for heated blood admin?
37-38 C
83
treatment for DIC?
platelets | FFP
84
define TRALI (transfusion-related acute lung injury)
Acute, noncardiogenic pulmonary edema associated with dyspnea and arterial hypoxemia that occurs within six hours of transfusion
85
contraindications of intraoperative blood salvage?
Malignancy CA Presence of blood-borne disease Blood contaminated with bowel contents
86
EBV Premi
95-100 ml/kg
87
EBV Term
85-90 ml/kg
88
EBV Up to 12 months
80 ml/kg
89
EBV Adult male
70-75 ml/kg
90
EBV Adult female
65-70 ml/kg
91
EBV Obese
55 ml/kg
92
Maintenence fluid calculations
1st 10 kg = 4 ml/kg/hr 2nd 10 kg = 2 ml/kg/hr >20kg = 1ml/kg/hr
93
Deficit =
maint x hours NPO First half in first hour, 1/4 in 2nd, and 1/4 in 3rd hour

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