W2 (2)

Question 1

Oncotic pressure

Answer 1

Colloids presence in the vascular space provides colloid osmotic pressure

Question 2

Describe the body as a closed system

Answer 2

Any fluid lost must come from either the ICF or the ECF​
Example:​ If an animal is hemorrhaging​
- Fluid is lost from the intravascular space (plasma)​
- Cells are lost from the ICF (red and white blood cells)​

Addition to losses : Fluid can and does move between compartments dynamically and changing fashion to maintain equilibrium​

• Technician’s responsibility​ : Keep in mind which compartment needs to be replenished and what needs to corrected​

Question 3

Why would you administer fluid

Answer 3

• Correction of dehydration​
• Expansion and support of intravascular vole​
• Correction of electrolyte disturbances ​(Sodium (Na+), Chloride (Cl-), Potassium (K+), Magnesium (Mg++), Calcium (Ca++), Phosphate (HPO4–), Bicarbonate (HCO3-)​)
• Ensure appropriate redistribution of fluids that may be in the incorrect compartment ​

Question 4

Oliguria

Answer 4

The production of abnormally small amounts of urine

Question 5

Hypovolemia

Answer 5

The loss of fluid in the intravascular space

Question 6

Compare dehydration to hypovolemia

Answer 6

Dehydration - The water deficit in the interstitial and intracellular compartments
Hypovolemia - The loss of fluid in the intravascular space

Question 7

How to assess hydration status in a patient

Answer 7

• Skin tent test (turgor)
• mucous membrane moisture
• Oliguria
• Increased packed cell and total protein levels

Question 8

Administration of blood products vs hypertonic saline vs blood plasma

Answer 8

​
- Administration of blood products​ : To provide RBC’s or hemoglobin to support oxygen carrying capacity​, Clotting factors and platelets to support clotting (normal coagulation)​

• Administration of hypertonic saline or colloid solutions​ : To draw water into the vascular space and raise the blood pressure
• Administration colloids or blood plasma (fluid containing large solutes) : Remain longer in the vascular space​, Maintain blood pressure and volume​

Question 9

Routes of administration of Fluids

Answer 9

Intravenous (IV) Route​

Intraosseus (IO) Route​ - Catheter in the medullary cavity of a bone​

Question 10

What is a characteristic of all IV fluids?

Answer 10

All intravenous fluid are solutions​

• Contain one or more solutes dissolved in water​
• Most contain one or more electrolyte​
• Some may contain Dextrose (form of glucose)​
• Some may contain buffers​ : Lactate, gluconate​;Acetate (liver converts in sodium bicarbonate / Help regulate pH​)
• Some may contain colloids​ : Larger solutes

Question 11

How are fluids classified

Answer 11

Classified based on their molecular weight and solutes the solution contains​

Question 12

Crystalloid vs colloid classifications

Answer 12

Classified by:​ Mix and quantity of solutes, Replacement or maintenance fluids​, Isotonic, hypotonic, or hypertonic​

• Replacement Fluids have high concentrations of sodium and chloride​ : Designed to replace fluid losses​
• Maintenance Fluids have lower concentrations of sodium and chloride, but also more Potassium​ : Designed to maintain fluid balance of a period of time​

Question 13

Isotonic fluids

Answer 13

Have an osmolarity near to blood plasma​

Question 14

Hypotonic and hypertonic fluids

Answer 14

Have an osmolarity either lower or higher than plasma​

Question 15

Characteristics of crystalloid solutions

Answer 15

Contain water and small weight solutes (electroyltes, dextrose, buffers)

Question 16

Types of Crystalloid solutions

Answer 16

Isotonic replacement solutions, Isotonic maintenance solutions, Normal saline solutions, Hypertonic Saline solution s

Question 17

Isotonic Replacement solutions

Answer 17

Lactated Ringer’s Solution (LRS) - has calcium, no magnesium
Plasma-Lyte A (PLA) - has magnesium, no calcium
Plasma-Lyte 148 (PL148) - has magnesium, no calcium
Normosol-R (NR) - No calcium, has magnesium

Question 18

Isotonic maintenance solutions

Answer 18

For maintenance fluid therapy over a longer period of time; reflects the solute composition of total body water
- Normosol-M (NM%) / Plasma-Lyte 56 in 5% dextrose (PL5) - both solutions have less sodium and chloride and more potassium

Question 19

Normal saline solutions

Answer 19

AKA - Physiologic saline, 0.9% saline, or sodium chorlide 0.9% normal saline solution (NS)

• contains only sodium and chloride ions in water
• an unbalanced replacement solution
• Used in : Addison’s disease, Administering blood transfusions, Bathe exposed tissue or body cavities during surgery, Flush intravenous catheters (+/- heparin)
• does not contain any potassium and can cause hypokalemia (need potassium supplement)

Question 20

Hypertonic saline solutions

Answer 20

• Highly concentrated solutions (3%,7%…)
• Treat patients with hypovolemic, traumatic, or endotoxin shock
• Rapidly draws water into the intravascular space and supports blood pressure ( rapidly diffuses into the intersititial space

Question 21

Dextrose solutions

Answer 21

Contains dextrose as the only solute in the solution​

• Are available on the market or can be mixed in house​ (2.5% or 5% solutions​)
• Not usually used for replacement fluid therapy​
• Used for specific purposes​ : Support blood glucose in neonates, hypoglycemic or debilitated patients, diabetic patients​

Question 22

Characteristics of colloid solutions

Answer 22

Are larger molecular weight solutes that do not freely diffuse across the vascular endothelium​

• Stay in the intravascular space​
• Support expansion of blood volume and blood pressure​
• Two basic types of colloids​ : Synthetic and blood product

Question 23

Why are fluid rates high? compensating?

Answer 23

For anesthesia the fluid rates are higher than the volume required to maintain hydration in the patient and compensate for:​

• Vasodilation​
• Decreased cardiac output​
• Increased insensible fluid loss (loss of fluid through skin, respiratory tract, feces)​

Question 24

Volume overload

Answer 24

Fluid Administration too rapid can result in volume overload​ –>Pulmonary edema / Cerebral edema​

All patients under anesthesia must be monitored for signs over hydration!​
(esp Patients under 5 kg (10 lbs.)​, Renal disease​, Cardiopulmonary disease​)

Question 25

Signs of over hydration

Answer 25

- Ocular and nasal discharge​ - Edema and swelling of the conjunctiva​ - Subcutaneous edema​ - Increased lung sounds (wetness)​ - Increased respiratory rate​ - Dyspnea (difficult or labored breathing)​

Question 26

How to avoid over hydration

Answer 26

- Good monitoring techniques!​ - Administer fluids via fluid pump or monitor fluid bag carefully​ (Fluid bag should be labeled with a time and volume scale for every hour​) - Use of a burette for smaller patients​

Question 27

What are the duties of the Tech during the preanesthetic period?

Answer 27

During the preanesthetic period, the technician has many duties. He or she must help the attending veterinarian develop a minimum patient database, ensure that fasting instructions were followed, place an intravenous (IV) catheter, administer fluids, stabilize the patient, prepare equipment, and administer medications

Question 28

How important is the patient history

Answer 28

An accurate and complete patient history is at least as important, if not more important, than results of diagnostic tests in shaping patient management prior to anesthesia​

Question 29

What are some conditions and diseases that require treatment and impact anesthetic management

Answer 29

Dehydration, anemia, abnormal bleeding, respiratory or cardiovascular system disease, kidney or liver dysfunction, and conditions that require treatment while the patient is under anesthesia are physical findings that may influence anesthetic management​

Question 30

What is the physical Status Classification?

Answer 30

This system is used to assess the patient’s overall health preoperatively by placing the patient into one of five grades ranging from a normal, healthy patient (class PS1) to one that is moribund and not expected to survive without the surgery (class PS5).

Question 31

What are factors that play into the selection of anesthesia

Answer 31

Established protocols in the clinic​ : Veterinary Technician is familiar with the protocol​, Remember to evaluate each patient on individual bases​, The veterinarian bears responsibility for the patient and must make the final decision regarding the anesthetic protocol​ - Facilities and Equipment​ - Familiar with the anesthetic agents​ : It is not advisable to anesthetize a high-risk patient with a new combination of drugs that the anesthetist may have heard or read about but has never tried before​ - Type of Procedures​ : Procedures vary in their duration and complexity. ​Require different degrees of analgesia, immobilization, muscle relaxation, and CNS depression ​ - Cost​ - Degree of Urgency​ : Critically injured patients​, Rapid blood loss, shock, chest or abdominal injury​ --> Selection of agents that allow preservation of adequate blood pressure and rapid induction to place the patient under anesthesia​