Term
| Fluid Distribution: TBW males vs. females |
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Definition
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Term
| True or False; because fat contains little water content, obese patients will have a lower percentage of TBW? |
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Definition
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Term
| Elderly patients will have a lower percentage of total body water ____ to ___% |
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Definition
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Term
| Infants have a _______ body water content about ____ to ___% |
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Definition
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Term
| 2/3 of the of body fluid is? |
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Definition
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Term
| 1/3 of body fluid is extracellular with the majority (3/4) _______ and only 1/4 in the_______ space |
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Definition
| intersitial, intravascular |
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Term
| True or False: Drug distribution is the same in elderly, adults, infants, and the obese |
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Definition
| false; drug distribution will differ based on fat & water content in the body |
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Term
| _______ is the number of impermeable particles in a solution |
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Definition
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Term
| These particles determine osmotic pressure |
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Definition
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Term
| Osmolality is the number of osmoles per____ of solvent |
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Definition
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Term
| The normal plasma osmolality is? |
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Definition
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Term
| Osmolarity is the number of osmoles per ____ of _____ |
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Definition
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Term
| hyper, hypo, and isotonic are used to describe what? |
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Definition
| tonicity- the ability of a solution to exert an osmotic force across a membrane |
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Term
| Oncotic pressure is the pressure produced by what? |
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Definition
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Term
| What are the 3 goals of fluid and electrolyte management? |
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Definition
| Maintaining fluid, electrolyte, and acid base balance (homeostasis) with the end result of reduced M &M |
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Term
| Name the 5 components of calculating intra-operative fluid requirements |
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Definition
1. hourly rate
2. replacement of the NPO deficit
3. Maintenance replacement
4. surgical loss replacement
5. insensible and sensible loss replacement |
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Term
| Calculating "hourly" fluid requirements is based on what rule? |
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Definition
4-2-1 rule;
4ml/kg/hr 1-10kg
2ml/kg/hr 11-20 kg
1ml/kg/hr >21kg |
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Term
| Calculating NPO deficit is done by? |
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Definition
| Multiplying the hourly rate x the number of NPO hours |
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Term
| What ultimately dictates how fast the NPO deficit is replaced? |
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Definition
| Pt's history and co-existing conditions |
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Term
| Maintenance fluid is based on what? and accounts for what type of losses? |
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Definition
calculations are based on the type of operation
accounts for evaporative loss and fluid redistribution out of the intravascular compartment |
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Term
| Maintenance fluid for procedure involving minimal tissue trauma/exposure? |
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Definition
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Term
| Maint. fluid for procedure involving moderate tissue trauma/exposure is? |
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Definition
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Term
| Maint. fluid for procedure involving severe tissue trauma/exposure? |
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Definition
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Term
| Maint fluid for procedure involving open chest or abdomen? |
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Definition
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Term
| Maint for complex laceration of left hand? |
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Definition
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Term
| lap appendectomy maintenance fluid? |
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Definition
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Term
| Bunionectomy fluid maintenance? |
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Definition
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Term
| Total hip fluid maintenance? |
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Definition
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Term
| Colectomy w/invasive tumor removal and colostomy fluid maintenance? |
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Definition
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Term
| open bariatric rue-en-y with chole fluid maintenace? |
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Definition
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Term
| Hysterectomy w/tumor debulking? |
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Definition
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Term
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Definition
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Term
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Definition
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Term
| open chest & open abd exploration s/p GSW |
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Definition
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Term
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Definition
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Term
| Crystalloid replacement of blood loss ratio is? |
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Definition
| 3:1, 3 ml of isotonic solution for every 1ml blood loss |
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Term
| Describe the difference between sensible loss and insensible loss? |
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Definition
| Insensible loss does not contain solutes; loss of free water. Sensible losses contains solutes |
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Term
| Name routes of insensible loss? |
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Definition
| skin, respiratory tract, evaporative loss via incision (accountanted for in maintenance fluid) |
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Term
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Definition
| mucous, tears, urine, stool, sweat |
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Term
| Average insensible loss via the skin is ____ and ____ via the respiratory tract |
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Definition
| 300ml/day, 400ml/day (total 700) |
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Term
| How does mechanical ventilation affect insensible losses? |
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Definition
| MV increases insensible water losses, air/oxygen/inhalation gases are dry. |
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Term
| What can help reduce insensible water loss due to mechanical ventilation? |
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Definition
| humidification- HME- reduces the KCal required to heat the inspired air, also decreases water loss |
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Term
| Insensible water loss is higher in neonates and is aprox? |
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Definition
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Term
| Insensible loss in the neonate is inversely proportional to what? |
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Definition
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Term
| Methods to reduce insensible water loss in neonates? |
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Definition
Increased ambient humidity (minus 12ml/kg/day)
Saran wrap/inner sheild (minus 4-12ml/kg/day) |
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Term
| Name 3 factors that will increase the insensible loss in neonates by 20ml/kg/day? |
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Definition
Tachypnea/RDS
Phototherapy
Radiant warmer use |
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Term
| Fever in a neonate will increase insensible fluid loss by how much? |
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Definition
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Term
| What condition will increase the insensible fluid loss in neonates the MOST? |
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Definition
| Major skin defects- ie: gastroschisis (bowel is outside the body) +120ml/kg/day |
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Term
| sensible loss increases by what % for every degree > 38 |
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Definition
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Term
| For every degree > 37, how much sensible loss will there be? |
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Definition
| 100 to 150 ml (in 70kg pt) |
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Term
| Usually sensible loss is not accounted for in hourly totals. Name 2 situations in which sensible loss should be accounted for? |
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Definition
Consider sensible loss in the neonate
Sensible loss should be accounted for if the patient is febrile |
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Term
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Definition
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Term
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Definition
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Term
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Definition
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Term
| What solution contains an electyrolyte profile most similar to plasma? |
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Definition
| LR- "balanced salt solution" |
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Term
| 1 L of d5W contains how much glucose? |
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Definition
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Term
| What type of fluid may be used for hourly in neonates? |
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Definition
| Dextrose solutions (neonates have limited glycogen stores) |
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Term
| Name the solution most physiological in large volumes |
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Definition
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Term
| How much free water is supplied by 1 liter of LR |
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Definition
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Term
| Lactate is metabolized what 2 ways: |
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Definition
70% via gluconeogensis into glucose
30% via oxidation into bicarbonate |
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Term
| Intravascular 1/2 life of LR |
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Definition
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Term
| What is the best solution to use for patients with neurological injuries? |
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Definition
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Term
| Patients with what 2 comorbidites may beneifit from NS over LR? |
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Definition
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Term
| This solution may cause hyperchloremic acidosis |
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Definition
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Term
| Intravascular half life of NS |
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Definition
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Term
| For Fluid boluses, the formula used is? |
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Definition
| 10-20 ml/kg of isotonic fluid |
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Term
| Fluid boluses in the neonate must be what? |
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Definition
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Term
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Definition
| Albumin, Dextran, & Hestastarch |
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Term
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Definition
| proteins/large molecules which create as osmotic/oncotic pull |
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Term
| When using COLLOIDS to replace blood loss, what is the ratio? |
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Definition
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Term
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Definition
when crystalloid fluid admin exceeds 3-4L
adjunct until blood arrives
Fluid resuscitation in pts with severe protein loss |
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Term
| Most common plasma protein is _______, responsible for 70-80% of the oncotic pressure |
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Definition
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Term
| ____% of albumin is located in the extravascular space, while ___ % is located in the intravascular space |
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Definition
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Term
| _________ binds and transports drugs, hormones, fatty acids, and enzymes |
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Definition
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Term
| Uses for Albumin include: |
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Definition
| ARDS, bacterial peritonitis, toxic bilirubin levels in infants with hemolytic disease |
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Term
| True or False: drugs may compete for albumin binding sites |
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Definition
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Term
| How does albumin levels affect the effects of drugs? |
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Definition
| if a drug binds to albumin, and albumin levels are low there will be more "free drug" to produce effects. |
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Term
| If a pt has a low albumin level, the amount of drug given should be _______? |
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Definition
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Term
| If albumin levels are high, and a drug binds to albumin, the amount of drug given may need to be _______ |
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Definition
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Term
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Definition
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Term
| For each 2.5g/dl decrease in serum albumin the risk of death increases by what? |
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Definition
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Term
| What colloid may be preferred in vascular cases? |
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Definition
| Dextran; decreases blood viscosity |
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Term
| Infusions of what colloid > 200ml/kg/day can interefere with blood typing and prolong bleeding time |
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Definition
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Term
| What is given to bind circulating dextran antibodies? |
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Definition
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Term
| What colloid is antigenic? |
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Definition
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Term
| What colloid is completely eliminated by the kidneys ? |
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Definition
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Term
| Benefits of using hetastarch |
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Definition
| less expensive than albumin, Nonantigenic |
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Term
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Definition
| should not exceed 20ml/kg/day because of effect on coagulation and bleeding times |
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Term
| Hgb is aproximately ____ of the Hct in the adult? |
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Definition
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Term
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Definition
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Term
| Total blood volume in the premature neonate is? |
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Definition
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Term
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Definition
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Term
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Definition
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Term
|
Definition
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Term
|
Definition
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Term
|
Definition
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Term
| Calculating ABL is based on what formula? & is acceptable to use when? |
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Definition
EBV X 20%,multiple EBL by triger hct, subtract the two, and multiply result by 2-3=allowable blood loss before transfusion
use for HEALTHY pts if no hgb/hct is available |
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Term
| What is the transfusion trigger for most healthy patients |
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Definition
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Term
| Transfusion trigger in elderly pts with pulmonary disease and cardiac disease is? |
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Definition
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|
Term
| The universal blood donor is? |
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Definition
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|
Term
| Universal blood recipient |
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Definition
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Term
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Definition
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|
Term
| Universal PLASMA recipient |
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Definition
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