Fluid Balance- Med Surg Exam 1

Front 1

1. Serous
2. Sanguinous
3. Serosanguinous
4. Purulent

Back 1

1. Clear (No Blood)
2. Bloody
3. Comb. Thin watery, pale red
4. Thick cloudy yellow/tan

Front 2

Albumin Blood Normal

Back 2

3.5-5

Front 3

Potassium Blood Normal

Back 3

3.5-5 mEq

Front 4

Sodium Blood Normal

Back 4

135-145 mEq

Front 5

1. Hyrdostatic Pressure
2. Osmotic pressure/pull=Oncotic Pressure/Colloid Osmotic Pressure

Back 5

1. Push From Heart
2. Big M&M

Front 6

CO = SV X HR

Back 6

4-6L/Min = 60-80cc X 60-100/Min

Front 7

Serum Osmolality

Back 7

The NUMBER of dissolved particles:
(270-)300 mOsm/Kg

Front 8

Nephrotic Syndrom

Back 8

Does not filter Albumin, gets to urine -> Edema

Front 9

Sepsis , overwhelming Gram minus infection

Back 9

Capillary beds get so big to let plasma protein out. Water follows -> Edema
BUT!!! FVD (as is liver disease and lymphatic block. IVF is lost!

Front 10

HR

Back 10

60-100/min

Front 11

B/P

Back 11

Systolic 90-140
Diastolic 60-90

Front 12

MAP (mean Arterial Pressure)

Back 12

sys+2xdis
----------
3
70-105mmHg : Under 60 Dangerous

Front 13

(English) Perfusion

Back 13

The process of nutritive delivery of arterial blood to a biological tissue.

Front 14

(English) Precipitate

Back 14

To hurry

Front 15

Baroreceptors Mechanism

Back 15

⇓ Stroke Volume

Front 16

Renin-Aldosterone Mechanism

Back 16

⇓ Renal Perfusion (also: ⇓ Na, ⇑ K, Hypovolemia, and Stress)

Front 17

ADH (Osmoreceptors)

Back 17

Water Retention Mechanism:
(HIGH:)Pituitary Gland secretes ADH

Front 18

Urine Output

Back 18

30cc/Hr Normal in a hospital setting

Front 19

ANP

Back 19

Atrial Naturetic Peptide:
Counteracts Aldosterone, ADH. Hypervolemia, Hypernatrimeia -Strech of atria - vasodialation, release of Na, release of water - Lower blood volume, blood pressure, preload, afterload.

Front 20

1. Normal Urinary Output/Day
2. How to assess total fluid output?

Back 20

1. ~1500cc.
Healthy Person: 60cc/Hr. Hospital: 30cc/Hr
2. Urine+1000cc insensible

Front 21

Insensible Loss/Day

Back 21

~1000cc

Front 22

Daily Baseline Fluid Requirment

Back 22

25-30ml/kg/day (less if obese, old, or head injury). Fever:15% increase.

Front 23

Define:
Enteral

Parenteral

Back 23

Via GI tract

Any route OTHER THAN GI tract (Intravenous)

Front 24

What are:
Keofeed/Dobhoff

Salem Sump Tube

Back 24

Small, single lumen tube. Cannot decompress stomach.

Larger double lumen tube. Can decompress.

Front 25

Define:
Rales
What are they associated with?

Back 25

Lung "crackles:. Fluid in lungs.
Secondary to: L Vent Failure or FVE

Front 26

Fluid Volume Assessment

Back 26

1. Skin Integrity.
2. Turgor.
3. Buccal Mucosa.
4. Lung Sounds (rales. +L. Vent Failure).
5. Heart sound S3 (FVE).
6. SOB (FVE)Veins in hands.
7. Jugular Vein (+R Vent Failure) . JVD
8. BP
9. Orthostatic BP.
10. Pulse pressure. Should be >30
11. Quality of pulse
12. Weight. In hospital 0.25-0.5 loss is normal.
13. I/O ALWAYS for 24Hrs.
14. H/H
15. Serum Osmolality
16. BUN:Cr and H/H(elevated: FVD,Lowered: FVE)
17. Urine Specific Gravity
18. CVP (Central Vein Pressure)
19. PAWP (pulmonary Artery Wedge Pressure)
20. Cardiac Output/ Cardiac Index (Indexed to pt body surface)
21. Edema ONLY when coupled with JVD

Front 27

Define:
Pulse Pressure
Normal value?

Back 27

Sys-dias
Gross Assess. for STROKE VOLUME.
Should be 60-80. If <30, FVD!

Front 28

CVP

Back 28

Central Vein Pressure (Subclavian or Jugular)
2-8mmHg
Less - FVD.
More FVE +R Vent Failure

Front 29

PAWP

Back 29

Pulmonary Arterial Wedge Pressure
6-12 mmHg

Front 30

JVD

Back 30

Jugular Vein Distention

Front 31

Urine Specific Gravity

Back 31

1.Urimeter measures Number, Size, and Weight of particles.
1.001- 1.035
(1.010-1.025)
2. Fast and Inexpensive way of Objective Fluid Balance
3. Note: Renal Failure: 1.010 fixed. Unknown reason.

Front 32

Serum Osmolality

Back 32

1. Number of dissolved substances regardless of size, weight.
2. Measured compared to BLOOD.
3. 50-290-1200 mOsm/Kg

Front 33

Normal weight Loss in hospital

Back 33

0.5 lb/day max is OK

Front 34

Oliguria

Back 34

<500cc/Day

Front 35

Anuria

Back 35

0cc/day

Front 36

Fluid Volume Deficit:
Physical Findings

Back 36

• skin turgor - delayed
• weight loss (Unless 3rd spacing)
• postural B/P, dizziness, syncope
• ⇓Central Venous Pressure- the measure of right ventricular preload,
• weak rapid pulse; ⇑ temperature
• generally output > intake
• mucous membranes dry, sunken eyeballs
• flat neck veins (CVP less than 4 mm Hg)
• Here’s another method to add to your bag of tricks, check the hand veins - put hands in dependent position, if it takes > 5 sec think Hypovolemia
• urine concentrated (dark yellow), sp. gravity . Oliguria < cc QD.
• labs Hct ⇑ (female 36-46%, male 39-55%);  BUN (5-15 mg/dl)

NOTE: Weight change outweighs Urine Output.

Front 37

1. Supine
2. Fowler
3. Semi Fowler
4. Trendelendberg
5. Reverse Trendelendberg

Back 37

1. Flat on Back
2. Sit up 90 degree
3. Sit up 45 degree
4. Flat. Feet higher than head (shock, inserting/changing central line - air emboli)
5. Flat, Head Higher than Feet

Front 38

Vasodilation
vasoconstriction
Where blood goes?
Hoe effect Preload?

Back 38

Dialation - More blood goes to extremities.
Constriction - Less blood to extremities, more in the core. More gets back to heart CVP increases.

Front 39

Dextran

Back 39

high-molecular-weight polysacharide.
Albumin and blood replacment for plasma volume expand. Every 1cc pulls 2cc/4cc(?)

Front 40

PIC

Back 40

Perepheral Intravenous Catheter.
Good for 3-6 months

Front 41

TPN
PPN
What is it?
Where administered?
For how long?
Risks

Back 41

Ready to use nutrition. High in sugar: Bacteria+hyperglacemia.

TPN:Total Parenteral Nutrition
Goes only in central line.
Long term
Risk of lung puncture, air emboli
Replace with D10W

PPN: PIC (Periph, IV, Catheter)
Shorter term 3-6 motnhs
Replace with D5W.

Front 42

What are:
KVO
IID
Bolus

Back 42

Keep Vein Open
intermittent infusion device
IV Push

Front 43

Parkland Formula
Burn Therapy

Back 43

V ( fluids volume)= total body surface area of burn (%) x weight (kg) x 4cc
Ringer's Lactate
50% first 8 Hrs
50% next 16 Hrs

Front 44

Urine Output Normal Calculationn

Back 44

1cc/Kg/Hr

Front 45

1. What is Bun
2. What is Creatinine?
3. Ratio?

Back 45

BUN: Blood Uria Nitrogen. Measures metabolism of protein by liver: 5-20

Creatinie: Muscle Metabolism Most should be excreted by kidnys. 0.1-1.1

Ratio 15:1
Only BUN incr -> GI bleed
Both Up -> Kidny fail

Front 46

cirrhosis

Back 46

A chronic liver disease of highly various etiology. often lead to jaundice, ascites, and hepatic failure