Ipapburke Surgery Test 1- Fluids

Front 1

% of body weight that is water

Back 1

60%

Front 2

Most Na- extra or intra cellular?

Back 2

extracellular

Front 3

Most K- extra or intra cellular?

Back 3

intracellular

Front 4

Daily intake requirement for most adults

Back 4

at least 2000 mL

Front 5

Sources of water intake

Back 5

75% oral and 25% extracted from solid food

Front 6

Routes for loss of fluid (3)

Back 6

urine output, insensible loss (sweating and lungs), GI tract

Front 7

If fluid replacement is done orally, how much is given in comparison to IV fluids?

Back 7

1.5 times

Front 8

How much urine output is needed to clear products of metabolism?

Back 8

500-800 mL

Front 9

What is normal urine output?

Back 9

1 liter per day

Front 10

What is “insensible” fluid loss?

Back 10

sweating from skin (both water and electrolytes) and lungs (pure water)

Front 11

Amount of fluid lost daily through the GI tract

Back 11

about 250 mL/day

Front 12

Amount of fluid lost daily through insensible loss?

Back 12

about 600 mL

Front 13

General reasons for giving IV fluids.

Back 13

resuscitation (blood loss or dehydration) and hydration (post op, unable to eat/drink)

Front 14

How long can a patient be with IV fluids alone when unable to eat?

Back 14

a week

Front 15

What is enteral nutrition?

Back 15

through GI tract

Front 16

What is TPN?

Back 16

total parenteral nutrition through central line

Front 17

What is PPN?

Back 17

peripheral parenteral nutrition

Front 18

Fluid that best mimics extracellular fluid.

Back 18

Lactated Ringer’s

Front 19

Percent of NaCl in Normal Saline

Back 19

0.90%

Front 20

Composition of D5 1/2 NS

Back 20

dextrose 5% in .45% NaCl

Front 21

Composition of D5 1/4 NS

Back 21

dextrose 5% in .225 NaCl

Front 22

Composition of D5W

Back 22

dextrose 5% in Water

Front 23

Composition of D50W

Back 23

dextrose 50% in Water

Front 24

Only fluid that contains in normal blood except for Mg

Back 24

Lactated Ringer’s

Front 25

What is the use for crystalloids?

Back 25

volume resuscitation

Front 26

What two fluids are used for volume resuscitation?

Back 26

NS and LR

Front 27

Which fluid used for volume resuscitation contains K, HCO3 and Ca?

Back 27

LR

Front 28

Fluid most commonly used for maintenance in adults?

Back 28

D5 1/2 NS

Front 29

If an adult needs fluid maintenance and also has been vomiting or on NG suction, what fluid is used?

Back 29

D5 1/2 NS with added 20 meq KCl/L

Front 30

What fluid is usually used for maintenance?

Back 30

classically D5 1/4 NS

Front 31

If you use D5W for resuscitation or maintenance, what will result (bad)?

Back 31

low serum sodium leading to lethargy and then seizure or coma

Front 32

Time for blood typing and then crossmatching.

Back 32

Few minutes for blood type and about 1 hour to crossmatch

Front 33

What is the best replacement for active hemorrhage?

Back 33

Whole blood because it has RBC and plasma (clotting factors)

Front 34

Why is there more immunologic reaction from whole blood than RBCs?

Back 34

WBC

Front 35

How much does one unit of RBC raise the Hct?

Back 35

3%

Front 36

What is normally used for replacement of blood due to the lack of whole blood available?

Back 36

PRBC

Front 37

Temperature whole blood and RBC should be before being used.

Back 37

warm

Front 38

Whole blood and RBC should be hung with what fluid?

Back 38

NS

Front 39

How many people are required to check patient ID and blood ID before transfusion?

Back 39

2

Front 40

When is FFP used?

Back 40

for coag deficiency plus active bleeding (not for volume replacement alone)

Front 41

How long does it take FFP to thaw?

Back 41

about 30 minutes

Front 42

How long can you keep thawed FFP for?

Back 42

about 5 days

Front 43

Normal platelet count

Back 43

over 200,000

Front 44

When are platelets given?

Back 44

when the platelet count is less than 50,000 and patient is bleeding

Front 45

A 6 pack of platelets can increase the platelet count by how much?

Back 45

as much as 25,000

Front 46

Describe storage of platelets

Back 46

stored at room temp and good for 5 days

Front 47

Lethal triad.

Back 47

hypothermia, coagulopathy, and metabolic acidosis

Front 48

Ratio of RBC to FFP that should be used in trauma requiring massive transfusion.

Back 48

1:01 AM

Front 49

There is an increased risk of this condition with 1:1 RBC:FFP

Back 49

ARDS

Front 50

What is albumin used for?

Back 50

volume expansion and albumin deficiency (due to burns, liver disease, nephrotic syndrome)

Front 51

What is the purpose of hypertonic saline (3-5% NaCl) in hemorrhage?

Back 51

to reduce the volume of fluids to maintain BP---the high Na concentration will draw fluid into the intravascular space

Front 52

Purpose of hypertonic solution in head injury?

Back 52

increases BP and CPP, and decreases ICP

Front 53

Why is there less risk of ARDS with use of hypertonic solution for head injury than albumin?

Back 53

inhibits PMN activation

Front 54

What does hypertonic solution do to tissue swelling?

Back 54

decreases it b/c it draws the interstitial fluid into the intravascular space

Front 55

Negative S.E. caused by use of hypertonic saline.

Back 55

hypernatremia----thirst

Front 56

IV maintenance rate for 10 Kg child

Back 56

40 ml/hr

Front 57

IV maintenance rate for 20 kg child

Back 57

60 ml/hr

Front 58

IV maintenance rate for 30 kg child

Back 58

70 ml/hr

Front 59

In a dehydrated or hypovolemic child, what size fluid bolus can you start with?

Back 59

20 ml/kg NS or RL (can repeat)

Front 60

IV maintenance rate for adults

Back 60

100 ml/hr or more

Front 61

Size of fluid bolus to use in dehydrated or hypovolemic adult

Back 61

500 mL to 1 L NS or RL (repeated PRN)

Front 62

KVO

Back 62

Keep Vein Open

Front 63

TKO

Back 63

To Keep Open

Front 64

Use for heparin or saline lock

Back 64

for intermittent meds

Front 65

How do you keep saline or heparin lock line from clotting?

Back 65

irrigate periodically

Front 66

NPO

Back 66

nil per os (nothing by mouth)

Front 67

2 general reasons why patient needs IV fluids at least maintenance rate.

Back 67

NPO for more than 12 hours or if there are continuing fluid losses

Front 68

Most common method for fluids.

Back 68

Peripheral line

Front 69

Use for butterfly

Back 69

to draw blood or give meds

Front 70

Site for intra osseous needle insertion in child

Back 70

tibia and femur

Front 71

Site for intra osseous needle insertion in adult

Back 71

tibia, sternum, humerus

Front 72

Contraindication for intra osseous

Back 72

fracture- causes compartment syndrome when the fluid leaks out of bone into the soft tissue

Front 73

Two vein locations MC used for central line

Back 73

subclavian and IJ catheter

Front 74

What is a PIC?

Back 74

peripherally inserted central line

Front 75

What are central lines used for?

Back 75

to administer fluids, blood, antibiotics, and hyperalimentation (TPN)

Front 76

Common complications of central lines

Back 76

pneumothorax, hematoma, infection

Front 77

What is the Seldinger technique?

Back 77

wire is inserted through needle and the needle then pulled out of vein leaving the wire; catheter is threaded over the wire and the wire pulled out leaving the catheter in place

Front 78

What is a tunneled catheter?

Back 78

central line with ports out of the skin that is used for hyperalimentation, chemo, and long term Ab

Front 79

What is implanted catheter?

Back 79

reservoir is completely under the skin and a special curved needed is used to access the reservoir

Front 80

What complication is avoided by using a PICC?

Back 80

pneumothorax

Front 81

Drawback to PICC

Back 81

more easily infected, can break off, embolize, cause air embolus

Front 82

Complications of femoral vein catheter

Back 82

infection and DVT

Front 83

Is the femoral vein medial or lateral to the artery?

Back 83

medial to the artery

Front 84

How many umbilical veins are in the umbilical cord?

Back 84

one

Front 85

How many umbilical arteries are in the umbilical cord?

Back 85

two

Front 86

Where is arterial line usually inserted?

Back 86

radial artery

Front 87

What are arterial lines connected to?

Back 87

pressure transducer (they are nor fluid replacement)

Front 88

What is the purpose of a blood filter when giving blood?

Back 88

to catch clots

Front 89

Low tech way to know if someone is dehydrated?

Back 89

skin turgor, HR, BP, tilts

Front 90

Medium tech ways to know if someone has enough fluid?

Back 90

hematocrit, measure I and O, urine specific gravity

Front 91

Is specific gravity of urine increased or decreased when dehydrated?

Back 91

increased when dehydrated

Front 92

Higher tech ways to determine is there is enough fluid?

Back 92

CVP, wedge pressure

Front 93

What signs on physical exam will tell you that a patient needs less than maintenance fluids?

Back 93

pedal or presacral edema, ascites, anasarca, S3 gallop, JVD

Front 94

Clues in history that tell you a person has volume excess

Back 94

fluid retention or weight gain over past few days, symptoms of CHF

Front 95

Clues in history that tell you a person has volume deficit

Back 95

vomiting, diarrhea, fever, profuse sweating, thirst, weight loss in past few days

Front 96

Physical exam signs that tell you a patient may have volume deficit?

Back 96

skin turgor, mucosal hydration , tachycardia, orthostatic hypotension, oliguria

Front 97

How do you treat oliguria in a person with volume deficit?

Back 97

with fluids, not a diuretic

Front 98

What is the Hematocrit a measure of?

Back 98

% of RBC in blood compared to plasma

Front 99

If there is no loss or gain of RBC and you add fluids, what happens to the hematocrit?

Back 99

it decreases (hemodilution)

Front 100

If there is no loss or gain of RBC and you lose fluids, what happens to the hematocrit?

Back 100

it increases (called hemoconcentration--dehydration)

Front 101

Hemolyzed blood may have high serum what?

Back 101

K

Front 102

What is seen on EKG because of hyperkalemia?

Back 102

peaked T waves and eventually PVCs

Front 103

What is low urine output in surgery patient considered as until proven otherwise?

Back 103

hypovolemia

Front 104

What urine output should be expected post surgery from an adult?

Back 104

.5 ml/kg/hr

Front 105

What urine output should be expected post surgery from a child?

Back 105

expect 1 ml/kg/hr

Front 106

What urine output should be expected post surgery from an infant?

Back 106

expect 2 ml/kg/hr

Front 107

Too ways to measure urine output?

Back 107

hat in toilet, collection bag from bladder catheter

Front 108

Where does the CVP line end?

Back 108

in SVC or right atrium

Front 109

If CVP and wedge pressure are low when measuring with Swan-Ganz, what is the patient’s fluid status?

Back 109

Probably needs more fluid

Front 110

What is the pulmonary artery catheter measuring?

Back 110

CVP, PA pressure, wedge pressure, and CO

Front 111

Purpose of feeding tube vs. NG tube

Back 111

Feeding tube to insert feeding; NG tube on low suction to drain the stomach

Front 112

What is the purpose of letting tube feedings drain in with gravity rather than pushing them in?

Back 112

minimizes aspiration

Front 113

Contraindication for NG tube

Back 113

nasal injury, nasal obstruction, cribriform plate injury

Front 114

Indication for NG tube

Back 114

persistent vomiting, bowel obstruction, surgery

Front 115

Function of Toomey Syringe

Back 115

inject air into the NG tube and sump to keep open

Front 116

What is Anti-reflux valve used for?

Back 116

used on sump with NG tube to keep fluid from leaking out while allowing air to go in

Front 117

Common causes of hypokalemia

Back 117

diuretics and NG suction (loss of HCl from stomach)

Front 118

How do you prevent hypokalemia?

Back 118

Add KCl to each liter of fluids