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45 Cards in this Set
- Front
- Back
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What is the distribution of total body fluid
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60% intracellular
40% extracellula |
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What is the distribution of the extracellular fluid
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75% interstitial (bathes cells)
25% extracellular volume |
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How much of a 1 liter infusion of 0.9% Nacl or LR infusion remain in the intravascular space
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Since these fluids do not cross into cells, they will evenly distribute into the extracellular space. Therefore 75% will distribute into the interstitial compartments (750ml) and 25% in the intravascular space (250ml)
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In terms of a fluid what is D5W equivalent to?
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Free water. it is metabolized to Water and Co2. Will distribute everywhere b/c free water can cross membranes
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What is a contraindication to D5W administration
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Elevated ICP, b/c water will cross into cerebral cells, further increasing ICP
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Intravascular volume expansion following 1 liter infusion of D5W
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100ml
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Intravascular volume expansion following 1 liter infusion of NS or LR
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250ml
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Intravascular volume expansion following 500ml infusion of 5% Albumin or Hetastarch 6%
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500ml
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Intravascular volume expansion following 100ml infusion of 25% albumin
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500ml
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In what condition is 25% albumin useful for
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when a patient needs a redistribution of fluid such as ascites/pleural effusion
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What are some sign's / symptoms of intravascular volume depletion
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tachycardia < 100 bpm
hypotension < 80 sbp orthostatic changes incr. bun:cr > 10:1 reduced urine output |
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How are IV fluids admnistred for fluid resuscitation
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Central catheter 500ml to 1000ml bolus. Continue as long as s/s of volume depletion improve
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For fluid resuscitation what is preferred crystalloid or colloid
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Crystalloid. No evidence of superiority of colloids and they are more $$$
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What is normal plasma osmolality
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275 to 290 mOsm / kg
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How can plasma osmolality be estimated
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2 x Na+ + glucose/18 + Bun/2.8
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What is the normal urine output for an adult
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0.5 to 1 ml/kg/hr
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What happens when plasma osmolality increases
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Fluid shifts from cell to plasma causing cell dehydration and shrinkage
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How is plasma osmolality maintained?
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Thirst
Secretion of Arginine vasopressin from posterior pituitary |
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What happens if plasma osmolality decreases?
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Fluid shifts from plasma and into cells causing swelling/overhydration
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Hypotonic fluid has an osmolality less than what?
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150 mosm/l
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What happens if hypotonic fluid is administered?
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fluid shift from EC to IC, causing cellular overhydration, rbc swelling and rupture, brain cell swelling and cerebral edema
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Number of osmoles in NaCl, KCl, CaCl2?
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nacl = 2
Kcl = 2 CaCl2 = 3 |
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Formula for converting molecular weight to mEq/mL
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concentration of solution x 1 equivalent x 1000 mEq
-------------- ----------- molecular weight 1 |
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Per Aspen guidelines, how long can a well nourished adult without excessive stress go with little to no nutrition
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7 days
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Contraindications of Enteral nutrition include
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- complete intestinal obstruction
- Gi fistula - extreme short bowel - severe vomit / diarrhea - intestinal inschemia - paralytic ileus |
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What type of EN delivery must be used for duodenal of jejunal feedings
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Continuous infusion. Reduced risk of aspiration compared to bolus feeding
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What type of EN delivery can only be used for feeding tubes ending in the stomach
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Intermittent bolus feeding 100 - 300ml for 30 - 60 mins every 4 - 6 hours
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Benefits of Enteral nutrition
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- reduced risk of infection (compared to pn)
- shorter los - reduced risk of gi atrophy NOTE - if the GI tract works, use it! |
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What type of EN formula is used for patients with reduced digestive capacity (pancreatitis, short bowel)
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Elemental formula. expensive. Petamen, Optimental, Vital HN, Vivonex TEN
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Most commonly used EN formula for majority of patients who have normal digestive proscesses
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Intact or Polymeric. Osmolite, Isocal (1 to 1.2 kcal/ml). inexpensive.
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When is excessive CO2 production caused during EN Feeding?
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Overfeeding with total calories causes excessive CO2 production. this is not necessarily due to total dextrose in formula
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How is aspiration pneumonia prevented during EN
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- Keep head of bed elevated 30 - 45 degrees
- Gastric residuals < 500 ml |
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How is clogged feeding tube prevented
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- flush before, during and after administration of drug
- unclog - cola, warm H2O, NaCo3, pancreatic enzyme |
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Meds used to promote gastric motility during EN feeding if necesary
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metoclopramide 5 - 20mg q 6, or erythromycin 250mg q 6 - 8) administer x 24 hours or until en tolerated. Can combine the two
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When does hypernatremia occur with EN feeding
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Patient not given sufficient water.
Requirement is 1 ml water for each calorie more common in calorie dense formulation (1.5 - 2 kcal/ml) |
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T/F. According to Aspen guidelines, in the absence of other signs of intolerance, holding EN for gastric residual < 500 should be avoided>
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True
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How much sterile water should be used to dilute Liquid Medication administered through EN tube
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2 - 3 times the medication volume
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How much sterile water should be used to flush tube before and after medication administration through EN tube
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20 ml
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How are capsules/tablets administered through EN feeding tube
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mix in 10 - 15ml of sterile water, administer each med seperately
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Examples of meds that require EN feeding to be stopped when administered
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fluoroquinolone, phenytoin, warfarin, bisphosphonate
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Max osmolality of PN if administered in peripheral vein
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900 mOsm, also can use peripheral vein if PN is expected to be used < 2 weeks
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Indication for Parenteral nutrition
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- Pt can't be fed for 7 days
- inability to meet needs with EN - severe pancreatitis - peritonitis - severe IBD - Bowel resection/obstruction |
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Max final concentrations of AA, dextrose, Ca+, K+ in PN
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AA - 2.5 - 4%
Dextrose - 10% Ca+ - 5 mEq/l K+ - 40 mEq/l |
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Max infusion rate for Lipid emulsion
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0.1g/kg/hr
Rapid adm = hypertriglyceridemia, h/a, fever, cyanosis, dyspnea, nausea |
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How is microbial growth in lipid infusion reduced
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- administer lipid emulsion in 12 hours
- use a 3 in 1 formula (lipid mixed with dextrose andAA, reduces pH and increases osmolarity) |
