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Questions by Nick and Sergey

Males are 60% and females are 50%

What is the volume distribution of water in the male and female?

As water

How does the body view D5W?

D5W

What solution do you use as a KVO (keep vein open) for congestive heart failure?

As ½ water and ½ nss

How does the body view .45% nss?

A volume expanding solution

What kind of fluid is albumin?

No albumin is given later, initial volume replacement should be .9% Saline

Do we give albumin as an initial volume replacement?

It views it as not having it. Example, if you lose 200ml of fluid into the third space the body no longer counts it as volume.

How does the body view "Third Spacing"?

Intestinal obstruction, Severe pancreatits, Peritonitis, Major venous obstruction, capillary leak syndrome, and BURNS, Compartment syndrome secondary to a fracture

What problems cause Third Spacing?

Air humidity (people in a higher humidity and higher temps are more vulnerable to heat emergencies than someone in high temps with no humidity.)

What environmental situation affects your insensible loss?

Total parenteral nutrition

What is TPN?

They keep close watch on labs during feeds to calculate the next bag of TPN

How is TPN use calculated?

D10W

What solution is given between TPN feedings?

Hyponatremia

What will .45% saline cause in hypovolemia?

A crystalloid that contains lactate ions (K, HCO3, Mg, Ca) and resembles body fluids

What is Ringers Lactate?

It is used to correct metabolic acidosis

When do we use ringers lactate (LR)?

Do not use it in renal failure patients because it can cause hyperkalemia

When do we NOT use LR?

80-1700 cal/liter

How many calories do dextrose solutions contain (D10%, DW)?

A Saline solution

What solution do we give with blood?

To infuse blood, good for dehydration, fluid replacement, and low sodium situations

What are saline solutions good for?

In cardiac, renal or pulmonary patients. Continue to check lung sounds and assess for edema as to not cause fluid overload

When do we use caution with saline solutions?

When 1 liter of NSS is given , 250cc will stay in the intervascular space. To return 1000cc to the space you must infuse 4 liters

What ration does .9% saline infuse at?

60cc per 1 liter stay in the intervascular space

What ratio does 5% dextrose infuse at?

This is called crystalloid resuscitation

If a patient responds to NSS fluids when hypovolumea what kind of resuscitation is this?

Diabetes insipidus, osmotic diarrhea

What kind of loses are from total body water? (all compartments of the body)

Secretory diarrhea, ascites, edema, burns, isotonic dehydration, cloreah, Third Spacing

What are some extracellular fluid loses?

Acute hemorrhage

What is the main intravascular volume loss?

60mg

What is the max IVP (IV Push) dose for lasix?

Thirst, Hypernatremia

What are signs of water depletion?

Cool extremities, reduces sweating, dry mucus membranes

What are signs of depletion?

Poor skin turgor, sunken eyeballs, weight change, hemodynamic effects (vital signs)

What are signs of extracellular depletion?

Always IV (Can be straight or diluted with NSS or DW, Rate of infusion depends on situation)

How do we give 25% Albumin?

Rapid increase in blood pressure

What effect can albumin have?

Crystalloids

What type of solution is most adequate for most situations?

0.9% saline does not diffuse/change across compartments

Does 0.9% saline diffuse across compartments?

0.45% saline will behave; half like water and half like saline

Does half saline diffuse across compartments?

Interstitial fluid

What is another word for extravascular fluid?

Albumin Solution(5%) is yellow, given 100-250cc, and stays in the intravascular space. Salpore Albumin is used to make sure there is no saline in that bag.

What should I know about albumin?

A volume expanding drug or infusion

What is albumin considered to be?

People who initially lost volume will not receive it. The first step is usually to get blood work back and to administer saline. Will NOT see it during the recitation phase of the initial emergency care phase.

When will the patient receive albumin?

It is fluid that has been sequestered in a body compartment that is not in equilibrium with the ECF.

What is third spacing?

A truly devastating injury that causes several problems within the body. It can cause respiratory problems. It can cause swelling in the extremities because fluid cannot come back.

What can burns cause?

Fever, perspiration, acid base balance play a role but the big factor would be humidity in the air. The moisture in the air would determine how much you would sweat off and also affect respiratory rate.

What would be a variable for a person to lose more or less fluid?

It is Total Parental Nutrition which is given through one of the large veins. Each bag is based on the patient's blood work during the bag before it. They are constantly adjusting to each of the electrolytes. This is an expensive procedure. (Central Line Only)

What is TPN?

It is a 1000cc bag or 500cc of normal IV fluid. It contains lactase ions, potassium, bicarbonate, magnesium, calcium.

What is ringer's lactate?

It can cause life threatening hyperkalemia very fast.

What happens if you give ringer's lactate to someone with renal failure?

It would cause hypoatremia.

What happens if you give hypotonic IV solutions (Half saline or quarter saline) to someone who had volume depletion (Example: Fresh post-op or bleed during an accident) ?

Colloid solutions

What are protein containing solutions?

Ringers lactase

What is used to reverse metabolic acidosis in burns?

It is used to expand blood volume in people.

What is dextran (low molecular weight) used for?

Normal saline has no calories and it is typical given with blood products

Does normal saline have calories?

Normal saline (NEVER use Dextrose to flush blood)

What is used to flush blood?

It is good for fluid replacement and low sodium situations.

What is saline good for?

Patients with CHF and pulmonary edema because the sodium in the saline would hold onto the water in the body. Keep listening to the patients lungs and check for edema.

Which patients should not receive saline?

If you infuse a liter of 0.9% saline into someone who is volume depleted and only 250cc will stay in the intravascular space and the rest will be excreted. To have the patient retain a total of 1000cc, the nurse must infuse 4L of that saline.

If you infuse a liter of 0.9% saline into someone who is volume depleted, how many liters will you need if only 250 is absorbed?

Crystalloid resuscitation

What is it called if you give someone 8L of saline to resuscitate (non-protein containing solutions)?

It depletes all the body compartments equally. Some common examples include diabetes insipidus, salt and water loss together (isotonic), burns, ascites, cholera.

What does dehydration do to the body?

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