MEDICAL NURSING II - Fluid Therapy

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What is a buffer?: A buffer is a substance that decreases the body's change in PH.
What is a colloid?: A colloid is a type of fluid that consists of small particles that do not settle out.
What is an electrolyte?: An electrolyte is a substance with disassociated ions.
What is hyperkalemia?: Hyperkalemia is an excess of potassium in the blood.
What is hypernatremia?: Hypernatremia is the excess of sodium in the blood.
What is hypokalemia?: Hypokalemia is a deficiency of potassium in the blood.
What is hyponatremia?: Hyponatremia is a deficiency of sodium in the blood.
Which 2 electrolytes are vital to movement of muscles?: Electrolytes vital to movement of muscles are sodium and potassium.
What is hypovalemia?: Hypovalemia is a decreased volume of circulating blood.
What is metabolic acidosis?: Metabolic acidosis occurs when kidneys cannot reabsorb bicarbonates, resulting in a breakdown of muscle tissue and accumulation of fatty acids in the blood.
What is metabolic alkalosis?: Metabolic alkalosis is an increase in the body's PH level.
What is turgor?: Turgor is the degree of elasticity of skin.
What are 5 major reasons for administering fluid therapy?: Fluid therapy is administered for hydration, to replace lost blood volume, to replace essential electrolytes, to provide nutrients, and to be used as a vehicle infusion of medications.
What is TBW?: TBW is total body water, otherwise known as body volume.
What percentage of total body weight is accounted for in total body water?: Total body water or body volume accounts for 60% of the total body weight.
What are the 4 steps to be accomplished before fluid therapy is started?: Steps to be performed before initiation of fluid therapy are: weighing the patient, estimating percentage of dehydration and fluid deficit, calculating maintenance needs, and estimating ongoing fluid loss.
Why is close monitoring of a patient undergoing fluid therapy important?: Fluid therapy must be monitored so as to not volume overload the patient.
What are clinical signs that a patient has been volume overloaded?: A volume overloaded patient will be swollen, with a depressed heart rate and crackling and gurgling in the lungs.
How is ongoing fluid loss estimated?: Ongoing fluid loss estimates must taken into account probable amounts lost thru urination, diarrhea, defecation, and vomiting.
How is the percentage of dehydration and fluid deficit estimated?: Percentage of dehydration and fluid deficit estimates are based on assessment of turgor of skin.
Which 4 history questions will aid in gathering information pertinent to fluid restoration?: Information that should be obtained about the patient to aid in fluid restoration should regard: vomiting and diarrhea, polyuria and polydipsia, anorexia, and rapid weight loss.
Which 5 physical exam assessments need to be made to determine the potential need for fluid therapy?: Fluid therapy assessments include: body weight, skin elasticity or turgor, pulse character and rate, mucous membranes, and capillary refill time.
What is the pulse character and rate of dehydrated animals?: Dehydrated animals will typically have a shallow rapid pulse.
What will be the condition of mucous membranes in an animal suffering from shock?: An animal suffering from shock will have pale pink to grey mucous membranes that are tacky and dry.
What are the capillary refill times to describe normal, mild dehydration, moderate dehydration, and severe dehydration conditions?: Normal CRT is <1, mild dehydration is a CRT of <1.5, moderate dehydration is a CRT of <1.5-2.0, and severe dehydration is a CRT of >2.5.
What are 3 common laboratory findings used in fluid therapy?: Laboratory findings used in fluid therapy are packed cell volume, total protein, and urine specific gravity.
What is PCV?: PCV is packed cell volume, in which laboratory findings will be elevated in an animal suffering from dehydration.
What is TP?: TP is total protein, which will show elevations in laboratory findings in a dehydrated animal.
What is USG?: USG is urine specific gravity, which measures concentration of urine or concentrating abilities of kidneys.
By which 4 main routes is water lost from the body?: Water is lost from the body by urinary, fecal, respiratory, and cutaneous routes.
What is the purpose of urinary water loss?: The purpose of urinary water loss is to expell wastes and excess fluids.
What are normal factors affecting the quantity of water lost through fecal functions?: Water quantity through fecal functions in a normal animal are affected by the species, diet, and unrelated diseases.
How is water lost through respiratory functions?: Water is lost through respiratory functions by panting, which causes normal expulsion of moisture from lungs.
How is water lost through a cutaneous route?: Water is lost through a cutaneous route via sweating.
What is the formula for computing total fluid needed?: Total fluid needed is computed by adding together deficit, maintenance, and contemporary losses.
What are contemporary losses as used in fluid therapy?: Contemporary losses as used in fluid therapy are those that are estimated from amounts lost through vomiting, polyuria, diarrhea, and other similiar factors.
What are maintenance fluids?: Maintenance fluids are administered in an amount solely to just maintain viability of life.
What quantity of maintenance fluids should be given to dogs and cats?: Dogs and cats should be given maintenance fluids in the amount of 20 to 30 ml per pound for 24 hours.
What are replacement fluids?: Replacement fluids are given in addition to maintenance fluids in order to replace those fluids lost to dehydration.
What are common conditions causing electrolyte losses?: Common conditions causing electrolyte losses are vomiting and diarrhea, metabolic diseases, anorexia, and malignancy and lactation.
What electrolytes are lost through vomiting and diarrhea?: Electrolytes lost through vomiting and diarrhea are chloride, sodium, potassium, and bicarbonate.
What electrolytes are lost through metabolic diseases?: Electrolytes lost through metabolic diseases are sodium and potassium.
What electrolyte is lost through anorexia?: Anorexia results in the loss of potassium.
What electrolyte is lost through malignancy and lactation?: Malignancy and lactation results in loss of calcium.
What is the purpose of pH?: The purpose of pH is to control homeostasis or chemical balance.
What happens if pH levels have an imbalance or shift?: Any imbalance or shift in pH will result in a corresponding disorder.
What are normal pH levels for blood and urine?: Normal pH level for blood is 6.4 and normal pH level for urine is 7.0.
What is acidosis?: Acidosis is an accumulation of acid in the body, caused by a depletion of bicarbonate and an increase of hydrogen ions.
What are the clinical signs for acidosis?: Clinical signs for acidosis are: muscle twitching, cardiac arrhythmias, disorientation, and possible coma.
What are the 2 types of acidosis?: Two types of acidosis are metabolic and respiratory.
What is respiratory acidosis?: Respiratory acidosis is caused by an impairment to respiratory system in which there has been retention of carbon dioxide.
What is alkalosis?: Alkalosis is a loss of acids without a comparable loss of bicarbonates, in which the high level of bicarbonates causes a decrease in hydrogen.
What are 2 types of alkalosis?: Two types of alkalosis are metabolic and respiratory.
What causes metabolic alkalosis?: Metabolic alkalosis is usually caused by uncompensated loss of acids due to diuretics, vomiting, and diarrhea.
What is the cause of respiratory alkalosis?: Respiratory alkalosis is typically a product of hyperventilation which causes an overexcretion of carbon dioxide from lungs.
What is the trigger mechanism for the respiratory reflex?: Levels of carbon dioxide causes respiratory reflex to initiate.
What is the treatment for acidosis and alkalosis?: Treatment for acidosis and alkalosis is administration of electrolytes to help balance pH.
What are the 2 most common force feeding methods?: The most common force feeding methods are gavage and by nasal gastric tube.
What are 4 common routes used for administration of fluid therapy?: Fluid therapy can be administered by oral, subcutaneous, intravenous, and intraosseous routes.
How is oral administration of fluids performed?: Fluids can be administered orally by free choice, gavage, or nasal gastric tube.
What are the advantages of using an oral route of administration for fluid therapy?: The advantages of using an oral route for fluid therapy are: safest method, most often least expensive procedure, and is the least stressful method to the animal.
What are the disadvantages to using an oral route of administration for fluid therapy?: The oral route of administration cannot be used on vomiting patients, often the patient will refuse to ingest it, it can cause aspiration penumonia if administered too fast, it can only be administered in limited amounts, and is the slowest method.
What are the 2 types of fluids used by oral administration of fluid therapy?: Two types of fluids used in oral administration of fluid therapy are electrolyte powders and premixed formulations.
What are electrolyte powders used in oral administration of fluid therapy?: Electrolyte powders are one type of fluid therapy available in using oral administration, and need to be reconstituted with water before use.
Why is it preferable to reconstitute electrolyte powders with distilled water?: Due to the minerals in tap water, if used in reconstituting electrolyte powders, it can upset the chemical balance of the mixture.
How is fluid therapy performed by a subcutaneous route?: Subcutaneous fluid therapy is performed by injecting substance under skin into subcutaneous layer which is composed of connective tissue.
Why is muscle tissue not used for fluid therapy?: Muscle tissue is not used for fluid therapy because that tissue is so tightly bound it has no capacity to hold sufficient fluid.
What are the advantages of using a subcutaneous route for fluid therapy?: The advantages of using a subcutaneous route are: convenience, no catheter needed, slow absorption which allows for a margin of error, high technical skill not required, and method works well for cats.
What are the disadvantages of using a subcutaneous route for fluid therapy?: The disadvantages of using a subcutaenous route for fluid therapy are: amounts given are limited at each site, slow rate of absorption, fluid will migrate to extremities, and only isotonic fluids can be used.
Why shouldn't hypertonic or hypotonic fluids be administered by subcutaneous route?: Hypertonic or hypotonic fluids administered by a subcutaneous route will cause tissue damage.
What are 3 types of fluid therapies administered by subcutaneous routes?: Subcutaneous fluid therapies are LRS, .9% NaCL, or D5W.
What is LRS?: LRS is Lactated Ringer's Solution which is a composition of water, sodium, chloride, and potassium, with lactate added to act as a buffer.
What is .9% NaCl?: .9% NaCl is 9% sodium chloride or also called normal saline, and is considered the fluid additive closest in composition to the plasma makeup of the blood.
What is D5W?: D5W is 5% dextrose, which is 5 grams of dextrose per 100 ml of distilled water.
Why is D5W not a good choice if fluid therapy is to be given in large amounts?: D5W is not a good choice to be given if large amounts of fluid therapy are needed because it will pull fluids from tissues and cause damage.
What 2 factors should be considered in administration of subcutaneous fluid therapy?: Subcutaneous fluid therapy should be administered to more than one site to prevent overflooding, and should be performed using a 20 to 18 gauge needle.
What is the subcutaneous administration rate for cats and small dogs?: The subcutaneous administration rate for cats and small dogs is a maximum of 100 ml per site, using redirection when possible.
What is the subcutaneous administration rate for large dogs?: The subcutaneous administration rate for large dogs is 200 ml per site, using redirection when possible.
Which route is the fastest for administration of fluid therapy?: The route for fastest administration of fluid therapy is intravenous because fluids are administered directly into blood stream.
What are the advantages of using an intravenous route for fluid therapy?: The advantages of using an intravenous route are: rapid absorption, capability to administer large volumes, causes minimal amounts of stress to patient, fluid choices are not limited, and it provides a vehicle for IV drugs.
What are the disadvantages of using an intravenous route for fluid therapy?: The disadvantages of using an intravenous route for fluid therapy are: less margin for error, most expensive method, requires hospitalization and close monitoring, has a higher occurence of infection, and can easily cause overhydration.
What are the two categories of fluids used intravenously?: Two categories of fluids used intravenously are crystalloids and colloids.
What are crystalloids?: Crystalloids are water based solutions.
What are colloids?: Colloids are used to replace blood factors and have a high molecular weight.
What are 2 types of crystalloids?: Two types of crystalloids are isotonic and hypertonic formulations.
What are 4 types of isotonic crystalloids used in fluid therapy intravenously?: Isotonic solutions used intravenously in fluid therapy are LRS, normal saline, D5W, and Normosol R.
What is the difference between Normosol R and LRS?: Normosol R has the same composition as LRS with the addition of magnesium.
Which hypertonic solution is used intravenously in fluid therapy?: A hypertonic solution used intravenously is 4 or 7 % NaCl, or sodium chloride.
What is the difference between .9% NaCl and 4 or 7% NaCl?: .9% NaCl is considered normal saline, and 4 or 7% sodium chloride does not have the composition of plasma.
What are 5 types of colloids used intravenously in fluid therapy?: Types of colloids used intravenously in fluid therapy are Dextran 40 or 80, hetastarch, plasma, whole blood, and packed RBC's.
What are 4 types of plasma?: Four types of plasma are fresh, platelet rich, fresh frozen, and frozen.
What are the characteristics of fresh plasma?: Fresh plasma contains clotting factors.
What are the characteristics of platelet rich plasma?: Platelet rich plasma is blood that has been separated so it spins off the platelets and clotting factors, which are then used.
What are the characteristics of fresh frozen blood?: Fresh frozen blood is a sample that is pulled fresh and then frozen, and contains clotting factors.
What are the characteristics of frozen plasma?: Frozen plasma does not contain clotting factors and is used to replace the lost liquid portion of blood.
How is whole blood used?: Whole blood is used in blood transfusions to replace entire blood volumes that have been lost.
How are packed RBC's used?: Packed RBC's are used in cases of anemia in which oxygen is depleted.
What are 3 types of intravenous catheters?: Types of intravenous catheters are: butterfly, over the needle, and through the needle.
What are the characteristics of a butterfly catheter?: Butterfly catheters are used for short-term infusions, and not used as an in-dwelling catheter.
What are the characteristics of an over the needle catheter?: An over the needle catheter is the most common catheter used, comes in different gauges, and has a stylet over the needle.
What are the advantages of using an over the needle catheter?: The advantages of using an over the needle catheter are: ease of use, and fairly safe type to use.
What are the disadvantages of using an over the needle catheter?: Disadvantages of using an over the needle catheter include: may become dislodged or bent, can only be left in for a maximum of 72 hours, and must be careful with thick skinned or dehydrated animals that needle does not develop a bur on the end.
What are the recommended sizes of over the needle catheters for different animals?: Over the needle catheters should be used as: 24g for puppies, kittens, birds, and pocket pets, 22g for cats and toy breeds, 20g for medium size dogs and cats in shock, 18g for large dogs, sheep, and goats, 16g for horses, and 14g for cows and horses.
What are the characteristics of a through the needle catheter?: A through the needle catheter has a stylet running inside the needle which is 8 to 14 inches in length, only to be used in jugular for short term use.
What are the advantages of using a through the needle catheter?: A through the needle catheter is able to administer large volumes rapidly and can measure arterial pressure.
What are the disadvantages of using a through the needle catheter?: Through the needle catheters are more likely to cause infection, are difficult to place, and must be placed aseptically.
What are supplies needed for catheter placement?: Supplies needed for catheter placement are: clippers with #40 blade, surgical scrub, antibiotic ointment, sterile gloves, catheter, suture, gauze, vetwrap, tape, and hep flush.
What is the purpose of hep flush in catheter placement?: Hep flush is used to keep catheter patent.
What are 2 types of surgical scrubs used in catheter placement?: Surgical scrubs used in catheter placement are chlorahexadine and betadine.
Which route of fluid therapy is most likely to have an occurrence of contamination in IV tubing or bags?: Contaminations occur most often with subcutaneous routes because of interrupted administration periods.
What supplies are needed to remove a catheter?: Supplies needed to remove a catheter are bandage scissors, cotton ball or gauze, 1 inch tape, and 1 inch vet wrap.
What is the purpose of using intraosseous routing for fluid therapy?: Intraosseous routing for fluid therapy is used when veins are not accessible, especially for kittens and puppies and birds, by administering fluids into bone marrow.
What are the advantages to using an intraosseous route for fluid therapy?: Advantages of using an intraosseous route are: there is an available site even when veins have collapsed, can be used in very small patients in which other routes a catheter would not fit, and can administer large amounts of fluid.
What are the disadvantages to using an intraosseous route for fluid therapy?: Disadvantages for using an intraosseous route are: difficulty of placement, can only be done by vets, painful for patient, can only use substances noncaustic to bone marrow, only patent for 48 to 72 hours, and predisposes animal to osteomyletis.
What administration sites should be used for performing intraosseous fluid therapy on dogs and cats?: Intraosseous sites to be used for dogs and cats are the head of femur or tibia.
What administration sites should be used for performing intraosseous fluid therapy on birds?: Intraosseous fluid therapy for birds should be administered on distal ulna or head of tibia.
What administration site should be used for performing intraosseous fluid therapy for rodents or lizards?: Intraosseous fluid therapy for rodents or lizards should be administered on head of tibia.
What supplies are needed to perform intraosseous fluid therapy?: Supplies needed for intraosseous fluid therapy are: spinal needle with stylet, 2% lidocaine, IV catheter, suture, bandage material, IV set, and sterile gloves.
What are the characteristics of crystalloids?: Crystalloids contain electrolytes and non-electrolyte particles which have ability to pass thru cell membrane, they are an isotonic fluid which performs equalization of intra and extracellular fluid, and are used as a replacement or maintenace type of fluid.
What are the clinical uses for crystalloids?: Crystalloids are used to correct dehydration, as treatment for shock cases, as a vehicle for IV drugs, to aid in maintenance of normal hydration, and as a replacement for electrolytes and nutrients.
What are some of the adverse side effects in the use of crystalloids?: Using crystalloids increases the chance of overhydration, can cause shivering in animal, animal can become restless, can bring on onset of serous nasal discharge, and can result in pulmonary edema if overhydrated.
What is pulmonary edema?: Pulmonary edema is fluid on the lungs.
What are the available forms for crystalloids?: Available forms of crystalloids are bottles, IV bags in sizes of 200-500-1000ml, and pillows of 3000ml.
What are 4 commonly used crystalloid fluids?: Commonly used crystalloid fluids are physiologic saline, Lactated Ringer's Solution, Ringer's solution, and D5W.
What is the difference in composition between LRS and Ringers solution?: The difference in composition between Lactated Ringer's Solution and Ringers Solution is that the latter has no lactate and has more sodium, chloride and calcium.
What is the purpose of using physiologic saline?: The purpose of using normal saline is to increase the plasma volume, to replace sodium deficit, and to keep tissues moist during surgery by bathing.
When would using normal saline be contraindicated in fluid therapy?: Normal saline would be contraindicated in fluid therapy in use with animals with heart conditions, as the sodium increases blood pressure and makes the heart work harder.
What are the characteristics of Lactated Ringer's Solution?: LRS is classified as a balanced fluid, contains lactate as a buffer which is converted by the liver into bicarbonate which helps to relieve condition of acidosis.
When is using LRS contraindicated?: LRS is contraindicated in blood transfusion use due to the calcium content possible causing the blood to clot.
What are the characteristics of D5W?: D5W is classified as a non-balanced solution because it is the equivalent of administering water, is a combination of water and dextrose, and is not used commonly.
Why is D5W not administered subcutaneously?: D5W is not administered subcutaenously because it will draw fluid out of the cells to create balance, resulting in dehydration.
What are the characteristics of colloids?: Colloids contain heavy large molecules which typically do not pass thru cell membranes, and are very expensive to administer.
What are the clinical uses of colloids?: Colloids are used to expand the plasma, especially in cases of septic shock or hypovolemia.
What are possible adverse side effects in using colloids?: Adverse side effects in using colloids are clotting deficiencies and allergic reactions.
What are 2 types of colloids?: Two types of colloids are dextran and hetastarch.
What are the characteristics of dextran?: Dextran comes in concentrations of 40 or 80%, is a very good treatment for shock, and is a polysaccharide.
What is a polysaccharide?: A polysaccharide is a multiple sugar complex.
What are the characteristics of hetastarch?: Hetastarch is a starch complex which is used most often in cases of hypovolemia and hypoproteinemia.
What are hypertonic colloid solutions?: A hypertonic solution are formulations of sodium chloride in percentages other than 9%.
Why are the clinical uses for hypertonic solutions?: Hypertonic solutions are used for the treatment of shock associated with trauma, endotoxemia, burns, pancreatitis, and major surgical procedures.
What are possible adverse side effects in using hypertonic colloid formulas?: Possible adverse side effects in using hypertonic colloid formulas are phlebitis, tissue irritation, electrolyte imbalance, and have a potential for hypotension, bradycardia, and bronchoconstriction if administered too quickly.
What are available forms of hypertonic colloids?: Hypertonic colloids are most commonly in 4 or 7% solutions, but also available in 3, 5, and 23.4% solutions.
What are 5 common fluid therapy additives?: Common fluid therapy additives are sodium bicarbonate, potassium chloride, calcium, 50% dextrose, and vitamin supplements.
What are the clinical uses of sodium bicarbonate as a fluid therapy addition?: Clinical uses for sodium bicarbonate are for treatment of metabolic acidosis, hyperkalcemia, and hyperkalemia.
What are possible adverse side effects in using sodium bicarbonate as a fluid therapy additive?: Possible adverse side effects in using sodium bicarbonate are development of metabolic alkalosis and hypokalemia if overdoses and an imbalance results.
What are the available forms for sodium bicarbonate to be used as a fluid therapy additive?: Sodium bicarbonate is available in liquid form in 5 and 8% solutions.
What are the characteristics of using potassium chloride as a fluid therapy additive?: Potassium is used frequently to supplement potassium deficit.
What are the clinical uses of potassium chloride as a fluid therapy additive?: Potassium chloride is used to treat hypokalemia.
What can bring on the condition of hypokalemia?: Hypokalemia can occur with diarrhea, anorexia, and diuresis.
What are possible adverse side effects in using potassium chloride as a fluid therapy additive?: Possible adverse side effects in using potassium chloride are muscle weakness, cardiac conduction, and hyperkalemia if overmedicated.
What are the clinical uses of calcium as a fluid therapy additive?: Calcium is used to treat milk fever in cows, hypokalcemia, and overexerted horses to prevent muscle spasms.
What are possible adverse side effects in using calcium as a fluid therapy additive?: Adverse side effects in the use of calcium are possible hypotension, cardiac arrhythmia and cardiac arrest if infused too rapidly as well as hyperkalcemia if administered in too high a dose.
What are the clinical uses of 50% dextrose as a fluid therapy additive?: 50% dextrose is used as a supplement to provide energy, and treatment of ketosis in ruminants.
What are the clinical uses of vitamin supplements as a fluid therapy additive?: Vitamin supplements are used during large amounts of fluid therapy because kidneys do not have as much to to reabsorb nutrients, and for restoration of water soluble vitamins.
What are 3 water soluble vitamins used in fluid therapy additives?: Water soluble vitamins used in fluid therapy are vitamin B complex, thiamine hydrochloride B1, and Cyanocobalamin B12.
What are 4 fat soluble vitamins used as fluid therapy additives?: Fat soluble vitamins used in fluid therapy are vitamins A, D, E, and K.
Which vitamin is used as a fluid therapy additive to treat lead poisoning in bovines?: Thiamine hydrochloride B1 is used to treat lead poisoning in bovines.
What condition can be caused by vitamin D deficiencies?: Rickets can be caused by vitamin D deficiencies.
What vitamin is used to reduce scar formation?: Vitamin E is used to reduce scar formation.
Which vitamin is important to clotting processes?: Vitamin K is important to blood clotting processes.
What is a possible adverse side effect in using vitamin K as a fluid therapy additive?: Use of vitamin K may cause hemorrhaging at intramuscular site at start of therapy.

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