An Tech IV: Fluid Therapy Review

Describe the clinical signs:

<5% dehydrated.

• No obvious clinical signs.

• Skin turgor <2 seconds.

Describe the clinical signs:

6-8% dehydrated —— mild dehydration

• Skin is inelastic and leathery.

• Skin turgor >3 seconds.

• Eyes dull and slightly sunken.

• Tacky to dry MM.

Describe the clinical signs:

**8-10% dehydrated —— moderate dehydration

• Skin elastic and leathery.

• Skin turgor >3 seconds.

• Eyes dull and sunken.

• MM tacky to dry.

• Increased HR.

**Describe the clinical signs:

10-12% dehydrated —— dehydration

• No elasticity to skin.

• Skin turgor pronounced.

• Eyes dry and deeply sunken.

• MM will be cynotic.

• CRT prolonged or absent.

• Increased HR and weak pulse.

**Describe the clinical signs:

12-15% dehydrated.

• Patient is in shock.

• Death is imminent.

What is the first stage of fluid therapy? What are the indications used to determine which phase we should start out therapy at?

Resuscitation

• Aimed at restoration of vascular restoration

What is the second phase of fluid therapy? What are the indications used to determine which phase we should start out therapy at?

Replacement phase

• Once resuscitation is achieved/isn’t needed.

• Correct dehydration.

• Replace ongoing losses.

What is the third phase of fluid therapy? What are the indications used to determine which phase we should start out therapy at?

Maintenance phase

• Once dehydration + ongoing losses are corrected.

• Patient presents with ongoing losses, but no dehydration.

List reasons why fluid therapy would be administered in patients.

• Maintaining hydration

• Correcting hydration

• Replace ongoing losses

• Treating shock + hypovolemia

• Improving urine output

• Correcting electrolyte disorders

• Maintaining IV access

1. What type of fluids would be used for SQ fluids?

2. What temperature should they be at?

3. How long does it take for them to absorb?

4. How much can be given at each site?

• Isotonic fluids.

• Body temperature.

• 6-8 hours.

• No more than 5-10 mls/# at each site.

What are the fluid compartments found in the body?

How much water is found in each compartment?

What are their barriers?

• Intracellular.

  • 30-40% fluid

• Extracellular

  • 16-20%

• Interstitial.

• Intravascular.

• Barriers: Cell membrane and vascular endothelium

What are insensible and sensible losses? Give an example of each.

Insensible losses: non-measurable losses.

• panting and sweating (resp)

Sensible losses: measurable losses.

• urine, fleas, vomiting, etc..

What is the difference between macro and micro drip sets?

Give an example of sizes for each drip set.

What patient info. would you use to determine which size drip set you would use?

Macro:

• Administer 1mL of fluid in 10,15, and 20gtts.

• Most common drip set used.

Micro:

• Administers 1mL of flui in 60gtts.

• Commonly used with pediatrics and animals under 10kg (22#).

What is one pound of BW equaled to in mLs?

1 pint or 480 mL of fluid.

Hydrostatic pressure:

The force that pushes a liquid. (think blood pressure).

Osmotic pressure:

The force of water moving from one side of a membrane to the other (osmosis).

Oncotic pressure:

The difference between the osmotic pressure of blood and the osmotic pressure of interstitial fluid.

What is occurring with metabolic pH imbalances? Give examples.

Metabolic acidosis: retaining acids for too long.

• kidney dysfunction

Metabolic alkalosis: losing too many acids.

• vomiting

What is occurring with respiratory pH imbalances? Give an example of each.

Respiratory acidosis: Hypoventilation.

• Build up of CO₂

Respiratory alkalosis: Hyperventilation.

• Too little CO₂

What is the difference between passive and active membranes?

Passive: requires no energy for fluid to leave/enter the cell.

Active: requires energy and carrier protein for fluids to enter/leave the cell.

What information is used to calculate manual drip rate for fluid therapy replacement?

• Amount of fluid to be given.

• Drip set size.

• Amount of time fluids are to be administered over.

What are a few ways that we can discuss dehydration in a patient?

• Skin turgor

• MM

• CRT

• Peripheral pulse

Capillary refill time can be used to indicate what in our patients?

Peripheral pulse/perfusion (local perfusion).