Neonatal Care, Medical Nursing, and Fluid Therapy

For chapter 24

Transfusion reactions from acute allergic _________ can include erythema, urticaria, and pruritus or anaphylaxis.

Hypersensitivity

If DEA 1.1–positive blood is transfused to a dog with anti-DEA 1.1 antibodies, ________ and _________ will result.

Agglutination; Hemolysis

A solution composed of electrolytes and water is a ______ fluid.

Crystalloid

Fluid resuscitation is aimed at restoration of vascular volume in an effort to reverse _________ and/or a shock state.

Hypovolemia

The __________ is the amount of fluid needed to fulfill the physiologic requirement for water.

Maintenance Rate

Colloids may have the ability to move fluid from the interstitium into the vascular space by increasing the ________ of blood.

Oncotic Pressure

The _______ is a large volume of fluid administered quickly. 

Bolus

Dehydration + Ongoing losses + Maintenance = __________. 

Replacement Fluid Rate

Blood products that can be processed from whole blood include platelet-rich plasma, cryoprecipitate, and platelet concentrate. Of these, _______ has a shelf life of one year.

Cryoprecipitate

Blood transfusion is likely to be necessary if __________ drops to below 20% to 25% during an acute bleeding episode, though the decision should be based on the full clinical picture.

Packed Call Volume (PCV)

TBW

Approximately 60% of body weight

Cell Membrane

Separates the ICF and ECF

ICF

Approximately two-thirds fo TBW

ECF

Approximately one-third of TBW

Vascular Endothelium

Separates the ISF and IVF

ISF

Approximately three-fourths of ECF

IVF

Approximately one-fourth of the ECF

Dextrose 5% in water

Hypotonic

0.45% NaCl

Hypotonic

7% NaCl

Hypertonic

Normosol M

Hypotonic

0.9% Saline

Isotonic

0.45% Sodium Chloride

Hypotonic

Lactated Ringer Solution

Isotonic

3% NaCl

Hypertonic

Plasmalyte 148

Isotonic

Plasmalyte 56

Hypotonic

Normosol R

Isotonic

Canine

Many, including DEA 1.1, 1.2, 3, 4, 5, and 7

Equine

Eight, including Aa, Ca, and Qa

Feline

A, B, and AB

Bovine

More than 70; negative for factor J

Universal canine donor

Positive for only the DEA 4 antigen

Ideal equine donor

Aa and Qa negative

Universal feline donor

No universal donor for this species

Ideal bovine donor

J negative

Washed RBCs

Neonatal isoerythrolysis

Packed RBCs

Anemia

Fresh plasma or fresh-frozen plasma

Replace some coagulation factors

Platelet-rich plasma or platelet concentrate

Thrombocytopenia

Cryoprecipitate

von Willebrand disease

Hyperimmune plasma

Neonatal foals with failure of passive transfer

Read the following statements and write “True” for true or “False” for false in the blanks provided. If a statement is false, correct the statement to make it true. The circulating blood volume of a horse is approximately 40 to 60 mL/kg body weight.

False

The circulating blood volume of a horse is approximately 80 mL/kg body weight

Read the following statements and write “True” for true or “False” for false in the blanks provided. If a statement is false, correct the statement to make it true. Both water and electrolytes are able to move freely across all fluid space barriers (the cell membrane and vascular endothelium) and so distribute throughout the total-body water.

False

Water can move freely across all fluid space barriers, but electrolytes only move freely across the vascular endothelium

Read the following statements and write “True” for true or “False” for false in the blanks provided. If a statement is false, correct the statement to make it true. Colloids tend to remain in the vascular space.

True

Read the following statements and write “True” for true or “False” for false in the blanks provided. If a statement is false, correct the statement to make it true. Dextrose 5% in water is an example of an isotonic fluid.

False

Dextrose 5% in water is an example of a hypotonic fluid because the dextrose is quickly metabolized, leaving free water.

Read the following statements and write “True” for true or “False” for false in the blanks provided. If a statement is false, correct the statement to make it true. Normosol R would be an appropriate fluid choice for a patient with severe acidemia.

True

Read the following statements and write “True” for true or “False” for false in the blanks provided. If a statement is false, correct the statement to make it true. Administration of hypertonic saline IV will promote rapid and long-lasting expansion of the vascular volume.

False

Administration of hypertonic saline IV will promote rapid expansion of the vascular volume that is transient, lasting only 20 to 30 minutes.

Read the following statements and write “True” for true or “False” for false in the blanks provided. If a statement is false, correct the statement to make it true. Routine cross-matching evaluates agglutination reactions but does not test for hemolytic reactions.

True

Read the following statements and write “True” for true or “False” for false in the blanks provided. If a statement is false, correct the statement to make it true. Arterial blood pressure is an accurate indicator of response to fluid resuscitation.

False

Arterial blood pressure is highly preserved and therefore decreases only in advanced stages as the patient decompensates. Along these lines, it is also the first parameter to moralize even through hypovolemc shook may continue. Therefore, changes improvenment in heart rate (HR), capillary refill time (CRT) nucus membrane color, warmth of distal extremities, etc., are better served to should be noted and used to help guide therapy.

Read the following statements and write “True” for true or “False” for false in the blanks provided. If a statement is false, correct the statement to make it true. When calculating the ongoing losses so that the fluid administration rate can be increased appropriately, normal urinary losses should be included in this calculation.

False

When calculating the ongoing losses because of vomiting, diarrhea, etc., normal urinary losses should NOT be included because these losses are accounted for the maintenance rate.

Read the following statements and write “True” for true or “False” for false in the blanks provided. If a statement is false, correct the statement to make it true. Pain or irritation when an IV catheter is flushed is a sign that the vein is inflamed.

True

Read the following statements and write “True” for true or “False” for false in the blanks provided. If a statement is false, correct the statement to make it true. An advantage of subcutaneous fluid administration is that this route works well for resuscitation, replacement, or maintenance.

False

Subcutaneous route should not be used for resuscitation of patients that are hypovolemic or hypotensive, because volume expresssion wil not be rapid enough, adn the peripheral vasoconstriction associated with shock will result in significantly impaired absorption of fluid from the subcutaneous space.

Read the following statements and write “True” for true or “False” for false in the blanks provided. If a statement is false, correct the statement to make it true.   Subcutaneous fluids can be given by a client at home.

True

Read the following statements and write “True” for true or “False” for false in the blanks provided. If a statement is false, correct the statement to make it true. Only certain medications that are safe for IV administration can be given IO.

False

Any medication that is safe dor IV administration can be given IO.

Read the following statements and write “True” for true or “False” for false in the blanks provided. If a statement is false, correct the statement to make it true. Sodium bicarbonate is commonly used to treat a variety of conditions that lead to acidosis.

False

The use of sodium bicarbonate is controversial, and should be reserved for select cases.

Read the following statements and write “True” for true or “False” for false in the blanks provided. If a statement is false, correct the statement to make it true. Sodium bicarbonate can be used for severe cases of hyperkalemia to promote a shift of potassium into the cells.

True

Read the following statements and write “True” for true or “False” for false in the blanks provided. If a statement is false, correct the statement to make it true. A normal blood pressure means everything is fine.

False

The compensatory response is aimed at sustaining blood pressure even though perfusion to some tissues may be impaired. In other words, low blood pressure is bad, but normal blood pressure does not mean that everything is okay.

Read the following statements and write “True” for true or “False” for false in the blanks provided. If a statement is false, correct the statement to make it true. If a patient has severe, acute hemorrhaging, the packed cell volume (PCV) will be decreased.

False

If a patient has severe, acute hemorrhaging, the packed cell volume (PVC) will usually be decreased, but can be normal until body fluid redistributes over that first 12 hours following hemorrhage.

Read the following statements and write “True” for true or “False” for false in the blanks provided. If a statement is false, correct the statement to make it true. The primary goal of blood transfusion is to improve oxygen delivery to the tissues.

True

Read the following statements and write “True” for true or “False” for false in the blanks provided. If a statement is false, correct the statement to make it true. Dogs do not have naturally occurring antibodies to erythrocyte antigens and so a reaction is less likely following a transfusion of red blood cells.

True

Read the following statements and write “True” for true or “False” for false in the blanks provided. If a statement is false, correct the statement to make it true. Like dogs, cats do not have naturally occurring antibodies to erythrocyte antigens, and so a reaction following a first transfusion is unlikely.

False

Cats have naturally occurring circulating alloantibodies to the blood type they do not have, and so are at the risk for reactions of varying intensity following a first transfusion on incompatible blood.

Read the following statements and write “True” for true or “False” for false in the blanks provided. If a statement is false, correct the statement to make it true. Glass blood-collection bottles are preferred over bags because they preserve blood cells more effectively.

False

Glass bottles with vacuum are not recommended as the glass inactivates platelets and can damage the RBCs.

Read the following statements and write “True” for true or “False” for false in the blanks provided. If a statement is false, correct the statement to make it true. o achieve optimal RBC viability during blood storage, blood bags should be weighed to ensure adequate fill (blood-to-anticoagulant ratio).

True

Read the following statements and write “True” for true or “False” for false in the blanks provided. If a statement is false, correct the statement to make it true. Transfusion reactions will not occur as long as major and minor crossmatches indicate compatibility.

False

Compatibility on crossmatch does not guarantee a lock of transfusion reaction and does not accurately predict RBC lifespan.

The circulating blood volume as a proportion of total body weight (mL/kg) is the lowest in a 

a. dog. 

b. horse. 

c. cow. 

d. cat.

d. cat

When 0.9% saline solution is administered intravenously within a short time, ___________________ will remain in the vascular space.

a. one-quarter. 

b. one-third. 

c. one-half. 

d. most of it.

a. one-quarter

Which of the following fluids is not a hypotonic fluid? 

a. 0.45% Saline. 

b. Normosol M. 

c. Plasmalyte 148. 

d. D5W.

c. Plasmalyte 148

Hypotonic fluids are used to treat 

a. shock. 

b. hypernatremia. 

c. hypokalemia. 

d. metabolic acidosis.

b. hypernatremia

Which of the following fluids has an acidifying effect? 

a. LRS. 

b. 0.9% Saline. 

c. Normosol R. 

d. Plasmalyte 148.

b. 0.9% Saline

Three percent or 7% hypertonic saline is used to treat 

a. heart failure. 

b. kidney failure. 

c. head trauma. 

d. hypernatremia.

c. head trauma

Which of the following fluids would increase intravascular oncotic pressure in a patient with hypoproteinemia? 

a. Hetastarch. 

b. Normosol M. 

c. Plasmalyte 148. 

d. D5W.

a. Hetastarch

The shock dose of isotonic crystalloid fluids in a cat is (in mL/kg body weight) 

a. 2 to 4. 

b. 10 to 15. 

c. 40 to 60. 

d. 80 to 90.

c. 40 to 60

What is the correct catheter placement for a patient requiring multiple blood samples to be taken over a period of time or that needs multiple medications given by constant rate infusion?

a. Cephalic. 

b. Central line. 

c. Butterfly. 

d. Peripheral.

b. Central line

Which of the following devices is often used to decrease the risk of fluid overload? 

a. Buretrol. 

b. Administration line filter. 

c. Carboy. 

d. 10 drops/mL drip set.

a. Buretrol

Fluids administered subcutaneously are usually absorbed in approximately 

a. 1 to 2 hours. 

b. 2 to 4 hours. 

c. 6 to 8 hours. 

d. 12 to 24 hours.

c. 6 to 8 hours

Even though it is isotonic, which of the following fluids can cause discomfort when given subcutaneously owing to its acidic pH? 

a. Lactated Ringer solution. 

b. Plasmalyte 148. 

c. Normosol R. 

d. Dextrose 5% in water.

b. Plasmalyte 148

Which of the following routes of fluid administration is used in neonates, because it has essentially the same effect as IV administration but does not require catheterization of a vein? 

a. Intramuscular, 

b. Subcutaneous. 

c. Enteral (via stomach tube). 

d. Intraosseous.

d. Intraosseous

Enteral fluids are often used to treat large-bowel im-paction in 

a. cattle. 

b. cats. 

c. dogs. 

d. Horses.

d. Horses

The combination of PU/PD, cardiac arrhythmias, and severe muscle weakness is very suggestive of 

a. hypokalemia. 

b. hypoglycemia.

c. lactic acidosis. 

d. dehydration.

a. hypokalemia

During the resuscitation phase of IV fluid therapy, arterial systolic blood pressure should be maintained at approximately 

a. 50 to 80 mm Hg. 

b. 80 to 110 mm Hg. 

c. 110 to 140 mm Hg. 

d. 140 to 170 mm Hg.

c. 110 to 140 mm Hg

Given the decreased load in patients with tolerance for sodium heart and kidney disease, ___________________ may be more ideally suited to replace deficits or maintain hydration in these patients. 

a. hypotonic fluids. 

b. fresh plasma. 

c. isotonic fluids. 

d. hypertonic fluids.

a. hypontonic fluids

A significant complication of fluid therapy is fluid overload. Of greatest concern in these patients is the possibility of 

a. coagulation abnormalities.

b. cavitary effusion. 

c. pulmonary edema. 

d. peripheral edema.

c. pulmonary edema

During an acute bleeding episode, a blood transfusion is necessary if the PCV drops below

a. 12% to 15%. 

b. 15% to 20%. 

c. 20% to 25%. 

d. 25% to 30%

c. 20% to 35%

A blood plasma transfusion is not indicated for treatment of 

a. low albumin. 

b. a blood-clotting disorder. 

c. failure of passive transfer of immunity in foals. 

d. anemia.

d. anemia

Canine blood-typing cards are used to detect 

a. DEA 1.1. 

b. DEA 1.2. 

c. DEA 4. 

d. DEA 7.

a. DEA 1.1

Which of the following statements regarding blood transfusions is most accurate? 

a. Transfusion of type A blood into a type B cat will result in decreased life span of transfused cells.

b. Transfusion of type B blood into a type A cat is expected to cause a severe, potentially fatal hemolytic reaction.

c. Transfusion of type B blood into a type AB cat is not expected to cause a reaction.

d. Transfusion of type AB blood into any cat should not cause a reaction, because this is the universal donor blood type in cats.

c. Transfusion of type B blood into a type AB cat is not expected to cause a reaction

A “major crossmatch” detects between donor RBCs and recipient

a. reactions of a recipient’s plasma with its own RBCs.

b. reactions plasma.

c. reactions between donor plasma and recipient RBCs.

d. reactions of a donor’s plasma with its own RBCs.

b. reactions plasma

The maximum recommended blood donation for dogs expressed as a percent of the blood volume is 

a. 5% to 10%. 

b. 10% to 15%. 

c. 15% to 20%. 

d. 20% to 25%.

c. 15% to 20%

Donor blood plasma is considered to be fresh plasma if used within___________________ hours of collection. 

a. 4. 

b. 8. 

c. 12. 

d. 24.

b. 8

When transfusing blood, it is usually given concurrently with isotonic crystalloid fluids. Which of the following fluids should not be used for this purpose because it can result in activation of the coagulation cascade? 

a. Normosol R. 

b. Plasmalyte 148. 

c. 0.9% Saline. 

d. Lactated Ringer solution.

d. Lactated Ringer solution

Using the rule of thumb provided, if you want to raise the PCV of a 25-kg patient by 10%, you should give approximately 

a. 250 mL of whole blood or packed RBCs. 

b. 500 mL of whole blood or 250 mL of packed RBCs. 

c. 250 mL of whole blood or 500 mL of packed RBCs. 

d. 500 mL of whole blood or packed RBCs.

b. 500 mL of whole blood or 250 mL of packed RBCs

The circulating blood volume of a dog is estimated to be approximately ____ to ____ mL/kg body weight.

80; 90

The two main categories of fluids based on the size of their solute molecules are _______ and ________.

Crystalloids; colloids

A 23% saline solution must be __________ before giving it IV to avoid osmotic injury to the tissues.

Diluted (to no greater than 7.5%)

The product “VetStarch” is a synthetic _______ that has a decreased impact on blood coagulation than hetastarch.

Colloid

The maintenance fluid administration rate includes losses from the following three sources: (a) the _____ system, (b) the ________, and (c) inappropriate ________ losses.

GI; Respiratory; Urinary

A route of fluid administration used in small animals but not usually in large animals is _____________. A route of fluid administration used in large animals but not in small animals is via a(n) ____________ tube.

Subcutaneous or intracosseous; Nasogastric or enteral

Subcutaneously administered fluids should have an osmotic pressure that is approximately ______ to extracellular fluid.

Equal

When tissues don’t receive enough oxygen because of decreased tissue perfusion, the levels of _______ increase.

Lactate