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Nursing Test 2
| Question | Answer |
|---|---|
| The normal adult body is approx _________ fluid by weigjt | 70% |
| If dehydration reaches _________ fluid by weight the animal will die if not treated | 60% |
| What is the normal fluid in take | 50 ml/kg/day |
| what is the normal output of fluids | 1-2 ml/kg/hr |
| what 4 outputs are hars to measure | respiratory losses, sweat, feces, and milk |
| what is the primary organ that is responsible for controlling output | kidney |
| what happens when output of fluids does not equal input fluids | leas to access in fluids or a decrease in fluids |
| what are the 3 reasons an animal becomes dehydrated | 1. inadequate input 2. excessive output 3. poor control mechanism |
| why would an animal have inadequate input of fluids | -too ill to drink or no water available |
| why would an animal have excessive output | vomiting, diarrhea, burns, haemorrhage or polyuria |
| why would an animal have poor control mechanism | kidney disease, adrenal or pituitary disease |
| what 3 things should you observe about a patients fluid level | -adequate intake -must check for over-hydration or dehydration -monitor acid/base balance and electrolytes |
| when do you start to see dehydration signs | not seen until 5% (</= 7) of body water is lost |
| what percent is moderate dehydration | 6-8% of fluid is lost |
| what percent is severe dehydration | >10% or more fluid is lost |
| 4 signs of moderate dehydration | -skin twists persists 1-2 seconds -mouth and MM are tacky -Eyes are dull -Elevated PCV, TP, BUN |
| 4 signs of severe dehydration | -mouth feels dry -eyes are sunken -pulse weak -extremities cold |
| how many mechanisms does the body have to combat dehydration and how many are hormonal | 5 mechanisms, 2 are hormonal |
| what are the 5 mechanisms to combat dehydration | 1. ADH 2. Aldosterone 3. Thirst 4. Feces 5.Milk and egg product |
| What does ADH stand for | Antidiuretic Hormone |
| process of ADH in dehydration | 1. osmotic pressure is increased 2. pituitary is stimulated to release vasopressin (ADH) 3. ADH causes kidney to retain water 4. results in decreased urine excretion and increased SG 5. as more water is retained the osmotic pressure will decrease |
| process of aldosterone in dehydration | 1. drop in blood pressure causes kidney to release angiotensin 2. Angiotensin causes adrenal cortex to release Aldosterone 4. Aldosterone makes kidney retain sodium 5. sodium retained = water retained 6. increased blood volume results |
| process of thirst in dehydration | 1. increase blood osmotic pressure stimulates hypothalamus 2. this stimulation results in thirst |
| process of feces in dehydration | 1. dehydration can cause dry stool 2. water is reabsorbed from the intestinal tract |
| process of milk/egg production in dehydration | 1. during dehydration milk and egg production will decrease as these are nonessential body functions |
| what 4 things compromise control mechanisms for dehydration and why | 1. Addisons disease (aldosterone not produced) 2. Diabetes insipidus (ADH not produced) 3. Kidney disease 4. Rapid fluid loss (body cant compensate fast enough) |
| what is insensible fluid losses and 2 examples | losses of fluids the body has little control over and are difficult to measure (humidification, sweating) |
| what is sensible fluid losses and 1 example | fluid losses that can be measured (Urine) |
| what 3 things to do you to treat dehydration | -treat the cause -treat the symptoms -supplement with fluids |
| 3 steps to rehydration | 1. decide route to give fluids 2. determine amount of fluids required 3. if IV fluids given, determine drip rate |
| Options for Oral route fluid administration | -fluids free choice -drenching -stomach tube |
| Oral fluid admin advantages | -inexpensive -no need to be sterile -owners can do it |
| Oral fluid admin disadvantages | -cannot do if animal is vomiting -absorbed slowly |
| how many ml can a cat receive of warm fluids by SQ route | 30-50 ml/kg/day |
| how should the SQ route for fluids be divided per site | 50-100 ml/site |
| SQ fluid advantages | -quick and easy -train owners at home |
| SQ fluid disadvantages | -must be sterile -fluids must be isotonic -not as quickly absorbed as IV |
| what is a not commonly used route for fluids | Intraperitoneal |
| the ____________ must be empty before giving IP fluids | bladder |
| For IP fluids prep area between the ____________ and _________. you need to shave and do _______ _________ perp. | umbilicus, pubis, three stage |
| IP fluid advantages | -useful in small animals with poor veins |
| IP fluid disadvantages | -must be sterile -risk of bowel perforation and peritonitis |
| what is the most frequently used route for fluid admin | IV |
| IV fluid advantages | -rapid, effective -best route for critically ill -can give hypotonic, isotonic and hypertonic solutions |
| IV fluid disadvantages | -must be able to catheterize the patient -must use aseptic technique -danger of over-hydration -hard in fractious animals |
| when is Intraosseous fluid admin useful | -small mammals -young mammals -cases of severe shock -when venous is difficult or impossible |
| IO fluid advantages | -large volumes can be given quickly -catheters are easily placed with practice -provides immediate vascular access to systemic circulation |
| IO fluid disadvantages | -possible infection -some degree of difficulty |
| what are the surgery rates for the 1st and 2nd hour | 1st: 5ml/kg.hr 2nd: 2ml/kg/hr |
| maintenance rate in dogs and cats and what rate can you NOT exceed in cats | 50ml/kg/24hrs (DO NOT EXCEED 150ml/hr in cats) |
| Shock rate for dogs and cats | Dogs: 90ml/kg/hr Cats: 45ml/kg/hr |
| what is the max amount of time a shock rate can be given for and how is most often given | max 1 hr -mostly given in bolus in 15-20 mins |
| what is edema | localized excess in fluids |
| what is pulmonary edema | excess fluids in the lungs |
| what is ascities | free fluid in the body cavity (abdomen) |
| what is pleural effusion | free fluid in the chest cavity |
| what is the definition of overhydration | entire body has too much fluid |
| what can happen is fluids are given too quickly | can get pulmonary edema |
| what can happen is blood pressure is too high in relation to fluids | often seen with kidney disease, hyperthyroidism |
| what can happen if osmotic pressure is too low in relation to fluids | results in blood leaking from the blood vessels into the body cavities |
| what is the biggest concern with over-hydration and why | pulmonary edema - can be fatal |
| what are the 5 patients that are prone to overhydration | -cats -small patients -animals in heart failure -animals in kidney failure -animals with urinary obstruction |
| 5 effects of over-hydration on an animal with kidney failure | -pulmonary edema (laboured breathing) -cerebral edema (delirium) -myocardial edema (diastolic dysfunction) |
| sings of over-hydration when giving fluids SQ | -edema will be seen in limbs, over shoulders, thorax/abdomen -not painful and not usually dangerous -wait for fluids to absorb before giving more |
| signs of over-hydration when giving IV fluids | -coughing, dyspnea, tears, nasal discharge, crackling on thoracic auscultation |
| what is the treatment of overhydration | -stop administering fluids, tell vet -give a diuretic to remove fluid from lungs (furosemide) -should see improvements in breathing -give 02 to improve respirations |
| how do you tape a IV fluid catheter | tape in 2 places -catheter to the leg -the IV line to the leg place gauze under connecter for comfort |
| what can you use to keep the leg straight during IV fluids | splints |
| what must you do to the jugular catheter to secure it | tape to the neck |
| 3 steps of aseptic technique to administering a catheter for fluids | -shave and surgically prep catheter site -keep catheter and fluid line capped when not in use -Betadine or Chlorhexidine solution used at catheter/skin junction |
| what do you use a Burette for | -when you are concerned about over-hydration -help to measure and control fluid intake accurately |
| what do you do to the line before restarting fluids | -use saline, saline + heparin to flush line |
| how often should you replace a IV fluid catheter | -every 3 days -although if proper care is performed and catheter is removed at first site of problems you can often exceed the 72 hour rule |
| True or False: you must catheterize another vein when changing out the catheter? | True |
| What do you do to the line if you are administering an irritating solution through it and why | Flush BEFORE to ensure catheter is patent Flush AFTER to ensure non remains in the catheter |
| troubleshooting with increased catheter flow | -is the line fully open? -is the catheter disconnected from the line? -has the catheter come out of the leg? -is the leg extended? -has the height of the bag been increased? |
| troubleshooting with decreased catheter flow | -is the animal still alive -is fluid bag empty -is bag high enough -is line kinked -is catheter/fluid line clotted |
| how to tell if the fluid is going in the vein and not perivascular? | -the drip should slow or stop when vein is held off -blood enters IV bag when bag is lowered -when the line is open fluids drip well -there is no swelling around the vein |
| what to do if your fluids are going perivascular | -turn of fluids ASAP -remove catheter -if using irritating substances, inject sterile saline mixed with lidocaine 2% to dilute and relieve pain |
| what is phlebitis | inflammation of the vein |
| what is phlebitis caused by | injection of irritating substance or infection |
| what usually happens in the body when there is phlebitis | -animals tend to develop blood clots which cut off blood flow to distal areas -clots may detach and go elsewhere -lidging of thrombi in the brain or lungs is very dangerous |
| signs of phlebitis at catheter area | -swollen with red/blue discolouration -area will be very painful -distal paw may be swollen as the circulation back to the heart is impaired |
| how to treat phlebitis | -remove catheter -start antibiotics if infection is present -immobilize area to decreased changes of thrombi circulating throughout the body |
| Nursing Care when on IV fluids | keep warm, turn often, observe/monitor, keep clean, analgesia. calories, rest and TLC, over-hydration, keep O and vet informed |
| why do you turn an animal frequently when on IV fluids | many animals will not be able to move so you want to avoid bedsores |
| why must we give calories when an animal is on IV fluids | -IV dextrose does not have enough calories long term, it also doesn't have protein so you must offer food and a supplement if animal in unable or unwilling to eat |
| what is the maximum rate of fluids a dog can receive | 40ml/kg/hr |
| what is the maximum rate of fluids a cat can receive | 20ml/kg/hr |
| when would you use maintenance rate | when animal is not drinking and eating normally or if animal is vomiting |
| when would you use the ongoing losses rate | when animal is vomiting and has diarrhea |
| what are electrolytes | charged ions that contribute to the osmolarity of the body's intracellular and extracellular fluids |
| what are the most common electrolytes found in IV fluids | Na+ (sodium) Cl - (chloride K+ (potassium) Ca2+ (calcium) Mg2+ (magnesium) PO4 (phosphate) |
| what are the nutrients in IV fluids | dextrose, lactate, acetate |
| what must you do if you add nutrients or drugs to an IV bag | - must record what has been added on the bag and must be labeled -change the rate supplements are given |
| what can happen if calcium is added to a bag and the rate is increased | could cause arrhythmias or even cause the heart to stop |
| commonly supplemented electrolytes | -potassium -bicarbonate -calcium |
| commonly supplemented nutrients | -dextrose -amino acids -B vitamins |
| what medications CAN be added to IV fluids | -insulin -dexamethasone -diazepam -barbiturates -antibiotics |
| what fluid can diazepam not be added to and why | -Lactated ringers, it will bind with the calcium in it |
| when would we use oral electrolyte fluids | -treat mild dehydration -useful in calves and foals with diarrhea |
| what does oral electrolyte fluids have in them? | baking sods, sugars, salt |
| what are advantages and disadvantages of oral electrolyte fluids | Advantages: do not need to be sterile, can be given by owner Disadvantages: not suitable for severely dehydrated/critical patients |
| when giving parenteral fluids what might a hypotonic and hypertonic solution do? | Hypo: will lyse the RBC's Hyper: may aggravate the dehydration already present |
| 3 types of Crystalloid fluid solutions | 1. balanced electrolyte solution 2. saline solution 3. dextrose solution |
| which crystalloid fluid solution is the most common | Balanced Electrolyte solutions |
| when are balanced electrolyte solutions useful | useful in acidotic animals |
| when are balanced electrolytes solutions not used | -avoided in animals with alkalosis, liver problems as they require metabolism |
| 3 examples of a balanced electrolyte solutions | -lactated ringers -normasol-R -Plasmalyte |
| Balanced electrolytes ____________ and contain extra __________. | buffer, calories |
| what strengths are saline solutions available in | -normal 0.9% -half strength 0.45% |
| saline solutions are safe in animals with..... | Hyperkalemia (increases potassium) |
| what does dextrose contain | water and dextrose, but no + electrolytes |
| what is the variation of strengths in dextrose solutions | 2.5%-50% (5% is the most common) |
| dextrose has some _____________ but not enough for long term maintenance | calories |
| when is dextrose useful | animals prone to hypoglycemia, diabetic animals, neonates, small animals, patients undergoing surgery |
| where can you not give dextrose and why | SQ because abscesses and sloughing may occur |
| what causes electrolyte imbalances | -diet -fluid supplementation -metabolic disease |
| commonly deficient electrolytes | -sodium (hyponatremia) -potassium (hypokalemia) -calcium (hypocalcemia) -bicarbonate (acidosis |
| common electrolytes found in axcess | -potassium (hyperkalemia) -calcium (hypercalcemia) -hydrogen (acidosis) |
| how are electrolyte balances diagnosed | -through blood testing, educated guesses, blood chemistry machines, observing the animal, knowing the history |
| what are the important electrolyte imbalances | sodium, potassium, and calcium |
| what is the chief electrolyte in extracellular fluid in the body | sodium |
| what does sodium maintain | water balance |
| what are sodium levels controlled by | controlled by aldosterone, acts on kidneys to retain sodium rather than excrete it |
| what happens with Hypernatremia (increased sodium) | -retention of water -increase blood volume -increase blood pressure |
| what is the primary condition associated with hyponatremia | Addison's disease |
| what happens during hyponatremia | -adrenal gland does not produce aldosterone -aldosterone causes kidney to retain sodium and excrete potassium -if no aldosterone there will be an decrease in sodium and increase potassium -abnormal Na:K ratio |
| when can hyperkalemia be seen in animals with... | -addisons disease -severe renal disease -urinary obstructions -acidotic animals |
| what are clinical signs of hyperkalemia | -bradycardia -ECG would show small P wave and large T wave -paralysis |
| treatment of hyperkalemia | -treat underlying cause -IV fluids flush out excess potassium -in severe cases treat with bicarbonate, glucose and insulin will help restore potassium back into the RBC's |
| when can hypokalemia be seen in animals.... | -anorexic animals -on fluids without potassium (saline) |
| clinical signs of hypokalemia | -anorexia -vomiting -muscle weakness -ventroflexion of neck and head in cats |
| treatment of hypokalemia | -oral or IV potassium -best to slowley correct to avoid inducing hyperkalemia |
| what is calcium involved in, in the body | -blood coagulation -heart beat regulation -muscle contraction -nerve transmission -structure of bones and teeth |
| what is calcium controlled by | parathyroid gland, which releases PTH and calcitonin |
| what does vitamin D help with | increases intestinal absorption of calcium and phosphorus |
| which is more common hypercalcemia or hypocalcemia? | hypocalcemia |
| when would you find hypercalcemia | -accidental finding, sample is lipemic or young growing animal) -often due to cancer somewhere in the body |
| clinical signs of hypocalcemia | -tachycardia -poor nerve conduction -weak muscle contraction -seizures |
| when would you find hypocalcemia | -puppies/kittens/rabbits on low calcium diets and will have bery soft bones |
| treatment of hypocalcemia | calcium supplements as well as vitamin D |
| hypocalcemia can also be seen in dogs and cats in the middle of their ___________. common in small dogs with large litters ____to____ weeks after giving birth | lactation, 3-4 |
| clinical signs of hypocalcemia of a lactating mother | -muscle tremors, weakness, high temps, seizures |
| treatment of hypocalcemia in a lactating mother | 10% calcium gluconate solution given slowly IV |
| prevention of Hypocalcemia in a lactating mother | feed a high quality growth or lactation diet during the last trimester of pregnancy and during lactation |
| hypocalcemia can occur by the accidental removal of what gland | parathyroid |
| where are the parathyroids located and how many are there | 4 small glands located behind the thyroid glands |
| signs if the animal has accidentally had their parathyroid glands removed during a thyroid removal surgery | -animal develops seizures a few days after thyroid surgery |
| treatment if parathyroid gland is removed | lifetime supplementation of vitamin D and calcium |
| what is milk fever and what species is it seen in | -seen in dairy cattle in early lactation -soon after calving there is a high demand for calcium -therefore calcium is therefor mobilized from the rest of the body |
| clinical signs of milk fever | muscle weakness, tachycardia, slowing of digestive tract, do not stand/defecate or eat |
| treatment of milk fever | -IV calcium borogluconate given slowly -after a few mins the cow will often lift her head, defecate. and stand |
| prevention of milk fever | -feed proper diet during gestation -give vitamin D one week prior to calving or give calcium gel PO after calving |
| 5 rules for choosing fluids | 1. avoid dextrose SQ 2. if hypoglycemic give destrose IV 3. be aware of buffers in fluids 4. colloids may be preffered over crystalloids in patients which IV rapid expansion is desired 5. K+ or bicarbonate can be added to IV fluids with caution |
| colloids VS crystalloids | Crystalloids: -aqueous solution of mineral salt and other water soluble molecules -included blanced electrolyte solutions Colloids: -contain larger insoluble molecules such as gelatin -can be synthetic (hetastarch) or natural (blood) |
| what is the similarity between colloids and crystalloids | both are volume expanders |
| what pH is neutral | 7.0 |
| blood acid/base balance is controlled precisely and even a minor deviation from normal range can affect ______ ________. | many organs |
| what is acidosis | condition where blood has too much acid (or too little base) resulting in a decreased blood pH <7.35 |
| what is alkalosis | condition where the blood has too much base (or too little acid) resulting in an increased blood pH >7.45 |
| 3 ways the body controls acid/base balance | 1. excess acid is excreted by the kidneys 2. body uses pH buffers in the blood 3. respiratory control centers and lungs |
| what is acid excreted in the form of | ammonia |
| what is the most important buffer in acid/base balance | bicarbonate and works in equilibrium with carbon dioxide |
| how does the respiratory control blood pH | controls blood pH minute by minute by regulating the speed and depth of breathing |
| what is carbon dioxide a by-product of | metabolism of oxygen |
| what are the 2 ways acidosis and alkalosis can be categorized and depending on what | -metabolic or respiratory depending on their primary cause |
| what is the equation called that explains the relationship of the metabolic and respiratory control of acid/base balance | Carbonic Acid or CO2 hydration equation |
| what is the process of metabolism in a normal animal | -hydrogen ions are constantly produced -these ions are temporarily buffered -then removed by the body thru kidney excretion |
| when does an animal become acidotic | -when they generate a large amount of acid -the kidney is unable to remove it |
| what is the most common acid/base abnormality | metabolic acisosis |
| level of ___________ influences the hydrogen concentration in the body | CO2 |
| what happens if there is a increased depth and rate of respirations | CO2 is blown off = decreased CO2 in the body which means respiratory alkalosis aka hyperventilation |
| hypoventilation happens when..... | decreased resp rate and/or depth = CO2 levels will rise increasing the hydrogen ions in the body which means respiratory acidosis |
| when does metabolic and respiratory alkalosis occur | after prolonged vomiting where the animal loses both hydrogen and chloride ions |
| 5 conditions that often result in metabolic acidosis | 1. renal failure or urinary obstruction 2. ethylene glycol poisoning 3.diabetes mellitus 4.grain overload 5.shock/cardiac arrest |
| what happens during ethylene glycol poisoning | -toxin that once ingested changes to oxalic acid in the liver and decreases the blood pH |
| what is diabetes mellitus and how does it work | -lack of insulin resulting in animals not being able to metabolize carbohydrates and body uses fast as energy source -metabolism of fat results in production of ketone bodies -ketone bodies are a form of acid |
| why is grain overload a common condition of metabolic acidosis | -when a ruminant eats a large amount of grain, fermentation takes place in the lumen and produces lactic acid -lactic acid is then absorbed in the blood stream which results in a decreased blood pH |
| why is shock or cardiac arrest a common condition of metabolic acidosis | -oxygen is not able to be delivered to tissue -cells must undergo anaerobic metabolism -a by product of this is lactic acid which accumulates |
| treatment for metabolic acidosis | 1. remove cause of problem 2. ensure renal function and pulmonary function are adequate 3. provide buffers 4. prove bicarbonate |
| what is the cause of metabolic alkalosis in dairy cattle | LDA or RDA |
| what is the condition LDA in cattle | -the abomasum will dilate and fills with hydrogen chloride -in some causes the abomasum will sometimes twist -when this occurs the hydrogen chloride is sequestered in the abomasum leaving the rest of the body alkaotic |
| how to treat LDA | surgically repair |
| how to treat vomiting | find cause and correct |
| what is respiratory acidosis | when carbon dioxide builds up in the body due to impairment in ventilation |
| causes of respiratory acidosis | 1. anesthesia 2. pulmonary disease or airway obstruction 3. |
| how does the body compensate for respiratory acidosis | ventilation increases in rate and depth, protein buffers absorb hydrogen ions and hydrogen ions are excreted in the urine |
| what is the normal PaCO2 | 40 mmHG |
| if a patient is acidotic and has an elevated _________ the acidosis is respiratory in origin | PaCO2 |
| why is just proving oxygen not sufficient when there is respiratory acidosis | patients must breathe OUT the carbon dioxide, therefore ventilation is needed |
| why does respiratory alkalosis happen | -occurs due to an excessive loss of CO2 through prolonged panting, or persistent over bagging |
| how do you treat for respiratory alkalosis | -correct underlying disorder to decrease the resp rate and depth -renal function should be checked to ensure hydrogen ions can be retained |
| what is the vets role in general treatment of acid/base disorders | -determining status, identifying cause, removing the problem |
| what is the techs role in general treatment of acid/base disorders | must ensure compensatory mechanisms (make sure they can breath and excrete urine) |
| in severe acidosis what additional substance can be given | bicarbonate |
| with alkalosis what can you give an additional substance | NaCI solution will help body excrete excess bicarbonate |
| steps to determine acid/base disorders | 1. determine if animal has acidosis or alkalosis 2. look at paCO2 (if its > or <40mmHg its respiratory) 3. look at paCO2 (if its = 40mmHG its metabolic |
| what is the anion gap | difference between measured concentrations of serum cations and serum anions |
| Calculated equation for anion gap | ANION GAP= ((Na+) + (K+)) - ((CI-) + (HCO3-)) |
| normal values for anion gap | dogs: 8-25 cats: 10-27 |
| what does an increased anion gap suggest | metabolic acidosis and is useful for differentiating the etiology of the metabolic acidosis |
| what can cause metabolic acidosis with an increased anion gap | -ethylene glycol, ketoacidosis, uremia, and lactic acidosis |
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jscott41
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