Ch 25 workbook activities (fluid therapy and transfusion medicine)

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

diluted

true or false? an advantage of SQ 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 expansion will not be rapid enough, and the peripheral vasoconstriction associated with shock will result in significantly impaired absorption of fluid from the subcutaneous space.

3% or 7% hypertonic saline is used to treat

head trauma

destruction of RBCs within the body

hemolysis

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

hetastarch

Enteral fluids are often used to treat large bowel impaction in

horses

hypotonic fluids are used to treat a. shock b. hypernatremia c. kypokalemia d. metabolic acidosis

hypernatremia

an exaggerated immune response to some source of stimulation

hypersensitivity

3% NaCl tonicity

hypertonic

7% NaCl tonicity

hypertonic

a fluid with an osmolality of 1026 mOsm/kg

hypertonic

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

hypokalemia

0.45% NaCl tonicity

hypotonic

a fluid with an osmolality of 154 mOsm/kg

hypotonic

dextrose 5% in water tonicity

hypotonic

normosol M tonicity

hypotonic

plasmalyte 56 tonicity

hypotonic

a decreased circulating blood volume

hypovolemia

0.9% saline tonicity

isotonic

LRS tonicity

isotonic

a fluid with an osmolality of 308 mOsm/kg

isotonic

normosol R tonicity

isotonic

plasmalyte 148 tonicity

isotonic

The ______ rate of fluid administration is needed to meet daily needs

maintenance

Blood group factors in canine

many, including 1.1, 1.2, and 3 through 7

Blood group factors in equine

many, including Aa, Ca, Pa, Qa, and Ua

Blood group factors in bovine

more than 70; negative for factor J

primary indication for hyperimmune plasma

neonatal foals w/ failure of passive transfer

primary indication for washed RBCs

neonatal isoerythrolysis

universal feline donor

no universal donor for this species

___ pressure is the portion of total osmotic pressure contributed by albumin and like substances

oncotic

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

plasmalyte 148

which of the following fluids is NOT a hypotonic fluid? a. 0.45% saline b.normosol M c. plasmalyte 148 d. d5W

plasmalyte 148

A blood product prepared by plateletpheresis

platelet concentrate

a concentrated source of platelets prepared by centrifugation of fresh whole blood

platelet rich plasma

universal canine donor

positive for only the DEA 4 antigen

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

pulmonary edema

primary indication for fresh plasma or fresh-frozen plasma

replace some coagulation factors

The phase of fluid therapy intended to correct dehydration

replacement

the phase of fluid therapy intended to reverse shock

resuscitation

cell membrane

separated ICF and ECF

vascular endothelium

separates ISF and IVF

primary indication for platelet-rich plasma or platelet concentrate

thrombocytopenia

TRALI and TACO are two types of these

transfusion reactions

true or false? SQ fluids can be given by a client at home

true

true or false? colloids tend to remain in the vascular space

true

true or false? dogs do not have naturally occurring antibodies to erythrocyte antigens and so a reaction is less likely following a transfusion of RBCs

true

true or false? hetastarch and 23.4% NaCl can be mixed in a 2:1 ratio to produce a combination fluid that reduces both the total dose of each and the side effects

true

true or false? normosol R would be an appropriate fluid choise for a patient w/ severe acidemia

true

true or false? pain or irritation when an IV catheter is flushed is a sign that the vein is inflamed

true

true or false? sodium bicarbonate can be used for severe cases of hyperkalemia to promote a shift of potassium into the cells

true

true or false? the primary goal of blood transfusion is to improve oxygen delivery to the tissues

true

true or false? to achieve optimal RBC viability during blood storage, blood bags should be weighed to ensure adequate fill (blood-to-anticoagulant ratio)

true

primary indication for cryoprecipitate

von Willebrand disease

Concerning anticoagulants used for blood collection: IF blood is going to be stored, either _________ or ________ anticoagulant should be used. If blood will be transfused immediately, _______ _______ is acceptable. (Used of abbreviations is okay)

CPD or CPDA sodium citrate

A 4-year-old, 50-pound, neutered, male Basset Hound is presents for anorexia and vomiting. He is estimated to be 6% dehydrated. The attending veterinarian orders a diagnostic workup including blood work, urinalysis, and abdominal radiographs. She also orders intravenous lactated Ringer solution. She asks you to calculate the infusion and drip rates based on the sum of (a) the volume necessary to correct dehydration over the first 18 hours, (b) the standard maintenance rate, and (c) the amount necessary to replace ongoing losses. Finally calculate the drip rate in drops/second.

1 drop/2 sec (176 mL/hours) x (1 hour/60 min) = (2.93 mL/min) x (1 min/60 sec) = 0.049 mL/sec x 10 drops/mL = (0.5 drops/sec) = 1 drop/2 sec

A 4-year-old, 50-pound, neutered, male Basset Hound is presents for anorexia and vomiting. He is estimated to be 6% dehydrated. The attending veterinarian orders a diagnostic workup including blood work, urinalysis, and abdominal radiographs. She also orders intravenous lactated Ringer solution. She asks you to calculate the infusion and drip rates based on the sum of (a) the volume necessary to correct dehydration over the first 18 hours, (b) the standard maintenance rate, and (c) the amount necessary to replace ongoing losses. 1. Calculate the fluid deficit of this patient based on the estimated level of dehydration.

1,360 mL 50 lb * 1 lb/2.2 kg = 22.7 kg 22.7 kg * 0.06 * 1L/1 kg = 1.36 L or 1,360 mL

the maintenance fluid administration rate include appropriate losses from the following 3 sources:

1. GI system 2. respiratory tract 3. urinary tract

A 2-year-old NM mix-breed dog weighing 20kg is presented after being HBC. He is estimated to have lost approximately 30% of his blood volume and is shocky. The doctor has ordered a variety of interventions, including IV fluid therapy and a transfusion of whole blood. Now calculate the drip rate in gtt/second. You are using a standard blood administration set rated at 10 gtt/mL. (400 mL/hr)

1.1 drop/sec (400 mL/hr) x (1 hr/60 min) = (6.67 mL/min) x (1 min/60 sec) = (0.11 mL/sec) x (10 drops/mL) = 1.1 drops/sec

A 4-year-old, 50-pound, neutered, male Basset Hound is presents for anorexia and vomiting. He is estimated to be 6% dehydrated. The attending veterinarian orders a diagnostic workup including blood work, urinalysis, and abdominal radiographs. She also orders intravenous lactated Ringer solution. She asks you to calculate the infusion and drip rates based on the sum of (a) the volume necessary to correct dehydration over the first 18 hours, (b) the standard maintenance rate, and (c) the amount necessary to replace ongoing losses. Calculate this patient's infusion rate (in mL/hour) necessary for replacement of the deficit and for maintenance

133 mL/hour total 76 mL/hour (for dehydration) + 57 mL/hour (for maintenance) = 133 mL/hour total

A 4-year-old, 50-pound, neutered, male Basset Hound is presents for anorexia and vomiting. He is estimated to be 6% dehydrated. The attending veterinarian orders a diagnostic workup including blood work, urinalysis, and abdominal radiographs. She also orders intravenous lactated Ringer solution. She asks you to calculate the infusion and drip rates based on the sum of (a) the volume necessary to correct dehydration over the first 18 hours, (b) the standard maintenance rate, and (c) the amount necessary to replace ongoing losses. Using the following formula, calculate the daily maintenance needs for this patient. 132*body weight (kg)(3/4) (Note: This is accomplished on a multifunction calculator by taking the body weight in kg, multiplying it by itself twice (wt*wt*wt), then pressing the square root button twice, and, finally, multiplying the result by 132.)

1373 mL/day 132 * 22.7 (kg)(3/4) = 1373 mL/day

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

15-20%

A 4-year-old, 50-pound, neutered, male Basset Hound is presents for anorexia and vomiting. He is estimated to be 6% dehydrated. The attending veterinarian orders a diagnostic workup including blood work, urinalysis, and abdominal radiographs. She also orders intravenous lactated Ringer solution. She asks you to calculate the infusion and drip rates based on the sum of (a) the volume necessary to correct dehydration over the first 18 hours, (b) the standard maintenance rate, and (c) the amount necessary to replace ongoing losses. Adjust the infusion rate in mL/hour to replace this loss over the next 6 hours (as well as to replace the deficit and provide maintenance).

176 mL/hour 133 mL/hour + 43 mL/hour = 176 mL/hour

If a blood donation is taken from a dog in an amount equivalent to 20% of the blood volume ___________to____________ml/kg intravenous crystalloid fluids should be given to compensate for the fluid loss

20-40

when giving blood to hypothermic patients or those receiving large volumes of blood, refrigerated blood should be warmed to ___

22-37C

A 2-year-old NM mix-breed dog weighing 20kg is presented after being HBC. He is estimated to have lost approximately 30% of his blood volume and is shocky. The doctor has ordered a variety of interventions, including IV fluid therapy and a transfusion of whole blood. By this blood loss estimation (480-540 mL), you determine that this patient needs about one unit of whole blood. During the first 10 to 20 minutes, there was no sign of a transfusion reaction. So the doctor would like you to administer the whole blood at a rate of 20 mL/kg/hour. Calculate the infusion rate (in mL/hour) for this patient.

400 mL/hour 20 kg × 20 mL/kg/hour = 400 mL/hour

A 4-year-old, 50-pound, neutered, male Basset Hound is presents for anorexia and vomiting. He is estimated to be 6% dehydrated. The attending veterinarian orders a diagnostic workup including blood work, urinalysis, and abdominal radiographs. She also orders intravenous lactated Ringer solution. She asks you to calculate the infusion and drip rates based on the sum of (a) the volume necessary to correct dehydration over the first 18 hours, (b) the standard maintenance rate, and (c) the amount necessary to replace ongoing losses. During the first 6 hours, the patient vomited several times into two absorbent pads. The pads by themselves weighed 160 grams each; including the vomitus, the two pads weighed 580 grams. Approximately how much volume (mL) did this patient lose through vomiting?

43 mL/hour 580 g − 320 g = 260 g or 260 mL over 6 hours or 43 mL/hour

A 2-year-old NM mix-breed dog weighing 20kg is presented after being HBC. He is estimated to have lost approximately 30% of his blood volume and is shocky. The doctor has ordered a variety of interventions, including IV fluid therapy and a transfusion of whole blood. Calculate the estimated volume of blood lost (in mL) by this patient.

480 mL to 540 mL 20 kg × 0.3 × 80-90 mL/kg = 480 mL to 540 mL

If incompatible blood is given to a horse for a first transfusion, it takes approximately ___ days for RBC antibodies to form

5-7

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

500 mL of whole blood or 250mL of packed RBCs

A 2-year-old NM mix-breed dog weighing 20kg is presented after being HBC. He is estimated to have lost approximately 30% of his blood volume and is shocky. The doctor has ordered a variety of interventions, including IV fluid therapy and a transfusion of whole blood. The donor dog at your clinic weighs 70 pounds. Calculate the maximum amount of blood you can collect from this donor using the rule of thumb in the text, and determine if this will be enough blood to meet this patient's needs.

540.6 mL 70 lb/2.2 = 31.8 kg. 31.8 kg ×-17 mL/kg = 540.6 mL Yes, it will be enough to meet this patient's needs

A 4-year-old, 50-pound, neutered, male Basset Hound is presents for anorexia and vomiting. He is estimated to be 6% dehydrated. The attending veterinarian orders a diagnostic workup including blood work, urinalysis, and abdominal radiographs. She also orders intravenous lactated Ringer solution. She asks you to calculate the infusion and drip rates based on the sum of (a) the volume necessary to correct dehydration over the first 18 hours, (b) the standard maintenance rate, and (c) the amount necessary to replace ongoing losses. Now calculate the hourly administration rate for maintenance.

57 mL/hour 1373 mL/day divided by 25 hours/day = 57 mL/hour

A 4-year-old, 50-pound, neutered, male Basset Hound is presents for anorexia and vomiting. He is estimated to be 6% dehydrated. The attending veterinarian orders a diagnostic workup including blood work, urinalysis, and abdominal radiographs. She also orders intravenous lactated Ringer solution. She asks you to calculate the infusion and drip rates based on the sum of (a) the volume necessary to correct dehydration over the first 18 hours, (b) the standard maintenance rate, and (c) the amount necessary to replace ongoing losses. Calculate the fluid infusion rate in mL/hour for replacement of this deficit over 18 hours.

76 mL/hour 1360 mL/18 hours = 76 mL/hour

Donor blood plasma that is frozen within ________ hour(s) of collection and is less than ________ month(s) old is considered to be fresh-frozen plasma. Otherwise, it is considered to be frozen plasma.

8 hours 12 months

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

80-90

The ideal equine blood donor is negative for factors ________ and _________.

Aa and Qa

ideal equine donor

Aa and Qa negative

a frozen plasma product

Cryoprecipitate

the ideal bovine donor should ne negative for factor ___

J

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

LRS

the percent of blood volume composed of RBCs

PCV

a "major crossmatch" detects

Reactions between donor RBCs and a recipient plasma

a route of fluid administraion used in small animals but not usually large animals is ___ or ___. A route of fluid administration used in large animals but not small animals is via a ___ tube

SQ or IO nasogastric

signs of a donor-recipient incompatibility on a crossmatch

agglutination

central venous pressure (CVP) is the pressure inside the vena cava. This pressure is used to monitor fluid therapy because it approximates cardiac preload and thereby ___ volume

blood

Tells you the specific erythrocyte antigens present in a donor or recipient

blood type

which of the following statements regarding blood transfusions is the most accurate? a. transfusion of type A blood into a type B cat will result in decreased life span and 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 blood type donor in cats

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

a codnition in which there is abnormal blood clotting

coagulopathy

the product "vetstarch" is a synthetic ___ that has a lesser negative effect on blood coagulation than hetastarch

colloid

the two main categories of fluids based on the size of their solute molecules are

crystalloids and colloids

A 4-year-old, 50-pound, neutered, male Basset Hound is presents for anorexia and vomiting. He is estimated to be 6% dehydrated. The attending veterinarian orders a diagnostic workup including blood work, urinalysis, and abdominal radiographs. She also orders intravenous lactated Ringer solution. She asks you to calculate the infusion and drip rates based on the sum of (a) the volume necessary to correct dehydration over the first 18 hours, (b) the standard maintenance rate, and (c) the amount necessary to replace ongoing losses. Calculate the drip rate in drops/second when using a drip set with a delivery rating of 10 drops/mL.

drop/2.5-3 sec (133 mL/hour) × (1 hour/60 min) = (2.22 mL/min) × (1 min/60 sec) = (0.037 mL/sec) × (10 drops/mL) = (0.37 drops/sec) = 1 drop/2.5-3 sec

SQ administered fluids should have an osmotic pressure that is approximately ___ to extracellular fluid

equal

true or false? only certain meds that are safe for IV administration can be given IO

false Any medication that is safe for IV administration can be given IO

true or false? dextrose 5% in water is an example of an isotonic fluid

false example of a hypotonic fluid because the dextrose is quickly metabolized leaving free water.

impaired blood coagulation is a possible side effect of administration of the synthetic colloid ___

hetastarch

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

lactate

for patients with hemorrhage, the volume of blood to be transfused can be calculated based on the estimated blood ___, whereas patients with chronic anemia, it can be calculated based on the ___

loss PCV

The primary goal of blood transfusion is to increase the __________-carrying capacity of the blood.

oxygen

During severe, acute hemorrhage, the total protein (TP) will decrease before the packed cell volume (PCV) because of contraction of the __________.

spleen

normal central venous pressure is

0-10 cm H2O

which of the following fluids has an acidifying effect? a. LRS b. 0.9% saline c. normosol R d. plasmalyte 148

0.9% saline

when 0.9% saline solution is administered IV, within a short time, ___ will remain in the vascular space

1/4

during the resuscitation phase of IV fluid therapy, arterial systolic BP should be maintained at approximately

110-140mmHg

during an accute bleeding episode, a blood transfusion is necessary if the PCV drops below

20-25%

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

40-60

fluids administered SQ are usually absorbed in approximately

6-8 hours

Blood group factors in feline

A, B, and AB

a serious hypersensitivity reaction to foreign proteins or drugs that may occur following transfusion of incompatible blood

anaphylaxis

a blood plasma transfusion is not indicated for treatment of

anemia

a condition that results from blood loss

anemia

primary indication for packed RBCs

anemia

ECF

approximately 1/3 of TBW

IVF

approximately 1/4 of ECF

ICF

approximately 2/3 of TBW

ISF

approximately 3/4 of ECF

TBW

approximately 60% body weight

true or false? if a patient has severe, acute hemorrhaging, the PCV will be decreases

false the packed cell volume (PCV) will usually be decreased, but can be normal until body fluid redistributes over the first 12 hours following hemorrhage.

canine blood-typing cards are used to detect

DEA 1.1

true or false? administration of hypertonic saline IV will promote rapid and long-lasting expansion of the vascular volume

false will promote rapid expansion of the vascular volume that is transient, lasting only 20 to 30 minutes

True or false? the circulating blood volume of a horse is approximately 40-60 mL/kg body weight

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

true or false? 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

ideal bovine donor

J negative

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. IM b. SQ c. enteral d. IO

OI - intraosseous

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

buretrol

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

cat

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 meds give by CRI?

central line

Canine albumin solution and hetastarch are two of these

colloids

a test for compatibility

crossmatch

the most common general fluid type given during given during the replacement and the maintenance phases

crystalloids

an abnormal depletion of body water

dehydration

true or false? arterial BP 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 normalize even though hypovolemic shock may continue. Therefore, changes improvement in heart rate (HR), capillary refill time (CRT), mucous membrane color, warmth of distal extremities, etc., are better served to should be noted and used to help guide therapy

true or false? 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 risk for reactions of varying intensity following a first transfusion on incompatible blood.

true or false? transfusion reactions will not occur as long as major and minor crossmatches indicate compatibility

false Compatibility on crossmatch does not guarantee a lack of transfusion reaction and does not accurately predict RBC life span

true or false? 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.

true or false? a normal BP 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.

True or false? both water and electrolytes are able to move freely across all fluid barriers 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

true or false? 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 in the maintenance rate


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