Ch 25 workbook activities (fluid therapy and transfusion medicine)
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
