M1L5: Intravenous Fluid Therapy, Burns, and Renal Failure

Intravenous fluids

are chemically prepared solutions that are administered to the patient

Euromed

Famous manufacturer of IVF in the Philippines

Braun

Famous international manufacturer of IVF

Abbott

Old, glass form of IVF

Replace — Rehydrate — Resuscitate
Maintain — Medicate — Monitor

A. Uses/Objectives

1. Crystalloids
2. Colloids
3. Blood and Blood products

B. IV fluids come in 4 different forms:

crystalloid solution

are the primary fluid used for pre-hospital IV therapy

contain electrolytes but lack the large proteins and molecules found in colloids

tonicity

Crystalloids come in many preparations and are classified according to their "__________"

Hypotonic, Isotonic, Hypertonic

Tonicity effect on cell:

Cell swells → bursts (Hemolysis)

Hypotonic

Cell shrinks → death

Hypertonic

a. Saline Solutions (H2O + Na+)
b. Dextrose Solutions
c. Lactated Ringer's Solution

Different Families of IV Fluids (Crystalloid Solutions)

1. 0.9% Sodium Chloride
2. 0.45% Sodium Chloride
3. 0.3% Sodium Chloride
4. 3% Saline solution

a. Saline Solutions (H2O + Na+)

1. 0.9% Sodium Chloride

Normal Saline/PNSS

2. 0.45% Sodium Chloride

1/2 Saline

3. 0.3% Sodium Chloride

1/3 Saline

3. 0.3% Sodium Chloride

IVF of choice for infants/children

4. 3% Saline solution

Induce abortion

Dextrose

is the simplest form of glucose

1. 5% Dextrose in water (D5W)
2. 10% Dextrose in water (D5W)
3. 5% Dextrose in 0.3% NaCl
4. 5% Dextrose in 0.9% NaCl
5. 5% Dextrose in Lactated Ringer's Solution
6. 50% Dextrose in water

b. Dextrose Solutions

1. 5% Dextrose in water (D5W)

Isotonic form

50

1 gram of Dextrose = ______ calories

3. 5% Dextrose in 0.3% NaCl

Popular in children/infants

5. 5% Dextrose in Lactated Ringer's Solution

IV of choice for patient in surgery

c. Lactated Ringer's Solution

Multiple electrolyte solution

1. Multi-ion MB
2. Multi-ion M
3. Multi-ion MR
4. Multi-ion K+

c. Lactated Ringer's Solution

1. Multi-ion MB

Maintenace for babies

2. Multi-ion M

Maintenance for adults

3. Multi-ion MR

Maintenance for replacement

4. Multi-ion K+

Maintenance with potassium

2. Colloid Solutions

Are IV fluids that contain solute in the form of large proteins (large molecules)

2. Colloid Solutions

They cannot pass through the walls of capillaries and onto the cell — remain in blood vessels — Increase IV volume (Blood)

1. Explain to the client/family
2. Determine preferred fluids/intake patterns
3. Offer fluids in small glasses
4. Offer ice chips, sugarless chewing gum
5. Provide mouth care
6. Divide fluid allowance: 1.2 am, 1.3 pm, remaining amt. = night

C. Fluid Restriction Guidelines

first-degree burn

A __________ is superficial and causes local inflammation of skin.

first-degree burn

Sunburns are often categorized as ____________

first-degree burn

Inflammation is characterized by pain, redness, and a mild amount of swelling; skin may be very tender to touch.

second-degree burn

A __________ is deeper and in addition to the pain, redness, and inflammation, there is also blistering of the skin.

third-degree burn

A __________ is deeper still, involving all layers of the skin, in effect killing that area of skin.

third-degree burn

Because the nerves and blood vessels are damaged, these burns appear white and leathery and tend to be relatively painless.

B. Rule of Nines

Burns are measured as a percentage of total body area affected; this measurement is adjusted (Body is measured in multiples of nine)

1. Head = 9%
2. Chest (front) = 9%
3. Abdomen (front) = 9%
4. Upper, mid/low back and buttocks = 18%
5. Each arm = 9%
6. Each palm = 1%
7. Groin = 1%
8. Each leg = 18% total
- Front = 9%
- Back = 9%

B. Rule of Nines

100

Total Body Surface Area (TBSA) = _____%

Minor type

Below 20% = ?

Major type

20-40% = ?

Critical type

Above 40% = ?

severe fluid loss

It is a widely accepted fact that ________ is the greatest problem following major burn injuries

effective fluid resuscitation

Therefore, ___________ is one of the cornerstones of modern burn treatment

1. Monitor using clinical and laboratory parameters.
2. If peripheral intravenous access cannot be achieved, central venous/surgical vascular access must be considered.
3. A urinary catheter and a nasogastric tube should be inserted to control and monitor the patient's fluid balance.

D. Fluid Management in Major Burns

1. Regulation of blood volume
2. Regulation of the pH of the blood
3. Regulation of blood pressure
4. Regulation of the ionic composition of blood
5. Production of red blood cells
6. Synthesis of vitamin D
7. Excretion of waste products and foreign substances

A. Kidney functions

Described as a decrease in glomerular filtration rate

serum creatinine level

Biochemically, renal failure is typically detected by an elevated ____________

glomerular filtration rate; checks the blood for creatinine (a waste product)

The best measure of kidney function is the _________, which can be estimated from a blood test that ______________

Higher than 90 ml/min

Normal result: __________

less than 60 ml/min

If result is persistently _________ for at least three months, this confirms that the person has kidney disease

C. Renal Failure: Dialysis

Blood is filtered and cleaned in a dialyzer, then blood is returned

Hypervolemia

Regulation of blood volume

Increased BP

Regulation of blood pressure

Increased Na+ retention, Increased potassium

Regulation of the ionic composition of blood

Anemia

Production of red blood cells

Increased Ca++ level = Hypercalcemia

Synthesis of vitamin D

1. MONITOR: V/S, IO, LOC, Lab results, Weight, Level of hydration
2. PROVIDE: Adequate dietary sources
3. INSTITUTE: Safety/seizure precautions
4. CHECK: IVF, Catheters, CVP lines, NGT
5. BE ALERT: Neonates, Infants, Children, Elderly, Pregnant women, Chronically ill

E. Nursing Interventions (Renal failure)