NURS3804 Chapter 12: Fluid Volume and Electrolytes

- 0.9% NaCl

- lactated ringers

What are examples of isotonic IV fluids?

- expands blood volume

- dilutes medications

- keeps vein open

What are functions of 0.9% NaCl?

fluid resuscitation

What is the main function of lactated ringers?

- D5W is isotonic until it metabolizes glucose

- it then becomes hypotonic

Explain the tonicity of dextrose 5% in water (D5W).

- infants

- head injury

What are contraindications for D5W?

- decreased pH

- increased CO2

- decreased HCO3

How does acidosis affect pH, CO2, and HCO3?

- increased pH

- decreased CO2

- increased HCO3

How does alkalosis affect pH, CO2, and HCO3?

hypoventilation which can be caused by:

- sedation

- airway obstruction

- mechanical ventilation

- neuromuscular disease

- pulmonary edema

- increased ICP

What causes respiratory acidosis?

- diabetic ketoacidosis (DKA)

- shock

- severe diarrhea

- renal failure

- salicylate overdose

- dehydration

- liver failure

What causes metabolic acidosis?

hyperventilation which can be caused by:

- anxiety

- high altitudes

- mechanical ventilation

- acute pulmonary problems

What causes respiratory alkalosis?

- loss of gastric juices

- diuretics

- overuse of bicarbonate

- Cushing's syndrome: excess cortisol results in excretion of K+

What causes metabolic alkalosis?

- confusion

- dysrhythmias

- hypoventilation

- dizziness

- increased irritability

- nausea, vomiting, diarrhea

- anxiety

- seizures

- tremors

- muscle cramps

- tingling of fingers and toes

What are signs and symptoms of metabolic alkalosis?

- headache

- hypotension

- hyperkalemia

- muscle twitching

- warm, flushed skin

- nausea, vomiting

- decreased muscle tone and reflexes

- Kussmaul respirations: hyperventilation

What are signs and symptoms of metabolic acidosis?

- rapid, shallow respirations

- hypotension

- pale or cyanotic skin and mucosa

- headache

- hyperkalemia

- dysrhythmias

- drowsiness

- dizziness

- muscle weakness

- hyperreflexia

What are signs and symptoms of respiratory acidosis?

- hyperventilation

- tachycardia

- decreased or normal BP

- hypokalemia

- numbness and tingling of extremities

- hyper reflexes and muscle cramping

- seizures

- increased anxiety and irritability

What are signs and symptoms of respiratory alkalosis?

intracellular

Is the majority of the fluid in the body intracellular or extracellular?

275-290 mOsm/kg

What is the osmolality for isotonic solutions?

they do not affect the cells, but they do increase the ECF

How do isotonic solutions effect the cells?

< 250 mOsm/kg

What is the osmolality for hypotonic solutions?

cause them to swell

How do hypotonic solutions effect the cells?

> 375 mOsm/kg

What is the osmolality for hypertonic solutions?

cause them to shrink

How do hypertonic solutions effect the cells?

- fluid volume overload can cause edema

- prolonged infusions may lead to alkalosis or acidosis

- rapid infusion may lead to hypernatremia and electrolyte depletion

What are complications of isotonic IV fluids?

- monitor I/O's and electrolytes

- monitor for s/s of fluid volume excess

- monitor liver function of patients receiving LR since the liver metabolizes lactate

What are nursing considerations for isotonic IV fluids?

- 0.45% NaCl

- 0.33% NaCl

- 0.25% NaCl

What are examples of hypotonic IV fluids?

- hypernatremia

- hyperglycemia

- used as a maintenance fluid

What are indications for hypotonic IV fluids?

- fluid overload

- decreased electrolyte concentrations

- over hydration

- pulmonary edema

- rapid infusion may lead to hemolysis of RBCs

What are complications of hypotonic IV fluids?

- monitor I/O's and electrolytes

- monitor for s/s of fluid volume deficit

- use caution in patients with liver disease, shock, or trauma

- do not administer to patient with increased ICP

What are nursing considerations for hypotonic IV fluids?

- 3% NaCl

- 5% NaCl

- D5%LR

- D5%1/2NS

What are examples of hypertonic IV fluids?

- treats severe hyponatremia

- decreases ICP with cerebral edema

What are indications for hypertonic IV fluids?

- renal failure

- heart failure

- cellular hydration

What are contraindications for hypertonic IV fluids?

- administer slowly and use an infusion control pump

- monitor for hypervolemia, hypernatremia, and respiratory distress

- in dextrose solutions, assess glucose in diabetic patients before administration

What are nursing considerations for hypertonic IV fluids?

- dextran solutions

- albumin

- hetastarch

What are examples of colloids?

plasma volume expansion

What are colloids used for?

- monitor I/O's

- monitor for anaphylaxis reaction or renal failure (dextran)

What are nursing considerations for colloids?

- administer within 30 minutes of receiving from blood bank

- blood should not be hanging for longer than 4 hours

- never add meds to blood products

- 18 or 20 gauge IV

- check vitals per policy

- change tubing after 4 hours

What are general guidelines for blood administration?

- extreme (greater than 25%) loss of blood volume

- contains plasma to help draw fluid back into blood vessels

What are indications for whole blood?

- anemia: increases O2 carrying capacity

- increases substantial hemoglobin deficits in those who have lost up to 25% of total blood volume

What are indications for packed red blood cells (PRBCs)?

increases clotting factor levels in patients with demonstrated deficiency

What are indications for fresh-frozen plasma (FFP)?

management of acute bleeding

What are indications for cryoprecipitate and plasma protein factors?

- incompatibility with immune system

- transfusion reaction

- anaphylaxis

- transmission of pathogens to recipient

What are adverse effects of blood products?

potassium

Which electrolyte is the major intracellular cation?

sodium

Which electrolyte is the major extracellular cation?

3.5-5.0 mEq/L

What is the normal serum range for potassium?

- PO

- IV infusion (must be diluted)

What routes are used for potassium?

- bananas

- strawberries

- oranges

- avocados

- tomatoes

- cucumbers

- tuna

- spinach

What are examples of foods that are high in potassium?

- potassium wasting diuretics

- laxatives

- corticosteroids

Which drugs promote potassium loss?

hypokalemia

hyperkalemia

- oral K

- IV K diluted with NS on an IV pump (not IV push)

How is hypokalemia treated?

- reduce potassium rich foods

- administer sodium bicarbonate and calcium gluconate

- polystyrene sulfonate (Kayexalate) enema

- administration of insulin and glucose

How is hyperkalemia treated?

135-145 mEq/L

What is the normal serum range for sodium?

- maintains fluid volume balance

- plasma osmolality

- maintains neuromuscular irritability

- conduction of nerve impulses

What are functions of sodium?

- fast food

- processed food

- bacon

- decaffeinated coffee

What are examples of foods high in sodium?

- administer PO sodium

- administer isotonic NS

- administer hypertonic saline

How is hyponatremia treated?

- restrict sodium

- administer hypertonic solutions

How is hypernatremia treated?

8.6-10.2 mg/dL

What is the normal serum range for calcium?

4.64-5.28 mg/dL

What is the normal serum range for ionized calcium?

- PO calcium

- calcium gluconate

How is hypocalcemia treated?

- bisphosphonates

- NS

- calcitonin

- loop diuretics

How is hypercalcemia treated?

1.5-2.5 mEq/L

What is the normal serum range for magnesium?

- PO magnesium

- IV magnesium

How is hypomagnesemia treated?

- laxatives

- antacids

- chronic kidney disease

What causes hypermagnesemia?

can cause cardiac dysrhythmias

Why is an imbalance of magnesium dangerous?