IV fluids

what do we need to administer IV fluids

• doctor orders, considered a medication

• patent IV

• central line - directly into heart, must be handled sterile always

isotonic fluids

• concentration?

• how does it affect fluid in our body

• what is it used to treat

• concentration of solutes is equal to blood

• no fluid shifting occurs

• used to increase circulating volume (low BP, dehydration, hemorrhage, trauma and NPO patients to keep the pt hydrated )

0.9% NS

• what is the solute

• what does it do

• sodium chloride as the solute in sterile water

• increases vascular and ECF volume

0/9% NS nursing considerations

• false alarm of ?

• may also cause?

• dilutes Hmg, Hct and electrolytes - may cause false alarm of hemorrhage.

• may cause fluid overload & generalized edema

Lactated Ringers

• what type of fluid

• solutes?

• what is lactate metabolized into ? what can it treat ? what can it cause ?

• who can we not give LR to

• isotonic

• solutes: sodium chloride, sodium lactate, potassium chloride

• lactate is dissolved into bicarbonate (HCO3 - base) useful in treating metabolic acidosis, but too much can cause metabolic alkalosis

• must have functioning and healthy liver to be metabolized

D5W / dextrose 5% in water

• what kind of solution

• nursing considerations?

• when do we not use D5W

• isotonic in the bag but hypotonic in the body

• dextrose is quickly metabolized and swells the cells once glucose is broken down

• may irritate veins or cause edema

• DO NOT use on patients with increased intracranial pressure (swelling in brain) or infants (brain is sensitive to fluid changes )

who may have ICP

• head trauma

• stroke

• any damage to Brain

hypotonic fluids

• concentration?

• where will the fluid shift ?

• what does it do to cells? what does it do to BP?

• used to trreat?

• lower concention of solutes and fluid than blood

• fluid goes form intravascular space to intracellular and interstitial space

• hydrates cells, but lowers blood volume and drops BP

• used to treat intracellular dehydration (DKA or hyperosmolar hyperglycemia)

what is hyperosmolar hyperglycemia

• treated with?

• seen in T2D

• when blood sugar is uncontrollable and cells are shriveled and dehydrated

• treated with hypotonic fluids

0.45 or half NS

• type of fluid

• what can it treat

• what can it cause and why

• hypotonic

• replaces fluid when pt needs sodium restricted

• may cause fluid overload or hypotension (fluid leaves vessels)

• may cause edema (fluid going into interstitial space)

hypertonic

• concentration

• what does it do

• used to treat? 2

• may cause? what are the s/s?

• contraindications

• how do we administer

• high solute concentration in comparison to blood

• draws fluid out of cells and into intravascular space

• initially decreased edema, but too much expansion vascular volume → FVE

• used to treat severe hyponatremia, and increased ICP (brings swelling down in brain)

• may cause FVE - monitor BP, HR, breathing (SOB? crackles?), edema, I &Os and daily weights

• HF and renal failure pts cannot be given hypertonic fluids

• administer only through a central line

what are examples of hypertonic solutions

• D5LR

• D5NS

• D10W

• D5 0.45NS

colloid solutions

• used to? in what conditions?

• considered?

• examples are

• Used to increase circulating volume and restore protein levels in conditions such as burns, and plasma loss through trauma

• Considered blood transfusion products

• 5% and 25% albumin

5% albumin is used for

Expands plasma volume and used for hypovolemia

25% albumin is used to

• after fluid shift what can we give

Draws fluid from interstitial to intravascular space

• used for severe edema (ascites)

• after fluid is in intravscualr space we can use diuretics to get the rest of the fluid out

colloid solutions nursing considerations

• how is it given

• what do we need to know first

• use when?

• monitor for

• Given IV, usually with a filter set

• Obtain an allergy history (especially to blood products)

• Use within 4 hours of opening

• Monitor for fluid overload