Intravenous (IV) Solutions, Electrolytes, Iron & Total Parenteral Nutrition (TPN) – Module 8

What characterizes an isotonic IV solution in relation to blood?

It has a similar solute concentration to blood, so fluid stays within the intravascular space.

Name three commonly used isotonic IV solutions.

0.9 % Normal Saline (0.9 % NaCl), Lactated Ringers (LR or RL), and 5 % Dextrose in Water (D5W).

Why is D5W NOT recommended for fluid resuscitation boluses?

After dextrose is metabolized it becomes hypotonic, which can cause cerebral edema.

Which IV solution is the ONLY fluid compatible with packed red blood cells during transfusion?

0.9 % Normal Saline (0.9 % NaCl).

List three signs of fluid overload that nurses monitor during isotonic infusions.

Shortness of breath, decreased oxygen saturation, and crackles on lung auscultation.

How do hypotonic IV solutions affect fluid movement?

They shift water from the intravascular compartment into the intracellular space.

Give two examples of hypotonic solutions.

0.45 % Normal Saline (0.45 % NaCl) and D5W (after dextrose metabolism).

For what two main conditions are hypotonic fluids indicated?

Cellular dehydration and hypernatremia.

What early symptoms can suggest cerebral edema from hypotonic therapy?

Confusion, headache, and nausea.

Describe the fluid shift caused by hypertonic IV solutions.

They pull water out of cells into the intravascular space.

Provide three examples of hypertonic solutions.

3 % NaCl, 5 % Dextrose in 0.45 % NaCl, and 5 % Dextrose in Lactated Ringers (D5LR).

Name two key indications for hypertonic fluid administration.

Severe hyponatremia and cerebral edema.

Why are hypertonic solutions avoided in patients with heart or renal failure?

They can rapidly cause hypervolemia and hypertension, worsening these conditions.

What common nursing action applies to all IV fluids regarding the IV site?

Assess for infiltration/extravasation (redness, swelling, pain, leaking) and stop the infusion while troubleshooting.

Which organ is the primary regulator of electrolyte balance?

The kidneys.

State the normal serum potassium range.

3.5 – 5.1 mmol/L.

What critical rule must be followed when giving IV potassium?

It must always be diluted before administration.

Why are older adults at greater risk for fluid overload with IV therapy?

They often have cardiovascular and renal comorbidities that impair fluid excretion.

What is the primary role of thiamine (vitamin B1) in the body?

Supports energy metabolism by converting carbohydrates into usable energy for the brain and nervous system.

Alcohol misuse commonly causes deficiency of which vitamin and what syndrome?

Thiamine deficiency leading to Wernicke-Korsakoff syndrome.

What is the preferred thiamine route for hospitalized patients?

Intravenous (IV) administration.

List three dietary sources rich in thiamine.

Whole grains (breads, cereals), meats, and fish.

What is iron’s essential function in blood?

It forms hemoglobin, enabling red blood cells to carry oxygen.

Provide four key teaching points for patients taking oral iron.

Take with meals or orange juice for absorption, avoid teeth staining, expect a metallic taste, and stools may become black.

What nursing precaution is vital during IV iron infusions?

Ensure a patent IV site and monitor closely for anaphylaxis (e.g., difficulty breathing, flushing, rapid weak pulse).

Identify the two main components of TPN solution.

An amino acid/dextrose solution plus a lipid emulsion containing vitamins and minerals.

Give four clinical situations where TPN is indicated.

Non-functional GI tract, major abdominal surgery, bowel obstruction/infant GI malformation, critically ill or NPO ≥ 7 days.

Why must the nurse verify IV access type before starting TPN?

TPN is hypertonic; it requires central access for long-term use, although peripheral lines may be used short-term.

Name at least three parameters nurses monitor during TPN therapy.

Weight, laboratory bloodwork (electrolytes, glucose, proteins), vital signs, blood glucose levels, and signs of fluid overload.

What complication can result from abrupt discontinuation of TPN?

Rebound hypoglycemia.

What equipment requirement is mandatory when infusing TPN?

Always use an in-line filter.

Which symptoms should TPN patients promptly report?

Fever, chills, malaise, excessive thirst/urination (hyperglycemia), or nervousness, dizziness (hypoglycemia).