IV Therapy 4
Important to monitor when giving hypertonic solutions:
slow rate to prevent fluid overload in the intravascular space/circulatory overload
When to not use isotonic solutions:
when client is at risk for intracranial pressure because pt can get hyponatremic encephalopathy and the brain will swell (premenopausal women most at risk)
Instructor's Isotonic range vs book isotonic range:
240-340 mOsm vs 250-375 mOsm
S/S fluid volume excess/hypervolemia
hypertension, short of breathm crackles in lungs, edema, tachycardia/bounding pulse, decreased hematocrit, osmolarity, BUN, and specific gravity (excess fluid will dilute)
When to not use hypotonic solutions:
in hypotension (can cause vascular collapse), with increased cranial pressure, for clients at risk for 3rd space fluid shifting
When not to give hypertonic solutions:
If pt is at risk for circulatory overload
Hypotonic range (instructor vs book):
less than 240 mOsm vs less than 250 mOsm (low contration)
Examples of Isotonic solutions:
LR (lactated Ringers) 310 mOsm 0.9% NaCl (sodium chloride) 308 mOsm D5W (5% dextrose in water) 252.52 mOsm - can also be hypotonic if the dextrose is metabolized Plasmalyte 148 296 mOsm
Important to monitor when giving hypotonic solutions:
Can cause a rapid shift of fluid from the ECC to the ICC and cause cardiovascular collapse so must monitor rate of administration carefully
Examples of hypertonic solutions:
D10% - D70% (D= Dextrose) 505 mOsm and up 2.225% - 5% NaCl (sodium chloride) 685.30 mOsm and up D5 in 1/2 NS 391 mOsm D5 NS 560 mOam
Examples of hypotonc solutions:
D5W (5% dextrose in water) 252.52 mOsm - can also be isotonic if the dextrose is not metabolized 1/2 Normal Saline 154 mOsm Normosol R 112 mOsm
What are hypotonic solutions used for? Hypotonic solutions will go where?
Used to shift fluid into interstitial space/cells for severe dehydration at cellular level. Fluid will travel from intravascular space into interstitial and cells if cells are hypovolemic.
What are hypertonic solutions used for? Hyertonic solutions will go where?
Used to shift fluid out of the ICC into the intravascular space in clients that have a severe sodium deficit and water intoxication. Fluid will shift from ICC into intravascular because Hyper has lower concentration of fluid.
What are isotonic solutions used for? Isotonic solutions go where?
Used to treat hypotension/hypovolemia to hydrate a mildly dehydrated client. The fluid will stay where we put them in intravascular space
A client is admitted with 40% second-degree burns. Which IV solution should a nurse anticipate being ordered for this client? a. Lactated Ringer b. 5% dextrose in water c. 0.45% sodium chloride d. 0.9% sodium chloride
a. Lactated Ringer Lactated Ringer closely resembles the body's extracellular fluid; it may be used to replace fluid loss from burns and is useful in mild acidosis. The lactate ion contained in the solution metabolizes in the liver to bicarbonate to assist with metabolic acidosis.
A physician orders a hydrating IV solution to be administered to an elderly adult client who is dehydrated. A nurse administers the solution knowing that the main role of a hydrating solution is to: a. check kidney function. b. promote wound healing. c. help metabolism of carbohydrates. d. expand the extracellular fluid compartment.
a. check kidney function. Hydrating fluids are used to assess the status of the kidneys. The administration of a hydrating solution at the rate of 8 mL/m² of body surface per minute for 45 minutes is called a fluid challenge.
A nurse is administering a hypotonic IV solution to a client. The nurse understands that hypotonic solutions are used to: a. hydrate cells. b. increase vascular space. c. supply sodium and chloride in deficit states. d. act as a colloid solution.
a. hydrate cells. Hypotonic fluids move from the vascular space to the interstitial and intracellular spaces, hydrating cells. This follows the principles of osmosis and the movement of water.
A client is ordered to receive maintenance IV fluids. A nurse administers the IV fluids knowing that maintenance solutions are used for clients who are: a. experiencing hemorrhage. b. NPO for a short period. c. experiencing draining fistulas. d. dehydrated by gastrointestinal losses.
b. NPO for a short period. In maintenance therapy, water has priority because the body needs water to replace insensible loss. Maintenance therapy provides nutrients that meet a client's daily needs for water, electrolytes, and dextrose. The typical client profile for maintenance therapy is one who is NPO or has restricted oral intake for a limited period.
A nurse prepares to administer a blood transfusion to a client. Which IV solution is the only acceptable solution for the nurse to use to prime the administration set before administering blood? a. Lactated Ringer solution b. 5% dextrose in water c. 0.9% sodium chloride d. 5% dextrose and 0.45% sodium chloride
c. 0.9% sodium chloride Saline solutions are the only solution to be used with any blood product. Dextrose solutions cause hemolysis of cells. Lactated Ringer solutions contain calcium ions that can also hemolyze the blood cells.
A client, who is bleeding profusely, presents in an emergency department with a compound fracture of the leg. A physician writes orders for an isotonic solution, similar to that of normal blood plasma, to replace lost electrolytes while preparing the client for surgery. Which most commonly prescribed multiple electrolyte solution should a nurse anticipate being ordered by the physician? a. 5% dextrose in water b. 0.9% sodium chloride c. Lactated Ringer solution d. 5% Dextrose and 0.45% sodium chloride
c. Lactated Ringer solution Lactated Ringer solution is classified as a balanced or isotonic solution because the fluid and electrolyte content contained in it are similar to that of normal blood plasma. This solution is used to replace electrolytes at physiological levels in the extracellular fluid compartment.
A client is hypovolemic, and plasma volume expanders are not available. Which solution should a nurse anticipate will be ordered for this client? a. 5% dextrose in water b. Ringer injection c. 0.45% sodium chloride d. 5% dextrose and 0.45% sodium chloride
d. 5% dextrose and 0.45% sodium chloride A hypertonic solution, such as 5% dextrose and 0.45% sodium chloride, may be used to treat hypovolemia when plasma volume expanders are not readily available. Hypertonic solutions pull water from intracellular and interstitial spaces into the vascular space; thus, they expand the plasma space. Options a, b, and c are isotonic solutions.
A pediatric nurse is preparing to administer a hypotonic IV solution to a child experiencing profound dehydration. Which solution would be considered a hydrating solution? a. 5% dextrose in water b. Lactated Ringer solution c. 10% dextrose in water d. 5% dextrose and 0.45% sodium chloride
d. 5% dextrose and 0.45% sodium chloride Solutions that contain dextrose and hypotonic saline provide more water than is required for excretion of salt and are also useful as hydrating fluids.
After administering a hypertonic IV solution to a client, which outcome should a nurse expect? a. Hydration of cells b. Acts as a colloid solution c. Supplies free water to vascular space d. Shifts extracellular fluid from intracellular space to plasma
d. Shifts extracellular fluid from intracellular space to plasma Hypertonic fluids have osmolarities greater than 375 mOsm, which shifts fluids from the interstitial and intracellular spaces into the vascular space. This follows the principles of osmosis and the movement of water and solutes.
S/S fluid volume deficit/hypovolemia:
dry mucous membranes, cracked lips, hypotension, oliguria, dizziness, decreased skin turgor, increased hematocrit, osmolarity, and BUN (concentrations will be up), increased specific gravity of urine, temp and resp may increase, the pulse will increase then decrease
Hypertonic range (instructor vs book)
greater than 350 mOsm vs greater than 375 mOsm
Important to monitor when giving isotonic solutions:
watch for fluid overload - these solutions expand intravascular compartment