Admission of IV Fluids

Question 1

What information is required to write complete Admit Orders?

Answer 1

ADC VANDALISM

Admit
Diagnosis
Condition
Vitals
Allergies
Nursing Orders
Diet
Activity
Labs
IV Fluids
Special Studies
Medications

Question 2

What is the difference between Inpatient, Outpatient, and an Observation Admission?

Answer 2

• Inpatient: Someone expected to stay more than 2 midnights due to their clinical presentation.
• Outpatient: Occurs within one day, no overnight stay, usually occurs in a surgery center, eye center, or special procedures
• Observation admissions: Needs hospital care but expected to stay only 1 midnight to observe progress. Can transition to an inpatient admission if meets criteria

Question 3

Criteria for ICU Admission

Answer 3

• Patients requiring, or likely to require, advanced respiratory support
• Patients requiring support of two or more organ systems
• Patients with chronic impairment of one or more organ systems who also require support for an acute reversible failure of another organ
• Support = care that cannot be addressed on another unit due to medication intensity, need for close monitoring, high risk of decline in condition

Question 4

What are the 5 R’s to fluid replacement?

Answer 4

Resuscitation
Routine Maintenance
Replacement
Redistribution
Oral/Enteral Maintenance

Question 5

Which fluids are used for isotonic/hypotonic/hypertonic solutions?

Answer 5

Isotonic: Normal Saline, Lactated Ringer’s, D5W

Hypotonic: 1/2 Normal Saline, D5W

Hypertonic: 3% NaCl, other dextrose infused solutions

Question 6

What are the average person’s needs for fluid maintenance?

Answer 6

The average person requires 25-30 ml/kg water per day and about 1 mmol/kg of Na+ and K+

Question 7

What is the most common reason to start I.V therapy on a child?

Answer 7

To correct dehydration that occurs most commonly from gastroenteritis and to administer I.V antibiotics

Question 8

Explain the Holliday-Segar Method for fluid maintenance.

Answer 8

First 10kg = 100ml per kg in 24 hrs
Second 10kg = 50ml per kg in 24hrs
Other kg (or remaining kg) = 20ml per kg in 24 hrs.

Example:
24 kg child: 1000 ml + 500 ml + 80 ml = 1580 ml
1580 / 24 hr = 66 ml/hr

Question 9

How much fluid is given to adult patients with severe volume depletion or hypovolemic shock?

Answer 9

At least 1 to 2 liters of isotonic saline are generally given as rapidly as possible in an attempt to restore tissue perfusion

Question 10

What type of fluid is typically used for replacement therapies?

Answer 10

Most patients are treated with isotonic or 1/2 isotonic saline, but this can vary based on concurrent abnormalities in serum sodium or potassium or the presence of metabolic acidosis