Fluid and Electrolyte Replacement

Question 1

Hypotonic IV Fluids

Answer 1

• lower osmolality when compared to plasma (dilutes ECF)
• water moves from ECF to ICF by osmosis
• usually maintenance fluids
• common hypotonic fluid = 0.45% NaCl aka 1/2 NS

Question 2

D5W

Answer 2

• technically isotonic as dextrose metabolizes quickly and the net result is free water.
• used to replace water losses, helps prevent ketosis

Question 3

Normal Saline

Answer 3

Isotonic

• 0.9% saline, or NS
• slightly more NaCl than ECF
• used when both fluid and sodium lost
• only solution used with blood

Question 4

Lactated Ringer’s Solution (LR)

Answer 4

Isotonic

• contains Na, K, Cl, Ca and lactate
• expands ECF - treat burns and GI losses
• contraindicated w/ liver dysfunction, hyperkalemia, and severe hypvolemia

Question 5

Hypertonic IV Fluids

Answer 5

• higher osmolality compared with plasma
• draws water out of cells into ECF
• require frequent monitoring of BP (Hypertonic solution pulls water into ECF which raises BP. When BP raises it puts a lot of stress on the heart), lung sounds (fluid can seep into lungs and cause crackles), serum sodium levels

Question 6

D5 1/2 NS

Answer 6

5% dextrose, 0.45% NaCl
Hypertonic

• common maintenance fluid that’s better than hypotonic or isotonic solution b/c it contains dextrose
• replaces fluid loss
• KCl added for maintenance or replacement

Question 7

D10W

Answer 7

10% dextrose with water
Hypertonic

• provides free water, but no electrolytes
• limit of dextrose concentration that may be infused peripherally

Question 8

Colloids

Answer 8

• products with large proteins in them
• helps fluid stay where it needs to stay
• stay in vascular space and increase oncotic pressure
• stabilizes pressure in plasma
• includes: human plasma products, semisynthetics

Question 9

PIV Needles

Answer 9

Gauge increases, size decreases

18 gauge (green): used in trauma, preferred in surgery, blood transfusions & CT scan with dyes

20 gauge (pink): most commonly used

22 gauge (blue): older adults, suitable for slow rate transfusions, NO blood products

24 gauge (yellow): pediatrics or elderly adults

Question 10

IV Therapy - Roles

Answer 10

Provider: orders the IV including amount and rate of solution, evaluates need or orders CVAD (central venous access device).

RN: Places PIV (selects size of catheter and location), initiates infusion, monitors and maintains infusion, system assessment of client, documentation of infusion and I&O as appropriate
-Delegation to LPN (cannot do first bag of fluids), UAP (aka tech, cannot do anything with IV, not even silence alarm, can unplug and plug back in to help pt go to bathroom)

Question 11

IV Therapy - Definition

Answer 11

Installation of fluid into vein, this fluid may contain electrolytes and nutrients

Question 12

Complication of IV Therapy

Answer 12

Infiltration: most common complication, occurs when cannula slips out of vein and is forced into vessel wall

• S/Sx: coolness, leaking, swelling, tenderness
• Action: remove and select new site, document

Phlebitis: Infection of vein

• S/Sx: red, swollen, tender
• action: remove, notify provider, warms soaks, document.

Extravasation: leaking of medication into surrounding tissue

• S/Sx: swelling, erythema, tender, cool, stave IV = necrosis, sloughing, blistering
• action: remove, know which meds cause the extravasation, know antidote, NO warm packs, document

Question 13

CVADs

Answer 13

catheters placed in large blood vessels (subclavian vein, jugular vein)

Three main types: Centrally inserted catheters, peripherally inserted central catheters, implanted ports.

Used to admin blood/blood products and parenteral nutrition

Useful for pt’s with limited peripheral vascular access or need for long-term vascular access.

Advantages: immediate access, reduced venipunctures, decreased risk of extravasation

Disadvantages: increased risk of CLABSI, invasive procedure

Question 14

Centrally Inserted Catheter

Answer 14

Inserted into vein in the chest or abdominal wall with tip resting in distal end of superior vena cava

• can be nontunneled or tunneled
• can be single, double, or triple lumen

Question 15

Peripherally Inserted Central Catheter

Answer 15

Central venous catheter inserted into a vein in arm

• can be single or multi-lumen
• nontunneled
• for pt’s who need vascular access for 1 week to 6 months
• cannot use arm for BP or blood draw

Advantages: lower infection rate, fewer insertion related complications, decreased cost

Complications: DVT, phlebitis

Question 16

Implanted Infusion Port

Answer 16

Central venous catheter connected to an implanted, single or double subcutaneous injection port

• port is titanium or plastic with self-sealing silicone septum
• medication injected through skin into port

Advantages: good for long term therapy, low risk of infection, cosmetic discretion

Question 17

Midline Catheters

Answer 17

Peripheral catheters

3-8 inches long, single or double lumen

use and care similar to PICC

may stay in place up to 4 weeks

Question 18

Complications of Catheters

Answer 18

Catheter occlusion: clamped or kinked catheter, tip against wall of vessel, thrombosis, precipitate buildup in lumen

Embolism: catheter breaking, dislodgement of thrombus, entry of air into circulation

Infection: contamination during insertion or use, migration of organisms along catheter, immunosuppressed pt

Pneumothorax: perforation of visceral pleura

Catheter migration: improper suturing, trauma/forceful flushing, spontaneous