FLUIDS PPT - Electrolytes Flashcards
Types of IV solutions?
- Crystalloids:
- Isotonic
- Hypotonic
- Hypertonic - Colloids
what is plasmolysis?
shrinking of the cell
(hypertonic)
what is cytolysis?
swelling of the cell
(hypotonic)
Osmolality of Blood is defined as what?
Concentration of all chemical particles found in the fluid part of the blood
what factors are going to increase osmolality of the blood? (increase the concentration of particles in the blood)?
- Dehydration
- Free water loss
- Diabetes Insipidus
- Hypernatremia
- Hyperglycemia
- Stroke of head injury
- Renal tubular necrosis
what factors are going to decrease the blood osmolality? (decrease the concentration of particles in the blood)
- Fluid volume excess
- SIADH (symptom of inappropriate Anti-Diuretic Hormone)
- Renal Failure
- Hyponatremia
- Overhydration
- diuretics
The type of IV solution is based on what 3 things?
- Condition
- Diagnosis
- Lab values
What are the characteristics of a Isotonic Solution? 3
- Has a Similar Osmolality
- Given to “replace” fluid loss
- It does not cause the RBC’s to shrink or swell
What is the osmolaltiy range for isotonic solutions?
280 - 300
what are your different types of isotonic solutions?
- D5W: 5% dextrose in water
- NS/NACL/0.9%: Normal Saline
- LR, RL: Lactated Ringers
D5W:
5% dextrose in water characteristics? 3
- 5g Dextrose in each 100ml solution
- Supplies water and glucose
- Isotonic outside body
D5W is used cautiously with which kinds of patients?
- Diabetics
- Hypernatremia
- Head trauma patients
What is the Tonicity of D5W?
- Dextrose is rapidly metabolized
- Hypotonic after dextrose metabolized
- Can cause hyperglycemia
NS characteristics:
- Corrects extracellular volume deficit:
-hyopovolemic states
-resuscitative efforts
- shock
- metabolic alkalosis
- hypercalcemia
- Na deficits - Does not supply calories
- Used with blood administration
- replaces large sodium losses
what is NS not used for? 3
CHF
Pulmonary Edema
Renal Impairment
What does Lactated Ringer consist of?
potassium
calcium
sodium chloride
what does LR correct?
- dehydration
- Na depletion
- GI losses
what patients are we gonna use caution when giving LR? 5
- CHF
- Renal Insufficiency
- Edema
- Na+ Retention
- Hyperkalemia
What are the characteristics of a Hypotonic solution?
- Dilutes ECF
- Lowering serum osmolality
- causes water to move into the interstitial spaces and cells which causes the cell to swell
what is the osmolality range for hypotonic solutions?
less than 280
what are the types of hypotonic solutions? 4
* think LOW numbers*
- 0.45% sodium chloride (1/2 NS)
- 0.33% sodium chloride (1/3 NS)
- 0.225% sodium chloride (1/4 NS)
- 2.5% Dextrose in water (D2.5W)
Hypotonic Solutions can cause fluid shifts in what ways?
Intravascular fluid depletion, Low Blood Pressure, Cellular edema
which patients are we not going to give hypotonic solutions to?
- Do Not give to patients at risk for ICP (increased cranial pressure ) , CVA, head trauma
- Do not give to patients who suffer from burns, trauma, malnutrition, liver disease
- Can worsen hypotension
what is the range of osmolality for hypertonic solutions?
greater than 300
Hypertonic solution characteristics? 5
- causes water to move out of the cells
- causes the cell to shrink
- decreases the risk for edema
- stabilizes BP
- regulates urine output
what are hypertonic solutions used for?
used to repair electrolyte and acid/base imbalances, TPN
hypertonic solutions are used cautiously with which patients?
Used cautiously in patient with diabetes, and impaired heart or kidney function
monitor closely for circulatory overload
what are the types hypertonic solutions?
* THINK HIGH NUMBERS*
- 10% Dextrose in Water (D10W)
- 5% Dextrose in Lactated Ringers (D5LR)
- 5% Dextrose in 0.225% Sodium Chloride (D₅¼NS)
- 5% Dextrose in 0.45% Sodium Chloride (D₅½NS)
- 5% Dextrose in 0.9% Sodium Chloride (D₅NS)
what are colloids?
- Large Molecules that do not dissolve and can not pass through a membrane
- Used clinically for volume expansion
- Pull fluid into the bloodsteam
when administering a colloid, during infusion we are going to closely monitor what? 5
- Increase in blood pressure
- Dyspnea
- Bounding pulse
- Fluid overload
- Anaphylaxis
what are we going to watch and the interventions for using colloids?
Fluid Overload: JVD, increased BP, respiratory distress
Monitor Fluid balance: I and O, V/S, Wt., increased heart rate or resp rate
Monitor electrolytes: potassium and sodium
Fluid volume deficit definition?
Decrease in circulating blood volume
HYPOVOLEMIA
what are some things that can cause fluid volume deficit ?
- vomiting
- severe dehydration
- trauma
- burns
- medication (diuretics)
moderate symptoms of fluid volume deficit?
- Dry Mucous membranes
- Excessive thirst
- Postural hypotension
- Thready Pulse
- Dark Urine
severe symptoms of fluid volume deficit?
(Body will try to compensate and vessels will try to vasoconstrict)
HR increases
what nursing interventions will you do for fluid volume deficit?
Oral Rehydration
Increasing Fluid intake
IV Hydration
fluid volume overload definition?
Overloading circulatory system with excessive IV fluids
HYPERVOLEMIA
what can cause fluid volume overload?
- Rapid Infusion rate
- Hepatic, cardiac or renal disease
- Can be more common in elderly patients
fluid volume overload symptoms?
- edema
- wt gain
- palpable veins
- crackles in lungs
- pulmonary edema
- increased bp and cvp
- JVD
- dyspnea
- shallow resp
- perioorbital edema
- decreased lab values
how do you prevent fluid volume overload?
-Infuse IVF via pump
-Monitor patients closely
what are the nursing interventions for fluid volume overload? 4
-Decrease IV rate
-Monitor V/S, assess respiratory status
-High-Fowlers position
-Notify MD
