Fluids Primer Flashcards
True or False
Water follows the solutes in a solution.
True
Solutes in a fluid =
• Osmolarity of the fluid
High osmolarity is…
- Large solute % in fluid
* AKA: hypertonic
Low osmolarity is…
- Small solute % in fluid
* AKA: Hypotonic
A hypertonic solution draws water out of ______ and into _____.
- The cells
* Extracellular space
A hypotonic solution draws water out of _____ and into _____.
- Extracellular space
* Into the cell
Define an isotonic solution.
• Both extracellular and intracellular fluids have the same osmolarity so there is no water movement between them
Crystalloid solutions are generally used for…
• Fluid resuscitation
Colloid solutions are generally used for…
• Volume expansion in the intravascular space
What some conditions where an isotonic 0.9% Normal Saline solution may be given?
- Dehydration
- Hypovolemia (absolute)
- Hemorrhage
- Sepsis
- Shock
What some conditions where an isotonic Lacted Ringers solution may be given?
- Burns and trauma
- Acute blood loss
- Hypovolemia (relative)
- Electrolyte imbalance
- Metabolic acidosis
Why is 0.9%NS used with caution or sometimes avoided for pts with cardiac or renal comprise?
• Because the sodium in the solution may cause fluid retention or volume overload
What is the only fluid used in conjunction with blood product administration?
• 0.9%NS
Dextrose (D5W) is an intravenous _____ solution.
• Sugar
Explain the tonicity of D5W.
- It is both an isotonic and hypotonic solution
- Initially hypotonic, D5 dilutes the osmolarity of the extracellular fluid.
- Once the cells have absorbed the dextrose, the remaining water and electrolytes become an isotonic solution
Why should D5 not be used as the sole treatment of fluid volume deficit?
• Because it dilutes plasma electrolyte concentrations
D5W is contraindicated for what scenarios?
- Resuscitation
- Early post-op recovery
- Cardiac and renal conditions
- Any case of suspected increased ICP
True or False
D5W can be administered for hypernatremia
• True
0.45% NS may be used to treat _____ and _____.
- Hypernatremia
* Diabetic ketoacidosis
For what conditions is 0.45% NS contraindicated? Why?
- Burns
- Trauma
- Liver disease
- Why: Because it depletes intravascular fluid volumes.
Infusing 0.45% NS too quickly can cause…
• Hemolysis of RBCs
Before administering fluids, what should be documented?
- Vital signs
- Edema status
- Lung and heart sounds
Hypotonic solutions may exacerbate existing _____ and ______ causing _____.
- Hypovolemia
- Hypotension
- Cardiovascular collapse
Why are hypotonic solutions contraindicated for conditions with ICP?
• The fluid shift makes the cells bigger and increases ICP
What is the tonicity of D10W, D20W and D50W?
• They are all hypertonic
When administering hypertonic solutions, we need to watch for signs of _____.
• Hypervolemia
Hypertonic solutions should be administered only in high acuity areas with…
• Constant nursing surveillance for potential complications
True or False
Patients with or heart disease and those who are dehydrated should not receive hypertonic IV fluids.
• True
True or False
Hypertonic dextrose solutions should not be administered peripherally
• True, they can cause irritation and damage to the blood vessel and should be administered through a central vascular access device inserted into a central vein.
Hypertonic dextrose solutions will have to be used with caution for patients with…
- Diabetes Mellitus
* Monitor blood glucose closely
3% and 5% NaCl are used for…
- The acute treatment of sodium deficiency
* When serum osmolality has decreased to critically low levels
True or False
3% and 5% NaCl can be used in pts with cerebral edema.
• True
What are colloid fluids?
- Fluids with large molecules that are unable to pass through semipermeable membranes and remain in the blood vessels.
- They also draw fluid from the interstitial space and increase intravascular volume
Why may a colloid solution be used as opposed to a crystalloid?
- Colloids don’t require as much volume to increase intravascular pressure as crystalloids
- As such, a colloid solution would be indicated for a pt that cannot tolerate large fluid volumes
Two common colloids are…
- Albumin
* Hespan
5% Albumin is commonly used to…
• increase the circulating volume and restore protein levels in conditions such as burns and pancreatitis and plasma loss through trauma.
25% Albumin is used together with sodium and water restriction to reduce…
• excessive edema
The use of albumin is contraindicated in patients with the following conditions:
- Severe anemia
- Heart failure
- Known sensitivity to albumin.
Angiotensin-converting enzyme (ACE) inhibitors should be withheld for at least 24 hours before administering _____ because of the risk of atypical reactions, such as _____ and _____.
- Albumin
* Hypotension and flushing
True or False
A small bore needle is needed when administering colloid solutions.
• False, a large 18 gauge needle should be used
What adverse reactions need to be monitored for when administering colloids?
- Hypervolemia
- Hypertension
- Dyspnea
- Crackles in the lungs
- Edema.
