IV Fluids Flashcards
Describe isotonic solutions
Same osmolality as body fluids
Increase ECF volume
Do not enter cells because no osmotic force exists to shift the fluids
Describe hypotonic solutions
More dilute solutions and have a lower osmolality than body fluids
Cause movement of water into the cells by osmosis
Administer slowly to prevent cerebral edema
Describe colloids
Also called plasma expanders
Pull fluid from the interstitial compartment into the vascular compartment
What are names of isotonic fluids
Normal saline 0.9%
5% dextrose in water D5W
5% dextrose in 0.225% saline
Lactated ringers
Name hypotonic solutions
- 45% sodium chloride NS
- 25% NS
- 33% NS
Name hypertonic solutions
5% NS 3% NS D10W 5% dextrose in 0.9% NS 5% dextrose in 0.45% NS 5% lactated ringers
Name colloid solutions and why are they used
Dextran
Albumin
-hypoproteinemia and malnourished states for those who cannot tolerate large volumes of fluids
Who would you give a isotonic solution
Hemorrhage
Diarrhea / vomiting
When they are losing fluids
Who would you give a hypertonic solution
Cerebral edema
Severe hyponatremia
usually only used for highly acute patients
Who would you give a hypotonic solution ?
Intracellular dehydration.
Diabetic ketoacidosis
Hyperosmolar hyperglycaemic state
Signs and symptoms of air embolism
Tachycardia Chest pain and dyspnea Hypotension Cyanosis Decreased LOC
Signs and symptoms of catheter embolism
Decrease in BP Pain along the vein Weak and rapid pulse Cyanosis of the nail beds LOC
Signs and symptoms of circulatory overload
Increased BP distended jugular veins Rapid breathing Dyspnea Moist cough and crackles
Signs and symptoms of electrolyte overload
Signs depend on the specific electrolyte overload
Signs and symptoms of a hematoma
Ecchymosis
Immediate swelling and leakage of blood at the site
Hard and painful lump at the site
Signs and symptoms of an infection.
Local - redness swelling drainage at the site
Systemic - chills, fever, malaise, headache, nausea, vomiting, backache, tachycardia
Signs and symptoms of infiltration.
Edema
Pain
Coolness at the site
May or may not have blood return.
Signs and symptoms of phlebitis
Heat Redness Tenderness at the site Not swollen or hard IV infusion sluggish
Signs and symptoms of tissue damage
Skin colour changes
Sloughing of the skin
Discomfort at the site
Who are at risk for circulatory overload?
Respiratory clients
Cardiac client
Renal or liver dysfunction
Older and very young persons
Hyponatremia - CV SIGNS
Normovolemic - rapid pulse rate, normal BP
Hypovolemic - thready weak rapid pulse rate, hypotension flat neck veins; normal or low CVP
hypervolemic - rapid bounding pulse BP normal or elevated; normal or elevated CVP
Hyponatremia - RESP SIGNS
Shallow
Ineffective respiratory movement is a late manifestation related to skeletal muscle weakness
Hyponatremia - NEUROMUSCULAR SIGNS
Generalized skeletal muscle weakness that is worse in the extremities
Diminished deep tendon reflexes
Hyponatremia - CNS SIGNS
Headache Personality changes Confusion Seizures Coma
HYPONATREMIA - GI SIGNS
Increased motility and hyperactive bowel sounds
Nausea
Abdominal cramping and diarrhea
HYPONATREMIA - RENAL SIGNS
Increased urinary output
HYPONATREMIA- integumentary signs
Dry mucus membranes
Labs findings - HYPONATREMIA
Serum less than 135
Decreased urine gravity
HYPERNATREMIA - cv signs
Heart rate and blood pressure respond to vascular volume status
HYPERNATREMIA - RESP SIGNS
Pulmonary edema if hypervolemia is present
HYPERNATREMIA- neuromuscular signs
Early; spontaneous muscle twitches, irregular muscle contractions
Late ; skeletal muscle weakness; deep tendon reflexes diminished or absent
HYPERNATREMIA- CNS SIGNS
Altered cerebral function is the most common
Normovolemia or hypovolemia - agitation, confusion, seizures
Hypervolemia ; lethargy, stupor , coma
HYPERNATREMIA- GI SIGNS
Extreme thirst
HYPERNATREMIA- RENAL SIGNS
Decreased urinary output
HYPERNATREMIA– integumentary signs
Dry and flushed skin
Dry and sticky tongue and mucus membranes
Presence or absence of edema depending on fluid volume changes
HYPERNATREMIA - labs
Serum sodium above 145
Increased urine gravity
HYPOKALEMIA - CV
Thready weak irregular pulse
Weak peripheral pulses
Orthostatic hypotension
HYPOKALEMIA- RESP
Shallow ineffective respirations - weakness of the skeletal muscles of RESP
Diminished breath sounds
HYPOKALEMIA - neuromuscular
Anxiety lethargy confusion coma Skeletal muscle weakness leg cramps Loss of tactile discrimination Parastesias Deep tendon hyporeflexia
HYPOKALEMIA- GI
Decreased motility hypo active to absent sounds
Nausea vomiting constipation abdominal distension
Paralytic Ileus
HYPOKALEMIA LABS
ST depression
Shallow flat or inverted t wave
Prominent u wave
HYPERKALEMIA - CV
Slow weak irregular heart rate
Decreased blood pressure
HYPERKALEMIA - RESP
Profound weakness of the skeletal muscles leading to respiratory failure
HYPERKALEMIA - neuromuscular
Early; muscle twitches, cramps, parasthesias, tingling and burning followed by numbness in the heads and feet and around the mouth
Late ; profound weakness, ascending flaccid paralysis in the arms and legs
Lethal level- trunk head and respiratory muscles become affected
HYPERKALEMIA - labs
Tall peaked T waves
Flat p wave
Widened QRS
Prolonged PR
HYPOCALEMIA - CV
Decreased heart rate
Hypotension
Diminished peripheral pulses
HYOCALCEMIA - RESP
Not directly affected
H/E RESP failure or arrest can result from decreased respiratory movement because of muscle tetany or seizures
HYPOCALEMIA- neuromuscular
Irritable skeletal muscles - twitches cramps tetany seizures
Painful muscle spasms in the calf or foot during periods of inactivity
Parasthesias followed by numbness that may affect the lips nose and ears in addition to the limbs
Positive trousseaus and chvosteks signs
Hyperactive deep tendon reflex
Anxiety irritability
HYPOCALEMIA- GI
Increased gastric motility
Hyperactive bowel sounds
Cramping diarrhea
HYPOCALCEMIA - renal
Urinaryoutput depends on the cause
HYPOCALEMIA labs
Prolonged ST LEVEL
prolonged QT
HYPERCALCEMIA - CV
Increased HR in the early phase ; Bradycardia that can lead to arrest in the late phases
Increased BP
Bouncing full peripheral pulses
HYPERCALCEMIA - RESP
Ineffective respiratory movement as a result of profound skeletal muscle weakness
HYPERCALCEMIA - Neuromuscular
Profound muscle weakness
Diminished or absent deep tendon reflexes
Disorientation lethargy coma
Hypercalcemia - renal
Varies on cause
Formation of renal calculi flank pain
Hypercalcemia - GI
Decreased motility and hypo active sounds
Anorexia nausea abdominal distension constipation
HYPERCALCEMIA - labs
Shortened ST SEGMENT
widened T WAVE
Hypomagnesemia - cv
Tachycardia
Hypertension
Hypomagnesemia - RESP
Shallow RESP
Hypomagnesemia - neuromuscular
Twitches parasthesias
Positives trousseaus sign and chvosteks sign
Hyperreflexia
Tetany seizures
Hypomagnesemia- CNS
Irritability
Confusion
Hypomagnesemia - labs
Tall t waves
Depressed st segment
Hypermagnesemia - cv
Bradycardia dysrhythmias
Hypotension
Hypermagesemia - RESP
Insufficiency when the skeletal muscles of respiration are involved
Hypermagnesemia - Neuro
Diminished or absent DTR
skeletal muscle weakness
Hypermagnesemia - CNS
Drowsiness and lethargy progresses to coma
Hypermagnesemia - labs
Prolonged Pr interval
Widened QRS COMPLEXES
Antidote for magnesium overdose
Calcium gluconate
Describe hypertonic solutions
More concentrated solutions have a higher osmolality than body fluids
Cause movement of water from cells into the ECF by osmosis
