IV Solutions Fluid Replacement

Question 1

Isotonic Fluid

Answer 1

Replaces ECF intravascular (plasma) volume

• 0.9% Sodium Chloride, D5W, Ringer’s Solution

Question 2

Hypotonic Fluid

Answer 2

Replaces intracellular fluid volume (ICF)
Cellular hydration

• 0.45% sodium chloride

Question 3

Hypertonic Fluid

Answer 3

Expands extracellular fluid volume or plasma
Pulls fluid from ICF volume

*3% sodium chloride, 20% dextrose D20W, albumin, TPN solution

Question 4

Fluid Volume Deficit

Answer 4

Manifestations and lab values

Question 5

Treatment of Fluid Volume Deficit

Answer 5

Give IV fluids to replace losses (will depend on cause of deficit)
Replace fluid and electrolytes (oral and enteral)
Maintaining fluid levels and electrolytes
Correct imbalances
Monitor I&O
Weight daily
Safety precautions: orthostatic hypotension
- Get up slowly, bed in lowest position, etc.

Question 6

Fluid Volume Excess

Answer 6

Manifestations and lab values

Question 7

Treatment of Fluid Volume Excess

Answer 7

Na+ retention is primary cause of fluid volume excess. (Restrict fluid intake)
Medications to remove fluids (diuretics)
- Loop diuretics (K+. Cl-, Na+, and H20 excretion)
- Thiazide diuretics (Na+, K+, Cl-, H20 excretion)
- Potassium-sparing diuretics (spare K+. but excrete Na+, and H20)

Question 8

Fluid Volume Excess

Answer 8

I&O
Edema (periorbital is generalized)
Good oral hygiene
Monitor for decreased K+ levels (diuretic side effect)
Rest with feet elevated
Semi-fowler’s to assist with breathing
Monitor lab values closely (cardiac and renal concerns)

Question 9

Electrolyte Concentrations

Answer 9

a

Question 10

Serum Electrolytes

Answer 10

Na+ : 135-145 mmol/L
K+ : 3.5 - 5.1 mmol/L
Ca+ : 2.1 - 2.6 mmol/ L

Question 11

Hyponatremia

Answer 11

Intake of foods high in sodium
Restrict oral fluids
Administer sodium - containing intravenous fluids
Medications
- Administer loop diuretics and sodium replacement to remove excess water
Priority of care is to increase sodium intake or decrease water intake

Question 12

Hyponatremia

Answer 12

Teach importance of drinking liquids containing sodium and other electrolytes

• When perspiring heavily
• In hot environment
• When experiencing prolonged watery diarrhea

Question 13

Hypernatremia

Answer 13

Correct water deficit
Medications
- Administer diuretics to increase sodium excretion (K+ sparing diuretics)
Prescribe low sodium diet
Priorities of care are to decrease sodium intake and increase water intake
Teach low sodium diet and sufficient water intake

*Dehydration of brain cells causes neuro deficits (confusion, altered LOC, severe cases = seizures)

Question 14

Hypokalemia

Answer 14

Potassium replacement orally or intravenously
Increase intake of foods high in potassium
Foods high in potassium:
- Fruits: avocados, apricots, bananas, cantaloupe, dates, oranges, raisins
- Vegetables: carrots, cauliflower, mushrooms, peas, potatoes, spinach, tomatoes
- Meat and fish
- Milk and milk products

Question 15

Hypokalemia

Answer 15

Priorities of care are early identification and monitoring of cardiac status
Teach high-potassium diet, administering potassium supplements, and regular follow-up assessments

*Occurs when clients are NPO or have anorexia nervosa, with excess GI loss, rapid tissue repair

Question 16

Hyperkalemia

Answer 16

Medications
- Administer loop diuretics, sodium polystyrene sulfonate (Kayexalate) (exchanges Na+ for K+) - K+ excreted
- Administer IV insulin, glucose, sodium bicarbonate, and calcium gluconate
Administer hemodialysis or peritoneal dialysis

Question 17

Hyperkalemia

Answer 17

Priorities of care are early detection and monitoring of cardiac status
Teach administration of medications, low-potassium diet, obtaining regular lab tests, and follow-up care

• Major cause kidney (inadequate K+ excretion)

Question 18

Hypocalcemia

Answer 18

Medications

• Adminiser oral calcium replacement and vitamin D
• Administer IV calcium chloride, calcium gluconate, or calcium gluceptate via slow IV push or infusion (to treat tetany)

*Calcium has a sedative effect

Question 19

Hypocalcemia

Answer 19

Increase dietary intake of calcium
Priority of care is to replace deficient calcium to prevent dysrhythmias and seizures
Teach dietary intake of calcium foods and vitamin D, administration of medications, and follow-up care

Question 20

Hypercalcemia

Answer 20

Medications

• Administer IV normal saline solution (to restore volume and dilute calcium)
• Administer diuretics (promotes calcium excretion)
• Administer biphosphonates, calcitonin, IV plicamycin, glucocorticoids

Question 21

Hypercalcemia

Answer 21

Decrease dietary intake of calcium

• Milk and milk products
• Canned salmon and sardines
• Rhubarb
• Broccoli, collard greens, spinach
• Soy flour, tofu

Question 22

Hypercalcemia

Answer 22

Priorities of care

• Monitor mental status (increased calcium in CSF affects behaviour)
• Monitor respiratory and cardiac status
• Protect against injury from falls due to muscle weakness and and fatigue
• Decrease incidence of kidney stones

Question 23

Hypercalcemia

Answer 23

Teach administration of medications, decreased dietary intake of calcium, increased dietary intake of fiber, and encourage weight-bearing activities

Question 24

Hypomagnesemia

Answer 24

Medications

• Administer oral magnesium supplements, such as antacids (Need to be careful since Mg+ affects K+ and Ca+)
• Administer magnesium via IV or deep IM injection

Question 25

Hypomagnesemia

Answer 25

Increased dietary intake of magnesium

• Green, leafy vegetables
• Legumes
• Whole grains
• Bananas, oranges, grapefruit
• Dairy products
• Meat
• Seafood

Question 26

Hypomagnesemia

Answer 26

Priorities of care

• Monitor deep tendon reflexes and serum magnesium levels (need to watch for rebound)
• Teach administration of magnesium supplements, dietary intake of magnesium foods, and referral for alcohol problems

Question 27

Hypermagnesemia

Answer 27

Medications
- Withhold all medications and solutions containing magnesium
- Administer IV calcium to counteract cardiac effects
Perform HD or PD if renal failure
Mechanical ventilation to support respirations

Question 28

Hypermagnesemia

Answer 28

Priorities of care
- Monitor cardiac and respiratory status
- Monitor changes in neuromuscular excitability
- Monitor GI function
Teach to avoid magnesium containing medications and to decrease dietary intake of magnesium containing foods

Question 29

Hypophosphatemia

Answer 29

Increase phosphorus in the diet, especially milk and milk products
Medications
- Administer oral phosphorus supplements
- Administer IV phosphate solutions
Priorities of care
- Monitor for signs of phosphate imbalance, and serum phosphate levels
- Protect from infection

Question 30

Hypophosphatemia

Answer 30

Teach to administer medications, increase dietary intake of phosphorus, effects of phosphorus-binding antacids, referrals for alcohol use

Question 31

Hyperphosphatemia

Answer 31

Decrease phosphorus in the diet
Medications
- Administer aluminum hydroxide (Amphogel)
- Administer IV normal saline
- Administer glucose and insulin to drive phosphate into cells
Perform dialysis

Question 32

Hyperphosphatemia

Answer 32

Priorities of care
- Monitor and report signs of phosphate imbalances
- Monitor phosphate levels
Teach to recognize signs of imbalance, avoid phosphate-containing laxatives and enemas, avoid dietary intake of phosphorus, and to take medications as ordered