IV Solutions Fluid Replacement Flashcards
Isotonic Fluid
Replaces ECF intravascular (plasma) volume
- 0.9% Sodium Chloride, D5W, Ringer’s Solution
Hypotonic Fluid
Replaces intracellular fluid volume (ICF)
Cellular hydration
- 0.45% sodium chloride
Hypertonic Fluid
Expands extracellular fluid volume or plasma
Pulls fluid from ICF volume
*3% sodium chloride, 20% dextrose D20W, albumin, TPN solution
Fluid Volume Deficit
Manifestations and lab values
Treatment of Fluid Volume Deficit
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.
Fluid Volume Excess
Manifestations and lab values
Treatment of Fluid Volume Excess
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)
Fluid Volume Excess
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)
Electrolyte Concentrations
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Serum Electrolytes
Na+ : 135-145 mmol/L
K+ : 3.5 - 5.1 mmol/L
Ca+ : 2.1 - 2.6 mmol/ L
Hyponatremia
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
Hyponatremia
Teach importance of drinking liquids containing sodium and other electrolytes
- When perspiring heavily
- In hot environment
- When experiencing prolonged watery diarrhea
Hypernatremia
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)
Hypokalemia
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
Hypokalemia
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
Hyperkalemia
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
Hyperkalemia
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)
Hypocalcemia
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
Hypocalcemia
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
Hypercalcemia
Medications
- Administer IV normal saline solution (to restore volume and dilute calcium)
- Administer diuretics (promotes calcium excretion)
- Administer biphosphonates, calcitonin, IV plicamycin, glucocorticoids
Hypercalcemia
Decrease dietary intake of calcium
- Milk and milk products
- Canned salmon and sardines
- Rhubarb
- Broccoli, collard greens, spinach
- Soy flour, tofu
Hypercalcemia
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
Hypercalcemia
Teach administration of medications, decreased dietary intake of calcium, increased dietary intake of fiber, and encourage weight-bearing activities
Hypomagnesemia
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
Hypomagnesemia
Increased dietary intake of magnesium
- Green, leafy vegetables
- Legumes
- Whole grains
- Bananas, oranges, grapefruit
- Dairy products
- Meat
- Seafood
Hypomagnesemia
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
Hypermagnesemia
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
Hypermagnesemia
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
Hypophosphatemia
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
Hypophosphatemia
Teach to administer medications, increase dietary intake of phosphorus, effects of phosphorus-binding antacids, referrals for alcohol use
Hyperphosphatemia
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
Hyperphosphatemia
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
