IV therapy solutions Flashcards
why is IV therapy used?
- to provide water, electrolytes and nutrients needed to reach the daily required amount.
- replaces and correct defeciencies
- beneficial to administer medications and blood products
what do IV solutions contain?
- dextrose or electrolytes mixed in varous proportions with water
can electrolyte free water be administered by IV?
NO.
it rapidly enters the cells and causes them to rupture.
IV solution additives:
Potassium
Potassium Chloride (KCL)
potassium can be administered:
- orally
- slow IV infusion
NEVER IVP, IM, or SC potassium
- COMMON ADDITIVE TO IV FLUIDS
- POTASSIUM CHLORIDE- MEASURED IN
MILLIEQUIVALENTS (MEQ) - ORDER USUALLY WRITTEN TO INDICATE THE
AMOUNT OF MILLIEQUIVALENTS PER LITER - IV SOLUTIONS ARE OFTEN AVAILABLE WITH
POTASSIUM PREMIXED IN THEM
remember the following when adding potassium to an IV:
- Check compatibility with the solution and make sure it is well-diluted.
- Monitor client during infusion; rapid infusion of potassium can cause death due to cardiac depression, arrhythmias, and arrest.
- Check IV site frequently; medication is extremely
irritating. - Administer IV using an infusion control device.
- Never administer potassium concentrate IV push.
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DO NOT add potassium to an IV bag that is already infusing.
- this would cause the medication to concentrate
in the lower portion of IV bag. - results in client receiving a concentrated
medication solution can be harmful.
- this would cause the medication to concentrate
IV Fluid Types
- isotonic
- hypotonic
- hypertonic
isotonic
same number of solutes outside the cell as there is on the inside
hypotonic
less solutes on the outside and more solutes on the inside
hypertonic
more solutes on the inside and less solutes on the inside
isotonic solutions
- 0.9% Sodium Chloride
- Lactated Ringer’s (LR)
- D5W
= number of solutes
- 0.9% Sodium Chloride = Normal Saline
Hypotonic solutions
- 0.45% NaCl
- 0.33% NaCl
- D5W
- D5/0.45 %NS
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- D5W- Glucose rapidly metabolized = hypotonic
Hypertonic
- 3% NS
- D5/LR
- D5/0.9%NS -> (D5/NS)
- D5/0.45%NS -> (D5 ½ NS)
- TPN
- Solutions containing meds
why dextrose?
it is given to patients who need extra sugar as glucose is rapidly metabolized in the body and leaves the extra fluids to help with volume.
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dextrose in water
- 5% dextrose in water (D5W)
- 10% dextrose in water (D10W)
- 20% dextrose in water (D20W)
- 50% dextrose in water (D50W)
- do not use these alone to treat fluid volume deficency because it will dilute the plasma and the electrolytes
- cautionin patients with ELEVATED ICP and diabetics(unless they are severly hypoglycemic)
dextrose in water
5% dextrose in water (D5W)
isotonic solution
- replaces water loss
- provides free water necessary for cellular rehydration
- lowers serum sodium in hypernatremia
- isotonic in the bag, hypotonic in the body
- good for diluting
dextrose in water
10% dextrose in water (D10W)
Hypertonic solution
- provides free water
- provides nutrition
- given with TPN; just incase the TPN runs dry we do not want the pt to become hypoglycemic
dextrose in water
20% dextrose in water (D20W)
Hypertonic solution
- provides nutrition
- may cause diuresis
dextrose in water
50% dextrose in water (D50W)
Hypertonic solution
- used to correct hypoglycemia
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saline solutions
0.45% sodium chloride
Hypotonic solution
- provides free water to replace hypotonic fluid losses
- maintains levels of plasma sodium and chloride
- enters cells
saline solutions
0.9% sodium chloride
Isotonic solution
- replaces water lost from extracellular fluid
- used with blood transfusions
- replaces large sodium losses (burns)
- does not enter cells
- equally gives back sodium and fluid and does not distrupt the homeostasis of the vasculature
- great resuscitative fluid
saline solutions
3% sodium chloride
hypertonic solution
- corrects serious sodium depletion
- draws water from cells into ECF
saline solutions
D5 ½ NS
Hypertonic solution
- tx hypovolemia
Hypertonic in sln, Hypotonic in body
saline solutions
D% NS
- provides calories, water and electrolytes
Hypertonic in solutionn, Isotonic in body
saline solutions
Multiple electrolyte solutions
- Lactated Ringer’s solution (LR)
- D5 LR
multiple electrolyte solution
Lactated Ringer’s solution (LR)
isotonic solution
- replaces losses from burns and the lower GI tract
- fluid of choice for acute blood loss, contains Na, K, Ca, Cl, and lactate
- does not enter cells
- contraindicated with liver disease bc the liver is not able to metabolize the lactate
- liver labs; get AST/ALP…
- caution in renal failure pts because they may not be able to excrete the potassium and cause a build up
multiple electrolyte solution
D5 LR
hypertonic solution
- provides calories, water, electrolytes
- tx metabolic acidosis
Hypertonic in solution, Isotonic in body
isotonic solutions
- are close to the same osmolarity as serum
- Isotonic fluids expand the ECF volume
- expand the intravascular space
What implications does this have for a patient with Hypertension or Heart failure if they receive isotonic IV’s?
Risk of fluid overload
Isotonic Solutions
PURPOSE
- hydration
- maintain electrolytes
- used during and after surgery
D5/W
- Provides free water necessary for renal excretion of solutes
- Used to replace water losses and treat hypernatremia
- Provides 170 calories/L
The nurse recognizes requires fluid replacement with isotonic solution. One of the isotonic solutions that may be ordered by the health care provider is:
a. 0.45% saline
b. Lactated Ringer’s
c. 5% dextrose in normal saline
d. 5% dextrose in lactated Ringer’s
b. Lactated Ringer’s
Hypotonic solution
PURPOSE
- Replace cellular fluid
- Provides free water for excretion of wastes
- Often use 0.45% NS – Rx hypernatremia or other hyperosmolar conditions
- Less osmolarity than serum
- Dilutes the serum
- good for intracellular dehydration: DKA, HHS patients
- caution in hypovelimia (monitor bp for hypotension) –> can lead to cardiovascular collapse, so monitor for: s/s of fluid volume deficency (confusion, decrease urinary output, dizzyness, confusion, tachycardia.
Excessive Use of hypotonic Solutions
- Leads to intravascular fluid depletion
- Decreased blood pressure
- Cellular edema
0.45% NS - Hypotonic
- Provides free water in addition to Na+ and Cl–
- Used to replace hypotonic fluid losses
- Used as maintenance solution
* does not replace daily losses of other electrolytes - Provides no calories
- A hypotonic solution that provides Na+, Cl−, & free water
* Used as a basic fluid for maintenance needs
Hypotonic helpful for:
Cellular dehydration:
- Fluid shifts out of blood vessel (less concentrated) to the tissue cells (more concentrated)
- Ex: dry mucous membranes
Hyperglycemic conditions:
- Diabetic ketoacidosis
Hypotonic harmful for:
- sudden shift of fluid from blood vessel to the cells - cardiovascular collapse
- potential to cause cellular swelling
- monitor for changes in mentation –> indicate cerebral edema
A client experiences a loss of intracellular fluid. The nurse anticipates that the intravenous (IV) therapy that will be used to replace this type of loss is:
a. 0.45% normal saline (NS)
b. 10% dextrose
c. 5% dextrose in lactated Ringer’s
d. Dextrose 5% in NS
a. 0.45% normal saline (NS)
Hypertonic (hyper-osmolar)
PURPOSE
- Higher osmolarity than serum
- Pulls fluids and electrolytes from the intracellular & interstitial compartments into the intravascular compartment
Examples
- 3% NS
D5/0.9NS and D5/0.45NS
Use Postop when some sodium is needed
- D5LR
Hypertonic helpful for:
- ↓ edema
- increase urine output
- Stabilize BP
- Used to maintain fluid intake
- Can temporarily be used to treat hypovolemia if plasma expander is not available
- Solutions with concentrations greater than 10% must be administered through a central line
- Allows adequate dilution to prevent shrinkage of RBCs
A client is prescribed 0.9% sodium chloride (normal saline), which is an isotonic solution. The nurse recognizes the primary goal of such intravenous therapy is to:
a. Expand the volume of fluid in the vascular system
b. Pull fluid from the cells
c. Keep protein levels normal
d. Move fluid into the cells
a. Expand the volume of fluid in the vascular system
A client is prescribed 3% sodium chloride, which is a hypertonic solution. The nurse recognizes the primary goal of such intravenous therapy is to:
a. Expand the volume of fluid in the vascular system
b. Pull fluid from the cells
c. Keep protein levels normal
d. Move fluid into the cells
b. Pull fluid from the cells
A client is prescribed 0.45% sodium chloride, which is a hypotonic solution. The nurse recognizes the primary goal of such intravenous therapy is to:
a. Expand the volume of fluid in the vascular system
b. Pull fluid from the cells
c. Keep protein levels normal
d. Move fluid into the cells
d. Move fluid into the cells
