Lilley Ch. 29 Flashcards
1
Q
IV Fluids
A
-purposes: maintenance, when oral intake is not adequate. replacement, when losses have occured
2
Q
Crystalloids
A
- better for treating dehydration-distributed faster into the compartments than colloids
- used to compensate for fluid loss, replace fluid loss, manage and replace electrolyte imbalances, promote urinary flow
- EX: NS, D5W, D10W, LR
3
Q
Colloids
A
- stay in vascular space and increase osmotic pressure
- Includes: Human plasma products (albumin, fresh frozen plasma, blood, cryoprecipitate)
Semisynthetics (dextran and starches, [Hespan]) - used to treat conditions that require plasma volume expansion (shock, burns)
- less likely to cause edema and have a longer duration of action
4
Q
Hypotonic Crystalloids
A
- more h2o than electrolytes (pure water lyses RBCS) (osmolality of 250 mOsm/kg)
- used when patients with hypernatremia (0.45% NaCl) as a maintenance fluid but not used as a replacement fluid (bolus) b/c could cause a shift in ECF and lower BP
- half normal saline (0.45% NaCl). quarter normal saline (0.225% NaCl), 2.5% dextrose in water
5
Q
Hypotonic crystalloids (contraindications)
A
- never give to patients who are at risk for increased ICP/cerebral edema
- patients with liver disease, trauma or burns due to potential for depletion of intravascular fluid volume
- monitor for changes in mentation
6
Q
Isotonic Crystalloids
A
- similar concentration of water and electrolytes to plasma (250-375 mOsm/L)
- expands only ECF
- no net loss or gain from ICF
- ideal to replace ECF volume deficit
- 0.9% NaCl, Lactated Ringer’s
7
Q
5% Dextrose in Water (D5W)
A
- isotonic
- free water without electrolytes
- provides 170 cal/L
- used to replace water losses, treat hypernatremia, prevent ketosis
8
Q
Normal Saline (NS or NSS)
A
- isotonic
- more NaCl than ECF
- expands intravascular volume (preferred fluid for immediate response) and replaces ECF fluid loss
- compatible with most meds.
- only solution used with blood
- contains no free water, calories, or other electrolytes
- can cause intravascular fluid overload and hyperchloremic acidosis
9
Q
Lactated Ringer’s Solution
A
-isotonic
- similar in composition to plasma except contains no Mg. contains Na, Cl, Ca, and lactate
- expands ECF: treats burns, hypovolemia and GI lossess, used in surgerys
- Contraindicated with hyperkalemia, liver dysfunction and severe hypovolemia, because these patients have a decreased ability to convert lactate to bicarbonate
- no free water or calories
10
Q
Hypertonic crystalloids
A
- initally expands and raises the osmolality of ECF
- causes fluid to move from the interstitial spaces and cells into the veins
- requires monitoring of: BP, lung sounds, serum sodium levels
- 3% NaCl, 10% dextrose in water (D10W)
11
Q
A
12
Q
D10W
A
- hypertonic glucose solution
- provides 340 kcal/L
- provides free water but no electrolytes
- highest concentration of dextrose that can be administered through a peripheral line.
13
Q
Colloids
A
- stay in vascular space and increase osmotic pressure
- AKA: volume expanders or plasma expanders
- include: human plasma products (albumin, fresh frozen plasma, blood) semisynthetics (dextran and starches, [Hespan])
- used to treat conditions that require plasma volume expansion: shock, burns
- less likely to cause edema and have a longer duration of action
14
Q
Dextrans
A
- synthetic complex sugar solution
- metabolizes slowly so it remains in the vascular system for a prolonged period but not as long as the colloids
- pulls additional fluid into the intravascular space
15
Q
Hydroxylethyl starches
A
- Hespan
- synthetic colloids that work similarly to dextran to expand plasma volume
