Adult IV, H&P, and progress note

Question 1

crystalloid

Answer 1

• pass readily thru a membrane (b/w intravascular and extravascular fluid compartments)
• ex- saline or LR

Question 2

colloid

Answer 2

• do not pass readily thru a membrane

- ex- albumin, hetastarch

Question 3

isotonic

Answer 3

• solution is close that that of plasma

- >250 mOsm/L but < 375

Question 4

free water

Answer 4

water that is not bound by macromolecules

Question 5

hypotonic

Answer 5

solution has less osmotic pressure than plasma

-< 250 mOsm/L

Question 6

hypertonic

Answer 6

• solution has more osmotic pressure than plasma

- >375 mOsm/L

Question 7

sizez of IV needles

Answer 7

• smaller number= bigger needle tubing
• bigger number= smaller needle/tubing
• blue 22G- slow transfusion, for older adults
• pink 20G- crystalloid infusion for maintenance
• green 18G- fluid resuscitation or blood transfusion
• grey 16G- fluid resuscitation or blood transfusion

Question 8

Isotonic- options

Answer 8

• 0.9% (aka NS) NaCl

- lactated ringers- contain K and Ca

Question 9

Isotonic- uses?

Answer 9

-NS and LR- expand extracellular fluid volume

Question 10

NS- used for?

Answer 10

• hypovolemia
• peri/post-operative fluid management
• shock
• hemorrhage (w packed RBCs)
• burns

Question 11

LR- used for?

Answer 11

• vascular expansion

- electrolyte replacement!!

Question 12

Isotonic IVF- cautions

Answer 12

• may cause ECF overload in pts w CHF, renal failure
• NS- hyperchloremic metabolic acidosis
• LR- Ca cant bind to drugs and reduce their bioavailability- contraindicated as a diluent for blood transfusions (bind to and inact anticoagulants)

Question 13

Hypotonic- options

Answer 13

• D5W (5% dextrose in water)
• 1/2 NS
• 1/4 NS
• D5 1/2 NS

Question 14

D5W

Answer 14

• wont cause volume overload (doesnt contain Na)- so not good to use as a volume expander in hypovolemia
• irritates veins
• can cause hyperglycemia
• pure free water cannot given intravenously as it causes hemolysis!!

Question 15

hypotonic- cautions

Answer 15

• if used for ECFV depletion- dangerous hyponatremia!!!- monitor Na closely!
• worsen hypotension, inc edema

Question 16

hypertonic- options

Answer 16

• 3% NaCl
• D5 NS (5% dextrose w NS)
• D5 1/2 NS
• D5LR

Question 17

hypertonic- uses

Answer 17

• 3% NS- tx severely symptomatic hyponatremia (Na 115)

- D5NS for head injuries

Question 18

hypertonic- cautions

Answer 18

• freq monitor Na and correct SLOWLY (if too fast- osmotic demyelination syndrome- Locked-in-syndrome!!!)
• fluid overload
• iatrogenic hypernatremia
• irritating to veins

Question 19

isotonic, hypotonic, hypertonic- pneumonic

Answer 19

• Isotonic- stay where “I” put it (stays in blood stream)
• HypOtonic- go Out of vessel (moves fluid into cells)
• HypErtonic- Enter the vessel (draw fluid out of cells and into blood)

Question 20

Dextrose containing IVF

Answer 20

• normally the glucose is assimilated into cells and does NOT change the gluc conc of the pt
• but in a diabetic pt, can cause hyperglycemia

Question 21

considerations for pts on IVF

Answer 21

• weight daily
• in’s and out’s
• daily BMP- BUN/Cr, glucose, electrolytes

Question 22

BMP

Answer 22

See picture