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1

Isotonic solutions

Same concentration as body fluid/plasma
250-375 mOsm
NO FLUID SHIFT OUT OF CELL OR INTO VASCULAR SPACE

Sample Solutions:
.9NS – Normal Saline
LR – Lactated Ringers

2

Hypotonic solution

Less concentrated than plasma
Below 250 mOsm
FLUID MOVES INTO THE CELLS AND OUT OF THE VASCULAR SPACE, cells swell
Sample Solutions:
.225, .33, and .45 NS
D5W
D5.225NS, D5.45NS,
D2.5W

3

Hypertonic solution

More concentrated than plasma
Above 375 mOsm
FLUID MOVES OUT OF CELLS INTO INTRAVASCULAR SPACE, Cells shrink
Sample Solutions:
D10W and higher conc
D5NS
D5RL
TPN

4

Crystalloids

Capable of crystallization
Dextrose
NaCL
Electrolyte solutions
Alkalizing and Acidifying Agents

5

Colloids

Expand plasma volume – pull fluid into the bloodstream
Albumin
Dextran
Hydroxyethyl starches
Gelatins

6

Nursing care for crystalloid solutions

Monitor for signs of fluid overload
Assess urine output and specific gravity
Monitor lab values
Maintain rate per orders
Intake and Output

7

Nursing care for colloid solutions

Assess for history of allergic response
Monitor urinary output
Monitor lab values
Evaluate CVP or jugular vein distention
Maintain infusion rate
Monitor for fluid overload – B/P, dyspnea, bounding pulse,
Monitor for bleeding

8

What IV solution is the most commonly prescribed

LR

9

Sodium chloride solution

Percentages: .25, .45, .9 (Normal saline), 3 and 5
Treats sodium depletion
ECF replacement when chloride loss greater or equal to Na loss
Metabolic alkalosis
Used for blood administration
Precautions – can cause hypernatremia, low potassium, acidosis when continuous infusion of .9NS
WATCH FOR CIRCULATORY OVERLOAD

10

Balanced electrolyte solution

Ringers Solution and Lactated Ringers (Hartmann’s)
LR most commonly prescribed
Used for trauma, alimentary fluid loss, dehydration, sodium depletion, acidosis, and burns
Ringers - also to restore fluid balance before and after surgery
Can be used for patients with liver disease unable to metabolize lactate
DISADVANTAGES – Don’t use in renal failure, can worsen sodium retention, CHF, renal insufficiency

11

Albumin

Natural plasma protein
Expands proportionate to amount of circulating blood
No danger of serum hepatitis
Improves cardiac output, reduces edema, and raises serum protein levels, maintains electrolyte balance (low sodium), promotes diuresis
CAUTIONS – Allergic reaction, circulatory overload, pulmonary edema, can alter lab findings

12

Dextran

Comes in low (40) and high molecular weight (70)
Treating SHOCK
EXPANDS BY ONCE OR TWICE ITS OWN VOLUME
Improves microcirculation
CAUTIONS – HYPERSENSITIVITY REACTIONS, INCREASED RISK OF BLEEDING, CIRCULATORY OVERLOAD
IV use only

13

HYDROXYETHYL STARCHES(Hetastarch, Pentastarch)

Synthetic, made from starch
Hespan 6 or 10%
Less toxic, less expensive
HEMODYNAMICALLY SIGNIFICANT PLASMA VOLUME EXPANSION
Permits retention of intravascular fluid
CAUTIONS – ALLERGIC REACTION, RISK OF INTRACRANIAL BLEEDING, ANEMIA OR BLEEDING DUE TO HEMODILUTION

14

Gelatins

Replacing blood volume due to acute blood loss
Large molecular weight protein
Priming heart – lung machines
Three types –
succinylated or modified fluid gelatins, urea- crosslinked, and oxypolygelatins
CAUTIONS – ANAPHYLACTOID REACTIONS, high calcium and potassium with urea linked,

15

Passive diffusion

Passive movement of water, ions, and lipid-soluble molecules randomly in all directions from a region of high concentration to an area of low concentration

16

Filtration

Transfer of water and dissolved substances from a region of high pressure to a region of low pressure; the force behind it is hydrostatic pressure

17

Osmosis

Movement of water from a lower concentration toward a higher concentration across a semipermeable membrane

18

Sensible fluid loss

urine output, GI tract

19

Insensible fluid loss

500 – 1000 mL per day
Lungs and skin

20

Assessments for fluid deficit/excess
Cardiovascular

-Deficit: increased pulse rate, decreased blood pressure, narrow pulse pressure, slow hand filling, decreased pulse volume

-Excess: bounding pulse, increased pulse rate, jugular vein distention, overdistended hand veins

21

Assessments for fluid deficit/excess
Respiratory

-Deficit: lungs clear

-Excess: moist crackles, respiratory rate >20, dyspnea, pulmonary edema

22

Assessments for fluid deficit/excess
Integumentary system

Deficit: decreased turgor, decreased skin temperature
Excess: warm, moist skin; fingerprinting over sternum

23

Assessments for fluid deficit/excess
Special senses

-Deficit: dry conjunctiva, sunken eyes, decreasing tearing, sticky mucous membranes, dry cracked lips, extra longitudinal furrows

-Excess: periorbital edema

24

Metabolic Acidosis: base bicarbonate deficit

Metabolic acidosis (HCO3 deficit) is characterized by a low pH and low plasma HCO3 level
Etiology
Loss of HCO3
Respiratory or circulatory failure
Ingestion of certain drugs or toxins
Septic shock

25

Tx for metabolic acidosis

Reversing the underlying cause
Eliminating the source
Administering NaHCO3 IV when pH is equal to or less than 7.2
NOTE: Give NaHCO3 cautiously to avoid patient developing metabolic alkalosis and pulmonary edema secondary to sodium overload

26

Metabolic Alkalosis: base bicarbonate excess

Metabolic alkalosis HCO3 excess is a clinical disturbance characterized by a high pH and high plasma HCO3 concentration
Etiology
Gain of HCO3
Loss of hydrogen ion (gastric suctioning and vomiting) Renal loss of hydrogen

27

Tx for metabolic alkalosis

Reversing the underlying cause
Administering sufficient chloride for the kidney to excrete the HCO3
Replacing potassium if a chloride deficit is also present

28

Respiratory Acidosis: Carbonic Acid Excess

Respiratory acidosis is caused by inadequate excretion of carbon dioxide and inadequate ventilation resulting in increased serum levels or carbon dioxide and H2HC03
Etiology
Pulmonary, neurologic, and cardiac causes
Aspiration of foreign body
Pneumothorax
Severe pneumonia
Overdose of sedatives

29

Tx of respiratory acidosis

Improve ventilation
Administer bronchodilators or antibiotics for respiratory infections
Administer oxygen as indicated
Administer adequate fluids to keep mucous membranes moist

30

Respiratory Alkalosis: Carbonic Acid Deficit

Respiratory alkalosis is usually caused by hyperventilation which causes “blowing off” of carbon dioxide and decrease in H2HCO3
Etiology
Pulmonary disorders that produce hypoxemia
Hypoxemia-induced fever, pneumonia, CHF, asthma
Stimulation of respiratory centers: anxiety, salicylate overdose