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Fluid, Electrolyte & Acid Base Balance

List 3 Isotonic Intravenous Solutions

1. 5% Dextrose in Water (D5W)
2. 0.9 NaCl (normal saline)
3. Lactated Ringer's Solution ("roughly isotonic")

D5W supplies what in cal/L?
It contains ? g of glucose?
How should D5W not be given and why?

1. 170 cal/L
2. 50 g of glucose
3. Should not be given in excessive volumes because it does not contain Na+ (or ANY electrolytes), therefore; the fluid dilutes the amount of Na+ in the serum. Brain swelling, or hyponatremic encephalopathy can develop rapidly and cause death unless recognized and treated promptly.

0.9 NaCl is not desirable when? Why?
Normal saline may used to treat what?

1. Not desirable as routine maintenance solution because it provides only Na+ and Cl-, which are provided in excessive amounts, which can result in increased Na and Cl levels.
2. May be used to expand temporarily the extracellular compartment if circulatory insufficiency is a problem; hypovolemic shock, diabetic ketoacidosis or bot Na and fluid loss.

Lactated Ringer's Solution contains what?
What is it used to treat? When is Lactacted Ringers Solution contraindicated?

1. Contains multiple electrolytes in about the same concentrations as found in plasma. This solution lacks magnesium and phosphate.
2. Used in treating hypovolemia, burns, fluids lost as bile or diarrhea and mild metabolic acidosis.
3. Hyperkalemic patients and lactic acidosis

List 2 Hypotonic Intravenous Solutions
Why can't water be entered through an IV?
Hypotonic solution are usually used as what? why?

1. 0.33 NaCl (1/3 strength normal saline)
2. 0.45 NaCl (1/2 strength normal saline)
3. It would cause hemolysis of RBCs
4. Maintenance fluids (0.45% NaCl) because normal daily losses are hypotonic.

Both hypotonic solutions provide what 3 things?

1. Na+
2. Cl-
3. Free water

0.33 NaCl allows kidney's to do what?
Why is free water desirable?

1. Allows kidney's to select and retain needed amounts of Na+ and Cl-
2. Aid to kidneys in elimination of solutes

0.44% NaCl is often used to treat what?

Hypernatremia: because this solution contains a small amount of Na+, it dilutes the plasma Na+ while not allowing it to drop too rapidly

List 3 Hypertonic Intravenous Solutions
What are hypertonic solutions used to treat?
Hypertonic solution require frequent monitoring of what by the nurse?

1. 5% dextrose in 0.45 NaCl
2. 10% dextrose in water (D10W)
3. 5% dextrose in 0.9 NaCl
4. Hypovolemia, Hyponatremia, primarily provision of calories (parental nutrition) , while raising ECF concentration and expanding it
5. BP, Lung Sounds, Na+ levels, Fluid Volume Excess

5% dextrose in 0.45 NaCl is a common hypertonic solution used to treat what?

hypovolemia and to maintain fluid intake

10% dextrose in water supplies what in cal/L?
This is why it is used for what?
Any hypertonic solution above 10% dextrose must be administered through what? why?

1. 340/L
2. Peripheral Parental Nutrition (PPN)
3. Central line, need dilution to prevent RBC shrinkage

5% dextrose in 0.9% NaCl replaces what?
It may be temporarily used for what?

1. replaces nutrients and electrolytes
2. treatment of hypovolemia if plasma expander is not available

Autologous Transfusion

a blood transfusion donated by the patient in anticipation that he or she may need the transfusion during a hospital stay

Central Venous Access Device (CVAD)

a venous access device in which the tip of the catheter terminates in the central venous circulation, usually in the superior vena cava just above the R. atrium.

Crossmatching

determining the compatibility of two blood specimens

Dehydration

decreased fluid volume

Edema

Accumulation of fluid in body tissue

Hypertonic

having a greater concentration of solutes than the solution with which it is being compared

Hypervolemia

excess isotonic fluid (water and sodium) in the extracellular space

Hypotonic

having a lesser concentration of solutes than the solution with which it is being compared

Hypovolemia

deficiency of isotonic fluid (water and sodium) from the extracellular space

Implanted Port

a type of CVAD; subcutaneous injection port attached to a catheter; distall catheter tip dwells in the lower one third of the superior vena cava to the junction of the superior vena cava and the R. atrium. The proximal end of the port is usually implanted into a subcutaneous pocket of the upper chest wall. Implanted ports placed in the antecubital area of the arm are referred to as peripheral access system port.

Isotonic

Having about the same solute concentration as the solution with which it is being compared

Overhydration

increased fluid volume

Typing

determining a person's blood type (A,B,AB, or O)

Nontunneled Percutaneous Central Venous Catheters

a type of CVAD that has a short dwell time (3-10 days) may have double, triple or quadruple lumens, are more than 8 cm, depending on pt. size. Introduced through the skin into the internal jugular, subclavian, or femoral veins and sutured into place; are mainly used in critcal care and emergency settings

Peripherally Inserted Central Catheter (PICC)

a type of CVAD, more than 20 cm depending on the pt. size, that can be introduced into a peripheral vein (usually the basilic, brachial, or cephalic vein), and advanced so the distall tip dwells in the lower one third of the superior vena cavaand the R. atrium.

Peripheral Venous Access Device

a short, less than 3 inches peripheral catheter placed in a peripheral vein for ST therapy. This device is not appropriate for certain therapies such as vesicant chemotherapy, drugs classified as irritants or TPN.

Tunneled Central Venous Catheter

a type of CVAD intended for LT use, implanted into the internal or external jugular or subclavian vein, length of catheter is more than 8 cm (approximately 90 cm on average) depending on pt. size; tunneled in subcutaneous tissue under the skin (usually the midchest area) for 3-6 inches to its exit site

When monitoring the IV infusion, the nurse should check it atleast q. ?

1 hr or per agency polices

When monitoring an IV site inspect the site for what? (in red)

1. redness, swelling or heat (indicates phlebitis)
2. coolnes or pallor (indicates infiltration)

What questions should you ask your patient when monitoring the IV site? (in red)

are you experiencing any pain or discomfort

If any of the above symptoms are present what will need to occur? (in red)

notify physician; the IV will need to be removed and started at a new site, check facility policy for treating infiltration

What is the most common complication related to IV therapy?

phlebitis

What will you check for regarding bacteria or infection present? (in red)

check for local manifestations of redness, pus, warmth, induration, and pain that may indicated infection is present at the site. systemic manifestations will include chills, fever, tachycardia and hypotension that may accompany local manifestations at the site. If signs are present d/c and notify physician.

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