1.
5% and 10% dextrose in water: can be given peripherally.
2.
20% dextrose: provides calories
3.
Advantages of dextrose in water: Acts as vehicle for administration of medications
Provides nutrition
Can be used as treatment for hyperkalemia (using high concentrations of dextrose)
Can be used in treatment of patients w/dehydration
Provides free water
4.
Circulatory Overload: Crackles in lungs, dyspnea, tachycardia, anxious (not perfusing, check vital signs and pulse Ox), increased HR cyanotic.
5.
Colloid Solution 214: Plasma volume expanders
Contain protein or starch molecules that remain distributed in the EC space; remain in vascular space for several days
Substances whose particles, when submerged in a solvent, cannot form a true solution because their molecules cannot dissolve, but remain suspended and distributed in the fluid.
Dextran
Albumin
Hetastarch
Mannitol
Gelatin
Disadvantages:
anaphylaxis or hypersensitivity reactions
6.
Concentrations higher than 10% of dextrose in water: are given through central veins.
7.
D w/NaCl Advantages: Temporarily treats patients w/ circulatory insufficiency
Provides early treatment of burns
Replaces nutrients and electrolytes
Acts as hydrating solution to assist in checking kidney function before replacement of potassium
8.
D w/NaCl Disadvantages: Hypernatremia
acidosis
circulatory overload
9.
Dextrose: well metabolized by all tissue
Always check compatibility before adding medication to dextrose solutions.
10.
Dextrose Combined w/ Sodium Chloride: D51/2
Carbohydrates and sodium chloride used when excessive loss of fluid through:
sweating
vomiting
gastric suctioning
11.
Disadvantages of dextrose in water: vein irritation
vein damage
thrombosis
Hyponatremic encephalopathy (permanent brain damage & death)
cellular dehydration w/rapid infusion
transient hyperinsulin reaction
do not provide electrolytes
cannot replace or correct electrolyte deficits
cannot be mixed w/blood components - causes hemolysis
12.
Goals of PNT Therapy/IV therapy: 1. Maintenance therapy for daily body fluid requirements.
(Maintain daily requirements)
2. Replacement therapy for present losses - vomiting, diarrhea,hemmorage
(Replace previous losses)
3. Providing fluids and electrolytes necessary to replace ongoing losses (restoring homeostasis) - critical losses.
(Provide fluids and electrolytes to restore ongoing losses) 225
13.
Hypertonic: 10%, 20%, 50%, 70% D/W; dont infuse into peripheral vein; goes into Central line
3%, 5% NaCl
10% Mannitol
20% Mannitol
14.
Hypertonic Fluids: Have an osmolarity of 375 mOsm/L or higher;
higher than plasma
Causes cell to shrink
5% dextrose in 0.45% sodium chloride-D5W 0.45 NS
5% dextrose in 0.9% sodium chloride
Colloids (albumin 25%, plasma protein fraction, dextran, and hetastarch)
Used to:
replace electrolytes,
treat hypotonic dehydration
temporary treatment of circulatory insufficiency
shock
Are irritating to vein walls; go into Central lines
contraindicated in patients w/cardiac or renal disease because of increased risk of CHF and pulmonary edema
Give hypertonic solutions slowly to prevent circulatory overload.
As acidity of solution increases, irritation to vein wall increases.
15.
Hypotonic: 0.225% , 0.33%, 0.45%, NaCl
16.
Hypotonic Fluids: Have osmolarity lower than 250 mOsm/L
(lower than plasma)
Causes cells to swell
Used for:
hypertonic dehydration
water replacement,
diabetic ketoacidosis
Hydrate cells and can deplete circulatory system. Water moves from vascular space to intracellular space.
Caution: Do not give to patients w/low blood pressure because it will further a hypotensive state.
0.45 % sodium chloride (half-strength saline)
0.33% sodium chloride
2.5% dextrose in water
17.
Isotonic: 0.9% NaCl
0.25% D and 0.9% NaCl
5%D and 0.225% NaCl
Lactated Ringer's solution
Ringer's injection
Normosol-R
D5 and Normosol-M
1/6 M Sodium lactate
NaHCO3
18.
Isotonic Fluids: Same osmolarity as plasma - blood and body fluids. (ICF)
250-375 mOsm/L
Cells neither shrink or swell
Used to treat fluid loss, dehydration and hypernatremia (sodium excess)
0.9% sodium chloride (normal saline goes w/blood)
5% dextrose in water
lactated Ringer's solution
19.
Lactated Ringer's Solution: Used to replace fluid loss resulting from burns, bile, and diarrhea.
Used for:
Rehydration in all types of dehydration
Restoration of fluid volume deficits
Replacement of fluid lost as a result of burns
Treatment of mild metabolic acidosis
Treatment of salicylate overdose.
20.
Nursing Fact: Don't play "catch up" if solution infusion is behind schedule. Make sure IV solution does not "run away" and that it does not infuse rapidly into patient. Infuse at prescribed rate.
All dextrose solutions are acidic (pH 3.5-5.0) and may cause thrombophlebitis. Assess IV site frequently.
202
21.
Nursing Fast Fact: During stress, the body retains sodium, adding to hypernatremia.
22.
Ringer's solution: Isotonic
Treatment of any type of dehyration
Restoration of fluid balance before and after surgery
Replacemnt of fluids resulting from dehydration, GI losses, and fistula drainage
Advantages:
Tolerated well in patients who have liver disease.
May be used as blood replacement for a short period of time
Disadvantages:
Provide no calories.
May exacerbate sodium retention, CHF, and renal insufficiency.
Contraindicated in renal failure.
23.
Sodium Chloride (NaCl): Disadvantage
Can lead to circulatory overload. Isotonic fluids expand the ECF compartment, which can lead to overload of the cardiovascular compartments.
24.
Sodium Chloride (NaCl): Initiates or terminates a blood transfusion
(the saline solutions are the only solutions to be used with any blood product)
