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IV Therapy CH 4

Parenteral solutions

balanced solution Pareteral solution that contains electrolytes in proportions similar to those in plama; also contains bicarbonate or acetate ion.
body surface area Surface area of the body determined through use of a nomogram.
caloric method Calculation of metabolic expenditure of energy, used in pediatric fluid mintenance and replacement.
Catabolism The breakdown of chemical compounds by the body; an energy-producing metabolic process.
Colloid A substance (e.g. blood, plasma, albumin, dextran) that does not dissolve into a true solution and is not capable of passing thru a semipermeable membrane.
Crystalloid A substance that forms a true solution and is capable of passing thru a semipermeable membrane (e.g., lactated Ringer's solution, isotonic saline).
Dehydration A deficit of body water; can involve one fluid compartment or all 3.
Hydrating solution A solution of water, carbs, sodium, and chloride used to determine adequacy of renal function.
Hypertonic solution A solution with an osmolarity higher than that of plasma, above 375 mOsm.
Hypotonic solution A solution with an osmolarity lower than that of plasma, usually below 250 mOsm.
Isotonic solution A solution with the same osmolarity as plasma; usually 250-375 mOsm.
Maintenance therapy Fluids that provide all nutrients necessary to meet daily patien requirements; usually water, glucose, sodium, and potassium.
meter square method Formula using a nomogram to determine surface areas of a pediatric client for maintenance of fluid needs.
Normal saline Solution of salt (0.9% sodium chloride)
Oncotic pressure The osmotic pressure exerted by colloids (proteins), and helps to hold the water content o the blood in the intravascular compartment.
Parenteral therapy Introductin of substances other that through the gastro tract; particularily to the introduction of substances into an organism by intravenous route, or subcutaneous, Intramuscular, or intramedullary injection.
Plasma volume expander A high molecular weight compound in a solution suitable for intravenous use.
Replacement therapy Replanishment of losses when maintenance cannot be met and when patient is in a deficit state.
Resoration therapy Reconstruction of fluid and electrolyte needs on a continuing basis until homeostasis returns.
Weight method Formula based on weight inkilograms to estimate the fluid needs of the pediatric client.
Rationales of Parental Therapy 1. The rationale for the physician’s orders of I.V. Therapy. 2. The type, composition and clinical usage of that particular solution.
Purpose for I.V. fluids being ordered maintain fluid balance, restore fluid balance, repair imbalances
Insensible water losses sweat and respiration
measurable fluid losses vomit, diarrhea, urination
Key elements of parenteral solutins water, carbohydrates, proteins, vitamins, electrolytes, pH
Isotonic (Iso-osmolar) Solutions Osmolarity of 250 to 375 mOsm/L The same osmolarity of normal body fluid For IV rehydration Replacing fluid losses Watch out for : fluid overload and pts w/ CHF and HTN
Examples of Isotonic solutions 0.9 % sodium chloride – normal saline 5 % dextrose in water - d5w Lactated Ringer’s – LR
Hypotonic Solutions Osmolarity lower than 250 mOsm/L Given short term Water moves into cells causing cell swelling
Hypotonic solution examples 0.45% sodium chloride – half normal saline 0.33% sodium chloride 2.5% dextrose in water – half of d5w
Hypertonic solution Tonicity exceeding 350-375 mEq/L. The higher the tonicity, the greater the damage to veins Pulls water out of cells causing them cells to shrink Closely monitor the patient for circulatory overload – watch out for fluid overload (edema)
ECF extracelluar fluid
Hypertonic solution examples 5% dextrose in .9% sodium chloride 5% dextrose in lactated Ringer’s 10% dextrose in water and colloids 5% dextrose in .45% sodium chloride
Examples of Colloids Albumin – plasma protein Dextran Hydroxyethyl starches Gelatins
Examples of Crystalloids "banana bag" Dextrose Sodium chloride Hydrating Balanced electrolyte solutions
Dextrose Solutions Used to provide calories for energy, reduce catabolism of protein, and reduce protein breakdown of glucose to help prevent a negative nitrogen balance; provides free water, can cause vein irritation
Sodium Chloride Solutions 0.9% referred to as "normal saline" used to initiate or terminate blood transfusions can lead to hypernatremia Can lead to circulatory overload
Sodium chloride uses treatment of shock hyponatremia given with blood transfusions resuscitation fluid challenges metabolic alkalosis hypercalcemia fluid replacement in diabetic ketoacidosis.
Hydrating Solutions Combination of dextrose and sodium chloride solutions Best used together when there has been an excessive loss of fluid through sweating, vomiting, or gastric suctionin Used to assess kidney function
Balanced Electrolyte Solutions patients with trauma, alimentary tract fluid losses, dehydration, sodium depletion, acidosis, diarrhea, excessive vomiting, fistula drainage, and burns used for restoration of fluid balance pre- and post-surgery
Balanced electrolyte solution example Ringer’s solutions – electrolytes are balanced Lactated Ringer’s
Ringers Solution Similar to .9% Treatment of any type of dehydration Restoration of fluid balance before and after surgery Replacement of fluids resulting from dehydration, GI losses, and fistula drainage Use for patients with liver disease who are unable to metaboliz
Lactated ringers solution Most commonly prescribed balanced solution Burns, aspirin o.d., given during labor, vomiting and diarrhea pts. Electrolyte concentration closely resembling ECF compartment
Key Points: Crystalloid Solutions Monitor for signs and symptoms of fluid overload Assess urine output and specific gravity Observe trending of pertinent laboratory values Monitor for IV patency Monitor intake and output Review prescriber’s order for accuracy and match the solution t
Hydroxyethyl Starches Synthetic colloid made from starch and is similar to human albumin Hetastarch and Pentastarch do not interfere with blood typing and crossmatching
Gelatins Animal protein from pigs and horses Large molecular weight protein formed from hydrolysis of collagen Three types available Succinylated or modified fluid gelatins Urea-crosslinked gelatins Oxypolygelatins
Gelatin uses replacement of intravascular volume due to acute blood loss (hemorrhage) priming heart lung machine
Creutzfeldt-Jakob disease brain damage that leads to rapid decrease to function and movement
bovine spongiform encephalitis AKA Mad Cow disease
Created by: MarieG