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IV Fluids/Elyte

IV fluids and electrolytes

Types of IV solutions Isotonic, Hyptonic, Hypertonic.
Isotonic Fluids Osmolarity: 270-300. No cellular effects, stays in vessels. (0.9% NS, LR). Keeps organ profused; volume expanders. Given for dehydration, surgery, etc. S/E: circulatory fl. volume overload (^ B/P). Monitor I&O, VS changes.
Hypotonic Fluids Osmolarity <270. Causes cells to swell. (D5W [most common], .45% NS [1/2 strength saline], .33% NS [1/3 strength saline]. Used to shift fluids back in to the cell, used in cellular dehydration. Will see extremely high Na level before IV ther.
Hypertonic Fluids Osmolarity >300. Causes cells to shrink. Fluid shifts from cells to blood plasma/vascular compartment. (D51/2 NS is most common)
Infiltration Cannula is no longer in proper placement. IV fluids are entering into surrounding tissue.
S & S of Infiltration Site is edematous. Cool to touch. Pale. Pain may be present. Rate of IV may slow (early symptom).
Tx for Infiltration Discontinue IV fluids, elevate extremity, apply cool compress, 20 mins, tid. Restart IV in opposite extremity.
Extravasation Cannula no longer in proper placement. IV meds are leaking into surrounding tissue.
S & S Extravasation Cool to touch, edema, blanching or discoloration, burning or discomfort.
Tx for Extravasation Similar to infiltration Tx. Cannula may be left in if antidote is being admin. Some drugs may cause necrosis. Additional Tx: debridement, wide excision, grafting, last resort- amputation.
Manifestations of Phlebitis Erythema, warm to touch, edema, IV rate may slow, streak formation, palpable venous cord, purulent drainage.
Causes of Phlebitis Mechanical (cannula has caused trauma), Chemical (due to highly acidic or alkaline fluids/meds), Bacterial (infection at the cannula).
Tx for Phlebitis Discontinue IV fluid, apply warm, moist compress (20 mins, tid), monitor for signs of infection, restart IV in opposite extremity.
Intracellular fluids Within the cell. Approximate 40% of total body weight.
Extracellular fluids Outside the cell. Approximate 20% total body weight. Subdivisions: Interstitial 15%, Intravascular 5%.
First spacing Normal. Fluids are inside the cell and where they should be. There is a normal distribution in the intracellular and extracellular spaces.
Second spacing There is an excess of fluid accumulation between the cells (edema)
Third spacing Accumulation of fluid in areas where there is normally minimal amt. (ascites, anasarca)
Plasma to interstitial Edema
Interstitial to plasma Dehydration
Cations K +, Na +, Mg +, Ca +
Anions Cl-, PO4- (phosphate), SO4- (sulfate), HCO3- (bicarbonate)
Main elytes in the intracellular fluid Potassium and Phosphate
Main elytes in extracellular fluid Sodium and Chloride
Main Elyte functions Regulate H2O distribution, especially sodium. Regulate acid base balance. Help with all body functions.
Osmosis H2O moves across selective membrane from area of low concentration to high concentration. (Water/fluids move from intracellular to extracellular)
Diffusion Solute molecules are moving from high concentration to low concentration and becoming evenly distributed.
Filtration Water and solutes move from area of high hydrostatic pressure to lower hydrostatic pressure, usually across capillary membranes.
2 major hormones affecting fluid and elytes ADH (antidiuretic hormone) and Aldosterone. Renin is an important enzyme affecting fluid and elytes.
Renin Enzyme produced by kidneys. Released when blood volume or B/P falls. Causes release of aldosterone
Aldosterone Produced in adrenal cortex. Regulates Na and K balance. Causes excretion of K and reabsorption of Na. Na absorption results in water reabsorption.
Created by: fulk_90