IV Therapy Ch4 Wk6
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| To understand the use of parenteral solutions the nurse must understand two important concepts: | 1. The rationale for the physician’s orders of I.V. Therapy. 2. The type, composition and clinical usage of that particular solution.
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| IV fluids are ordered for the following purposes | To maintain fluid balance (replace insensible water losses); To replace volume losses; To repair imbalances
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| Isotonic | 250 – 375 mOsm
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| Hypotonic | below 250
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| Hypertonic | above 375
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| Key Elements of Parenteral Solutions | Carbohydrates Protein Vitamins Electrolytes pH
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| Isotonic (Iso-osmolar) Solutions | Osmolarity of 250 to 375 mOsm/L; isotonic solutions are given to replace fluid losses; When infused, there is little or no change in the concentration of solute and water in the bloodstream, so osmosis neither moves water into the circulation nor pulls it
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| Isotonic (Iso-osmolar) Solution examples | 0.9 % sodium chloride 5 % dextrose in water Lactated Ringer’s
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| Hypotonic Solutions | Osmolarity lower than 250 mOsm/L; fluid will hydrate the cells while reducing fluid in the circulatory system; When administered, more water is being infused than is already present in the vessel and inside the cells. Therefore, water moves into the cells
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| Hypotonic Solution examples | 0.33% sodium chloride 0.45% sodium chloride 2.5% dextrose in water
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| Hypertonic Solutions | Tonicity exceeding 350-375 mEq/L. Most admixed medications infused intravenously fall into this category; When infused, osmosis pulls water out of the cells. This causes the cells to shrink.
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| Hypertonic Solution examples | 5% dextrose in .9% sodium chloride 5% dextrose in .45% sodium chloride 5% dextrose in lactated Ringer’s 10% dextrose in water and colloids
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| IV Solutions | Crystalloids Colloids
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| Crystalloids | Substance that forms a true solution and is capable of passing through a semipermeable membrane
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| Colloids examples | Albumin Dextran Hydroxyethyl starches Gelatins
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| Crystalloids examples | Dextrose Sodium chloride Hydrating Balanced electrolyte solutions
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| 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.
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| Dextrose Solutions percentages | 2.5, 5, 10, 20, 30, 40, 50, & 70 Available in combination with other solutions
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| Dextrose Solutions advantages | Acts as a vehicle for administration of medications Provides nutrition Can be used as treatment for hyperkalemia Used for treatment in dehydration Provides free water
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| Dextrose Solutions disadvantages | Vein irritation! rapid infusion of 5% in dextrose in water causes Hyponatremic encephalopathy with (especially in premenopausal women) Solutions of 20 – 70% can act like osmotic diuretic if administered too rapidly Transient hyper-insulin reaction
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| Sodium Chloride Solutions | 0.9% often referred to as “normal saline”; uses: treatment of shock, hyponatremia, given with blood transfusions, resuscitation, fluid challenges, metabolic alkalosis hypercalcemia, and fluid replacement in diabetic ketoacidosis.
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| Sodium chloride percentages | 0.25, 0.45, 0.9, 3, and 5
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| Sodium Chloride Solutions advantages | Provides ECF replacement when chloride loss is > than or = to sodium losses Treats metabolic alkalosis Treats sodium depletion Initiates or terminates blood transfusions
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| Sodium chloride solutions disadvantages | Provides more sodium and chloride than patients need, leading to hypernatremia Can cause acidosis in patients receiving continuous infusions of 0.9% sodium chloride May cause low potassium level due to lack of electrolyte in solution Can lead to circul
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| Hydrating Solutions | Combination of dextrose and sodium chloride solutions; for excessive loss of fluid through sweating, vomiting, or gastric suctioning; potassium free
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| Hydrating Solutions advantages | Assess kidney status Hydrate patient in dehydrated state Promote diuresis Use in hypodermoclysis
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| Hydrating solutions disadvantages | Same as for sodium chloride solutions Requires cautious administration in edematous patients
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| Balanced Electrolyte Solutions | used in 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
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| common Balanced electrolyte solutions | Ringer’s solutions Lactated Ringer’s
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| Ringers Solution | Similar to .9%; Treatment of any type of dehydration; Use for patients with liver disease who are unable to metabolize lactate
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| Ringer’s Solution advantages | Tolerated well in patients with liver disease May be used as volume replacement for short period of time
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| Ringer's solution disadvantages | May exacerbate sodium retention, CHF, renal insufficiency Provides no calories Contraindicated in renal failure
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| Lactated Ringer’s Solution | AKA Hartmann’s solution; Most commonly prescribed balanced solution Electrolyte concentration closely resembling ECF compartment; used for Restoring fluid volume deficits Replacing fluid lost due to burns, vomiting, and diarrhea; Treating mild metabolic
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| Lactated Ringer’s Solution advantages | Contains the bicarbonate precursor to assist in correcting or preventing acidosis Most similar to body’s extracellular electrolyte content
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| Lactated Ringer’s Solution disadvantages | Three liters of lactated Ringer’s contains about 390 mEq of sodium — hypernatremia Lactated Ringer’s cannot be used in patients with impaired lactate metabolism
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| Alkalizing & Acidifying Infusion Fluids | Alkalizing fluids-used to treat metabolic acidosis when too much bicarbonate is lost. 1/6 molar Sodium lactate 5% Sodium bicarbonate Acidifying fluids-used to treat metabolic alkalosis (excess bicarb.) .9 sodium chloride Ammonium chloride
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| Crystalloid Solutions key points | 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
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| Colloid Solutions key points | Substance that does not dissolve into a true solution and is not capable of passing through a semipermeable membrane Albumin Dextran Hydroxyethyl starches Gelatins
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| Albumin | Natural plasma protein prepare from donor plasma Available as a 5, 20, or 25% solution 5% available in 50, 250, 500, and 1,000 mL solutions 20% available in 100 mL vial 25% solution is equivalent to 500 mL of plasma and available (25 Gm/100 mL) in 20,
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| Albumin advantages | Free of danger of serum hepatitis Expands blood volume proportionately to amount of circulating blood Improves cardiac output Prevents marked hemoconcentration Aids in reduction of edema Raises serum protein levels Low sodium content helps to mainta
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| Albumin disadvantages | May precipitate allergic reaction May cause circulatory overload (greatest risk with 25%) May cause pulmonary edema May alter laboratory findings
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| Dextran | polysaccharide that behaves as a colloid Used as plasma volume expanders; Used as adjunct in treatment of impending shock or shock states Expands volume by once or twice its own volume Improves microcirculation
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| Dextran advantages | Intravascular space is expanded in excess of the volume infused
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| Dextran disadvantages | Possibility of hypersensitivity reactions Increased risk of bleeding Circulatory overload For IV use only
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| Hydroxyethyl Starches | Synthetic colloid made from starch and is similar to human albumin Use for the prevention and treatment of critically low blood volume
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| Hydroxyethyl Starches advantages | Hetastarch and Pentastarch do not interfere with blood typing and crossmatching Provides hemodynamically significant plasma volume expansion Permits retention of intravascular fluid
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| Hydroxyethyl Starches disadvantages | Possibility of allergic reaction Anemia or bleeding due to hemodilution Risk of intracranial bleeding
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| Gelatins | Animal protein Large molecular weight protein formed from hydrolysis of collagen
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| 3 types of gelatins | Urea-crosslinked gelatins Succinylated or modified fluid gelatins Oxypolygelatins
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| gelatins advantages | Used for replacement of intravascular volume due to acute blood loss Priming heart-lung machines Have the least effect of hemostasis
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| gelatins disadvantages | Associated with anaphylactoid reactions Urea-linked have higher calcium and potassium levels Risk associated with bovine-derived due to association between new variant Creutzfeldt-Jakob disease and bovine spongiform encephalitis
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| Colloid Solutions key points | Carefully assess history of allergic responses Monitor urinary output Monitor laboratory values Monitor CVP or jugular venous distension Maintain infusion rate Monitor for fluid overload Monitor for bleeding
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| Potassium Chloride Solutions | Premixed solutions: Follow MD order and policy Mix in an isotonic non-dextrose solution Never give KCl IV push Always dilute first Never add to hanging IV bag KCl preparations greater than 60 mEq/L should not be given in peripheral vein Rate may not
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