Isotonic Solutions
What is the main purpose of an isotonic solution?
To treat fluid volume defecit
What fluid is used for first line resuscitation for burn and trauma patients.
Lactated ringers
Provides some calories, but not enough nutrition for prolonged use.
How long do you have to use thawed out plasma?
No longer then 20 minutes
How many ml is 1 unit of whole blood?
500 ml
What assessments as a nurse will you take before giving a isotonic solution?
Document baseline vital signs, edema, lung sounds, and heart sounds, and continue monitoring during and after the infusion.Monitor for signs of hypervolemia such as hypertension, bounding pulse, pulmonary crackles, dyspnea, shortness of breath, peripheral edema, jugular vein distension (JVD) and extra heart sounds such as S3.
Carries a risk of hypersensitivity?
No
Hyponic or isotonic?
Both isotonic and hypotonic. Initially dilutes osmolality of extracellular fluid (hypotonic); once cell has used dextrose, remaining saline and electrolytes act isotonic, expanding the extracellular compartment.
Do you dilute albumin?
No
Action of albumin?
Provides colloidal oncotic pressure, which serves to mobilize fluid from extravascular tissues back into intravascular space.
What is the Fluid of choice for resuscitation efforts.
0.9% NaCL
Normal Saline
Used for?
Used to treat acute blood loss or hypovolemia due to third-space fluid shift; GI loss and fistula drainage; electrolyte loss; and metabolic acidosis.
What electrolyte imbalance would 5% dextrose help treat?
hypernatremia
DAILY DOUBLE
General nursing considerations for hypotonic solution?
May worsen existing hypovolemia and hypotension causing cardiovascular collapse. Monitor for signs of fluid volume deficit, such as confusion in older adults and dizziness. Never administer to patients at risk for increased ICP as the potential fluid shift may cause cerebral edema. Avoid in patients with liver disease, trauma or burns.
Contraindications for albumin?
Allergic reactions to albumin, severe anemia, and increased intravascular volume.
DAILY DOUBLE
What lab should be monitored when giving large amounts of normal saline?
Monitor for hyperchloremia with large volumes of fluid replacement with 0.9%NaCl.
What patient would be contraindicated for giving LR?
Contraindicated in patients who cannot metabolize lactate, (i.e. liver disease) or experiencing lactic acidosis. Caution in patients with renal failure (LR contains some potassium and hyperkalemia can occur).
What would be contraindications for 5% dextrose?
Contraindicated in resuscitation, early postoperative period, and patients with known or suspected increased intracranial pressure (ICP).
General nursing considerations for hypertonic solutions?
Administer only in high acuity areas.
Monitor electrolytes and assess for hypervolemia. May cause fluid volume overload and pulmonary edema.
What is a common severe adverse reaction to albumin?
Pulmonary edema?
What is the only solution that should be administered with blood products.
0.9% NaCL
Normal Saline
What lab will you watch that will tell you not to use lactated ringers?
Do not administer if pH > 7.5. (Normal liver will convert LR to bicarbonate, worsening alkalosis.)
How long does a typical bag of blood run for?
2 hours
What would 3% NaCl be used for?
Used for treatment of severe, critical symptomatic hyponatremia.
Give slowly and cautiously to avoid intravascular fluid volume overload and pulmonary edema and the rare life-threatening complication of central pontine myelinolysis.
What is a significant lab and complication to watch for that go hand in hand?
Watch for hemorrhage and monitor hemoglobin/hematocrit. These values may decrease because of hemodilution.