CLIENTS REQUIRING IV THERAPY

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CLIENTS REQUIRING IV THERAPY

• CHAPTER 19

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IV FLUID THERAPY pg. 224

• I.V. therapy provides the Pt with life-sustaining
  fluids, electrolytes and medications offers the
  advantages of immediate and predictable
  therapeutic effects.
• This route good for Pts with GI malabsorption.

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DISADVANTAGES

• Drug and solution incompatibility, adverse
  reactions, infection and other complications.

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ISOTONIC SOLUTIONS

• ISOTONIC SOLUTIONS
• No net fluid shift occur between isotonic
  solutions because the solutions are equally
  concentrated.
• Therefore, cells neither shrink nor swell with
  fluid movement
• Examples--Normal saline (0.9 Saline 0.9 g
  sodium chloride/100 mL solution), D5W, LR

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HYPOTONIC SOLUTION

• HYPOTONIC SOLUTION
• Has a lower solute concentration than another
  solution. When a less concentrated, or
  hypotonic, solution is placed next to a more
  concentrated solution, fluid shifts from the
  hypotonic solution into the more concentrated
  compartment to equalize concentrations.

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• Osmotic pressure draws water into the cells
  making cells swell.
• Use cautiously --can cause CV collapse from
  vascular fluid depletion.
• May cause Cerebral Edema r/t increased
  intracranial pressure from fluid shifting into
  brain cells.
• Examples of Hypotonic solutions include
• 1/2 normal saline (0.45 Sodium Chloride), D5 ½
  NS (5 g of Dextrose in 100 mL of 0.45 NS)

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HYPERTONIC SOLUTION

• HYPERTONIC SOLUTION
• If one solution is more solute concentrated than
  an adjacent solution, it has less fluid relative
  to the adjacent solution. Fluid will move out of
  the less concentrated solution into the more
  concentrated, or hypertonic, solution until both
  solutions are equal in concentration of solutes
  and fluid.

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HYPERTONIC SOLUTIONS

• Draws water out of the cells causing them to
  shrink
• Examples of Hypertonic solutions include
• D10W--Dextrose 10 in water
• 3 NS
• 20 Dextrose in water

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ISOTONIC SOLUTIONS AND USAGES

• ISOTONIC--
• Dextrose 5 in water
• Use fluid loss and dehydration, hypernatremia
• Special Considerations Solution is isotonic
  initially becomes hypotonic when dextrose is
  metabolized.

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ISOTONIC SOLUTIONS AND USAGES

• ISOTONIC (CONT)
• Dont use for resuscitation can cause
  hyperglycemia
• Use cautiously in renal and cardiac disease can
  cause fluid overload
• Does not provide enough daily calories for
  prolonged use may cause eventual breakdown of
  protein.

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ISOTONIC SOLUTIONS AND USAGES

• ISOTONIC
• 0.9 Sodium Chloride (Normal Saline)
• Contains only the electrolytes sodium and
  chloride.
• Uses shock, hyponatremia, blood transfusions,
  resuscitation, fluid challenges, metabolic
  alkalosis, hypercalcemia, fluid replacement in DKA

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ISOTONIC SOLUTIONS AND USAGES

• Isotonic NS
• Special considerations
• since this replaces extracellular fluid, dont
  use in pts with CHF, edema, or hypernatremia
  can lead to overload.

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ISOTONIC SOLUTIONS AND USAGES

• Isotonic Lactacted Ringers (L/R or R/L)
• Contains Na, K, Calcium and chloride. Also
  contains lactate, which the liver converts to
  bicarbonate.
• Uses--dehydration, burns, lower GI tract fluid
  loss, acute blood loss, hypovolemia due to third
  spacing

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ISOTONIC SOLUTIONS AND USAGES

• Isotonic L/R special considerations
• Lyte content is similar to serum but doesnt
  contain magnesium
• contains K dont use with renal failure can
  cause hyperkalemia
• Dont use in liver dx because the pt cant
  metabolize lactate functional liver converts it
  to bicarb dont give if pH gt 7.5

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HYPOTONIC SOLUTIONS AND USAGES

• Hypotonic
• 0.45 sodium chloride (half-normal saline)
• Uses water replacement, hypertonic dehydration,
  sodium and chloride depletion, gastric fluid loss
  from nasogastric suctioning or vomiting.

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HYPOTONIC SOLUTIONS AND USAGES

• Hypotonic 1/2 NS Considerations
• use cautiously may cause CV collapse or
  increased intracranial pressure.
• Dont use in pts with liver disease, trauma or
  burns.

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HYPERTONIC SOLUTIONS AND USAGES

• Hypertonic Dextrose 5 in 1/2 NS
• Uses DKA after initial tx with NS--and 1/2 NS
  --prevents hypoglycemia and cerebral edema
  (occurs when serum osmolality is reduced too
  rapidly)
• Special In DKA, use only when glucose falls lt
  250 mg/dl

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HYPERTONIC SOLUTIONS AND USAGES

• Hypertonic Dextrose 5 in NS
• Use hypotonic dehydration, temporary tx of
  circulatory insufficiency and shock if plasma
  expanders not available, syndrome of
  inappropriate antidiuretic hormone (or use 3
  sodium chloride), Addisonian crisis
• Considerations Dont use in cardiac or renal
  pts because of danger of CHF and pulmonary
  edema.

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HYPERTONIC SOLUTIONS AND USAGES

• Hypertonic Dextrose 10 in water
• Uses--water replacement, conditions in which some
  nutrition with glucose is required.
• Considerations monitor serum glucose levels.

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WARNINGS

• Never give a hypotonic(D5w) to a Pt at risk for
  increased ICP --example, stroke, head trauma, or
  neurosurgery
• Never give K IV push
• Never give Mg IV push
• Never give Pts at risk for cellular dehydration
  (DKA) a hypertonic solution

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COLLOIDS

• Colloids or plasma expanders are used to pull
  fluid into the bloodstream. The effects of
  colloids lasts several days if the lining of the
  capillaries is normal.
• Monitor these pts closely for fluid
  overload---dyspnea, hypertension, bounding pulse.
• Examples albumin, dextran, hetastarch, plasma
  protein fraction

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COMPLICATIONSTABLE 19-4 PG 235

• Infection
• Circulatory Overload
• Infiltration (extravasation)
• Phlebitis
• Thrombus formation
• Pulmonary embolus
• Air embolus

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Complications of Blood Transfusions Table 19-5

• Incompatibility Reaction
• Febrile reaction
• Septic reaction
• Allergic reaction
• Moderate chilling
• Circulatory overload
• Hypocalcemia
• HIV and Hepatitis B virus transmission

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Nursing Guideline 19-1pg. 233

• Administering TPN!