Pee Rey oY eesrolbeCdaey eee) ‘Osmolality Uses ‘© 308 mOsm/L ‘# Isotonic solution of choice for expanding ECF volume. Contains Infused to correct extracellular fluid volume deficit. Water Used alongside administration of blood products ‘© Sodium (154 mEq/L) | __ Used to replace large sodium losses such as burn injuries and trauma. © Chloride (154meqiL) | caution ‘© Should not be used for patients with heart failure, pulmonary edema, and renal impairment. Peed ‘Osmolality fe 252 mOsm. we. nitally sotonic and provides free water when dextrose s metabolized (making I Contains hypotonic) Water Expands the ECF and ICF helpful in rehydrating and excretory purposes. © Glucose (50g/1) © Used to treat hypernatremia caution ‘© Should NOT be used for fluid resuscitation because hyperglycemia can result. Should be voided in clients at risk for increased intracranial pressure, eT eee Other Names ‘© DSLRS. My Used to correct dehydration, sodium depletion, and replace Gl trac fld losses. oR Also used in fuid losses caused by burns fistula drainage, and trauma Ringer's Lactate ‘Often administered for patients with metabolic acidosis because itis an alkalizing Hartmann Solution selution ‘Osmolality caution ‘© 273 mOsm. ‘© Should not be given to patients who cannot metabolize lactate (eg, iver disease, lactic Contains acidosis). Used in caution for patients with heart failure and renal failure. ‘© Water ‘© Sodium (130 meq/t) Potassium (4 mEq/L) © Calcium (3 mEq/L) Chloride (109 méq/L) Lactate 28 meq/t) ‘Osmolality ‘© 273 mOsm. ee Similar incatons for Lactated Ringer's solution but without the contraindication Contains Telated to lactate. ‘© Similar composition with Lactated Ringers but without the lactate ‘Nursing Considerations for Isotonic Solutions Document baseline data. Before infusion, assess the patient's vita signs, edema status, lung sounds, and heart sounds, Continue monitoring during and after the infusion, Observe for signs of fluid overload. Look for signs of hypervolemia such as hypertension, bounding pulse, pulmonary crackles, dyspnea, shortness of breath, peripheral edema, jugular venous distention, and extra heart sounds. Monitor manifestations of continued hypovolemia. Look for signs that indicate continued hypovolemia such as, decreased urine output, poor skin turgor, tachycardia, weak pulse, and hypotension. Prevent hypervolemia, Patients being treated for hypovolemia can quickly develop fluid overload following rapid or over infusion of isotonic IV fluids Elevate the head of the bed at 35 to 45 degrees, Unless contraindicated, position the cient in seml-Fowler’s position, Elevate the patient’ legs. if edema is present. elevate the legs of the patient to promote venous return. Educate patients and families. Teach patients and families to recognize signs and symptoms of fluid volume overload, Instruct patients to notify their nurse if they have trouble breathing or notice any swelling. Close monitoring for patients with heart failure. Because isotonic fluids expand the intravascular space, patients vith hypertension and heart failure should be carefully monitored for signs of fluid overload. Check integrity of IV Solution. Solution should be clear with the container and seals intact. IV solutions are covered in ‘overwrap, do not remove until ready for use, Check for minute leaks by squeezing the container firmly, if leaks are found, discard solution as sterlty may be compromised.aM execooesro Cola ete ee ‘Other names Uses ‘© Halfstrength normal |» Used for replacing water in patients who have hypovolemia with hypernatremia, saline caution © 12Ns ‘¢ Excessive use may ead to hyponatremia due to the dilution of sodium. Osmolality is 154 mOsm/L contains CE Other names Uses ‘© Onesthird strength ‘© Typically administered with dextrose to increase tonicity, Osmolality *- Used in caution for patients with heart failure and renal insufficiency contains Ceo eee ‘Other names Uses Osmolality + Typically administered with dextrose ta increase toni Contains 2.5% Dextrose in Water (02.51) ‘Osmolality Uses contains caution Water Sodium (77 mEq/L) Chloride 7 meq) 5% Dextrose ina3 | © Used to allow kidneys to retain needed amounts of water, Free water helps kidneys Sodium Chloride eliminate solutes. normal saline caution [365 mOsm/L (typotonic once dextrose is metabolized) Water Sodium (56 mEq/L) CChioride (56 mEq/l) Glucose 50g/) 170 kcal. 5% Dextrosein 0.255 | «Used as maintenance fluid for pediatric patients as it isthe most hypotonic ud Sodium Chloride available, 77 mOsm. Water Sodium (38 mEq/L) Chioride (8 meg/L) Glucose (50g/1) 126 mOsm Used to treat dehydration and decrease the levels of sodium and potassium, Water ‘© Should NOT be administered with blood products as it can cause hemolysis of red blood Glucose (258/1) cells rc Document baseline data. Before infusion, assess the patient's vital signs, edema status, lung sounds, and heart sounds, Continue monitoring during and after the infusion, Do not administer in contraindicated conditions, Hypotonic solutions may exacerbate existing hypovolemia and hypotension causing cardiovascular collapse. Avoid use in patients with ver disease, trauma, or burns. Risk for increased intracranial pressure (IICP). Should not be given to patients with risk for ICP as the uid shift may ‘cause cerebral edema (remember: hypotonic solutions make cell swell). Monitor for manifestations of fluid volume deficit. Signs and symptoms include confusion n older adults. Instruct patients to inform the nurse if they feel dizzy ‘Warning on excessive infusion. &xcessve infusion of hypotonic IV Muids can lead to intravascular fluid depletion, decreased blood pressure, celular edema, and cell damage. o not administer along with blood products. Most hypotonic solutions can cause hemolysis of red blood cell, especially during rapid infusion ofthe solution. ‘Check integrity of IV Solution. Solution should be clear with the container and seals intact. I solutions are covered in ‘overwvrap, do nat remove until ready for use, Check far minute leaks by squeezing the container firmly, leaks are found, discard solution as sterility may be compromisedaN eascalesrey eta) PraReereeaed 3% Nacl Sodium (513 mEa/t) Used inthe acute treatment of severe hyponatremia and should only be used in critical © Chloride (513 meq/t) situations to treat hyponatremia, + 1030mOsnvv Used in patients with cerebral edema, 5% Nacl Some patients may need diuretic therapy to assist in fluid excretion, ‘¢ Sodium (855 meq/t) | Caution Chioride (855 meal) Should be infused at a very ow rate to avoid risk of pulmonary edema, © 1710mOsnvt © Ifadministered in large quantities and rapidly, they may cause ECF excess and circulatory overload, ‘Other names Uses Dextrose 10% in ‘Used in the treatment of ketosis of starvation and provides calories and free water. Water ition Osmolality ‘Should be administered using a central line if possibe, 505 mOsm, Do NOT infuse using the same line as blood products as it can cause RBC hemolysis. Contains Water © Glucose 100g/t) = 380 kcal. Dextrose 20% (020) ‘Other names Uses: © Dextrose 20% in ‘© Used as an osmotic diuretic that causes fluid shifts between various fluid compartments Water to promote diuresis, ‘Osmolality 660 mOsm, Contains © Water # Glucose 2003/1) ‘Other names Uses: © Dextrose 50% in ‘© Used to treat severe hypoglycemia Water ‘Administered rapidly via W bolus Osmolality 2523 mOsnvL contains © Water # Glucose 5008/1) '* Document baseline data. Before infusion, assess the patient's vital signs, edema status, lung sounds, and heart sounds, glucose levels, Continue monitoring during an after the infusion, ‘© Watch for signs of hypervolemia, Since hypertonic solutions move fluid from the ICFto the ECF, they increase the ‘extracellular fluid volume and increase the risk for hypervolemia, Look for signs of swelling in arms, legs, fac, shortness ‘of breath, high blood pressure, and discomfort in the body (eg. headache, cramping) Monitor and observe the patient during administration. Hypertonic solutions should be administered only in high ‘acuity areas with constant nursing suvellance for potential complications, ‘= Verify order. Prescriptions for hypertonic solutions should state the specific hypertonic fuid to be infused, the total volume to be infused, the Infusion rate and the length of time to continue the infusion ‘= Assess health history. Patients with kidney or heart disease and those who are dehydrated should not receive hypertonic V fuids, These solutions can affect renal fitration mechanisms and can easily cause hypervolemia to patients with renal or heart problems, ‘= Prevent fluid overload. Ensure that administration of hypertonic fluids does not precipitate fuid volume excess or ‘overload, * Donot administer peripherally. Hypertonic solutions can cause iritation and damage to the blood vessel and should be administered through a central vascular access device inserted into a central vein, ‘© Monitor blood glucose closely. Rapid infusion of hypertonic dextrose solutions can cause hyperglycemia. Use with ‘ution for patients with diabetes mellitus. © Check integrity of IV Solution. Solution should be clear with the container and seals intact. IV solutions are covered in ‘overwap, dont remove until ready for use. Check for minute leaks by squeezing the container firmly, if leaks are found, scard solution as sterility may be compromised. Ped Dextrose 50% (D50W) cnnColloid Solutions Human Albumin 5% Albumin Uses ‘© 309 mOsm/L ‘© Commonly utlized colloid solution. 25% Albumin {5 Used to increase the circulating volume and restore protein levels in conditions such as ‘© 312 mOsm/t burns, pancreatitis, and plasma loss through trauma. ‘¢ 254 Albumin is used together with sodium and water restriction to reduce excessive edema ‘¢ They are considered blood transfusion products and uses the same protocols and rursing precautions. caution ‘© Contraingicated in patients with the following conditions: severe anemia, heart failure, or known sensitity to albumin. ‘© Angiotensin-converting enzyme inhibitors (ACE Inhibitors) are withheld for at least 24 hours before administering alourin, Low-Molecular-Weight Dextran (LMWD) Other names Uses ‘© Dextran 40 "© Used to improve microcirculation In patients with poor peripheral circulation. 1S Used to treat shock related to vascular volume lass (e.g, burns, hemorrhage, trauma, surgery. Used to prevent venous thromboembolism on certain surgical procedures, caution ‘= Contraindlcated in patients with thrombocytopenia, hypofbrinogenemia, and hypersensitivity to dextran. High-Molecular-Weight Dextran (HMWD) Other names Uses ‘© Dextran 70 ‘© Used for patients with hypovolemia and hypertension. © Dextran 75 Caution ‘© Contraingicated in patients with hemorrhagic shock. Eon Other names Uses ‘© EIOHAES ‘© These are solutions derived from starch. ‘© HyperHAacs: {Used to increase intravascular fluid but can interfere with normal coagulation. = Voluven Gelatin Uses "© Gelatins have lower molecular weight than dextrans and therefore remain in the circulation fora shorter period of time, ee) Uses "© Ths solutions also prepared from plasma, and lke albumin, is heated before infusion, i Is recommended to infuse slowly to inereace circulating volume. eee ‘© Assess allergy history. Most colloids can cause allergic reactions, although rar, so take a careful allergy history, asking. specifically theyve ever had a reaction to an IV infusion before Use a large-bore needle (18-gauge). larger needle is needed when administering colloid solutions. Document baseline data. Before infusion, assess the patient's vital signs, edema status, lung sounds, and heart sounds. Continue monitoring during and ater the infusion. ‘© Monitor the patient’ response. Monitor intake and output closely for signs of hypervolemia, hypertension, dyspnea, ‘crackles inthe lungs, and edema ‘© Monitor coagulation indexes. Colloid solutions can interfere with platelet function and increase bleeding times, 50 ‘monitor the patient's coagulation indexes,