Iv Therapy And Fluids

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isotonic solution

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Administration of an isotonic solution expands only the ECF. There is no net loss or gain from the ICF. An isotonic solution is the ideal fluid replacement for a patient with an ECF volume deficit. Examples of isotonic solutions include lactated Ringer's solution and 0.9% NaCl. Lactated Ringer's solution contains sodium, potassium, chloride, calcium, and lactate (the precursor of bicarbonate) in about the same concentrations as those of the ECF. It is contraindicated in the presence of hyperkalemia and lactic acidosis because of the body's decreased ability to convert lactate to bicarbonate.

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hypotonic solution

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A hypotonic solution provides more water than electrolytes, diluting the ECF. Osmosis then produces a movement of water from the ECF to the ICF. After osmotic equilibrium has been achieved, the ICF and the ECF have the same osmolality, and both compartments have been expanded. Examples of hypotonic fluids are given in Table 17-19. Maintenance fluids are usually hypotonic solutions (e.g., 0.45% NaCl) because normal daily losses are hypotonic. Additional electrolytes (e.g., KCl) may be added to maintain normal levels. Hypotonic solutions have the potential to cause cellular swelling, and patients should be monitored for changes in mentation that may indicate cerebral edema

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hypertonic solution

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A hypertonic solution initially raises the osmolality of ECF and expands it. It is useful in the treatment of hypovolemia and hyponatremia. Examples are listed in Table 17-19. In addition, the higher osmotic pressure draws water out of the cells into the ECF. Hypertonic solutions (e.g., 3% NaCl) require frequent monitoring of blood pressure, lung sounds, and serum sodium levels and should be used with caution because of the risk for intravascular fluid volume excess.

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crystalloid solution

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a solution containing a substance that can diffuse through a semipermeable membrane

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colloid

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a state or division of matter in which large molecules or aggregates of molecules (1 to 100 nm in size) do not precipitate and are dispersed in another medium. In a suspension colloid the particles are insoluble and the medium may be solid, liquid, or gas. In an emulsion colloid the particles are usually water, and the medium is any of several complex hydrophilic, organic substances that become evenly dispersed among the particles of water.

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colloid solution: a solution in which small particles, such as large polymeric molecules, are homogenously dispersed through a liquid medium.

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vesicant

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a drug capable of causing tissue necrosis when extravasated.

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infiltration

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the process whereby a fluid passes into the tissues, such as when a local anesthetic is administered or an IV infusion infiltrates.

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extravasation

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1. a passage or escape into the tissues, usually of blood, serum, or lymph. Compare bleeding.


2.passage or escape into tissue of antineoplastic chemotherapeutic drugs. Signs and symptoms may be sudden onset of localized pain at an injection site, sudden redness or extreme pallor at an injection site, or loss of blood return in an IV needle. Tissue slough and necrosis may occur if the condition is severe. Treatment depends on the causative agent. Nursing responsibilities include maintaining the patient IV line, elevating the affected area, applying ice packs, and notifying the physician of the need for antidote injections, if applicable

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third spacing

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fluid volume moves out of the vascular space into the extravascular space (e.g., interstitial or intracavitary space).

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parenteral nutrition

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the administration of nutrients by a route other than the alimentary canal, such as subcutaneously, intravenously, intramuscularly, or intradermally. The nutrients, or parenteral fluids, usually consist of physiologic saline solution with glucose, amino acids, electrolytes, vitamins, and medications. They may not be nutritionally complete but maintain fluid and electrolyte balance during the immediate postoperative period and in other conditions, such as shock, coma, malnutrition, and chronic renal and hepatic failures