Need assistance w/IV Fluid & Angina

[joaniekay]

Hey All,

I need a little assistance. In my last semester of a 2 yr RN program, in NY. We are doing an Angina Case study.

here is the scenerio...

RK is an 85yo woman who lives with her husband, 87.Last night she awoke with heavy substernal pressure accompanied by epigastric distress. The pain was reduced somewhat when she rolled onto her side, but did not completely subside. She has been hospitalized to R/O MI.

Labs were drawn in the ED. O2 2l.min NC. Non-enteric coated ASA 325mg given. An IV was started.

Hx: No smoking/alcohol use; good health except for osteoarthritis of hands and knees. Takes ranitidine, ibuprofen and "herbs"

VS BP 132/84, 88. 18. 37.2 C. Weighs 52kg. Moderate edema of both ankles, positive peripheral pulses. Telemetry shouws premature atrial contractions, no ventricular ectopy. Denies discomfort at present.

One of the questions is what kind of IV fluids & at what rate would you give??

1st I thought Isotonic 0.9%NaCl - it will increase vascular & extracellular fluid volumes.

then I thought D5NS - decreases edema, replaces electrolytes & shifts fluid from intracellular compartment into intravascular space, expanding vascular volume.

Can someone let me know if I'm on the right path. As far a rate, i really have no idea.

Thanks!!

Joan

[liberated847]

Typically you don't want to give someone with an MI or a suspected MI extra IV fluids. Most MI's affect the left ventricle and you don't want to challenge the left ventricle with extra afterload. An MI that affects the right ventricle is different and will often benefit from additional preload.

Agree Muno, my previous post was meant to start an iv at kvo or approx. 30 ml/hr not 100 ml/hr like I stated before.

[psu_213, BSN, RN]

Count me in the "no fluids" group. In our ER, the general protocol is to go with KVO (unless it obvious that they need the fluid)--the KVO is there is they suddenly drop their pressure and need to be bolused. This is especially true if the pt is also started on a nitro drip--which is beyond the scope of the original question.

I would also want to listen to her lungs and look for other signs of volume overload (you already mentioned edema of the legs) before any aggressive fluid administration.