Jump to content

IV flulids/solutions and WHY??

Posted

Specializes in Longterm/Rehab and Hematology/Oncology. Has 6 years experience.

I really would like someone to EXPLAIN to me, or guide to a resource. Seem to have some confusion as to why a solution is given to a patient. When I ask my preceptor(just started on a med/surg unit), she says "I don't know, different doctors prescribe different solutions, so I don't know why they did it". And that we're not about to page the Dr to ask him/her why the pt is having the solution!!!

Well, aren't we suppose to know why a solution is prescribed and what it does in the body in relation to fluid shifts, electrolytes and cautions?!

I tried to find answers online, but google just lists basic iso/hypo/hyper solutions with no explanations?

You tell me....

Are you supposed to know that?

You passed NCLEX and are working as an RN?

I have a book titled Manual of I.V. Therapeutics by Lynn Phillips. It's goes into great detail about all the different types of fluids, and why a patient gets them, and what they do in the body. It's such a great resource.

psu_213, BSN, RN

Specializes in Emergency, Telemetry, Transplant. Has 6 years experience.

I don't mean to be rude, but this is not really rocket science. There is probably and pretty good explanation in your Med/Surg text from school.

And, yes, we are supposed to know why a solution is prescribed and its effects on fluids shifts and electrolytes, but in most cases we should not need the doctor to spell it out to us.

Tsatalstrana

Specializes in Longterm/Rehab and Hematology/Oncology. Has 6 years experience.

ok..psu__213...you have 2 pt's that are fairly stable...both post op several days. One gets D5 1/2 sodium chloride, the other gets LR. Labs both normal. Vs stable. Hemodynamically stable as well. No past medical hx. Healthy adults. Ready for discharge any when dr rounds. I wasn't asking for a rocket science answer. Textbooks ONLY provide basic nursing thinking, not real life practical applications.

Tsatalstrana

Specializes in Longterm/Rehab and Hematology/Oncology. Has 6 years experience.

huh??

maybe the one not on LR was lactose intolerant? ;)

Dixielee, BSN, RN

Specializes in ER. Has 38 years experience.

ESME, Great resource with the IV fact sheet. I just printed it for my reference. Thanks!

OP, as far as specific scenarios, they vary from patient to patient and doctor to doctor. Many times it is just physician preference and what they are use to ordering. You should not hesitate to ask a doc why they are ordering one particular fluid (but calling in the middle of the night is not a good idea). Most are more than willing to teach as long as you are not issuing a challenge. I have asked many times over the years why one thing is ordered and another not. That is how we learn. An RN should have basic knowledge of each type of fluid and why it is used, but sometimes it just boils down to personal preference.

Good Morning, Gil

Specializes in Rehab, critical care. Has 3 years experience.

0.9% NS and LR are isotonic solutions used to maintain a balance that already exists, prevent dehydration.

0.45% NS is a hypotonic solution, which means that it will cause the cells to swell with water, diluting out serum sodium levels if they're high. Physicians will sometimes prescribe this, but more often, if sodium levels are high, they will prescribe free water boluses through the NGT to bring down sodium levels if high if they're not a dialysis patient, etc.

Hypertonic solutions are just the opposite, and are used if edema is an issue. Albumin is hypertonic, and so is TPN, but those aren't what you typically think of since it's not the typical IVF. Albumin helps with 3rd spacing in sepsis, helps bring fluids back where they should be instead of leaking into the tissues. Sometimes a septic patient's pressure will drop a little, and all they need is a little albumin, not levophed or fluid boluses (though not always the case obviously). If you suspect this is the case, just add on an albumin to the labs you just drew (but if they recently just got albumin, then add on a pre-albumin. Also, Ca is bound to albumin, so if your calcium level is low, make sure you know the albumin level before asking for calcium replacement (can get an order to draw an ionized calcium, but that's more expensive for the patient, and may be tough for you to get along with your other labs since the lab requires a full tube for this test lol, and adding on an albumin is just as effective).

Sodium levels should be in balance (remember the risk of hypo and hypernatremia). No, your patient probably won't seize with a Na of 133, but the goal is to keep everything in balance. If your patient is NPO, and they haven't started TF yet, and it looks like the last BG was 85, I always ask for an order for some D5NS to prevent hypoglycemia. Sometimes the physicians will forget the little minor details like that. Again, only been an icu nurse for several months, so others may have more to add or correct me where I may be wrong.

Creamsoda, ASN, RN

Specializes in ICU.

ok..psu__213...you have 2 pt's that are fairly stable...both post op several days. One gets D5 1/2 sodium chloride, the other gets LR. Labs both normal. Vs stable. Hemodynamically stable as well. No past medical hx. Healthy adults. Ready for discharge any when dr rounds. I wasn't asking for a rocket science answer. Textbooks ONLY provide basic nursing thinking, not real life practical applications.

How were their labs? The choice of IVF will often be related to their sodium levels, are they hypovolemic ect. We could also go into a long discussion of hyonatremia/ hypernatremia ,hypovolemia/hypervolemia, but even I can get really lost on that one it gets a bit more complicated

AgentBeast, BSN, RN

Specializes in Cardiology and ER Nursing. Has 7 years experience.

maybe the one not on LR was lactose intolerant? ;)

LR contains lactate not lactose and there is a huge difference between the two.

classicdame, MSN, EdD

Specializes in Hospital Education Coordinator.

I got the Fluids and Electrolytes for dummies book and it is helpful.

Isotonic fluids have tendency to be about equal in blood and in cells

Hypertonic fluids tend to be MORE in the blood (used if fluid loss or edema or burns to dehydrate cells)

Hypotonic fluids tend to be LESS in the blood (to rehydrate).

Salts and sugars are crystals. Water wants to go where crystals are (think sponge). So if the fluid has higher concentrations of salt or sugar then the MD is trying to get the water to a certain site. So a burn would require higher salt/sugar concentration to draw out the fluid from the cells so the bloodstream can help pee it off). A diabetic is generally dehydrated so will need a hypotonic fluid to provide more water to the cells and less in the blood. Over-simplified of course, but a place to start.

Most important to remember that HYPERTONIC fluids are dangerous and should be d/c as soon as possible. People do not generally get 3 days worth of hypertonic fluids at 150 cc/hr. Watch for that

Tina, RN

Specializes in Acute Care, CM, School Nursing. Has 20 years experience.

I don't mean to be rude, but this is not really rocket science. There is probably and pretty good explanation in your Med/Surg text from school.

And, yes, we are supposed to know why a solution is prescribed and its effects on fluids shifts and electrolytes, but in most cases we should not need the doctor to spell it out to us.

This is a pretty harsh reply, IMO. OP states that he/she is just starting out in med/surg and already tried to find the info online. Haven't you ever heard "there is no such thing as a stupid question"? Or "the only dumb question is the one not asked"? What is the harm in asking a question? Show some support for a fellow nurse.

I don't have any further info on IV fluids to add to the thread. I think the links and info already posted are excellent.

Best wishes!

Dixielee, BSN, RN

Specializes in ER. Has 38 years experience.

LR contains lactate not lactose and there is a huge difference between the two.

It was a joke :)

mrmedical, ASN, BSN

Specializes in Critical Care. Has 7 years experience.

I think the OP is asking why patients are getting a variety of normotonic crystalloids; such as why the doctor would prescribe NS versus LR or Normosol.

I think a lot has to do with prescriber preference and the institution policies. LR has more electroyles but generally isn't used in long term fluid maintenance as it can induce hypernatremia and hypokalemia if gone unchecked. In addition long(er) term use of lactate products can induce alkalosis (which actually may be why it is prescribed if the patient is starting to go acidemic). Giving LR for burns and trauma is understood.

NS is the standard for fluid replacement and rapid rehydration and compatible with blood products. In essence NS is always a safe bet to prescribe and administer.

Here's a study comparing albumin, NS, and LR for your reading pleasure: http://www.emjournalclub.com/uploads/Ringers_Lactate_vs._Normal_Saline_Schott_1.2010.pdf

Edited by mrmedical
spll chk

ok..psu__213...you have 2 pt's that are fairly stable...both post op several days. One gets D5 1/2 sodium chloride, the other gets LR. Labs both normal. Vs stable. Hemodynamically stable as well. No past medical hx. Healthy adults. Ready for discharge any when dr rounds. I wasn't asking for a rocket science answer. Textbooks ONLY provide basic nursing thinking, not real life practical applications.
Like someone else said, the LR is usually reserved for a patient who needs the electrolyte bump for stability and won't be on fluids very long. An example is someone who had a cardiac cath. "Stable post op patients, ok labs" could be where the similarities end for those two. Maybeeee Patient 1 got Lantus and isn't eating so well just yet. We need more info.

In all fairness, my friend who is taking NP classes is learning about which fluids to give when. Sure, we learned the basics in undergrad but at this stage in the game don't overstress it.

Edited by Vespertinas
Darn iPad