IV flulids/solutions and WHY??

mindlor · Apr 25, 2012

You tell me....

Are you supposed to know that?

You passed NCLEX and are working as an RN?

jadedjane, ASN, RN · Apr 25, 2012

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.

Esme12, ASN, BSN, RN · Apr 25, 2012

table of commonly used iv solutions.doc - most commonly used iv solutions; includes tonicity, ph, the ingredients of the solutions, its uses and complications

http://www.icufaqs.org/

http://www.merckmanuals.com/professional/critical_care_medicine/shock_and_fluid_resuscitation/intravenous_fluid_resuscitation.html

i'm sure you will find these helpful.

psu_213, BSN, RN · Apr 25, 2012

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 · Apr 25, 2012

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 · Apr 25, 2012

huh??

mindlor · Apr 25, 2012

maybe the one not on LR was lactose intolerant?

Dixielee, BSN, RN · Apr 25, 2012

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 · Apr 25, 2012

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 · Apr 25, 2012

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 · Apr 25, 2012

maybe the one not on LR was lactose intolerant?

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