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

[schnookimz]

Does it give you her labs?

If she's not dehydrated and has edema, why give her any fluid?

[joaniekay]

That was the whole scenario.. I fell like we really havent learned much about IV Fluids. SCARES ME!!

[kool-aide, RN]

Does it give you her labs? If she's not dehydrated and has edema why give her any fluid?[/quote']

I agree, unless I had CMP, CBC, & BNP, I wouldn't want to give any fluid.

[schnookimz]

Extra fluid will make her heart have to work even harder. I would hold off on fluid.

[Do-over, ASN, RN]

Personally, outside of sepsis/bleeding, I am very cautious of running fluids on the elderly - especially if there is any question of cardiac problems.

Pulse and pressure good, without seeing labs I wouldn't want anything except NS at KVO for a push line.

[joaniekay]

Thank You all!!

[liberated847]

What about a 12 lead ECG to rule out STEMI? If positive troop in I, Aspirin was given, what about Heparin, clopidogrel ? IV NSS at 100 ml/hr would be reasonable.

[schnookimz]

What about a 12 lead ECG to rule out STEMI? If positive troop in I Aspirin was given, what about Heparin, clopidogrel ? IV NSS at 100 ml/hr would be reasonable.[/quote']

But it's not asking about other meds or interventions...just the fluid.

Why would you choose to run it at 100ml/hour? Doesn't seem like she needs it.....

[joaniekay]

What about a 12 lead ECG to rule out STEMI? If positive troop in I, Aspirin was given, what about Heparin, clopidogrel ? IV NSS at 100 ml/hr would be reasonable.

That was another question.. what meds would we give & list 7 lab/dx tests you would expect were drawn or conducted in ed & why.. I got those!

[MunoRN, RN]

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.

[kfitzy89]

This is a semi-difficult question to answer. To be frank, I would write that I require more information in order to answer it, haha. The response is contingent upon the lab results. Honestly, you don't want to fluid overload, but I suppose they may be looking for NaCl a TKO in case of an emergent situation requiring IV access?