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What intravenous fluids should be given

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by snowflake22 snowflake22 (New) New

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Hello i wanna make sure that i am on the right track with my answers,

A 70- year old woman is admitted to your unit with sepsis-dehydration. She has a history of heart failure. Her blood pressure is 70/40. An order is given for 0.45%saline at 75mL/hour.

Yes I would hang this solution. The patient is dehydrated and this happens after the body has already tried to pull water from extracellular spaces by using ADH. To re-hydrate the body you would give this solution to put water into the intravascular space where the cells are moving. Using any other solution such as isotonic would help with extracellular losses and hypertonic pulls water from intracellular to extracellular spaces.

A 45 year old man is admitted to your unit with a history of hypertension. Blood pressure on admission is 220/120. He has been on furosemide therapy and has severe intracellular dehydration. A order is given for D5 ½ NS at 50mL/hour.

No I would not hang this solution because it is hypertonic. Hypertonic solutions pull water out of intracellular spaces to extracellular spaces. If this solution were given it would further dehydrate the patient and led to further complications. Instead I would give a hypotonic solution to pull water back into the intracellular space and re-hydrate the cells.Hypotonic solutions are given to patients with conditions causing intracellular dehydration.

P.S. i really appreciate anyone who can comment on this to help me better understand intravenous fluids ;)

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327 Posts; 4,371 Profile Views

I would not hang 1/2 NS @75ml/hr as the first line treatment for sepsis and dehydration with unstable vitals. I would anticipate an order to replace the loss with 0.9% normal saline as a bolus. I would closely assess for crackles in the lungs and SOB to make sure this patient is tolerating the fluid s/t their history of heart failure . The blood pressure is too low/the patient is not stable, an infusion rate of 75ml/ is too slow. You need to aggressively treat the volume loss/blood pressure and hopefully avoid the need to give vasopressors. Sepsis is serious, patients can crash quickly.

Where I work our sepsis protocol states to give 3L of normal saline as a bolus if the patient can tolerate followed by LR @75ml/hr

Edited by Loo17

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TheNGTKingRN specializes in General Surgery.

208 Posts; 4,760 Profile Views

Hello i wanna make sure that i am on the right track with my answers,

A 70- year old woman is admitted to your unit with sepsis-dehydration. She has a history of heart failure. Her blood pressure is 70/40. An order is given for 0.45%saline at 75mL/hour.

No. Half NS is hypotonic will pull fluid into the cell from the intravascular space. In a state of sepsis that is not want you want to do. You want to give something that'll expand the intravascular volume. I would want to give 0.9% NS or LR's. I would anticipate an order for Levophed and possibly steroids.

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TheNGTKingRN specializes in General Surgery.

208 Posts; 4,760 Profile Views

A 45 year old man is admitted to your unit with a history of hypertension. Blood pressure on admission is 220/120. He has been on furosemide therapy and has severe intracellular dehydration. A order is given for D5 ½ NS at 50mL/hour.

D5 1/2 NS is technically hypnotic because dextrose is metabolized and half NS is hypotonic. Yes, I agree the pt needs hypotonic fluids but whether D5 1/2 NS is OK to give IS debatable.

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327 Posts; 4,371 Profile Views

The guy with the high blood pressure receiving Lasix should not get D5 1/2 NS.

Diuretics interfere with reabsorption of chloride and sodium in the renal tubules. This patient is on diuretics and at risk to develop metabolic alkalosis. He is volume depleted and should be treated with 0.9% NS. Hypokalemia is common in these patients so his K+ level should be checked to see if he also needs potassium replacement. I would anticipate the doctor to also order a BP medication and to possibly switch this patient to a potassium sparing diuretic if the level is low.

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Esme12 has 40 years experience as a ASN, BSN, RN and specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

6 Followers; 4 Articles; 20,908 Posts; 149,592 Profile Views

Take a peek at this thread included are charts that I have been made and others I have collected I think they'll help a TON! https://allnurses.com/nursing-student-assistance/why-type-iv-886710.html

Fluids and Electrolytes Study Guide.docGrntea always has the best explanation of this....perhaps these documents might help Fluids and Electrolytes Study Guide.doc IV fluids chart.pdf

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