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Would you hang these IVs?

Student Assist   (1,228 Views 8 Comments)
by Toaast Toaast (New Member) New Member

340 Visitors; 7 Posts

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Hi guys, I am having trouble with deciding whether these IVs should be hanged or not. 

Your patient has just returned to the surgical unit from the PACU after gastric resection. Prior to surgery, this patient has a NG tube to low continuous wall suction. The gastric output exceeds 1000mLs per shift. Her Ph is 75. The physician ordered LR at 150 mL an hour. Do you hang it? Why or Why not? If no what would be the correct solution?
I was thinking that you should not hang the solution and hand 0.9 NS. The patient can go into metabolic alkalosis so LR shouldnt be hanged.

 

A 9 year old patient is admitted to the ER in DKA. This morning the patient fell off his bike striking his head on the curb. He also has a epidural hematoma. The Dr ordered 2.5% dextrose in water to be infused at 50 mL/he. Do you hang it?

I was thinking no because he is already in a DKA state, so infusing that will make it worse. But I dont know what to infuse.

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Ruby Vee has 40 years experience as a BSN and specializes in CCU, SICU, CVSICU, Precepting & Teaching.

11 Followers; 65 Articles; 170,460 Visitors; 13,938 Posts

What country are you in?  Because in this country (US) a pH of 75 would be an enormous issue!  Perhaps your country measures pH differently?

These sound like homework questions to me.  

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340 Visitors; 7 Posts

oops i mean 7.5!!! & it is an assignment for class, which I am having trouble with. I was hoping someone would help me understand when you should hang solutions for IV and when not to because it is dangerous

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Okami_CCRN has 4 years experience as a ADN, RN and specializes in Critical Care.

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6 hours ago, Toaast said:

Hi guys, I am having trouble with deciding whether these IVs should be hanged or not. 

Your patient has just returned to the surgical unit from the PACU after gastric resection. Prior to surgery, this patient has a NG tube to low continuous wall suction. The gastric output exceeds 1000mLs per shift. Her Ph is 75. The physician ordered LR at 150 mL an hour. Do you hang it? Why or Why not? If no what would be the correct solution?
I was thinking that you should not hang the solution and hand 0.9 NS. The patient can go into metabolic alkalosis so LR shouldnt be hanged.

 

LR vs NS is a topic of debate when it comes to fluid resuscitation. While LR can make an alkalosis worse with the metabolism of lactate it usually arises when it is administered as a bolus. NS on the other hand can cause a chloremic acidosis in large quantities. However, in this this post-operative patient I think LR is the more appropriate solution since it contains some extra stuff like K+, Ca++, and Na+

6 hours ago, Toaast said:

A 9 year old patient is admitted to the ER in DKA. This morning the patient fell off his bike striking his head on the curb. He also has a epidural hematoma. The Dr ordered 2.5% dextrose in water to be infused at 50 mL/he. Do you hang it?

I was thinking no because he is already in a DKA state, so infusing that will make it worse. But I dont know what to infuse.

Soo.... this is a difficult situation because one of the treatments for DKA once the anion gap starts closing and their glucose falls below 200 is to add a dextrose solution. However, the problem here is that they have a head injury which takes priority.

Can you tell me what kind of solution D2.5W is?

How does the type of solution D2.5W is affect patients with a brain injury?

What would be an appropriate IVF therapy instead?  

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traumaRUs has 27 years experience as a MSN, APRN and specializes in Nephrology, Cardiology, ER, ICU.

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Moved to nursing student assistance forum

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204 Visitors; 14 Posts

Interesting! Homework help!! 🙂

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IVRUS has 32 years experience as a BSN, RN and specializes in Vascular Access.

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If the patient has a pH of 7.50, he/she is already Alkalotic.   The Lactate Ion converts in the Liver to Bicarbonate.  If this person has already tipped the 1:20 ratio of Acid vs Base, giving Lactated Ringers just exacerbates the problem. 

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GSDlvrRN has 4 years experience as a BSN and specializes in Telemetry.

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I have actually never heard of D2.5, but have hung D5 1/2 NS for a DKA patient because sodium was 163.

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