What Kind of Fluid Does This Client Need? IV fluids are give

What Kind of Fluid Does This Client Need? IV fluids are given (only…  What Kind of Fluid Does This Client Need?            IV fluids are given (only when necessary!) to help correct fluid and electrolyte imbalances. There are many different kinds of IV fluids: crystalloids, colloids, and blood products.Crystalloid fluids contain water and small molecules like dextrose, sodium and chloride. They may be isotonic (the same concentration as the plasma and other body fluids), hypotonic (more watery than body fluids) or h     tonic (more concentrated than body fluids).The IV fluid (left) is a one kind of cry     ___  fluid: 0.9% sodium chloride (which we call “saline”, or in this case “normal saline”. Fluids like 0.9% saline are  ISOTONIC – which means they have the s       concentration as the blood plasma and other body fluids. Colloid fluids may contain proteins (like albumin) or starches (like hetastarch) that work to “thicken” the blood. When the blood thickens it tends to “pull” fluids from the interstitial fluid into the blood. This works to RAISE the B/P. Colloids also help to hold fluids inside the circulation. How do we know if the IV fluids we’re giving are appropriate and safe? Providers who order fluids look at several things: the client’s current condition, VS and basic labs. Let’s look at a “simple” case of dehydration.Henry Potter is an 84-year-old who comes to the ED with altered mental status. VS: T 98°F; AP 116, weak but regular; R 20, nonlabored; B/P 60/40; Pulse ox 95% on room air. No response noted to IV start to left forearm. NCAT (normocephalic, atraumatic); Breath sounds CTAB (clear to auscultation bilaterally); heart sounds weak but regular; Abdomen nondistended, with good bowel sounds; Peripheral pulses +1 both feet; Poor skin turgor with “tenting” under the clavicles and dry mucous membranes. Basic labs are drawn.Before the basic labs come back, the major goal is to RAISE Mr. Potter’s B/P. He has already passed out due to lack of oxygen to the brain! If his B/P drops much further he will pass on. Since a focused assessment indicates severe dehydration it is likely that isotonic fluids (like 0.9 NS) will be ordered. Image transcription text1030 ml: 0.9%% SODIUM CHLORIDE : INJECTION,USP… Show moreIsotonic fluids like lactated ringers solution and 0.9%      __ tend to stay inside the circulation to RAISE the B/P. Once he is through the first 200 mL of 0.9% NS his basic labs come back:       BMPHenry Potter                    3/24/2019Glucose100 (70 – 110)Sodium155 (H) (136 – 145)Potassium3.8 (3.5 – 5.0)Chloride110 (H) (98 – 106)BUN80 (H) (10 – 20)Creatinine1.0 (0.6 – 1.2)CO224 (22 – 26)         Once Mr. Potter’s B/P is up to 96/60 and he is responding to verbal stimuli, the provider changes his IV fluids to a liter of 0.45 NS. This      tonic saline will work to “shift” fluids into the dehydrated cells and lower the sodium (and chloride) levels in the blood.            So – you can see that even though the BMP shows hypernatremia, 0.9% NS was given initially to r      the B/P. Once Mr. Potter is more stable, the IV fluids will be discontinued. The nurses will monitor him closely to make sure he drinks enough fluids and doesn’t become dehydrated again!BMP                   Evelyn Anderson                          3/24/2019Glucose88 (70 – 110)Sodium112 (L) (136 – 145)Potassium3.5 (3.5 – 5.0)Chloride94 (L) (98 – 106)BUN12 (10 – 20)Creatinine1.0 (0.6 – 1.2)CO224 (22 – 26)Let’s look at another case:Evelyn Anderson is a 58-year-old who comes to the ED with altered mental status. VS are all WNL except for the B/P which is 210/120. She has slurred speech and left-sided weakness. The ED provider thinks she is having a stroke but gets basic labs:Do Ms. Anderson’s labs show dehydration?     Does she need isotonic fluids to RAISE the B/P?      Why does the ED provider order hypertonic (3%) saline?      ________________________________________________________________Image transcription textLOT EXP 281 353 NOC 0338-0054-03 Hypertonic Saline 3NI 3% Sodium Chloride Injection USP 500 mL EACH 100 mLCONTAINS 3 0 300 UM CHLORIDE USP CH MA… Show more… Show more The      tonic saline is given slowly and very cautiously. The body does not respond well to sudden, rapid changes. Especially with hyponatremia, rapid sodium replacement could cause pontine myelinolysis and BRAIN DAMAGE! Once Ms. Anderson is able to swallow she may also receive salt tablets. Again – treatment will be done cautiously to       the sodium level back to normal. She will also be on a strict fluid restriction and may be on furosemide to help the kidneys get rid of excess water. Ms. Anderson is in ICU where she can be monitored more frequently.Let’s look at another (fascinating) case study!Angie Johnson is a 76-year-old client who comes to the ED with acute pulmonary edema. VS: T 98.2°F; AP 62, regular; R 48 with pink, frothy sputum; B/P 170/90. Alert but very anxious. Heart sounds: S1, S2 & S4 gallop (which indicates heart failure and FVO – Fluid Volume Overload!). The ED nurse starts an IV right away but puts on a saline lock (instead of IV fluids). Why?Ms. Johnson receives 40 mg of IV furosemide (Lasix) and labs are drawn. Values are normal except for a BUN of 55 with a creatinine of 0.8.Why would a diuretic like furosemide be given to a client whose labs show mild dehydration???     _____________________________________________________________________________________________________________________________________How would the nurse KNOW if the diuretic was working?       ____________________________________________________________________________________________Health Science Science Nursing NURSING 210

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