1. the reason for infution theripy 

2.the type of solution, it's composition, and clinical use.

What are the 3 goals for Parenteral Solutions?

(type of theripys)

1. maitenace therapy- daily body requierments.

2.replacement therapy- losses such as blood...

3.restoring homeostasis- fluis and electrolytes.

1. fluids that provide all nutrients necessary to meet daily patient requirements

Water!!!!!

30 ml. 

1. Improves hepatic function

2. supplies calories.

3. spairs protein loss.

4. minimizes ketosis.

a pt that is NPO for surgery.

a pt in acute distress that need fluids , electrolytes and/or blood.

ex: hemorrhage, low platelet count, V/D, starvation

when should the MD order Replacement therapy. 

In what time frame is the Replacement therapy given.

given over 48 hours.

FUN FACT!!!

what is the > amount of potassium you can give in 24 hours if pt is not on telle.

what groups of pts are you most concerned about when reciving repacment potassium.

Those whith dysfunctios of the:

Renal system

cardiovascular system

adrenal glands

pituitary gland

sodium

Calcium

base bicarbonate

blood vol. (hypovolemic)

what groups of pts are you most concerned about when reciving repacment potassium.

base bicarbonate

extracellular potassium

extracellular calcuim

stress

excreation in urin

tissue injury

↓ in diet

diarrhea

                                                                                                   Restorative therapy is for those patients who's fluid imbalince  can not be turned around in 48 hours

Restoration Therapy

What arethe causes of the loss of fluid and electrolytes

Intake and out put is critical for these pts.

also daily weights and a complete head to toe assessment.

accurate I/O

blood pressure

weight is not reliable!!

4ml of lactate solution x Kg of body waight x % of TBSA BURND

EXAMPLE

4ml x 10 kg x 50% = 2000 ml

restorative and replacement

K+, Na+, CL-, magnesium, Phosphorus,

Ca++, Hco3,  and acetate

The pH of IV solutions is slightly acidic.

True of False?

Hypotonic solutions higher serum Osmolarity by causing fluid to move out of the blood and into the cells and interstitial spaces.

True or Fales?

Fales

Hypotonic solutions lower serum Osmolarity by causing fluid to move out of the blood and into the cells and interstitial spaces

what is the purpus of a Hypotonic solution?

Isotonic solutions have the same or close to the same Osmolarity as the patient’s Blood serum.

True or Fales

Hypotonic solutions dehydrate cells.

True or Fales?

Fales

These solutions are used to hydrate the intracellular and interstitial compartments and lower sodium levels.

Lower

by causing fluid to move out of the blood vessels and into the cells and interstitial spaces.

they shrink up as water is drawn out of the cells. This is known as crenation.

5% dextrose in 0.45% Na chloride

5% D/W in Na chloride

5% D/W in LR

10% D/W and colloids

Colloids

Crystalloidscan diffuse across cell membranes.

True or fales?

Colloids

*so they cannot form a true solution

Colliods are too small to pass through cell membranes.

True or Fales?

Fales

They are too large to pass through cell membranes

5%, 10%, 20% and 70% in TPN solutions.

and 50 % for push

vein irritation , thrombosis, osmotic dehydration

hyponatremic encephalopathy ( in 5%)

why should you never suddenly stop TPN or any high concentration dextrose solution?

dextrose 5% is offten given with blood?

True or fales?

Fales

Dextrose 5% causes hemolysis

NS it is the ONLY solution that is used with blood.

Normal saline has equill parts sodium and chloride.

True or fales?

True

Normal saline has 154 mEq of sodium and 154 mEq of chloride

treat: shock, hyponatremia,  metabolic alkalosis,

replace ECF losses

 It is also used to dilute medications, irrigate intravascular devices and to administer blood

acid-base imbalances-acidosis can occur due to high chloride levels that lead to bicarbonate losses,

hypernatremia, hypokalemia, and circulatory overload.

NS 3-5% is hyperosmolar so the nusre shoul fallow what step to give it safely. Choose all that apply

• check serum Na levels before and during administation
• If not corected after first dose pt needs to be on a ICU unit
• moniter for pulmonary edema
• give in few but large volumes
• always put it on a pump

corect: check serum Na levels,moniter for pulmonary edema, always put it on a pump

incorect:

If not corected after first dose pt needs to be on a ICU unit. Pt need to be on an ICU unit before starting the first does.

give in few but large volumes. Only give small volumes!!!!!

it is best used for excessive loss of fluid through sweating, vomiting, or NG suctioning.

also shock and hypovolemia, burns.

Same as for NS.

hypernatremia, hypokalemia, and circulatory overload.

Using hydration fluids how would a nurse test the status of the kidneys 

(also called a fluid challenge)

start the solution at a rate of 8ml/m² of BSA pre min for 45 min

when the pt has to urinate you know they have kidnys are functioning. 

during a fluid challenge if a pt in not voiding after 45 min

how should the nurse proceed?

reduce the rate of infution ,

the IV hung  not contain any electrolyte additives, esp- K⁺ 

combinations of dextrose and Hypotonic NS

5% dextrose in 0.45% NS

Lactated Ringers and Ringers Injection are the same solution 

True or Fales?

Fales

Notice that Lactated Ringers and Ringers Injection are two different solutions both are isotonic but the concentration of electrolytes is different

treatment of dehydration

fluid balance befor and after surgery

replacemrnt of fluids

ringers injection may be used as a substition for blood for a short piriod of time.

true or fales?

Does RINGERS INJECTION proide calories?

Sodium Retention

Congestive Heart Failure

Renal Insufficiency

Rehydration

Restoration

Replacement

Metabolic Acidosis

Salicylate Overdose

LR does not elivate sodium levels

True or False

False

LR contains 390 meq of sodium that can quickly raise sodium levels.

Liver Disease

Addisons Disease

Severe: Metabolic Acidosis, Alkalosis, Hypovolemia, Shock

Cardiac Failure

Presence of any Fluid Loss

Renal Function

Vital Signs

Weight

S/S of fluid imbalance

Increase

This draws fluid into the intavascular space.

Dextran

Albumin

Hetastarch

Mannitol

Gelatin

Choose all that apply

Advantages of colloid solutions include:

• distributes into all body compartments
• long shelf life
• inexpensive
• stores at refrigerator temp
• doesn't interfere with blood 

Correct:long shelf life, inexpensive, doesn't interfere with blood

Incorrect: it should only distribute within the intravascular space, no special storage is required

a plasma protein. 

A type of colloid.

5%

this means that it is isotonic

hypovolemic 

or pts on bypass

For pts that fluids and Na intake should be limited.

hypoproteinmia, hypovolemia, burns, acute nephrosis, bypass.

how much will Albumin 25% increase plasma volume by

-for every 100 mls given

(in ml)

500 ml

this means it draws this amount towards it in the vascular space.

Whta is .Mannitol?

Albumin

but because it is a synthetic substance there are no incompatibility issues