Chapter 8: IV Therapy

8.4 IV Fluids

Critical Thinking Exercises: Questions, Answers, and Sources / References

  1. Describe what is meant by isotonic, hypotonic, and hypertonic.  Describe a situation where each of these kinds of IV solutions might be used. Answer:
Solution Isotonic Hypotonic Hypertonic
Osmolality 250 to 375 mOsm/L equal to or less than 250 mOsm/L. equal to or greater than 375 mOsm/L
Indications
  • same osmotic pressure as plasma
  • constant pressure inside and outside the cells
  • causes the cells to remain the same (they will not shrink or swell)
  • does not cause any fluid shifts within compartments
  • increase intravascular volume
  • treat vomiting, diarrhea, shock, and metabolic acidosis,
  • used for resuscitation purposes and the administration of blood and blood products
  • lowers the osmolality within the vascular space
  • causes fluid to shift to the intracellular and interstitial space
  • Cells will swell but may also delete fluid within the vascular space.
  • Hydrate cells and interstitial compartments
  • draws water out of the intracellular space into the extracellular space.
  • hyponatremia, volume resuscitation, and brain injury
examples
  • 0.9% normal saline
  •  lactated Ringer’s & Ringers Lactate
  • ·5% dextrose in water (D5W)
  • 0.45% sodium chloride
  • 0.33% sodium chloride
  • 2.5% dextrose in water
  • 0.2% sodium chloride
  • D5W with 0.45% NaCl
  • D10W
  • 3% NaCl
Potential complications
  • fluid volume overload
  • hypovolemia
  • hypotension related to fluid shifting out of the vascular space,
  • do not administer to patients with increased intracranial pressure (ICP), as it may exacerbate cerebral edema.
  • Use cautiously in patients with burns, liver failure, and traumas
  • intravascular fluid volume overload
  •  pulmonary edema
  • Should not be used for an extended period of time. not to be used in patients with heart or renal disease who are dehydrated

Source: Crawford, A., & Harris, H. (2011). IV fluids: What nurses need to know. Nursing 2018, 41(5), 30-38.  http://journals.lww.com/nursing/Fulltext/2011/05000/I_V__fluids_What_nurses_need_to_know.10.aspx?WT.mc_id=HPxADx20100319xMP

Johnson A., Criddle, L. (2004). Pass the salt: Indications for and implications of using hypertonic saline. Critical Care Nurse, 24(5). pp.36-48. http://ccn.aacnjournals.org/content/24/5/36.full.pdf+html

Rosenthal, K. (2012). IV Rounds: Intravenous fluids: the whys and wherefores. Nursing, 36(7). https://www.nursingcenter.com/journalarticle?Article_ID=652137&Journal_ID=54016&Issue_ID=652101 

 

Sample Quiz Questions

 

Answer true or false to the following statements: Answer Further explanation
Hypotonic solutions must be used carefully in persons with increased intracranial pressure (ICP) due to risk of exacerbating the condition. True Hypotonic solutions hydrate cells including brain cells.
Isotonic solutions can cause hypervolemia. True Isotonic solutions general remain in the vascular space.
Ringers Lactate contains more electrolytes than Normal saline. True Both solutions are isotonic, but RL provides other electrolytes
Hypertonic solutions used over an extended period can increase a person’s risk for hypervolemia. True Hypertonic solutions increase extracellular volume. They are also known as volume expanders.

Source: as above

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