Fluids Primer

Question 1

True or False

Water follows the solutes in a solution.

Answer 1

True

Question 2

Solutes in a fluid =

Answer 2

• Osmolarity of the fluid

Question 3

High osmolarity is…

Answer 3

• Large solute % in fluid

* AKA: hypertonic

Question 4

Low osmolarity is…

Answer 4

• Small solute % in fluid

* AKA: Hypotonic

Question 5

A hypertonic solution draws water out of ______ and into _____.

Answer 5

• The cells

* Extracellular space

Question 6

A hypotonic solution draws water out of _____ and into _____.

Answer 6

• Extracellular space

* Into the cell

Question 7

Define an isotonic solution.

Answer 7

• Both extracellular and intracellular fluids have the same osmolarity so there is no water movement between them

Question 8

Crystalloid solutions are generally used for…

Answer 8

• Fluid resuscitation

Question 9

Colloid solutions are generally used for…

Answer 9

• Volume expansion in the intravascular space

Question 10

What some conditions where an isotonic 0.9% Normal Saline solution may be given?

Answer 10

• Dehydration
• Hypovolemia (absolute)
• Hemorrhage
• Sepsis
• Shock

Question 11

What some conditions where an isotonic Lacted Ringers solution may be given?

Answer 11

• Burns and trauma
• Acute blood loss
• Hypovolemia (relative)
• Electrolyte imbalance
• Metabolic acidosis

Question 12

Why is 0.9%NS used with caution or sometimes avoided for pts with cardiac or renal comprise?

Answer 12

• Because the sodium in the solution may cause fluid retention or volume overload

Question 13

What is the only fluid used in conjunction with blood product administration?

Answer 13

• 0.9%NS

Question 14

Dextrose (D5W) is an intravenous _____ solution.

Answer 14

• Sugar

Question 15

Explain the tonicity of D5W.

Answer 15

• It is both an isotonic and hypotonic solution
• Initially hypotonic, D5 dilutes the osmolarity of the extracellular fluid.
• Once the cells have absorbed the dextrose, the remaining water and electrolytes become an isotonic solution

Question 16

Why should D5 not be used as the sole treatment of fluid volume deficit?

Answer 16

• Because it dilutes plasma electrolyte concentrations

Question 17

D5W is contraindicated for what scenarios?

Answer 17

• Resuscitation
• Early post-op recovery
• Cardiac and renal conditions
• Any case of suspected increased ICP

Question 18

True or False

D5W can be administered for hypernatremia

Answer 18

• True

Question 19

0.45% NS may be used to treat _____ and _____.

Answer 19

• Hypernatremia

* Diabetic ketoacidosis

Question 20

For what conditions is 0.45% NS contraindicated? Why?

Answer 20

• Burns
• Trauma
• Liver disease
• Why: Because it depletes intravascular fluid volumes.

Question 21

Infusing 0.45% NS too quickly can cause…

Answer 21

• Hemolysis of RBCs

Question 22

Before administering fluids, what should be documented?

Answer 22

• Vital signs
• Edema status
• Lung and heart sounds

Question 23

Hypotonic solutions may exacerbate existing _____ and ______ causing _____.

Answer 23

• Hypovolemia
• Hypotension
• Cardiovascular collapse

Question 24

Why are hypotonic solutions contraindicated for conditions with ICP?

Answer 24

• The fluid shift makes the cells bigger and increases ICP

Question 25

What is the tonicity of D10W, D20W and D50W?

Answer 25

• They are all hypertonic

Question 26

When administering hypertonic solutions, we need to watch for signs of _____.

Answer 26

• Hypervolemia

Question 27

Hypertonic solutions should be administered only in high acuity areas with…

Answer 27

• Constant nursing surveillance for potential complications

Question 28

True or False | Patients with or heart disease and those who are dehydrated should not receive hypertonic IV fluids.

Answer 28

• True

Question 29

True or False | Hypertonic dextrose solutions should not be administered peripherally

Answer 29

• True, they can cause irritation and damage to the blood vessel and should be administered through a central vascular access device inserted into a central vein.

Question 30

Hypertonic dextrose solutions will have to be used with caution for patients with...

Answer 30

* Diabetes Mellitus | * Monitor blood glucose closely

Question 31

3% and 5% NaCl are used for…

Answer 31

* The acute treatment of sodium deficiency | * When serum osmolality has decreased to critically low levels

Question 32

True or False | 3% and 5% NaCl can be used in pts with cerebral edema.

Answer 32

• True

Question 33

What are colloid fluids?

Answer 33

* Fluids with large molecules that are unable to pass through semipermeable membranes and remain in the blood vessels. * They also draw fluid from the interstitial space and increase intravascular volume

Question 34

Why may a colloid solution be used as opposed to a crystalloid?

Answer 34

* Colloids don’t require as much volume to increase intravascular pressure as crystalloids * As such, a colloid solution would be indicated for a pt that cannot tolerate large fluid volumes

Question 35

Two common colloids are…

Answer 35

* Albumin | * Hespan

Question 36

5% Albumin is commonly used to…

Answer 36

• increase the circulating volume and restore protein levels in conditions such as burns and pancreatitis and plasma loss through trauma.

Question 37

25% Albumin is used together with sodium and water restriction to reduce…

Answer 37

• excessive edema

Question 38

The use of albumin is contraindicated in patients with the following conditions:

Answer 38

* Severe anemia * Heart failure * Known sensitivity to albumin.

Question 39

Angiotensin-converting enzyme (ACE) inhibitors should be withheld for at least 24 hours before administering _____ because of the risk of atypical reactions, such as _____ and _____.

Answer 39

* Albumin | * Hypotension and flushing

Question 40

True or False | A small bore needle is needed when administering colloid solutions.

Answer 40

• False, a large 18 gauge needle should be used

Question 41

What adverse reactions need to be monitored for when administering colloids?

Answer 41

* Hypervolemia * Hypertension * Dyspnea * Crackles in the lungs * Edema.