Fluids & Electrolytes NAPNES Guidelines Presented by Laura Zdancewicz MSN, CRNP

Types of Solutions Crystalloids Crystalloids Colloids Colloids Blood products Blood products Electrolytes Electrolytes

Crystalloids Mechanism of Action Mechanism of Action Supply sodium and water Supply sodium and water Maintain osmotic gradient Maintain osmotic gradient Between fluid outside blood vessels and fluid inside blood vessels Between fluid outside blood vessels and fluid inside blood vessels Expands plasma volume Expands plasma volume Therapeutic uses Therapeutic uses Maintenance fluids Maintenance fluids Replacement fluids Replacement fluids Promote urinary flow Promote urinary flow

Crystalloids Examples Examples NS (0.9% sodium chloride) NS (0.9% sodium chloride) Most commonly used Most commonly used Hypertonic saline Hypertonic saline Lactated Ringer’s Lactated Ringer’s D5W D5W Plasma-Lyte Plasma-Lyte

Colloids Mechanism of Action Mechanism of Action Fluid is pulled from extravascular space to the intravascular space Fluid is pulled from extravascular space to the intravascular space Thus increasing blood volume Thus increasing blood volume “Plasma expanders” “Plasma expanders”

Colloids Therapeutic uses Therapeutic uses Severe conditions Severe conditions Acute liver failure, Acute liver failure, Acute nephrosis Acute nephrosis Adult respiratory distress syndrome Adult respiratory distress syndrome Burns Burns Cardiopulmonary bypass Cardiopulmonary bypass Hypoproteinemia Hypoproteinemia DVT reduction DVT reduction Renal dialysis Renal dialysis Shock Shock

Colloids Examples Examples Dextran 70 Dextran 70 Dextran 40 Dextran 40 Hetastarch Hetastarch 5% albumin 5% albumin 25% albumin 25% albumin

Blood Products Mechanism of Action Mechanism of Action Increase plasma volume Increase plasma volume Same manner as colloids and crystalloids Same manner as colloids and crystalloids Pulling fluid from extravascular to intravascular space Pulling fluid from extravascular to intravascular space Red blood cells (RBC) Red blood cells (RBC) Ability to carry oxygen Ability to carry oxygen Therapeutic uses Therapeutic uses Refer to table 26-8 Refer to table 26-8

Blood Products Examples Examples Cryoprecipitate and PPF Cryoprecipitate and PPF Fresh frozen plasma (FFP) Fresh frozen plasma (FFP) Packed red blood cells (PRBCs) Packed red blood cells (PRBCs) Whole blood Whole blood

Electrolytes Potassium Potassium Most abundant cationic electrolyte inside cells Most abundant cationic electrolyte inside cells Sodium Sodium Counterpart to potassium Counterpart to potassium Principal cation outside cells Principal cation outside cells Therapeutic uses Therapeutic uses Treatment or prevention of depletion Treatment or prevention of depletion

Nursing process Assessment Assessment Nursing diagnosis Nursing diagnosis Planning Planning Implementation Implementation Evaluation Evaluation