After completing this chapter, the reader will be able to:
1.Define terminology related to infusion fluids.
2.Identify three indications for infusion fluid administration.
3.Differentiate between the effects of isotonic, hypotonic, and hypertonic fluids.
4.List the key elements of crystalloid fluids.
5.Differentiate between crystalloid and colloidal infusion fluids.
6.Compare the indications for dextrose, sodium chloride, hydrating fluids, and balanced electrolyte fluids.
7.Identify the use of alkalinizing and acidifying solutions.
8.Identify indications for common colloidal solutions.
9.Apply formulas used to calculate the fluid needs of pediatric clients.
10.Describe why older adults are at increased risk for dehydration.
The nurse is responsible for the administration of infusion therapy, which includes a variety of types of fluids and medications via various routes of administration. Most often solutions for the purpose of fluid replacement are administered via the intravenous (IV) route, and that is the focus of this chapter. However, isotonic fluids also can be administered via the subcutaneous route for patients with mild to moderate dehydration, as addressed in Chapter 10. Along with administering infusion therapy, the nursing role includes assessing fluid volume status and monitoring the patient's response to interventions. Knowledge regarding the contents of infusion solutions, their purpose and actions on the body, and their potential complications is imperative. The complex subject of fluids and electrolytes is covered in Chapter 3, which provides the requisite background knowledge for this chapter on infusion solutions.
The nursing process is a five- or six-step process for problem-solving to guide nursing action. Refer to Chapter 1 for details on the steps of the nursing process related to vascular access. The following table focuses on nursing diagnoses, nursing outcomes classification (NOC), and nursing interventions classification (NIC) for patients with IV fluid needs. Nursing diagnoses should be patient specific, and outcomes and interventions individualized. The NOC and NIC presented here are suggested directions for development of outcomes and interventions.
| Nursing Diagnoses Related to IV Solution Administration | Nursing Outcomes Classification (NOC) | Nursing Interventions Classification (NIC) |
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Deficient fluid volume related to:
Active loss of body fluids or failure of regulatory mechanisms | Fluid and electrolyte balance, hydration | Fluid management, hypovolemia management, shock management: volume |
Excess fluid volume related to:
Compromised regulatory mechanism; excess fluid intake; excess sodium intake | Fluid balance, hydration | Fluid monitoring, fluid management |
Risk for electrolyte imbalance related to:
Excessive or insufficient fluid volume; gastrointestinal losses (diarrhea/vomiting/fistula output); renal dysfunction | Electrolyte and acid-base balance; fluid balance; hydration; kidney function | Electrolyte monitoring; fluid/electrolyte management; hypokalemia/hyperkalemia; hypocalcemia/hypercalcemia; hyponatremia/hypernatremia; hypomagnesemia/hypermagnesemia; hypophosphatemia/hyperphosphatemia; laboratory data interpretation |
Deficient knowledge related to:
Inadequate information: New procedure and maintaining infusion therapy at home | Knowledge of disease process; infusion therapy treatment regimen | Teaching: Disease process, treatment |
Risk for allergy reaction related to:
Exposure to potential allergen, colloid administration | Allergic response: Systemic; immune hypersensitivity response | Allergy management |
Source: Herdman et al., 2021; Ackley et al., 2020.
- Objectives of IV solution administration include:
- Maintaining and meeting daily fluid/electrolyte body fluid requirements
- Replacing present and ongoing fluid losses and correcting any electrolyte imbalances
- Acting as a diluent for delivery of infusion medications
- Solutions have an osmolarity that is hypotonic, isotonic, or hypertonic:
- Hypotonic is 250 mOsm/L or below.
- Isotonic ranges from 250 to 375 mOsm/L.
- Hypertonic is above 375 mOsm/L.
- Infusates are categorized as:
- Crystalloids: Solutions that are considered true solutions and whose solutes, when placed in a solvent, mix, dissolve, and cannot be distinguished from the resultant solutions. Crystalloids are able to move through membranes. Examples include dextrose and sodium chloride solutions and lactated Ringer's solution.
- Colloids: Substances whose particles, when submerged in a solvent, cannot form a true solution because their molecules cannot dissolve but remain suspended and distributed in the fluid. Examples include dextran, albumin, hetastarch, and gelatins.
Critical Thinking: Case StudyOver a 16-hour period of time, a 6-year-old child was inadvertently given 800 mL of 3% sodium chloride solution instead of the prescribed 0.33% sodium chloride. She developed lethargy, convulsions, and coma before the error was discovered. Despite resuscitative efforts, the child died. Case Study Questions1.Identify the mEq of each electrolyte in the IV solutions. 2.Identify the osmolality/tonicity of each of the electrolyte solutions. 3.Refer to Chapter 1 on legal aspects for factors involved in malpractice. Who was liable? 4.What types of safeguards should be in place for the pediatric patient receiving IV fluids? (Refer to Chapter 6 for pediatric peripheral infusions.)
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Media Link: Chapter post tests and answers are provided on FADavis.com, along with case studies and critical thinking activities.