Intravenous Fluids • Hypertonic Higher osmolality than ECF Use only when serum osmolality is critically low D10W, D50W, D5NS, D5W in 0.45% NaCl, D5LR • Hypotonic Lower osmolality than ECF For intracellular dehydration 0.45% NS, 2.5?xtrose in 0.45% NS • Isotonic Concentration equal to plasma For deficit of fluid in vascular system 0.9% NS, LR, D5W Fluid Volume Deficit (FVD) • Causes : excess GI/renal loss, fever, diaphoresis, long term NPO, hemorrhage, insufficient intake, burns, diuretics, aging (older adults have less body water and decreased thirst) • S/S : weight loss, dry mucous membranes, rapid/weak/thready pulse, cap refill <3>30 ml/hr, increased RR LATE SIGNS: oliguria, decreased CVP, flattened neck veins • Diagnosis : serum electrolytes, BUN, creatinine, Hct (may be high due to hemoconcentration), urine specific gravity and osmolality • Monitor vitals (pulse quality), I&Os (output at least 0.5 mL/kg/hr), skin turgor, weigh daily, fall precautions (RISK FOR FALL IS PRIORITY) • Correct cause with: Fluid replacement (oral or IV for severe); electrolyte replacement/IV fluids Fluid Volume Excess (FVE) • Causes : kidney failure, heart failure, cirrhosis, burns, hypertonic solutions, excessive water intake, long term corticosteroid therapy • S/S : cough, dyspnea, crackles, increased BP, tachycardia/tachypnea, bounding pulse, weight gain, JVD, increased CVP, pitting edema • Diagnosis : serum electrolytes, BUN, creatinine, Hct (may be low due to dilution), urine specific gravity and osmolality. Chest xray if respiratory complications present. • Monitor vitals (RR, symmetry, and effort), breath sounds for pulmonary edema • Monitor for edema: pitting edema scale 1+ (minimal) to 4+ (severe); dependent edema measured by circumference of extremities • Monitor for ascites (measure abdominal girth