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IV Fluids What Nurses Need To Know
IV Fluids What Nurses Need To Know
I.V. fluids
What nurses
Copyright © 2011 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
2.8
ANCC
CONTACT HOURS
need to know By Ann Crawford, PhD, RN, and Helene Harris, MSN, RN
CAN YOU IMAGINE A LIFE without live several weeks without food, they
water? Of course not, because water can survive only a few days without
is essential to sustain life. Likewise, water.1
body fluids are vital to maintain Water has many functions in the
normal body functioning. body; for example, it
The body reacts to internal and • serves as the transport system for
environmental changes by adjusting nutrients, gases, and wastes in and
vital functions to keep fluids and out of the cells.
electrolytes in balance, maintaining • facilitates the elimination of wastes
homeostasis. This article will explore through the kidneys, gastrointestinal
how fluid acts within the body and (GI) tract, skin, and lungs.
discuss when and why various I.V. • regulates body temperature
fluids can be used to maintain through evaporation from the skin.
homeostasis. Subsequent articles in Water is gained and lost from the
this series will discuss specific elec- body every day. For the body to
trolyte imbalances. Unless otherwise maintain normal function, the intake
specified, information applies to and output of fluid should remain
adults, not pediatric patients. fairly equal. We obtain water through
drinking fluids and the metabolism
Water water everywhere of nutrients obtained from eating
I STOCK P HOTO / NICOLAMARGARET
May l Nursing2011 l 31
Copyright © 2011 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
center, triggering the impulse to stitial fluid found in the tissue spaces. someone who’s lean and muscular.
increase fluid intake.4 The intracellular, intravascular, and Similarly, women typically have a
Water is lost from the body interstitial spaces are the major fluid lower percentage of total body water
through the kidneys, GI tract, lungs, compartments in the body. than men due to a higher percent-
and skin. Losses from the kidneys A third category of the extracellu- age of body fat. Older adults tend to
and GI tract are known as sensible lar fluid compartment is the transcel- have a lower concentration of water
losses because they can be measured. lular compartment, which includes overall, due to an age-related de-
Insensible losses describe water loss cerebrospinal fluid and fluid con- crease in muscle mass. Conversely,
that can’t be measured, including tained in body spaces such as the children tend to have a higher per-
losses through the skin from evapo- pleural cavity and joint spaces. Be- centage of water weight—as much
ration and through the lungs from cause transcellular fluids don’t nor- as 80% in a full-term neonate.1,4
respiration.2 mally contribute significantly to fluid Fluids don’t remain static within
balance, they’re beyond the scope of body compartments; instead, they
Two main fluid compartments this article.1,2 move continuously among them to
Fluids within the body are contained maintain homeostasis. Cell mem-
in two basic compartments, intracel- How much of you is water? branes are semipermeable, meaning
lular and extracellular. Cell mem- The amount of water in the body they allow fluid and some solutes
branes and capillary walls separate varies depending on age, gender, (particles dissolved in a solution) to
the two fluid compartments. See Two and body build. In nonobese adults, pass through.
basic fluid compartments. intracellular fluid constitutes ap- Fluids and electrolytes move
The intracellular fluid compart- proximately 40% of body weight, between compartments via passive
ment, which consists of fluid con- and extracellular fluid, 20%.1,4 (See and active transport. Passive trans-
tained within all of our body cells, is How body fluid is distributed.) port occurs when no energy is
the larger of the two compartments. Lean body muscle mass is rich in required to cause a shift in fluid
The extracellular fluid compartment water, while adipose tissue has a and electrolytes. Diffusion, osmo-
contains all the fluids outside the cells lower percentage of water content. sis, and filtration are examples of
and is further divided into two major Because of this, someone who’s over- passive transport mechanisms that
subcomponents: intravascular fluid weight or obese has a lower percent- cause body fluid and electrolyte
contained in blood vessels and inter- age of water overall compared with movement.2
Osmolality and osmolarity are
Two basic fluid compartments two similar terms that are often con-
fused. Osmolality, which is usually
The intracellular and extracellular spaces are the body’s basic fluid compartments.
The extracellular space is further divided into the intravascular and interstitial spaces.
used to describe fluids inside the
body, refers to the solute concentra-
tion in fluid by weight: the number
of milliosmols (mOsm) in a kilo-
gram (kg) of solution. Osmolarity
refers to the solute concentration in
Intracellular fluid by number of mOsm per liter
water (L) of solution. Because 1 L of water
weighs 1 kg, the normal ranges are
the same and the terms are often
Extracellular
used interchangeably.
(plasma) water
Changes in the level of solute
concentration influence the move-
Extracellular ment of water between the fluid
(interstitial) water compartments. The normal osmolal-
ity for plasma and other body fluids
varies from 270 to 300 mOsm/L.
Optimal body function occurs when
the osmolality of fluids in all the
Source: Porth CM. Essentials of Pathophysiology. 3rd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2011: 160.
body compartments is close to 300
mOsm/L. When body fluids are fairly
Copyright © 2011 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
equivalent in this particle concentra-
tion, they’re said to be isotonic. How body fluid is distributed
Fluids with osmolalities less than This is the approximate size of fluid compartments in a 70-kg adult. Total body
270 mOsm/L are hypotonic in com- water equals about 60% of body weight.
parison with isotonic fluids, and Intracellular water Extracellular water
fluids with osmolalities greater than 40% body weight 20% body weight
300 mOsm/L are hypertonic.2 Tonic- 300 14% 5% 1%
ity of I.V. fluids will be discussed in
Osmolarity - mOsm/L
detail later in this article.
Copyright © 2011 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
certain patients, such as those with trolytes are dispersed as an isotonic
cardiac or renal disease, because of the electrolyte solution, providing addi-
potential for fluid volume overload. tional hydration for the extracellular
Lactated Ringer’s (LR), also fluid compartment. Dextrose solu-
known as Ringer’s lactate or Hart- tions also provide free water for the
mann solution, is the most physi- kidneys, aiding renal excretion of
ologically adaptable fluid because its solutes. Because it provides free wa-
electrolyte content is most closely ter following metabolism, D5W is
related to the composition of the also considered a hypotonic solu-
body’s blood serum and plasma. Be- tion.6
cause of this, LR is another choice for D5W is basically a sugar water so-
first-line fluid resuscitation for cer- lution that provides 170 calories per
tain patients, such as those with liter, but it doesn’t replace electro-
burn injuries. It contains 130 mEq/L lytes. However, it’s appropriate to
of sodium, 4 mEq/L of potassium, treat hypernatremia because it di-
3 mEq/L of calcium, and 109 mEq/L lutes the extra sodium in extracellu-
of chloride. LR doesn’t provide calo- lar fluid.
ries or magnesium, and has limited D5W shouldn’t be used in isola-
potassium replacement.2 Older adults tend to have tion to treat fluid volume deficit be-
LR is used to replace GI tract fluid a lower concentration cause it dilutes plasma electrolyte
losses, fistula drainage, and fluid of water overall due concentrations. It’s also contraindi-
losses due to burns and trauma. It’s to an age-related cated in these clinical circumstances:
also given to patients experiencing decrease in muscle mass. • for resuscitation, because the solu-
acute blood loss or hypovolemia due tion won’t remain in the intravascu-
to third-space fluid shifts.6 Both lar space.
0.9% sodium chloride and LR may used in a similar fashion as LR, but • in the early postoperative period,
be used in many clinical situations, doesn’t have the contraindications because the body’s reaction to the
but patients requiring electrolyte related to lactate. However, because surgical stress may cause an increase
replacement (such as surgical or it’s not an alkalizing agent, it may not in antidiuretic hormone secretion.2
burn patients) will benefit more be indicated for patients with meta- • in patients with known or suspected
from an infusion of LR.6 bolic acidosis.3,6 increased intracranial pressure (ICP)
LR is metabolized in the liver, D5W is unique in that it may be due to its hypotonic properties fol-
which converts the lactate to bicar- categorized as both an isotonic and a lowing metabolism.
bonate. As an alkalinizing solution, hypotonic solution. The amount of Although it supplies some calo-
LR is often administered to patients dextrose in this solution makes its ries, D5W doesn’t provide enough
who have metabolic acidosis. Don’t initial tonicity similar to that of intra- nutrition for prolonged use.
give LR to patients who can’t me- vascular fluid, making it an isotonic
tabolize lactate for some reason, such solution. But dextrose (in this con- Nursing considerations for
as those with liver disease or those centration) is rapidly metabolized by isotonic solutions
experiencing lactic acidosis. the body, leaving no osmotically ac- Be aware that patients being treated
Because a normal liver will convert tive particles in the plasma.6 for hypovolemia can quickly develop
it to bicarbonate, LR shouldn’t be D5W provides free water: free, un- hypervolemia (fluid volume overload)
given to a patient whose pH is great- bound water molecules small enough following rapid or overinfusion of
er than 7.5. Because it does contain to pass through membrane pores to isotonic fluids. Document baseline
some potassium, use caution in pa- the intracellular and extracellular vital signs, edema status, lung sounds,
tients with renal failure.3 spaces. This smaller size allows the and heart sounds before beginning
Ringer’s solution, like LR, contains molecules to pass more freely be- the infusion, and continue monitoring
sodium, potassium, calcium, and tween compartments, thus expand- during and after the infusion.
chloride in similar concentrations ing both compartments simultane- Frequently assess the patient’s re-
(147 mEq/L of sodium, 4 mEq/L of ously.6 The free water initially dilutes sponse to I.V. therapy, monitoring for
potassium, 4 mEq/L of calcium, and the osmolality of the extracellular signs and symptoms of hypervolemia,
156 mEq/L of chloride). But it doesn’t fluid; once the cell has used the dex- such as hypertension, bounding
contain lactate. Ringer’s solution is trose, the remaining saline and elec- pulse, pulmonary crackles, dyspnea/
Copyright © 2011 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
shortness of breath, peripheral ede-
ma, jugular venous distention (JVD), Checking for pitting edema
and extra heart sounds, such as S3. Press firmly with your thumb for at least 5 seconds over the dorsum of each foot,
Monitor intake and output, hemato- behind each medial malleolus, and over the shins. Look for pitting—a depression
crit, and hemoglobin. Elevate the caused by pressure from your thumb. Normally there is none. The severity of edema
is graded on a four-point scale. The photo at right illustrates 3+ pitting edema.
head of bed at 35 to 45 degrees, un-
less contraindicated. If edema is pres-
ent, elevate the patient’s legs. Note if
the edema is pitting or nonpitting
and grade pitting edema. For an ex-
ample, see Checking for pitting edema.
Also monitor for signs and symp-
toms of continued hypovolemia, in-
cluding urine output of less than 0.5
mL/kg/hour, poor skin turgor, tachy-
cardia, weak, thready pulse, and
hypotension.2
Educate patients and their families
about signs and symptoms of volume
overload and dehydration, and in-
struct patients to notify their nurse if
they have trouble breathing or notice Source: Bates B. Bates’ Guide to Physical Examination and History Taking. 6th ed. Philadelphia, PA:
Lippincott Williams and Wilkins; 1995:438.
any swelling. Instruct patients and
families to keep the head of the bed
elevated (unless contraindicated). requirements, but don’t contain any cular bed volume can worsen exist-
electrolytes (except for sodium and ing hypovolemia and hypotension
HYPOTONIC FLUIDS chloride) or calories (except for D5W, and cause cardiovascular collapse.6
Compared with intracellular fluid (as which is also considered a hypotonic Monitor patients for signs and
well as compared with isotonic solu- solution after metabolism).3 Admin- symptoms of fluid volume deficit as
tions), hypotonic solutions have a istering hypotonic saline solutions fluid is “pulled back” into the cells and
lower concentration, or tonicity, of also helps the kidneys excrete excess out of the vascular bed. In older adult
solutes (electrolytes). Hypotonic I.V. fluids and electrolytes. patients, confusion may also be an
solutions have an osmolality less All these solutions provide free indicator of a fluid volume deficit. In-
than 250 mOsm/L.6 water, sodium, and chloride, and re- struct patients to inform a nurse if
Infusing a hypotonic solution into place natural fluid losses. In addition, they feel dizzy or just “don’t feel right.”
the vascular system causes an un- the solution containing dextrose of- Never give hypotonic solutions to
equal solute concentration among fers a low level of caloric intake. patients who are at risk for increased
the fluid compartments. The infu- ICP because of a potential fluid shift
sion of hypotonic crystalloid solu- Nursing considerations for to the brain tissue, which can cause
tions lowers the serum osmolality hypotonic solutions or exacerbate cerebral edema. In ad-
within the vascular space, causing Hypotonic fluids are used to treat pa- dition, don’t use hypotonic solutions
fluid to shift from the intravascular tients with conditions causing intra- in patients with liver disease, trauma,
space to both the intracellular and cellular dehydration, such as diabetic or burns due to the potential for de-
interstitial spaces. These solutions ketoacidosis, and hyperosmolar hy- pletion of intravascular fluid volume.2
will hydrate cells, although their use perglycemic state, when fluid needs to
may deplete fluid within the circula- be shifted into the cell. Be aware of HYPERTONIC SOLUTIONS
tory system.6 how the fluid shift will affect various Compared with intracellular fluid
Types of hypotonic fluids include body systems. The lower concentra- (as well as with isotonic solutions),
0.45% sodium chloride (0.45% tion of solute within the vascular bed hypertonic solutions have a higher
NaCl), 0.33% sodium chloride, 0.2% will shift the fluid into the cells and tonicity or solute concentration,
sodium chloride, and 2.5% dextrose also into the interstitial spaces. causing an unequal pressure gradient
in water. Hypotonic solutions assist Use caution when infusing hypo- between the inside and outside of
with maintaining daily body fluid tonic solutions; the decrease in vas- the cells. Hypertonic fluids have an
Copyright © 2011 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
osmolarity of 375 mOsm/L or higher. sion. As an additional precaution,
The osmotic pressure gradient draws many institutions store hypertonic
water out of the intracellular space, sodium chloride solutions apart from
increasing extracellular fluid volume. regular floor stock I.V. fluids, so they
Because of this property, hypertonic must be ordered separately from the
solutions are used as volume ex- pharmacy.
panders. Hypertonic solutions may Monitor serum electrolytes and
be prescribed for patients with severe assess for signs and symptoms of
hyponatremia. Patients with cerebral hypervolemia. Because hypertonic
edema may also benefit from an infu- solutions can cause irritation, dam-
sion of hypertonic sodium chloride.6 age, and thrombosis of the blood
Hypertonic sodium chloride solu- vessel, some of these solutions
tions contain a higher concentration shouldn’t be administered peripher-
of sodium and chloride than that ally. The Infusion Nurses Society
normally contained in plasma. Ex- states that “[p]arenteral nutrition
amples include 3% sodium chloride solutions containing final concentra-
(3% NaCl), with 513 mEq/L of so- tions exceeding 10% dextrose should
dium and chloride, and 5% sodium be administered through a central
chloride (5% NaCl), with 855 mEq/L Unbound molecules in free vascular access device with the tip
of sodium and chloride. As the infu- water are small enough to located in the central vasculature,
sion of these hypertonic solutions pass through membrane preferably the subclavian/right
raise the sodium level in the blood- pores into the intracellular atrium junction for adults.”9
stream, osmosis comes into play, re- and extracellular spaces. Instruct patients to notify a nurse
moving fluid from the intracellular if they develop breathing difficulties
space, and shifting it into the intra- or if they feel their heart is beating
vascular and interstitial spaces. These very fast.
solutions are highly hypertonic and ing the fluid shift it causes between Hypertonic solutions shouldn’t be
should be used only in critical situa- various compartments promotes given to patients with cardiac or renal
tions to treat hyponatremia. Give diuresis. conditions who are dehydrated. These
them slowly and cautiously to avoid Fifty percent dextrose in water solutions affect renal filtration mecha-
intravascular fluid volume overload (D50W) is a highly concentrated sug- nisms and can cause hypervolemia.
and pulmonary edema.3 ar solution. It’s administered rapidly Patients with conditions causing cel-
When dextrose is added to iso- via I.V. bolus to treat patients with lular dehydration, such as diabetic
tonic or hypotonic solutions, the net severe hypoglycemia.3 ketoacidosis shouldn’t be given hy-
result can be a slightly hypertonic pertonic solutions, because it will
solution due to the higher solute Nursing considerations for exacerbate the condition.
concentration. Thus, adding D5W to hypertonic solutions
sodium chloride solutions (such as Maintain vigilance when administer- Why colloid solutions stay put
5% dextrose and 0.45% sodium ing hypertonic saline solutions be- Unlike crystalloids, colloids contain
chloride, and 5% dextrose and 0.9% cause of their potential for causing molecules too large to pass through
sodium chloride) or to lactated Ring- intravascular fluid volume overload semipermeable membranes, such as
er’s solutions such as D5LR will pro- and pulmonary edema.2 Hypertonic capillary walls. Because they remain
vide the same electrolytes already sodium chloride solutions should be in the intravascular compartment,
discussed for each of those solutions, administered only in high acuity areas they’re also known as volume ex-
with the addition of calories. Plain with constant nursing surveillance for panders or plasma expanders. Ex-
glucose solutions with a concentra- potential complications. Hypertonic amples include albumin, dextrans,
tion higher than 5%, such as 10% sodium chloride shouldn’t be given and hydroxyethylstarches.
dextrose in water (D10W), are also for an indefinite period of time. Pre- Colloids expand intravascular vol-
considered hypertonic. D10W pro- scriptions for their use should state ume by drawing fluid from the inter-
vides free water and calories (340 the specific hypertonic fluid to be stitial spaces into the intravascular
per liter), but not electrolytes. infused, the total volume to be compartment through their higher
Twenty percent dextrose in water infused and infusion rate, or the oncotic pressure. They have the same
(D20W) is an osmotic diuretic, mean- length of time to continue the infu- effect as hypertonic crystalloids of
Copyright © 2011 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
increasing intravascular volume, but A study was conducted during Dextran interferes with lab blood
require administration of less total 2001-2003 called the Saline versus crossmatching, so if a type and cross
volume compared with crystalloids. Albumin Fluid Evaluation (SAFE) is anticipated, draw the patient’s
In addition, colloids have a longer study. This study compared the use blood before administering dextran.
duration of action than crystalloids of albumin and saline for ICU pa- Dextran may interfere with some
because the molecules remain within tients requiring fluid resuscitation. other blood tests and may also cause
the intravascular space longer. The Among 6997 patients studied, 3497 anaphylactoid reactions.7
effects of colloids can last for several received 4% albumin solution and Hydroxyethalstarches, such as heta-
days if capillary wall linings are in- 3500 received 0.9% sodium chloride starch (6%) and hespan, are another
tact and working properly. Colloids solution. The aim of the study was to form of hypertonic synthetic colloids
are indicated for patients exhibiting determine if one fluid was better used for volume expansion. They
hypoproteinemia, and malnourished than the other for preventing death. contain 154 mEq/L of sodium and
states, as well as for those who re- After 28 days, researchers found sim- chloride and are used for hemody-
quire plasma volume expansion but ilar outcomes in both groups.10 Be- namic volume replacement following
who can’t tolerate large infusions of cause neither solution has proven major surgery and to treat major
fluid. Patients undergoing orthopedic clearly superior, healthcare providers burns. Synthetic colloid preparations
surgery or reconstructive procedures use their judgment to decide which are less expensive than albumin and
with an elevated potential for throm- fluid to administer to critically ill their effects can last 24 to 36 hours.9
bus formation may also benefit from patients in the ICU. Unlike other colloids, hetastarch
colloid solutions.6 Besides albumin, several synthetic doesn’t interfere with blood typing or
Five percent albumin (Human albu- colloid preparations are available for crossmatching. Hetastarch is contra-
min solution) is one of the most com- patient use. Low-molecular weight indicated in patients with liver dis-
monly utilized colloid solutions. It dextran (LMWD) and high-molecular ease and severe cardiac and renal
contains plasma protein fractions weight dextran (HMWD) are synthetic disorders. It may also cause a severe
obtained from human plasma and plasma expanders infused to draw anaphylactoid reaction.6
works to rapidly expand the plasma water into the intravascular space.
volume. It’s used for volume expan- • LMWD contains polysaccharide Nursing considerations
sion, moderate protein replacement, molecules that behave like colloids for colloids
and achievement of hemodynamic with an average molecular weight of Because colloids pull fluids from the
stability in shock states. Albumin is 40,000 (dextran 40). It contains no interstitial space to the vascular
also available in a 25% solution, which electrolytes and is used for volume space, the patient is at risk for devel-
is much more hypertonic and can expansion and support. LMWD is oping fluid volume overload. If the
draw about four times its volume used for early fluid replacement and patient’s fluid imbalance doesn’t
from the interstitial fluid into the to treat shock related to vascular vol- respond to either crystalloids or
vascular compartment within 15 ume loss, such as that produced by colloids, blood transfusions or other
minutes of administration. burns, hemorrhage, surgery, or trau- treatment may be necessary.2
Albumin is considered a blood ma. It’s used to prevent venous As for blood products, use an
transfusion product and requires all thromboembolism during surgical 18-gauge or larger needle to infuse
the same nursing precautions used procedures, because its mechanism colloids. Monitor the patient for
when administering other blood of action is to prevent the sludging of signs and symptoms of hypervol-
products. It can be expensive and its blood. LMWD is contraindicated in emia, including increased BP, dysp-
availability is limited to the supply of patients with thrombocytopenia, hy- nea, crackles in the lungs, JVD,
human donors.9 pofibrinogenemia, and hypersensitiv- edema, and bounding pulse. Closely
Albumin is, however, contraindi- ity to dextran.7 monitor intake and output. Colloid
cated in patients with the following • HMWD contains polysaccharide solutions can interfere with platelet
conditions: severe anemia, heart molecules with an average molecular function and increase bleeding times,
failure, or a known sensitivity to weight of 70,000 (available as dex- so monitor the patient’s coagulation
albumin. In addition, angiotensin- tran 70) or 75,000 (available as dex- indexes.9 Elevate the head of bed
converting enzyme inhibitors should tran 75). It also contains no electro- unless contraindicated.
be withheld for at least 24 hours be- lytes. HMWD shouldn’t be given to Anaphylactoid reactions are a rare
fore administering albumin because patients in hemorrhagic shock. but potentially lethal adverse reaction
of the risk of atypical reactions, such Dextran solutions are available in to colloids. Take a careful allergy his-
as flushing and hypotension.7 either saline or glucose solutions. tory from patients receiving colloids
Copyright © 2011 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
4. Copstead LC, Banasik JL, eds. Pathophysiology.
(or any other drug or fluid), asking fluid status. Regularly check the ve- 4th ed. St. Louis, MO: Saunders Elsevier; 2010.
specifically if they’ve ever had a reac- nous access site for signs of infiltra- 5. LeMone P, Burke K. Medical-surgical Nursing:
tion to an I.V. infusion. tion, inflammation, infection, or Critical Thinking in Client Care. 4th ed. Upper
Saddle River, NJ: Pearson Education; 2008.
thrombosis.
6. Phillips L. Parenteral fluids. In: Alexander M,
Use best practices for optimal Educate the patient and the family Corrigan A, Gorski L, Hankins J, Perucca R, eds.
outcomes about the prescribed therapy, includ- Infusion Nurses Society: Infusion Nursing, An evidence-
based Approach. 3rd ed. St. Louis, MO: Saunders
No matter what I.V. fluid you’re ad- ing potential complications and Elsevier; 2010.
ministering, follow best practices to symptoms that require immediate 7. Hankins J. Fluids & electrolytes. In: Alexander
ensure optimal response to therapy attention. M, Corrigan A, Gorski L, Hankins J, Perucca R,
eds. Infusion Nurses Society: Infusion Nursing, An
and prevent complications. For ex- Evidence-based Approach. 3rd ed. St. Louis, MO:
ample, assess and document baseline Crucial balancing act Saunders Elsevier; 2010.
8. Holcomb SS. Third-spacing: When body fluid
vital signs, heart and lung sounds, Maintaining fluid and electrolyte shifts. Nursing. 2008;38(7):50-53.
and fluid volume status. balance is essential for life. Future 9. Infusion Nursing Standards of Practice. J Infus
As with any drug, make sure articles in this series will discuss how Nurs. 2011;34(1S).
you’re familiar with the type of fluid to assess for specific imbalances and 10. Finfer S, Bellomo R, Boyce N, et. A comparison
of albumin and saline for fluid resuscitation in the
being administered, the rate and intervene appropriately. ■ intensive care unit. N Engl J Med. 2004;350(22):
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adverse reactions. Throughout thera- Philadelphia, PA: Lippincott Williams & Wilkins; Ann Crawford is professor, College of Nursing, at
2011. University of Mary Hardin-Baylor in Belton, Tex.
py, monitor the patient’s response to Helene Harris is a clinical educator at Central Texas
2. Ignatavicius D, Workman MI, eds. Medical- Veterans Healthcare System in Temple, Tex.
treatment, watching closely for any Surgical Nursing: Patient-centered Collaborative Care.
signs and symptoms of hypervol- 6th ed. St. Louis, MO: Saunders Elsevier; 2010. The authors have disclosed that they have no financial
3. Urden LD, Stacy KM, Lough ME. Thelan’s Critical relationships pertaining to this article.
emia or hypovolemia. Monitor lab Care Nursing. Diagnosis and Management. 5th ed. St.
values to assess kidney function and Louis, MO: Mosby Elsevier; 2006. DOI-10.1097/01.NURSE.0000396282.43928.40
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I.V. fluids: What nurses need to know
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