Fluids & ElectrolytesFluids & ElectrolytesNAPNES GuidelinesNAPNES Guidelines

Presented by Laura Zdancewicz MSN, CRNPPresented by Laura Zdancewicz MSN, CRNP

Types of SolutionsTypes of Solutions

CrystalloidsCrystalloids ColloidsColloids Blood productsBlood products Electrolytes Electrolytes

Crystalloids Crystalloids

Mechanism of ActionMechanism of Action Supply sodium and waterSupply sodium and water

Maintain osmotic gradientMaintain osmotic gradient Between fluid outside blood vessels and Between fluid outside blood vessels and

fluid inside blood vesselsfluid inside blood vessels Expands plasma volumeExpands plasma volume

Therapeutic usesTherapeutic uses Maintenance fluidsMaintenance fluids Replacement fluidsReplacement fluids Promote urinary flowPromote urinary flow

CrystalloidsCrystalloids

ExamplesExamples NS (0.9% sodium chloride)NS (0.9% sodium chloride)

Most commonly usedMost commonly used Hypertonic salineHypertonic saline Lactated Ringer’s Lactated Ringer’s D5WD5W Plasma-LytePlasma-Lyte

ColloidsColloids

Mechanism of ActionMechanism of Action Fluid is pulled from extravascular Fluid is pulled from extravascular

space to the intravascular spacespace to the intravascular space Thus increasing blood volumeThus increasing blood volume

““Plasma expanders”Plasma expanders”

ColloidsColloids

Therapeutic usesTherapeutic uses Severe conditionsSevere conditions

Acute liver failure,Acute liver failure, Acute nephrosisAcute nephrosis Adult respiratory distress syndromeAdult respiratory distress syndrome BurnsBurns Cardiopulmonary bypassCardiopulmonary bypass HypoproteinemiaHypoproteinemia DVT reductionDVT reduction Renal dialysisRenal dialysis Shock Shock

ColloidsColloids

ExamplesExamples Dextran 70Dextran 70 Dextran 40Dextran 40 HetastarchHetastarch 5% albumin5% albumin 25% albumin25% albumin

Blood ProductsBlood Products

Mechanism of ActionMechanism of Action Increase plasma volumeIncrease plasma volume

Same manner as colloids and Same manner as colloids and crystalloidscrystalloids

Pulling fluid from extravascular to Pulling fluid from extravascular to intravascular spaceintravascular space

Red blood cells (RBC) Red blood cells (RBC) Ability to carry oxygenAbility to carry oxygen

Therapeutic usesTherapeutic uses Refer to table 26-8Refer to table 26-8

Blood ProductsBlood Products

ExamplesExamples Cryoprecipitate and PPFCryoprecipitate and PPF Fresh frozen plasma (FFP)Fresh frozen plasma (FFP) Packed red blood cells (PRBCs)Packed red blood cells (PRBCs) Whole bloodWhole blood

Electrolytes Electrolytes

PotassiumPotassium Most abundant cationic electrolyte Most abundant cationic electrolyte

inside cellsinside cells SodiumSodium

Counterpart to potassiumCounterpart to potassium Principal cation outside cellsPrincipal cation outside cells

Therapeutic usesTherapeutic uses Treatment or prevention of Treatment or prevention of

depletiondepletion

Nursing processNursing process

AssessmentAssessment Nursing diagnosisNursing diagnosis PlanningPlanning ImplementationImplementation Evaluation Evaluation