Isotonic Solutions – NCLEX Review (Nursing)

by Prof. Lawes

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    00:00 So, you saw the overall summary slide.

    00:03 Don't let that overwhelm you.

    00:05 I'm gonna break it down a little bit.

    00:06 If you're already a rock star in IV solutions, then this next session will be really easy for you.

    00:12 But it still feels a little shaky, then I promise by the end of it, you'll feel like a rock star.

    00:17 Now, let's look at isotonic solutions as a group.

    00:21 So, I know we've listed several there, but I just want you to think isotonic solutions as a group.

    00:26 Their job is to expand the intravascular compartment.

    00:29 That means put fluid into your intravascular spaces, usually to raise blood pressure or to replace volume.

    00:37 Now, keep an eye on your patients for fluid volume overload.

    00:40 I mean every solution in this category, watch your patient for fluid volume overload.

    00:45 So, why do we write hypertension and CHF there? Well, that's a note to remind you that as we're filling up that intravascular space, the blood pressure's going to go up.

    00:55 So, watch your patients for hypertension.

    00:57 If your patient already has congestive heart failure, you wanna watch them extra closely for fluid volume overload.

    01:06 Make sure that you auscultate to lungs sounds, front and back because crackles are gonna start in the bases in the back first so do the extra work that it takes to listen to lung sounds there.

    01:16 Now, look at the drawing over here.

    01:18 Remember, we've got that, oh, that looks familiar, right? Fluid is just one of two places. Inside the cell, outside the cell.

    01:25 So, now, we're talking about putting fluid volume in the intravascular space.

    01:30 Okay. So obviously, fluid outside the cell.

    01:34 So, you already start looking at individual solutions, let's break them down of each of the different types of isotonic solutions.

    01:41 We've got the listing there again, just to remind you so you can use that as a quick reference or the summary slide that we've provided you.

    01:49 But zero percent normal saline is an example of isotonic solution.

    01:53 So, we use it to increase circulating volume.

    01:56 Now, you noticed I bolded some things there for you, but I'd love for you to write your notes on it too.

    02:01 Increasing circulating volume, that's the key because normal saline is an isotonic solution.

    02:08 But I'm sure you've noticed in the hospital, we give a ton of this stuff, so it's really important that you recognize what it can do.

    02:16 Now, since it increases circulating volume, it's appropriate to use it for shock, hypovolemic shock, particularly.

    02:23 Also, special note, normal saline is the fluid for giving a blood transfusion.

    02:30 So, don't use anything else. Use 0.9% normal saline, an isotonic solution.

    02:38 Now, I know I've got some extra details for you there, they're very helpful.

    02:41 But if I'm -- you're down to the minute in the crunch and what you need to be is most important.

    02:46 Then I would know increasing circulating volume, we use it for hypovolemic shock, and it is the solution for blood transfusions. Now, watch them for fluid overload.

    02:57 We've talked about that over and over again.

    02:59 However, it's a big risk with isotonic solutions. Good.

    03:04 You'll hear me use repetition all throughout this section because if this is relatively new to you, you need that repetition for your brain. If you've already got it. Enjoy.

    03:14 Celebrate the stuff you've worked hard to learn.

    03:18 Also, keep in mind we call it normal saline for a reason so be careful with patients with renal disease who are already on glucocorticoids because of the extra sodium that you're adding.

    03:30 Alright. Well, that's normal saline, one example of an isotonic solution.

    03:35 Here's another one, lactated ringer's is the second example of an isotonic solution, but it's a little bit different than normal saline.

    03:43 Right, the isotonicity, that's the same, right? It's equal to the concentration is equal to your blood.

    03:49 However, lactated ringers is different because it has lactate in it.

    03:54 So, a healthy liver will convert the lactate to bicarbonate.

    03:57 So, if I hang lactated ringers on a patient who's relatively healthy, their liver's gonna convert that lactate. Everything's good.

    04:05 But there's a group of patients you wanna be careful with.

    04:08 Patients who have liver disease, or whose liver is struggling can't metabolize that lactate well.

    04:14 Ah-hah. So, what's the deal? Why would the nurse need to know this? How would it keep a patient safe? Well, if I have a patient who's showing me signs of liver disease, maybe the stem of the question will have lab work in it like AST or ALT.

    04:29 Maybe the patient will show me some signs of, "You know, I've just been really tired lately." Their skin color is starting to look jaundice. Some of those signals.

    04:38 This would be the order you would question.

    04:41 So, keep in mind, when you're learning this information, it's really important that you know it for exams.

    04:47 But it's the most important that you recognize that if you are taking care of an actual patient who had lactated ringers ordered and they look to you like they're having some liver problems.

    04:57 It's also not good for alkalosis and that probably makes sense to you because you know the liver's gonna convert the lactate to bicarbonate.

    05:05 The patient's already alkalotic. They don't need to be made more alkalotic.

    05:10 So, we give this as a fluid and electrolyte replenisher, and we give a fair amount of this in the hospital.

    05:15 Now, I've given you some unusual cases but it's important that you recognize these two types of patients, somebody with liver disease or liver problems, or who is already an alkalosis, this would not be the best IV solution.

    05:31 Now, D5W is another example of an isotonic solution.

    05:35 It's not good for patients with an elevated ICP.

    05:38 Why? Well, remember, we've got some issues with hypotonic solution but this is an isotonic solution. So, why is that a problem? Well, remember this is isotonic in the bag, D5W, but once its gets in the body and the body rips through that dextrose, it becomes hypotonic.

    06:00 That's why it's not good for patients with elevated intracranial pressure.

    06:04 I've listed some other options for you there.

    06:06 Just keep an eye on those and see if you can review those when you come back and go over the content.

    06:10 Now, we can use it for fluid loss and dehydration and hypernatremia because it kinda dilutes that extra sodium in the extracellular fluid.

    06:19 So, that's why we would use a D5W solution.

    06:23 We give it, don't be afraid of it because we do use it for fluid loss and dehydration.

    06:29 We can help deal with that extra sodium in the extracellular fluid.

    06:33 Just keep in mind, it's isotonic in the bag but becomes hypotonic in the body.

    06:40 Hetastarch and Normosol, didn't give you a lot of information on these, just think of them as volume expanders.

    About the Lecture

    The lecture Isotonic Solutions – NCLEX Review (Nursing) by Prof. Lawes is from the course NCLEX Pharmacology Review (Nursing).

    Included Quiz Questions

    1. Fluid volume overload
    2. Fluid volume deficit
    3. Seizures
    4. Increased intracranial pressure
    1. 0.9% sodium chloride
    2. Lactated Ringer's
    3. 0.45% sodium chloride
    4. 5% dextrose in water (D5W)
    1. Bicarbonate
    2. Sodium
    3. Chloride
    4. Lactic acid
    1. 5% dextrose in water (D5W)
    2. Lactated Ringer's
    3. 3% normal saline
    4. 0.9% normal saline

    Author of lecture Isotonic Solutions – NCLEX Review (Nursing)

     Prof. Lawes

    Prof. Lawes

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