The Fluid & Electrolytes Course eliminates the confusion and content overwhelm when learning about fluid balance in the body and the most common electrolytes. We break down where fluid is stored in the body, how and why it moves between those places, and the different types of IV fluid solutions we can give patients. We also talk about the most important electrolytes, their role in the body, and what happens when they’re too high or too low. We break all of it down and make it easy to understand, you’ll be a fluid & electrolytes expert in no time.

<h2>Key Fluid &amp; Electrolytes Nursing Lessons</h2>
<h3><a href="https://nursing.com/lesson/fluid-01-01-fluid-compartments/">Lesson 01.01 – Fluid Compartments</a></h3>
In this lesson, you will learn about the different compartments including intracellular, extracellular, interstitial, and intravascular.  You will also be able to define different types of fluids and modes of transport for fluid and electrolytes including diffusion, facilitated diffusion, and osmosis.
<h3><a href="https://nursing.com/lesson/fluid-02-01-potassium-k/">Lesson 02.01 – Potassium K (Hyperkalemia, Hypokalemia)</a></h3>
After this lesson you will be able to identify what potassium is, the role it plays in the body, what a patient with hyperkalemia or hypokalemia looks like, and how to treat the different disorders in your patients. 
<h3><a href="https://nursing.com/lesson/fluid-01-04-isotonic-solutions/">Lesson 01.04 – Isotonic Solutions</a></h3>
In this lesson you will gain an understanding of the osmolarity of isotonic solutions and different types like 0.9% normal saline, lactated ringers, and D5W.  You will be able to identify the indications for use, contraindications, and specific patient education for isotonic solutions.

Jon Haws

Nichole Weaver

Brad Bass

fluid-00-01-course-introduction

00.01 Fluid & Electrolytes Course Introduction

0 – Fluid & Electrolytes Course Introduction

fluid-01-01-fluid-compartments

01.01 Fluid Compartments

fluid-01-02-fluid-pressures

01.02 Fluid Pressures

fluid-01-03-fluid-shifts

01.03 Fluid Shifts (ascites) (pleural effusion)

fluid-01-04-isotonic-solutions

01.04 Isotonic Solutions (IV solutions)

fluid-01-05-hypotonic-solutions

01.05 Hypotonic Solutions (IV solutions)

fluid-01-06-hypertonic-solutions

01.06 Hypertonic Solutions (IV solutions)

1 – Fluid Balance

fluid-02-01-potassium-k

02.01 Potassium-K (Hyperkalemia, Hypokalemia)

fluid-02-02-sodium-na

02.02 Sodium-Na (Hypernatremia, Hyponatremia)

fluid-02-03-calcium-ca

02.03 Calcium-Ca (Hypercalcemia, Hypocalcemia)

fluid-02-04-chloride-cl

02.04 Chloride-Cl (Hyperchloremia, Hypochloremia)

fluid-02-05-magnesium-mg

02.05 Magnesium-Mg (Hypomagnesemia, Hypermagnesemia)

fluid-02-06-phosphorus-phos

02.06 Phosphorus-Phos

2 – Electrolytes

fluid-electrolytes

Fluid & Electrolytes

<h3>Overview</h3>
<ol>
<li style="font-weight: 400;">Isotonic solutions
<ol>
<li style="font-weight: 400;">Similar osmolarity to blood</li>
<li style="font-weight: 400;">250 &#8211; 375 mOsm/L</li>
</ol>
</li>
</ol>
<h3>Nursing Points</h3>
<h4>General</h4>
<ol>
<li style="font-weight: 400;">Examples
<ol style="list-style-type: lower-alpha;">
<li style="font-weight: 400;">0.9% Sodium Chloride (Normal Saline)</li>
<li style="font-weight: 400;">Lactated Ringers</li>
<li style="font-weight: 400;">D5W (in the bag)
<ol style="list-style-type: lower-roman;">
<li style="font-weight: 400;">In the body dextrose used as energy → hypotonic</li>
</ol>
</li>
<li style="font-weight: 400;">Colloids</li>
</ol>
</li>
</ol>
<h4>Assessment</h4>
<ol>
<li style="font-weight: 400;">Fluid shifts
<ol style="list-style-type: lower-alpha;">
<li style="font-weight: 400;">NONE</li>
<li style="font-weight: 400;">Increases Extracellular Fluid (ECF) volume</li>
</ol>
</li>
<li style="font-weight: 400;">Effects on cells
<ol style="list-style-type: lower-alpha;">
<li style="font-weight: 400;">NONE</li>
</ol>
</li>
</ol>
<h4>Therapeutic Management</h4>
<ol>
<li style="font-weight: 400;">Indications for use
<ol style="list-style-type: lower-alpha;">
<li style="font-weight: 400;">Increase intravascular volume
<ol style="list-style-type: lower-roman;">
<li style="font-weight: 400;">Blood loss</li>
<li style="font-weight: 400;">Surgery</li>
<li style="font-weight: 400;">Dehydration</li>
<li style="font-weight: 400;">Other fluid loss</li>
</ol>
</li>
<li style="font-weight: 400;">Hydration
<ol style="list-style-type: lower-roman;">
<li style="font-weight: 400;">Maintenance fluids</li>
<li style="font-weight: 400;">NPO</li>
</ol>
</li>
</ol>
</li>
<li style="font-weight: 400;">Contraindications
<ol style="list-style-type: lower-alpha;">
<li style="font-weight: 400;">ONLY NS can be used when giving blood products</li>
<li style="font-weight: 400;">Caution in heart failure
<ol style="list-style-type: lower-roman;">
<li style="font-weight: 400;">Risk for volume overload</li>
</ol>
</li>
<li style="font-weight: 400;">Caution with LR in Metabolic Alkalosis
<ol style="list-style-type: lower-roman;">
<li style="font-weight: 400;">Converts to Bicarb in the blood</li>
</ol>
</li>
</ol>
</li>
</ol>
<h4>Nursing Concepts</h4>
<ol>
<li style="font-weight: 400;">Fluid &amp; Electrolyte Balance</li>
</ol>
<h3>Patient Education</h3>
<ol>
<li style="font-weight: 400;">Report s/s volume overload (shortness of breath, cough, crackles, edema, increasing blood pressures)</li>
</ol>

In which situation would a nurse most likely use a pressure sleeve when administering IV fluids?

A nurse notes that a client’s receiving IV fluids with Ringer’s lactate and the the order is for D5W. What is the nurse&#8217;s priority action?

 The nurse is caring for a client who requires fluids for hydration. The client needs an isotonic solution to which potassium can be added. Which of the following solutions would the nurse expect to give?

A client is receiving an IV infusion of lactated Ringer’s solution during surgery. Which best describes a potential complication of using this type of fluid?

A nurse is caring for a client with IV fluids running into a peripheral IV. Which of the following would indicate the client is experiencing IV fluid-induced hypervolemia? Select all that apply.

A client has been brought in to the emergency department where the provider orders a bolus of colloid solution. Which of the following types of solutions are considered to be colloids? Select all that apply.

A 56-year-old client has been hospitalized for acute renal failure. During a shift, the nurse notes that the client&rsquo;s urine output has dropped to 5 mL/hour, despite a continuous infusion of IV fluids at a rate of 150 mL/hr. If left uncorrected, which complication would the nurse most likely expect to see?

A client is brought into the emergency department with severe injuries. The physician orders lactated Ringer’s solution to be given for fluid volume replacement. Which explanations best describe why crystalloid solutions would be used before colloid solutions in an emergent situation? Select all that apply.

The nurse is caring for a client receiving rapid fluid resuscitation. Which of the following are important for the nurse to monitor? Select all that apply.

A recovery room nurse is caring for a client who is recovering from anesthesia after colon surgery. The nurse is providing IV fluids of Normal Saline at a rate of 150 mL/hr to the client. In order to avoid complications associated with fluid overload, which intervention would the nurse most likely perform?

IV Solutions

<span data-sheets-value="{&quot;1&quot;:2,&quot;2&quot;:&quot;The tonicity of fluids compared to blood plasma will determine the impact it may have on blood cells. Hypotonic solutions will cause cells to swell, while Hypertonic solutions will cause them to shrink.&quot;}" data-sheets-userformat="{&quot;2&quot;:33555201,&quot;3&quot;:[null,0],&quot;11&quot;:4,&quot;12&quot;:0,&quot;28&quot;:1}">The tonicity of fluids compared to blood plasma will determine the impact it may have on blood cells. Hypotonic solutions will cause cells to swell, while Hypertonic solutions will cause them to shrink.

Tonicity of Fluids

<span data-sheets-value="{&quot;1&quot;:2,&quot;2&quot;:&quot;Isotonic solutions have similar osmolarity to blood plasma, therefore they will not cause any fluid to shift in or out of the cells&quot;}" data-sheets-userformat="{&quot;2&quot;:33555201,&quot;3&quot;:[null,0],&quot;11&quot;:4,&quot;12&quot;:0,&quot;28&quot;:1}">Isotonic solutions have similar osmolarity to blood plasma, therefore they will not cause any fluid to shift in or out of the cells

Isotonic Solutions

In this lesson, we’re going to talk about isotonic solutions. What are they, how do they affect the body, and why do we use them?

Before we start, let’s quickly review what we mean when we talk about tonicity. Tonicity compares the osmolarity of two solutions. In these cases, we’re comparing an IV fluid to blood plasma. If we have a solution that is less concentrated than blood plasma, or has a lower osmolarity, it’s considered hypotonic. If the solution has a similar concentration, or osmolarity, we call it an isotonic solution - iso meaning ‘same’. If the solution has a higher concentration or osmolarity, we call it a hypertonic solution.

So, when we’re looking at a isotonic solution - that means it has an osmolarity that is similar to the blood plasma, typically between 250 and 375 mOsm/L. Remember blood is between 275-295 mOsm/L.

Some examples are normal saline - which is 0.9% sodium chloride. It has an osmolarity of 308 mOsm/L. The other common fluid we see is Lactated Ringers or LR. This fluid is a mixture of sodium chloride, sodium lactate, potassium chloride, and calcium chloride in water. So it has more than just sodium in it, really important to know that. Also - another fact that is good to know - sodium lactate will actually convert bicarb in the body - so we’ll see this used specifically to treat metabolic acidosis because the bicarb can help buffer the acids. We also classify D5W, or 5% dextrose in water, to be isotonic in the bag because it has an osmolarity of 252 mOsm/L (so it’s over 250). The big distinction here, though, is that once it enters the bloodstream, this dextrose - which is just sugar - is actually used up as energy by the body. So it leaves us with something a lot closer to just water. So in the BAG it’s isotonic - but in the body it acts as a hypotonic solution. And finally any colloids are considered isotonic - those are blood products, so that’s red blood cells, fresh frozen plasma, albumin, etc., as well as Hetastarch.

As we already mentioned, the osmolarity of an isotonic solution is between 250 and 375 mOsm/L. So the solution we’re introducing to the bloodstream has the same (or similar) concentration to the blood plasma itself. So what we see is that there is actually NO net shift in fluids. That means it really doesn’t affect the cells because the concentrations will balance out easily. The benefit of this is that it means we can effectively increase the extracellular fluid volume - specifically we can increase the volume inside the blood vessels - or the intravascular volume.

And we’re going to see that that is one of our biggest benefits - increasing intravascular volume. So we’d give these fluids if a patient has experienced blood loss - maybe because of a trauma or a surgery - or is experiencing dehydration - or really any other extracellular fluid loss like excessive vomiting or diarrhea. We can also use these during fluid resuscitation - again remember they help increase our blood volume so they’re perfect for that. We can even put these in a pressure bag and give them rapidly if necessary. We can also just use these for general hydration or maintenance fluids, especially if someone is NPO and can’t take oral fluids. A couple cautions to know - if you’re administering blood products, you can ONLY use normal saline. Even though the other solutions are considered isotonic, they can still cause issues in the IV tubing with red blood cells - so we ONLY use 0.9% sodium chloride - or normal saline. Another thing to consider is patients with heart failure or kidney failure because they are at high risk for volume overload if we give them too much too fast. And again, we know that LR can convert to bicarb in the blood, so we wouldn’t want to give it to a patient who has metabolic alkalosis, because they already have too much bicarb. Check out the lessons on metabolic acidosis and metabolic alkalosis to understand that a little better.

Okay let’s recap - remember that a isotonic solution has about the same solute amount as blood plasma - so it’s actually not going to cause any fluid shifts in or out of the vessels or the cells. Examples are 0.9% sodium chloride, or normal saline, Lactated Ringers or LR, D5W in the bag, and colloids. Remember also that 5% dextrose will actually be hypotonic in the body because the dextrose gets used up and what’s left is just sterile water. The main reason we use isotonic solutions is to increase intravascular volume when someone has lost a bunch of blood or fluids or even when they just need good maintenance hydration. We are cautious in heart failure because of volume overload - so we don’t give too much too fast, and we know that NS is the only solution that should EVER be given with blood products.

So that’s it for isotonic solutions - make sure you have also checked out the hypotonic and hypertonic solutions lessons, as well as all the resources attached to this lesson. Now, go out and be your best selves today. And, as always, happy nursing!!

01.04 Isotonic Solutions (IV solutions)

Included In This Lesson

Study Tools

Outline

Overview

Nursing Points

General

Assessment

Therapeutic Management

Nursing Concepts

Patient Education

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Fluid & Electrolytes

0 – Fluid & Electrolytes Course Introduction

1 – Fluid Balance

2 – Electrolytes

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