Intravenous Fluids

Fluids & electrolytes are a dynamic process that is crucial for life. Disorders of fluids and electrolytes occurs in every setting, with every disorder and with a variety of changes that affect well people and those who are ill. Example...people engaging in strenious activity may result to an increase fluid and sodium loss.

If you are a nursing student, you need to understand the physiology of fluids & electrolyte balance as well as acid-base balances in order to anticipate, identify & respond to possible imbalance of each. For student nurses who will be exposed to clinical areas with patients attached to IV fluids, it is very important to know why such an IVF is indicated for a particular patient.

IVF or intravenous fluid therapy is a common practice today. It is an efficient and effective method of supplying fluids directly into the ECF compartment, specifically the venous
system.

Purposes of IV Fluids

1. to supply fluids when clients are unable to take in an adequate volume of fluids by mouth.

Example: patients who are vomiting, patients with altered level of consciousness, patients with disabilities or patients under certain conditions cannot take in fluids orally.

2. to provide salts needed to maintain electrolyte balance.

You have to understand that electrolytes in the body were placed in such a way that it should maintain cellular equilibrium to achieve normal body functioning. If there will be an imbalance to these electrolytes, it will result to a serious disorder or malfunctioning....that's why IVF may come in a form of prevention --- to prevent electrolyte imbalance to occur.

3. to provide glucose (dextrose), the main fuel for metablism.

Glucose is NOT an electrolyte. It is a form of sugar. When carbohydrate is metabolized, it turns into glucose which the cell absorbs for cellular energy production and consumption.

4. to provide water-solube vitamins and medications.

Patients who cannot take in medications or even vitamins orally, may still be given through intravenous route. Either incorporated in an intravenous fluid or as an IV bolus.

5. to promote a life line for rapidly needed medications.

In cases patients develop convulsions or life-threatening conditions, the intavenous line is a helpful medium to give medications for rapid effects.

Common Type of Intravenous Solutions

IV solutions may come in different forms:

1. Depending on its TONICITY (the ability of the solute to cause water movement from one compartment to another)

• Isotonic Solutions


• Hypotonic Solutions


• Hypertonc solutions

2. May also come in a form of:

• Nutrient solutions


• Electrolyte solutions


• Alkalyzing solution


• Acidifying solutins

Isotonic Solutions

-solutions that have a concentration of dissolved particles or tonicity equal to that of ICF. Osmotic pressure is equal both in ICF & ECF.
- there is no water displacement, thus, no effect on the cell.

Examples of IVfluids:

1. NSS (NOrmal Saline Solution/ 0.9% NaCl) - contains only electrolytes Na&Cl.


2. D5W (5% dextrose in water) - contains no electrolytes


3. Ringer's solution - &


4. Lactated Ringer's Solution - contains Na, K, Ca, Cl & Lactate
   

Purpose:

• used to maintain fluid intake and reestablish water volume because these fluids stays in the vascular compartment, therefore, it expands the vascular volume. Example...patients who are vomiting, patients with acute diarrhea and fever.


• take note: D5W is an isotonic fluid on initial administration, but when glucose is metabolized, it produces free water.This water may expand both the ICF & ECF fluid volume, thus, acts as a hypotonic solution.


• D5W when given in large amounts may cause hyperglycemia.

Hypotonic Solutions

Hypotonic solutions have lesser tonicity than that of the ICF because it has lesser solute concentration. ICF becomes more concentrated, it pulls water from the ECF, thus, makes the cell swell.
Examples of Hypotonic Fluids:

1. 0.45% NaCl (half strength normal saline)


2. 0.33% NaCl ( one third strength normal saline)


3. 2.5% Dextrose in water
   

Purpose:

• used to provide free water and treat cellular dehydration.


• Note: Free water is desirable to aid the kidneys in elimination of solute via urine output.

Hypertonic Solutions

Hypertonic solutions have tonicity or solute concentration in ECF greater than that of the ICF. Therefore, it pulls fluids out of the ICF...... and the cell shrinks.

Examples of Hypertonic Fluids:

1. D5NSS (5% Dextrose in normal saline solution)


2. D5 in 0.45% NaCl ( 5% Dextrose in half strength normal saline)


3. D5LR (5% Dextrose in Lactated Ringer's Solution)


4. D10W ( 10% Dextrose in water)


5. D50W50 (50% Dextrose in 50 ml of water)

Purpose:

Hypertonic solution draws fluids from the ICF causing cells to shrink and ECF to expand.

Given to patients with hyponatremias (Na deficits) with edema

Aside from being isotonic, hypotonic & hypertonic. IVF may also come in a form of nutrient solution, electrolyte solution, alkalyzing solution & acidifying solution....

Nutrient Solution

Nutrient solutions contain some form of carbohydrates and water. Water is supplied for fluid requirements and CHO for calories and energy requirement. Example... 1 liter of 5% Dextrose provides 170 of calories.

Common Nutrient Solutions are:

1. D5W (5% Dextrose in water)
2. 3.3% Glucose in 0.3% NaCl (Glucose in saline)
3. 5% Dextrose in 0.45% NaCl (Dextrose in half strength saline)

Purpose:

• Nutrient solutions are useful in preventing dehydration. However, it is a wrong notion to say that dextrose increases weight, or promotes normal growth in children or promotes wound healing or healing disorders. The calories it provide are not for such purposes but mainly for prevention of dehydration and ketosis.

Electrolyte Solutions

Electrolyte solutions are either NaCl (saline solutions) or multiple electrolyte solutions containing varying amounts of cations and anions.

Commonly Used Solutions are:

1. Normal Saline Solution (0.9% NaCl Solution) - contains electrolytes Na & Cl only
2. Ringer's Solution - contains Na, Cl, K, Ca
3. Lactated Ringer's Solution - contains Na, Cl, K, Ca & Lactate( a salt of lactic acid that is metabolized in the liver to form bicarbonate)

NOte: Normal saline solutions are frequently used as initial hydrating solutions. Multiple electrolyte solutions are useful to prevent dehydration or to restore or correct fluid and electrolyte imbalances.

Alkalyzing Solution

Alkalyzing solutions are administered to counteract or prevent Metabolic Acidosis. Example....Lactated Ringer's Solution

Acidifying Solution

Acidifying slutions are administerd to counteract or prevent Metabolic Alkalosis. Example... 0.9% NaCl &/or D5NSS.

Organizational Concept

Organizations are viewed as established social systems designed to carry out specific objectives. To accomplish the goals & objectives of the organization efficiently & effectively, human & material resources are essential.
An organization includes people working together for a common purpose while working in different areas.Relationships are emphasized in an organization.

Organizational Structure

The organizational structure provides the framework in whick management process is carried out in an organization. It is designed to show clear lines of authority, flow of communication, & relationships among the various departments, & to pinpoint person/s responsible & accountable.
There are 2 types of organizational structure:
1. Formal type : planned and made public
2. Informal type: unplanned & covert

Informal Structure

The Informal organizational structure consists of personal & social erlationships among the members of the organization.It is not reflected on the organizational chart. It is through the informal structure that people with little or no formal status or position may gain recognition. The informal structure also has its own channel of communication called the grapevine, where information is disseminated faster than in the formal system of communication. However, information transmitted through the grapevine may or may not be accurate.

Formal Structure

The formal structure describes the positions, the responsibilities of those occupying the positions, and the working relationships among the various units or departments.
There are two basic forms of formal organizational structure :
1. The Hierarchic or Bureaucratic model
2. Adaptive or Organic model

Hierarchic or Bureaucratic Model

This model is designed to facilitate large-scale administration by coordinating the work of many personnel. It is associated with subdivisions, specializations, technical qualifications, rules and standards, impersonality & technical efficiency.

Adaptive / Adhocracy or Organic Model

Tomey describes the adaptive or organic model as newer organizational framework that are more free form, open, flexible, and fluid than the older bureaucratic models.

Characteristics of an Organic model are:

1. Motivation is not derived from supervision but rather from the needs of the system, peer pressure & task-related factors;
2. Rewards and recognitions are based on the results of individual & group work rather than on subjective evaluations from supervisors or managers;
3. Management is participative;
4. since relationships are flexible, the organizational chart is likely to be used;
5. It is staffed by independent & self-reliant people; &
6. Job descriptions are less meaningful.

Adhocracy organizational models consist of several types of structures, as follows:

1. Free form
2. Collegial Management
3. Project Management
4. Task Forces
5. Matrix Organization

Free Form

Free form organizational structure stresses open communication, concensus, independent judgement & self-regulation.

Collegial Mangement

Collegial management enhances democratic management. It limits authocratic leadership and ensures that each functional area of the organization is represented. It maintains a division and balance of power among top management through collective responsibility.

Project Management

Project management is useful for long-range projects that need much planning, coordination and research. There are 2 types: (a.) General or Functional Management
(b.) Aggregate Management

General or Functional Management

- the most common type of project management. In this type of management, department heads manage activities of the functional groups. The functional group's activities are being coordinated by the general manager. In this type of management, there is no central authority and decisions are made not for the best interest of the project but to the advantage of the strongest functional group.

Aggregate Management

- the manager in this type of management is appointed, he has his own staff, and has full authority and control over the projects. The people directly involved in the project report directly to him.

Task Forces

Task forces are organized for special projects that are short-range. It is a temporary assignment of a group of people who have been selected because of their special qualifications and expertise. They are relieved of their usual tasks and duties to concentrate on the project which otherwise could not be accomplished while performing their usual work.

Matrix Organization

Matrix organizational design is a structure within a formal bureaucratic design. It allows the creation of groups within the organization itself. Although the groups may belong to various department or units, they have common goals and visions.

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