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Pharmacology · chapter 5 · Fluids and Electrolytes, Vitamins, Minerals, and Alternative Therapies

Intravenous Fluid Therapy, Total Parenteral Nutrition, and Blood Products

The 14 things this section of the textbook says that you are most likely to be asked about — quoted word for word, not retold. Then 6 practice questions with the reasoning.

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Key points

  1. What IV fluid therapy treats

    IV fluid therapy is used for a wide variety of medical conditions including hypovolemia, electrolyte imbalances, and shock. It is commonly used during and after surgical procedures to help maintain fluid balance and prevent complications.

  2. Crystalloids cross capillary walls

    Crystalloid Solutions Crystalloid solutions are a type of IV fluid therapy that consists of electrolytes and fluids that can readily cross the capillary walls.

  3. Isotonic solutions and their use

    Because of their osmotic equilibrium, water does not enter or leave the cells. Isotonic solutions are typically used to treat conditions such as dehydration caused by vomiting, diarrhea, or excessive sweating or other conditions that cause fluid volume deficit (Epstein Waseem, 2022).

  4. Hypotonic solutions move water into cells

    This means they exert less osmotic pressure than ECF, which allows water to move into the cell or ICF compartment. Hypotonic solutions are often used to treat intracellular fluid volume deficit conditions, such as diabetic ketoacidosis or hyperosmolar hyperglycemic state (Epstein Waseem, 2022).

  5. Hypertonic solutions shrink cells

    This results in a higher solute concentration than the serum, thus pulling water from the interstitial space into the ECF and causing cell shrinkage. They are used to treat conditions such as severe hyponatremia (low sodium levels), cerebral edema (swelling of the brain), or increased intracranial pressure (ICP) (Epstein Waseem, 2022).

  6. Colloids stay in the vessels

    Due to their large size, colloid solutions cannot cross the semipermeable membrane of capillary walls and remain confined to the intravascular compartment. These solutions increase the colloidal oncotic pressure, which draws fluid from the interstitial space into plasma, resulting in an increase in blood volume.

  7. Hydroxyethyl starch risk

    Use of hydroxyethyl starch (HES) products increases the risk of mortality, kidney injury, and coagulopathy. Do not use HES products (such as hetastarch) unless an adequate alternative treatment is unavailable.

  8. Who needs TPN

    TPN is used for clients who are unable to receive adequate nutrition through their digestive system due to illness, injury, or surgery.

  9. TPN never through a peripheral line

    Safety Alert TPN and Peripherally Inserted Venous Catheters Due to its high osmolality, TPN should not be administered through a peripheral venous catheter because it can cause vein irritation, damage, or thrombus formation (American Society for Parenteral and Enteral Nutrition, n.d.)

  10. What PRBCs treat

    PRBCs are used to treat conditions such as anemia, blood loss, or other conditions that require a boost in red blood cells.

  11. What cryo contains

    Cryo contains factors such as fibrinogen, von Willebrand factor, and Factor VIII, which are essential for blood clotting (American Red Cross, n.d.; Sachais Senaldi, 2019).

  12. IV catheter size for transfusion

    An adult client will need a 16–18 gauge IV catheter for rapid transfusions and a 20–22 gauge IV catheter for routine transfusions. A pediatric client will need a 22–25 gauge IV catheter for transfusions.

  13. Monitoring during transfusion

    During the transfusion, the client’s vital signs should be monitored regularly and per the facility’s protocol. The client should be observed closely for any signs of a transfusion reaction, which can range from mild to severe.

  14. Premedication to reduce reactions

    Health care providers can take steps to minimize the risk of transfusion reactions, including premedicating with acetaminophen and diphenhydramine.

Terms to know

Colloid solutions
Colloid Solutions Colloid solutions, also known as volume expanders, differ from crystalloid solutions in that they contain large molecular structures, such as proteins, carbohydrates, and lipids, that increase their osmolality without dissolving in the solution.
Total parenteral nutrition (TPN)
Total Parenteral Nutrition Total parenteral nutrition (TPN), also known as intravenous nutrition, is a medical treatment that involves administering a specialized nutritional formula directly into a person’s bloodstream through a central venous catheter.
Blood fractionation
Blood products are components of blood that have been separated from whole blood through a process called blood fractionation.
Packed red blood cells (PRBCs)
Packed Red Blood Cells (PRBCs) Packed red blood cells (PRBCs) are a blood product that contains concentrated red blood cells.
Thrombocytopenia
Platelets can be separated from donated blood and are used to treat conditions such as thrombocytopenia, which is a low platelet count (American Red Cross, n.d.)

Practice questions

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Every question here, with the answer

  1. A client with increased intracranial pressure and severe hyponatremia is ordered an IV solution to pull water out of the brain tissue. Which type of solution does the nurse expect?

    1. 5% dextrose in water
    2. Hypotonic, such as 0.45% normal saline
    3. Hypertonic, such as 3% normal saline
    4. Isotonic, such as lactated Ringer's

    Answer: Hypertonic, such as 3% normal saline

    Hypertonic solutions pull water from the interstitial space into the ECF and are used for severe hyponatremia, cerebral edema and increased ICP. Hypotonic and isotonic solutions are not to be given to clients with increased intracranial pressure.

  2. A nurse is preparing to start TPN for a client with short bowel syndrome. The only access the client has is a peripheral IV in the forearm. What should the nurse do?

    1. Dilute the TPN with normal saline and give it peripherally.
    2. Hold the TPN and obtain central venous access, because TPN is not given through a peripheral line.
    3. Give only the lipids peripherally and hold the rest.
    4. Start the TPN through the peripheral IV at a slow rate.

    Answer: Hold the TPN and obtain central venous access, because TPN is not given through a peripheral line.

    Because of its high osmolality, TPN is not given through a peripheral venous catheter; it can cause vein irritation, damage or thrombus. TPN is given through a central venous catheter, so slowing or diluting it peripherally is not the answer.

  3. A client is receiving TPN. Which adverse effects should the nurse monitor for? Select all that apply.

    1. Hyperglycemia
    2. Hypokalemia from the lipids
    3. Refeeding syndrome
    4. Catheter site infection
    5. Fluid volume overload

    Answer: Hyperglycemia, Refeeding syndrome, Catheter site infection, Fluid volume overload

    Listed adverse effects of TPN include catheter site infection, fluid volume overload, hyperglycemia, hypoglycemia if stopped suddenly, bleeding, refeeding syndrome and venous thrombosis. Hypokalemia from lipids is not listed in the section.

  4. Thirty minutes into a unit of packed red blood cells, a client develops a fever and chills. Which transfusion reaction is the most common and matches these findings?

    1. Febrile reaction
    2. Hemolytic reaction
    3. Anaphylaxis
    4. Transfusion-associated circulatory overload

    Answer: Febrile reaction

    Febrile reactions are the most common transfusion reaction and are characterized by fever and chills. Hemolytic reactions involve the immune system breaking down transfused cells, circulatory overload is fluid excess, and anaphylaxis is a severe allergic reaction.

  5. A nurse is preparing to give a routine unit of PRBCs to an adult client. Which actions are appropriate? Select all that apply.

    1. Plan to infuse the unit over 15 minutes.
    2. Observe closely for signs of a transfusion reaction.
    3. Confirm the blood has been typed and cross-matched.
    4. Use a 20–22 gauge IV catheter.
    5. Monitor vital signs regularly per facility protocol.

    Answer: Observe closely for signs of a transfusion reaction., Confirm the blood has been typed and cross-matched., Use a 20–22 gauge IV catheter., Monitor vital signs regularly per facility protocol.

    Blood is transfused after typing and cross-matching, routine adult transfusions use a 20–22 gauge catheter, and vital signs and signs of reaction are monitored throughout. A unit of PRBCs generally takes about 2–4 hours, not 15 minutes.

  6. A client who takes an ACE inhibitor is scheduled to receive albumin 25%. What should the nurse anticipate?

    1. Hold the ACE inhibitor for 24 hours before the albumin.
    2. Give the ACE inhibitor with the albumin.
    3. Double the ACE inhibitor dose after the albumin.
    4. No change is needed.

    Answer: Hold the ACE inhibitor for 24 hours before the albumin.

    ACE inhibitors are held 24 hours before albumin because of the risk of adverse reactions such as flushing and hypotension. Giving them together or increasing the dose ignores that risk.

Where every quote comes from

Section 5.3 Intravenous Fluid Therapy, Total Parenteral Nutrition, and Blood Products of Pharmacology for Nurses by Tina Barbour-Taylor, Leah Mueller (Sabato), Donna Paris, Dorie Weaver, OpenStax, 2024. Read the whole section free at openstax.org.

The textbook is licensed under CC BY-NC-SA 4.0. This page quotes it word for word and adds the headings, the order and the practice questions; references to the book's figures and stray spaces left by its formatting are removed. The page is shared under the same licence. Nothing here is sold.