FLUIDS
Isotonic Fluids
Indication Fluid solution that is the same tonicity of
plasma. Usually .9% Normal Saline. Given in
states of dehydration.
Mechanism of Action Keeps fluid in plasma space to provide
increase in fluid volume rather quickly. Used
in dehydration or fluid replacement.
Adverse Effects Looking for fluid volume overload. Not too
many adverse effects, but can be dangerous
if not eliminated.
Evaluation Monitor for the adverse effects - S/Sx for fluid
volume overload. Monitor the patient’s I/Os
Client Education Education is going to be on the S/Sx of fluid
volume overload and the indication for the
treatment
Hypotonic Fluid
Indication Less tonicity than that of plasma, Fluid will
move out of vessel and into interstitial fluid.
Less solute, less water. Given in states of
cellular dehydration. Diabetic Ketoacidosis,
hypernatremia.
Mechanism of Action Will push water out of the vessel. Cells will
receive water and rehydrate. Can be used in
times of dehydration at level outside of
vascular space.
Adverse Effects Fluid volume deficit possible. Mass decrease
in blood pressure, high heart rate and
possible edema. Cardiac output may drop.
Looking for mass inflammation and possible
shock if given in a state of mass
inflammation.
Evaluation Monitor for the adverse effects - S/Sx of fluid
volume deficit. Monitor for edema. Monitor
the patient’s I/Os.
Client Education S/Sx of the adverse effects.
,Hypertonic Fluid
Indication Larger tonicity than that of plasma, Fluid will
move into the vessel. More solute, more
water. Given in states of too much Interstitial
pressure. Especially the brain. Could also be
used in cases of hyponatremia.
Mechanism of Action Used in brain swelling to suck water into
vascular space. High ICP will allow this to be
administered. Drug will pull water into
vascular space.
Adverse Effects Will raise blood pressure, must have a good
heart and kidneys. Could lead to mass fluid
volume overload. Need to watch patient’s
blood pressure.
Evaluation Monitor for the adverse effects - S/Sx for fluid
volume overload. Monitor the patient’s I/Os.
Client Education S/Sx of the adverse effects.
Colloids(Albumin)
Indication Given as a supplement of lack of albumin.
Will increase oncotic pressure in blood
vessels. Used in states of high ICP and
possible liver failure patients.
Mechanism of Action Will contribute Albumin to vascular space,
pulling in fluid and increasing vascular
volume. Pulls fluid into the vascular space.
Adverse Effects Could lead to high blood pressure. Patients
could experience shock secondary to heart
failure or high BP.
Evaluation Monitor for the adverse effects - increased
intravascular volume and increased BP.
Monitor the patient’s I/Os.
Client Education S/Sx of the adverse effects.
, DIURETICS
Hydrochlorothiazide
Indication Treatment for HTN and peripheral edema.
Will work best with adequate functioning
kidneys. More of a chronic drug.
Mechanism of Action Will chronically speed up the filtration process
for kidneys. Mostly used for HTN but can be
used for longer term filtration of excess water
in the water.
Adverse Effects Can be harmful in diabetes Mellitus, can also
cause various electrolyte imbalances.
Looking for hypo- various electrolytes.
Evaluation The nurse will give this in terms that are the
result of possible fluid volume excess.
Looking for imbalances of electrolytes and
urine output to increase. Monitor BP
Client Education S/Sx for hypo- electrolyte. Looking for diet
fixes for loss of various electrolytes. Veggies,
bananas, avocado. Teach on results of drug
on HTN, Orthostatic hypotension.
Furosemide
Indication More of a rapid acting diuretic. Mostly used in
heart failure patients. Used in terms where
fluid needs to fall quickly.
Mechanism of Action Inhibits reabsorption of sodium. Mainly for
rapid loss of fluids. Potent in terms of loss of
water.
Adverse Effects Need to look for Hypokalemia in particular.
Fast loss of electrolyte can cause imbalance
rather quickly.
Evaluation Need to monitor BP, electrolytes, and
dehydration for rapid loss of fluids.
Client Education Clients need to be educated on the effects of
rapid onset and mass amounts of urine to be
excreted. BP and dehydration S/sx
Isotonic Fluids
Indication Fluid solution that is the same tonicity of
plasma. Usually .9% Normal Saline. Given in
states of dehydration.
Mechanism of Action Keeps fluid in plasma space to provide
increase in fluid volume rather quickly. Used
in dehydration or fluid replacement.
Adverse Effects Looking for fluid volume overload. Not too
many adverse effects, but can be dangerous
if not eliminated.
Evaluation Monitor for the adverse effects - S/Sx for fluid
volume overload. Monitor the patient’s I/Os
Client Education Education is going to be on the S/Sx of fluid
volume overload and the indication for the
treatment
Hypotonic Fluid
Indication Less tonicity than that of plasma, Fluid will
move out of vessel and into interstitial fluid.
Less solute, less water. Given in states of
cellular dehydration. Diabetic Ketoacidosis,
hypernatremia.
Mechanism of Action Will push water out of the vessel. Cells will
receive water and rehydrate. Can be used in
times of dehydration at level outside of
vascular space.
Adverse Effects Fluid volume deficit possible. Mass decrease
in blood pressure, high heart rate and
possible edema. Cardiac output may drop.
Looking for mass inflammation and possible
shock if given in a state of mass
inflammation.
Evaluation Monitor for the adverse effects - S/Sx of fluid
volume deficit. Monitor for edema. Monitor
the patient’s I/Os.
Client Education S/Sx of the adverse effects.
,Hypertonic Fluid
Indication Larger tonicity than that of plasma, Fluid will
move into the vessel. More solute, more
water. Given in states of too much Interstitial
pressure. Especially the brain. Could also be
used in cases of hyponatremia.
Mechanism of Action Used in brain swelling to suck water into
vascular space. High ICP will allow this to be
administered. Drug will pull water into
vascular space.
Adverse Effects Will raise blood pressure, must have a good
heart and kidneys. Could lead to mass fluid
volume overload. Need to watch patient’s
blood pressure.
Evaluation Monitor for the adverse effects - S/Sx for fluid
volume overload. Monitor the patient’s I/Os.
Client Education S/Sx of the adverse effects.
Colloids(Albumin)
Indication Given as a supplement of lack of albumin.
Will increase oncotic pressure in blood
vessels. Used in states of high ICP and
possible liver failure patients.
Mechanism of Action Will contribute Albumin to vascular space,
pulling in fluid and increasing vascular
volume. Pulls fluid into the vascular space.
Adverse Effects Could lead to high blood pressure. Patients
could experience shock secondary to heart
failure or high BP.
Evaluation Monitor for the adverse effects - increased
intravascular volume and increased BP.
Monitor the patient’s I/Os.
Client Education S/Sx of the adverse effects.
, DIURETICS
Hydrochlorothiazide
Indication Treatment for HTN and peripheral edema.
Will work best with adequate functioning
kidneys. More of a chronic drug.
Mechanism of Action Will chronically speed up the filtration process
for kidneys. Mostly used for HTN but can be
used for longer term filtration of excess water
in the water.
Adverse Effects Can be harmful in diabetes Mellitus, can also
cause various electrolyte imbalances.
Looking for hypo- various electrolytes.
Evaluation The nurse will give this in terms that are the
result of possible fluid volume excess.
Looking for imbalances of electrolytes and
urine output to increase. Monitor BP
Client Education S/Sx for hypo- electrolyte. Looking for diet
fixes for loss of various electrolytes. Veggies,
bananas, avocado. Teach on results of drug
on HTN, Orthostatic hypotension.
Furosemide
Indication More of a rapid acting diuretic. Mostly used in
heart failure patients. Used in terms where
fluid needs to fall quickly.
Mechanism of Action Inhibits reabsorption of sodium. Mainly for
rapid loss of fluids. Potent in terms of loss of
water.
Adverse Effects Need to look for Hypokalemia in particular.
Fast loss of electrolyte can cause imbalance
rather quickly.
Evaluation Need to monitor BP, electrolytes, and
dehydration for rapid loss of fluids.
Client Education Clients need to be educated on the effects of
rapid onset and mass amounts of urine to be
excreted. BP and dehydration S/sx
