BALUNAN, MIKAELLA C.

NCM 106 RLE BSN 4Y1-1

Types of IV Fluid Purpose/Function Classification Contraindication Nursing Implication Nursing Responsibility

0.9 NaCl (Normal Saline) The cell has the same ISOTONIC SOLUTIONS D5W is isotonic on initial Isotonic solutions such as NS and  Document baseline data. Before infusion,
Lactated Ringer’s concentration on the inside and administration but provides free Lactated Ringer’s initially remain in the assess the patient’s vital signs, edema
5% Dextrose in Water (D5W) outside which in normal conditions water when dextrose is vascular compartment, expanding status, lung sounds, and heart sounds.
5% Dextrose in 0.225% saline the cell’s intracellular and metabolized, expanding vascular volume. Assess carefully for Continue monitoring during and after the
(D5W1/4NS) extracellular are both isotonic. intracellular and extracellular signs of hypervolemia such as bounding infusion. 
Isotonic solutions are used to fluid volumes. D5W is avoided in pulse and shortness of breath.  Observe for signs of fluid overload. Look
increase the clients at risk for Intracranial for signs of hypervolemia such
extracellular fluid volume due to Pressure (ICP) because it can as hypertension, bounding pulse,
blood loss, surgery, increase cerebral edema. pulmonary crackles, dyspnea, shortness
dehydration, fluid loss that has been of breath, peripheral edema, jugular
loss extracellularly. venous distention, and extra heart
sounds. 
 Monitor manifestations of continued
hypovolemia. Look for signs that indicate
continued hypovolemia such as,
decreased urine output, poor skin turgor,
tachycardia, weak pulse,
and hypotension.
 Prevent hypervolemia. Patients being
treated for hypovolemia can quickly
develop fluid overload following rapid or
over infusion of isotonic IV fluids. 
 Elevate the head of the bed at 35 to 45
degrees. Unless contraindicated, position
the client in semi-Fowler’s position. 
 Elevate the patient’s legs. If edema is
present, elevate the legs of the patient
to promote venous return.
 Educate patients and families. Teach
patients and families to recognize signs
and symptoms of fluid volume overload.
Instruct patients to notify their nurse if
they have trouble breathing or notice
any swelling. 
 BALUNAN, MIKAELLA C.
NCM 106 RLE BSN 4Y1-1

 Close monitoring for patients with heart

failure. Because isotonic fluids expand
the intravascular space, patients
with hypertension and heart failure
should be carefully monitored for signs
of fluid overload. 
+0.45% NaCl (half normal The cell has a low amount of HYPOTONIC SOLUTIONS Do not administer to clients at Hypotonic solutions are used to provide  Document baseline data. Before infusion,
saline) solute extracellularly and it wants to risk for ICP or third space fluid free water and treat cellular assess the patient’s vital signs, edema
0.33% NaCl (one-third normal shift inside the cell to get everything shift. dehydration. These solutions promote status, lung sounds, and heart sounds.
saline) back to normal via osmosis. This will waste elimination by the kidneys. Continue monitoring during and after the
0.225% Saline (1/4 NS) cause CELL SWELLING which can infusion. 
cause the cell to burst or lyses.  Do not administer in contraindicated
Hypotonic solutions are used conditions. Hypotonic solutions may
when the cell is dehydrated and exacerbate existing hypovolemia
fluids need to be put back and hypotension causing cardiovascular
intracellularly. This happens when collapse. Avoid use in patients with liver
patients develop diabetic disease, trauma, or burns. 
ketoacidosis (DKA) or hyperosmolar  Risk for increased intracranial pressure
hyperglycemia. (IICP). Should not be given to patients
with risk for IICP as the fluid shift may
cause cerebral edema (remember:
hypotonic solutions make cells swell). 
 Monitor for manifestations of fluid
volume deficit. Signs and symptoms
include confusion in older adults. Instruct
patients to inform the nurse if they feel
dizzy. 
 Warning on excessive infusion. Excessive
infusion of hypotonic IV fluids can lead to
intravascular fluid depletion,
decreased blood pressure, cellular
edema, and cell damage. 
 Do not administer along with blood
products. Most hypotonic solutions can
cause hemolysis of red blood cells
 BALUNAN, MIKAELLA C.
NCM 106 RLE BSN 4Y1-1

especially during rapid infusion of the

solution

5% Dextrose in Normal Saline The cell has an excessive amount HYPERTONIC SOLUTIONS Do not administer to clients with Hypertonic solutions draw fluid out of  Document baseline data. Before infusion,
(D5NS) of solute extracellularly and osmosis kidney or heart disease or clients the intracellular and interstitial assess the patient’s vital signs, edema
3% Dextrose in Normal Saline is causing water to rush out of the who are dehydrated. Watch for compartments into the vascular status, lung sounds, and heart sounds.
(D3NS) cell intracellularly to the extracellular signs of hypervolemia. compartment, expanding vascular Continue monitoring during and after the
5% Dextrose in 0.45% NaCl area which will cause the CELL TO volume. infusion. 
(D5 ½ NS) SHRINK.  Watch for signs of hypervolemia. Since
5% Dextrose in Lactated When hypertonic solutions are hypertonic solutions move fluid from the
Ringers used very cautiously most likely to be ICF to the ECF, they increase the
10% Dextrose in Water given in the ICU due to quickly arising extracellular fluid volume and increases
(D10W) side effects of pulmonary the risk for hypervolemia. Look for signs
edema/fluid over load. In addition, it of swelling in arms, legs, face, shortness
is preferred to give hypertonic of breath, high blood pressure, and
solutions via a central line due to the discomfort in the body (e.g., headache,
hypertonic solution being vesicant on cramping). 
the veins and the risk of infiltration.  Monitor and observe the patient during
administration. Hypertonic solutions
should be administered only in high
acuity areas with constant nursing
surveillance for potential complications. 
 Verify order. Prescription for hypertonic
solutions should state the specific
hypertonic fluid to be infused, the total
volume to be infused, the infusion rate
and the length of time to continue the
infusion. 
 Assess health history. Patients
with kidney or heart disease and those
who are dehydrated should not receive
hypertonic IV fluids. These solutions can
affect renal filtration mechanisms and
can easily cause hypervolemia to
patients with renal or heart problems. 
BALUNAN, MIKAELLA C.
NCM 106 RLE BSN 4Y1-1

 Prevent fluid overload. Ensure that

administration of hypertonic fluids does
not precipitate fluid volume excess or
overload. 
 Do not administer
peripherally. Hypertonic solutions can
cause irritation and damage to the blood
vessel and should be administered
through a central vascular access device
inserted into a central vein. 
 Monitor blood glucose closely. Rapid
infusion of hypertonic dextrose solutions
can cause hyperglycemia. Use with
caution for patients with diabetes
mellitus. 

Date Completed: September 16, 2020

Date Submitted: 01:10 am