hi ninja nerds in this video we're going to be talking about iv fluids if you like this video
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videos that we put up on youtube let's get into it when we talk about iv fluids we're going to
specifically be talking about the crystalloids and we're going to be talking about why we
give our patients and how this works remember that when we give iv fluids we're specifically
giving it to our patient when they have trouble maybe taking it in orally any type of fluids
or they need some type of rapid infusion or if they need some type of electrolyte
imbalance or anything else that's going on that we want to rebalance for them
so when we're giving them fluids we need to talk about how does this happen how does the fluid
go into the body go into the cell and help our our patient out and when we give someone fluids we're
specifically going to be talking about the process of osmosis we're going to be giving them an iv
intravenously or through whatever other type of access point that they have and we're going to
give them fluids through that and when we do that we are going to be talking about how that fluid
goes into the vein into the body and then into our cell that process is called osmosis and we want to
understand that osmosis is the movement of water molecules through a semi-permeable membrane from
a low to high concentration and you're probably like whoa is a lot of information already too fast
let's slow it down think about it again osmosis is the movement of water right when we give our
patients crystalloids solutions they're mostly made of water and what we're looking at here
is that water movement through a semi-permeable membrane meaning some things will move through
and some won't and we're going from a low concentration to a high concentration okay so
i want you to keep that in mind low concentration to high concentration and you're probably like
this still doesn't make any sense to me i don't understand what hypotonic is what isotonic is what
hypertonic is and i'll understand what you mean by low concentration to high concentration so the way
i remember and the way it's easier for managing nerds is to look at the solution versus the cell
so for every single one of these we're going to write down solution versus the cell because that
allows me to remember okay if i'm going from a low to a high and i have this solution versus the
cell then i'm going to be able to figure out how this is moving and how this is affecting our cell
because remember when we talk about the movement of water our cell is always constant within our
body it's going to be our constant for us and we're going to look at the fluid
based upon that constant let's first talk about hypotonic hypotonic the word hypo meaning low
tonic meaning tonicity of the solution so we have a low concentration right so when we think
about this cell we're going to be thinking about our low versus cell right and when we look at
low versus cell right solution versus the cell our hypotonic is a low low versus our cell we
said that the low concentration goes to the high concentration so we have a low that's going to go
to the cell in this right here we already know what's going on we know hypotonic is a low
concentration and it's going to cause our cell to swell right and when it swells too far and bursts
we can have lysis and we don't want that to happen so what are some solutions that are
hypotonic we have three of them right here i want you to look at that we have a .45 saline
0.225 saline and a 0.33 saline these are all solutions that we can give but we don't
typically call them in the nursing setting we call them either half normal saline or
quarter normal saline or a third okay and that's ns and when we give our patient this
we're typically giving it to them for someone who has something like cellular dehydration they're
dehydrated and we want to make sure we're giving them their fluid back and as we give that fluid
back it's going to go into the cell so if you're looking at this diagram here we have all this
extracellular fluid and we have a lot of water right outside the cell and inside the cell we have
a lot of different solutes and what we're looking at here is to move this water into here because
what is this this water water likes to follow salt right and typically with our body we're looking
at lots of salt type of molecules so water is obsessed with salt and it says hey there's a lot
of salt inside that cell i'm going to go follow i'm going to go right in there and as that water
goes in it pushes the cell makes it swell and then we have a swollen cell something that is a little
more bigger than what it normally is because of that you know that hypotonic makes the cell swell
you're not going to want to give it to your patients with intracranial pressure
right that is increased that increased intracranial pressure they already have
some swelling they already have some pressure in that brain and if you're going to be swelling all
those cells you're going to create more pressure and that's not good let's move on to our isotonic
with our isotonic again we're going to go back to solution versus cell what does the word iso mean
iso means equal right so we have iso versus cell and we know that iso means equal so we have iso
is equal to cell so what does that mean does that mean there's going to be any movement
absolutely not so because we have the isotonic we have an equal concentration and we have no change
this is just going to be giving us then in our patients increased extracellular fluid so they're
going to have more fluid available but they're not going to be changing any type of shaping within
the cells so some of those fluids that we have available that we can give our patients is our
0.9 normal saline we can give them our lactated ringers commonly referred to as lr our 5 dextrose
in water also known as d5w and our five percent in 0.25 normal saline or are five percent in one
third normal saline i mean sorry one-fourth normal saline remember when we give these fluids and for
the nclex when we see a test and we're like hey a test question and we're like hey i want
to give this patient an isotonic or i want to am i going to give this patient this fluid because the
question's asking me these uh fluids right here are based upon what it is doing at the time of
it entering the body not 10 minutes after not when it's being metabolized just for the state of what
it is in the bag as it goes into the body so these are all considered isotonic or equal to our cell
so why are we giving these to our patients we're just going to be increasing their extracellular
fluid so what we want to do is to give it to our patients that have had some type of volume loss
they've either lost some blood they've dehydrated from vomiting diarrhea or they've had some type of
surgery and they're going to get volume loss and if you think about that in your nursing clinical
so you think about that when you're at the bedside typically when a patient's in pre-op they're going
to be getting some fluids typically a patient who has some blood loss they're going to be getting
normal saline maybe with something else going on like red blood cells last thing we're going to
talk about here is hypertonic now remember with hypertonic again we're going to go back solution
versus cell solution versus cell keep getting that in your head i think this works the best
so we know that hyper means like excess or a lot so we got hyper versus cell so what does that mean
hyper oops i can't spell hyper there we go so we got hyper versus cell so what's happening here
low to high right so hyper is bigger than the cell so we're going to go
out of the cell into this fluid so remember hypertonic is a high concentration
and our water that's in the cell is obsessed with all that salt that's outside the cell
so it's going to move out so as it moves out our cell starts to shrink what are some of our
hypertonic solutions or fluids that we can give we can give our three percent five percent saline
we have our ten percent dextrose in water our five percent dextrose and our 0.5 normal saline our
five percent dextrose and our 0.45 normal saline or percent or five decks in half normal saline
and then our five percent dex in lr all of these typically should be given with a central venous
catheter there are outstanding circumstances that maybe you want to get it in quicker and
that's not readily available but they can cause some issues with the patient
but when we give these fluids we are giving them because of somebody who maybe is hyponatremic
or they have some type of cerebral edema think about it think about what's going on we have
swelling of these cells right maybe the cells are too big and we want to bring them down to a back
to our normal state so what we're going to do is we're going to move that fluid out of the cell
okay back into our extracellular fluid so if you look at this picture here
we have a lot of water that was in the cell and it wants to move out a lot of water in that cell
a lot more of any all of our concentration outside of the cell in that hyper tonic solution so if you
see a lot of stuff outside the cell water is going to move out as it moves out it starts to shrink
all right so that is our hypo isotonic and hypertonic solutions remember ninja nerds
i want you to keep into your head solution versus selks i think that works the best
don't forget that water is always obsessed with salt so where there is more salt water is going to
follow and that's our process of osmosis i hope this made sense and as always until next time
you