IV Fluids: Isotonic Solutions

IV Fluids

• Isotonic fluids have similar dissolved contents compared to blood and remain in the intravascular space

Common Isotonic Fluids

• Normal saline (0.9% NaCl) is an isotonic fluid
• Lactated Ringer's (LR) is an isotonic fluid
• 5% dextrose in water (D5W) is an isotonic fluid that becomes hypotonic once dextrose is metabolized

Isotonic Fluid Indications

• Fluid resuscitation for dehydration, blood loss, or surgery using bolus or continuous administration
• Medication infusions and reconstituting medications
• 0.9% saline is the only fluid that can be administered with packed RBC in blood transfusion
• Do not use D5W for fluid resuscitation

Isotonic Fluid Nursing Considerations

• Monitor for hypervolemia (fluid overload)
• Consider age, cardiovascular and renal status
• Assess for signs and symptoms of fluid overload like shortness of breath (SOB), low oxygen saturation, and crackles in lungs
• Perform IV site assessment

Monitoring IV Sites

• Monitor for infiltration, indicated by redness, swelling, pain, a change in flow, and fluid leaking around the site
• Stop the infusion if infiltration occurs

Hypotonic Solutions

• Hypotonic solutions have a lower solute concentration than blood, causing osmotic movement of water from the intravascular to the intracellular space
• Common hypotonic solutions include 0.45% normal saline (0.45% NaCl) and D5W

Hypotonic Solution Indications

• Used for treating cellular dehydration and hypernatremia

Hypotonic Solution Nursing Considerations

• Monitor for cerebral edema, indicated by confusion, headache, and nausea
• Watch for hyponatremia and hypotension, especially if on antihypertensives
• Perform IV site assessment, monitoring for infiltration, and stopping the infusion if it occurs

Hypertonic Solutions

• Hypertonic solutions have a higher solute concentration than blood
• Causes osmotic movement of water from the intracellular space to the intravascular space (outside of cell)
• Examples include 3% sodium chloride (3% NaCl), 5% dextrose and 0.45% sodium chloride, and 5% dextrose and lactated ringer's (D5LR)

Hypertonic Solution Indications

• Used for severe hyponatremia and cerebral edema

Hypertonic Solution Nursing Considerations

• Monitor for hypervolemia/hypertension (fluid overload) and respiratory distress
• Monitor for hypernatremia
• Avoid use in patients with heart failure or renal failure
• Perform IV site assessment, monitoring for infiltration, and stopping the infusion if it occurs

Client Education for IV Fluids

• Explain the reason for the fluids and the type being used
• Educate on IV site care

Electrolytes

• Electrolyte balance maintains homeostasis
• Electrolyte imbalances can result from medications or health conditions
• The kidneys are the primary regulator of electrolytes
• Key electrolytes include sodium, chloride, potassium, phosphate, calcium, magnesium, and bicarbonate

Electrolytes Nursing Considerations

• Regularly check serum electrolyte levels
• Monitor fluid status in correlation with blood work
• Follow electrolyte replacement protocols
• Dilute potassium when administering IV
• Electrolyte orders come from an MD or NP
• Consider cardiovascular comorbidities, renal failure, and pediatric fluid status, when looking at electrolyte levels

Thiamine (Vitamin B1)

• Plays a primary role in energy metabolism, changing carbs into energy for the brain and nervous system

Thiamine Deficiency

• May result in anorexia, fatigue, and nervous irritability
• Common in those with alcohol abuse, as it impairs thiamine absorption in the intestine

Thiamine Nursing Considerations

• Patients with alcohol misuse could be prescribed thiamine
• Prescriptions can be PO (outpatient) or IV (inpatient)
• Education covers dietary sources such as whole grains, meats, and fish

Thiamine and Older Adults

• Older adults with less dietary intake may not be getting enough thiamine

Iron

• Required to build red blood cells
• Hemoglobin groups of red blood cells are responsible for carrying oxygen
• Iron deficiency results in anemia
• Can be administered PO or IV

Iron Nursing Considerations

• Ensure a patent IV site for infusion
• Observe for signs of anaphylaxis - respiratory distress, flushing, weak/rapid pulse

Iron Patient Education

• Take with meals
• Take with orange juice to help absorption
• Avoid contact with teeth (staining)
• May cause a metallic taste
• May cause stools to turn black

Total Parenteral Nutrition (TPN)

• TPN consists of amino acids, dextrose solutions, and a lipid emulsion solution

TPN Administration

• Provides proteins, fats, carbs, vitamins, and minerals via IV
• Ordered based on individual metabolic needs, history, and lab work

TPN Indications

• Administered when nutrients cannot be absorbed via the GI tract or when the GI tract is not functional
• Used for critically ill and NPO(nothing by mouth) patients and can be administered through a central or peripheral line

TPN Nursing Considerations

• Monitor weight, blood work, vital signs, and fluid overload
• Track blood glucose levels
• Assess the IV site
• Always infuse with a filter

TPN Health Teaching

• Educate about potential fever, chills, soreness, and malaise
• Educate about hyperglycemia and hypoglycemia
• Educate about IV site care

Musculoskeletal and Immune Therapies

• Bisphosphonates, such as alendronate (PO), risedronate (PO), and zoledronic acid (IV), inhibit bone reabsorption and osteoclast activity

Bisphosphonates Indications

• Used for osteoporosis in postmenopausal women and men
• Glucocorticoid-induced osteoporosis
• Malignancies with metastasis to the bone

Bisphosphonates Nursing Considerations

• Assess baseline and regular blood work for serum calcium and renal function
• Follow weekly or monthly dosing schedules
• Contraindicated in clients with hypocalcemia
• Watch for gastrointestinal side effects, common when discontinuing medication
• Monitor for rare but serious adverse effects like atypical femur fracture and osteonecrosis of the jaw

Bisphosphonates Client Education

• Gather a detailed dental history
• Instruct the patient to notify their doctor if they are doing any major invasive dental procedures
• Weight-bearing exercise helps strengthen bone
• Take medication 30 minutes before oral intake with ++ water
• Remain upright post intake
• May need supplemented calcium and vitamin D

Disease-Modifying Antirheumatic Drugs (DMARDs)

• Methotrexate, Sulfasalazine, and Hydroxychloroquine suppress the body's overactive immune and/or inflammatory system

DMARD Indications

• Used for clients living with rheumatoid arthritis
• Decreases pain and inflammation, Reduces/prevents joint damage and preserves joint structure/function

DMARD Nursing Considerations

• Methotrexate and sulfasalazine are immunosuppressants, increasing the risk of illness/infection
• Methotrexate is teratogenic – avoid pregnancy for 24 months after use
• Adverse effects include GI distress and hepatotoxicity

DMARD Health Teaching

• Improvements may take 4-6 weeks
• Limit alcohol intake
• Immunosuppressants requires education
• Practice hand hygiene
• Avoid sick people

Antigout Drugs

• Gout is a complex arthritis caused by uric acid buildup, commonly affecting the great toe
• Medications include allopurinol and colchicine

Antigout Drugs Mechanism

• Inhibit xanthine oxidase action, blocking uric acid production

Antigout Drugs Indications

• Treat gout, arthritis, and nephropathy and second hyperuricemia (increased levels of gout)

Antigout Drugs Nursing Considerations

• Regular blood work monitors serum uric acid levels
• Increase water intake to limit kidney stone formation
• Reduce dose for renal impairment
• Side effects involve hepatitis, renal failure, nausea, vomiting, and diarrhea

Antigout Drugs Client Teaching

• Limit alcohol intake
• Increase water intake
• Take medications after meals
• Monitor for allergic reactions

Module #10 - Substance Abuse, Cessations, and Withdrawal

• "No one size fits all" approach is used
• Re-using drugs and alcohol is common
• Returning to a healthier lifestyle is common

Substance Abuse Treatment Types

• Medications, psychosocial supports, withdrawal management, and peer support

Substance Abuse Treatment Settings

• Home, health care facility, youth shelter, and mental health services
• Access addiction medicine clinics quickly (RAAM)
• Consider live-in programs with 24-hour support

Substance Abuse Medications

• Nicotine receptor agonists, alcohol aversion agents, opioid antagonists, cannabinoid receptor agonists, and opioid agonists

Nicotine Receptor Agonists

• aid in smoking cessation and provide relief through nicotine withdrawal
• Nicotine binds to/activates nicotinic acetylcholine receptors
• Mimic effects of acetylcholine

Nicotine Receptor Agonists Adverse Effects

• Patch - rash
• Irregular heart rates/palpitations
• Nausea, vomiting, dizziness, weakness from Nicotine overdose

Nicotine Receptor Agonists Nursing Considerations

• Various routes of administration are available
• Not recommended for children or pregnant women
• Designated a Hazardous drug
• Discontinue if an allergic reaction, irregular heartbeat or palpitations, or symptoms of nicotine overdose occur
• Vivid dreams or sleep overdose may occur

Nicotine Receptor Agonists Client Education

• Stop smoking completely if using nicotine replacement therapy
• Encourage use a comprehensive smoking cessation program
• May cause skin sensitivity that should resolves within one hour
• Keep away from children and pets

Alcohol Aversion Agents

• Used for moderate to severe alcohol use disorder
• Reduces heavy drinking and increases days of abstinence

Alcohol Aversion Agents Mechanism

• Alters reinforcing effects of alcohol
• Involves neurotransmitter systems such as opioids, glutamate, gamma-aminobutyric acid, and serotonin

First-Line Alcohol Aversion Agents

• Naltrexone (IM/PO) preferred
• Acamprosate

Second-Line Alcohol Aversion Agents

• Disulfiram
• Topiramate (immediate release)
• Gabapentin

Alcohol Aversion Agents Nursing Considerations

• Naltrexone is the first choice due to dose scheduling
• Can remain drinking
• Contraindications for clients include usage of opioids, prescribed opioids and individuals with liver disease

Naltrexone Adverse Reactions

• IM - Injection site reaction
• Oral - nausea, headache, and dizziness

Acamprosate

• Alternative if contraindications occur with Naltrexone
• Contraindications involve severe renal function
• May result in Diarrhea, nervousness, and fatigue

Disulfiram

• Use if clients fails to respond to Naltrexone or Acamprosate
• 48 hours of no drinking is required
• Sweating, headache, low BP, nausea, and vomiting may occur
• If they drink while on this they may experience MI, chest pain, confusion, headaches, and vomiting
• Fatigue, drowsiness, headache and dermatitis are considered mild adverse reactions
• Psychosis and hepatitis are considered severe adverse reactions

Opioid Antagonists

• Include Naloxone and Naltrexone which provide Complete or partial reversal of opioid depression

Opioid Antagonists Mechanism

• Reverses analgesia and CNS and respiratory depression through opioid antagonism

Opioid Antagonist Side Effects

• Tremors, drowsiness, sweating, decreased respirations, hypertension nausea, and vomiting may occur
• Possible acute narcotic abstinence syndrome
• Pain (if opioid was used for pain previously)

Opioid Antagonists Nursing Considerations

• Safety and effectiveness has not been determined for children
• Contraindications for pregnant and lactating women
• Obtain baseline pain assessment and provide comfort measures

Opioid Antagonists Client Education

• Educate about the risks regarding opioid analgesic use
• Naloxone should take home kits are free

Cannabinoid Receptor Agonists

• Include Nabilone and Sativex

Nabilone

• Manages severe nausea and vomiting associated with cancer therapy

Cannabinoid Receptor Agonists Mechanism

• Interacts with and stimulate cannabinoid receptors

Cannabinoid Receptor Agonists Side Effects

• Drowsiness, psychological high, vertigo, dry mouth, depression, ataxia, blurred vision, anorexia, orthostatic hypotension, euphoria, and hallucinations may occur

Cannabinoid Receptor Agonists Nursing Considerations

• Contraindications for clients that are under 18, breastfeeding, pregnant, sensitivity to weed or other agents
• Do not drive
• Avoid alcohol and drugs

Sativex

• Relieves muscle stiffness in clients with multiple sclerosis

Sativex Side Effects

• Fatigue and dizziness may occur
• Can cause over-excitement, feeling a loss of touch with reality, memory issues, disoriented/confusion

Sativex Nursing Considerations

• Buccal spray and usage
• Spray varies to different areas of mouth
• Has many contraindications
• May affect birth control
• May cause changes in HR and BP
• Do not drive

Opioid Agonist Therapy

• Used for long acting medications that are administrated by healthcare providers
• Medical treatment for Opioid use disorders

Opioid Agonist Side Effects

• Acts slowly
• Reduces or stops opioid use and cravings
• Prevent severe withdrawal symptoms and limits opioid harms (death)

Opioid Agonist Examples

• Buprenorphine
• Methadone
• Slow-release oral morphine
• Injectable opioid agonist treatment

Opioid Agonist Therapy Nursing Considerations

• Requires time to get the right dose and schedule
• Except for Buprenorphine all others require supervision
• Length of time varies per person
• To d/c OAT dose is lowered very slowly

Module #11 Anti-Cancer: Cytotoxic and Hormonal Agents

• Chemotherapy inhibits cell proliferation and tumor multiplication
• Chemotherapy affects healthy cells and can administer orally or IV

Cytotoxic Agents

• Alkylating agents inhibit DNA replication and transcription
• Antimetabolites inhibit DNA replication
• Anti-tumour antibiotics inhibit RNA and DNA synthesis
• Cytotoxic agents are chosen based on type, stage, age, health, past treatments and patient preference

Cytotoxic Agent Nursing Considerations

• Rapidly dividing cells are more sensitive to cytotoxic agents and will increase side effects ( skin, GI tract, bone marrow, hair follicles)
• Assess Renal and liver function
• Pre-medicate with benadryl when doing infusions
• Multiple treatment options and drug interactions can occur, consult with healthcare teams

Cancer Patient Education

• Avoid pregnancy for 1 year minimum
• The drug is excreted in all body fluids for up to 48 hours

Cancer Treatment Side Effects

• Symptom management
• Infection and sepsis
• Fatigue

Hormone Therapy in Cancer Treatment

• Aromatase inhibitors, androgen deprivation therapy, and selective estrogen receptor modulators may be prescribed due to its drug therapy

Cancer Treatment Surgery

• Removes hormone-making organs, such as testicles through orchiectomy (prostate) or ovaries through oophorectomy (breast cancer)

Cancer Treatment Radiation Therapy

• Destroys/shrinks hormone-producing tissue to stop hormone production, targeting hormone-producing organs/glands External beam of radiation is used

Cancer Treatment Pharmacodynamics

• Slow growth of cancer and uses hormones to grow Three groups: blocking body to produce hormone, blocking hormone attaching to cells, interfering with hormones

Hormonal Therapy use

• To use hormones and targets that are prostate, breast and endometrial cancer
• Side effects are targeted and depends on what drug its target to
• Fatigue, hot flashes, weight gain, erectile vaginal dryness and bone loss and high risk for fractures are important to know

Cancer Treatment Health Teaching

• Interprofessional care team that are oncologist, surgeons, NP, RN and social workers is important and collaborates on patients wellbeing
• Side effects are different
• Side effect, education and lifestyle need to be accounted for the health team

Module 12 - Radiation Therapy and Medical Dressings

Radiation therapy

• Use Hormone therapy

External Radiation Therapy

• Shrinks tumors, chemo is combined and used after surgery plus high radiation is targeted toward affected area
• Damaged cells die and healthy cells can be healed

External Beam Radiation

• Machine is used and uses photon beams and has different forms

Therapy Internal and Side effects

• Implants are near cancer
• Treates cancer with radioactive implant that reduces time

Brachytherapy

• Ballon is used a mutli catheter to intake radiation
• Ballon is done in 5 days

Seeds Catheters and Systems

• deliver into catheter
• uses radioactive druge with physicians orderings only
• uses thyroid in order to target minimal radiation within the body
• radioimmunotherapy (2types) - targets cancer

Medical Aspects and Nursing Considerations

• has special proteins
• administered in med dept and used by technicians and physicians
• dirrahea side effects within pt
• clients need to drink clear liquids and hydrate
• check side effects

Medical Aspects pt 2

• Medical dressings includes silvers
• Bismuth is used for fresh skin and mafenide is used instead in the wound

Sexual Considerations

• Hormones is used more often in forms like injects and rings

Module13 - Sexual and Reproductive Health

• Oral combined rings are used for hormones
• Uses the egg to prevent fertilization and decrease the chance of stds

Teaching tools and medications

• educate clients on how to stay safe in pregnancy by using emergency pills
• hormones are used for long term pt
• hrt are used for post menapausal symt

Menapause Symptoms

• Hot lashes and sweats with vaignal irritations
• only works on pts in menstrual for over 2yrs

Contradiction

• VTE and should be monitored if risk is up

Prostatic Hyperplasia Symptoms pt1

Benign (non cancerous) condition of the prostate

Prostatic Hyperplasia Symptoms pt 2

Prostate Health

• blocks alpha receptors which blocks bladder
• BPN treatement and should discuss risk factors
• check vitals
• Erecitile Disfuntion
• use siddenfail and ask for support