IV Therapy and Parenteral Nutrition

IV Therapy and Parenteral Nutrition

• IV therapy is a medication prescribed by primary care providers (PCPs) based on patient presentation, vital signs, and lab results.
• Intravenous fluids (IVF) are important for accurate intake management.
• Do not disconnect IVF for routine care.
• Assess patient response and for complications, as with any medication.
• Prescribed IV fluids should be administered based on client condition.

Types of IVF

• Isotonic: Isotonic fluids have an osmolality similar to blood serum. Used to treat hypotension and hypovolemia. Common isotonic fluids are 0.9% sodium chloride (normal saline, NS) and Lactated Ringer's (LR). Monitor patients at risk for fluid overload.
• Hypotonic: Hypotonic fluids have an osmolality lower than blood serum and are used to treat cellular dehydration (e.g., hyperglycemic conditions). Common hypotonic fluids include 0.45% NaCl (1/2 normal saline, ½ NS), 0.33% NaCl (1/3 NS), and 0.2% NaCl (1/4 NS). Avoid for patients at high risk of increased intracranial pressure (ICP) as these can cause/exacerbate cerebral edema.
• Hypertonic: Hypertonic fluids have an osmolality higher than blood serum and are used to decrease edema, increase urinary output, and increase circulatory volume. Common hypertonic fluids include D5NS (5% dextrose and 0.9% sodium chloride), D5 0.45%NS (5% dextrose and 0.45% sodium chloride), 3% NaCl, 5% NaCl, and 10% dextrose in water (D10W).

Parenteral Nutrition (PN)

• PN is a method of feeding clients who cannot be nourished sufficiently through the GI tract.
• Conditions requiring PN include severe malnutrition, extensive burns, trauma, and cancer.
• GI issues requiring bowel rest also necessitate PN.
• Components of PN include water, glucose, amino acids, essential fatty acids, vitamins, minerals, trace elements, and lipid emulsion.
• PN is usually administered through an infusion pump.
• Common PN delivery methods include central venous access catheters, peripherally inserted central catheters (PICCs), and peripheral lines.
• Potential complications of PN include infection, septic shock, blood clots, liver dysfunction, gallbladder disease, and altered blood glucose.

PN Order & Components

• Nurses should check the PN formula, including amino acids, dextrose, lipids, vitamins, and minerals/trace elements, as per the doctor's order.
• Assess IV access, lab values, and daily caloric needs.

Additional Notes

• A question asks about clarifying an order for D5W with 20 mEq of KCl IV at 125 mL/hr. This order requires clarification
• Another asks about administering antibiotics (Cefoxitin) separately from an insulin infusion
• Yet another asks about a patient receiving high volumes of D25 that cause blood sugar drops after discontinuation.
• One question asks for decisions on PN delivery sites when both angiocatheter and a port-a-cath are available.

This quiz covers the essential principles of IV therapy and the administration of intravenous fluids. It includes information on isotonic and hypotonic fluids, their uses, and monitoring patient response to treatment. Test your knowledge on managing patient care with IV therapy.