The nurse is caring for 4 clients requiring IV fluid therapy. For which client should the nurse anticipate the need for isotonic crystalloid administration?

Question

The nurse is caring for 4 clients requiring IV fluid therapy.  For which client should the nurse anticipate the need for isotonic crystalloid administration?

Quizplus · Accepted Answer

Acute gastroenteritis is associated with nausea, vomiting, and diarrhea, placing the client at risk for dehydration and sodium loss. Clients with gastroenteritis are encouraged to increase fluid intake but may require IV fluid therapy. Isotonic crystalloid fluids (eg, 0.9% sodium chloride, lactated Ringer solution) are the treatment of choice due to the similarity in concentration with plasma and ability to increase extracellular fluid (ECF) without moving into the intracellular space. In addition, isotonic fluids may increase sodium levels in clients experiencing excess sodium loss (eg, vomiting, diarrhea) (Option B). (Option A) Hypertonic solutions (eg, 3% sodium chloride) are administered to clients with increased intracranial pressure (ICP) to raise the osmolality of ECF, which decreases cellular swelling by drawing water from the cells. Isotonic fluids are avoided because an increase in circulating isotonic fluid promotes additional fluid shifting into the cells, which further increases ICP. (Option C) The client with a serum sodium of 112 mEq/L (112 mmol/L) is dangerously hyponatremic and at risk for further neurological decline. A hypertonic solution (eg, 3% sodium chloride) is the most appropriate choice to rapidly correct sodium deficits. (Option D) Isotonic solutions can exacerbate fluid overload in clients with chronic renal failure and cause increased blood pressure. Educational objective: Isotonic fluid therapy is used to treat clients with extracellular fluid deficits (eg, dehydration). Clients at risk for cerebral swelling (eg, increased intracranial pressure, hyponatremia) require hypertonic fluid administration to decrease cellular swelling. Isotonic fluid administration may cause fluid overload in clients with renal failure.

The Nurse Is Caring for 4 Clients Requiring IV Fluid