The nurse will anticipate administration of isotonic IV fluids in which clients? Select all that apply.

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Isotonic IV fluids expand only the extracellular fluid and are used as fluid replacement for fluid volume deficit. Common examples are normal saline and lactated Ringer's. Capillary refill indicates adequate circulation and perfusion. Normal capillary refill time is less than 3 seconds, and a delay can be an indication of dehydration. Mottling is characterized by patches of pink, pale, and cyanotic skin and can be indicative of poor perfusion (Option B). Clients in labor usually receive 500-1000 mL of isotonic fluids prior to an epidural anesthesia as vasodilation below the epidural site can occur and result in hypotension. Up to 40% of these clients may experience hypotension after an epidural anesthesia. The preadministration of IV fluids can lessen hypotension (Option D). Hyperemesis gravidarum is severe vomiting that can result in dehydration. Despite being given some fluids, this client still needs additional fluids. Minimal obligatory urine output is 30 mL/hr or 120 mL/4 hr. Urine output is the best indicator of adequate rehydration. Tachycardia with pulse of 120/min indicates dehydration unless there is another clear etiology (Option E). (Option A) Urinary output of 2 mL/kg/hr and a flat fontanel are normal findings in an infant. (Option C) Normal serum sodium in children is 138-145 mEq/L (138-145 mmol/L). Hyponatremia often results from excess fluids. There would be no need to give this client additional fluids. Normal blood urea nitrogen (BUN) in children is 5-18 mg/dL (1.8-6.4 mmol/L), and BUN is elevated with dehydration or a need for fluids. This range is normal and does not indicate that additional fluids are required. Educational objective: Indications of a need for IV isotonic fluids include capillary refill more than 3 seconds and mottling, prehydration before an epidural anesthesia, and inadequate urine output and tachycardia due to hyperemesis gravidarum.

The Nurse Will Anticipate Administration of Isotonic IV Fluids in Which