You should review the patient as discussed in the initial assessment section, but also review key laboratory results to better understand the patient’s current fluid and electrolyte status: Once the patient is haemodynamically stable their daily fluid and electrolyte requirements can be considered. If the patient appears normovolaemic but has signs of shock you should seek expert help immediately.giving fluid boluses of 250 ml rather than 500 ml and seeking expert help earlier). heart failure, renal failure) and/or are elderly then you should apply a more cautious approach to fluid resuscitation (e.g. If patients have complex medical comorbidities (e.g.persistent hypovolaemia), you should seek expert help.
After administering the initial 500 ml fluid bolus you should reassess the patient using the ABCDE approach, looking for evidence of ongoing hypovolaemia as you did in your initial assessment (if you find yourself unsure about whether any further fluid is required you should seek senior input).ģ. If the patient still has clinical evidence of ongoing hypovolaemia give a further 250-500 ml bolus of a crystalloid solution, then reassess as before using the ABCDE approach: Administer an initial 500 ml bolus of a crystalloid solution (e.g NaCl 0.9%/Hartmann’s solution) over less than 15 minutes. the patient is septic so antibiotics need to be administered). In addition, you need to start considering the cause of the deficit and take appropriate actions to treat it (e.g. Ok, so you’ve performed your initial assessment and things aren’t looking great, the patient has clinical signs suggestive of hypovolaemia you, therefore, need to prescribe some resuscitation fluids. If you consider the patient to be hypervolaemic, do not administer IV fluids. If however, the patient appears stable and normovolaemic you can skip this step and move straight to calculating maintenance fluids. If after your initial assessment you feel there is evidence of hypovolaemia your next step would be to initiate fluid resuscitation as shown in the next section.
IV fluids can be categorised into 2 major groups: This real-world guide supports students and new nurses in class, on the unit and with NCLEX® preparation, while also serving as a solid refresher for experienced nurses.You might also be interested in our OSCE Flashcard Collection which contains over 2000 flashcards that cover clinical examination, procedures, communication skills and data interpretation. Written in the enjoyable Incredibly Easy! ® style, it offers step-by-step direction on balancing fluids and electrolytes, understanding fluid imbalances and the disorders that cause them, treating imbalances and more. Fluids & Electrolytes Made Incredibly Easy!®, 7th Edition.įor expert, confidence-building guidance on handling fluids and electrolytes, turn to the irreplaceable quick-reference guide Fluids & Electrolytes Made Incredibly Easy!®, 7th Edition.