Isotonic, Hypotonic, Hypertonic IV Solutions Made Easy | Fluid Electrolytes Nursing Students

hey everyone it's Sarah with register nurse rn.com and in this video I'm going to be covering isotonic hypotonic and hypertonic Solutions and what I want you to get out of this lecture is the following I want you to know what's happening to this cell when these conditions are presenting what are the different types of fluids that may be ordered to help a patient who's in these type of conditions and I want to hit on key Concepts that you need to know for lecture exams and for the incl now after this lecture be sure to go to my website register nurse rn.com and take the free quiz that goes along with this lecture it's going to test you on these Solutions it'll give you scenarios and you'll have to pick which options are the correct and you may see some of these questions on a lecture exam now the link should be in the description below or a card should be popping up and you can access that okay first let's familiarize ourself with the cell and how osmosis work Works cuz this is the foundation for understanding isotonic hypotonic and hypertonic Solutions so let's look at a cell okay our body is made up of millions of these little things and in the cell you have the inside of your cell which is made up of the organ naels you have your electrolytes and it's referred to as the intracellular part of the cell then surrounding the cell is fluid and it's also made up of electrolytes and it's referred to as the extra cellular so intracellular is the inside remember in intracellular cellular and then extra is outside very important and then you have your um solvent and in the solvent you have solides and your body loves to have everything equal it wants the same amount on the outside that's on the inside and if one of these conditions like we're going to talk about here in a second happens the body will use a osmosis to correct that and osmosis is where you have less of a concentration trying to move to a higher concentration through a semi-permeable membrane so that's what's happening with osmosis and I always like to refer to sodium and water sodium and water love each other especially water loves sodium and I like to think of it like this I try to always think of little illustrations to help me remember things and maybe you're like that too I like to think of sodium as the popular kid and water is the kid that wants to be popular and they love hanging out with the popular kid so what happens is that sodium sometimes likes to congregate inside the cell or maybe it'll shift and go to the outside but wherever it goes water wants to go so if sodium jumps off a bridge water will jump off a bridge so try to remember that because that'll help you remember the hypotonic and hypertonic what's happening because what will happen is that you will have all this sodium congregated inside of a cell now the sodium on the outside of the cell there won't be as many now according to the rule of Osmosis you will have a shift in fluid from a less concentrated which is the outside to a higher concentrated so all that water will want to move in to where sodium's congregating and it can cause different conditions first let's go over isotonic okay isotonic ISO means equal ISO and then tonic the second half of the word means concentration of the solution so there is an equal concentration of the solution on the inside of the cell and on the outside of the cell the body is happy they love it having it like this now the type of fluids because in the healthcare setting we will give isotonic fluids so you probably want to write these down because you want to remember them there are four of them and they are um 0.9 saline uh dextrose 5% in water which is known as D5W and I have an aster by that and I'm going to explain that here in a second 5% dextrose and. 225% saline and then lactated ringers also known as LR now why do I have an aster by D5W now D5W whenever you administer it before you administer it it's considered an isotonic solution but after Administration the body Qui quickly metabolizes this dextrose and after the dextrose is gone you just have the water left over so it turns into a hypotonic solution so you may be reading some literature and it'll talk about it's either hypotonic or isotonic they use them interchangeably for things and that's the reason why is because your body is absorbing that dextrose and then after it absorbs it you're just left over with the other fluid and that's a hypotonic fluid so keep that in mind now why would a patient be ordered an isotonic fluid they are ordered to increase the extracellular fluid volume because what's happened is that the patient has lost this extracellular fluid either through blood loss dehydration with vomiting diarrhea or surgery again probably with the fluid loss um mean the blood loss so we give isotonic solutions to increase this it won't cause a shift it won't mess up this cell cause it to shrink or blow up or anything like that so we just want to replace the extracellular fluid and that's how isotonic Solutions allow us to do that now let's go over hypotonic Solutions hypo means under or beneath so it's low and tonic again is just the concentration of the solution so the concentration of the solution is lower than it should be and I've tried to represent it in this picture of this cell right here you have this cell and notice extra cellularly you have not a lot of water molecules or your solute which is sodium but on the inside of the cell you have all this water and all these solutes now according to osmosis remember this part the extracellular where it's less concentrated is going to want to move where it's more concentrated which is on the inside of the cell so what's going to happen is you're going to have the shift of all this fluid that's extracellular into the cell intracellularly and what will happen is that your cell will swell up and it can Lis mean it can rupture and break apart so that is what's happening whenever you have that side effects again are cell liis and another thing you have to watch out for whenever you have a patient in this state is that you can deplete the circulatory systems fluid you can make them hypo vol liic because what's happening is all this fluid that's in the blood is leaving and entering into the cells so they're not going to have any more fluid left so you really have to watch that now in the hospital setting we like to give patients sometimes hypotonic fluids because they have dehydrated cells so we will give them this fluid in certain circumstances now there's three hypotonic solutions that you need to remember and remember with this because I know it gets confusing when you're trying to remember what's isotonic what's hypotonic and what's hyperonic and what helps me remember this is the number of fluids for each hypo it's low it's less of all the three and there's only three hypotonic solutions that you really need to remember so and they are 0.45% of saline which is half normal saline 22% of saline which is 1/4 saline and then 33% which is 1/3 saline and those are generally the most popular and again D5W what we said about with isotonic it is sometimes used as a hypotonic solution because the dextris metabolized now why are they used um they are used again whenever the cell becomes dehydrated because we actually want to move all that fluid into the cell because the cell's all shrinked up and what what causes the cell to do that diabetic keto acidosis dka will cause it and hyperosmolar hypoglycemia will also cause as well so generally if you have a patient who is in these conditions they will be ordered one of these solutions to help hydrate that cell back now there are instances where you do not want to give a hypotonic solution and this is a popular test question they'll give you a scenario and they may say a patient comes in with increased interial pressure and they are ordered um 33% normal saline would you give this and you wouldn't because you will not give a patient who has increased inter cranial pressure hypotonic um solution because it will shift the fluid into the brain tissue and cause brain swelling which is not good and patients who have Burns any type of Burns and Trauma because these patients are already hypovolemic and remember this depletes your circulatory system you don't want to do that anymore now let's go over hypertonic okay hypertonic hyper means excessive and tonic again is the concentration of the solution so you have too much of a concentrated solution going on and let's look at this picture to see what's going to happen now extracellular if you notice you have a lot of water molecules and you have a lot of a Sol solute and but on the inside of the cell you hardly have anything at all so remember according to osmosis that fluid will want to shift from a lower concentration ation which is the inside of the cell to a higher concentration where everyone else is at so whenever that happens you're going to have your cells just shrink up and that is what's happened so side effect is your cell is going to shrink now sometimes we want to cause this to happen because the patient has some conditions that's going on now what are um hypertonic Solutions now to help you remember this there are six of those six of these hyper tonics and remember hypertonic is increased you have six of those fluids isotonic you just had four of them and remember how many did you have for hypotonic three so you have six and what they are is 3% saline 5% saline 10% uh dextrose and water 5% dextrose in 0.9% Saline 5% dextrose in point um well half normal saline and 5% dextrose in LR now let me try to go over this to help you remember the fluid types A little bit pay attention to these percentages because hypo let's look at hypo hypo is less notice these numbers these are very low percentages of saline so they are on the low end in low Spectrum so you know that they're hypotonic now normal you have 0.9 sailing that's a normal that's isotonic and then the 5% and then the half with the 22% saline that equals isotonic and LR is an isotonic then look over here at your hypertonic you have these higher percentages 3% saline 5% saline very very salty so it's very concentrated so just try to whenever you're trying to analyze and ask yourself is this a hypertonic hypotonic isotonic fluid make sure you're paying attention to those percentages now these fluids are typically given in the Intensive Care Unit or um unit that can really monitor a patient very closely and it's given via a central line usually because these um hyperonic Solutions are very very hard on the veins will cause fitis and things like that and the reason you have to normally give these in the ICU is because a patient's condition can change very fast if they're not monitored closely because these fluids cause very quickly fluid overload which can lead to pulmonary edema and if you see here because what's happening remember is that all the fluid is shifting into your vascular system because you're just shrinking that cell up so all this is just running through your system and if you put too much and dehydrate those cells too much you're going to have too much um volume and it's going to back up the heart's not going to be able to handle it it's going to back up into the lungs you're going to put them in fluid overload so that is why they have to be watched very carefully now why would you give a hypertonic solution now a lot of times you will have patients who cells they're very swall and we need to pull all that stuff out of those cells into the body so the patient can excrete them out and get rid of it and patients with cerebral edema we like to give that because they because it helps decrease the swelling by um removing the fluid off of the brain so if they have that um you may give like 3% saline and a patient who has hyponatremia low sodium in their blood because what's happening you have like hardly any sodium in the blood you're going to pull all that sodium from the cell into the blood so you're going to increase their sodium so it helps balance that out okay so that is the difference between isotonic hypertonic and hypotonic Solutions now go to my website register nurse rn.com and take the quiz to see how well you know this material and be sure to check out my other videos on fluid and electrolytes and thank you so much for watching and please consider subscribing to this YouTube channel

Channel: RegisteredNurseRN

Views: 2,461,343

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Id: 51FkahHUBwc

Length: 13min 56sec (836 seconds)

Published: Mon Jan 11 2016