A nurse is caring for a client who has dehydration due to vomiting and diarrhea. The client's blood pressure is 90/60 mm Hg, pulse is 110/min, and respirations are 22/min. The nurse should anticipate a prescription for which of the following types of IV fluids?

Choice A reason:

Decreased urine specific gravity indicates improvement in hydration status. Urine specific gravity is a measure of the concentration of solutes in the urine. It reflects the ability of the kidney to concentrate or dilute urine. A high urine specific gravity (>1.030) indicates concentrated urine, which can be caused by dehydration, reduced renal blood flow, or increased fluid loss. A low urine specific gravity (<1.010) indicates diluted urine, which can be caused by overhydration, diuretic use, or impaired renal function. A normal urine specific gravity ranges from 1.010 to 1.030.

Choice B reason:

Increased hematocrit level indicates worsening of dehydration. Hematocrit is the percentage of red blood cells in the total blood volume. It is affected by the plasma volume and the number of red blood cells. A high hematocrit (>47% for males and >42% for females) indicates hemoconcentration, which can be caused by dehydration, polycythemia, or hypoxia. A low hematocrit (<37% for males and <32% for females) indicates hemodilution, which can be caused by overhydration, anemia, or hemorrhage. A normal hematocrit ranges from 37% to 47% for males and 32% to 42% for females.

Choice C reason:

Decreased skin turgor indicates persistent dehydration. Skin turgor is the elasticity of the skin that reflects its hydration status. It is assessed by pinching a fold of skin on the chest, abdomen, or forearm and releasing it. Normally, the skin should return to its original position in less than 3 seconds. If the skin remains elevated or takes longer to return, it indicates poor skin turgor, which can be caused by dehydration, aging, or edema.

Choice D reason:

Increased serum osmolarity indicates worsening of dehydration. Serum osmolarity is a measure of the concentration of solutes in the blood plasma. It reflects the balance between water and electrolytes in the body fluids. A high serum osmolarity (>300 mOsm/kg) indicates hyperosmolarity, which can be caused by dehydration, hypernatremia, hyperglycemia, or mannitol infusion. A low serum osmolarity (<280 mOsm/kg) indicates hypoosmolarity, which can be caused by overhydration, hyponatremia, syndrome of inappropriate antidiuretic hormone secretion (SIADH), or diuretic use. A normal serum osmolarity ranges from 280 to 300 mOsm/kg.

Choice A reason:

Crystalloid solutions are fluids that contain electrolytes and can diffuse across semipermeable membranes. They are used to treat dehydration, electrolyte imbalances, and hypovolemia. However, they are not as effective as colloids in expanding the intravascular volume and maintaining the blood pressure. Therefore, choice A is incorrect.

Choice B reason:

Colloid solutions are fluids that contain large molecules such as proteins, starches, or gelatin that cannot cross the capillary membrane. They exert an osmotic pressure that draws fluid from the interstitial and intracellular spaces into the intravascular space. They are used to treat hypovolemic shock, burns, and hemorrhage. Albumin is a type of colloid solution that is derived from human plasma and contains 5% or 25% protein. It increases the plasma volume and the blood pressure by increasing the oncotic pressure. Therefore, choice B is correct.

Choice C reason:

Hypertonic solutions are fluids that have a higher osmolarity than the blood plasma. They draw water out of the cells and into the intravascular space. They are used to treat hyponatremia, cerebral edema, and severe dehydration. However, they can cause fluid overload, hypertension, and cellular dehydration if given in excess. Therefore, choice C is incorrect.

Choice D reason:

Hypotonic solutions are fluids that have a lower osmolarity than the blood plasma. They provide free water and electrolytes to the cells and the interstitial space. They are used to treat hypernatremia, cellular dehydration, and fluid loss due to burns or diuresis. However, they can cause fluid shifts from the intravascular space to the interstitial and intracellular spaces, resulting in hypovolemia, hypotension, and edema. Therefore, choice D is incorrect.