Which fluid order should the nurse question for a patient with a traumatic brain injury?
a. 0.45% sodium chloride
b. 0.9% sodium chloride
c. Lactated Ringer's
d. Dextrose 5% in 0.9% sodium chloride
ANS: A
0.45% sodium chloride is a hypotonic solution, and hypotonic solutions cause cells to swell, which can cause increased intracranial pressure. This can be life threatening for a patient with a traumatic brain injury. The other solutions are physiologically isotonic sodium-containing solu-tions that will expand ECV but will not cause cell swelling. In the fluid container, dextrose 5% in 0.9% sodium chloride is hypertonic, but the dextrose enters cells rapidly, leaving isotonic 0.9% sodium chloride.
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