IV therapy.txt

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SPCADN
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144310
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IV therapy.txt
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2012-03-27 23:00:59
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IV therapy
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IV therapy
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  1. What are 7 reasons for IV therapy use?
    • 1. Fluid volume maintenance
    • 2. Fluid volume replacement
    • 3. Medication administration
    • 4. Blood and blood product administration
    • 5. Nutritional supplementation
    • 6. To keep vein open for emergency
    • 7. Blood sampling for diagnostic tests
  2. What are some advantages of IV therapy?
    • Continuous fluid
    • Intermittent fluid
    • When pt is NO
    • Comatose
  3. What are some disadvantages of IV therapy?
    • Infection
    • Difficulty finding a vein
    • Painful
    • Dangers:
    • Embolism
    • Thrombosis
    • Overdose
    • Sepsis
  4. Hematoma
    localized collection of blood outside of the vessels
  5. Thrombosis
    formation of blood clot inside a vessel
  6. Phlebitis
    inflammation of a vein
  7. Thrombophlebitis
    swelling of a vein caused by a blood clot
  8. Infiltration
    when an IV fluid or medication enters the surrounding tissue rather than the vein
  9. Venous spasm
    sudden involuntary movement or contraction of a vessel wall
  10. Septicemia
    bacteria in the blood that often occurs with severe infections
  11. Pulmonary edema
    abnormal build up of fluid in the air sacs of the lungs, which leads to shortness of breath
  12. Air embolism
    gas bubbles in a vascular system
  13. Speed shock
    a sudden adverse physiologic reaction to IV medications or drugs that are administered too quickly. Some signs of speed shock are a flushed face, headache, a tight feeling in the chest, irregular pulse, loss of consciousness, and cardiac arrest.
  14. What are 6 nursing responsibilities of IV therapy?
    • 1. Assessment
    • 2. Five rights of medication administration
    • 3. Site care
    • 4. Documentation
    • 5. Teaching
    • 6. Discontinuance
  15. What should be considered during the planning process of IV therapy?
    • •wear gloves
    • •maintain aseptic technique
    • •choose tubing and needle appropriate for solution to provide optimal blood flow
    • •attempt to enter vein at its lower end
    • •NEVER ATTEMPT TO RETHREAD A CATHETER
  16. What is the preferred site for venipuncture?
    Distal branches of a large vein
  17. List 5 convenient veins that can be used for venipuncture.
    • 1. Back of hand
    • 2. Forearm
    • 3. Inner aspect of elbow
    • 4. Ankle
    • 5. Foot
  18. What are the steps taken when selecting a vein?
    • •perform hand hygiene, apply gloves
    • •apply tourniquet 3-5 inches below elbow
    • •look for vein with largest diameter and fewest curves or junctions
    • •clean site per policy
  19. What are 3 common peripheral infusion devices?
    • 1. Scalp vein needle (butterfly)
    • 2. Over-the-needle catheter
    • 3. Inside-the-needle-catheter
  20. Define and describe scalp vein needles (butterflies).
    Peripheral infusion device

    • •wings allow for ease of insertion
    • •not for long term use
  21. Define and describe over-the-needle catheters.
    Peripheral infusion device

    • •easy to insert
    • •patent longer
    • •stable which allows greater patient mobility
  22. Define and describe insise-the-needle catheters.
    Peripheral infusion device

    • •less likely to damage vein
    • •permits insertion into superior vena cavalry
    • •CVP monitoring
    • •rarely used
  23. Name 2 types of central infusion devices.
    • Percutaneous catheters
    • Tunneled catheters
  24. Define, describe and give examples of percutaneous catheters.
    Central infusion device

    • •infraclavicular approach - no tunneling
    • •may remain for a few days to several weeks
    • •examples
    • Jugular
    • Femoral
    • Subclavian
  25. Define and give examples of tunneled catheters.
    Central infusion device

    • •Broviac
    • •Hickman
    • •Groshong
  26. Describe a Broviac catheter.
    • •90 cm long
    • •1 mm diameter
    • •silicone, Silastic
    • •used primarily in pediatric patients
  27. Describe a Hickman catheter.
    modified Broviac with larger diameter

    tunneled subcutaneously
  28. Describe a Groshong catheter.
    thin-walled translucent silicone rubber catheter

    similar to Hickman

    allows both fluid administration and blood draw through same lumen
  29. What are the steps taken when inserting an IV catheter?
    • 1. Hold skin taught, insert catheter with bevel up
    • 2. Watch for backflow of blood, advance quarter inch
    • 3. Remove needle, slide catheter into vein
    • 4. Attach solution or cap
    • 5. Secure according to policy
  30. When assessing an IV site, what are you looking for?
    • No erythema (redness)
    • No warmth
    • No edema (swelling)
    • No infiltration (cold, swelling)
    • No leakage of blood or fluid
    • Dressing intact
    • Dressing should be dated
  31. When caring for any patient with an IV, the nurse should _____________.
    assess the SITE and the INFUSION RATE at least every HOUR
  32. What are the 5 Rights of medication administration?
    • 1. Right patient
    • 2. Right medication
    • 3. Right amount
    • 4. Right route
    • 5. Right time
  33. When should an IV dressing be changed?
    when it opens, when it becomes soiled or every 48-72 hours
  34. How often should an IV be resited?
    every 72 hours
  35. What should the nurse assess when caring for a patient with an IV?
    • Daily weights
    • Compare I & O's
    • Vital signs (pulse)
    • Breath sounds
    • Skin turgor
    • Urine specific gravity
    • Lab values
  36. What should a nurse document in the nurse's notes about a healthy IV site?
    • No s/s of infection or infiltration
    • Location and appearance of site
    • Date marked on the dressing
  37. What should the nurse include in her documentation when initiating an IV?
    • Location and size of catheter used
    • Number of attempts
    • INT or continuous fluids
    • Patient toleration
    • Patient teaching
  38. When should patient teaching about IV therapy be done?
    • Before and after cannulation
    • Before and after discontinuance
  39. With IV administration, the solution is delivered directly into the ________________.
    vascular compartment
  40. Absorption of IV fluids is virtually ________________.
    Instantaneous and complete
  41. Once an IV med is given, _________________!!
    it's given and can't be taken back
  42. What are 3 reasons parenteral fluids are given?
    • 1. Maintenance therapy
    • daily body fluid requirements
    • 2. Replacement therapy
    • for present deficits with acute distress
    • 3. Restoration therapy
    • for concurrent or continuing losses
  43. Why are parental supplements beneficial?
    • to maintain or replenish body levels of essential chemicals
    • water provides hydration
    • Na+, K+ and Ca++ for normal nerve and muscle function
    • Cl- and Bicarb buffer to correct acid base balance
    • sugars in concentrations less than 10% carbohydrate calories
  44. What are the 4 different types of parenteral fluids?
    • 1. Hypertonic
    • 2. Isotonic
    • 3. Hypotonic
    • 4. Blood
  45. How do hypertonic solutions work?
    They cause the ECF to shift from interstitial space to plasma
  46. Why are hypertonic solutions used?
    To replace electrolytes
  47. What should a nurse keep in mind when giving hypertonic solutions?
    Give slowly to prevent circulatory overload
  48. What are some examples of hypertonic solutions?
    • D5NS 0.45%
    • D5NS 0.9%
    • D5LR
  49. How do isotonic fluids work?
    By expanding extracellular fluid (ECF)
  50. What affects do isotonic solutions have on the body?
    They have no affect on intracellular and interstitial compartments
  51. What danger to the patient exists when administering isotonic solutions?
    Danger is circulatory overload
  52. How do hypotonic solutions work?
    They cause fluid to shift out of vessels and into the interstitial and intracellular compartments
  53. Why are hypotonic solutions given?
    To hydrate cells while depleting circulatory system
  54. What are some examples of isotonic solutions?
    • LR
    • 0.9% NS
  55. When should a hypotonic solution NOT be given?
    with low blood pressure
  56. What is an example of a hypotonic solution?
    0.45% NS
  57. What are crystalloid solutions?
    • electrolyte solutions
    • "True" solutions
  58. Which fluids are considered crystalloid solutions?
    • hypotonic
    • isotonic
    • hypotonic
  59. What are colloid solutions?
    solutions that do not dissolve
  60. What fluids are considered colloid solutions?
    blood and blood products
  61. Describe Dextrose and Water fluids.
    hydrate intersitium more than intravascular space

    difficult to get total calories needed

    more than 20% cause vein damage

    DO NOT mix with blood
  62. Describe Sodium Chloride fluids.
    provides ECF replacement

    treats metabolic alkalosis

    used with blood transfusions
  63. Describe Dextrose and Sodium Chloride fluids.
    replaces nutrients and electrolytes

    temporarily treats circulatory insufficiency and shock
  64. Descibe Hydrating fluids.
    assess status of kidneys

    use cautiously in edematous patients

    hydrates medical and surgical patients
  65. Describe reasons to use multiple electrolyte fluids.
    may be balanced hypotonic or isotonic maintenance and replacement solutions
  66. Describe Ringer's fluids.
    • fluid and electrolyte content similar to plasma
    • short time replacement for blood


    substitute K+ and Ca++ for Na+
  67. Describe Lactated Ringer's fluids.
    less Na+, Ca++ and Cl-

    • adds bicarbonate precursor
    • assists in acidotic states
  68. Describe plasma expanders.
    increase blood volume
  69. Describe alkalizing and acidifying.
    bicarbonate levels increased or decreased

    lactate or ammonium chloride
  70. Why is parenteral nutrition (TPN) used?
    for normal metabolism

    tissue growth

    weight gain

    preparations containing concentrated sugars, amino acids and lipids

    nutrients administered via IV replace those that normally would be absorbed from the GI tract
  71. What types of patients would TPN be administered to?
    cachectic or debilitated persons

    client who cannot take adequate oral nutrition

    clients going to surgery

    clients with severe intestinal malfunction

    as a temporary measure to imporve the prognosis

    long term measure for maintaining clients with chronic malfunction
  72. How is TPN administered?
    parenteral formulas
  73. What are some important considerations when administering TPN?
    parenteral formulas containing sugars and amino acids are concentrated and CANNOT be infused into peripheral veins

    high osmotic tonicity would damage erythrocytes, other cells and vessels
  74. How is rapid dilution to normal tonicity achieved when administering TPN?
    by directly infusing into the largest veins (vena cava, subclavian or jugular)
  75. What are some dangers associated with TPN?
    • air embolism
    • lipid embolism
    • protein aggregation embolism
    • hyperglycemia
    • hyperammonemia
  76. What are some interventions that can be done when a problem arises with TPN?
    • valsalva maneuver
    • left side, Trendelenberg
    • in-line filters
    • strict aseptic technique
    • monitor and assess
  77. Define hematocrit (Hct) and how is it expressed?
    the volume of red blood cells found in a 100mL of blood


    expressed as a percentage
  78. What symptoms might a patient with a low hematocrit (Hct) level exhibit?
    blood loss or anemia

    • tired
    • pale
    • tachycardia
  79. What symptoms might a patient with a high hematocrit (Hct) level exhibit?
    • dehydration
    • hypovolemia
  80. Define hemoglobin (Hgb).
    a protein substance found in red blood cells (RBC's)

    composed of iron and carries oxygen
  81. What might cause a patient to have a low hemoglobin (Hgb)?
    • anemia
    • iron deficiency or aplastic

    severe hemorrhage

    excess IV fluids
  82. What might cause a patient to have a high hemoglobin (Hgb)?
    dehydration

    polycythemia

    COPD

    CHF
  83. List different blood products that can be used for infusion.
    • whole blood
    • packed red cells (PRBC's)
    • plasma
    • platelets
    • albumin
    • clotting factors
    • gamma globulins
  84. Why might a person need a blood transfusion?
    hemorrhage

    • temporary correction for deficiencies
    • RBC, WBC, Platelets

    bone marrow depression

    hemolysis
  85. True or False.

    Patients may be transfused with synthetic blood.
    false
  86. What problems may arise with a blood transfusion?
    • antigen-antibody reaction
    • hemolysis
    • disrupts circulation
    • damages organs - especially kidneys
    • circulatory overload
    • hyperkalemia and hypocalemia
    • allergic reactions
    • infectious diseases
  87. What are antigens?
    substance capable of producing an immunological response
  88. What antigen does type A blood carry?
    A antigen
  89. What antigen does type B blood carry?
    B antigen
  90. What antigen does type O blood carry?
    no antigens
  91. What antigen does type AB blood carry?
    both A and B antigens
  92. What will happen if A serum is mixed with B serum?
    it will clump as a result of the antigen-antibody reaction
  93. Which type of blood can a person with type A receive?
    A or O
  94. Which type of blood can a person with type B receive?
    B or O
  95. Which type of blood can a person with type AB receive?
    A, B, AB or O
  96. Type AB is known as the _____________.
    universal RECIPIENT
  97. Which type of blood can a person with type O receive?
    O
  98. Type O is known as the ______________.
    universal DONOR
  99. Does a person who is Rh+ have the D antigen?
    yes
  100. Does a person who is Rh- have the D antigen?
    no
  101. What type of blood must a person who is Rh- receive and why?
    An Rh- person must receive Rh- blood to avoid the formation of antibodies to Rh+ blood.
  102. What type of blood can an Rh+ person receive?
    Rh+ or Rh-
  103. What are some signs and symptoms of a transfusion reaction?
    • anxiety
    • restlessness
    • chest or back pain
    • flushing
    • increased pulse &/or respirations
    • shaking, chills, fever and cyanosis

    OR ANY COMPLAINT OF ANYTHING STRANGE FROM THE PATIENT!
  104. If you suspect a blood transfusion reaction, ________________________.
    STOP THE TRANSFUSION IMMEDIATELY!!
  105. What is the normal range for serum K+?
    3.5-5.0 mEq/L
  106. What is the normal range for serum Na+?
    135-145 mEq/L
  107. What is the normal range for serum Ca++?
    8.9-10.3 mg/dl
  108. What is the normal range for hemoglobin (hgb)?
    • women
    • 12-16g/dl

    • men
    • 14-18 g/dl
  109. What is the normal range for hematocrit (hct)?
    • women
    • 39-47%

    • men
    • 44-52%
  110. What is the normal range for serum glucose?
    60-110 mg/dl
  111. What is the normal range for BUN?
    8-25 mg/dl
  112. What is the normal range for creatinine?
    0.6-1.5 mg/dl
  113. Ordered: 1000 mL D5W every 12 hours.

    How many mLs per hour would you infuse?
    • 1000mL = XmL
    • 12hr = 1 hr
  114. X = 83.3 mls/hr
  115. Ordered: 1000 mL D5W every 12 hours.

    How many gtt/min would you infuse if using a microdrip?
    • 1000mL = XmL
    • 12hr = 1hr

    X = 83.3 mL/hr

    • 83.3mL = 1.39mL
    • 60min = 1min


    • 60 gtt = Xgtt
    • 1mL = 1.39mL

    X = 83.4 gtt/min

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