IV Therapy – Lewis – Chapter 17 – Flashcards
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What is the Osmolality range?
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275 to 295 mOsms/kg
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What does >295 mOsms/kg mean?
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water deficit = hypovolemia
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What are signs of hypovolemia?
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urine output less than 30 mL/hr weak, thread pulse subnormal temperature flat neck veins
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What are signs of hypervolemia?
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bounding pulse shortness of breath distended neck veins
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What does <275 mOsms/kg mean?
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water excess = hypervolemia
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0.9% sodium chloride is what kind of solution?
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Isotonic
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What is the only solution that you can hang with blood products?
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0.9% sodium chloride also called normal saline
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D5W is what kind of solution?
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D5W is isotonic until it is metabolized making it a hypotonic solution.
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Name other isotonic solutions.
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0.9% NaCl = normal saline; sodium chloride; NS Lactated Ringer's (LR) Ringer's (R) 5% Dextrose in water (D5W) D5 in 0.225 Saline
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What is isotonic solutions used for?
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to replace ECF and electrolytes
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What nursing implications you monitor for when using isotonic solutions?
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hypervolemia = bounding pulse; shortness of breath; distended neck vein hypovolemia = urine output <30 mL/hr; weak, thread pulse; subnormal temperature; flat distended veins * monitor for fluid overload; especially in patients who have HTN or CHF * avoid giving D5W to a patient at risk for increased intracranial pressure - closed brain injury patients
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What electrolytes are in Ringer's solutions?
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Na, K, Ca, and has a similar concentration as plasma. There is no dextrose, Mg, or HCO3; also no calories or free water
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What electrolytes are in Lactated Ringer's solutions?
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Na, Cl, K, Ca, and lactate (HCO3 precursor) in concentrations similar to normal plasma. There is no dextrose, Mg or free water
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What is LR used to treat?
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losses from burns and lower GI metabolic acidosis since it is an alkalizing solution, however shouldn't be used to treat lactic acidosis
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Why is it contraindicated to use LR to treat lactic acidosis or hyperkalemia?
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Because the body's ability to convert the lactate to HCO3 and LR already contains lactate which is the HCO3 precursor
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When can Isotonic solution 0.9% NaCl be used?
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when patient has experienced both fluid and Na losses when patient needs vascular fluid replacement in hypovolemic shock.
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What is an example to Hypertonic Solution?
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0.3% NaCl = sodium chloride
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What should you monitor for when administering a hypertonic solution?
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blood pressure lung sounds serum sodium levels
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Name other hypertonic solutions.
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D5 0.9% NS D5 0.45% NS D5LR 3% normal saline Dextrse 10% in water TPN
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What is a hypertonic solution used to treat?
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Hypovolemia and hyponatremia
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Which kind of patients shouldn't receive hypertonic solutions?
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kidney or heart disease patients patients that are dehydrated as occurs with diabetic ketoacidosis
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How should 3% saline be administered?
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slowly and cautiously since it may cause intravascular volume overload and pulmonary edema
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How should 10% Dextrose or less should administered?
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through the peripheral line
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How should 10% Dextrose or greater be administered?
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through the central line to prevent shrinking of RBCs
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What is TPN?
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Total parenteral nutrition
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What does TPN do?
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Provides long-term therapy (3 weeks or longer) to supply large quantities of Nutrients and calories Replaces essential vitamins, electrolytes, minerals, trace elements Restores nitrogen balance Promotes tissue synthesis, wound healing Allows bowel rest and healing Improves tolerance to surgery if severely malnouished
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What is an example of Hypotonic solution?
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0.45% sodium chloride
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What do Hypotonic solutions do?
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treats cellular dehydration, decrease serum Na levels
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Why do you need to use Hypotonic solution with caution?
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Hypotonic solutions can cause a sudden fluid shift from blood vessels into cells and cause circulatory collapse from fluid depletion and increase intracranial pressure from fluid shift to brain cells. (cause swelling- do not give to close head injury patients)
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What do you want to monitor for with patients who are receiving hypotonic solutions?
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mental state -- this is indicative of cerebral edema
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What solution do you NOT administer to patients at risk for ICP or third-space fluid shift?
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hypotonic soultions
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Name hypotonic solutions.
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0.45% saline D5W - once metabolized in body 0.33% NaCl
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What is Fluid Volume Deficit?
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when the body loses water and electrolytes from ECF in similar proportions
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What are your nursing interventions with FVD?
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Assess for clinical manifestations of FVD Monitor Weight and vital signs, including temperature Assess tissue turgor Monitor fluid I&O's Monitor laboratory findings Administer oral and IV fluids as indicated Provide frequent mouth care Implement measures to prevent skin breakdown Provide safety
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What are some clinical manifestations of FVD?
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decreased blood pressure weak pulse, tachycardia dry mucous membrane, sunken eyeballs increased respiratory rate restlessness, drowsiness
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What is an example of FVD?
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heat stroke GI -- vomiting, NG suction, diarrhea, fistula drainage
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What is Fluid Volume Excess?
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when the body gains water and sodium in similar proportions to normal ECF
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What are your nursing interventions with FVE?
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Asses for clinical manifestations of FVE Monitor weight and vital signs Assess for edema Assess breath sounds (listen to lungs) Monitor fluid intake and output Monitor laboratory findings Place in Fowler's position Administer diuretics as ordered Restrict fluid intake as indicated Restrict dietary sodium as ordered Implement measures to prevent skin breakdown
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What are some clinical manifestations for FVE?
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full, bounding pulse, tachycardia increased blood pressure and CVP distended neck veins (JVD) Moist crackle (rales) in lungs (pulmonary edema) Periperal edema dyspnea, shortness of breath Mental confusion
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What is an example of FVE?
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Heart Failure Renal Failure Cushing syndrome Primary polydipsia Long-term use of corticosteroids
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What are the High Alert IV Medications?
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Magnesium (Hight Alert) Heparin Insulin Potassium phosphate (High Alert) Potassium Chloride Opiate & Narcotics Saline Solutions > 0.9%
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What is the SASH method?
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Saline, Administer Med/Solution, Saline, Heparin
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Do you flush Heparin in Groshong? (close ended tunneled catheter)
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No
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How much Heparin is used in the SASH method?
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usually 2-3 mL of 100 units/mL
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CVADs ports can be used only after what?
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Catheter of port need to be confirmed by x-ray prior to accessing it (need to show tip is in the superior vena cava)
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How often do you change the dressing of CVADs?
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every 7 days or when loose or soiled
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How often do you change the catheter caps?
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every 7 days
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Can you take a BP on the arm with a PICC line?
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NO
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Can you take a shower with a PICC Line?
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Yes but needs to be covered
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What is a risk that can develop with for CVADs when using the SASH method?
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Heparin-induced thrombocytopenia (HIT) -- use of a needless ports/connectors that DO NOT require Heparin to lock the catheter
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What are S/S of Infiltration?
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Coolness of skin around site Skin blanching Edema at, above, or below the insertion site leakage at insertion site absence of or "pinkish" blood return difference of size of opposite hand or arm
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What are S/S of Extravasation?
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pain, temperature, or discomfort edema at, above, or below the insertion site skin blanching change in temperature of skin at insertion site burning at insertion site feeling of tightness below the site
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What can cause Extravastation?
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uninteded administration of a vesicant drug or fluid in the subcutaneous tissue
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What are S/S of Phlebitis?
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Erythema-red streak at vein site skin warm swelling palpable cord along the vein pain along vein, tenderness increase in temperature sluggish flow rate
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What are you inspecting for on a CVADs?
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redness, edema, warmth, drainage and tenderness or pain observation for misplacement or slippage
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How do you administer IV push medications on existing lines?
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Prepare medication according to manufacturer's direction Clean port Stop IV flow Connect syringe to IV system
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How do you administer IV push medications of IV Locks?
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Clean diaphragm Insert syringe with normal saline and aspirate from blood to confirm placement Flush with saline Clean diaphragm Administer medication Flush with NS Flush with heparin
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What angle should be used on an elderly patient when starting an IV?
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10-15 degrees or less for elderly patient 30 degrees for adults
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How do you anchor a vein so it does not roll?
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with index finger and thumb --- especially on elderly patient
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How often should you change your IV, containers, tubing, and Dressing?
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IV site every 72 hours every 72 hours for administration sets and secondary tubing IV containers every 24 to 96 hours dressings every 48 hours or immediately is the integrity of a dressing is compromised
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How long should you cleanse the hub and what is the best thing to use?
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scrub chlorhexidine gluconate vigorously back and forth and around the hub for 15 seconds
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What are you looking for when starting a new IV solution bag?
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clear - no cloudiness container hasn't been opened (no leaks) expiration date
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How many drops is macro?
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10, 12, 15, and 20 gtt/mL
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How many drop is micro?
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always 60 gtt/mL
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When an IV is not flushing what is the first thing you do?
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check to see if there are any kinks in the tubing
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What do you do if the IV medication is not compatible with IV that is already being infused?
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clean port w/antiseptic swab; stop IV flow by closing the clamp or pinching the tube above the injection port, flush with NS, administer push med in the closest port to patient; flush with NS; reopen clamp, start IV pump again
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What would you do if the IV site became infiltrated?
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Discontinue the IV and apply warm compress and elevate the hand
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How do you know that an IV site has extravasation?
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there is no back flow when tubing is pinched or you attempt to aspirate.
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Red Man Syndrome
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Adverse reaction of IV Vancomycin ** should be administered over an hour.** Occurs within minutes Due to rapid infusion Includes: puritis, erythema, angioedema,Tachycardia, hypotension, muscle aches,Maculopapular rash
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If patient develops Red Man Syndrome how do you treat this situation?
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Give patient Benadryl (an anti-histamine to reverse the effects)
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What would you give to a patient in a Diabetic Ketacidosis?
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hypotonic solution - 0.45% NaCl
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What gauge is blood products administered through?
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18 G or 19 g needle to prevent damage to the RBCs
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Name Potassium-Rich foods
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Vegetables -- avacado, raw carrot, baked pototoe, raw tomato, spinach fruits -- dried fruits (raisins and dates), banana, apricot, orange, cataloupe meats and fish -- beef, cod, pork, veal beverage -- milk, orange juice, apricot nectar
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What is the only solution you can hang with blood products?
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0.9% NaCl (Normal Saline)
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What are the signs of Infection?
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local - redness, heat, pain, swelling, loss of function systemic - increase in WBC w/a shift to the left malaise, nausea, anorexia, increase pulse, increase respiratory rate, fever
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What kind of patients are hypertonic solutions contraindicated for?
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do not use w/patients with kidney, or heart disease or patients who are dehydrated
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What kind of solution can you use to treat metabolic acidosis?
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Lactated Ringer
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If a patient is in Lactated Acidosis what solution can you not use?
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Lactated Ringer
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What nursing diagnoses would you give a patient who was admitted to patient with the following manifestations: edema, JVD, Crackles in lungs, dyspnea, and tachycardia?
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Fluid Volume Excess
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How do you check placement of CVADs?
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x-ray
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What are the S/S of hypoxia?
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rapid pulse rapid, shallow respiration and dyspnea increased restlessness or light-headedness flaring of the nares substernal or intracostal retractions cyanosis
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How many units are in a Heparin flush?
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100 units not a 1000 **1000 is considered a dose**
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What is the priority nursing assessment when administering 3% sodium chloride?
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assess lung sounds - listen for crackles
