question

IV therapy involves what

answer

administering fluids via an IV catheter for the purpose of providing meds, supplementing fluid intake, or giving fluid replacement, electrolytes, or nutrients

question

large volume IV infusions are administered how

answer

on a continuous basis

question

an IV med may be mixed in a lage volume of fluid and given as a

answer

continuous IV infusion

question

intermittent IV bolus

answer

mixed in a small amount of solution and given

question

IV bolus dose

answer

given in small amount of solution, concentrated or diluted, and injected over a short time

question

scope of practice for PNs

answer

venipunctures, insert IV catheters, MAY NOT administer IV meds

question

advantages of IV therapy

answer

rapid effects, precise amounts, less discomfort after initial insertion, control over therapeutic blood levels, and less irritation to subcut and muscle tissue

question

disadvantages of IV therapy

answer

circulatory fluid overload is possible if the infusion is large and/or too rapid, immediate absorption leaves no time to correct errors, IV admin can casue irritation to the lining of the vein, and failure to maintain surgical asepsis can lead to local infection and septicemia

question

the provider prescribes what

answer

the type of IV fluid, volume to be infused, and either the rate at which the IV fluid should be infused or the total amount of time it should take for the fluid to be infused

question

the nurse regulates what

answer

the IV infusion to ensure the appropriate amount is administered (IV pump or manually)

question

large volume IV infusions are administered

answer

on a continuous basis (0.9% NaCl IV to infuse at 100 ml/hr or 0.9% NaCl 1000 ml to be given IV over 3 hr)

question

fluid bolus

answer

a large amount of IV fluid given in a short period of time, usually less than 1 hr; it is given to rapidly replace fluid loss that could be caused by dehydration, shock, hemorrhage, burns, or trauma

question

a large gauge IV catheter comes in what size(s)

answer

18 gauge or larger; and is essential for maintaining the rapid rate necessary to give a fluid bolus to an adult

question

methods to administer IV med infusions

answer

mix meds in a large volume of fluid (500 - 1000 ml) and admin as continuous IV infusion; and use premixed solution bags or solutions that have been prepared by the pharmacist

question

intermittent IV bolus admin

answer

some meds like antibiotics, are given in small amounts of solution (25 - 250 ml) through a continuous IV system, or with saline or heparin lock system; the meds infuse for short periods of time and are given on a scheduled basis; and these infusions can be administered by a secondary IV bag or bottle or tandem setup, volume control administration set, or mini infusion pump

question

IV bolus dose administration

answer

the meds are typically in small amounts of solution, concentrated or diluted, that can be injected over a short time in emergent and nonemergent situations; some meds like pain meds are given directly into the peripheral IV or access port to achieve an immediate med level in the blood; observe for complications (localized redness, burning, or increasing pain); and monitor for adverse effects of the meds, like hypotension or respiratory depression and observe for therapeutic effects like pain relief

question

types of IV access

answer

via peripheral or central vein (central venous access device which can be peripherally inserted or directly inserted into the jugular or subclavian vein through venipuncture, or by surgical intervention with implantation of access ports for long term use)

question

when caring for clients who are receiving IV meds, be aware of the following guidelines

answer

KCl can cause serious adverse reactions and should be infused with an electronic IV pump for accurate dosage control and never given by IV bolus; IV meds shooud be in a new IV fluid container, IV meds must NOT infuse through tubing that is infusing blood, blood products, or parenteral nutritional solutions; and multiple meds infusing through the same tubing MUST BE compatible

question

older adult clients, clients taking anticoagulants, or clients who have fragile veins; what are their special considerations

answer

avoid tourniquets and use BP cuff instead, DO NOT slap the extremity to visualize veins, apply traction to the skin below the vein to stabilize the vein, use a small gauge catheter when possible, instruct the client to hold their hand below the level of the heart, and avoid using the back of the clients hand

question

edema in extremities; what do you do

answer

apply digital pressure over the seleced vein to displace edema, apply pressure with an alcohol pad, and perform cannulation quickly; obese patients my use anatomical landmarks to find veins

question

preventing IV infections

answer

fluids should NOT hang longer than 24 hr unless it is a closed system; and DO NOT allow ports to remain exposed to air

question

correct catheter size

answer

16, 18, 20, 22-24

question

16 gauge catheter for what kinds of patients

answer

trauma; rapid fluid volume

question

18 gauge catheter for what kinds of patients

answer

surgical; rapid blood admin

question

20 gauge catherter for who

answer

adults

question

22-24 gauge catheter for who

answer

older adults and kids

question

nursing actions when selecting a vein

answer

choose distal veins FIRST on the nondominant hand; a site that is not painful or bruised and will not interfere with activity; and a vein that is resilient with a soft, bouncy feeling

question

documentation in med record

answer

date and time of insertion; insertion site and appearance; catheter size; type of dressing; IV fluid and rate; number, location, and condition of site attempted cannulations; and clients response

question

maintaining patency of IV access

answer

DO NOT stop a continuous infusion or allow blood to back up into the catheter for any length of time; clots can for at the tip of the needle or catheter and can abecome lodged against the vein wall, blocking the flow of fluid; make sure the dressing is not too tight; flush intermittent IV catheters with appropriate solution after every med admin or q 8-12 hr when not in use; and monitor site and infusion rate at least q hr

question

infiltration s/s

answer

pallor, local swelling at the site, decreased skin temp arount the site, damp dressing, slowed infusion

question

treatments of infiltration

answer

stop the infusion and remove the catheter, elevate the extremity, encourage active ROM, apply warm or cold compresses based on the type of solution that infiltrated the tissue, and chech with the provider to determine whether the client still needs IV therapy; if so, restart the infusion proximal to the site or in another extremity

question

prevention of infiltration

answer

carefully select site and catheter; and secure the catheter

question

extravasation (infiltration of a vesicant or tissue damaging med) s/s

answer

pain, buring, redness, and swelling

question

tx of extravasation

answer

stop the infusion and notify the provider; and follow facility protocol, which may include infusing an antidote through the catheter before removal

question

prevention of extravasation

answer

closely monitor the IV site and dressing; and always use an infusion pump

question

phlebitis/thrombophlebitis s/s

answer

edema, throbbing, burning, or pain at the site; increased skin temp; erythema; a redline up the arm with a palpable band at the vein site, and slowed infusion

question

treatments of phlebitis/thrombophlebitis

answer

promptly discontinue the infusion and remove the catheter, elevate the extremity, apply a cold compress to minimize the flow of blood, then apply a warm compress to increase circulation, check with the provider to determine whether the client still needs IV therapy; if so, restart the infusion in the opposite extremity; and if drainage is present, obtain a specimen from the site and send it and the catheter for culture

question

prevention of phlebitis/thrombophlebitis

answer

rotate IV sites when indicated or per policy, avoid the lower extremities, use hand hygiene, and use surgical aseptic technique

question

hematoma s/s

answer

ecchymosis ( a discoloration of the skin resulting from bleeding underneath, causing bruises) at site

question

treatments of hematoma

answer

do not apply alcohol, apply pressure after IV catheter removal, and use warm compress and elevation after bleeding stops

question

prevention of hematomas

answer

minimize tourniquet time, remove the tourniquet before starting IV infusion, and maintain pressure after IV catheter removal

question

cellulitis s/s

answer

pain, warmth, edema, induration, red streaking, fever, chills, and malaise

question

treatment for cellulitis

answer

promply discontinue the infusion andremove catheter, elevate the extremity, apply warm compresses 3-4 times/day, if drainage is present, obtain a specimen from the site and send it and the catheter for culture; admin antibiotics, analgesics, antipyretics

question

prevention of cellulitis

answer

rotate IV sites when indicated on per policy, avoid the lower extremities, use hand hygiene, and use surgical aseptic technique

question

fluid overload s/s

answer

distended neck veins, increased BP, tachycardia, SOB, crackles in the lung, edema

question

treatment for fluid overload

answer

slow the IV rate to keep the vein open in accordance with facility policy, raise the head of bed, check vitals, and anticipate admin of diuretics

question

prevention of fluid overload

answer

use an infusion pump, and monitor I&Os

question

catheter embolus s/s

answer

missing catheter tip when discontinued, severe pain at the site with migration, or no symptoms if no migration

question

treatments of catheter embolus

answer

place the tourniquet high on the extremity to limit venous flow, prepate for removal under x-ray or via surgery, and save the catheter after removal to determine the cause

question

prevention of catheter embolus

answer

do not reinsert the sylet into the catheter

question

a nurse is observing a clients IV site; which of the following findings indicate phlebitis? (select all)

answer

palpate, hard mass above insertion site; and pain at site

question

a nurse manager is reviewing facility policies for IV therapy management with the members of his team; the nurse manager should inform the team members that which of the following techniques will minimize the risk of catheter embolism?

answer

avoid reinserting the needle into the IV catheter

question

a nurse is preparing to initiate IV therapy for an older adult client; which of the following actions should the nurse plan to take?

answer

distend the veins by using a bp cuff

question

a nurse is caring for a client receiving dextrose 5% in water IV at 250 ml/hr; which of the following findings indicate fluid overload? (select all)

answer

SOB, crackles heard in lungs, and distended neck veins

question

a nurse is preparing to administer dextrose 5% in water 200 ml IV to infuse over 5 hr; the nurse should set the IV pump to deliver how many ml/hr?

answer

volume (ml)/time (hr) = ml/hr 200 ml/5 hr = 40 ml/hr

question

a nurse on a med surge unit is providing care for a group of clients who are receiving IV therapy; the nurse is monitoring the clients for related complications: identify 3 indications for IV therapy

answer

admin med, supplement fluid intake, and replace electrolytes and nutrients

question

a nurse on a med surge unit is providing care for a group of clients who are receiving IV therapy; the nurse is monitoring the clients for related complications: identify 4 potential complications of IV therapy

answer

phlebitis/thrombophlebitis, hematoma, cellulitis, fluid overload, infiltrations, extravasation, catheter embolus

ATI: PN Pharm for nursing ch 4 – Flashcards

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