ATI: PN Pharm for nursing ch 4 – Flashcards

Unlock all answers in this set

Unlock answers
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
Get an explanation on any task
Get unstuck with the help of our AI assistant in seconds
New