Complex IV solutions, dosage calculation, med admin study guide – Flashcards
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What is the only IV solution that can be administered concurrently during a Blood Transfusion?
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Normal Saline
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What two classifications are IV solutions categorized as?
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Crystalloids Colloids
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Characterize Crystalloid IV solutions
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Either Isotonic, hypotonic, or hypertonic NS LR D5W 1/3NS 1/2NS
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Characterize Colloid IV solutions
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(referenced as volume expanders) typically blood products, these solutions contain larger concentrations of solutes ALWAYS HYPERTONIC Albumin 5% Albumin 25% Dextran 40 Hetastarch Plasma Protein fraction Plamanate
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Characterize Isotonic IV solution.
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Solutions with osmolality of normal body, 250-350 mOsm/kg. cell concentration equal within ICF and ECF, no change in cells size
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What are some examples of isontonic IV solutions
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0.9% normal saline (NS) Lactated Ringers (LR) Dextrose 5% in water (D5W)
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Characterize 0.9% normal saline (NS) IV solution.
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Isotonic Crystalloid Only IV solution that can be administered concurrently in blood transfusions Increases fluid volume in intravascular and interstitial spaces with minimal fluid displacement
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What are some uses of (NS) 0.9% normal saline IV solution?
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Shock treatment Resuscitation Fluid challenges Metabolic Acidosis Hyponatremia DKA
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What are some nursing implications of (NS) 0.9% normal saline IV solution?
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Caution with heart failure and edema Hypernatremia could cause fluid overload Assess for S&S of hypervolemia such as bounding pulse, shortness of breath, and distended neck veins.
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Characterize (LR) Lactated Ringers IV solution.
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Isotonic Crystalloid increases fluid volume in intravascular and insterstitial spaces with minimal fluid displacement
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What are some uses of (LR) Lactated Ringers IV solution?
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Dehydration (balances electrolytes) Burns GI tract fluid loss Acute blood loss Hypovolemia
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What are some nursing implications of (LR) Lactated Ringers IV solution?
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Solution contains potassium and can cause hypervolemia in patients with impaired renal function. Caution in patients with liver disease due to impaired liver function; impaired liver cannot metabolize lactate which is normally converted in bicarbonate in liver. Assess for S&S of hypervolemia such as high blood pressure, bounding pulse, shortness of breath, and distended jugular vein
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Characterize Dextrose in 5% water, (D5W).
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Crystalloid Isotonic (INITIALLY) Eventually becomes hypotonic as body metabolizes
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What are some uses of (D5W)
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Fluid loss/dehydration Cellular dehydration Hypernatremia Promotes fluid elimination by kidneys Provides free water
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What are some nursing implications of (D5W)
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Inappropriate for patients with increased inner cranial pressure (IICP) (increases free water which could increase inner cranial pressure). Do not use for resuscitation caution with cardiac and renal patients
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Characterize Hypotonic IV solution.
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Solutions with less osmolality than body, less than 250 mOsm/kg. Cell fluid concentration is greater within ECF than ICF, cells swell in size as fluid moves from ECF into cell.
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What is an example of a hypotonic IV solution?
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0.45% sodium chloride (1/2NS) 0.33% sodium chloride (1/3NS)
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Characterize 0.45% sodium chloride (1/2NS) IV solution
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hypotonic crystalloid
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What are some uses of 0.45% sodium chloride (1/2NS) IV solution?
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Gastric fluid loss. Cellular dehydration from excess diuresis Hypertonic dehydration Slow rehydration
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What are some nursing implications of 0.45% sodium chloride (1/2NS)?
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Inappropriate for patients with increased inner cranial pressure (IICP) (increases free water which could increase inner cranial pressure). Not for rapid rehydration Caution, monitor for S&S of electrolyte imbalance
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Characterize Hypertonic IV solutions.
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Solutions with osmolality greater than normal body, greater than 350 mOsm/kg. Cell concentration in ECF is less than ICF, cells shrink in size as fluid moves from inner cell into vascular cavity.
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What are some examples of hypertonic IV solutions?
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5% Dextrose in 0.9% sodium chloride (D5NS) 5% Dextrose in Lactated Ringers (D5LR) 5% Dextrose in 0.45% sodium chloride (D51/2NS) 10% Dextrose in Water (D10W) 20% Dextrose in Water (D20W) 50% Dextrose in Water (D50W)
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Characterize (D5NS) 5% dextrose in normal saline IV solution.
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Crystalloid Hypertonic
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What are some uses of D5NS?
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Heat related disorders Freshwater drowning Peritonitis
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What are some nursing implications of D5NS?
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Should not be given to patients with impaired cardiac or renal function Draw blood before administering to diabetics
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Characterize (D5LR) 5% Dextrose in Lactated Ringers IV solution.
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Crystalloid Hypertonic
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What are some uses of D5LR?
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Hypovolemic shock Hemorrhagic shock certain types of acidosis
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What are some nursing implications of D5LR?
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Do not administer to patients with cardiac, liver, or renal dysfunction. Monitor for circulatory overload
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Characterize 5% Dextrose in 0.45% sodium chloride (D51/2NS).
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Crystalloid Hypertonic
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What are some uses of D51/2NS?
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Heat exhaustion diabetic disorders TKO solution for patients in renal or cardiac dysfunction
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What are some nursing considerations of D51/2NS?
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Not for rapid fluid replacement
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What is a use of D10W?
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Stand by solution for patients receiving total parenteral nutrition (TPN)
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What is a use of D50W?
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use for patients in extreme hypoglycemia
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IV Fluid bags should be changed how often?
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Q 24 hours
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IV insertion sites should be rotated how often?
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Q 72-96 hours
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IV tubing should be changed how often?
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Q48-72 hours
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IV solution labels should have what information included?
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Patient name type of solution date and time hung Staff initials
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What gauge needle is typically used for IM injections?
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20 - 25 gauge
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What is the typical length of needle for IM injection?
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1 - 1.5 inches
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What are the typical injection sites for IM injections?
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Ventrogluteal Vastus Lateralis Dorsogluteal Rectus Femoris Deltoid
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What is the preferred injection site for IM injections for adults?
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Ventrogluteal
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What is the landmark for the ventrogluteal injection site?
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Greater trochanter
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What is the preferred site for IM injections for infants?
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Vastus lateralis
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What is the landmark for vastus lateralis injection site?
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upper aspect of middle third of thigh muscle, separate into thirds
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What IM injection site is not recommended due to safety issues?
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Dorsogluteal
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What is the landmark for the deltoid IM injection site?
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Acrominon process and axilla
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What gauge needle is used for subcutaneous injections?
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25 - 30 gauge
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What lengths of needles are used for subcutaneous injections?
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3/8 - 5/8 inch
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What injection sites are used for subcutaneous injections?
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outer aspects of arms upper aspects of legs Abdomen Scapular areas on back ventrogluteal dorsogluteal
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How are ear medications administered in adults?
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Pull ear up and back
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How are ear medications administered in children?
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pull ear down and back
