Complex IV solutions, dosage calculation, med admin study guide

question

What is the only IV solution that can be administered concurrently during a Blood Transfusion?
answer

Normal Saline
question

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
question

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)
question

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
question

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.
question

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
question

Characterize Dextrose in 5% water, (D5W).
answer

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)
question

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
question

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)
question

Characterize (D5NS) 5% dextrose in normal saline IV solution.
answer

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
question

Characterize (D5LR) 5% Dextrose in Lactated Ringers IV solution.
answer

Crystalloid Hypertonic
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What are some uses of D5LR?
answer

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).
answer

Crystalloid Hypertonic
question

What are some uses of D51/2NS?
answer

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
question

IV Fluid bags should be changed how often?
answer

Q 24 hours
question

IV insertion sites should be rotated how often?
answer

Q 72-96 hours
question

IV tubing should be changed how often?
answer

Q48-72 hours
question

IV solution labels should have what information included?
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Patient name type of solution date and time hung Staff initials
question

What gauge needle is typically used for IM injections?
answer

20 – 25 gauge
question

What is the typical length of needle for IM injection?
answer

1 – 1.5 inches
question

What are the typical injection sites for IM injections?
answer

Ventrogluteal Vastus Lateralis Dorsogluteal Rectus Femoris Deltoid
question

What is the preferred injection site for IM injections for adults?
answer

Ventrogluteal
question

What is the landmark for the ventrogluteal injection site?
answer

Greater trochanter
question

What is the preferred site for IM injections for infants?
answer

Vastus lateralis
question

What is the landmark for vastus lateralis injection site?
answer

upper aspect of middle third of thigh muscle, separate into thirds
question

What IM injection site is not recommended due to safety issues?
answer

Dorsogluteal
question

What is the landmark for the deltoid IM injection site?
answer

Acrominon process and axilla
question

What gauge needle is used for subcutaneous injections?
answer

25 – 30 gauge
question

What lengths of needles are used for subcutaneous injections?
answer

3/8 – 5/8 inch
question

What injection sites are used for subcutaneous injections?
answer

outer aspects of arms upper aspects of legs Abdomen Scapular areas on back ventrogluteal dorsogluteal
question

How are ear medications administered in adults?
answer

Pull ear up and back
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How are ear medications administered in children?
answer

pull ear down and back

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