question

List the purposes for initiating intravenous (IV) therapy.

answer

Fluid and electrolyte replacement and hydration Medication Administration Open line for emergency treatment/medication(KVO rate) IV therapy may be continuous (continuous flow) or intermittent (via access device)

question

Identify laboratory tests to assess in clients receiving IV therapy and what these tests indicate.

answer

Serum electrolyte tests usally are performed routinely on any patient entering a hospital to screen for imbalances and serve as a baseline for future comparisons

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Isotonic Solutions

answer

prevents shift of fluid and electrolytes. Approximately the same osmolarity as body fluids: Cells remain the same. Used for fluid replacement of extracellular and intravascular volume. Examples: 0.9% Normal Saline (308), Lactated Ringer's solution (309), and 5% Dextrose in water (278).

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Hypotonic

answer

Less osmolarity than body fluids (less than 250). Used to rehydrate cells-shifts fluid into cells. Used for dehydration. Example: 0.45% saline (154)

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Hypertonic

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Higher osmolarity than body fluids (375mEq/L). Pulls solution into the vascular space, shifting water out of the cell and causing cell to shrink. Must be very careful not to create excess fluid resulting in pulmonary edema. Examples: 10% dextrose in water (556) as a nutrient that provides 340 calories/L, 3% Saline (1026) used, although rarely, in severe hyponatremia.

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Fluid overload

answer

Prevent by monitoring rate. Use mini-drip, small bags of fluid, controller devices. Signs: shortness of breath, tachycardia, crackles in lungs. Slow infusion, raise head of bed, monitor vitals, notify physician.

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Dehydration

answer

Thirst, Dark urine, dry mucous membranes, Sunken eyeballs, flat neck veins(with head to bed 30-45 degrees), hypotensions, tachycardia, tachypena, acute weight loss

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Potassium excess

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irregular, slow heart rate, decrease BP, ECG changes, muscle twitching, hyperactive bowel sounds, diarrhea, nausea, potassium level greater than 5

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Potassium deficiet

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thready pulse, decrease breath sounds, dyspnea, polyuria and nocturia, lethargy, weakness, polydipsia

question

Explain why the elderly and infants do not tolerate dehydration as well as middle age adults.

answer

Infant proportion total body water is greater than that of children or adults. Older have more difficulty recovering for imbalances resulting form the combined effect of normal aging, various disease conditions, and multiple medications.

question

Why is weighing a patient important when assessing fluid and electrolyte status?

answer

Daily weights are useful for patients with clinical dehydrations or other causes or risks for ECV deficit.

question

Describe ways to remove air from tubing during priming and when the IV is already connected to the patient

answer

Air in tubing: Prime carefully. Use a needle to aspirate air if tapping does not move the air to the port or drip chamber

question

Describe how you would restrain the child, when starting the IV in the hand and in the foot.

answer

When securing the child's extremity to an armboard, use clear tape to allow visualization of the I.V. site and digits or skin immediately adjacent to the site.

question

How does the height or an IV pole affect IV therapy? How are adjustments made?

answer

the pressure on the secondary IV bag will be greater than the pressure on the primary IV bag, and so this pressure will push it down into the tubing and prevent any of the fluid from the primary IV from entering the tubing until the secondary IV has emptied.

question

Describe techniques to correct for an over or under filled drip chamber.

answer

This is where we measure the speed of a manual IV setup; we look at this chamber and count the number of drops we see per minute.

question

Where might fluid collect when infiltration occurs in scalp vein IV sites?

answer

Superficial Temporal vein, Occiptal vein, Posterior Auricle vein, Posterior Facial vein, Supraorbital vein, Frontal vein

question

A filter needle may be indicated during preparation of prescribed medication from a glass vial. What is it intended to filter? If a filter needle is not available, what technique should be used?

answer

Must be used whenever blood is transfused; many blood administration sets are manufactured with an in-line filter, bu nurse must be sure one is utilized. Aseptic technique

question

Discuss recent research on the effectiveness of substituting normal saline flushes for heparin.

answer

Reduce the risk of phlebitis, low incidence of side effects when properly used, low risk of tort liability with heparin flushing practice

question

Describe the positive pressure technique (antegrade) when flushing a heparin lock and why it is used.

answer

This is in contrast to "antegrade" technique that is generally used where tubing is pinched above the port and the IV flow stopped while the medication is pushed into the tubing. Medications should be diluted when given IV push or the tubing should be alternately pinched and released while pushing the medication to allow for dilution.

question

When is the retrograde technique used?

answer

Used primarily for children. Tubing is pinched just below port. Medication is added in the port and flows up towards the IV bag. Tubing is released and allows medication to travel slowly into the vein rather than being "pushed" as a bolus.

question

Your patient is weighed daily and has gained 2 lbs. This corresponds closest to how much fluid retention?

answer

1000 mL

question

Serum electrolyte concentrations are most commonly given in terms of

answer

mEq/L

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A hypertonic solution is ordered for your patient. The result would be

answer

fluid would move out of the intracellular space into extracellular space

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While giving care to your postoperative patient you notice that the IV solution has stopped infusing. You would do all

answer

inspect the IV tubing for kinks reposition the patient release tape above the site and re-tape

question

In distinguishing between infiltration and phlebitis, signs you expect to find include

answer

erythema, warmth and slight induration indicates phlebitis a cool blanched area around insertion site indicates infiltration a palpable venous cord can accompany phlebitis

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How fast should IV bolus medications be given?

answer

It varies depending on the medication

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Measures used to remove air in the IV line include

answer

hold tube taut and give sharp tap to line invert y sites when priming tubing withdraw air using a needle and syringe

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The objective for a patient's IV fluid therapy is to replace both water and electrolytes. From the following solutions, which best meets the objective?

answer

Ringer's Lactate

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Current recommendations for changing IV tubing and IV solutions are

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tubing change every 72 hrs; IV solutions every 24 hrs

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Research supports that the incidence of infection at the site of an IV increases significantly after

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72 hours

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The butterfly needle is particularly useful for

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the elderly for short-term therapy

question

A drug frequently added to IV solution that is irritating to veins and has a high specific gravity

answer

KCL

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The rate and dose volume of intermittent IV drug delivery should

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not vary from dose to dose be delivered according to recommended rate be discussed with physician if recommended dose volume and rate of delivery exceed a patient's fluid needs

question

Most intermittent IV drug infusions should be given within

answer

30 to 60 minutes

question

What is another name for an intermittent access device?

answer

Hep-lock

question

Syringe pumps are used particularly when

answer

a constant, precise infusion rate is required

question

Manual antegrade and retrograde methods (IV bolus) for IV drug administration are particularly useful when

answer

IV flow is less than 20 mL/hr and dose volume is 2.5 mL or less

question

Why is lower extremity venipuncture not recommended for adults?

answer

There is an increased danger of thrombophlebitis

question

You notice that you have to give your patient an IV piggyback of Dilantin, which is not compatible with the patient's primary D5W IV solution. What should you do?

answer

Obtain an order to change to a compatible IV solution.

question

Which of the following is a sign that your patient is fluid overloaded?

answer

Elevated blood pressure

question

Phlebitis

answer

Inflammation of the vein. Red streak at site, swelling, pain. Prevent by using as small a needle as possible (catheter), tape the tubing and catheter to prevent irritation. Change site every 7 days or more frequently if signs and symptoms of complication are present.

question

Infiltration

answer

IV site is white, cool, swollen, and tender, IV rate is altered. Prevent by securing site...taping and board. Discontinue IV and restart.

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Embolus of air

answer

Properly prime the tubing. Tape connections. Do not open the IV system for any reason. Symptoms of embolus are air hunger and respiratory distress.

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Clot Dislodges

answer

Do not let IV run dry and form clot. Do not flush the IV to try to "save" a dry IV.

question

Describe techniques to correct for an over or under filled drip chamber.

answer

Invert bag and squeeze drip chamber to expel fluid back in bag.

question

Peripherally Inserted Central Catheter

answer

Goes into basilica vein and is threaded into the superior vena cava. X-ray to check placement. Some tubes have valve to prevent blood back up in the catheter. Lasts 6 weeks to 1 year. Dressing must be sterile and kept dry.

question

Central Catheters, Tunneled

answer

Catheter placed under the chest wall into the subclavian or jugular veins and may extend to the superior vena cava. Use air occlusive dressing. Tunneled catheters are Hickman, Broviac, and Groshong and can be used for long periods of time up to years

question

Non-tunneled central catheters

answer

large bore catheters that enter the jugular or subclavian directly and used for a short period of time than tunneled.

question

Implanted Ports

answer

Ports are under skin in the subcutaneous pockets of the chest, arm, abdomen, or back. Catheter line then goes into the superior vena cava. Made to withstand 2000 needle sticks with special needle. Used for infrequent access...monthly meds or treatment.

question

Care and maintenance of venous access devices

answer

Use sterile technique with mask as indicated.

question

Microdrip

answer

tubing for administering under 100cc per hour.

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Macrodrip

answer

tubing for over 100cc per hour

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Osmotic pressure

answer

controls the distribution and movement of the water between body compartments.

question

Normal serum osmolarity is approximately

answer

280-303 m/Osm/L.

question

Handwashing before touching components

answer

gloving and asepsis as indicated.

question

Keep IV spike, IV port, and end of IV tubing sterile.

answer

Use aseptic technique

question

Describe nursing interventions when you suspect an IV occlusion.

answer

Raise the bag or lower the arm. Fluid runs by gravity except when administered by and IV pump. Increase flow rate briefly to flush blood back if the IV is intact. Discontinue if the blood has clotted and fluid does not run.

question

Groshong catheters

answer

3 way pressure sensitive valve that restricts air from entering the venous system and prevents backflow of blood

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