I.V. Therapy – Flashcards
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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
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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
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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
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Explain why the elderly and infants do not tolerate dehydration as well as middle age adults.
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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.
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Why is weighing a patient important when assessing fluid and electrolyte status?
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Daily weights are useful for patients with clinical dehydrations or other causes or risks for ECV deficit.
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Describe ways to remove air from tubing during priming and when the IV is already connected to the patient
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Air in tubing: Prime carefully. Use a needle to aspirate air if tapping does not move the air to the port or drip chamber
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Describe how you would restrain the child, when starting the IV in the hand and in the foot.
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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.
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How does the height or an IV pole affect IV therapy? How are adjustments made?
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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.
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Describe techniques to correct for an over or under filled drip chamber.
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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.
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Where might fluid collect when infiltration occurs in scalp vein IV sites?
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Superficial Temporal vein, Occiptal vein, Posterior Auricle vein, Posterior Facial vein, Supraorbital vein, Frontal vein
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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?
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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
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Discuss recent research on the effectiveness of substituting normal saline flushes for heparin.
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Reduce the risk of phlebitis, low incidence of side effects when properly used, low risk of tort liability with heparin flushing practice
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Describe the positive pressure technique (antegrade) when flushing a heparin lock and why it is used.
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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.
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When is the retrograde technique used?
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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.
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Your patient is weighed daily and has gained 2 lbs. This corresponds closest to how much fluid retention?
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1000 mL
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Serum electrolyte concentrations are most commonly given in terms of
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mEq/L
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A hypertonic solution is ordered for your patient. The result would be
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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
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inspect the IV tubing for kinks reposition the patient release tape above the site and re-tape
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In distinguishing between infiltration and phlebitis, signs you expect to find include
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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?
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It varies depending on the medication
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Measures used to remove air in the IV line include
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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?
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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
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A drug frequently added to IV solution that is irritating to veins and has a high specific gravity
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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
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Most intermittent IV drug infusions should be given within
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30 to 60 minutes
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What is another name for an intermittent access device?
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Hep-lock
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Syringe pumps are used particularly when
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a constant, precise infusion rate is required
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Manual antegrade and retrograde methods (IV bolus) for IV drug administration are particularly useful when
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IV flow is less than 20 mL/hr and dose volume is 2.5 mL or less
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Why is lower extremity venipuncture not recommended for adults?
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There is an increased danger of thrombophlebitis
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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?
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Obtain an order to change to a compatible IV solution.
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Which of the following is a sign that your patient is fluid overloaded?
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Elevated blood pressure
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Phlebitis
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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.
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Infiltration
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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
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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
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Do not let IV run dry and form clot. Do not flush the IV to try to "save" a dry IV.
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Describe techniques to correct for an over or under filled drip chamber.
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Invert bag and squeeze drip chamber to expel fluid back in bag.
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Peripherally Inserted Central Catheter
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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.
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Central Catheters, Tunneled
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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
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Non-tunneled central catheters
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large bore catheters that enter the jugular or subclavian directly and used for a short period of time than tunneled.
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Implanted Ports
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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.
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Care and maintenance of venous access devices
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Use sterile technique with mask as indicated.
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Microdrip
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tubing for administering under 100cc per hour.
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Macrodrip
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tubing for over 100cc per hour
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Osmotic pressure
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controls the distribution and movement of the water between body compartments.
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Normal serum osmolarity is approximately
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280-303 m/Osm/L.
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Handwashing before touching components
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gloving and asepsis as indicated.
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Keep IV spike, IV port, and end of IV tubing sterile.
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Use aseptic technique
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Describe nursing interventions when you suspect an IV occlusion.
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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.
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Groshong catheters
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3 way pressure sensitive valve that restricts air from entering the venous system and prevents backflow of blood
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