question

True or False Intravenous therapy is a method of replacing fluid and electrolytes into the blood stream rather than the digestive stream.

answer

True

question

What is the technique used where the vein is punctured through the skin by a sharp rigid stylet?

answer

Venipuncture

question

What does Parenteral Replacement include?

answer

1. TPN - Total Parenteral Nutrition 2. Crystalloids - fluid and electrolyte replacement 3. Colloid - blood and blood components.

question

When did IV therapy become popular? A. 1980's B. 1960's C. 1950's D. 1970's

answer

1950's

question

What Percentage of all patients have IV's?

answer

80%

question

IV therapy

answer

- Standard precautions must be implemented when performing IV therapy * Risk for HIV, Hep B/C, etc.

question

What are the 7 reasons for IV therapy/

answer

1. Correct fluid and electrolytes 2. Give continuous or intermittent meds 3. Give blood or blood components (colloids) 4. Give a bolus preparation 5. Obtain blood samples 6. Provide TPN (total parenteral nourishment) 7. Keep the vein open (KVO)

question

Cathilons

answer

- Gauge - the larger the gauge number, the smaller the diameter of the shaft. - If you use a large cathilon, use a large vein - Always used the smallest possible needle to get the job done. Consider the age, size, and condition of th patient.

question

When would you use a 16 G needle?

answer

Major Surgery

question

When would you use a 18 G needle?

answer

Blood and lots of fluid

question

When would you use a 20 G needle?

answer

Universal

question

When would you use a 22 G needle?

answer

Small and elderly (appropriate for fluid maintenance)

question

Veins in the upper extremities

answer

Digital Metacarpal Cephalic Median Vein Median cubital Basillic

question

What vein is this: - Not commonly used - Begins at the fingers - Only short term use

answer

Digital

question

What vein is this: - Knuckles to wrist - Easy to access - Longer lasting

answer

Metacarpal

question

What vein is this: - Most commonly used vein - Larger in size - Allows larger cannula - larger vein for blood administraiton

answer

Cephalic

question

Median vein and median cubital vein

answer

Large veins

question

What vein is this: - Must flex arm up - large vein also - can roll, but is also a good vein if established.

answer

Basillic

question

Other insertion sites

answer

1. Scalp and lower extremities - foot beans may be used in children, but avoided in adults due to danger of thrombophlebitis (blood clot) - Scalp veins were used frequently in infants. many psychosocial considerations for parents.

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Insertion site considerations

answer

1. avoid areas easily bumped in the elderly and children (wrists) 2. Always start distal with insertion sites and move proximal. 3. Avoid any site which appears infected 4. Avoid using any side with a graft/fistula or mastectomy.

question

Additional forms of IV therapy

answer

1. Central lines - CVC (Central Venous Catheter) - Usually Triple Lumen 2. PICC Lines - Peripherally Inserted Central Catheter (starts in the arm and goes to the heart). 3. Mediports - device implanted under the skin.

question

IV Equipment

answer

1. Bags - most common, collapsable, no venting is required. 2. Bottles - if additives absorbed by plastic (usually lipids seen with TPN)

question

IV Solutions

answer

1. IV solutions fall into three categories and most are mixed. 1. Isotonic 2. Hypertonic 3. Hypotonic

question

Isotonic

answer

- Same effective osmality as body fluids - Indicated for extracellular volume replacement Ex. FVD after prolonged vomiting - D5W, NSS, LR (multipe electrolytes) - D5W (Dextrose is quickly metabolized leaving free water to be evenly distributed) - LR contains Na, K, Ca, Cl and lactate.

question

Hypertonic

answer

- Have an effective osmality greater than the body fluids. Example - D5WNS, D51/2NS (5% dextrose and 0.45NS) D5LR

question

Hypotonic

answer

- Have an effective osmality less than body fluids. Ex. 1/2 NS = 0.45NS

question

Hypertonic and Hypotonic

answer

Based on the patient's specific fluid and electrolyte imbalance

question

IV additives

answer

- Potassium is commonly added to IV solutions to correct imbalances or for clients who are NPO. - Body cannot conserve Potassium (NPO status) and the kidneys continue to excrete K, leading quickly to Hypokalemia. - Likely, assess to see if the client has adequate urinary output before administering K to avoid Hypokalemia. - Potassium is very closely monitored, because it is directly related to cardiac dysrrhythmia.

question

IV administration Sets

answer

1. Heparin Lock 2. Extension Tubing 3. Piggy Back Admin Set 4. Basic Tubing 5. Primary Tubing 6. Plum Pump tubing 7. Secondary Tubing 8. Secondary sets 9. Volume Chambers/Solusets/buretrols 10. Controllers - can be added to the IV tubing station (Stat Masters) 11. Pumps

question

IV pumps

answer

Altoona Hospital uses the PLUM PUMP - This helps to prevent fluid overload. - Must know how to operate it. - Tubing contains a cassette which is inverted into the pump after bing primed. - 5 main buttons: 1. Rate: ml/hr 2. VTBI (Volume to be infused) 3. Run 4. Hold 5. Clear

question

Initiating a peripheral Intravenous Infusion

answer

- Review physicians orders for TYPE, AMOUNT, RATE OF ADMISSION. - Follow the 6 rights of med administration - Observe for S/S of fluid and electrolyte imbalance: - Edema and/or increased body weight - dry skin/mucous membranes - Distended neck veins - blood pressure changes - irregular pulse rhythm - thirst - decreased urine output. **** The pump is the most effective way of doing IV meds

question

Initiating a Peripheral Intravenous Infusion

answer

1. Assess client's previous IV experience, and arm preference. 2. Determine if cline needs to undergo any procedures, surgeries, blood transfusions, etc, so that you know what size needle is needed. 3. Assess lab data 4. Assess risk factors (child, heart failure...) 5. Explain the procedure

question

Initiating a Peripheral Intravenous Infusion

answer

1. Wash hands 2. Organize equipment 3. Check solution per 6 rights and for color, clarity, etc. 4. Open infusion set maintaining sterility on both ends of tubing 5. remove protective covering over IV bag port and spike of tubing.

question

Initiating a Peripheral Intravenous Infusion

answer

1. Insert spike into bag 2. place IV pole (minimum 35 inches) 3. Squeeze drip chamber to fill with 1/3 to 1/2 full of liquid 4. open clamp and prim with solution to rid of all air and air bubbles 5. to remove air bubbles, firmly tap IV tubing where air bubbles are located.

question

Initiating a peripheral intravenous infusion

answer

1. cleanse heplock connector site with alcohol and connect tubing. 2. set flow rate

question

Regulating the IV

answer

1. check site placement and positioning 2. know calibration (drop factor) per milliliter of infusion set (gtt/ml) (usually 15 at altoona hospital except pediatrics) 3. Calculate flow rate 4. Verify order and check 6 rights 5. place adhesive tape on IV bag next to markings 6. Calculate drops per minute.

question

Retulating the IV

answer

1. count the drops in the drip chamber and adjust roller clamp 2. If on a pump - ensure bag is at least 36 inches above the IV site - ensure that air is out of the tubing (prime) - Thread tubing through pump per protocol - Close control chamber door - set rate and volume and press start/run

question

Regulating the IV

answer

1. Monitor infusion rates and IV site for complications 2. assess potency, trouble shooting and alarm sounds on the pump. 3. If policy states, place 2 hour allotment into chamber device 4. assess the system at least hourly 5. Observe client for s/s of complications 6. evaluate and document response

question

IV maintenance

answer

- Line maintenance is achieve by: 1. keeping the system sterile 2. changing dressings, solutions, and tubing 3.assisting the client with self care activities 4. change solutions before the bag empties to prevent clotting. 5. follow agency policy and procedure relating to IV tubing change, dressing change, etc.

question

Which of the following activities can be successfully delegated to a nursing assistive personnel? (select all that apply) a. measuring I & O b. preparing IV tubing for systemic changes c. reporting an IV container that is low in fluid d. discontinuing an IV per health care providers

answer

A and C

question

Infusion complications

answer

1. decreased flow, increased flow, height of bag, fluids remaining, tubing kinked, air in line, tubing clamped, catheter against vein wall

question

Infusion complications

answer

Decreased flow - could lead to further cardiovascular and circulatory collapse in the critically ill.

question

Infusion complications

answer

Increased flow can result in fluid volume excess, may be fatal in some patients

question

Infusion complications

answer

- Height of bag, make sure it is at 36 inches. - Empty bag - be sure to replace bag before fluids empty - Kinked tubing - check tubing for kings, may block infusion - Clamped tubing - make sure tubing is not clamped off

question

Infusion complications

answer

- Air in line - will need to remove air from the line. disconnect tubing and print to remove air. Clean with alcohol, flush IV site, clean again with alcohol and reconnect.

question

infusion COmplications

answer

- Catheter against wall - reposition patient. **** If patient complains, take it out.

question

Blood transmissible diseases

answer

- Hepatitis, HIV - be sure to always follow standard precautions

question

IV complictions

answer

1. Infiltrations - occurs when IV fluids enter the surrounding space around the venipuncture site. - s/s: swelling (increased tissue fluid) pallor and coolness (decreased circulation) patient may complain of pain at site - stop infusion immediately - to decrease edema, wrap a warm moist towel around for 20 minutes and elevate extremity

question

IV complications

answer

1. Phlebitis - inflammation of the vein - risk factors: antibiotics, anatomical position of catheter and material of the catheter. s/s: pain, edema, erythema and increased skin temperature over the vein, redness may travel along the vein. - IV line must be discontinued, may apply warm moist compress, could cause damage to veins and blood clots may form.

question

Assessment of IV infiltration includes: (choose all that apply) a. edema and pain b. streak formaiton c. pain and erythema d. pallor and coolness e. numbness and pain

answer

A and D

question

Things to remember

answer

- always check bag for expiration - check for contaminates - check the physicians orders - assemble all of the equipment - wear gloves - check IV flow rate - assess for complications - document

question

discontinuing an IV

answer

wash hands, remove tape, hold sterile pad just above the site and smoothly remove cathilon, old pressure until bleeding stops, inspect for any fragments, document

question

Documentation

answer

1. label the tubing 2. label the container (time, date, additives, rate) 3. document (chart and flow sheets, legible, NEVER Write directly on the bag, be specific, remember this is common for law suits)

question

Blood replacement (Colloids)

answer

- IV administration of whole blood or a component such as plasma, packed RBCs or platelets. - Objectives of Blood Transfusions 1. increase circulating blood volume 2. maintain hemoglogin volumes for severe anemia 3. component replacement therapy

question

Blood replacement (Colloids) - Blood Groups/types

answer

- very critical patient to have blood matched properly (2 RN's need to to verify) - need to know patient's blood type and RH factor (antigenic substance) - If blood is mismatched, will cause a transfusion reaction ranging from mild to life threatening. AUTOLOGOUS TRANSFUSION - a collection of the client's own blood prior to the surgery or preoperative, and infused back into the client.

Nursing 251 Intravenous Therapy Exam 2 – Flashcards

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