Vascular / IV Therapy / Electrolytes – Flashcards
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Pulmonary System
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Blood flows from Right Ventricle through Pulmonary Artery to the Lungs where it is oxygenated then returned to the Left Atrium via Pulmonary Vein
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Peripheral Vascualar System
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Oxygenated blood flows from Left Ventricle to all parts of body via arteries and returns deoxygenated blood to the Right Atrium via veins
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Epidermis
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Outer, protective layer of skin
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Dermis
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Soft, connective tissue layer made up of collagen and elsastic fibers; Contains blood and lymphatic vessels, sebaceous, sweat glands, hair follicles, nerve receptors
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Subcutaneous Tissue
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Contains loose connective tissue, adipose tisue, and superficial veins used for PERIPHERAL VENIPUNCTURE
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Arteries
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Pulsates, contain bright red / oxygenated blood, No Valves
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Veins
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Do not pulsate, contain dark red / deoxygenated blood, Valves
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Blood Vessels
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Made of Smooth Muscles-permits uninterrupted blood flow
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3 Layers Blood Vessels
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Tunica Intima-inner most layer; smooth/elastic Tunica Media-middle layer; receive impulses from nerve fibers allowing contraction and relaxation--BP management Tunica Adventitia-outer layer; connective tissue supports and protects vessels
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Metacarpal Vein (Hand)
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Easily accessible for short-term infusions; veins small require good stabilization
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Acessory Cephalic Vein (Upper Radial Forearm)
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*Most Commonly Used* Large vein-Excellent for venipuncture; accepts large gauge needles; Does NOT impair mobility
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Cephalic Vein (Lower Radial Forearm)
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Large vein-Excellent for venipuncture; accepts large gauge needles; Proximity to elbow may decrease joint movement
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Basilic Vein (Mid Ulnar Forearm)
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Large vein-accepts large gauge needle; Often used for midline insertion-May be painful for venipuncture due to nerves
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Antecubital Veins (Crook of Arm)
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Use in Emergency if no other veins accessible Difficult to splint and stabilize Change site ASAP
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Median Antebrachial Vein (Lower Ulnar Forearm)
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Last Resort Many nerve endings--painful Infiltration easily occurs
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Circulation Volume
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Approximately 5 LITERS of Blood Per Minute is circulated in the resting adult
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IV Insertion Considerations
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Use Smallest Cannula in the Largest Vein possible to allow for adequate blood flow around the cannula to prevent thrombus formation
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Homeostasis
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Mechanisms the body uses to maintain constant conditions in the body
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Body Gains Liquids
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Liquid Intake = 1100-1400/day Solid Foods = 800-1000/day (meat 70% water;fruits/vegetables 90%water) Oxidation of carbohydrates, proteins, fats = 200-350/day
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Body Loses Liquids
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Exhalation (Insensible) = 300-400/day Skin (Insensible) = 300-400/day Sweating = 100/day (hot weather/exercise =1L) Fever 101-103 = 500/day Fever >103 = 1000/day Feces = 100/day (unless diarrhea) Urine = 1500/day (40-80/hr)
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Fluid Loss Conversion
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1 Kg weight = 1 L fluid
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2 Compartments Body Fluids
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Intracellular 2/3 Extracellular 1/3
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2 Compartments Extracellular Fluid
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Interstitial 2/3 Intravascular 1/3
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Interstitial Extracellular Fluid
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Fluid around cell; includes lympatic
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Intravascular Extracellular Fluid
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Fluid within blood vessels (blood) = 5L
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Transcellular Fluid
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Saliva, Pancreatic secretions, CSF, Synovial Fluid, Pericardial Fluid
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Solution
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Mixture Solute and Solvent
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Solute
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Particles / Substance in the solution Examples: Na, K, Ca, HCO3, Cl, Mg
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Solvent
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Fluid in the solution that dissolves the solute
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Cations
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An ion with fewer electrons than protons, giving it a POSITIVE CHARGE Na, K, Ca, Mg
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Anions
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An ion with more electrons than protons, giving it a net NEGATIVE CHARGE Cl, HCO3, Phos
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Isotonic Fluids
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Similar to Plasma Fluid Expander Osmotic pressure constant both inside & outside cells = NO SHIFT (*stays in extracellular*) 0.9%NaCl, LR, D5W, Ringers
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Nursing Considerations Isotonic IV
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Watch Hypervolemia Watch Continued Hypovolemia Assess: VS, Edema, Lung sounds, Heart sounds
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S/S Hypervolemia
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Hypertension, Bounding Pulse, Crackles, Dyspnea, Periperal Edema, JVD, Extra Heart Sounds
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Nurse Interventions Hypervolemia
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Monitor I/O, Hct, Hgb, Elevate HOB 30-45, Elevate legs for edema, Note pitting/nonpitting edema and grade (1+ - 4+)
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.9% NaCl (Normal Saline) Solution
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Salt water Tx: Fluid Volume Deficit, Resuscitation *Only fluid used with blood products* Caution: Cardia, Renal
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Lactated Ringers Solution (LR)
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Most adaptable-Electrolyte content closest to blood serum and plasma Tx: Burns, Electrolyte Replacement, Metabolic Acidosis Caution: Renal, Liver Disease, Alkalosis
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Ringers Solution
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No lactate - used similarly to LR *Not alkalizing so, not for treating metabolic acidosis*
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D5W Solution
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Sugar Water *Both Isotonic and Hypotonic* Isotonic until dextrose is metabolized leaving only free water (Hypotonic) Tx: Hydration, Inc Renal Excretion of Solutes, Hypernatremia Caution: Provides 170 calories/L; Dilutes Plasma; Resuscitation, Early Postop, Increased ICP
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Hypotonic Fluids
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Lower concentration of solutes Fluid shifts FROM Intravascular TO Intracellular/Intersitial HYDRATE CELLS Provide free water, Na, Cl, Replace natural fluid losses .45NaCl, .33NaCl, .2 NaCl, 2.5 DW
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Hypotonic Fluid Uses
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Tx Intracellular Dehydration (diabetic ketoacidosis, hyperglycemia) SHIFT FLUIDS INTO CELLS
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Hypotonic Fluid Uses Caution
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Can worsen existing hypovolemia and hypotension - lead to Cardiovascular Collapse
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Nursing Considerations Hypotonic Solutions
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Monitor S/S fluid volume deficit (Confusion, Dizzy) *Never give if increased ICP, Liver disease, Burns*
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Hypertonic Solutions
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Higher concentration of solutes DRAWS WATER FROM CELLS - Increase Extracellular Volume (VOLUME EXPANDERS) D5LR, D10W, D5NS, D20W, D50W
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Hypertonic Fluid Uses
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Volume Expanders, Severe Hyponatremia, Cerebral Edema
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Hypertonic Fluid Uses Caution
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Potential Intravascular fluid volume overload, Pulmonary Edema Do Not Use: Cardiac, Renal, Diabetic Ketoacidosis
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Nursing Considerations Hypertonic Solutions
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Maintain vigilence (high acuity areas) / constant surveillance DO NOT give for indefinite period of time Monitor serum electrolytes, Assess S/S hypervolemia Can cause irritation, damage, thrombosis of blood vessels and require central line (if D10W or higher)
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Colloids
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Remain in Intravascular Compartment (large molecules) Volume Expander / Plasma Expander *Same effect as hypertonic, but require less total volume and have longer duration of action* Albumin, Dextrans, Hydroxyethylstarches
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Colloids Usage Indications
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Hypoproteinemia, malnourishment, Need volume expansion but cannot tolerate large amt fluid
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Albumin (Colloid)
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Considered blood transfusion Contraindicated: Severe Anemia, Heart Failure, Sensitivity to Albumin *Hold ACE Inhibitors 24 hours prior to adminsitration (hypotension)*
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Nursing Considerations Colloid Solutions
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Patient at risk for FLUID VOLUME OVERLOAD
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Blood Product Administration
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18-gauge or larger IV Monitor S/S hypervolemia (Inc BP, Dyspnea, Crackles, JVD, Edema, Bounding Pulse) Monitor I/O *4 Hours Maximum Infusion Time* *Change Tubing with Each Transfusion* *Only Administer with NS*
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Diffusion
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Passive movement of molecules or particles along a concentration gradient, from regions of HIGHER CONCENTRATION TO LOWER CONCENTRATION Active Transport
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Osmosis
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Spontaneous net movement of solvent molecules through a partially permeable membrane into a region of higher solute concentration LOWER CONCENTRATION TO HIGHER CONCENTRATION
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Starling's Hypothesis
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The flow of fluids across capillary walls depends on the balance between the force of blood pressure on the walls (force fluids out) and the osmotic pressure across the walls (force fluids in) due to the greater concentration of dissolved substances in the blood; Results in an OUTFLOW of fluids at its ARTERIAL end with an increasing INFLOW toward its VENOUS end
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Banana Bag IV
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Multi-Vitamin Solution that is YELLOW Contains vitamins and minerals: thiamine, folic acid, and 3 grams of magnesium sulfate Used to replenish nutritional deficiencies or correct a chemical imbalance in the human body
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IV Infiltration S/S
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Inflammation at or near the insertion site Swollen taut skin with pain Blanching and coolness of skin around IV site Damp or wet dressing Slowed or stopped infusion No blood return
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IV Infiltration Interventions
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Stop IV Cold Compresses Elevate Affected Extremity
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Extravasation
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Infiltration of a vesicant or chemotherapeutic drug
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Extravasation Interventions
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Stop IV Apply Pressure Aspirate as much fluid/blood as possible Elevate Affected Extremity Remove cannula, if applicable Follow all substance-specific measures *May lead to tissue necrosis requiring surgical debridement and/or reconstruction
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Extravasation of Anthracyclines
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Recent clinical trials have shown that Totect (Dexrazoxane) is effective in preventing the progression of anthracycline extravasation into progressive tissue necrosis
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Blood Transfusions
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Minimum 18 gauge peripheral IV Administer immediately upon receiving from blood bank Never add any medications to blood Confirm MD order Check labels on blood/patient with 2 Nurses as per policy Baseline vitals and assess lung status prior to begin May only mix blood with NS Utilize a blood transfusion set with a FILTER Infuse over 2-4 hours No longer than 4 hours
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Blood Transfusion Febrile Reaction
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Usually occur within the first 15-30 minutes/50cc Fever/Chills N/V Headache Flushing
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Blood Transfusion Allergic Reaction
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Hives Pruritis Facial Flushing Severe SOB Bronchospasm
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Nursing Intervention Transfusion Reaction
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STOP INFUSION Treat sypmtoms Return blood to blood bank
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Starting an IV
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Strict aseptic technique Clean area with prep agent-let Completely Dry Avoid valves Begin with distal veins-work way proximal if nec Stabilize catheter Monitor s/s infiltration Administration of cold fluids will lead to venospasm
