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Pharmacology 5 & 6
IV Therapy
| Question | Answer |
|---|---|
| Why is an IV route used? | When it is necessary for medication or fluids to directly enter the blood stream |
| What is the benefit of using an IV route? | Medications are absorbed faster and have an increased onset of action |
| When do you use an IV route? | When a patient is unable to tolerate other forms of a medication, also may be used to administer dyes or other mediums for certain diagnostic test |
| Why is IV therapy used? | Replace lost fluids, rapidly administer medications, deliver nutrients, and administer blood products |
| What percentage of the body's fluids are the intracellular compartments, and where are they located? | 65%, within the cell |
| What percentage of the body's fluids are the extracellular compartments, and where are they located? | 35%, outside the cell |
| What are the two extracellular compartments? | Interstitial & Intravascular |
| Describe interstitial fluid | Approximately 27% of body's fluid, which include lymph, cerebrospinal fluid & gastrointestinal secretions |
| Describe intravascular fluid | Approximately 7% of body's fluid |
| What is the approx. total intake of fluid/day? | 2500mL/day |
| How does the fluid intake breakdown? | 1200mL is oral fluids & 1300mL is from food that has been metabolized |
| What can affect the balance of I/O? | Illness |
| What are the signs of adequate hydration? | Skin turgor, mucous membranes, skin temperature & appearance, I&O, and amount & appearance of urine |
| What role does water play in the body? | Aids in digestion, metabolism, regulation of body temperature, and transportation of nutrients & waste products |
| What is the normal range for sodium (Na)? | 134-145mEq/L |
| What happens when Na levels get to high? | Hypernatremia, caused by fluid loss and excess Na |
| What are symptoms of hypernatremia? | Dry mucous membranes, low urine output, urine is more concentrated, & poor skin turgor |
| What happens when Na levels are too low? | Hyponatremia, caused by fluid excess & Na loss |
| What are the symptoms of hyponatremia? | Headache, fatigue, postural hypotension, muscle weakness, & often accompanies K imbalance |
| What is the normal range for potassium (K)? | 3.5-5.5mEq/L |
| What happens when K gets too high? | Hyperkalemia, caused by renal disease, severe tissue damage with shock, and metabolic acidosis |
| What are symptoms of hyperkalemia? | Nausea, vomiting, diarrhea, cardiac dysrhythmias, EKG changes, and cardiac arrest |
| What happens when K is too low? | Hypokalemia, caused by diuretic meds, trauma, burns, and metabolic alkalosis |
| What are symptoms of hypokalemia? | Muscle weakness, anorexia, nausea, vomiting, EKG changes, and cardiac dysrhythmias |
| What is the normal range for Calcium (Ca)? | 8.4-10.6mEq/L |
| What happens when you have too much Ca? | Hypercalcemia, caused by calcium released from bone to circulation due to immobility & bone destruction; excessive intake of Calcium containing antacids or Vit D & calcium |
| What are symptoms of hypercalcemia? | Thirst, polyuria, decreased muscle tone, and kidney stones |
| What happens when you don't have enough Ca? | Hypocalcemia, caused by diarrhea, decrease in Ca intake, intestinal disease, and decreased parathyroid function |
| What are symptoms of hypocalcemia? | Osteoporosis, pathological fractures, tingling in face, fingers & toe, muscle spasms, nausea, vomiting, diarrhea, and tetany |
| What are the normal ranges for magnesium (Ma)? | 1.3-2.1mEq/L |
| What happens when Ma levels are too high? | Hypermagnesemia, caused by renal failure & diabetic ketoacidosis with severe fluid loss |
| What are symptoms of hypermagnesemia? | Hypotension, vasodilation, including heat, thirst, and nausea / vomiting, and decreased deep tendon reflexes. Hypermagnesemia can lead to coma & cardiac arrest |
| What happens when Ma levels are too low? | Hypermagnesemia, caused by decreased Ma intake, impaired absorption from GI tract due to diarrhea, alcoholism, and draining fistula's |
| What are symptoms of hypomagnesemia? | Mental changes such as depression, agitation, confusion, parenthesis, cramps, and tetany |
| When does fluid volume deficit (FVD) occur? | Loss of large amounts of body fluid / dehydration |
| What happens when you have FVD? | Heart rate increases and BP decreases |
| What percentage of fluid loss in an adult is lethal? | 20% |
| What percentage of fluid loss in an infant is lethal? | 15% |
| What causes fluid overload? | Body retains too much fluid |
| What are symptoms of fluid overload? | BP increases, HR decreases, and respiratory sounds are wet with crackles |
| What can fluid overload lead to? | CHF, because the heart has to increase workload |
| What patients are at rise for fluid imbalances? | Burn, cardiac, gastroenteritis, renal, infants, elderly, and those with hormone disturbances |
| What are the three types of IV solutions? | Isotonic, hypertonic, and hypotonic |
| Define isotonic | Causes no changes in cell volume & has the same osmality of body fluid |
| What are examples of isotonic solutions? | 0.9% sodium chloride (aka, normal saline - NS), D5W, LR |
| What is the only fluid that can be infused with blood products? | Normal Saline |
| What do hypertonic solutions do? | Cause the cells to shrink and has a higher osmolarity than the body fluids |
| What are examples of hypertonic solutions? | D5NS, D5 in 0.45% NS, D5LR, D10W, & D50W50 |
| What do hypotonic solutions do? | Cause cells to swell, and have a lower osmolarity than body fluids |
| What are examples of hypotonic solutions? | 0.45% NaCl, 0.33% NaCl, 2.5%DW |
| What is the major electrolyte found in extracellular fluid? | Sodium (Na) |
| What is the major electrolyte found in intracellular fluid? | Potassium (K) |
| What is the difference between cations and anions? | Cations have a positive charge, anions have a negative charge |
| What form of measurement is used for electrolytes in the blood? | MEQ/L - milliequivalent / liter |
| Where are the common sites where a peripheral IV are placed? | Back of hand or forearm |
| What do you do if fluid overload occurs while infusing? | Stop infusion, notify charge nurse & physician, and complete orders as directed |
| How do you prevent phlebitis? | Reduce injurious agents, maintain sterile technique when starting IV, and use in line filters when indicated |
| What do you do if a patient presents with phlebitis? | DC IV and restart in opposite extremity, place warm compress to decrease discomfort |
| What do you do to prevent infiltration/extravasation? | DC site, monitor site for 24hrs to ensure fluid is reabsorbed, warm compress may be used to decrease discomfort (unless infiltration was caused by blood products or vesicants) |
| How do you prevent an air emboli in IV? | Use an electronic infusion pump, monitor IV frequently for air in tubing and improper connection |
| What is the cause of cellulitis in an IV site? | Poor aseptic technique and failure to follow infection control policies |
| What is the treatment for cellulitis? | DC IV & restart in a new location, elevate affected extremity, alternate cool & warm compresses, and administer analgesics, antipyretics, and antibiotics |
| Where are short term IV started in adults? | Back of the hand or forearm |
| What is a common IV site in a child? | Foot |
| Where are long term IV sites typically placed? | High flow veins such as the superior vena cave or the inferior vena cava |
| What are the common solutions used for veins in the arm or hand? | NS and D5 |
| What are the common solutions used for central venous sites? | D25, TPN, large fluid volumes, and irritating medications |
| What are sites to avoid when looking to place an IV? | Distal to previous venipuncture, hardened cordlike veins, infiltrated sites, veins in extremities with compromised circulation, dialysis graft, mastectomy, or paralysis |
| What vein do you start with when starting an IV? | Most distal |
| What do you consider when selecting a needle size for IV? | Patients age, size, and condition |
| What is the best needle size to use for IV? | Smallest gauge and shortest angiocath for prescribed therapy |
| What is the most appropriate angiocath size? | 20-22g, 1-1 1/2" for most adults |
| What do you document for a peripheral venipuncture? | Date, time, size & type of needle used, times attempted, type & amount of fluid infusing, rate of infusion, patient response to procedure, IV pump/controller used (document type & settings of pump), and patient teaching |
Created by:
tandkhopkins
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