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Stack #171828
HCC 2008 parenteral Fluid therapy
| Question | Answer |
|---|---|
| What is the purpose of fluids? | provide H2O, electrolytes and nutrients, replace H2O and correct electrolyte deficits, administer meds and blood products |
| types of intravenous | Isotonic, Hypertonic, Hypotonic |
| Isotonic | same osmolality as plasma 290 mOsm/L, ability of fluid to move freely btw intravascular tissue and cells |
| examples of isotonic solutions | NSS (0.9% sodium chloride), D2W, LR |
| some uses of Isotonic solutions | expand intravascular compartment, maintain hydration |
| S/E of Isotonic solution | electrolyte imbalance, circulatory overload |
| Nursing actions when using isotonic solution | monitor BP and P (increase, bounding), monitor electrolyte levels, monitor to avoid fluid overload |
| Hypotonic | osmolality is LOWER than plasma, shift fluid from IV compartment to cell and IS |
| examples of hypotonic solutions | 0.45 NaCl(1/2 NS), D2.5W, 1/3 NS |
| uses of hypotonic solutions | treat dehydration |
| S/E of hypotonic solutions | over hydration of cells |
| Nursing Implications when using hypotonic solution | avoid if risk of 3rd space fluid shift, avoid with increased ICP or cerebral edema(run risk of increasing edema) |
| Hypertonic | osmolality is HIGHER than plasma, pull fluid from IS/cells into IV space |
| examples of hypertonic solution | D5 1/2NS, D5NS, D10W |
| uses of hypertonic solutions | treat edema, replace electrolytes i.e: Na+ or glucose |
| S/E of hypertonic solution | circulatory overload |
| Nursing Implications when using hypertonic solution | monitor BP, P and electrolytes, avoid with kidney or heart problems, avoid with dehydrated patients |
| Hyperalimentation(TPN) examples | CHO, amino acids, lipids, e-lytes, vitamins, minerals |
| uses for TPN | provides nutrients (NPO long periods or not getting enough nutrition PO |
| S/E of TPN | hyperglycemia, electrolyte imbalances, infection(look @ labwork WBC, infection site and over all S/S), circulatory overload |
| TPN nursing implications | nutritional assessment: wt, electrolytes QD, albumin level, increase hydration status(urine output; monitor VS q4H and strict I&O, central line not though a peripheral line, sterile technique ALWAYS |
| what should you check when monitoring hydration? | weight, turgor, BP and P, mucous membranes (moist pale and pink), JVD (jugular vein distention), edema(everywhere-starts hands, eyes, face feet legs and lungs), IV therapy record and I&O sheet, Nutritional Status (lab work, weight,stable or increased, wou |
| Cause of Infiltration | dislodged needle, leaky site |
| Symptoms of infiltration | swelling, coldness, pallor, decreased IV flow, pain, white |
| Infiltration Prevention | check site frequently (every time you walk in the room), leave site visible, pt teaching |
| Treatment of Infiltration | Disconnect IV and restart ABOVE site, elevate extremity, order for heat (promote circulation) or cold (minimize med from spreading into SubQ) therapy |
| IF IN DOUBT... | TAKE IT OUT |
| Phlebitis | inflammation of vein |
| Causes of Phlebitis | mechanical/chemical trama, contamination |
| Symptoms of Phlebitis | pain, tenderness, warmth, redness along vessel, slight swelling, fever, sometimes it become harder |
| Prevention of Phlebitis | use a large vein (especially if giving a highly irritating med), use a filter with caustic medications, tape securely, aseptic technique |
| Thrombus/Thrombophlebitis | clot |
| Cause of Thrombus | trauma(in the vein when placing the IV, flow rate slowed or stopped |
| symptoms of a Thrombus/Thrombophlebitis | thrombus: no flow; Thrombophlebitis: no flow, same S/S as phlebitis |
| prevention of Thrombus/Thrombophlebitis | good venipuncture technique, flush saline lock at least q8hrs |
| treatment of Thrombus/Thrombophlebitis | stop the infusion and discontinue IV, DO NOT flush, DO NOT massage site, restart above site, warm compress(Thrombophlebitis)-promote circulation |
| Causes of bleeding (IV) | Tubing: bag below level of heart, increased pressure in vessel... Site: disconnected from tubing (didn't hook clamp properly) |
| Symptoms of Bleeding | blood in tubing, blood dripping from site |
| preventing Bleeding | keep IV bag elevated, tight connections, tape IV securely |
| Treatment of bleeding | tubing-raise bag, flush... witnessed- flush and change tubing.... Not witnessed: D/C and restart |
| causes of Circulatory overload | improper IV rate, miscalculation of fluid, fluid shift |
| Symptoms of Circulatory overload | JVD, resp distress, crackles ---> resp. arrest, increased BP and P, I>O |
| Prevention of Circulatory Overload | use an IV pump, check flow rate often, recheck calculation of fluid requirements, asses patient and infusion often (q2h) |
| Tx Circulatory overload | raise HOB, stop fluid, notify MD, meds: diuretics |
| Causes of Systemic Infection | non-aseptic technique, phlebitis( allowed to continue without treatment), poor dressing, prolonged indwelling catheter time, immunocompomised pt |
| Symptoms of Systemic infections | fever chills, malaise, contaminated IV site |
| Prevention of Systemic infections | aseptic technique, secure all connections, change solution, tubing and cannula |
| how often should you change solution, tubing or cannula? | every 96 hours or agency policy(usually 72 hrs; less than 72 hrs if there is a problem) TPN changes every 24 hrs w/ filter |
| Air Embolism | air bubble in blood stream |
| Causes of Air Embolism | NURSE- not monitoring IV, empty solution container, air in tubing leads to resp arrest |
| Symptoms of air embolism | resp distress, unequal breath sounds, weak pulse, increased CVP (cardiovascular pressure), decreased BP, loss of consciousness |
| preventing and Air embolism | purge air from tubing, use air detection device, secure connections |
| Tx for an Air Embolism | stop infusion but keep IV access, Trendelenburg position on left side, Oxygen, notify MD, emergency equipment to bedside |
| Causes of Allergic Reactions | allergens: medication, latex |
| Allergic (anaphlaxis) Reaction is | an antigen antibody reaction |
| Symptoms of an Allergic Reaction | itching, runny eyes and nose, bronchospasm, wheezing, urticarial rash, edema at IV site, anaphylactic reaction |
| Prevention of Allergic Reaction | allergy history, test done, monitor closely- first 15min |
| Treatment of Allergic Reaction | stop infusion but maintain IV access, maintain airway, notify MD, meds: antihistamines, steroids, epinephrine, document allergy |
| Speed Shock Cause | IV fluid infuses too rapidly |
| Symptoms of Speed Shock | pounding headache, increased pulse, apprehension, chills, backache(kidneys), dyspnea |
| Speed Shock prevention | monitor IV rate and flow-time tape, use correct size IV tubing |
| Tx speed shock | stop infusion but maintain IV access, monitor V/S, notify MD |
| Advantages of IV medications | immediate or rapid effect, maintain blood levels, bypass body system or tissue irritated by medication, avoid inactivation by GI secretions, unconscious pt/unable to swallow, absorption not affected by barriers in GI system |
| Disadvantages of IV medications | unable to retrieve, toxic effects develop quickly, incompatibilities, technical difficulty, complications (infection) |
| Vitamins (banana bag) | used as supplement |
| Side effects of Vitamins | hypersensitivity, phlebitis |
| Nsg implications of Vitamins | yellow tint to solution, check Iv site for irritation, monitor allergic reaction |
| uses of Potassium Chloride | treat hypokalemia |
| side effects of Potassium Chloride | highly irritating to the skin (chemical phlebitis) if given IV, and Gastric lining if given orally |
| Methods of intermittent Infusion | IVPB, Saline lock, Gravity or IV pump |
| Piggyback Infusion | piggyback higher, lower bag runs when IVPB is complete |
| Saline/Heparin Lock | catheter ONLY in vein, intermittent use, flushed at least q8hrs to maintain patency |
| IV push | one-time drug admin, small amount, short infusion time, use injection part on tubing |
| IV bolus | large amount, bag or bottle, administered all at one |
| Example of IV Bolus is | NSS |
| Furosemide/Lasix | loop diuretic |
| Uses of Furosemide/Lasix | hypertension, edema, fluid overload |
| S/E of Furosemide/Lasix | dehydration, hypokalemia (k+ wasting) |
| Nursing Implications Furosemide/Lasix | monitor BP(systolic >100 DONT GIVE), P( directly related to K+ too low or high), weight(watch for retention or lack of), K+ level, administer slowly over 2 minutes |
| Potassium Sparing Diuretics: Sprinolactone (Aldactone) | never use salt substitutes, increased risk of hyperkalemia, only po avalible |
| Sprinolactone (Aldactone) pulls excess fluid but does not waste ____ | K+, K+ level is not effected |
| The ________ is responsible for regulating the infusion according to the ___________ order | Nurse, Physicians |
| Infusion Rate depends on Patient related conditions such as | age and condition of the pt, fluid status of pt, need for fluid or med, cardiac or renal status, size of needle, reaction of vein to infusion |
| Infusion Rate depends on External Factors such as | catheter must be patent, tubing free of kinks or knots, hight of solution bag, viscosity of fluid, position of extremity(remind pt to keep arm straight and out) |
| Drop-regulated IV pumps | sensor over drip chamber, counts drops/min |
| Volume-regulated (Volumetric) IV pumps | ml/hr |
| Common Characteristics of IV pumps | volume to be delivered/infused (VTBI), amount over time- ml/hr(rate) |
| Alarms on IV pumps might sound for | occlusion, air, infusion complete |
| two types of calculations are in | drops per minute (gtts/min), or ml per hour (ml/hr) |
| Macrodrop | 10-30 gtts/mL |
| Microdrop | 60 gtts/min used to titrate medications or to control flow if no infusion pump ----usually used in peds |
| ? gtts equals ... | 1 mL of solution |
| N/R with Infusion pumps | check flow, monitor level of bag |
| N/R with Rapid Infusion | Circ overload/speed shock, increased S/E from medications |
| N/R when using Slow Infusion | dehydration, inaccurate med blood levels |
Created by:
jaed008
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