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Stack #171828

HCC 2008 parenteral Fluid therapy

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
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