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Pharmacology 5 & 6

IV Therapy

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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