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Pharmacology 7 & 8

IV Therapy

What is the goal of IV therapy administration? Correct or prevent fluid & electrolyte imbalances
What are the indications for IV therapy? Poor tissue absorption, inadequate GI tract functioning, and need for maintaining medications at optimum levels
What is the fastest way to get medication in to your patient? IV route (oral is the slowest)
What are the guidelines for monitoring IV therapy? Ensure solution is infused at ordered rate, ensure correct amount of solution is infused, maintain catheter patency, monitor IV q4hrs, educate pt. to report pain, burning, redness, & swelling @ IV site
Who can an LPN delegate assessing IV site to? Nobody
What is fluid overload caused by? Increased infusion rates
What can fluid overload lead to? Death
What are the signs and symptoms of fluid overload? Dyspnea, rapid/bounding pulse, cough, disorientation, increased BP, crackles, pitting edema, weight gain, and decreased urine output, and distended neck vein
What body system does fluid overload affect? Respiratory
What four groups does fluid overload affect? Very young, very old, those with renal history, and those with cardiac history
What is phlebitis and what is it caused by? Inflammation of the vein, caused by mechanical irritation, low Ph of some IV solutions, and highly concentrated additives
What are the signs and symptoms of phlebitis? Erythema, warmth, edema, and discomfort
What do you do if phlebitis occurs? IV should be discontinued and restarted in a different site with new tubing and fluids
What can you apply to the area of phlebitis to decrease a patients pain & discomfort? Warm compress
What must you have before you can apply a warm compress? Physicians order
How does phlebitis present? Streaking formation and throbbing
What is infiltration/extravasation? Edema that does not subside at IV catheter site (indicates that catheter is out of vein)
What are the signs and symptoms of infiltration/extravasation? Discomfort/dysfunction, decrease in drip rate, IV site will feel cool and skin may have a blanched appearance
What are the steps once infiltration is confirmed? Wash hands, don gloves, discontinue site, and restart new IV in opposite extremity if possible
What must you never do to an infiltration? Apply heat/warm compress
Why must you never apply heat/warm compress to infiltration site? If the infiltration was caused by blood products or vesicants, it can lead to necrosis of the tissue
What is speed shock? Occurs when IV medication is pushed to rapidly
What are signs and symptoms of speed shock? Flushed face, headache, tightness in chest, loss of consciousness, and cardiac arrest
Who do you notify and what do you do in the case of speed shock? Physician / follow orders given to reverse
What is an air embolus? Occurs when air travels from IV line to vein
What are the signs and symptoms of an air embolus? Abrupt decrease in blood pressure, weak/rapid pulse, and cyanosis
What is the treatment of air embolism? Get emergency crash cart, notify physician immediately, place patient in a left side lying position with feet elevated and head of bed lowered (allows for reabsorption of air, if embolism is minor), have patient on high flow O2 (non rebreather mask)
What causes septicemia/systemic infections? Pathogens introduced into the circulatory blood stream. The result is septicemia (blood poisoning)
What are the signs and symptoms of septicemia? Fever, chills, prostration (extreme exhaustion), pain, headache, nausea, and vomiting
How do you treat septicemia? Vigorous antibiotic therapy
What is the best way to reduce risk of infection? Always use sterile technique when starting an IV
What are the many factors that influence the gravity flow of IV solutions? Air in tubing, kinked tubing, clotted tubing, infiltration of IV site, IV pole height, and needle position
How do you ensure correct infusion rate is maintained? Monitor infusions frequently
What is the correct way to count drip rate? Count drips for 15 seconds, then multiply times four
What do you record when documenting intake of IV therapy? Amount & type of fluid infused, and amount & type of new fluid infused
When is the typical time to evaluate final assessment of IV fluids remaining in containers? Approximately 1 hour before shift ends
How do you refer to the amount of fluid that is left to count for the next shift? LTC
What is important to always include when determining fluid intake for your shift? Partial bags, piggybacks, and push medications
What goes on the I & O sheet? Documentation of input and output
What is narcan? Antagonist drug that reverses the effects of opioids
What is Benadryl? Antihistamine
What is morphine? Opioid used to relieve pain
What is Zofran? Antiemetic used to reduce nausea/vomiting
What are the six rights of medication administration? Drug, time, dosage, patient, route, & documentation
Where do you hang the main IV bag when hanging a piggyback? Below the piggyback
What are the steps to preparing IV piggyback? Verify order for medication, dose & time, verify allergies, check PB label for length of infusion time, calculate drops/min or mL/hr for infusion, wash hands and follow standard precautions
How much do you flush before and after PB? 3 mL
What is a PCA? Patient controlled analgesia - continuous infusion of opioids into the blood stream
What is basal rate? Continuous
What is the typical lock out interval? 15 mins
When are PCA's used? Only when needed - usually by patients with terminal cancer, or other chronic conditions, also for short term treatment of surgical pain
What is loading dose? Dose given right away
What do you assess with a patient who has a PCA? Check patient at regular/frequent intervals, monitor patients behavior, vital signs, level of consciousness, and pain level
What is the patient teaching for PCA? Teach to use before the pain gets severe, how to rate pain on pain scale, educate about lockout interval
What do you document when a PCA is used? Setting of PCA pump, loading dosage, maintenance dosage, & lockout interval, shift totals, patient response to medication, patients pain level, and patient & family teaching
When patient's PCA is discontinued, what must you make sure to do? Waste all pain medication that is left PCA pump with another nurse immediately
What is important to do before administering IV push medications? Check for compatibility when being mixed into the same syringe
If medications can not be mixed, what must you make sure to do in between each push? Flush with 3 mL of NS
What is a buretrol? Device that holds limited quantities of IV fluids of medications
Why is a buretrol used? To prevent fluid overload in pediatrics and elderly patients
What is a Hickman or Broviac catheter use for? Obtaining blood samples and administer medications
Where is a Hickman or Broviac catheter placed? Large vein such as cephalic or internal jugular vein (tip extends to the right atrium (Always use sterile technique)
What is an implanted port (Port-a-cath, Venoport)? Surgically implanted port that is commonly used in patients who will require long term intravenous access
What is a triple lumen catheter? IV catheter that has three lumens
What is each of the three lumens in a triple lumen catheter used for? Transfusion lumen, blood-feeding lumen, and blood-removing lumen
What is a central venous catheter (central line)? Catheter inserted in a large vein until it reaches a vein near the heart
What is a peripheral inserted central catheter (PICC) line? Catheter inserted into a peripheral vein until it reaches the superior vena cava
What is TPN? Total parenteral nutrition, administered through central line, hypertonic solution
What are the components of TPN? Glucose, amino acids, vitamins, minerals, and electrolytes. Fats can be administered separately through a Y-connector tube
What is important to watch for when administering TPN? Hyperglycemia or hypoglycemia
What are the symptoms of hyperglycemia? Polyuria, excessive thirst, increased urine output, and increased appetite
What are the symptoms of hypoglycemia? Cold & clammy skin, shaking, confusion, seizures, and loss of consciousness
Who may require TPN? Patients needing highly concentrated formula, those needing IV feedings for more than 3 weeks, and those with unsuitable or unavailable peripheral veins
What is PPN? Peripheral parenteral nutrition
When is PPN indicated? Patient with nonfunctioning or dysfunctional GI track
What are the benefits of PPN vs. TPN? PPN is cheaper and risk of complications are less than TPN
What is the most common reason for blood transfusion? Replace blood loss
What are the blood products that are most commonly administered? Whole blood, packed RBC/ washed RBC, fresh frozen plasma & cryoprecipitate, WBC, platelets, protein & clotting factors, albumin & volume expanders
What blood type is the universal donor? O
What blood type is the universal receiver? AB
What happens to a pregnant woman who is RH-? Gets a Rhogam shot at 24 weeks
What happens when the RH- pregnant woman delivers? The baby's blood type is tested, if the baby is RH+, the mother will get another Rhogam shot within 72hrs of delivery
If you have + antigen, what type of blood can you receive? Both - and + blood types
If you have - antigen, what type of blood can you receive? Only - blood types
Once the blood is removed from the blood bank, when must it be administered? Within 30 minutes
What do you infuse blood products with? Normal Saline
What is the length of time that blood products are allowed to run? 1 1/2 to 4 hours
What are the roles of the RN and LPN during blood administration? RN is only one allowed to spike blood, and must monitor patient for the first 15 mins for reactions. LPN can monitor patient for reactions after the first 15mins
When do most reactions occur when blood products are given? Within the first 15mins
What are the signs and symptoms of transfusion reactions? "Not feeling well", chills, fever, low back pain, pruritus, hypotension, nausea, vomiting, decreased urine output, chest pain, dyspnea
What are the steps if a transfusion reaction occurs? STOP transfusion, keep vein open with 0.9% or 0.45% NS, notify charge nurse, dr, and blood bank of react. Monitor pt v/s & urine output q5-15mins, reassure the patient, prepare to perform CPR, obtain urine specimen, save blood containers & tubes, document
What do you document when a patient experiences adverse reaction to IV therapy? Time reaction occurred, patient complaints, and any signs or symptoms that are observed, notification of doctors, dr's orders, and patients response to those orders in the chart
What are the steps to changing IV site dressing? Provide privacy, gather supplies, wash hands, inspect appearance of venipuncture site for redness, edema, or exudate, apply transparent dressing over IV site, and document dressing change
What are the steps in converting IV to hep. locks? Verify order to change, gather supplies, wash hands, loosen & remove IV tubing from catheter hub, attach syringe to saline lock & aspirate for blood, fill access port with saline
What are the steps in discontinuing IV therapy? Verify orders, gather supplies, wash hands, close the valve on IV tubing, stabilize catheter while you loosen & remove tape, remove catheter, document procedure & pt. teaching
What two items are required when assisting with blood transfusion? Physicians order & informed consent
What gauge is used for administering blood or packed cells 18g
What gauge is used for administering other blood products? 18-20g
Blood is normally administered through what type of infusion set? Y-type
How much NS is used on the other side of the infusion set? 250 mL
What is included in the Y-type infusion set (blood tubing)? Special blood filter
Why does blood transfusion need to be administered within the required time? To avoid blood clots and bacterial growth
What must the two nurses do prior to leaving the blood bank, after they have verified blood? Sign blood bank requisition form
What are the three areas a patient can experience pain that would indicate blood reaction? Headache, chest pain, and pain in low back
What happens to v/s during a blood reaction? BP decreases, dyspnea, chest pain, fever, and chills
What respiratory symptoms indicate blood reaction? Respiratory rate and lung sounds
What skin reactions indicate blood reaction? Pruritus (itching)
What are other symptoms of blood reaction? Nausea, vomiting, decreased urine output, low back pain
What are five major symptoms of fluid overload? Dyspnea, rapid/bounding pulse, cough/crackles, disorientation, pitting edema & weight gain
What are patient teachings regarding blood transfusion? Reason for transfusion, how long transfusion will last, signs & symptoms of problems that need to be reported to nurse immediately
Define platelets are used to treat thrombocytopnea and hemorrhage
Define whole blood is to treat massive hemorrhage or hypovolemic shock due to hemorrhage
Define serum albumin is used to expand the blood volume in patients with hypovolemic shock as a safe volume expander
Define granulocytes are used to transfuse granulocytopenic patients or those who have severely deficient white blood cells
Define packed red are used to treat anemia
Define plasma is used to replace the deficiencies in coagulation factors and to treat patients with severe liver disease
Created by: tandkhopkins



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