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Ch 36 IV admin
| Question | Answer |
|---|---|
| IV is the primary method of supplying PT with | fluids and meds via vein |
| IV infusion | slow into of fluid into a vein |
| IV infusions is used to... | maintain hydration |
| IV bolus is used to | treat dehydration rapidly |
| Substances delivered via IV | fluids elecrtolytes meds blood and blood products nutritional formulas |
| nutritional formulas contain | glucose amino acids lipids |
| daily fluid need for adults | 1500-2000 mL |
| fluid loss can be caused by | diarrhea vomiting hemorrhage drainage from wounds (esp. burns) change in metabolic process (fever) |
| Intake and output is need to determine | amount of fluids needed daily |
| solutions most frequently used in IV | Glucose saline electrolyte vitamins amino acids |
| Isotonic solutions concentration is | same as blood |
| isotonic solutions are used for | expanding the body's fluid volume |
| Hyptotonic solutions solute is | less than extravascular fluid |
| hypotonic solutions cause | fluid to shift out of the vascular comp. and into cells |
| Hypotonic solutions can cause cells to | rupture |
| What type of solution is unsafe for children | hypotonic |
| Hypertonic solutions tonicity is | greater than bloods |
| hypertonic solutions are used to | replace electrolytes |
| Hypertonic solutions given as concentrated dextrose solutions produce | shift in fluid from intracellular to extracellular |
| hypertonic solutions can effect cells by | causing them to shrink |
| solutions given for cerebral edema | glucose mannitol sucrose |
| solutions given for cerebral edema should never be | hypotonic |
| cerebral edema can be caused by | head injury |
| the iv solution bags come in what sizes | 250 500 1000 mL |
| smaller bags can contain | sterile water dextrose in water normal saline |
| different administration sets are specified for specific | type of IV solution container IV pump |
| IV tubing should be changed | no more than every 96 hrs at least every 7 days |
| primary IV sets are used for | any type of IV therapy except blood products |
| tubing size for gravity delivery are sized by | number of drops per mL |
| regular drop | 10-20 gtt/mL |
| macrodrops | 10-15 gtt/mL for viscous fluids blood regular fluids |
| microdrops | 60 gtt/mL pediatric older adults with fragile veins |
| Piggybacks are used for | adding meds to an existing IV line |
| meds for piggyback include | antibiotics antineoplastics |
| antibiotics and neoplastics must be diluted in | 50-150 mL of solution |
| antibiotics and neoplastics should never be given via | bolus |
| piggybacks should be hung | higher than primary IV |
| injections sites should be scrubbed for how long | 15 sec |
| Y-type admin sets are used for | infusing blood products |
| blood products must have | normal saline in a seperate bag |
| transfusion | intro of blood components into blood stream |
| when transfusions start and are done you should | flush with normal saline |
| controlled-volume IV sets are used for | diluted medication small amount of fluid over long period |
| controlled-volume IV usually uses | infusion pump |
| burette | tube like chamber that holds 150mL of fluid |
| Controlled volume IV is used for what PT | infants, children, older adults to give fluids |
| what is the benefit of controlled volume iv | decreases likelihood of fluid overload |
| signs of fluid overload | sudden weight gain, crackles in lungs, peripheral edema |
| Labs monitored for fluid overload | elecrolytes, BUN, serum creatinine |
| Intermittent IV devices (saline or PRN lock ) are used to | recieve meds at intervals or when emergency meds may be needed |
| how much fluid is available in controlled volume IV sets | 50-100 mL |
| what meds are given viaintermittent IV device | antibiotics heparin corticosteriods animetabilites |
| what is used to flush intermittent IV devices | saline or dilute heparin |
| what should never be used to flush for neonates | multidose heparin |
| how are intermittent IV devices established | luer-lok cap or extension set to the IV cannula |
| Intermittent locks, prn lock, saline lock are what kind of device | peripheral |
| filter used for most solutions is | 0.22-micron |
| filter for solutions containing lipids or albumin | 1.2-micron |
| Infusion pumps are mandatory for | total parenteral nutrition (TPN) |
| infusion pumps are used for what meds | insulin, heparin, cardiovascular meds, cheotherapy, labor inducers |
| Pottasium must be | diluted |
| pottasium is never given | as a bolus can cause cardiac arrest |
| Infiltrated | solution is deposited in tissue outside the vein |
| insulin pump site must be changed | 2-3 days |
| when using insulin pump glucose must be checked | 4-6 hrs |
| safety venous access devises | decrease the risk of needle sticks |
| gauge for older adult with small veins | 24 gauge |
| gauge for large volumes of fluid | 18 |
| gauge for rapid infusion of blood or fluids | 18 |
| clear aqueous solutions use what gauge | 20-22 |
| viscous fluids use what gauge | 18-19 |
| winged tip or butterfly needles come in gauges | odd numbers (17-25) |
| butterfly needles are used for | older adults and pediatrics |
| over-the-needle catheters | have a needle with catheter sheath. needle is inserted, threaded and then needle removed |
| over-the- needle catheters reduce | infection, irritation, phlebitis |
| what vein is used when normal ones are hard to find or unusable in adult | large subclavian vein into superior vena cava of right atrium |
| how long can iv into superior vena cava be kept in place | 6-8 weeks |
| long term catheters are used for | 6-8 weeks |
| long term catheters are placed as | tunneled broviac, hickman or groshong |
| long term caths are placed by | operation |
| what kind of catheters are used for adults and children in need of peripheral IV with high blood flow | peripherally inserted central catheter (PICC) midline catheter (MLs) |
| what kind of catheter is used for in home care of 6-8 weeks | PICC or MLs |
| cascular access device | devices such as needle of catheter that allow direct access to circulatory system |
| long term drug therapy, fluid therapy or chemotherapy use what | central venous catheter or implanted infusion port |
| central venous catheters and implanted infusion ports are placed by | physician or specially trained nurse |
| where are short-term central venous caths placed | subclavian or jugular |
| long term central venous caths are threaded to where | tip of right atrium |
| central venous caths are how long | 15-30 cm |
| how many lumens do central venous caths have | 1-3 or more |
| how are subclavian caths verified | radiographic study before fluid given |
| you should never use a syringe that is......to flush a central IV line | less than 10 mL |
| single or dual lumen caths can be implanted where | subcut on chest under right clavicle |
| where are implanted single/ double lumen caths threaded to | superior vena cava |
| what kind of needle is used to give meds via infusion port | huber noncoring needles |
| signs and symptoms of infiltration | local edema, skin blanching, skin coolness, leakage at the puncture site, pain , feeling of tightness, numbness |
| what should be done if infiltration occurs | stop infusion, remove cath and use different site |
| infiltration is reavsorbed within | 24 hours |
| extravasation | infiltration of a vesicant (chemical irritant that causes tissue destruction) |
| damage from extravasation may go unnoticed for | 48-72 hr |
| results of extravasation | infection, disfigurement, loss of function |
| drugs that may have vesicant properties | antibiotics, antineoplastics |
| what to do if extravasation occurs | do not stop iv, antidote must be delivered directly to site |
| phlebitis | irritation of the vein by the needle, cath, med or additives |
| typical signs of phlebitis | erythema, warmth, swelling, tenderness |
| what to do if phlebitis occurs | stop IV, find new site, use warm to reduce inflammation |
| septicemia | bloodstream infection |
| signs and symptoms of septicemia | fever, chills, pain, headache, nausea, vomiting, extreme fatigue |
| what is done if septicemia is suspected | blood cultures, aggressive antibiotics, iv immediately stopped |
| caps are to be changed no more often than | every 72 hours |
| what reduces infections in adults and is being studied for children | antibiotic impregnated central venous caths |
| catheter embolus | piece of cath breaks off and travels in the vein until it lodges |
| air embolus occurs when | changing bag or opening the line of a subclavian cath |
| speed shock | when fluid or med is given by bolus and is given too rapidly |
| speed shock is what kind of reaction | systematic |
| signs of speed shock | light headed, tightness in chest, flushed face, irregular pulse, loss of consciousness, shock, cardiac arrest |
| vesicant meds should be monitored every | 5 min |
| normal ivs should be monitored | every 1-2 hours |
| factors that influence flow rate | cath size, height of container, viscosity of fluid |
| bore | internal diameter |
| standard set drop rate | 10-20 gtt/mL |
| pediatric or microdrop chamber drop | 60 gtt/mL |
| how long does it take IV to enter circulation | immediately |
| best rate for adult | 80-250 mL/hour |
| rapid infusion can lead to | fluid overload and heart failure |
| veins for infusions and intermittent doses should be | distal to the antecubital area, not distal to old site |
| sites for infusions and intermittent doses | cephalic, basilic, antecrachial veins of lower arm and those in back of hand |
| what veins should not be used extensively for iv infusion | veins in antecubital space |
| keeping the arm extended may cause | muscle or nerve damage |
| what veins are frequently used in infants | scalp |
| what can be used instead of tourniquet in older adult with fragile veins | blood pressure cuff pumped to 10 mm over hh Mg of diastolic pressure 20 mm Hg in fluid depleted |
| ways to give meds via IV | adding to primary bag, piggyback, controlled volume burettes, directly injecting into vein |
| what meds need to be diluted in 1000 mL | potassium, insulin, sodium bicarbonate, calcium, magnesium sulfate, vitamin B and C |
| meds might be mixed with small amounts of solution may be done in what | controlled-volume burette |
| meds can be given directly into vein over a few minutes using | bolus or IV push |
| IV pushing promethazine may cause | serious tissue dmg, loss of circulation or amputation |
| promethazine should never use veins in | hand, wrist, foot vein |
| IV antibiotics for community aquired pneumonia are given | within 4 hrs of arrival |
| Heparin requires | IV pump |
| what lab study is used to adjust heparin dose | partial thromboplastin time |
| Antineoplastic medication | chemotherapy. destroy or alter the growth of malignant cells |
| antineoplastic meds are toxic to | normal and abnormal cells |
| antineoplastic meds may be absorbed through | skin, inahalation, orally |
| antineoplastics can lead to alterarions in what cells | ova, sperm, fetal tissue |
| if IV access if required after stopping are | converted to saline lock |
| blood components used in transfusion | fresh or frozen plasma, packed RBC, platelets |
| autologous | from the patients own body |
| packed RBC are used for | acute or chronic anemia |
| platelets and fresh frozen plasma are used for | replenishing platelets and providing clotting factors |
| how fast do reactions from blood transfusions occur | within 5-15 minutes |
| reactions in transfusions are most common with | RBC or whole blood |
| signs of blood transfusion reaction | hives, itching, facial flushing, chills, back pain, apprehension, fever |
| short term TPN | up to 2 weeks |
| long term TPN | 6 weeks or more |
| nutritional status of PT on NPO are assessed | daily |
| TPN provides ..... calories compained to total daily requirements | less |
| 1000 mL of 5% glucose solution provides how many calories | 200 |
| suplemental calories may be provided by | amino acids and fat emulsions |
| 10% dextrose is best given through | central line |
| 10% dextrose through peripheral veins may lead to | thrombophlebitis |
| specially prepared solutuions for TPN given through peripheral veins may | provide fewer cals |
| when PT is recieving TPN you must monitor | weight gain and blood glucose |
Created by:
katt3y
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