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Stack #4655930
| Question | Answer |
|---|---|
| what are the purposes of intravenous therapy? | providing daily body fluid and electrolyte replacing abnormal or excessive loss of fluids and lytes providing an avenue for IV administration of meds |
| electrolytes are necessary for? | maintain homeostasis |
| glucose is necessary for? | production of energy by providing calories and fuel |
| vitamins are necessary for? | growth of new tissue |
| what is hypovalemia? | the direct loss of blood from the cardiovascular system, in the form of hemorrhage |
| s/s of hypovalemia | |
| ways to administer IV push | PRN lock, intermittent infusion device, or through the y injection port |
| many meds must be diluted with or flushed with? | 1-10 ml of NS , usually Q8h |
| precipitate | one of the agents int he solution separates from the solvent and becomes a solid. it is important to remember you can never let an infusion continue if you see this in the fluid |
| What are common components found in different IC fluids? | Glucose, electrolytes, vitamins, and amino acids |
| What is an isotonic solution? | there is no net movement of water, the fluid stays in the bloodstream which increases the overall blood volume w/o changing size of the cells |
| What is tonicity? | how much "stuff" (solutes like salt or sugar) is dissolved in the water compared to the "stuff" inside our red blood cells. |
| What does an isotonic solution treat? | Dehydration from v/d or replace fluid loss from surgery |
| Examples of isotonic solution? | 0.9% Sodium chloride or NS (normal saline) |
| When do you not use an Isotonic solution? | in patients allergic to corn |
| What is a hypotonic solution? | IV fluid has a lower concentration of solutes than the RBC. It it more "waterier" than the blood. Hypotonic Solutions: Movement INTO the Cell. Cells swell |
| What does a hypotonic solution treat? | Use when pts cells are dehydrated, typical in cases of DKA, and replacement of fluids during gastric suction |
| Examples of hypotonic solution? | 1/2 NS of 0.45 NaCl or 1/2 NS of 0.33% NaCl |
| When should you not use a hypotonic solution? | In patient with hypotension, can cause BP to drop further |
| What is a hypertonic solution? | IV fluid has a higher concentration of solutes than the RBC. It is very "salty" or "sugary". Fluid becomes so concentrated that it sucks the water out of the RBC. Causes the cells to shrivel up. Movement OUT of the Cell |
| When do you use a hypertonic solution? | to treat hyponatremia, pull fluid off the brain in cases of cerebral edema, treat severe hypoglycemia |
| What are examples of hypertonic solutions? | 3% NS, 5% Dextrose in 0.9% NS (D5NS) |
| What are some intravenous equipment? | IV needle cannula or catheter winged butterfly - shorter infusion time, phlebotomy, children/fragile veins IV tubing IV infusion pump Intermittent infusion / prn lock |
| What is cannulation? | the process of advanicing the IV cannula into the vein |
| Cannula sizes | 24g - 12g , smaller the number the bigger the needle |
| Most common gauses and lengths used in adult patients | 20g - 22g and 1-1.5 in |
| 20g can infuse | 3,900 ml/hr |
| 22g can infuse | 2,220 ml/hr |
| 24g can infuse | 1,400 ml/hr |
| What is a flange? | hard plastic projection that provides a place for your fingers to push the piercing pin into the solution |
| When is it recommended to change a continuously infusing IV tubing | at least every 72-96 hours |
| Tubing used for intermittent infusions, such as secondary tubing is changed? | every 24 hours |
| What is recommended you clean the skin with prior to IV insertion? | 10% povidone-iodine ( dont use alcohol after) 2% tincture of iodine ( if using iodine, assess pt for allergy to shellfish) 2% aqueous chlorhexidine gluconate (CHG) 70% isopropyl alcohol |
| How to apply a tourniquet | apply the tourniquet proximal to the elbow or 4-6 inches proximal to inj site, , once the vein is selected, remove the tourniquet. gather supplies then reapply. avoid using in older adults |
| How does a good vein feel? | rounded, spongy, resilient, elastic, or bouncy |
| Choosing a vein | Choose a vein on the non-dominant hand and avoid in pts on the side they had a mastectomy, paralysis or dialysis |
| Tips to dilating veins | apply a BP cuff instead have pt squeeze a rolled up wash cloth or rubber ball apply moist warm packs to extremity for 10-15 mins use thumb and middle finger to gently flick the vein use alcohol wipe and friction to rapidly wipe back and forth |
| Hold a needle at what angle? | 20-30 or 15 degrees for superficial and 45 degrees for obese pt |
| IV site assessment | Q2h in adult, QH for childer / older adutlts |
| S/S of infiltration | blanching or pallor of skin complaint of tightness edema at site lock of blood return site is cool to touch sluggish flow taut skin around site solution leakage |
| S/S of phlebitis | edema erythema increased warmth reports of burning or discomfort Sluggish infusion rate Vein feels like a hard cord when palpated |
| Infiltration | leakage of nonvesicant IV fluid or meds |
| Extravasation | leakage of vesicant IV fluids or medication into the tissue surround IV site |
| Vesicant vs Nonvesicant | nonvesicant means that it does not cause blistering and death of tissue vesicant means that it causes blistering, necrosis, and sloughing of tissue |
| Phlebitis | inflammation of a vein |
| thrombophlebitis | inflammation of a vein in conjunction with the formation of a thrombus (blood clot in vein or artery) |
| Septicemia | life-threatening infection of the bloodstream |
| Speed shock | shock caused by rapid IV infusion or medication |
| Nursing care for infiltration | immediately discontinued and restarted PRN, elevate and position, apply warm or cool packs |
| Nursing care for extravasation | stop the infusion, leave the cannula in place, estimate the volume of vesicant fluid, notify provider + stat response and treatment |
| If phlebitis occurs? | apply warm moist packs to the site for 20-30 mins every 2 hours and elevate arm on pillow |
| S/S of air embolism | cyanosis, dyspnea, chest or shoulder pain, hypotension, tachycardia, and loss of consciousness. |
| S/S of speed shock | flushed skin, dizziness, headache, chest tightness, hypotension, irregular pulse, syncope or fainting, and cardiac arrest. |
| True or false: Blood and blood products are not compatible with any IV solution other than 0.9% sodium chloride (NS) | true |
| Functions of water: | regulate body temp, transports electrolytes, minerals and waste it protects our brain and spinal cord, lubricates our joints helps food move |
| Hypovalemia | water/electrolyte is lost ( cause = hemmorage, vomiting, diarrhea) / |
| Dehydration | water only is lost (cause = sweating, hyperventilation, prolonged fever) |
| Causes of fluid loss | The body loses fluids through the elimination of urine and feces. It can also be lost by results of bleeding, sweating, fever, diarrhea, nausea, prolonged tachypnea, vomiting, excessive urination. |
| S/S Fluid Volume Deficit | D – Dizzy / Dry skin & mouth I – Increased Heart Rate / Increased Urine Specific Gravity R – Reduced Blood Pressure / Reduced Urine Output T – Tachycardia / Tenting of the skin (very late sign = non elastic tugor) |
| Severe fluid volume deficit = | decreased level of conciousness / confusion |
| Signs / Symptoms of Fluid Volume Excess: body has more fluid than it can handle: ● too much sodium/ too many IV fluids ● Heart / kidney failure | W – Weight gain (Rapid) E – Edema (Pitting) / Elevated BP T – Tachypnea (Fast breathing) / Thumping (Bounding) pulse |
| What nursing actions would be appropriate for fluid volume excess? | replace fluids orally /IV, monitor lytes, VS for low bp, increased PR/ temp, give antinausea/diarrhea, measure I/O, assess mucous membrane, make sure pt voids at least Q8h |
| pH | PH - between 7.35 - 7.45 , >7.35 pt is acidic/ acidosis <7.45 pt is alkalinic/ alkalosis |
| PaCo2 | between 35-45 mm Hg = respiratory |
| HC03 | between 22-26 = metabolic |
| What are ABG's | ABG’s are a blood test that help us determine how well your lungs and kidneys are controlling acid-base balance. It helps us determine if the cuase of acidosis or alkalosis is a respiratory or metabolic problem. |
| Which two body organs are involved in managing acid–base balance? W | Respiratory and renal |
| What are the specific functions of each system? | Resp - retain or remove CO2, works in mins Renal - kidneys control retention and elimination, slower but more powerful hours to days |
| Which system works most effectively to make pH adjustments? | renal |
| Hyperventilation | more carbonic acid is lost ( respiratory alkalosis) caused by fear, anxiety and overdose of aspirin |
| Hypoventilation | CO2 gets trapped and pH = acidosis caused by opioid medications, certain types of medications, pneumonia, emphysema, and chronic bronchitis |
| If a patient has a condition that causes either a marked loss of hydrogen ions or a marked increase of sodium bicarbonate, will it lead to which acid base imbalance? | Metabolic alkalosis caused by severe vomiting or nasogastric suction |
| Potassium values | 3.5–5.3 mEq/L |
| Calcium values | Ca2+: 8.2–10.2 mg/dL Ionized Ca2+: 4.64–5.28 mg/dL |
| Magnesium values | 1.6 –2.2 mg/dL |
| Sodium values | 135–145 mEq/L |
| Phosphorus values | 2.5–4.5 mg/dL (May be higher in children) |
| Chloride values | 97–107 mEq/L |
| What medication do you use to treat hyperkalemia | Sodium polystrene sulfonate (kayexalate) |
| S/S of hyperkalemia (excess potassium) | bradycardia / arrhythmia Nausea / diarrhea Anxiety Muscle weakness Numbness / prickly sensations Flaccid paralysis |
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