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IV therapy ch 29

fundamentals chapter 29

What is Intravenous therapy? is the infusion of a fluid into a vein to prevent or to treat fluid or electrolyte imbalance or to deliver medications, nutrition, or blood products
what is venipuncture? is the technique that permits insertion of a needle or catheter into a vein
In most facilites who is responsible for starting IVs? nurses
what are crystalloid types of intravenous solutions? fluids that are clear
what are colloid types of intravenous solutions? fluids that contain proteins or starch molecules
how can crystalloids be classified? isotonic, hypotonic, or hypertonic.
what is osmolarity? refers to the number of particles or solutes that are in a liter of a solution
Isotonic fluids... have an osmolarity of 250-375mOsm/L, which is the same osmotic pressure found within the cell
What are isotonic fluids used for? used to expand the intravasular compartment and thus increase circulating volume
when would an isotonic solution be helpful? for hypotension caused by hypovolemia
What are examples of isotonic fluids? normal saline(0.9%NaCl) and lactated Ringer's
Hypotonic fluids... have an osmolarity below 250mOsm/L or a lower osmotic pressure thatn the cell.
When a hypotonic solution is infused what happens? it lowers serum osmolarity, causing body fluid to shift out of the blood vessels and into the cells and interstitial space
when are hypotonic fluids administered? when a client needs cellular hydration
what is an example of hypotonic solution? one-half normal saline (0.45 NaCl)
What is 5% dextrose in water before entering the body and after entering the body? isotonic before administration but quickly becomes hypotonic once in the body bc dextrose is quickly metabolize
hypertonic solutions _______ fluid from cells draw
hypotonic solutions _________ fluid into cells shift
Hypertonic fluids.... have an osmolarity of 375 mOsm/L or higher and a greater osmotic pressure than the cell
When hypertonic fluid is infused... it raises serum osmolarity, pulling fluid from the cells and the interstitial tissues into the vascular space
What is an example of a hyptertonic solution? 3% saline and 5% saline
How should hypertonic fluids be administered? slowly to prevent circulatory overload
isotonic indications could be? intravascular dehydration
hypotonic indications could be? cellular dehydration
hypertonic indications could be? intravascular dehydration with interstitial and intracellular fluid overload
what are the common devices used for peripheral IV therapy? winged infusion needles and over-the-needle IV catheters
describe winged infusion needles.. short, beveled needles with plastic flaps or wings, short term therapy, used with children or infants
odd numbers are used to measure... winged infusion needles, 19,21,23
even numbers are used to measure... designated catheter sizes.
how long are most catheters? 1 or 1 1/4 inches long
intermittent infusion devices are sometimes referred to as.... saline or heparin locks. and are infused with saline to prevent clot formation
who usually inserts a central venous catheter? physician
what are some complication associated with central venous access devices? pneumothorax and air embolisms
what are the four main types of central veous catheters? single or multilumen catheter(short term therapy at hospital), tunneled catheters(long term therapy),PICC(long term therapy at hospital or at home), Implanted access device(cancer, and surgically implanted)
what is the most commonly used central venous catheter? multilumen central catheter;two or three lumens;placement is confired with x-ray
what does a electronic infusion device do? bc it accurately regulates the infusion rate
what are the two general classifiations of tubing? macrodrip and microdrip
macrodrip tubing delivers... 10,15,or 20 drops/mL and is used for adults
microdrip tubing delivers... 60 drops/mL used for children and infants and when fluid is infused slowly
what are factors that affect flow rate? height of solution container, position of extremity, tubing obstruction, postion of the IV access, and IV patency, and clogged air vents
what are the components of an IV order? type and amount of solution, other medications or electrolytes to be added to the solution, length of time for infusion to be given or infusion rate
what can influence the flow rate of IV? viscosity, height of container, cannula position, position or extremity
what are the peripheral sites for IV? arms and legs
what are the central sites of IV? subclavin, internal jugular
what are isontic solutions used for? intravascular dehydration
When would you avoid using lactated ringers in a client? liver disease or metabolic acidosis
when administering an isotonic solution what would be a nursing consideration? to monitor patient closly for signs of fluid overload, especially if they have a history of cardiovascular disease
What are hypotonic solutions used for? cellular dehydration
when would you not administer a hypotonic solution to a client? clients at risk for increased cranial pressure, abnormal fluid shifts into the intersititial cavity, or abdominal cavity(burn victims, trauma, liver failure, severe protein malnutrition)
Why would a nurse need to monitor someone who has been adminitered a hypotonic solution? bc these solutions can cause sudden shit of fluid into the cells and lead to intravascular fluid depletion and cardiovascular collapse
What are hypertonic solutions used for? intravascular dehydration w/interstitial and intracellular fluid overload
Why does a nurse need to closely monitor someone who has been administered hypertonic solution? for fluid overload bc solution can expand int intravascular compartment
when would you avoid using hypertonic solutions? renal, cardiac impairment. diabetics, ketoacidosis. (rarely used outside of ICU).
hypertonic solutions draw fluid fluid... from intracellular to intravascular compartments
Never irrigate the catheter if you meet pressure when attempting to flush, why? bc irrigation may push clot into the circulatory system
in acute care or long-term care facility evaluate the clients IV at least... once each hour. if child perform assessment more frequently
gauze dressing change should be done? every 48 hours on peripheral site
what are s/s of infiltration? swelling, coolnes, discomfort at site, slowed infusion rate, absence of blood return
what should your action be when infiltration occurs? discontinue IV, start another one;apply warm soaks to decrease swelling
How can you prevent infiltration? select site over long bones, avoid over joints, use manufactured stabilization devices, use long-term cath.
what are s/s of phlebitis? pain, warmth, redness, veing may feel hard and cordlike, slowed infusion rate
what should your action be when phlebitis occurs? discon. and start another one; apply warm soak, do not irrigate
how can you prevent phlebitis? change IV site every 72 hrs, use large veins and large gauge-needle rather than cath, dilute meds well and infuse slowly, use central line for very irritating solutions
what are s/s of infection of IV? local: red, warm, and purulent drainage at IV site. systemic:fever, chills, malaise, and elevated WBC
What should you do if infection occurs? discontinue IV and restart; culture catheter tip and draw blood cultures;treat appropriate antibiotics
how can you prevent infection at IV site? asepsis, handwashing, change tubing and dressing every 72 hrs.
What are s/s of fluid overload? elevate BP, increased pulse and respirations, dyspnea, crackles, neck vein distention, weight gain
what should you do if fluid overload occurs? slow IV to "keep open" rate and notify physician; place client in high or semi-fowlers posistion; administer O2.
How can fluid overload be prevented? minitor rates carefully especially high risk(elderly,infants, CHF, renal disease);Use EID; don't catch up when IV gets behind for high-risk clients.
what are s/s for air emobolism (usually in central venous catheters) chest, shoulder,back pain; dyspnea, hypotenstion; thready pulse;cyanosis;loss of consciousness
What should you do if air embolism occurs? place on left side in Trendelenburg position, call doc, monitor VS
how can you prevent air embolism? tape all connectors or use luer lock connectors, use air-eliminating filters,use EID, instruct client to use valsalva maneuver when changing tubing or discontinuing a central line
what is thrombophlebitis? a blood clot accompanied by inflammation
phlebitis inflammation of a vein
infiltration when fluid enters subcutaneous tissue
what are IV sites on the hand? basilic vein, cephalic vein, dorsal venous network, dorsal metacarpal veins
what are s/s of a hematoma? discoloration, swelling, tenderness
where should the tourniquet be placed? 4-6inches above site
what type of vein is preferred? distalvein
how should you stabilize the vein uponn insertion? pull the skin taut below the site
at what degree(s) should you insert the catheter and what should yo watch for? 10-30 degrees, flashback
what should you do to the skin while changing from stylet to tubing? apply pressure above site
in between infusions you should flush the catheter every ____ hours or once a shift as policy requires 8
when catheter is out apply firm pressure for how long? 2-3 minutes or 5-10 minutes if taking anticoagulants
what should you note when discontinuing IV? amount remaining in the bag for I & O
how long should you assess the site after a cath is taken out? 15-30 minutes
post infusion phlebitis may occur withing _______ hours after the catheter is removed 48-96
when may fluid overload occur? when a client receives IV fluid too rapidly
should an EID be used for very young clients? yes EID should always be used for continous therapy bc too rapid an infusion of fluid can be lethal
what size needle should be used for blood transfusions? 18 gauge
what is usually administered with blood transfusion? normal saline
Created by: sandrasafou1