IV Therapy
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| What is the goal of IV therapy administration? | Correct or prevent fluid & electrolyte imbalances
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| What are the indications for IV therapy? | Poor tissue absorption, inadequate GI tract functioning, and need for maintaining medications at optimum levels
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| What is the fastest way to get medication in to your patient? | IV route (oral is the slowest)
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| 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
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| Who can an LPN delegate assessing IV site to? | Nobody
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| What is fluid overload caused by? | Increased infusion rates
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| What can fluid overload lead to? | Death
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| 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
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| What body system does fluid overload affect? | Respiratory
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| What four groups does fluid overload affect? | Very young, very old, those with renal history, and those with cardiac history
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| 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
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| What are the signs and symptoms of phlebitis? | Erythema, warmth, edema, and discomfort
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| What do you do if phlebitis occurs? | IV should be discontinued and restarted in a different site with new tubing and fluids
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| What can you apply to the area of phlebitis to decrease a patients pain & discomfort? | Warm compress
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| What must you have before you can apply a warm compress? | Physicians order
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| How does phlebitis present? | Streaking formation and throbbing
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| What is infiltration/extravasation? | Edema that does not subside at IV catheter site (indicates that catheter is out of vein)
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| 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
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| What are the steps once infiltration is confirmed? | Wash hands, don gloves, discontinue site, and restart new IV in opposite extremity if possible
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| What must you never do to an infiltration? | Apply heat/warm compress
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| 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
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| What is speed shock? | Occurs when IV medication is pushed to rapidly
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| What are signs and symptoms of speed shock? | Flushed face, headache, tightness in chest, loss of consciousness, and cardiac arrest
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| Who do you notify and what do you do in the case of speed shock? | Physician / follow orders given to reverse
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| What is an air embolus? | Occurs when air travels from IV line to vein
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| What are the signs and symptoms of an air embolus? | Abrupt decrease in blood pressure, weak/rapid pulse, and cyanosis
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| 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)
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| What causes septicemia/systemic infections? | Pathogens introduced into the circulatory blood stream. The result is septicemia (blood poisoning)
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| What are the signs and symptoms of septicemia? | Fever, chills, prostration (extreme exhaustion), pain, headache, nausea, and vomiting
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| How do you treat septicemia? | Vigorous antibiotic therapy
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| What is the best way to reduce risk of infection? | Always use sterile technique when starting an IV
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| 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
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| How do you ensure correct infusion rate is maintained? | Monitor infusions frequently
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| What is the correct way to count drip rate? | Count drips for 15 seconds, then multiply times four
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| What do you record when documenting intake of IV therapy? | Amount & type of fluid infused, and amount & type of new fluid infused
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| When is the typical time to evaluate final assessment of IV fluids remaining in containers? | Approximately 1 hour before shift ends
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| How do you refer to the amount of fluid that is left to count for the next shift? | LTC
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| What is important to always include when determining fluid intake for your shift? | Partial bags, piggybacks, and push medications
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| What goes on the I & O sheet? | Documentation of input and output
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| What is narcan? | Antagonist drug that reverses the effects of opioids
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| What is Benadryl? | Antihistamine
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| What is morphine? | Opioid used to relieve pain
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| What is Zofran? | Antiemetic used to reduce nausea/vomiting
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| What are the six rights of medication administration? | Drug, time, dosage, patient, route, & documentation
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| Where do you hang the main IV bag when hanging a piggyback? | Below the piggyback
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| 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
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| How much do you flush before and after PB? | 3 mL
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| What is a PCA? | Patient controlled analgesia - continuous infusion of opioids into the blood stream
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| What is basal rate? | Continuous
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| What is the typical lock out interval? | 15 mins
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| 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
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| What is loading dose? | Dose given right away
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| 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
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| 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
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| 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
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| 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
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| What is important to do before administering IV push medications? | Check for compatibility when being mixed into the same syringe
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| If medications can not be mixed, what must you make sure to do in between each push? | Flush with 3 mL of NS
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| What is a buretrol? | Device that holds limited quantities of IV fluids of medications
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| Why is a buretrol used? | To prevent fluid overload in pediatrics and elderly patients
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| What is a Hickman or Broviac catheter use for? | Obtaining blood samples and administer medications
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| 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)
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| 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
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| What is a triple lumen catheter? | IV catheter that has three lumens
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| What is each of the three lumens in a triple lumen catheter used for? | Transfusion lumen, blood-feeding lumen, and blood-removing lumen
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| What is a central venous catheter (central line)? | Catheter inserted in a large vein until it reaches a vein near the heart
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| What is a peripheral inserted central catheter (PICC) line? | Catheter inserted into a peripheral vein until it reaches the superior vena cava
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| What is TPN? | Total parenteral nutrition, administered through central line, hypertonic solution
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| What are the components of TPN? | Glucose, amino acids, vitamins, minerals, and electrolytes. Fats can be administered separately through a Y-connector tube
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| What is important to watch for when administering TPN? | Hyperglycemia or hypoglycemia
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| What are the symptoms of hyperglycemia? | Polyuria, excessive thirst, increased urine output, and increased appetite
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| What are the symptoms of hypoglycemia? | Cold & clammy skin, shaking, confusion, seizures, and loss of consciousness
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| 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
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| What is PPN? | Peripheral parenteral nutrition
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| When is PPN indicated? | Patient with nonfunctioning or dysfunctional GI track
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| What are the benefits of PPN vs. TPN? | PPN is cheaper and risk of complications are less than TPN
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| What is the most common reason for blood transfusion? | Replace blood loss
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| 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
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| What blood type is the universal donor? | O
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| What blood type is the universal receiver? | AB
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| What happens to a pregnant woman who is RH-? | Gets a Rhogam shot at 24 weeks
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| 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
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| If you have + antigen, what type of blood can you receive? | Both - and + blood types
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| If you have - antigen, what type of blood can you receive? | Only - blood types
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| Once the blood is removed from the blood bank, when must it be administered? | Within 30 minutes
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| What do you infuse blood products with? | Normal Saline
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| What is the length of time that blood products are allowed to run? | 1 1/2 to 4 hours
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| 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
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| When do most reactions occur when blood products are given? | Within the first 15mins
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| 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
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| 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
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| 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
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| 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
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| 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
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| 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
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| What two items are required when assisting with blood transfusion? | Physicians order & informed consent
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| What gauge is used for administering blood or packed cells | 18g
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| What gauge is used for administering other blood products? | 18-20g
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| Blood is normally administered through what type of infusion set? | Y-type
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| How much NS is used on the other side of the infusion set? | 250 mL
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| What is included in the Y-type infusion set (blood tubing)? | Special blood filter
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| Why does blood transfusion need to be administered within the required time? | To avoid blood clots and bacterial growth
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| What must the two nurses do prior to leaving the blood bank, after they have verified blood? | Sign blood bank requisition form
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| What are the three areas a patient can experience pain that would indicate blood reaction? | Headache, chest pain, and pain in low back
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| What happens to v/s during a blood reaction? | BP decreases, dyspnea, chest pain, fever, and chills
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| What respiratory symptoms indicate blood reaction? | Respiratory rate and lung sounds
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| What skin reactions indicate blood reaction? | Pruritus (itching)
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| What are other symptoms of blood reaction? | Nausea, vomiting, decreased urine output, low back pain
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| What are five major symptoms of fluid overload? | Dyspnea, rapid/bounding pulse, cough/crackles, disorientation, pitting edema & weight gain
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| 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
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| Define platelets | are used to treat thrombocytopnea and hemorrhage
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| Define whole blood | is to treat massive hemorrhage or hypovolemic shock due to hemorrhage
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| Define serum albumin | is used to expand the blood volume in patients with hypovolemic shock as a safe volume expander
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| Define granulocytes | are used to transfuse granulocytopenic patients or those who have severely deficient white blood cells
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| Define packed red | are used to treat anemia
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| Define plasma | is used to replace the deficiencies in coagulation factors and to treat patients with severe liver disease
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