2. IV, PN Flashcards
Examples of Isotonic
.9NSS, D5W, Ringer’s Lactate, Normal Saline
Hypotonic def
(push fluid into cell) prevent fluid overload
Hypotonic examples
.45NSS (1/2 NSS) half strength saline
hypotonic complications
intravascular fluid depletion, decreased blood pressure, cellular edema, and cell damage
hypertonic def
(pull fluid out of cell) increase blood pressure
hypertonic examples
10% Dextrose in water, D5.45NSS, D5.9NSS, DSLR, 50% Dextrose in Water
hypertonic complications
extracellular volume excess and precipitate circulatory overload and dehydration
What size needle for blood?
18 or larger needle
Gauges of needle
14-24 (14 largest, 24 smallest)
What affects IV flow?
diameter (bigger than faster flow); height of bag (higher bag, faster flow)
When flush IV?
every 8 hours and before and after administration of meds
If using iodine for IV insertion ask pt?
if allergic to shell fish
How to know if IV inserted in artery?
if bright red blood and blood shooting out with each heart beat
How should vein feel once tourniquet is placed?
firm, elastic, engorged, and round; not hard, flat or bumpy
degree of angle of needle when inserting IV
10-30 with bevel up
What requires own IV site?
Heprin, blood, and TPN
change IV tubing and equipment every?
72-96 hours/site & tubing (thick liquids changed every 24 hours - TPN, blood, lipids/24 hours)
hematoma?
could be caused by inserting IV at the wrong angel, should be 5-30; results when blood leaks into tissues surrounding the IV insertion site (puncturing the back wall of the vessel)
infiltration?
leaking of fluid into interstitial space
- Regular infiltration – noncaustic type of fluids
- Extravasation – Caustic fluids
- Causes: ruptured vessel, dislodge cannula, occlusion
- Assessment: swelling, blanched, cool, pain, occlusion
• Tie tourniquet above IV site to determine if present (tight enough to restrict venous flow, if infusion continues to drip despite the venous obstruction, infiltration is present)
• Will not have blood return
level 4 infiltration?
compartment syndrome
phlebitis?
inflammation of a vein
- Causes: irritant solution, dehydration, infection
- Assessment: erythema, warmth, pain
• Site – red, warm to touch, painful, burns when touched (“burned the vein”), sometimes red streak
• Can get blood return
fluid overload
overloading the circulatory system with excessive IV fluids causes increased blood pressure and central venous pressure (so making the heart work too hard)
- Ex. Albumin (hypertonic) draws more fluid in because of concentrations)
- Causes: Rapid or large volume fluid administration, compromised cardiac function
- Assessment: SOB & crackles, tachycardia, agitation or anxiety
- Intervention: slow infusion, raise HOB to set patient up, monitor VS, notify provider
veins used for PN
Typically, a large, high-flow vein such as the subclavian vein or superior vena cava is the preferred site. femoral lines (last resort)
TPN
Total Parenteral Nutrition contains glucose, amino acids, vitamins, and minerals all mixed into 1 bag; Does not have fat (lipids), so sometimes have to give pt fat emulsions
PPN
Peripheral Parenteral Nutrition; “half dosing”, Can give through midline, Given for supplement, Individualized to the pt by pharm and orders written every 24hrs
TNA
Total Nutrient Admixture; Same as TPN but also has lipids
Important monitoring of PN
Blood sugar measured every 6-8 hours
Intake and Output – to make sure pt is excreting properly
Daily weight – make sure taken at the same time every day, good time is the morning; every L gain 2.2 lbs
complications of PN
Sepsis – because of glucose Electrolyte imbalance Hyperglycemia – think about how fast start rate Hypoglycemia – if stop abruptly Hypervolemia Hepatic dysfunction – because of lipids Hypercapnea – CO2 in the blood Lipid intolerance
administering PN
Remove TPN and lipids from the refrigerator at least an hour before hanging. TPN solution should be clear, not cloudy.
Lipids will be white. Do not use the fluid if cracking or creaming of the fluid is present because it may indicate fluid separation.
Input and Output defined
Defined as the measurement and recording of all fluid intake and output during a 24 hour period
1 tablespoon (tbsp) = ___milliliters(ml)
15
___ teaspoons(tsp) = 15 milliliters(ml)
3
1 cup(C) = ___milliliters(ml)
240
8 ounces(oz) =___ milliliters(ml)
240
1 teaspoon(tsp) = __milliliters(ml)
5
1 cup(C) =__ounces(oz)
8
16 ounces(oz) = __pound(lb)
1
1 ounce (oz) = ___milliliters(ml)
30
Jello?
120 ml
Ice cream/sherbet
120 ml
4oz of juice
120 ml
1 ice cup
120 ml
16 oz milkshake
480 ml
popsicle
90 ml
120 oz soda
360 ml
pudding/yogurt
120 ml
