202B Test #2 Flashcards
what route should not be used when pt is on an anticoagulant
IM
you never give heparin IM but also don’t give other meds IM when they are anticoagulants
what should you assess with heparin infusions
- if pt has any bleeding issues
- compatibility
- what to teach your pt
what are K-riders usually run at
generally run at 10mEq/hr
what is a possibility of a K-rider
cardiac dysrhythmias
so pts may need to have cardiac monitors on while recieving infusion
Burning at IV site- which is why it needs to be ran with a primary infusion
what is special about heparin and k rider infusions
it needs its own primary pump
what is the pre assessment
- assess potassium levels
- check IV site
- any K+ sparing diuretics they are taking
what can you do to help with the burning sensation
- may have to switch to PO
- decrease IV rate
- increase the amount of fluid running with K+ (need to ok with dr)
- Ice/heat
why do we give insulin subQ
because the subQ tissue is less vascular and we want the insulin to metabolize slower
when would you use a 45 degree angle on sub Q injections
for a child or a thin person to insure you are not entering muscle
what is the usual angle of subQ injections
90 degrees
advantage of subQ injections
- slow sustained and complete absorption
- faster absorption
- used for meds that are inactivated by the GI tract. allows them to bypass
Disadvantage of SubQ inj
- discomfort
- various absorption rates- larger pt may have slower absorption than a thin person
what are common subQ inj
-all types of injections
-heparin and LMWH
-terbutaline
-immunizations
-colony stimulating factors
(epogen, darbepoetin, heupogen, neumega)
what are the subQ inj sites
- abdomen
- thigh
- upper arm
- upper buttocks
rate of absorption in abdomen
the fastest route of absorption
what is the slowest absorption for a subQ inj
upper buttocks and thigh
why is the upper buttock and thigh preferred for infants <12months
because they don’t have much muscle in the legs and buttock
what areas do you want to avoid with subQ inj
- the umbilical region
- areas of abnormal tissue
- areas with burns, birthmarks, scars, inflammation
- bruising
- lipodystrophy
what is lipodystrophy
lipo formation associated with incorrect injection habits
what is the average volume for subQ inj
adult- up to 1mL
pediatrics- up to 0.5mL
average needle size for subQ injections
25-30guage
size syringe for heparin
1-3mL syringe
in addition to syringe with med, what else do you need to bring to the pt room
the medication vial to scan
after you remove the needle what do you want to do
cover the injection site with a guaze and apply gentle pressure.
Do NOT massage the site.
when giving a subQ injection what do you want to assess prior to giving the injection
- assess the prior injection site
- inspect selected site(make sure free of scar tissue, bruising, burns, birthmarks, etc)
- assess pt anxiety
how is insulin measured
units only
why we need to use an insulin syringe
when is a sliding scale used
typically AC(before meals) and HS(at bedtime)
can a diabetic patient be on scheduled insulin and sliding scale
yes- most pts are on a long acting insulin daily and short acting doses before meals and at night
what are pre assessments of giving insulin
- blood sugar level
- where it was last given
- what are their trends
- are they going to eat soon
- short acting or long acting insulin
- check expiration date
what anticoagulant lab are you going to look at with heparin
PTT
how is heparin measured
in units but measured out in mLs- no rounding of doses
where should heparin and lovenox be administered
in the abdomen
- it has faster absorption
- hurst less
- less chance of hematoma and hitting muscle
how do you assess effectiveness of enoxaparin
you want to look for signs and symptoms of bleeding
- signs and symptoms of things we are trying to prevent such as TIA or DVT
- you an look at their platelet , and H&H
what are the reassessments for administering heparin or enoxaparin
- calculations based on pts weight
- hx of thromboembolic events
- signs of bleeding
- platelet counts
- PTT for heparin
what is a contraindications of heparin or enoxaparin injections
-IM injections it can cause a hematoma in pt. -severe hypertension -pregnancy -hemorrhage -hx of HIT
how is PPN and TPN administered
either peripherally through IV pump and line
or centrally through a central line
what assessments do you want to check prior to hanging TPN
- monitor I&O
- daily weight
- labs-especially electrolytes
- orders
- MAR to make sure has correct components &rate
- compare bag to flowsheet
- make sure solution is refrigerated
- inspect solution
when should you pull out TPN bag out of fridge
30 minutes prior to admin
what are you inspecting when looking at the TPN bag
for any sediment, cloudiness leaks, etc
what are 2 main components you want to assess when hanging TPN
- Assess the IV site for patentcy
- check blood sugars
what is the difference between PPN and TPN
PPN- given peripherally, the concentration is <10% dextrose and <5% amino acids
<600mOsmol
TPN is more concentrated and is through a central line
what does the patient have an increased risk for with PPN
-phlebitis
what do you want to monitor with PPN and TPN
labs- electrolytes
K+, Na+ etc.
what do you need to use with TPN and PPN
a filter device
what is PPN used for
to increase volume
used to give them more than what IV fluids would give
it will maintain nutritional status
-used for short term
how is TPN administered
via central line or PICC d/t the osmolarity (1500-2800mOsml/L)
to prevent phlebitis, infiltration etc.
what is TPN used for
- long term
- for pts with large caloric and nutritional needs
- someone who had GI sx and can’t use GI system for few days or has GI dysfunction etc.
why do you need a filter when administering TPN/PPN
to reduce any particulate matter from infusing into the pt.
why do we use a dark cover for TPN/PPN bags
light breaks down electrolytes in the feeding
how are lipids administered
peripherally or centrally
what is the only thing allowed to go through the TPN line
Lipids are the ONLY thing allowed to go through the TPN line (at the y site below the filter closest to the pt)
-if IV medications are needed a new IV site will be required
why do you attach lipids to the y site closest to the pt
because you do not want the lipids to go through the filter
unless lipids are mixed in the TPN bag
what allergies should you assess for when administering lipids
- eggs
- soy
- soybean oils
what do you want to monitor during TPN
- vital signs-especially temp
- BS-checks, s/s of hyper/hypogclycemia
what complications can happen during TPN/PPN admin
- phlebitis w. peripheral sites
- sepsis-d/t high glucose content
- fluid overload
- hyper/hypoglycemia
- electrolyte imbalance
- fatty acid deficiency
why would hypoglycemia be a concern with TPN/PPN
because if feeding is stopped abruptly, the BG can drop (will occur about 30 min after cessation)
what would you want to monitor for during TPN to assess for sepsis
-lookat site, monitor labs, and temp
if your IV infiltrates and must be d/c’d and you have abruptly stopped the infusion what should you do next
-start a new IV to begin running infusion again
if pt has elevated glucose of 165mg/dl and is on TPN what should you do
-check the sliding scale and administer insulin coverage
what impact does TPN have on a diabetic pt
- increased blood sugars
- may end up with insulin in the bag
what are factors of diabetes
genetics
autoimmune
environmental
how much insulin is produced per day by the pancreas
approx 40- 50 units /day
what are triggers for type 1 diabetes
a viral or toxin that triggers the autoimmune reaction to stop producing insulin
what are the 3Ps of DKA
polyphagia, polydipsia, polyuria
what are s/s of type 2
may be very subtle or vague symptoms such as fatigue or infections and eventually the 3 Ps
what ethnicity is more at risk for type 1 diabets
caucasians
s/s hypoglycemia
- cold/clammy skin
- diaphoresis
- pallor
- rapid heart rate
- anxiety
- hunger
- headache
- nervousness
- tremmors
- slurred speech
- vision changes
- changes in LOC
- Seizures/Coma
what can s/s of hypoglycemia mimic
stroke or alcohol intoxication
what should you do if someone is showing s/s of hypoglycemia
give them a snack with sugar and take their Blood glucose
what are causes of hypoglycemia
- too little food
- too much diabetic med
- too much exercise w/o food
- alcohol intake w/o food
what does alcohol due to blood sugar
inhibits glycogenolysis
what are treatments for hypoglycemia
-give them simple carbs such as glucose or dextrose via PO or IV routes
what is the goal of diabetes treatemetn
to have tight glucose control and prevent long term complications
what labs would you look at in diabetes treatemetn
- blood glucose
- Hgb A1C,
- fasting & post parandial glucose
- renal function
what is the #1 trigger of DKA
a viral infection/illness/stress
what is osmotic diuresis
the pt starts to urinate a lot and lose a lot of electrolytes
what does osmotic diuresis occur in
Diabetic Ketoacidosis
what does an accumulation of keytones lead to
they accumulate in the blood and urine and lead to metabolic acidosis
what are s/s of ketoacidosis
- 3 Ps
- lethargy
- dehydration
- abdominal pain
- anorexia
- vomiting
- tachy
- hypotension
- kussmaul respirations
- sweet fruity breath
what is the first priority of diabetic ketoacidosis
Fluid Replacement!
then an insulin drip
and potassium replacement
and close glucose monitoring
what are symptoms of hyperosmolar-hyperglycemic syndrome
-few early symptoms
-dehydration
-hypotension
-tachycardia
-altered LOC
LATE SIGNS
-neurologic impairment
-lethargy
-seizures
-hemiparesis
-aphasia
-coma
what is the first priority of hyperosmolar hyperglycemic syndrome
Fluid replacement
usually with 0.45 or 0.9% NS to rehydrate
