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IGGY > Administration of IV Fluids > Flashcards

Administration of IV Fluids Flashcards

1
Q

6 “Rights” of medication administration

A 
Right person
Right route
Right dose
Right time
Right medication
Right documentation
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2
Q

Changing IV equipment

A 
IV tubing – 96 hours
Intermittent infusion – 24 hours
Blood tubing – 4 hours
IV dressings
Gauze – 48 hours
Transparent – 96hours
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3
Q

IV tubing

A

96 hours

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4
Q

Intermittent infusion

A

24 hours

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5
Q

Blood tubing

A

4 hours

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6
Q

IV dressings

A

Gauze – 48 hours

Transparent – 96hours

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7
Q

If a client who is receiving IV fluids develops tenderness, warmth, erythema, and pain at the site, the nurse suspects:

A

Phlebitis

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8
Q

Most medication errors occur when the nurse:

A

Fails to follow ROUTINE PROCEDURES

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9
Q

The patient receiving IV therapy is at risk for becoming infected with any number of organisms.
A common microbe that is constantly present on the skin and poses a threat to a client receiving infusion therapy is:

A

Coagulase Negative Staphylococcus

The major cause of intravenous catheter-related infections.

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10
Q

Potentially Hazardous Body Fluids:
Blood serves as the reservoir for countless pathogenic organisms, the most lethal being hepatitis viruses that cause hepatitis B (HBV), C (HCV), D (HDV), E (HDE), and the human immunodeficiency virus (HIV), responsible for advanced HIV disease (AIDS).

A 
A – stool
B – blood and body fluid
C – blood
D – Patients with hep B – called supra imposed infection 
E – fecally contiminated water
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11
Q

Hepatitis A

A

Transmitted through stool

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12
Q

Hepatitis B

A

Transmitted through blood and body fluid

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13
Q

Hepatitis C

A

Transmitted through blood

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14
Q

Hepatitis D

A

Patients with Hep B, called supraimposed infection.

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15
Q

Hepatitis E

A

Transmitted through fecally contaminated water.

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16
Q

ntermittent Venous Access (SL-Saline Lock or HL-Heparin Lock)

A

Convenient
Safe
Flushed before and after use

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17
Q

Dehydration…”the excessive loss of water from the body.”

A

Symptoms…Increasing thirst, dry mouth, weakness or lightheadedness (particularly if worsening on standing), darkening of the urine, or a decrease in urination, lower blood pressure.

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18
Q

Over hydration… “the abnormal increase in the volume of circulating fluid (plasma) in the body.

A

Symptoms…Edema, shortness of breath, hemoptysis, JVD, cough, crackles on auscultation.

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19
Q

Infiltration

A

Definition: Accumulation in the tissue of fluid not normal to the body system

Treatment:

  • IV would need to be removed and restarted
  • Raise the extremity
  • Warm moist towel for 20 minutes to promote circulation and reabsorption
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20
Q

Phlebitis

A 
Inflammation of the layers of the vessel.
CAUSES:
From cannula
Chemical irritation
Anatomical position

S/S: Pain, edema, redness that can travel up the arm. Can cause blood clots.

INTERVENTIONS:
Remove IV an insert a new line
Warm moist heat

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21
Q

Cellulitis

A

Infection of the skin and the tissue beneath the skin. May need antibiotic therapy.

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22
Q

Common IV Complications

A 
Infiltration
Extravasation
Phlebitis
Necrosis
Bruising
Local Infection
Cellulitis
Bleeding at the Venipuncture Site
Bruising
Compartment Syndrome
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23
Q

Extravasation

A

The leakage of intravenous drugs from the vein into

the surrounding tissue.

24
Q

Bruising

A

Injury to the soft tissue, leading to leaking of red cells under the skin.

May take weeks to resolve completely
Pay attention when individuals are on blood thinners (coumadin, lovenox, asa, plavix, heparin)
Bleeding disorder - hemophilia

25
Q

Necrosis

A

Death of tissue; can be caused by ischemia.

May need surgical debridement and grafting

26
Q

Compartment Syndrome

A

Acute medical problem in which increased pressure (usually caused by inflammation) within a confined space (fascial compartment) in the body impairs blood supply, without prompt treatment, may lead to nerve damage and muscle death.

27
Q

Blood Types

A

A, B, O, AB Positive or Negative.
Transfusion reaction occurs in the event blood is mismatched or has antibodies
O - is the Universal Donor
AB + is the Universal Recipient
Most common blood type is O + (45% of the population)
Least common blood type is AB – (approximately 1 in 167)

28
Q

IV Solutions

A
  • Check expiration date
  • Clarity
  • Sediment
  • Leaking
  • Solution label
29
Q

IV Fluids - Crystalloids

A 
The goal of IV fluid administration is to CORRECT and PREVENT fluid and electrolyte disturbances.
Continuously regulated
KNOWLEDGE TO INCLUDE:
*Solution Type
*Equipment Needed
*Procedures
*Regulation of line
*Maintenance
*Discontinuation
*Identification and correction of problems
30
Q

Types of IV Solutions

A

An IV solution is prescribed to maintain or restore fluid balance.

The physician can chose from three basic type of solutions:

  • Isotonic
  • Hypotonic
  • Hypertonic
31
Q

Isotonic Solutions

A

*An isotonic IV solution possesses about the same osmolarity as serum and other body fluids
*It stays where you put it
*Expands this compartment without pulling fluid from other compartments
*Useful in hypotension from hypovolemia
EXAMPLES:
*Normal Saline (0.9NS)
*Lactated Ringers (LR or RL)
*5% Dextrose in Water (D5W)

32
Q

Isotonic Fluids

A

*Close to the same osmolarity as serum.
*They stay inside the intravascular compartment, thus expanding it.
*Can be helpful in hypotensive or hypovolemic patients.
*Can be harmful. There is a risk of fluid overloading, especially in patients with CHF and hypertension.
*Isotonic fluids contain an approximately equal number of molecules as serum so the fluid stays within the intravascular space.
*Remember that fluid flows from an area of lower concentration of molecules to an area of high concentration of molecules (osmosis) to achieve equilibrium (fluid balance).
*In this example, there is no fluid flow into or out of the intravascular space.
Examples: Lactated Ringer’s (LR), NS (normal saline, or 0.9% saline in water).

33
Q

D5W Information - Susceptible to water intoxication

A

Patients receiving 5% Dextrose in Water are particularly susceptible to water intoxication.
*D5W starts out as an ISOTONIC solution. Once it is introduced into the circulatory system, the glucose is metabolized leaving behind water which is a HYPOTONIC solution.

34
Q

Hypotonic Solution

A

DESCRIPTION: Osmolarity lower than that of serum

  • Body fluid and electrolytes shift out of the blood vessels and into the cells and interstitial space
  • Hydrates cells while depleting the circulatory system.

EXAMPLES:

  • 0.45% Sodium Chloride (0.45NS ½ NS)
  • 0.33% Sodium Chloride (0.33NS or 1/3NS)
35
Q

Hypotonic Fluids

A
  • Have less osmolarity than serum (i.e., it has less sodium ion concentration than serum).
  • It dilutes the serum, which decreases serum osmolarity.
  • Water is then pulled from the vascular compartment into the interstitial fluid compartment.
  • Then, as the interstitial fluid is diluted, its osmolarity decreases which draws water into the adjacent cells.
  • Can be helpful when cells are dehydrated such as a dialysis patient on diuretic therapy.
  • May also be used for hyperglycemic conditions like diabetic ketoacidosis, in which high serum glucose levels draw fluid out of the cells and into the vascular and interstitial compartments.
  • Can be dangerous to use because of the sudden fluid shift from the intravascular space to the cells.
  • This can cause cardiovascular collapse and increased intracranial pressure (ICP) in some patients.
36
Q

Hypertonic Solutions

A

DESCRIPTION: Higher osmolarity than serum

  • Fluid and electrolytes are pulled from the intracellular and interstitial compartments into the intravascular compartment
  • Used for Edema

EXAMPLES:

  • 3-5% NS
  • 5% Dextrose in 0.45% Saline (D5W.45NS or D51/2 NS)
  • Dextrose in Normal Saline (D5WNS or D5.9NS )
  • 5% Dextrose in lactated Ringers (D5WLR or D5LR)
37
Q

Hypertonic Fluids

A
  • Have a higher osmolarity than serum.
  • Pulls fluid and electrolytes from the intracellular and interstitial compartments into the intravascular compartment.
  • Can help stabilize blood pressure, increase urine output, and reduce edema.
  • Care must be taken with their use.
  • Dangerous in the setting of cell dehydration.
38
Q

Potassium (K+)

A
  • Normal renal function
  • NPO
  • Body cannot conserve K+
  • Kidneys continue to excrete
  • Need to supplement IV

NEVER GIVE KCL IV PUSH …. Only piggy back or added in IV Fluid

39
Q

Electrolytes

A

An element or compound that, when dissolved or dissociated in water or another solvent, separates into ions that are electrically charged.

Measured in milliequivalents per liter (mEq/L)
Na+, K+, Ca+, Mg+, Cl-.

40
Q

(Na+)Sodium

Normal 135-145 mEq/L

A 
HYPONATREMIA:
*Sodium Loss
*Water Excess
*Serious Illness
EXAMPLES:
*GI Losses
*Diuretics
*Burns
HYPERNATREMIA:
*Excess water loss
*Sodium excess
*Body conserves water
EXAMPLES:
*Large amounts of salt solutions
*Diabetes insipidus
*Water deprivation
 *Increase insensible and sensible water loss
41
Q

Hyponatremia

A

HYPONATREMIA:

  • Sodium Loss
  • Water Excess
  • Serious Illness
SIGNS AND SYMPTOMS:
Apprehension
Hypotension
Dizziness
Abdominal cramping
Nausea and Vomiting
Diarrhea
Tachycardia
Dry mucous membranes
42
Q

Hypernatremia

A

HYPERNATREMIA:

  • Excess water loss
  • Sodium excess
  • Body conserves water
SIGNS AND SYMPTOMS:
Extreme thirst
Dry and flushed
Dry and sticky tongue
Postural hypotension
Fever
Agitation
Convulsions 
Restlessness
43
Q

Water Intoxication

A

When too much water enters the body, the tissues swell with the excess fluid and hyponatremia occurs. This results in cells desperately trying to increase the sodium concentration in body fluids by taking in tremendous amounts of water. Some cells can swell a great deal; others cannot. Brain cells are constrained by the skull and can end up bursting with the pressure of the water they are taking in.

This causes the cells to swell. In the brain, this swelling increases intracranial pressure(ICP). It is this increase in pressure which leads to the first observable symptoms of water intoxication:  
Headache
Personality Changes
Changes in Behavior
Confusion
Irritability
Drowsiness
44
Q

(K+)Potassium

Normal 3.5 -5.0 mEq/L

A

HYPOKALEMIA:

  • Vomiting
  • Potassium wasting diuretics
  • Little tolerance for fluctuations

EXAMPLES:

  • GI Losses
  • Diuretics
  • Polyuria
  • Alkalosis

HYPERKALEMIA:
*Renal Failure

EXAMPLES:

  • Fluid volume deficit
  • Burns or Trauma
  • Acidosis
  • Rapid infusion of blood
  • K+ Substitutes
45
Q

HYPOKALEMIA

SIGNS AND SYMPTOMS

A
  • Weakness
  • Fatigue nausea and vomiting
  • Intestinal distention
  • Decreased bowel sounds
  • Decreased deep tendon reflexes
  • Ventricular dysrhythmia
  • Irregular pulse
46
Q

HYPERKALEMIA

SIGNS AND SYMPTOMS

A
  • Anxiety
  • Dysrhythmias
  • Weakness
  • Abdominal cramps
  • Diarrhea
  • Cardiac Arrest

**Do not give K+ supplements if urine output is inadequate

NO PEE, NO K!
*If you have poor urine output and are receiving K+ supplements, you can induce hyperkalemia.

47
Q

(Ca+) Calcium

Normal 9.0 – 10.5 mg/dl

A

HYPOCALCEMIA:

  • Illness
  • Disease affecting the thyroid and parathyroid gland
  • Renal insufficiency

EXAMPLES:

  • Pancreatitis
  • Chronic Renal Failure
  • Vitamin D deficiency

HYPERCALCEMIA:

  • Neoplasm
  • Prolonged Immobilization
  • Hyperparathyroidism

EXAMPLES:

  • Osteoporosis
  • Paget’s Disease
  • Osteometastasis
48
Q

CHVOSTEK’S SIGN:

A

When the facial nerve is tapped at the angle of the jaw, the facial muscles on the same side of the face will contract momentarily (typically a twitch of the nose or lips)

49
Q

TROUSSEAU’S SIGN

A
  • Inform the patient about the procedure as it is very uncomfortable and painful:
  • A blood pressure cuff is inflated to a pressure above the patient’s systolic level
  • This pressure has to be continued for several minutes
  • Look for carpopedal spasm which involves the following:
  • flexion at the wrist
  • flexion at the metacarpophalangeal joints
  • extension of the interphalangeal joints
  • adduction of the thumbs and fingers
50
Q

(Mg++) Magnesium

Normal 1.3 – 2.1 mEq/L

A

HYPOMAGNESEMIA:

  • Malnutrition
  • Malabsorption Disorders

EXAMPLES:

  • Alcoholism
  • GI loss
  • Thiazide diuretics

HYPERMAGNESEMIA:
Excess magnesium intake by patient with renal insufficiency

EXAMPLES:

  • Renal Failure
  • Excess oral or parenteral intake
51
Q

HYPOMAGNESEMIA

SIGNS AND SYMPTOMS:

A
  • Muscle Tremors
  • Hyperactive deep tendon reflexes
  • Confusion and disorientation
  • Tachycardia
  • Hypertension
  • Dysrhythmias
  • Positive Chvostek’s and Trousseau’s sign
52
Q

HYPERMAGNESEMIA

SIGNS AND SYMPTOMS:

A
  • Hypoactive deep tendon reflexes
  • Decreased depth and rate of respiration
  • Hypotension
  • Flushing
53
Q

CALCULATING IV FLOW RATES:

A

To calculate the flow rate of an I.V. infusion, divide the amount of solution to be administered by the delivery time.

Example… 1,000 ml of solution over 8 hours would look like this:

1000 ML = 125 ML/HR
8 HOURS

54
Q

CALCULATING IV DRIP RATE

A

Once you determine the flow rate, you’ll need to decide on a delivery system. Remember, a microdrip delivers a little fluid over a long time, and a macrodrip delivers a lot of fluid over a short time.

55
Q

MICRODRIP SYSTEM

A

60 drops equals 1 ml of solution.

To figure the flow rate for this system, divide the number of drops in 1 ml(60) by 60 (the number of minutes in an hour).
Then divide the amount of fluid ordered to be given (125) per hour by 1.
Multiply the two figures together to get drops per minute.

Your formula will look like this:
60 125 =125 DROPS/MINUTE
60 1

56
Q

MACRODRIP SYSTEM

A

Delivers 1 ml by 10, 15, or 20 drops. The number of drops per milliliter is designated by the manufacturer on the I.V. tubing package. To figure the flow rate for a macrodrip system, use one of the following formulas (based on 10, 15, or 20 drops/ml of solution). In each formula, drops/ml is divided by 60 (the number of minutes in an hour) then multiplied by the infusion rate over 1.

57
Q

COUNTING IV GTT RATE

A
  • Need a watch with a sweep hand
  • Count the number of gtts in the gtt chamber for one full minute
  • Use the roller clamp to adjust

IGGY (5 decks)

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