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Care of Patients with Chronic Conditions Nursing: N2335 > Advanced Skills IV Theory (Exam One) > Flashcards

Advanced Skills IV Theory (Exam One) Flashcards

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1
Q

What is the most commonly used infusion route?

A

Intravenous (IV) route

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2
Q

List the advantages of IV therapy.

A
  • Instant effects
  • Better control of medications
  • More specific (mL/hr)
  • Boluses
  • Direct access to blood stream
  • Able to give medications if patient is NPO
  • Good for medications that cannot be absorbed via another route
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3
Q

List the disadvantages of IV therapy.

A
  • Irritating substances
  • Medication incompatibility
  • Errors in mixing medication
  • Extravasation
  • Speed shock
  • Chemical phlebitis
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4
Q

IV substance irritation usually occurs due to what?

A
  • Lack of assessment

- Incorrect placement

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5
Q

What is the nurses role in relation to IV therapy?

A
  • Assess
  • Manage
  • Initiate
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6
Q

How is competency assessed in relation to IV therapy?

A

Evidence-based practice

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7
Q

A patient complains of pain after having an IV placed. The site is without redness, swelling, and is not warm to the touch. This is considered what type of data?

A

Subjective

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8
Q

Upon assessment of a patient’s IV site, the nurse visualizes redness and swelling along with warmth and tenderness upon palpation. This is considered what type of data?

A

Objective

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9
Q

What population may be less likely to be aware of IV site complications? Why?

A

-Older population

  • Decreased sensory perception
  • Acute confusion
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10
Q

The nurse should __________ care for each patient.

A

Individualize

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11
Q

The nurse should provide _________ to each patient regarding IV therapy.

A

Education

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12
Q

What must the nurse know when providing medications to patients via infusion therapy?

A
  • Antidote(s)
  • Reversal agent(s)
  • Physicians order
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13
Q

The physicians order for IV therapy will include what?

A
  • Type of solution
  • Rate of solution
  • Duration of the solution
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14
Q

The nurse may decide what two factors when inserting an IV?

A
  • Size of catheter

- Location of catheter insertion

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15
Q

The nurse will require an order from the physician to place an IV site on which body part?

A

Foot

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16
Q

What is a sentinel event?

A

Any event that has caused major harm to the patient

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17
Q

The nurse is responsible for including what information within their documentation when inserting an IV?

A
  • Placement time
  • Placement site
  • Securement device
  • Currently infusing
  • How the patient is tolerating the IV
  • IV site description
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18
Q

T/F: The nurse is allowed to place an IV in a patient, even if the patient is coherent and denies the IV. Explain.

A
  • False

- Coercion of a coherent adult patient can result in the nurse being charged with assault or battery

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19
Q

What is the most common type of error made by nurses?

A

Medication error

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20
Q

What must the nurse do before administering a high-risk medication?

A

Have the medications check by another nurse (double-check)

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21
Q

What medications are considered high-risk or double-check medications?

A
  • Insulin

- Blood thinners

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22
Q

What must the nurse know about the medication being administered prior to running or pushing the medication?

A

How fast to run or how slow to push the medication/solution

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23
Q

If infusing more than one solution, they must be what?

A

Compatible

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24
Q

What is a nonspecific immune response?

A
  • Acquired at birth

- May function without previous exposure to antigen

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25
Q

What is a specific immune response?

A

Acquired immunity through repeated exposure to antigens

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26
Q

What is the body’s first line of defense against an antigen?

A

Intact skin

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27
Q

What vital sign changes will a patient exhibit if an infection is present or worsening?

A
  • Decreased blood pressure
  • Increased heart rate
  • Increased temperature
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28
Q

A decrease in blood pressure and an increase in heart rate and temperature are considered what type of mechanism?

A

Second line defense mechanism

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29
Q

Older adults are most likely to NOT exhibit which symptom when presenting with an infection?

A

May not show an increase in temperature

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30
Q

What is the most common type of IV related sepsis?

A

Staph infection

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31
Q

List the type of patients who are immunosuppressed and most at risk for infection?

A
  • Chemotherapy patients
  • HIV patients
  • Transplant patients
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32
Q

What are the four major concerns if a patient is considered to be immunosuppressed?

A
  • More frequent infections
  • More severe infections
  • Unusual infections
  • Decreased response to therapy
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33
Q

Define colonization.

A
  • Growth of an organism without detection

- Person has infectious agent and does not know

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34
Q

Define dissemination.

A
  • Person is shedding the organism into their environment

- Person has infectious agent and is infecting other people

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35
Q

What type of patient is most at risk for complications or health acquired infections?

A

Patient with co-morbidities

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36
Q

List the three sources of infusion related infections.

A
  • Insertion site
  • Cannula hub
  • Contaminated fluids
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37
Q

Define phlebitis?

A

Inflammation of the vein

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38
Q

What size of veins are more prone to irritation?

A

Small veins

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39
Q

List the signs and symptoms of phlebitis.

A
  • Inflammation
  • Pain
  • Tenderness
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40
Q

An elderly patient begins to display signs of phlebitis along her IV site, which was inserted this morning. The night nurse stated the patient was a hard stick at hand-off. The IV site cannot be moved to her other arm due to an intact fistula. How should the nurse treat the phlebitis?

A

Manage the symptoms using a warm compress

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41
Q

What is infiltration?

A

When IV fluid escapes from the vein into the surrounding tissue

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42
Q

Is a local or systemic infection accompanied by vital sign changes?

A

Systemic

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43
Q

Which bacteria is the most common source of infection?

A

Staph

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44
Q

Where does a local infection occur?

A

In one central or localized area on the body

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45
Q

What are the signs and symptoms of a local infection?

A
  • Drainage from insertion site
  • Erythema
  • Swelling
  • Pain or tenderness
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46
Q

Will a patient who has a local infection also display signs and symptoms of a systemic infection?

A

No

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47
Q

Describe extrinsic contamination.

A

Contamination that occurs during preparation or administration

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48
Q

Describe intrinsic contamination.

A

Contamination that occurs during manufacturing

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49
Q

List factors that contribute to contamination during infusion procedures.

A
  • Faulty handling
  • Admixtures
  • Manipulation of in-use IV equipment
  • Injection ports
  • Additional ports
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50
Q

What procedure is necessary if an infusion related infection is suspected?

A

Obtaining a culture from the suspected source

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51
Q

Where should a peripheral IV end up after insertion?

A

In the vein

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52
Q

Valves of the veins are located how far apart? Can a peripheral IV catheter be inserted into a vein valve?

A
  • Approximately every 3 in

- No

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53
Q

T/F: A pulse can be felt in a vein.

A

False, you cannot feel a pulse in a vein

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54
Q

When attempting to start a peripheral IV, should the nurse begin high and work down the arm or begin low and work up the arm?

A

Begin low and work up the arm

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55
Q

A nurse has attempted to insert a peripheral IV in the AC vein of a patients left arm, but was unsuccessful. A different nurse attempts to insert another peripheral IV on the same arm immediately following the unsuccessful attempt . Can the current nurse attempt to insert below the AC vein previously accessed by the first nurse?

A

No, the new IV must be proximal to the previous attempted IV insertion

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56
Q

What is the first step of a peripheral IV insertion?

A

Confirm the provider order

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57
Q

What should the nurse check the IV fluid, or solution, for, prior to starting the IV?

A
  • Expiration date
  • Clarity
  • Holes or punctures of the bag
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58
Q

After cleaning, why does the skin need to dry completely before inserting the IV?

A

To avoid skin irritation

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59
Q

If a patient becomes anxious before or during an IV insertion what will this cause?

A

Vasoconstriction

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60
Q

List the considerations of IV site selection.

A
  • Type of solution
  • Condition of vein
  • Duration of therapy
  • Cannula size
  • Patient age
  • Patient activity
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61
Q

An IV may NOT be placed over what type of skin conditions?

A
  • Rash

- Scar

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62
Q

An IV may NOT be placed in a patients arm if they have/had what?

A
  • Graft
  • Fistula
  • Mastectomy
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63
Q

Why should the AC vein be avoided when choosing an IV site?

A

Constant manipulation and bending can cause IV to go bad

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64
Q

What size gauge needles are used to administer blood?

A
  • 18 gauge

- 20 gauge

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65
Q

List the different methods used to dilate a vein.

A
  • Tourniquet
  • BP cuff (>30 mmHg)
  • Warm compress
  • Flicking vein
  • Hanging dependent
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66
Q

What is a 16 gauge catheter used for? What color is it?

A
  • Trauma

- Gray

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67
Q

What is an 18 gauge catheter used for? What color is it?

A
  • Blood
  • Pre-surgery
  • Green
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68
Q

What is a 20 gauge catheter used for? What color is it?

A
  • Routine and most common

- Pink

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69
Q

What is a 22 gauge catheter used for? What color is it?

A
  • Pediatric or older adults

- Blue

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70
Q

What is a 24 gauge catheter used for? What color is it?

A
  • Pediatric or older adults

- Yellow

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71
Q

What length of needle is used for IV catheter insertion?

A

1 inch or smaller

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72
Q

The catheter must be _______ than the vein.

A

Smaller

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73
Q

Larger needles are required for what type of solutions?

A

Caustic (irritating)

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74
Q

The tourniquet should be applied how many inches above the IV site?

A

3 to 4 inches

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75
Q

What type of solutions are acceptable to use for cleaning the IV site?

A
  • Chlorhexidine gluconate
  • Iodine
  • 70% isopropyl alcohol
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76
Q

What percentage of alcohol is acceptable to use for cleaning the IV site?

A

70%

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77
Q

What is considered the first choice of cleaning solution to prep the IV site?

A

Chlorhexidine gluconate

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78
Q

What cleaning solution can NOT be used on pediatrics/infants or neonates?

A

Iodine

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79
Q

When inserting an IV, the bevel should face what direction?

A

Up

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80
Q

When is it considered safe to thread the catheter off of the needle?

A

When flashback is visualized (blood return is confirmed)

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81
Q

Why are transparent dressings used for IV sites?

A

Ability to assess and identify problems with the IV

82
Q

How often is the nurse required to assess a patient IV site?

A

AT LEAST once a shift, preferably more if possible

83
Q

What should the nurse label on the cannula post-insertion?

A
  • Initials
  • Date
  • Time
84
Q

How often should an IV cannula be replaced? Why?

A
  • Every 72 to 96 hours

- Risk of phlebitis increases past 4-day indwelling time

85
Q

Is it necessary to replace the IV cannula every 72 to 96 hours even if the IV is patent and without complications?

A

Yes

86
Q

Upon removal of an IV, the nurse should assess what? Why?

A

The tip of the catheter to ensure it is intact

87
Q

How often should mainline sets be replaced or changed?

A

Every 72 hours

88
Q

How often must an IV be flushed?

A

Once every 12 hours

89
Q

Describe the order of administration when giving a medication via IV push?

A
  • Flush with 5 mL of NS
  • Push medication over required length of time
  • Flush with 5 mL of NS at the same rate of time as medication was administered
90
Q

What is the minimum size syringe that can be used to flush an IV?

A

3 mL

91
Q

The nurse knows they may have to do what when administering medications to special populations via IV push?

A

Push the medication in at a slower rate

92
Q

What percentage of total adult body weight is water?

A

60%

93
Q

Does a newborn have more or less total body water weight compared to an adult? What is the percentage?

A
  • More

- 70% to 80%

94
Q

List instances in which fluid replacement via IV would be necessary.

A
  • Dehydration
  • Burns
  • Bleeding
95
Q

List the routes of fluid intake.

A
  • Oral

- IV

96
Q

List the routes of fluid loss.

A
  • Sweat
  • Vomit
  • Diarrhea
  • Existence
97
Q

What are the three classifications of tonicity of solutions?

A
  • Isotonic
  • Hypotonic
  • Hypertonic
98
Q

What does protein do in relation to fluid?

A

Protein keeps fluid inside of the cells

99
Q

Describe isotonic solutions.

A

Balanced amount of solution on the inside and outside of the cell

100
Q

Isotonic solutions are most commonly given to patients who present with what types of medical issues?

A
  • Dehydration

- Sodium imbalance

101
Q

List examples of isotonic solutions.

A
  • Lactated ringers
  • 0.9% Sodium chloride (NS)
  • 5% Dextrose in water
102
Q

Describe hypotonic solutions.

A

Solution stays on the inside of the cell

103
Q

Hypotonic solutions are most commonly given to patients who present with what types of medical issues?

A
  • Intracellular dehydration

- Diabetic ketoacidosis

104
Q

List examples of hypotonic solutions.

A
  • 0.45% Sodium chloride
  • 0.33% Sodium chloride
  • 0.225% Sodium chloride
105
Q

Describe hypertonic solutions.

A
  • Causes the cells to shrink

- Enters and exits the cell

106
Q

Hypertonic solutions are most commonly given to patients who present with what types of medical issues?

A

Intracranial pressure

107
Q

List examples of hypertonic solutions.

A
  • 3% Sodium chloride
  • 5% Dextrose and 0.45% Sodium chloride
  • 5% Dextrose and 0.9% Sodium chloride
108
Q

What type of solution would the nurse administer to a patient with intracranial pressure?

A

Hypertonic solution

109
Q

The nurse knows to be extra cautious when providing IV fluids to a patient with medical diagnoses involving what specific organs?

A
  • Heart
  • Liver
  • Kidneys
110
Q

What percentage of dextrose solution can be administered via peripheral IV? How must it be administered if it exceeds this percentage?

A
  • 10% or less

- Central line

111
Q

Hypertonic solutions are usually ran for _______ periods of time in _______ amounts.

A
  • Short

- Small

112
Q

List signs and symptoms of fluid volume deficit.

A
  • Decreased skin turgor
  • Hypotension
  • Thirst
  • Dry skin
  • Dry mucous membranes
  • Tachycardia
113
Q

List signs and symptoms of fluid volume excess.

A
  • Pitting edema
  • Weight gain
  • JVD
  • Hypertension
  • Dyspnea
114
Q

List signs of dehydration of the pediatric patient.

A
  • Lack of tears

- Shrunken fontanels

115
Q

What is the primary cause of hypervolemia?

A

Cardiac dysfunction

116
Q

What is the safest intravenous solution to give a patient with severe hypernatremia?

A

0.45% Sodium chloride

117
Q

For a patient diagnosed with hyponatremia, at what rate should electrolytes be replaced?

A

Slowly

118
Q

If electrolytes are replaced too quickly in a patient with hyponatremia, what may happen?

A

Neurological issues

119
Q

What electrolyte should never be given through IV push?

A

Potassium!

120
Q

How should potassium be administered intravenously? A patient receiving potassium might complain of what type of sensation?

A
  • Combined with other fluids
  • Small milliequivalent bags
  • Slowly in small increments

-Burning sensation

121
Q

What is a common medication given to a patient with hyperkalemia?

A

Kayexalate

122
Q

What does kayexalate cause?

A

Diarrhea

123
Q

What is considered a temporary fix for hyperkalemia?

A

Combination glucose and insulin

124
Q

What should the nurse monitor in a hypokalemic patient?

A

Dysrhythmias

125
Q

How much potassium can be given over a 24 hour period?

A

No more than 120 MEQ

126
Q

Potassium affects the ______/_______ balance of the body.

A

Acid/Base

127
Q

What are the two signs of hypocalcemia?

A
  • Trousseau’s

- Chvostek’s

128
Q

What electrolyte is complementary to potassium?

A

Magnesium

129
Q

What is the most common cause of hypermagnesemia?

A

Renal failure

130
Q

A patient with hypomagnesemia should be on what type of precautions?

A

Seizure precautions

131
Q

Hypomagnesemia can cause what other comorbidities?

A
  • Renal impairment

- CNS depression

132
Q

Chronic alcoholism can cause what?

A

Hypomagnesemia

133
Q

How does hypermagnesemia affect the respiratory system?

A

Can cause decreased respirations

134
Q

What are the two types of infusion delivery systems?

A
  • Plastic

- Glass

135
Q

What must the nurse do before spiking the plastic infusion delivery system?

A

Clamp!

136
Q

Is a primary IV set long or short?

A

Long

137
Q

How is the nurse able to distinguish between primary and secondary tubing?

A
  • Blue key on primary tubing

- Primary tubing is 2x longer than secondary tubing

138
Q

List the advantages of the plastic infusion delivery system.

A
  • Closed system
  • Flexible
  • Lightweight
  • Container composed of one substance
  • Better storage
139
Q

List the disadvantages of the plastic infusion delivery system.

A
  • Puncture easily
  • Difficult to determine fluid level
  • Some systems composed of plasticizers
  • Environmentally unsafe
140
Q

Only one main bag of infusate is used with which tubing set?

A

Primary administration set

141
Q

What specific medication and what specific population require a volutrol?

A
  • Heparin drip

- Pediatric population

142
Q

What is a volutrol?

A

Metered-volume chamber/volume controlled set

143
Q

The nurse knows they will have to do what if the patient has a volutrol? Why?

A
  • More frequent assessment

- Volutrol can only hold a specific amount of fluid

144
Q

Why must the piggyback/secondary set be connected to the primary port above the pump?

A

The pump must control the rate at which the medication is being delivered

145
Q

The secondary set can deliver how many milliliters of fluid?

A

50 mL to 150 mL

146
Q

What should the nurse do before priming the tubing?

A

Clamp!

147
Q

Piggyback set must always be _______ than the primary set.

A

Higher

148
Q

Which fluid bag is hung with the blue hook? Why?

A

Primary bag to ensure it is lower than the piggyback/secondary set

149
Q

The primary y administration set is used to infuse what substance?

A

Blood

150
Q

Blood can be hung with what other substances?

A
  • 0.9% Normal saline

- Plasmalyte

151
Q

How long can blood remain viable (expires) after being received from the blood bank?

A

4 hours

152
Q

What size of filter is used when infusing blood products?

A

170 micron filter (in-line)

153
Q

Lipids cannot be infused through what type of set?

A

PVC

154
Q

What size of filter is used when infusing lipid products?

A

1.2 micron filter

155
Q

How long can lipids be infused before they expire?

A

12 hours

156
Q

What must be changed out every time a lipid set expires or a new bag is hung?

A

Tubing

157
Q

Does a J-Loop slow down fluids or speed up fluids in an emergent situation?

A

Slows down fluids

158
Q

What size of filter is the most common?

A

0.22 micron filter

159
Q

List the benefits of using a 0.22 micron filter.

A
  • Decreases the risk of air emboli
  • Decreases the risk of phlebitis
  • Prevent bacteria contamination
160
Q

What size of filter is used when infusing parental or IV nutrition?

A

1.2 micron filter

161
Q

What are the benefits of a needless system?

A
  • Safest mechanism
  • Maintains a more closed system
  • Reduces infection risk
  • Less manipulation
162
Q

What are electronic infusion devices (EID’s) used for?

A

Delivering fluids, medications, or nutrients into circulatory system accurately

163
Q

What must the nurse know regarding an infusion regulation device?

A
  • Indications for use
  • Operation of pump
  • Troubleshooting of pump
164
Q

Where does a downstream occlusion occur?

A

Below the pump (pump to patient)

165
Q

Where does an upstream occlusion occur?

A

Above the pump (pump to bag of solution)

166
Q

PCA pumps are often used for what types of patients?

A
  • Surgical
  • Chronic pain
  • Epidural
167
Q

The nurse should always _______ guess the amount of fluid in the bag to be infused.

A

Under guess

168
Q

What two solutions are titrated?

A
  • Heparin

- Insulin

169
Q

List nursing management of infusion equipment.

A
  • Suitable vascular access for length and type of therapy
  • Adequate level of patient understanding and compliance for delivery of infusion
  • Knowledge of therapies and equipment used to deliver specific infusions
  • Monitor the infusion equipment
170
Q

What should the nurse do if a reaction occurs during infusion?

A

Stop infusing the medication immediately

171
Q

What is infiltration?

A

Cannula is no longer in the vein and regular/maintenance fluid goes into the surrounding tissue

172
Q

What is extravasation?

A

Cannula is not longer in the vein and caustic medication goes into the surrounding tissue

173
Q

What does vesicant refer to?

A

Irritating substance

174
Q

What does non-vesicant refer to?

A

Non-irritating substance

175
Q

Before administering a medication via IV, what must the nurse know?

A
  • Potential side effects
  • Why the medication is being given
  • Interventions
  • Allergies
  • Last dose of medication received
  • Laboratory levels
  • Has the patient ever received this medication before
176
Q

What type of needle is used when withdrawing medication from an ampule or glass packing? Why?

A
  • Filter needle

- To eliminate pieces of glass

177
Q

What is physical drug incompatibility?

A

When mixed medication is unsafe to administer to the patient

178
Q

What is chemical drug incompatibility?

A

A pH reaction that makes one drug unstable in a solution

179
Q

What is therapeutic drug incompatibility?

A

When two drugs given at the same time (or too closely together) cause a reaction or problem for the patient

180
Q

List the different modes of medication delivery via IV therapy?

A
  • Intravenous infusion
  • Intermittent infusion
  • Intraosseous
  • Epidural/intrathecal
181
Q

Intraosseous catheterization occurs where?

A

Directly into the bone

182
Q

In the pediatric population, the intraosseous route can cause damage to what?

A

Growth plate

183
Q

What types of infection should the nurse monitor for a patient with an intraosseous catheter?

A
  • Osteomyelitis

- Cellulitis

184
Q

What is the most common delivery method of intermittent infusions?

A

Secondary infusion through primary pathway

185
Q

A secondary infusion through a primary pathway is often referred to as what?

A

Piggyback

186
Q

Secondary infusions are generally administered over what length of time?

A

15 to 120 minutes

187
Q

What is the purpose of administering medications via direct injection or IV push medication?

A

Achieve rapid serum concentrations of medications

188
Q

Why are most medications diluted before being administered via IV push?

A

Makes the substance less irritating to the vein

189
Q

List the advantages of IV push.

A
  • Drug response is rapid
  • Drug response usually predictable
  • Patient must be closely monitored during entire medication administration
190
Q

List the disadvantages of IV push.

A
  • Adverse effects occur at the same time and rate as therapeutic effects
  • Greatest risk of adverse effect and toxicity
  • Speed shock
  • Faster onset of complications and reaction
191
Q

What should the nurse do prior to administering medication via direct IV push?

A

Flush the line with 0.9% sodium chloride

192
Q

Medications should be diluted with what type and what amount of substance?

A

10mL of NS

193
Q

After administering medication via direct IV push, what should the nurse do?

A

Flush the line with 0.9% sodium chloride

194
Q

How long should the nurse flush the IV cannula after completing a direct IV push?

A

The same amount of time as the medication was pushed

195
Q

How do PCA pumps prevent post surgical complications?

A
  • Patients ambulate sooner
  • Patients better able to cough and deep breath
  • Therapeutic level remains consistent therefore patient is more relaxed
196
Q

What must be closely monitored in a patient receiving opioid analgesics via PCA?

A
  • Respiratory rate
  • LOC
  • Heart rate
  • Oxygen saturation
  • Blood pressure
  • Constipation
  • N/V
197
Q

Who is allowed to push the control of a PCA pump?

A

Only the patient!

198
Q

A spinal catheter is inserted into which part of the spine?

A

Subarachnoid space

199
Q

An epidural is inserted into which part of the spine?

A

Epidural space

200
Q

How many Gtts/mL is delivered in macrodrops?

A

10, 15, or 20

201
Q

How many Gtts/mL is delivered in microdrips?

A

60

202
Q

Microdrips are used in what population?

A

Pediatrics

Care of Patients with Chronic Conditions Nursing: N2335 (2 decks)

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