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

Advanced Skills IV Theory (Exam Two) Flashcards

1
Q

What is the primary concern or complication of placing a peripherally inserted central line catheter (PICC) in the subclavian vein?

A

Puncturing the lung/collapsing the lung

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2
Q

What are the signs and symptoms of lung puncture?

A
  • Chest pain
  • SOB
  • Elevated respiratory rate
  • Tachycardia
  • Low O2
  • Cyanosis
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3
Q

Why is the femoral vein not an ideal location for central line placement?

A

High risk of infection

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4
Q

Where does the tip of a peripherally inserted central line catheter (PICC) end once inside of the body?

A

Lower one-third of superior vena cava (top of the heart)

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5
Q

List the therapeutic indications for central venous catheter (central line) placement.

A
  • Prescribed therapy (medication)
  • Expected duration of therapy
  • Health history
  • Vascular integrity (condition of veins)
  • Device availability
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6
Q

What types of medications should only be infused through a central line catheter?

A

-Highly vesicant medications

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7
Q

Why should the nurse or doctor be cautious in placing a peripherally inserted central line catheter (PICC) in a patient with end stage renal failure?

A

The PICC line eliminates a potentially good vein to place a dialysis port due to scarring of the vein

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8
Q

Why might a patient with end stage renal failure have a central line placed?

A

Due to an immediate need for dialysis

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9
Q

Fistulas and grafts must be what before they can be utilized to delivery therapy?

A

Mature

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10
Q

How long does it take a fistula or graft to mature?

A

Three to six months

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11
Q

The patient may not be considered a viable candidate for a central line placement if what medical condition is listed within their health history?

A

Renal disease/impairment

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12
Q

The nurse should be concerned with vascular integrity of what types of patients?

A
  • Drug users
  • Chemotherapy
  • Chronic illness (who have had multiple/repetitive IV’s)
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13
Q

Why might a medical professional be hesitant to give a patient who currently abuses drugs a central line?

A

May attempt to inject drugs through the port

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14
Q

What are the most common uses of a central line catheter?

A
  • Chemotherapy
  • Total parenteral nutrition
  • Long-term medication therapy
  • Long-term blood sampling
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15
Q

After drawing blood from a central line port, how many mL of NS should be used to flush the tubing?

A

10mL to 20mL

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16
Q

What is the minimum size of syringe that can be used with a central line?

A

10mL

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17
Q

Prior to drawing blood out of a central line, when should the nurse stop the medication that is currently infusing?

A

10 minutes prior to drawing the patients blood

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18
Q

What is the smallest gauge of needle that can be used for a central line?

A

20 gauge

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19
Q

If not being utilized, the central line catheter should be what?

A

Clamped

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20
Q

Why should any port on a central line that is not in use be clamped?

A

To avoid possible occlusion

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21
Q

What should be placed on a central line that is not infusing as a standard of practice?

A

Alcohol soaked caps

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22
Q

What is the most common type of central line?

A

Peripherally inserted central line catheter (PICC)

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23
Q

Who is able to insert or place a PICC line?

A
  • Physicians

- Skilled nurses

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24
Q

What devices are inserted for short-term access?

A
  • Non-tunneled CVC
  • PICC line
  • Midline catheter
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25
Q

What is a midline catheter?

A

Similar to a PICC line, but the catheter tip ends at or near the axilla

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26
Q

A non-tunneled CVC is inserted into which vein?

A

Subclavian vein

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27
Q

What position must the patient be placed in when inserting a non-tunneled CVC?

A

Supine or Trendelenburg

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28
Q

When and why is the valsalva maneuver utilized during central line catheterization?

A
  • Used during the needle stick

- Decreases the risk of air embolism

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29
Q

How long is a non-tunneled CVC good for?

A

7 to 10 days

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30
Q

What must be obtained before beginning infusion on a non-tunneled CVC? Why?

A

Chest x-ray to verify correct placement

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31
Q

What medical personnel is capable of removing a central line?

A
  • Nurses (as long as competent and trained)

- Physicians

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32
Q

What maneuver must be used when removing a central line?

A

Valsalva

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33
Q

How long can a PICC line remain inserted and be utilized?

A

Up to one year

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34
Q

What is the best site to insert a PICC line?

A

Basilic vein

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35
Q

List the advantages of a PICC line?

A
  • Location of insertion (eliminates insertion risk of pneumothorax)
  • Eliminates most peripheral sticks
  • Cost effective
  • Time efficient
  • Home care availability
  • Lower risk of infection
  • Appropriate for all ages
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36
Q

A patient needs IV antibiotics for six weeks to be administered at home, what type of central line is most appropriate for this type of therapy?

A

Peripherally inserted central line catheter (PICC)

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37
Q

List the disadvantages of a PICC line?

A
  • Possible bruising
  • One hour insertion
  • Special training required for insertion
  • Daily or weekly care
  • Removes viable option for dialysis
  • Potential for vein thrombosis
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38
Q

PICC lines are contraindicated for patients with what types of conditions?

A
  • Lifestyles involve being in water
  • Pre-existing skin infection of arms
  • Anatomic distortions related to injury
  • Coagulopathies
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39
Q

What lab values should the nurse assess before inserting a PICC line?

A

Coagulation factors

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40
Q

Solutions should not be _______ into a PICC line.

A

Forced

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41
Q

Regarding any central line, once the patient has completed their entire course of therapy, what should happen to the central line? Why?

A

It should be removed to avoid infection

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42
Q

List long term central venous access devices.

A
  • Tunneled catheters

- Implanted ports

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43
Q

How long are central venous tunneled catheters intended for use?

A

Months to years

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44
Q

What solutions or fluids can be administered through a central venous tunneled catheter?

A
  • Hypertonic solutions
  • Blood
  • Medications
  • Parenteral nutrition
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45
Q

How are central venous tunneled catheters inserted?

A

Surgically

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46
Q

Describe non-tunneled catheters.

A

Enters directly into the vein

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47
Q

Describe tunneled catheters.

A

Tunnels underneath the skin before entering the vein

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48
Q

What is less likely to occur if a patient has an implanted port?

A

Infection

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49
Q

What type of needle is used to access an implanted port?

A

Huber needle

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50
Q

Describe a huber needle?

A

Non-coring needle

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51
Q

Implanted ports are commonly mistaken for what?

A

Pacemakers

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52
Q

How often must an implanted port be flushed, even if it is not in use?

A

Every one to two months

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53
Q

The procedure used to access an implanted port is what? Explain.

A
  • Sterile

- Mask is needed for nurse and patient, nurse must don sterile gloves

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54
Q

What solution is used to flush an implanted port?

A

500 units/5 mL of heparin

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55
Q

Why is it important for an implanted port to remain heparin flushed and locked?

A

To prevent blood clots in the tube

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56
Q

Who can insert an implanted port? Who can access/deaccess and implanted port?

A
  • Physician must insert

- Nurse may access or deaccess

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57
Q

What type of therapy are implanted ports commonly used for?

A

Chemotherapy

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58
Q

Implanted ports are more likely to ______ if not flushed properly.

A

Occlude

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59
Q

It may be ___________ to access an implanted port.

A

Painful

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60
Q

A systemic infection affects what part of the body?

A

Entire body system

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61
Q

A local infection affects what part of the body?

A

One central or localized area on the body

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62
Q

What vital sign changes will a patient exhibit if they are becoming septic?

A
  • Decreased blood pressure
  • Increased heart rate
  • Increased temperature
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63
Q

What type of complication is a hematoma?

A

Local

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64
Q

List the signs and symptoms of a hematoma.

A
  • Discoloration of skin
  • Site swelling
  • Site pain
  • Inability to advance cannula
  • Resistance during flushing
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65
Q

What are the treatment options for a hematoma?

A
  • Apply direct, light pressure
  • Elevate extremity
  • Apply ice
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66
Q

What may happen if extreme pressure is applied to a hematoma?

A

Too much force for a prolonged period of time will cause circulation issues

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67
Q

What type of complication is phlebitis/thrombophlebitis?

A

Local

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68
Q

What are the causes of phlebitis/thrombophlebitis?

A
  • Chemical damage
  • Mechanical vein trauma
  • Bacteria
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69
Q

List the signs and symptoms of phlebitis/thrombophlebitis.

A
  • Erythema at the site
  • Pain at site
  • Local swelling
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70
Q

What are the treatment options for phlebitis/thrombophlebitis?

A
  • Apply warm compress
  • Elevate limb
  • Analgesics or anti-inflammatory agents as needed
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71
Q

Does the peripheral IV always have to be changed if phlebitis occurs? Explain.

A
  • Not always

- Phlebitis that occurs without any reason will likely require the IV to be changed

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72
Q

What is the difference between infiltration and extravasation?

A

Type of IV fluid that leaks into the surrounding tissue

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73
Q

What is infiltration?

A

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

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74
Q

What is extravasation?

A

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

75
Q

What type of fluids or solutions are vesicant?

A

Medications with the ability to cause necrosis or tissue damage

76
Q

What type of fluids or solutions are nonvesicant?

A

Maintenance IV fluids

77
Q

Give an example of vesicant medication(s). What should the nurse do before administering these medications?

A
  • Vancomycin
  • Phenergan

-Ensure the line is patent

78
Q

List the signs and symptoms of infiltration/extravasation.

A
  • Cool skin temperature
  • Skin blanched and taut
  • Patient complains of skin discomfort
  • Swelling near insertion site
79
Q

What should the nurse do when assessing for infiltration?

A

Assess both arms

80
Q

What should the nurse immediately do if infiltration or extravasation is noted?

A

Immediately stop infusion and notify the physician

81
Q

What are the treatment options for infiltration/extravasation?

A
  • Warm or cold compress
  • Antidote
  • Elevating extremity
82
Q

What are the signs and symptoms of a local infection?

A
  • Redness
  • Swelling
  • Induration
  • Drainage
83
Q

How are localized infections prevented?

A
  • Proper hand hygiene
  • Avoiding femoral area
  • Cleaning patients skin
  • Wearing clean gloves
84
Q

Before notifying the provider of a suspected infection, the nurse must first have gathered what?

A

Assessment data

85
Q

What causes a local nerve injury?

A

Infiltration or extravasation of an infusion

86
Q

What are the signs and symptoms of a local nerve injury?

A

Immediate sharp shooting pain upon placement

87
Q

What should the nurse do if a local nerve injury occurs?

A

Immediately remove catheter and notify the physician

88
Q

What causes a venous spasm?

A
  • Cold infusate
  • Irritating solution
  • Too-rapid infusion
89
Q

What are the signs and symptoms of a venous spasm?

A

Cramping or sharp pain above IV site

90
Q

Venous spasms may prohibit what?

A

Prohibit midline or PICC line from exiting the body

91
Q

How are venous spasms prevented?

A
  • Dilute medication properly
  • Run medication at prescribed rate
  • Warm medication to room temperature
92
Q

What are the signs and symptoms of sepsis?

A
  • Cold sweats
  • Tachycardia
  • Increased respirations
  • Mental status changes
  • Decreased blood pressure
  • Possible elevation of temperature
93
Q

What is sepsis?

A

Presence of bacteria in the bloodstream

94
Q

What is the number one prevention method of sepsis?

A

Hand hygiene

95
Q

A patient presents with tachycardia, hypertension, a seven pound weight gain in two days, crackles in the lungs and jugular vein distention. What nursing concept or diagnosis is related to this patients current condition?

A

Fluid volume overload

96
Q

What are the causes of fluid volume excess or circulatory overload in relation to intravenous therapy?

A
  • Infusing excessive amounts of solution or blood

- Failing to monitor IV infusion

97
Q

Why is it important to prime tubing for IV therapy?

A

To prevent air embolism

98
Q

List the risks for developing a venous air embolism.

A
  • Not using clamp correctly
  • Failure to prime line
  • Adding new bag to line that has “gone dry”
  • Loose connections
99
Q

List the signs and symptoms of a venous air embolism.

A
  • Light-headedness
  • Weakness
  • Pulmonary findings
  • Cardio findings
  • Neuro findings
  • Agitation and anxiety
100
Q

How are venous air embolisms prevented?

A
  • Priming all air from administration sets
  • Using only Luer-lock devices
  • Checking infusion system regularly
101
Q

What is speed shock?

A

Administration of a medication too quickly

102
Q

List the signs and symptoms of speed shock.

A
  • Dizziness
  • Flushing
  • Severe headache
  • Chest tightness
  • Hypotension
  • Arrhythmias
103
Q

What is a pneumothorax?

A

Collection of air

104
Q

What is a hemothorax?

A

Collection of blood

105
Q

List the signs and symptoms of a pneumothorax.

A
  • Crunching sound upon heart auscultation
  • Dyspnea
  • Persistent cough
  • Tachycardia
  • Decreased breath sounds
  • Sudden chest pain
106
Q

List the signs and symptoms of a hemothorax.

A
  • Bleeding into pleural cavity
  • Hypotension
  • Tachycardia
  • Diminished breath sounds
107
Q

The signs and symptoms of a hemothorax are similar to what other condition?

108
Q

How does the nurse know the difference between a patient who is suffering from a hemothorax and a patient who is suffering from sepsis?

A

Patient history

109
Q

What is the most immediate treatment for a pneumothorax/hemothorax that can be completed by the nurse?

A

Administer oxygen

110
Q

Besides administering oxygen, what other treatment might be done for a patient suffering from a pneumothorax/hemothorax?

A

Inserting a chest tube

111
Q

What are the signs and symptoms of pinch-off syndrome?

A
  • Difficulty with flushing, infusing and aspirating

- Frequent occlusion alarms

112
Q

How is pinch-off syndrome prevented?

A

Using ultrasound guidance for catheter placement

113
Q

What are the three different types of occlusions?

A
  • Mechanical occlusions
  • Precipitate occlusions
  • Thrombotic occlusions
114
Q

What is the nurses priority intervention for preventing catheter occlusions?

A

Flush tubing often and correctly

115
Q

What is the best indication of an infectious process in an older adult?

A

Mental status changes

116
Q

What is the acute treatment option for a patient suffering from catheter associated venous thrombosis?

A

Low-molecular weight heparin

117
Q

What is the long term treatment option for a patient suffering from catheter associated venous thrombosis?

A

Vitamin K antagonist (warfarin)

118
Q

What is a major nursing responsibility when administering blood to a patient?

A

Patient identification at bedside

119
Q

Most errors involving blood transfusions occur at what three stages?

A
  • Labeling of the sample
  • Patient identification at bedside
  • Decision to transfuse
120
Q

The presence of D antigen is considered what?

121
Q

The absence of D antigen is considered what?

122
Q

What three antigens on the red blood cells cause problems? Which of these are most significant?

A
  • A
  • B
  • Rh factor

-A and B are most significant

123
Q

What is an antibody?

A

A protein that identifies and neutralizes or destroys a specific antigen

124
Q

Where are antibodies found?

A

Plasma or serum

125
Q

What blood type is the universal donor?

126
Q

What blood type is the universal recipient?

127
Q

What must the nurse obtain from the patient before transfusing blood?

128
Q

What culture or religion will not receive blood products?

A

Jehovah’s witness

129
Q

Blood should be ______ _______ the entire time it is being transfused.

A

Closely monitored

130
Q

T/F: It is common to transfuse whole blood products? Why or why not?

A
  • False

- Few conditions require transfusions of whole blood

131
Q

How long is a bag of blood good for?

132
Q

What conditions must be present in order to receive a blood transfusion?

A
  • Active bleeding

- Hemoglobin below 7

133
Q

Describe a patient that would be most likely to receive platelets.

A

Patients with thrombocytopenia after chemotherapy to prevent bleeding

134
Q

Consent must be obtained from patients who are _______.

135
Q

The flow rate for a blood transfusion should always begin at what? Can it be increased?

A
  • 75

- Can be increased if patient is tolerating well

136
Q

In order to transfuse blood peripherally, what size gauge catheter is needed?

A

20 gauge or larger

137
Q

What happens to the blood components if less than a 20 gauge catheter is used to transfuse?

A

Hemolysis of cells

138
Q

Blood can be hung with what other two solutions?

A
  • NS

- Plasmalyte

139
Q

What type of administration tubing is used to administer blood?

140
Q

What type of devices are used to push blood in faster during a trauma situation?

A

Pressure devices

141
Q

Heart failure patients who receive blood may receive what other medication? Why?

A
  • Lasix

- Decrease the amount of fluid on the body

142
Q

Blood products should be double-checked by who besides the nurse?

A
  • Blood bank

- Another RN

143
Q

How many minutes after initiating a blood transfusion should vital signs be checked?

A

Within 5 to 15 minutes

144
Q

The same Y-tubing can be utilized for how many bags of blood before a new set must be hung?

145
Q

The nurse should treat every bag of blood like what?

A

It is the first bag of blood the patient has ever received regardless of any prior bags

146
Q

What vital sign may increase with blood transfusions?

A

Temperature

147
Q

Adverse reactions to blood or blood products occur within how many minutes or hours of transfusion?

A

Usually within first 10 to 15 minutes but can occur up to 24 hours after receiving transfusion

148
Q

Older adults are at an increased risk for what transfusion reaction?

A

Transfusion related circulatory overload (TACO)

149
Q

A blood transfusion will be stopped and discontinued if what type of reactions occur?

A
  • Acute hemolytic transfusion reactions (AHTR)
  • Transfusion related acute lung injury (TRALI)
  • Transfusion related circulatory overload (TACO)
150
Q

What is the best indication of nutritional status?

A

Calorie count or intake (think quantity, not quality)

151
Q

What is a primary nutritional requirement for all adults?

A

Amino acids

152
Q

Parenteral nutrition is given to what type of patients?

A
  • Patients already malnourished
  • Patients at risk for becoming malnourished
  • Patients who are not candidates for enteral nutrition
153
Q

Patients receiving parenteral nutrition must be able to tolerate what? Approximately how much?

A
  • Large volumes of fluid per day

- Up to 3L per day

154
Q

What are the advantages of parenteral nutrition?

A
  • Avoids insertion and maintenance of central line
  • Delivers less hypertonic solutions (dextrose)
  • Reduces risk of metabolic complications
  • Increases calorie source along with fat emulsions
155
Q

Parenteral nutrition is ideal for what type of patients?

A

Acute patients who will begin to eat on their own soon

156
Q

Parenteral nutrition is to keep patients from continuing to ______ weight.

157
Q

Are other solutions or fluids able to be administering using the same tubing that delivered parenteral nutrition?

A

No, parenteral nutrition must have its own line or tubing

158
Q

Central venous access is necessary for what type of nutrition? Why?

A
  • Total parenteral nutrition

- It is a hypertonic solution

159
Q

Total parenteral nutrition is an admixture composed of what substances?

A
  • Amino acids

- Dextrose

160
Q

Will total parenteral nutrition cause a patient to gain weight or maintain weight?

A

Gain weight

161
Q

The protein in any type of parenteral nutrition is what?

A

Synthetic crystalline amino acids

162
Q

What medications can be added to total parenteral nutrition?

A
  • Insulin
  • Heparin
  • H2 inhibitors
163
Q

If a diabetic patient is receiving total parenteral nutrition, how often will they have glucose checks?

A

Every 6 hours

164
Q

Can Vitamin K be mixed into total parenteral nutrition?

A

No, must be given IM

165
Q

Is total parenteral nutrition for acute or chronic use?

A

Chronic or long term

166
Q

What is total nutrient admixture?

A

Three-in-one solution of dextrose, amino acids, and fat emulsions in one bag

167
Q

Total nutrient admixture is infused over how many hours before it is necessary to switch out the bag?

168
Q

Why are patients who receive total nutrient admixture at risk of catheter occlusions?

A

Due to fat deposits

169
Q

Why type of filter is used to deliver parenteral nutrition?

A

1.2 micron filter

170
Q

A patient with fatty acid deficiency would require what type of nutrition?

A

Total nutrient admixture

171
Q

If fats are hung separately from the other nutrition mixture, how many hours should it infuse over? Where must the nurse connect the fats on the tubing line?

A
  • 12 hours

- Below the filter

172
Q

Is C-TPN intermittent or continuous? When it is normally infused?

A
  • Intermittent

- When patient is sleeping

173
Q

What type of nutrition treats hepatotoxicity induced by continuous TPN?

A

Cyclic TPN (C-TPN)

174
Q

What must the nurse look out for in a patient receiving cyclic TPN?

A
  • Hypoglycemia

- Dehydration

175
Q

What is the nursing management regarding nutrition administration?

A
  • Monitor blood sugar every 6 hours
  • Maintain strict I&O’s
  • Serial daily weights
176
Q

What is an ideal weight gain for a patient on total parenteral nutrition?

A

2 to 3 pounds per week

177
Q

How often should sterile dressings be changed on nutritional access sites if not transparent?

A

Every 48 to 72 hours

178
Q

How often should sterile dressings be changed on nutritional access sites if they are transparent?

A

Every 4 to 7 days

179
Q

If a patient is receiving parenteral nutrition, the nurse should monitor for what type of electrolyte imbalances?

A
  • Hypophosphatemia
  • Hypokalemia
  • Hypomagnesemia
  • Hypernatremia
180
Q

List the complications of parenteral nutrition?

A
  • Altered glucose metabolism
  • Electrolyte imbalances
  • Refeeding syndrome
181
Q

What is refeeding syndrome?

A

The body inability to adapt to having the proper and necessary nutrients

182
Q

What must be established before discontinuing parenteral or enteral nutrition? Give examples.

A

-Another type of nutrition to replace it

  • Oral
  • NGT
  • PEG
183
Q

What must the patient do before they are removed from nutritional support?

A
  • Must be eating enough calories to allow body to function

- Bodily system must be able to tolerate

184
Q

A palpable cord along the vein is an indication of what?

A

Phlebitis/thrombophlebitis

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

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