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
2
Q
What are the signs and symptoms of lung puncture?
A
- Chest pain
- SOB
- Elevated respiratory rate
- Tachycardia
- Low O2
- Cyanosis
3
Q
Why is the femoral vein not an ideal location for central line placement?
A
High risk of infection
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)
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
6
Q
What types of medications should only be infused through a central line catheter?
A
-Highly vesicant medications
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
8
Q
Why might a patient with end stage renal failure have a central line placed?
A
Due to an immediate need for dialysis
9
Q
Fistulas and grafts must be what before they can be utilized to delivery therapy?
A
Mature
10
Q
How long does it take a fistula or graft to mature?
A
Three to six months
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
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)
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
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
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
16
Q
What is the minimum size of syringe that can be used with a central line?
A
10mL
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
18
Q
What is the smallest gauge of needle that can be used for a central line?
A
20 gauge
19
Q
If not being utilized, the central line catheter should be what?
A
Clamped
20
Q
Why should any port on a central line that is not in use be clamped?
A
To avoid possible occlusion
21
Q
What should be placed on a central line that is not infusing as a standard of practice?
A
Alcohol soaked caps
22
Q
What is the most common type of central line?
A
Peripherally inserted central line catheter (PICC)
23
Q
Who is able to insert or place a PICC line?
A
- Physicians
- Skilled nurses
24
Q
What devices are inserted for short-term access?
A
- Non-tunneled CVC
- PICC line
- Midline catheter
25
What is a midline catheter?
Similar to a PICC line, but the catheter tip ends at or near the axilla
26
A non-tunneled CVC is inserted into which vein?
Subclavian vein
27
What position must the patient be placed in when inserting a non-tunneled CVC?
Supine or Trendelenburg
28
When and why is the valsalva maneuver utilized during central line catheterization?
- Used during the needle stick
| - Decreases the risk of air embolism
29
How long is a non-tunneled CVC good for?
7 to 10 days
30
What must be obtained before beginning infusion on a non-tunneled CVC? Why?
Chest x-ray to verify correct placement
31
What medical personnel is capable of removing a central line?
- Nurses (as long as competent and trained)
| - Physicians
32
What maneuver must be used when removing a central line?
Valsalva
33
How long can a PICC line remain inserted and be utilized?
Up to one year
34
What is the best site to insert a PICC line?
Basilic vein
35
List the advantages of a PICC line?
- 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
36
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?
Peripherally inserted central line catheter (PICC)
37
List the disadvantages of a PICC line?
- Possible bruising
- One hour insertion
- Special training required for insertion
- Daily or weekly care
- Removes viable option for dialysis
- Potential for vein thrombosis
38
PICC lines are contraindicated for patients with what types of conditions?
- Lifestyles involve being in water
- Pre-existing skin infection of arms
- Anatomic distortions related to injury
- Coagulopathies
39
What lab values should the nurse assess before inserting a PICC line?
Coagulation factors
40
Solutions should not be _______ into a PICC line.
Forced
41
Regarding any central line, once the patient has completed their entire course of therapy, what should happen to the central line? Why?
It should be removed to avoid infection
42
List long term central venous access devices.
- Tunneled catheters
| - Implanted ports
43
How long are central venous tunneled catheters intended for use?
Months to years
44
What solutions or fluids can be administered through a central venous tunneled catheter?
- Hypertonic solutions
- Blood
- Medications
- Parenteral nutrition
45
How are central venous tunneled catheters inserted?
Surgically
46
Describe non-tunneled catheters.
Enters directly into the vein
47
Describe tunneled catheters.
Tunnels underneath the skin before entering the vein
48
What is less likely to occur if a patient has an implanted port?
Infection
49
What type of needle is used to access an implanted port?
Huber needle
50
Describe a huber needle?
Non-coring needle
51
Implanted ports are commonly mistaken for what?
Pacemakers
52
How often must an implanted port be flushed, even if it is not in use?
Every one to two months
53
The procedure used to access an implanted port is what? Explain.
- Sterile
| - Mask is needed for nurse and patient, nurse must don sterile gloves
54
What solution is used to flush an implanted port?
500 units/5 mL of heparin
55
Why is it important for an implanted port to remain heparin flushed and locked?
To prevent blood clots in the tube
56
Who can insert an implanted port? Who can access/deaccess and implanted port?
- Physician must insert
| - Nurse may access or deaccess
57
What type of therapy are implanted ports commonly used for?
Chemotherapy
58
Implanted ports are more likely to ______ if not flushed properly.
Occlude
59
It may be ___________ to access an implanted port.
Painful
60
A systemic infection affects what part of the body?
Entire body system
61
A local infection affects what part of the body?
One central or localized area on the body
62
What vital sign changes will a patient exhibit if they are becoming septic?
- Decreased blood pressure
- Increased heart rate
- Increased temperature
63
What type of complication is a hematoma?
Local
64
List the signs and symptoms of a hematoma.
- Discoloration of skin
- Site swelling
- Site pain
- Inability to advance cannula
- Resistance during flushing
65
What are the treatment options for a hematoma?
- Apply direct, light pressure
- Elevate extremity
- Apply ice
66
What may happen if extreme pressure is applied to a hematoma?
Too much force for a prolonged period of time will cause circulation issues
67
What type of complication is phlebitis/thrombophlebitis?
Local
68
What are the causes of phlebitis/thrombophlebitis?
- Chemical damage
- Mechanical vein trauma
- Bacteria
69
List the signs and symptoms of phlebitis/thrombophlebitis.
- Erythema at the site
- Pain at site
- Local swelling
70
What are the treatment options for phlebitis/thrombophlebitis?
- Apply warm compress
- Elevate limb
- Analgesics or anti-inflammatory agents as needed
71
Does the peripheral IV always have to be changed if phlebitis occurs? Explain.
- Not always
| - Phlebitis that occurs without any reason will likely require the IV to be changed
72
What is the difference between infiltration and extravasation?
Type of IV fluid that leaks into the surrounding tissue
73
What is infiltration?
Cannula is no longer in the vein and regular/maintenance fluid goes into the surrounding tissue
74
What is extravasation?
Cannula is not longer in the vein and caustic medication goes into the surrounding tissue
75
What type of fluids or solutions are vesicant?
Medications with the ability to cause necrosis or tissue damage
76
What type of fluids or solutions are nonvesicant?
Maintenance IV fluids
77
Give an example of vesicant medication(s). What should the nurse do before administering these medications?
- Vancomycin
- Phenergan
-Ensure the line is patent
78
List the signs and symptoms of infiltration/extravasation.
- Cool skin temperature
- Skin blanched and taut
- Patient complains of skin discomfort
- Swelling near insertion site
79
What should the nurse do when assessing for infiltration?
Assess both arms
80
What should the nurse immediately do if infiltration or extravasation is noted?
Immediately stop infusion and notify the physician
81
What are the treatment options for infiltration/extravasation?
- Warm or cold compress
- Antidote
- Elevating extremity
82
What are the signs and symptoms of a local infection?
- Redness
- Swelling
- Induration
- Drainage
83
How are localized infections prevented?
- Proper hand hygiene
- Avoiding femoral area
- Cleaning patients skin
- Wearing clean gloves
84
Before notifying the provider of a suspected infection, the nurse must first have gathered what?
Assessment data
85
What causes a local nerve injury?
Infiltration or extravasation of an infusion
86
What are the signs and symptoms of a local nerve injury?
Immediate sharp shooting pain upon placement
87
What should the nurse do if a local nerve injury occurs?
Immediately remove catheter and notify the physician
88
What causes a venous spasm?
- Cold infusate
- Irritating solution
- Too-rapid infusion
89
What are the signs and symptoms of a venous spasm?
Cramping or sharp pain above IV site
90
Venous spasms may prohibit what?
Prohibit midline or PICC line from exiting the body
91
How are venous spasms prevented?
- Dilute medication properly
- Run medication at prescribed rate
- Warm medication to room temperature
92
What are the signs and symptoms of sepsis?
- Cold sweats
- Tachycardia
- Increased respirations
- Mental status changes
- Decreased blood pressure
- Possible elevation of temperature
93
What is sepsis?
Presence of bacteria in the bloodstream
94
What is the number one prevention method of sepsis?
Hand hygiene
95
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?
Fluid volume overload
96
What are the causes of fluid volume excess or circulatory overload in relation to intravenous therapy?
- Infusing excessive amounts of solution or blood
| - Failing to monitor IV infusion
97
Why is it important to prime tubing for IV therapy?
To prevent air embolism
98
List the risks for developing a venous air embolism.
- Not using clamp correctly
- Failure to prime line
- Adding new bag to line that has "gone dry"
- Loose connections
99
List the signs and symptoms of a venous air embolism.
- Light-headedness
- Weakness
- Pulmonary findings
- Cardio findings
- Neuro findings
- Agitation and anxiety
100
How are venous air embolisms prevented?
- Priming all air from administration sets
- Using only Luer-lock devices
- Checking infusion system regularly
101
What is speed shock?
Administration of a medication too quickly
102
List the signs and symptoms of speed shock.
- Dizziness
- Flushing
- Severe headache
- Chest tightness
- Hypotension
- Arrhythmias
103
What is a pneumothorax?
Collection of air
104
What is a hemothorax?
Collection of blood
105
List the signs and symptoms of a pneumothorax.
- Crunching sound upon heart auscultation
- Dyspnea
- Persistent cough
- Tachycardia
- Decreased breath sounds
- Sudden chest pain
106
List the signs and symptoms of a hemothorax.
- Bleeding into pleural cavity
- Hypotension
- Tachycardia
- Diminished breath sounds
107
The signs and symptoms of a hemothorax are similar to what other condition?
Sepsis
108
How does the nurse know the difference between a patient who is suffering from a hemothorax and a patient who is suffering from sepsis?
Patient history
109
What is the most immediate treatment for a pneumothorax/hemothorax that can be completed by the nurse?
Administer oxygen
110
Besides administering oxygen, what other treatment might be done for a patient suffering from a pneumothorax/hemothorax?
Inserting a chest tube
111
What are the signs and symptoms of pinch-off syndrome?
- Difficulty with flushing, infusing and aspirating
| - Frequent occlusion alarms
112
How is pinch-off syndrome prevented?
Using ultrasound guidance for catheter placement
113
What are the three different types of occlusions?
- Mechanical occlusions
- Precipitate occlusions
- Thrombotic occlusions
114
What is the nurses priority intervention for preventing catheter occlusions?
Flush tubing often and correctly
115
What is the best indication of an infectious process in an older adult?
Mental status changes
116
What is the acute treatment option for a patient suffering from catheter associated venous thrombosis?
Low-molecular weight heparin
117
What is the long term treatment option for a patient suffering from catheter associated venous thrombosis?
Vitamin K antagonist (warfarin)
118
What is a major nursing responsibility when administering blood to a patient?
Patient identification at bedside
119
Most errors involving blood transfusions occur at what three stages?
- Labeling of the sample
- Patient identification at bedside
- Decision to transfuse
120
The presence of D antigen is considered what?
Rh +
121
The absence of D antigen is considered what?
Rh -
122
What three antigens on the red blood cells cause problems? Which of these are most significant?
- A
- B
- Rh factor
-A and B are most significant
123
What is an antibody?
A protein that identifies and neutralizes or destroys a specific antigen
124
Where are antibodies found?
Plasma or serum
125
What blood type is the universal donor?
O
126
What blood type is the universal recipient?
AB
127
What must the nurse obtain from the patient before transfusing blood?
Consent
128
What culture or religion will not receive blood products?
Jehovah's witness
129
Blood should be ______ _______ the entire time it is being transfused.
Closely monitored
130
T/F: It is common to transfuse whole blood products? Why or why not?
- False
| - Few conditions require transfusions of whole blood
131
How long is a bag of blood good for?
4 hours
132
What conditions must be present in order to receive a blood transfusion?
- Active bleeding
| - Hemoglobin below 7
133
Describe a patient that would be most likely to receive platelets.
Patients with thrombocytopenia after chemotherapy to prevent bleeding
134
Consent must be obtained from patients who are _______.
Competent
135
The flow rate for a blood transfusion should always begin at what? Can it be increased?
- 75
| - Can be increased if patient is tolerating well
136
In order to transfuse blood peripherally, what size gauge catheter is needed?
20 gauge or larger
137
What happens to the blood components if less than a 20 gauge catheter is used to transfuse?
Hemolysis of cells
138
Blood can be hung with what other two solutions?
- NS
| - Plasmalyte
139
What type of administration tubing is used to administer blood?
Y-tubing
140
What type of devices are used to push blood in faster during a trauma situation?
Pressure devices
141
Heart failure patients who receive blood may receive what other medication? Why?
- Lasix
| - Decrease the amount of fluid on the body
142
Blood products should be double-checked by who besides the nurse?
- Blood bank
| - Another RN
143
How many minutes after initiating a blood transfusion should vital signs be checked?
Within 5 to 15 minutes
144
The same Y-tubing can be utilized for how many bags of blood before a new set must be hung?
2 bags
145
The nurse should treat every bag of blood like what?
It is the first bag of blood the patient has ever received regardless of any prior bags
146
What vital sign may increase with blood transfusions?
Temperature
147
Adverse reactions to blood or blood products occur within how many minutes or hours of transfusion?
Usually within first 10 to 15 minutes but can occur up to 24 hours after receiving transfusion
148
Older adults are at an increased risk for what transfusion reaction?
Transfusion related circulatory overload (TACO)
149
A blood transfusion will be stopped and discontinued if what type of reactions occur?
- Acute hemolytic transfusion reactions (AHTR)
- Transfusion related acute lung injury (TRALI)
- Transfusion related circulatory overload (TACO)
150
What is the best indication of nutritional status?
Calorie count or intake (think quantity, not quality)
151
What is a primary nutritional requirement for all adults?
Amino acids
152
Parenteral nutrition is given to what type of patients?
- Patients already malnourished
- Patients at risk for becoming malnourished
- Patients who are not candidates for enteral nutrition
153
Patients receiving parenteral nutrition must be able to tolerate what? Approximately how much?
- Large volumes of fluid per day
| - Up to 3L per day
154
What are the advantages of parenteral nutrition?
- 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
Parenteral nutrition is ideal for what type of patients?
Acute patients who will begin to eat on their own soon
156
Parenteral nutrition is to keep patients from continuing to ______ weight.
Lose
157
Are other solutions or fluids able to be administering using the same tubing that delivered parenteral nutrition?
No, parenteral nutrition must have its own line or tubing
158
Central venous access is necessary for what type of nutrition? Why?
- Total parenteral nutrition
| - It is a hypertonic solution
159
Total parenteral nutrition is an admixture composed of what substances?
- Amino acids
| - Dextrose
160
Will total parenteral nutrition cause a patient to gain weight or maintain weight?
Gain weight
161
The protein in any type of parenteral nutrition is what?
Synthetic crystalline amino acids
162
What medications can be added to total parenteral nutrition?
- Insulin
- Heparin
- H2 inhibitors
163
If a diabetic patient is receiving total parenteral nutrition, how often will they have glucose checks?
Every 6 hours
164
Can Vitamin K be mixed into total parenteral nutrition?
No, must be given IM
165
Is total parenteral nutrition for acute or chronic use?
Chronic or long term
166
What is total nutrient admixture?
Three-in-one solution of dextrose, amino acids, and fat emulsions in one bag
167
Total nutrient admixture is infused over how many hours before it is necessary to switch out the bag?
24 hours
168
Why are patients who receive total nutrient admixture at risk of catheter occlusions?
Due to fat deposits
169
Why type of filter is used to deliver parenteral nutrition?
1.2 micron filter
170
A patient with fatty acid deficiency would require what type of nutrition?
Total nutrient admixture
171
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?
- 12 hours
| - Below the filter
172
Is C-TPN intermittent or continuous? When it is normally infused?
- Intermittent
| - When patient is sleeping
173
What type of nutrition treats hepatotoxicity induced by continuous TPN?
Cyclic TPN (C-TPN)
174
What must the nurse look out for in a patient receiving cyclic TPN?
- Hypoglycemia
| - Dehydration
175
What is the nursing management regarding nutrition administration?
- Monitor blood sugar every 6 hours
- Maintain strict I&O's
- Serial daily weights
176
What is an ideal weight gain for a patient on total parenteral nutrition?
2 to 3 pounds per week
177
How often should sterile dressings be changed on nutritional access sites if not transparent?
Every 48 to 72 hours
178
How often should sterile dressings be changed on nutritional access sites if they are transparent?
Every 4 to 7 days
179
If a patient is receiving parenteral nutrition, the nurse should monitor for what type of electrolyte imbalances?
- Hypophosphatemia
- Hypokalemia
- Hypomagnesemia
- Hypernatremia
180
List the complications of parenteral nutrition?
- Altered glucose metabolism
- Electrolyte imbalances
- Refeeding syndrome
181
What is refeeding syndrome?
The body inability to adapt to having the proper and necessary nutrients
182
What must be established before discontinuing parenteral or enteral nutrition? Give examples.
-Another type of nutrition to replace it
- Oral
- NGT
- PEG
183
What must the patient do before they are removed from nutritional support?
- Must be eating enough calories to allow body to function
| - Bodily system must be able to tolerate
184
A palpable cord along the vein is an indication of what?
Phlebitis/thrombophlebitis
