ch 13 notes pp

Question 1

Infusion Therapy

Answer 1

Delivery of medications in solutions and fluids by parenteral routeIntravenous (IV) therapy most common routeIV therapy most common invasive therapy administered to hospitalized patients

Question 2

Delivery of medications in solutions and fluids by parenteral routeIntravenous (IV) therapy most common routeIV therapy most common invasive therapy administered to hospitalized patients

Answer 2

Specially trained nurse initiates and maintains infusion therapyTeams promote cost savings, patient satisfaction, patient outcomes

Question 3

Types of Infusion Therapy Fluids

Answer 3

IV solutions (including parenteral nutrition)Blood and blood componentsDrug therapy

Question 4

Intravenous Solutions

Answer 4

Isotonic = 270 to 300 mOsm/L
Hypertonic= Fluids >300 mOsm/L
Hypotonic= Fluids <270 mOsm/L

Question 5

Normal serum osmolarity (adults) =

Answer 5

270 to 300 mOsm/L

Question 6

Isotonic Infusate

Answer 6

Water does not move into or out of body’s cellsRisk for fluid overload, especially older adults

Question 7

Hypertonic Infusate

Answer 7

Corrects fluid, electrolyte, and acid–base imbalances by moving water out of body’s cells, into bloodstreamParenteral nutrition is example

Question 8

Hypotonic Infusate

Answer 8

Moves water into cells and expands them

Question 9

If osmolarity is >600 mOsm/L,

Answer 9

best infused in central circulation where greater low provides adequate hemodilution

TPN has osmolarity >1400 mOsm/L

TPN should never be infused in peripheral circulation—can damage blood cells and endothelial lining of vein

Question 10

Blood Transfusions and Other Components

Answer 10

Packed red blood cellsPlateletsFresh frozen plasmaAlbuminSeveral specific clotting factors

Question 11

Administering IV Medications

Answer 11

Medication safetyRapid therapeutic effectNever assume IV administration is same as giving that drug by other routesPrescribing infusion therapy

Question 12

Vascular Access Devices

Answer 12

Major types
Short peripheral catheters
Midline catheters
Peripherally inserted central catheters (PICC)
Nontunneled percutaneous central venous catheters (CVC)
Tunneled catheters
Implanted ports
Hemodialysis catheters

Question 13

Peripheral IV Therapy

Answer 13

Short peripheral cathetersSuperficial veins of dorsal surface of hand and forearmDwell for 72 to 96 hours, then require removal and insertion into another sitePortable vein transilluminators available

Question 14

Veins cannot be used in patients with

Answer 14

MastectomyAxillary lymph node dissectionLymphedemaParalysis of upper extremitiesDialysis graft or fistulas

Question 15

Infection Control

Answer 15

CDC recommends aseptic preparation and technique includingHand hygieneClip hair; do not shaveEnsure skin is cleanWear glovesPrepare skin with 70% alcohol or chlorhexidine

Question 16

Midline Catheter

Answer 16

3 to 8 inches long, 3 to 5 Fr, double or single lumen Inserted through vein in upper armUsed for therapies lasting 1 to 4 weeksDo not use for vesicant drugs; can cause tissue damage if extravasation occursDo not use to draw blood

Question 17

Central IV Therapy

Answer 17

Vascular access device (VAD) placed in central circulation, specifically within superior vena cava (SVC) near junction with right atriumChest x-ray to confirm placement

Question 18

Peripherally Inserted Central Catheter (PICC)

Answer 18

Length of 18 to 29 inches (45 to 72 cm)Chest x-ray determines placement Power ICCs used for contrast injection; can also attach to transducers for CVP monitoring

Question 19

Nontunneled Percutaneous Central Venous Catheter

Answer 19

Inserted through subclavian vein in upper chest or jugular veins in neckMay require insertion in femoral vein—Rate of infection is high7 to 10 inches (15 to 25 cm) long; up to 5 lumensTip resides in superior vena cavaChest x-ray confirms placement

Question 20

Tunneled Central Venous Catheter

Answer 20

Portion lies in subcutaneous tunnelUsed for frequent and long-term infusion therapyHas cuff of antibiotic-containing material to help reduce infection

Question 21

Implanted Port

Answer 21

Consists of portal body, dense septum over a reservoir, and catheterSingle or doubleSurgically created subcutaneous pocket houses the port bodyUsually placed in upper chest/extremityNot visible externallyFlushing after each use and at least once per month between therapies prevents clot formation in internal chamber

Question 22

Hemodialysis Catheter

Answer 22

Large lumens accommodate hemodialysis or pheresis procedure (harvests specific blood cells)Catheter-related bloodstream infections (CR-BSI), vein thrombosis are common problemsDo not use for administering other fluids/medications (except in emergency)

Question 23

Infusion System

Answer 23

Containers—Plastic (PVC-free or DEHP-free), glassAdministration sets—Secondary, intermittentAdd-on systemsNeedleless connection devicesRate-controlling infusion devicesUse of IV pumps does not decrease the nurse’s responsibility to carefully monitor the patient’s infusion rate and site!

Question 24

Remember …chANGING TUBING

Answer 24

Change lipid tubing every 24 hrChange blood tubing within 4 hr

Question 25

Local Complications of IV Therapy

Answer 25

InfiltrationPhlebitis and post-infusion phlebitisThrombosisThrombophlebitisEcchymosis and hematomaSite infectionVenous spasmNerve damage

Question 26

Systemic Complications of IV Therapy

Answer 26

Circulatory overloadSpeed shockAllergic reactionCatheter embolism

Question 27

Interventions to reduce infection risk

Answer 27

Clean needleless system connections before use with antimicrobial for 30 secondsDo not tape connections between tubing setsUse evidence-based hand hygiene guidelines from CDC and OSHA

Question 28

Compartment Syndrome

Answer 28

When increased tissue perfusion in a confined space causes decreased flow to the area

Question 29

Older Adult Care

Answer 29

Skin careVein and catheter selectionCardiac and renal changes

Question 30

Alternative Sites for Infusion

Answer 30

Intra-arterial therapyIntraperitoneal (IP) infusionSubcutaneous infusionIntraspinal infusionIntraosseous therapy

Question 31

A nursing student is preparing to insert a vascular access device in an older patient. Which action by the nursing student requires intervention by the nurse?

Answer 31

A.Performing hand hygiene prior to insertion.B.Preparing for insertion immediately following cleaning with iodophors. C.Using friction to clean the skin around the insertion site.D.Clipping the hairs in the preferred insertion area.

Question 32

A man with severe burns over 90% of his body has been brought to the ED. The rescue personnel were unable to establish IV access during transport to the hospital. Which type of IV device would be most appropriate at this time?

Answer 32

A.PICC lineB.Central lineC.Intraosseous catheterD.Subcutaneous infusion

Question 33

During the insertion of an IV catheter, a patient with dehydration reports feeling “pins and needles” in his arm. The nurse is aware that this sensation may have been caused by what?

Answer 33

*A.Nerve puncture may have occurred.B.The patient’s dehydration caused this sensation.C.The vein has collapsed during the catheter insertion.D.The vein has been accessed properly for the infusion.