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NU 340 > Ch. 15 > Flashcards

Ch. 15 Flashcards

1
Q

infusion therapy is the _____

A
  • delivery of medications in solutions and fluids by parenteral route
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2
Q

the most common route of infusion therapy

A

IV

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3
Q

most common invasive therapy administered to hospitalized patients

A

IV therapy

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4
Q

types of infusion therapy fluids

A
  • IV solutions (including parenteral nutrition)
  • blood and blood components
  • drug therapy (benadryl, antibiotics, replacements)
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5
Q

IV solutions: normal serum osmolarity (adults)

A

270-300 mOsm/L

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6
Q

isotonic solution (amount)

A

270-300 mOsm/L

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7
Q

hypertonic solution

A

fluids > 300 mOsm/L

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8
Q

hypotonic solution

A

fluids < 270 mOsm/L

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9
Q

isotonic infusate

A
  • water does not move into or out of the body’s cells
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10
Q

patients receiving isotonic solutions are at risk for ____

A

fluid overload
- esp. older adults

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11
Q

hypertonic infusate

A
  • used to correct fluid, electrolyte, and acid-base imbalances by moving water out of the body’s cells and into the bloodstream
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12
Q

parenteral solutions is an example of ___ infusions

A

hypertonic infusions

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13
Q

hypotonic infusate moves water

A

into cells and expands them

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14
Q

hypertonic infusate moves water

A

out of the body’s cells into the bloodstream

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15
Q

if osmolarity is > 600 mOsm/L, it is best to infuse in _____ circulation

A

central circulation
- where greater low provides adequate hemodilution

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16
Q

TPN (total parenteral nutrition) has osmolarity of

A

> 1400 mOsm/L

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17
Q

TPN should never be infused in ___ circulation

A

peripheral circulation
- can damage blood cells and endothelial lining of vein

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18
Q

common IVFs

A
  • 0.9% Saline
  • 0.45% Saline
  • D5W
  • D10W
  • D5/.9%NS
  • D5/.45%NS
  • Ringer’s Lactated
  • D5RL
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19
Q

isotonic IVFs

A
  • 0.9% Saline
  • D5W
  • Ringer’s Lactated
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20
Q

hypotonic IVFs

A
  • 0.45% Saline
  • D5RL
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21
Q

hypertonic IVFs

A
  • D10W
  • D5/.9%NS
  • D5/.45%NS
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22
Q

components of Saline (0.9%), NaCl, 3% or 5% saline

A

Na and Cl

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23
Q

indications of Saline (0.9%), NaCl, 3% or 5% saline

A
  • alkalosis
  • fluid loss
  • sodium depletion
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24
Q

components of D5W, D10W

A

dextrose in water

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25
Q

indications for D5W, D10W

A
  • replace calories as carbohydrates
  • prevent dehydration
  • maintain H2O balance
  • promote Na diuresis
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26
Q

components of D5NS, D51/2NS, D10NS

A

dextrose in saline

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27
Q

components of LR or RL

A

Na, Cl, K, Ca, and lactate

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27
Q

indications of D5NS, D51/2NS, D10NS

A
  • promote diuresis
  • correct moderate fluid loss
  • prevent alkalosis
  • provide calories and NaCl
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28
Q

indications of LR or RL

A
  • replaces fluid lost d/t vomiting or GI suctioning
  • treats dehydration
  • restores normal fluid balance
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29
Q

blood transfusions: components

A
  • packed RBCs (PRBCs)
  • platelets (PLT)
  • fresh frozen plasma (FFP) (for clotting d/o)
  • albumin (for low protein state)
  • several specific clotting factors (for hemophilia)
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30
Q

prescribing infusion therapy: fluids

A
  • type of fluid
  • rate of administration in mL/hr (or total amount of fluid and hours for infusion)
  • drugs and dose to be added
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31
Q

prescribing infusion therapy: drugs (in IV fluids)

A
  • drug name
  • specific dose and route
  • frequency of administration
  • time(s) of administration
  • length of time for infusion (number of doses/days)
  • purpose
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32
Q

vascular access device (VAD)

A

short peripheral catheters
- superficial veins of the hand and forearm

33
Q

VAD can dwell for ____ and then requires removal and insertion into another venous site

A

72-96 hours

34
Q

complaints of what can indicate nerve puncture during insertion of VAD?

A
  • tingling
  • pins and needles feeling in the extremity
  • numbness
35
Q

veins cannot be used in patients with

A
  • mastectomy (no blood work in the arm on that side)
  • axillary lymph node dissection
  • lymphedema
  • paralysis of upper extremities
  • dialysis graft or fistulas

*usually wearing a bracelet on arm that cannot be used

36
Q

CDC recommends aseptic preparation and technique including _____ (for infection control)

A
  • hand hygiene
  • clip hair, do not shave (shave = infection risk)
  • ensure skin is clean
  • wear gloves
  • prepare skin with 70% alcohol or chlorhexidine
37
Q

midline catheter

A
  • 3-8” long, 3-5 Fr, double or single lumen
  • inserted through vein in upper arm
38
Q

midline catheters are used for

A
  • hydration
  • drug therapy given longer than 6 days, (used up to 14 days)
39
Q

do not use a midline catheter for:

A

vesicant drugs
- can cause tissue damage if extravasation occurs

parenteral nutrition formulas with low concentrations of dextrose, or solutions with osmolarity > 600 mOsm/L

drawing blood

40
Q

central IV therapy

A

VAD placed in central circulation, specifically within superior vena cava (SVC) junction with right atrium

*placed by IV team, not regular nurse
*may be ultrasound guided

41
Q

how is the placement of central IV therapy confirmed?

A
  • chest x-ray
  • new technologies: magnet tip locator, electrocardiogram
42
Q

peripherally inserted central catheter (PICC)

A
  • length of 18-29” (45-72cm/2-3 ft long)
  • single (1), dual (2), or triple (3) lumen available
  • can stay in for weeks, months or up to 1 year
43
Q

what determines the placement of a PICC?

A
  • chest x-ray
44
Q

Power PICCs are used for

A

contract injection
- can also be attached to transducers for CVP monitoring

45
Q

Power PICCs

A

a wider catheter in comparison to normal PICC

46
Q

complications of PICCs

A
  • phlebitis
  • thrombophlebitis
  • DVT
  • CRBSIs
47
Q

PICC uses

A
  • no limitation on pH or osmolarity of fluids that can be infused (meds, fluids, nutrition)
  • can be used for blood sampling (lumen size 4 Fr or larger recommended)
  • patients on IV therapy for 6-8 weeks, ie. endocarditis, cellulitis
  • limes disease
48
Q

patient teaching: PICC

A
  • avoid excessive physical activity and heavy lifting
49
Q

CRBSI bundle includes

A
  • proper aseptic hand hygiene
  • measuring upper arm circumference as a baseline before insertion
  • maximal barrier precautions on insertion
  • chlorhexidine skin antisepsis
  • optimal catheter site selection and post-placement care with avoidance of the femoral vein for central venous access in adult patients
  • daily review of line necessity with prompt removal of unnecessary lines
50
Q

nontunneled percutaneous central venous catheter are inserted

A

through subclavian vein in upper chest or jugular veins in neck
- may require insertion in femoral vein (*rate of infection is high)

51
Q

nontunneled percutaneous central venous catheter

A
  • 7-10” (15-25cm) long
  • up to 5 lumens
  • tip resides in superior vena cava
  • used for long-term infusions (short- not as often, but possible)
52
Q

what confirms the placement of a nontunneled percutaneous central venous catheter?

A

chest x-ray

53
Q

tunneled central venous catheter

A
  • used for frequent and long-term infusion therapy
  • portion lies in subcutaneous tunnel
  • has cuff of antibiotic-containing material to help reduce infection
  • back up if can’t do a PICC line
54
Q

tunneled central venous catheter: Broviac, Hickman, Leonard

A

the physicians that designed these catheters

55
Q

implanted ports consist of

A
  • a portal body
  • a dense septum over a reservoir
  • a catheter
56
Q

what houses the port body of an implanted port?

A
  • a subcutaneous pocket
57
Q

where is an implanted port placed?

A

a subcutaneous pocket in the upper chest or upper extremity

58
Q

how often does a port need to be flushed?

A
  • after each use
  • at least once a month between courses of therapy
59
Q

hemodialysis catheters

A
  • very large lumens accommodate hemodialysis or pheresis procedure
  • can be tunneled or nontunneled
60
Q

what are common complications of hemodialysis catheters?

A
  • CRBSI
  • vein thrombosis (blood clots)
61
Q

hemodialysis catheters are maintained by

A

specially trained hemodialysis nurses

62
Q

nursing care for patients receiving IV therapy

A
  • educate patient
  • perform the nursing assessment: edema, redness, tenderness, heat, signs of infection
  • securing and dressing the catheter
  • changing administration sets and needleless connectors (change every 72-96 hours)
  • controlling infusion pressure
  • flushing the catheter (with NS, before and after medication administration)
  • obtaining blood samples from CVCs
  • removing the vascular access device (VAD)
  • documenting IV therapy
63
Q

local complications of IV therapy

A
  • infiltration
  • extravasation
  • phlebitis and post-infusion phlebitis
  • thrombosis
  • thrombophlebitis
  • ecchymosis and hematoma
  • site infection
  • venous spasm
  • nerve damage
64
Q

systemic complications of IV therapy

A
  • circulatory overload
  • speed shock
  • allergic reaction
  • catheter embolism
65
Q

interventions to reduce infection risk with IV therapy

A
  • 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
66
Q

older adult care with IV therapy

A
  • skin care
  • vein and catheter selection
  • cardiac and renal changes
67
Q

infiltration

A
  • swollen, tender, cool to touch, fluid outside the site
68
Q

extravasation

A

occurs due to extricate medication (Ca, IV dopamine)

69
Q

phlebitis

A

inflammation of the vein
- d/c I/V fluids
- take out site
- warm, red, tender, hard cord-like

70
Q

thrombosis

A

blood clott in the vein
- d/c IV fluids
- take out site

71
Q

ecchymosis

A
  • bruising
72
Q

hematoma

A

collection of blood under skin
- hard bump where IV site is

73
Q

s/sx of a site infection

A
  • redness, purulent drainage, edema, warmth
74
Q

venous spasm

A

insertion of IV
- take out if patient reports numbness and tingling

75
Q

nerve damage

A

insertion of IV
- take out if patient reports numbness and tingling

76
Q

general measures for local IV

A

d/c fluid
d/c site
elevate arm (2 pillows)
call HCP to determine further care
cold/warm compress

77
Q

s/sx of circulatory overload

A
  • SOB, crackles
78
Q

speed shock

A

rapidly infusing drugs through IV and patient becomes light-headed or dizzy

79
Q

allergic reaction

A
  • rash, hives, swelling
  • stop what is causing reaction
80
Q

catheter embolism

A
  • small piece of catheter breaks off and travels into bloodstream, and gets stuck
  • can cause PE

NU 340 (26 decks)

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