CH 4 Intravenous Therapy

Question 1

Advantages of IV therapy

Answer 1

1. Rapid effects
2. Precise amounts
3. Less discomfort after initial insertion
4. Constant therapeutic blood levels
5. Permits the use of large volumes of fluid for medications that are poorly soluble and need larger amounts of fluid to dissolve
6. Permits the use of medications that contain irritant properties, such as chemotherapy

Question 2

Disadvantages of IV therapy

Answer 2

1. Circulatory fluid overload is possible if the infusion is large or too rapid
2. Immediate absorption leaves little time to correct errors.
3. IV fluid administration can irritate the lining of the vein
4. Failure to maintain surgical asepsis can lead to local and systemic infection

Question 3

Ways to administer IV medications

Answer 3

1. Give the medication to the pharmacist mixed in a large volume of fluid (500 to 1,000 mL) as a continuous IV infusion, such as potassium chloride and vitamins
2. Deliver the medication in premixed solution bags from the medication’s manufacturer
3. Administer volume-controlled infusions.
4. Give an IV bolus dose

Question 4

Guidelines for Safe IV Medication Administration

Answer 4

1. Use an infusion pump to administer meds that can cause serious adverse reactions. Never administer them by IV bolus. Double-check the dose prescribed. the dilution or amount of fluid, and the rate at which to give the med
2. Add meds to a new IV fluid container, not to an IV container that is already hanging
3. Never administer IV meds through tubing that is infusing blood, blood products, or parenteral nutrition solutions
4. Verify the compatibility of medications with IV solutions before infusing meds through tubing that infusing an IV solution
5. Perform any assessments required prior to administration, based on the medication, and determine if continuous monitoring is required during administration (ECG).
6. Use the IV port closest to the client to administer the medication
7. Ensure the IV is patent prior to administration. If the client does not have IV fluids infusing or has fluids that are not compatible with the medication, flush the IV access before and following administration.

Question 5

Specific Considerations for Older adult clients, clients who are taking anticoagulants, and clients who have fragile veins

Answer 5

1. Avoid tourniquets. Use a blood pressure cuff to help visualize, but not over-distend, the veins to help prevent hematoma formation.
2. Do not slap the extremity to visualize veins
3. Instruct the client to hold their hand below the level of the heart to help distend and thus visualize the veins
4. Avoid using the back of the client’s hand
5. Avoid rigorous friction while cleaning the site

Question 6

Specific Considerations for clients who have edema in extremities

Answer 6

1. Apply digital pressure over the selected vein to displace edema
2. Apply pressure with an alcohol pad
3. Cannulate the vein quickly

Question 7

Specific Considerations for clients who are obese

Answer 7

Use anatomical landmarks to find veins

Question 8

What should you do if there is a complication with the IV?

Answer 8

Notify provider, complete documentation, use new tubing and catheters for restarting IV infusions after detecting complications

Question 9

IV Complications include

Answer 9

Infiltration, Extravasation, Catheter embolus, phlebitis/thrombophlebitis, cellulitis, fluid overload

Question 10

What is infiltration?

Answer 10

infiltration of a non-vesicant solution

Question 11

Infiltration: Expected Findings

Answer 11

Pallor, Local swelling at site, Decreased skin temp around site, Damp dressing, Slowed infusion

Question 12

Infiltration: Treatment

Answer 12

1. Stop the infusion and remove the catheter
2. Elevate the extremity
3. Encourage active range of motion
4. Apply a cold or warm compress depending on the type of solution that infiltrated the tissue
5. Check w/ the provider to determine whether the client still needs IV therapy. If so, restart the infusion proximal to the site or in another extremity.

Question 13

Infiltration: Prevention

Answer 13

1. Carefully select the site and catheter
2. Secure the catheter.
3. Inspect IV infusion site frequently for any findings of infiltration

Question 14

What is extravasation?

Answer 14

infiltration of a vesicant or tissue-damaging medication

Question 15

Extravasation: Expected Findings

Answer 15

Pain, Burning, Redness, Swelling

Question 16

Extravasation: Treatment

Answer 16

1. Stop the infusion and notify the provider
2. Follow the facility’s protocol, which can include withdrawing the vesicant solution from the IV access and infusing an antidote through the catheter before removal.
3. Further treatment is the same as IV infiltration

Question 17

Extravasation: Prevention:

Answer 17

1. Closely monitor IV site and dressing
2. Always use an infusion pump

Question 18

A nurse is caring for a client experiencing IV extravasation. The facility requires the administration of an antidote for the prescribed IV solution. After stopping the IV infusion, which of the following actions should the nurse take first?

a. remove the IV catheter
b. withdraw the solution from the IV access
c. administer the antidote to the vesicant.
d. insert a new IV access in a different extremity

Answer 18

b

Question 19

A nurse is preparing to initiate IV therapy for an older adult client. Which of the following actions should the nurse plan to take?

a. use a disposable razor to remove excess hair on the extremity.
b. select the back of the client’s hand to insert the IV catheter.
c. distend the veins by using a blood pressure cuff
d. direct the client to raise their arm above the heart

Answer 19

c

Question 20

A nurse is assessing the IV catheter insertion site for a client receiving a nonvesicant solution and notes swelling at the site with decreased skin temp. Which of the following actions should the nurse take? (Select all that apply).

a. stop the infusion
b. start a new IV access distal to this site.
c. apply warm compresses to the insertion site
d. elevate the client’s arm
e. obtain a specimen for culture at the insertion site

Answer 20

a, c, d

b is incorrect. A new IV should be started proximal to this site
e. is incorrect. specimens should be collected for the client experiencing phlebitis.