Ch 40.4 Fluids

Question 1

Vascular Access Devices

Answer 1

3 Kinds PVADS (traditional IV) CVADS and midline catheters

These are devices used for patients that require repeated venous access so they don’t have to be poked repeatedly.May be used for medication administration, fluid and electrolyte replacement and or for parenteral nutrition (TPN). May be a catheter, a cannular or an infusion port

Question 2

Central vascular access devices (CVADS)

Answer 2

• long term use

* Deliver fluid into the superior vena cava

Question 3

Central Venous Catheter (CVC)

Answer 3

• Called a central line – dialysis use

* Large fluid volumes

Question 4

PICC (peripherally inserted Central catheter)

Answer 4

• Can be in place for 1.5 year
• Lower risk of blood vessel damage and skin irritation than central line
• Usually inserted in basilic vein, median cubital vein or cephalic vein to the superior vena cava

Question 5

Implanted port (port-a-cath).

Answer 5

Often used with chemo. Implanted under the skin. Accessed using a gripper….
Needle that pokes through the skin and into the port. Gripper is removed when not in use.

Lowest incidence of infections

Question 6

Catheter Embolism

Answer 6

may be from a catheter fragment and symptoms will vary depending on where it is, must use 10ml syringe or may blow the catheter:
cyanosis, dyspnea, chest pain, hypotension, tachycardia, increased central venous pressure, fainting or loss of consciousness

Question 7

Cardiac tamponade

Answer 7

• fluid accumulates in the pericardium, compressing the heart.
• Leads to decrease in cardiac output and shock.
• Beck’s triad: hypotension, jugular venous distension and muffled heart sounds are the classic 3 symptoms.
• If patient has decrease of more than 10mm Hg in systolic blood pressure with inspiration, or pulsus paradoxus, it suggests pericardial effusion is causing cardiac tamponade

Question 8

Catheter malposition

Answer 8

catheter is not where it is supposed to be
absence of blood return; difficulty or inability to flush; blood pressure or heart rate changes; shoulder, chest or back pain; edema in neck or shoulder; respiration changes; pt reports hearing a gurgling sound on ipsilateral side (same side)

Question 9

Infiltration

Answer 9

• fluid is leaking into the surrounding tissue

Symptoms:
• swelling in chest, neck or extremity with CVAD
• pain, burning or stinging during infusion
• changes in skin color, blanching bruising or redness on extremity with CVAD
• tight-feeling, taut skin
• changes in skin temperature on extremity with CVAD
• numbness, tingling
• fluid leaking from insertion site
• slow capillary refill
• impaired ability to move fingers, hand or extremity, blisters

Question 10

Venipuncture site

Answer 10

• most commonly the hand and arm. Try to choose an area that isn’t easily bumped. Go distal to proximal.
• Feet sometimes used, but not as first choice. In adults using the foot increases the risk of thrombophlebitis.
• Never use a site that has signs of infection (red, tender, swollen and possible warm to touch, may have exudate) , infiltration or thrombosis.
• Avoid arms on the side of a mastectomy (just like BP),
• avoid an extremity with an arteriovenous graft (looped plastic tube that connects an artery to a vein) or fistula (connection between and aretery and vein made by a surgeon) for dialysis – to create a larger vein for easy repeated access to cardiovascular system.
• Insertion site close to wrist increases risk of nerve damage

Question 11

Phlebitis

Answer 11

inflammation of the vein, can be from solutions with a high osmolality, vein trauma during insertion, IV catheter is too large, or with prolonged use of same IV site. Warmth, edema, redness, tenderness, streak formation, palapable venous cord. Iv must be discontinued and new line inserted in another vein. Warm moist heat for comfort. Can be dangerous due to possible formation of blood clots and may result in emboli.

Question 12

Restorative Care

Answer 12

Refers to ongoing maintenance following an alteration in fluid, electrolyte or acid-base balance

Question 13

Home Intravenous Therapy.

Answer 13

For those discharged home. May be to continue treatment for something like antibiotics, or it may be a form of long term therapy
Home care nurse works with pt and family to manage

Question 14

Autologousbloodtransfusion

Answer 14

the collection of blood from a single patient and retransfusion back to the same patient when required

Question 15

Blood transfusion

Answer 15

Whole blood, plasma, packed red blood cells, platelets, cryoprecipitate

Question 16

Blood Transfusion Allergic reactions

Answer 16

may be mild or anaphylactic: flushing, itching, to anaphylactic: anxiety, dyspnea, severe hypotension, circulatory shock, possible cardiac arrest
Mild treat prophylactically with antihistamines
Alaphylactic, washed RBC products or use blood from an IgA-deficient donor

Question 17

Hemolytic transfusion reactions.

Answer 17

caused by ABO incompatible blood or recipients plasma attaching to antigens on transfused blood and causes red blood cell destruction. Stop transfusion right away. Keep IV site open with normal saline. Will need to maintain BP and treat shock if present. Life threatening. Chills, fever, C, flushing, tachycardia, tachypnea, hypotension, hemoglobinuria, hemoglobinemia, sudden oliguria (acute kidney injury), circulatory shock, cardiac arrest, death

Question 18

ABO transfusion reactions

Answer 18

antibody reaction

Question 19

Transfusion-related acute lung injury

Answer 19

is the most serious transfusion reaction and requires critical care. Sudden acute respiratory distress within hours of transfusion.

Question 20

Transfusion infection

Answer 20

Bacterial contamination of transfused blood components Rapid onset of chills, high fever, severe hypotension, and circulatory shock.

Question 21

Circulatory overload

Answer 21

Blood administered faster than circulation can accommodate

is a risk when a patient receives large volumes of whole blood or packed RBC transfusions for massive hemorrhagic shock or when a patient with normal blood volume receives blood. Patients particularly at risk for circulatory overload are older persons and those with cardiopulmonary diseases.

Question 22

Buffer

Answer 22

A substance that can absorb or release hydrogen ions to stabilize pH, such as bicarbonate, phosphate, and proteins

Question 23

Buffer systems

Answer 23

Combinations of a weak acid and a weak base and are the short-term regulators of acid–base balance

Question 24

Volume imbalances:

Answer 24

disturbances in the amount of ECF

– water and electrolytes are lost or gained proportionately

Question 25

Osmolality imbalances

Answer 25

disturbances in the concentration of body fluids

– loss or excess of only water so it effects concentration

Question 26

Isotonic volume deficit

Answer 26

not enough fluids, but concentrations ok; not enough water and sodium intake, increased GI output such as diarrhea and vomiting, loss of blood, burns, sweating without replacement
Dark yellow urine, postural hypotension, tachycardia, poor skin turgor, urine output below 30ml/hr; increased hematocrit, increased BUN

Question 27

Isotonic volume excess

Answer 27

too much fluid, but concentrations ok; too much sodium intake from diet or fluids, heart failure, cirrhosis, kidneys keeping too much sodium,
Edema, pulmonary edema, decreased hematocrit, decreased BUN