Chapter 7: nursing care of patients receiving IV therapy Flashcards
IV therapy
administration of fluids or medication via a needle or catheter (cannula) directly into the bloodstream
indications for IV therapy
- hydration
- electrolyte replacement
- parenteral nutrition (PN)
- peripheral parenteral nutrition (PPN)
- medication administration
- blood product transfusions
types of IV infusions
- continuous
- intermittent: piggyback
- direct injection/IV push
- patient controlled analgesia (PCA)
methods of IV infusion
- gravity drip (if it’s not higher than IV site, not going to drip)
- electronic infusion devices (EIDs)
- mechanical controllers
factors affecting flow
- change in cannula position
- height of solution
- patency of cannula
- vein condition
types of fluids
- Dextrose solutions (have sugar) —> can burn and cause red rashes, not phlebitis, can enflame veins. Used if someone also is hypoglycemic.
- sodium chloride solutions (most common, 0.9% normal saline solutions)
- combined dextrose and sodium chloride solution
- ringer’s and lactated ringer’s solutions (matches blood volume, no fluid shift)
- balanced electrolyte solutions
osmolarity of IV solutions
- osmotic concentration: ionic concentration of the dissolved substances per unit of solvent
- isotonic (osmolarity 250 to 375 milliosmoles / liter). ex: 0.9% sodium chloride
- hypotonic (osmolarity < 250 milliosmoles per Liter). ex: 0.45% sodium chloride
- hypertonic (osmolarity 375 milliosmoles per liter or higher) for ex: dextrose 5% in 0.9% sodium chloride
IV access
peripheral
central
Gerontological issues
- elevated bp
- increasing weight
- bounding pulse
- shallow, rapid respirations
- jugular venous distention
- increased urine output
- crackles
local complications
hematoma
thrombosis
phlebitis/thrombophlebitis
infiltration/extravasation
local infection
venous spasm
nerve injury
septicemia
circulatory overload (air embolism from tubing)
speed shock
central venous access devices: types
non tunneled central catheter
tunneled catheter
peripherally inserted central catheter
implanted vascular port
rationale for use of central venous access devices
parental nutrition
chemotherapy
long term treatment
parental nutrition: contents
- carbohydrates: dextrose most common in PN
- proteins/amino acids
- electrolytes
- trace elements
- vitamins
- lipids: may be administered as a separate solution
rationale for parenteral nutrition
- for patients unable to eat or tolerate tube feedings
- promotes wound healing
- achieves optimal weight before surgery
- avoids malnutrition from chronic disease
- treats cancer cachexia (wasting syndrome)
nursing care of patients receiving PN
- initial and ongoing assessment
- monitor blood glucose
- monitor daily weights
- monitor signs and symptoms of infection
- initiate SLOWLY
