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3-Third semester > DONESkills exam 1-powerpoints/ book > Flashcards

DONESkills exam 1-powerpoints/ book Flashcards

1
Q

QSEN & Monitoring IVs

always

do not

if you

A

Always follow a routine!

Do not trust anyone!

If you do not identify an error and allow it to occur, you are responsible as well.

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2
Q

intravenous therapy review

admisntered

A

fluids and medicines and can be admisntered through catheter

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3
Q

QSEN & Monitoring IVs

Check all parts in a sequential fashion from fluid bag to patient:

check
how much
check
how would
follow
when does
check the
inspect tubing
check iv site
inspect
is ??

A

Check fluid—is it correct?

How much is left in bag? (when will it need changing)

Check drip chamber—is it half-full?

How would you fix it if it is not?

Follow tubing to the pump

When does the tubing need changing?

Check the IV pump—correct rate set?

Inspect tubing for kinks, air, obstructions- follow tubing to iv site to male sure its running to patient

Check IV site- appropriate and infusing

Inspect insertion site for complications

Is the dressing intact?

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4
Q

Why is IV Therapy Ordered?

allows

meds

highly

used for

used to replace

A

Allows rapid fluid replacement

Medications bypass the GI tract

Highly potent medications can go through venous system

Used for nutritional support

Used to replace, maintain, or repair imbalances in fluids and electrolytes

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5
Q

hypertonic

A

Hyper-has higher concertation of solutes. Water will leave cell and shrink

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6
Q

hypotonic

A

Hypo-has low concentration of solutes.water will enter cell and expand

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7
Q

isotonic

normal saline remains

however

A

-normal saline remains in vascular compartment and increases blood volume.

However when administer rapidly this solution can cause acid base imbalances

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8
Q

isotonic d5w

used in
not to be

can cause
causing

A

Used in fluid loss, dehydration, hypernatremia,

not to be used with high volume deficient

can cause hyponatremia causing Brain swelling

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9
Q

isotonic .9% nacl

not typically used

can treat

USED IN

A

Not typically used as maintenance solution because it only provides Na and Cl in excessive amounts.

Can treat hypovolemia, metabolic alkalosis, hyponatremia and hypochloremia.

Used in Blood Transfusions

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10
Q

isotonic lactated ringers

contains

used in

used to

A

Contains electrolytes—about same as plasma,

used in hypovolemia, burns, and fluid loss for GI sources.

Used to treat Metabolic acidosis

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11
Q

hypotonic .33% Nacl

provides

allows

used

A

Provides Na, Cl and free water.

Allows kidney to select and retain needed amounts,

used in treating hypernatremia.

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12
Q

hypotonic .45% nacl

provides

used

often used
because

A

Provides Na, Cl and free water.

Used for maintenance.

Often used to treat hypernatremia.

Because it dilutes the plasma Na while not allowing it to drop too rapidly

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13
Q

hypertonic d5 0.45 nacl

used

A

Used to maintain fluid intake

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14
Q

hypertonic d10w

supplies

used in

A

Supplies 340 cal/L.

Used in peripheral parenteral nutrition (PPN)

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15
Q

hypertonic d5 0.9% nacl

used to treat

can temp be used

if

A

Used to treat SIADH (Syndrome of inappropriate Antidiuretic Hormone.

Can temporarily be used to treat hypovolemia
if plasma expander not available

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16
Q

18 gauge—

where used
allows

A

surgical and trauma patients—

allows rapid volume infusion

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17
Q

20 gauge—
most
minimal

A

most infusions and can use for blood,

20 gauge – minimal size needed for blood administration

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18
Q

22-24 gauge—

where used

why

A

fluids and medications

, use for older adults/ pediatric pts

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19
Q

Start low why w iv-

can/cant

due to

A

you can go back up but cant go down

because of potential leakage when going back in to body

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20
Q

Vein evaluation

apply
hold
compress
fist
choose

A

-apply tornequte to enlarge the vein.

Hold area depdendnt(drop arm to ground) to prmote blood return back to vein.

Warm compresses.

Open and close fist.

Choose a straight, firm and elastic vein.- want a vein that you can palpate and feels bouncy

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21
Q

Non-dominant side

why

A
  • because most pateitns wipe themlseves with dominant hand and can lead to probelms
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22
Q

Site to avoid

A

antecubital area beucase the site will clot off easier due to usage

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23
Q

saline lock

average flush

injet slowly- what does it do

A

average flush is 2-5 ml even with srygne being 10 ml

inject slowly- push pause

This motion creates turbulence within the catheter lumen causing a swirling effect to move fibrin, lipids, medications and other adherents attached to the catheter lumen and prevents occlusions from occurring

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24
Q

Place tourniquet-
prep
allow
do not
do not
placed

A

skin prep with chlorhedixidine for 20 secinds.

Allow 30 secinds to dry

  • do not fan area to dry.

Do not touch after prepping.

Placed 4-6inches above site that we are looking at going to

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25
Q

ensure patency in saline lock

do not

if there is

watch for

A

Do not force-if have to force, then iv is bad and will blow the vein

If there is burning/pain, then stop- means iv is bad and pt feels it

Watch for fluid leakage or swelling- is fluid coming out of catheter site and going underneath dressing, or at site is swelling occuring

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26
Q

Administering IV Medications presentation

check a
check ar
why am
check com
administer where
check I
adminster at
flush when
ALWAYS
prior
if continuous infusion
complete a
what type
teach

A

Check allergies

Check armband and have patient state name and birth date

Why am I giving this pt. this medication?

Check compatibility-might be giving 2-3 meds in iv site and meds to be compataible so they aren’t causing adverse reactions

Administer in the closest port to the IV insertion site….why??? Because we need medications to go in at the time frame that they need to go in. meds and saline flish are at same exact rate

Check IV patency

Administer at correct rate

Flush before and after (after at the same rate)

ALWAYS verify order with MAR

Prior to administering always check proper IV placement by flushing the IV if the IV is capped.

If the IV is a continuous infusion, ensure there is no infiltration

Complete a FOCUSED assessment related to the medication to be given. Remember to reassess AFTER medication is administered! If this is a new medication for the patient stay with them for a period of time to check for allergy reaction

What type of medications would require a focused assessment?

Teach your patient about the medication to be administered

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27
Q

Infusion Pumps

requirement
the pump
frequent
use
complications:

A

Requirement by Joint Commission that all fluids should be on a pump (per agency policies: i.e. clinics)

The pump is only as good as the operator

Frequent checks required

Use appropriate IV tubing

Complications of pumps: Occlusion Alarm, air in line alarm, malfunction Alarm

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28
Q

Decreased Fluid Volume cause
v
d
g s
s
I i
a
m e
e

A

Vomiting
Diarrhea
GI suctioning
Sweating
Inadequate intake
Ascites
Massive edema (burns)
Elderly (forget)

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29
Q

Decreased Fluid Volume symptoms

w l
poor
o
c u
d m m
postural __
–pulse
__Tension
hemoglobin
na
bun

A

Weight loss
Poor skin turgor
Oliguria
Concentrated urine
Dry mucous membranes
Postural hypotension
Weak/rapid pulse
Hypotension
Hemoglobin elevated
Na+ normal or increased
BUN elevated

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30
Q

Decreased Fluid Volume treatment

record
replace
remember
monitor

A

Intake and output

Replace fluids—isotonic

Remember H20 is hypo

Monitor weight

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31
Q

Excess Fluid Volume cause

chf
rf
lf
excess _ ingestion
over
excess __

A

Congestive heart failure
Renal failure
Liver failure
Excessive salt ingestion
Over-hydration
Excessive IV fluids

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32
Q

Excess Fluid Volume symptoms

p e
__/ __pulse
__bp
lungs
neck
d
c
d u
w g
na+
decreased
BUN

A

Peripheral edema
Increased// Bounding pulse
Elevated BP
Crackles lungs
Distended neck veins
Dyspnea
Confusion
Decreased urine SpG
Weight gain
Na+ decreased
Hgb/Hct decreased
BUN may be decreased

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33
Q

Excess Fluid Volume treatment
d
f r
m w
limit intake

A

Diuretics

Fluid restriction

Monitor weights

Limit sodium intake

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34
Q

Infiltration

what is it

how to treat

A

fluid is leaking out of vein and into tissue; area is swollen and cool to touch.

Stop infusion, remove catheter (physician order per agency)

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35
Q

Phlebitis—

what is it

how treat

A

vein is irritated due to injury or irritation; area is red, warm, possible swelling noted.

Stop infusion, remove catheter, apply warm compress

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36
Q

Fluid or blood leaking –
wear
check
change

A

Wear GLOVES!

Check all connections to make sure they are tight

Change dressing

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37
Q

extravasation of iv fluids s/s

A

Pain

Stinging

Burning

Redness

Swelling

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38
Q

Extravasation nursing considaerations and interventions

A

– stop immediately, take iv out, contact physician and pharmacy for orders and potential antidote.

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39
Q

difference between infiltration and extravasation

A

Infilatratiion is the leaking out of fluids

Extrvasation is the leaking of a vesicant or chemo drug- can cause tissue destruction or blistering// can lead to pain, loss of usage in infected extremetie or infection

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40
Q

differnece between iv bolus and push

A

IV “bolus” = an amount of medication or IV fluids given at one time. (Usually RAPID)

IV “push” = is a bolus, but SLOW administration

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41
Q

flush after meds

ensure length

A

Adminster flush after medication at same rate as medication

Ensure that length of tube and catheter are taken into account when flushing- longer tubing = more amount of flush

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42
Q

follow

ensure

green

A

Follow medication to pump to patient

Ensure pump is at ordered and correct rate for each medication

Green caps are used for open ports

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43
Q

Compatible iv push meds

if med is compatible
put
use
pinch
unpinch
restart

A
  • If medication is compatible with IV fluids you need to turn the IV pump off (IV flow rate may be running faster than administration time of the med)

Put on gloves

Use the closest port to the patient

Pinch the tubing above and inject medication according to time

Unpinch tubing, may need to flush

Re-start IV pump

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44
Q

iv push meds

remember to

alchohol

use the

A

Remember to REASSESS as indicated

Alcohol wipes and saline flushes are sterile. Don’t set down, then pick up and use again!

Use the smallest syringe possible for the most accurate dose

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45
Q

iv push meds

if dose small

scrub the hub

A

If the dose is extremely small such as 0.2ml, dilute further to be able to administer in the appropriate time frame-usually 1mL as a minimum

Scrub the hub
15-30 seconds of a vigorous scrub is required on the port in order to decrease the risk of bacteria entering the port

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46
Q

PCA

enables-
doses-3
has what

A

Enables patients to self-administer analgesics

loading doses
continual dose (basal dose)
bolus dose

Has a lock out so patient is protected from overdosing themselves

47
Q

advantages of pca

A

dose precision,

timeliness and convenience- pt isn’t waitng for nurse and can do it on own

48
Q

disadvantages of PCA

care
potential
cost

A

: Nursing care for any IV line,

potential for infection

, cost of disposal of supplies

49
Q

PCA

requires what

ensure what

A

Requires careful patient teaching and monitoring to patient and family

Ensure compatibility of PCA medication with any other medications to be administered in the IV Don’t forget about the PCA when you give IV Push medications

50
Q

THINGS TO CHECK AHEAD OF blood TRANSFUSION

check / ask if

identify
explain/ask
check that/ and that

A

Check the physician’s orders and patient allergies –ask if they’ve ever had transfusions before

Identify patient using two identifiers

Explain procedure to patient and ask about any cultural needs/variations.

Check that type and crossmatch are complete and that blood is ready in the Blood Bank

51
Q

things to check ahead of transfusion

perform
provide
review
assess
asses if

A

Perform basic physical assessment before initiating skill, including baseline set of vital signs - especially temperature

Provide Privacy

Review agency policy/protocol and procedure

Assess if patient has informed consent for transfusion

Assess if patient has established IV site, appropriate gauge catheter for administration of blood

52
Q

administering blood — saline aspect

prepare
begin
close
spike
open
close
set

A

prepare supplies

begin infusion of sodium chloride

close clamps on y set tubing

spike bag of ns with 1 arm of y tubing

open clamp below tubing filter to prime main tubing

close main clamp when tubing is primed

set iv pump to run saline @ kvo rate

53
Q

administering the product- blood

obtain

validate w/

pull/ to

spike w

open

administer

A

obtain blood from bank

validate name, blood, id number with another RN

pull back tabs on blood unit and expose port

spike blood bag with pre arm of y tubing

open clamp to blood

administer blood as ordered

54
Q

Why must we monitor our patients so closely during any blood product administration?

A

Pts could have reactions from blood products

55
Q

blood product

start __ for 15 minutes

stay with//take what

observe

regulate rate – complete in how long

A

Start blood infusion, administer slowly (15-30 ml blood) for initial 15 minutes (rate 60-120 ml/hr)

Stay with patient for first 15 minutes. Take vital signs within 5-15 minutes of initiating transfusion and at completion of transfusion or per agency policy.

Observe patient closely for adverse reactions; report as necessary or per agency policy

Regulate rate per health care provider orders; Complete transfusion within 4 hours so it doesn’t get warm and expire

56
Q

post blood

obtain

place

document

A

Obtain post transfusion vital signs

Place transfusion related equipment in biohazard container as per agency policy

Document vital signs and patient’s tolerance to procedure on appropriate agency forms

57
Q

Infusion Rate of blood

administer_ for first 15

if patient tolerates-> give how long

infuse at/// but care elderly

A

Administer slowly (15-30 ml blood) for initial 15 minutes (rate 60-120 ml/hr)

If the patient tolerates this “test dose”, the rate may be increased, the remainder of the unit is given over 2-3 hours. no more than 4 hours

Infuse at a rate patient tolerates, but care must be taken to avoid circulatory overload in elderly.

58
Q

SYMPTOMS AND SIGNS OF TRANSFUSION REACTION

f
s o b
c
h
i
pain where
n
w
what at infusion site
facial what
c
what feeling
c
__tension
m
d
abnormal
u
edema where
o
r
j

A

Fever > 1°C/2°F
Shortness of Breath
Chills
Headache
Itching
Chest/back pain
Nausea
Wheezing
Heat at infusion site
Facial flushing
Coughing
Uneasy feeling
Cyanosis
Hypotension
Myalgia
Dyspnea
Abnormal bleeding
Urticaria (Hives)
Pulmonary edema
Oliguria/anuria
Rash
Jaundice

59
Q

allergic reaction to blood

mild s/s
severe s/s

what do

A

Mild-: Hives/urticaria, itching

Severe: Coughing, wheezing, hypotension

Stop, new bag of saline, notify MD

60
Q

febrile reaction to blood
s/s
do what
as ordered

A

Fever (1°C/2°F), chills

Stop, new bag of saline, notify MD

Pre-medicate, administer antipyretics as ordered

61
Q

Circulatory overload reaction to blood

s/s
do what

A

Dyspnea, cough, edema

Slow/stop, elevate HOB, notify MD

62
Q

Hemolytic reaction to blood
s/s
do what
clumped

A

Fever, chills, back pain, shock, burning@vein, tachycardia, hypotension

Stop, saline, notify MD – treat shock

Clumped rbc block vlow to organs- can cause renal failure

63
Q

Infectious Disease Transmission/Bacterial reaction to blood

s/s
do what

A

Fever, hypotension, vomiting/diarrhea

Stop, notify MD, blood cultures, possible antibiotics

64
Q

If any symptom of reaction occurs…

stop
keep iv
contact
notify

A

Stop Transfusion.

Keep intravenous (IV) line open with new saline. – not one in tubing

Contact treating physician for directions for patient care and administer supportive/definitive care.

Notify the transfusion service or lab

65
Q

If any symptom of reaction occurs…

rule out_ by
complete
send _ to
defer_ until

A

Rule out clerical error by RECHECK of Unit, transfusion tag and patient identification.

Complete appropriate work-up/forms and send to laboratory.

Send actual unit to laboratory only when directed to do so.

Defer future transfusions until workup complete.

66
Q

documentation of reaction to blood work
Complete all required information including:

times
recored all
pts
and

A

start, and stop times
,
record all vitals,

patients tolerance

any appropriate agency forms

67
Q

DISPOSING OF BLOOD PRODUCT BAGS

discard

do not dispose if

A

Discard blood product container and IV tubing according to hospital policy for waste disposal.

Do not dispose of bags or tubing if transfusion reaction suspected.

68
Q

blood compatibility

whole blood
unknown
o
a
b
ab

A

unknown- contraindicated
o o
a a
b b
ab ab

69
Q

blood compatibility

red cells
unknown
o
a
b
ab

A

unknown-o
o-0
a- a or 0
b- b or 0
ab- any abo

70
Q

blood compatibility

platlets
unknown
o
a
b
ab

A

unknown- any abo
o-any abo
a-any abo
b-any ano
ab- any abo

71
Q

blood compatibility
FFP

unknown
o
a
b
ab

A

unknown –AB
o –any abo
a –a or ab
b –b or ab
ab –ab

72
Q

Blood type and crossmatch-

types what
screening for
crossmatching

A

types pts abo antigen and rh factor//

screening for antibodies/

/ crossmatching serum and donor cells

73
Q

Complete blood count-
evalautes

A

evaluates compotents of bloof including rbc and wbc

74
Q

Arterial blood gas-

evalautes

presence of

A

evaluates oxygenation, acid-base balance,

and presence of metabolin or respiratory compensatory mechanisms

75
Q

Blood alcohol Level

measures

alcohol does what

A

measues amount of alchohol in pts blood/

/ alchohol alters pts loc and repsone to pain

76
Q

Urine drug screen-

drugs can do what

A

drugs can also alter loc and response

77
Q

Pregnancy test

rules out

A

-rules out potential fot pregnancy/fetal injury

78
Q

Focused assessment by sonography in trauma
evalautes

A
  • evaluates identification of blood in cavities where its not suppoed to be
79
Q

Focused assessment with sonography-

bedside
should be when

A

bedside ultrasouns that can detect blood in pericardial. Pritonieal or plueral spaces/

/ should be performed immedialy after primary survey

80
Q

Computerized tomography (CT) scnas-

reveals

A

reveal injuries to brain, skull, spine, spinal cord, chest and abdomen

81
Q

Magnetic ronasnce imagine scans-
reveals

A

reveal injures to brain/spinal cord

82
Q

Blood componets/ crstalloids

when
replaces-

A

administered iv in treatment of shock–

replaces intravasluar volume

83
Q

Inotropic and vasopressive meds-

given to

only administered when

meds

A

given to increase cardiac ouput and improve tissue perfusion/

/ only amdisnted after adequate fluid resoration/

/ dopamine. Dovuatmine, epinephrine, norepinephren, vasopressin, phenelphrin

84
Q

Opiods-

admisntered how
treats
can alter
causes

A

admisterd bolus or continuous/

/treat pain asap/

/can alter response to injury,

cause hypotension and repository depression//closely monitored

85
Q

Immunixations-

given when

what needs to be determined

A

given if pt has open wounds.

Tetanus status must be determained- if pt is unable to remember when last tetanus shot was given, unable to answer, ot has not received in 5 yers- give tetnaus

86
Q

ringer lactate indications

restoration of
replacement of

A

Restoration of circulating volume

//Replacement of electrolyte deficits

87
Q

ringer lactate advantages

readily
to use
cost
aids in

A

readily avaialbe,

safe to use,

low cost,

aids in buffering acidosis

88
Q

ringer lactate disadvantages

rapid

leading

A

rapid movement from intrvascular to extravasdsluar,

leading to 3x or more requirements for replacement

89
Q

advantages normal saline

a
cost
to use

A

avaialbe,

low cost,

safe to use

90
Q

disadvantages whole blood

contains
greatest risk are for
risk of

A

contains few platelets,

greatest risk are for incompatilibty or circulatory overload,

risk of transmitting bloodborne pathpgens

91
Q

disadvantages normal saline

what with prolonged use

A

hypercholermic acidosis associated with prolonged use of sodium solutions

92
Q

indications whole blood

replaces

in what

A

replaced blood volume and oxygen carrying capacity

in hemorrhage and shock

93
Q

indications packed rbc

restoration of
replacement of

A

restoration of intravascular volume,

replacement of oxygen carrying capacity

94
Q

normal saline indications

restoration

vehicle

A

resortaion of circulating volume/

/ vehichle compatible with adminstation of blood

95
Q

advantages. whole blood

contains

A

contains rbc, plasma, proteins, clotting factos and plasma

96
Q

advantages packed rbc

one unit
in what

A

one unit should increase hemoglobin by approximetly 1 g

in absence of volume overload or blood loss

97
Q

indications platelets

significant
continued

A

significant throimbocyopenia- >20000-50000/

continued hemorrhage

98
Q

disadvantages packed rbc

requires
risk of
should be
contains

A

red cells require compatibility testing,

risk of transmitting bloodborne pathogens,

should be warmed to prevent hypothermia

, contains little to no clotting facotrs

99
Q

disadvantages albumin

not
risk of
risk of

A

not a substitute for whole blood/

risk of hypersentaive reactions,

risk of trasmiting bloodborne pathofgens

100
Q

indications albumin

expands
in

A

expands volume

in shock and truma

101
Q

indications fresh frozen plasma

documented
restoration
supplies

A

documented coagulopathy,

resortation of clotting factors,

supplies plasma protens

102
Q

disadvantages platelets

should be considered

risk of

A

postexposure prophalxis should be considered following rh+ transfusion in rh- women/

/ risl of transmitting bloodborne pathoegens

103
Q

advantages platelets

testing
should

A

compatibility testing not required,

should raise adult platelets by 30,000 – 50,000

104
Q

advantages albumin
good

A

good avlaiblity

105
Q

disadvantages fresh frozen plasma

must be
should also
risk of

A

must be thawed in 37°C (98.6°F) water bath for approximately 30 min//

should be abo compatable,

risk of transmitting bloodborne pathogens

106
Q

advantages fresh frozen plasma

not required

A

crossmatching and rh compatibility is not required

107
Q

indications Cryoprecipitate

Coagulopathy w
restoration of

A

Coagulopathy with low fibrinogen/

Restoration of fibrinogen

108
Q

advantages Cryoprecipitate

not important

A

rh

109
Q

disadvantages Cryoprecipitate

risk of

contains

if large

A

risk of transmitting bloodborne pathogens/

/ contains hemagglutinins

, if large volumes of abo- are admisnted, hemolysis can occur

110
Q

Blood group a

RBC Agglutinogens

Serum Agglutinogens

Compatible Donor Blood

Incompatible Donor Blood Groups

A

RBC Agglutinogens a

Serum Agglutinogens anti b

Compatible Donor Blood Group a,o

Incompatible Donor Blood Groups b, ab
111
Q

Blood group b

RBC Agglutinogens

Serum Agglutinogens

Compatible Donor Blood

Incompatible Donor Blood Groups

A

RBC Agglutinogens b

Serum Agglutinogens anti a

Compatible Donor Blood Group b,o

Incompatible Donor Blood Groups a, ab
112
Q

Blood group ab

RBC Agglutinogens

Serum Agglutinogens

Compatible Donor Blood

Incompatible Donor Blood Groups

A

RBC Agglutinogens a,b

Serum Agglutinogens none

Compatible Donor Blood Group a,b,ab,o

Incompatible Donor Blood Groups none
113
Q

Blood group o

RBC Agglutinogens

Serum Agglutinogens

Compatible Donor Blood

Incompatible Donor Blood Groups

A

RBC Agglutinogens none

Serum Agglutinogens anti a and anti b

Compatible Donor Blood Group o

Incompatible Donor Blood Groups a,b,ab

3-Third semester (13 decks)

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