DONESkills exam 1-powerpoints/ book Flashcards
QSEN & Monitoring IVs
always
do not
if you
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.
intravenous therapy review
admisntered
fluids and medicines and can be admisntered through catheter
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 ??
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?
Why is IV Therapy Ordered?
allows
meds
highly
used for
used to replace
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
hypertonic
Hyper-has higher concertation of solutes. Water will leave cell and shrink
hypotonic
Hypo-has low concentration of solutes.water will enter cell and expand
isotonic
normal saline remains
however
-normal saline remains in vascular compartment and increases blood volume.
However when administer rapidly this solution can cause acid base imbalances
isotonic d5w
used in
not to be
can cause
causing
Used in fluid loss, dehydration, hypernatremia,
not to be used with high volume deficient
can cause hyponatremia causing Brain swelling
isotonic .9% nacl
not typically used
can treat
USED IN
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
isotonic lactated ringers
contains
used in
used to
Contains electrolytes—about same as plasma,
used in hypovolemia, burns, and fluid loss for GI sources.
Used to treat Metabolic acidosis
hypotonic .33% Nacl
provides
allows
used
Provides Na, Cl and free water.
Allows kidney to select and retain needed amounts,
used in treating hypernatremia.
hypotonic .45% nacl
provides
used
often used
because
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
hypertonic d5 0.45 nacl
used
Used to maintain fluid intake
hypertonic d10w
supplies
used in
Supplies 340 cal/L.
Used in peripheral parenteral nutrition (PPN)
hypertonic d5 0.9% nacl
used to treat
can temp be used
if
Used to treat SIADH (Syndrome of inappropriate Antidiuretic Hormone.
Can temporarily be used to treat hypovolemia
if plasma expander not available
18 gauge—
where used
allows
surgical and trauma patients—
allows rapid volume infusion
20 gauge—
most
minimal
most infusions and can use for blood,
20 gauge – minimal size needed for blood administration
22-24 gauge—
where used
why
fluids and medications
, use for older adults/ pediatric pts
Start low why w iv-
can/cant
due to
you can go back up but cant go down
because of potential leakage when going back in to body
Vein evaluation
apply
hold
compress
fist
choose
-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
Non-dominant side
why
- because most pateitns wipe themlseves with dominant hand and can lead to probelms
Site to avoid
antecubital area beucase the site will clot off easier due to usage
saline lock
average flush
injet slowly- what does it do
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
Place tourniquet-
prep
allow
do not
do not
placed
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
ensure patency in saline lock
do not
if there is
watch for
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
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
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
Infusion Pumps
requirement
the pump
frequent
use
complications:
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
Decreased Fluid Volume cause
v
d
g s
s
I i
a
m e
e
Vomiting
Diarrhea
GI suctioning
Sweating
Inadequate intake
Ascites
Massive edema (burns)
Elderly (forget)
Decreased Fluid Volume symptoms
w l
poor
o
c u
d m m
postural __
–pulse
__Tension
hemoglobin
na
bun
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
Decreased Fluid Volume treatment
record
replace
remember
monitor
Intake and output
Replace fluids—isotonic
Remember H20 is hypo
Monitor weight
Excess Fluid Volume cause
chf
rf
lf
excess _ ingestion
over
excess __
Congestive heart failure
Renal failure
Liver failure
Excessive salt ingestion
Over-hydration
Excessive IV fluids
Excess Fluid Volume symptoms
p e
__/ __pulse
__bp
lungs
neck
d
c
d u
w g
na+
decreased
BUN
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
Excess Fluid Volume treatment
d
f r
m w
limit intake
Diuretics
Fluid restriction
Monitor weights
Limit sodium intake
Infiltration
what is it
how to treat
fluid is leaking out of vein and into tissue; area is swollen and cool to touch.
Stop infusion, remove catheter (physician order per agency)
Phlebitis—
what is it
how treat
vein is irritated due to injury or irritation; area is red, warm, possible swelling noted.
Stop infusion, remove catheter, apply warm compress
Fluid or blood leaking –
wear
check
change
Wear GLOVES!
Check all connections to make sure they are tight
Change dressing
extravasation of iv fluids s/s
Pain
Stinging
Burning
Redness
Swelling
Extravasation nursing considaerations and interventions
– stop immediately, take iv out, contact physician and pharmacy for orders and potential antidote.
difference between infiltration and extravasation
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
differnece between iv bolus and push
IV “bolus” = an amount of medication or IV fluids given at one time. (Usually RAPID)
IV “push” = is a bolus, but SLOW administration
flush after meds
ensure length
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
follow
ensure
green
Follow medication to pump to patient
Ensure pump is at ordered and correct rate for each medication
Green caps are used for open ports
Compatible iv push meds
if med is compatible
put
use
pinch
unpinch
restart
- 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
iv push meds
remember to
alchohol
use the
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
iv push meds
if dose small
scrub the hub
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