Exam 1 Study Cards Flashcards
The GOAL of IV therapy is?
To correct or prevent fluid and electrolyte disturbances
Allow direct access to vascular system
Can be continuous or intermittent
Require frequent monitoring
Administration of medicines
Administration of blood/blood products
Knowledge to identify and correct problems & discontinue the infusion to maintain patient safety.
Roughly, what percentage of your body is water?
60%
Intracellular fluid makes up roughly 42%
Extracellular makes up 17%
Osmolality-
Is used to describe fluids inside the body
Osmolarity-
Refers to fluids in solutions
Isotonic solutions are used…
To expand blood volume
Isotonic solutions include Normal Saline or 0.9% NaCl as well as Lactated Ringers
Hypotonic solutions are used…
For dehydration
Hypotonic solutions include 0.45% NaCl as well as 0.33% NaCl
Hypertonic solutions are used…
To draw fluid into vascular compartments (not for clients with kidney or heart problems)
Hypertonic solutions include D5 NS, D5 1/2 NS, and D5LR
Intravenous Fluids are delivered directly into the bloodstream via a…
Vein
The fluid rate of a 24 gauge (yellow) needle is…
15-25 ml/min
The fluid rate of a 22 gauge (blue) needle is…
26-36 ml/min
The fluid rate of a 20 gauge (pink) needle is…
50-65 ml/min (maintenance rate)
The fluid rate of a 18 gauge (green) needle is…
85-105 ml/min
The IV bag should be hung how many inches above the patients heart?
36
For adults the typical needle gauge for an IV would be…
20-22 gauge
If an adult was expecting to have a blood transfusion, what gauge needle would be used?
18-20 gauge
The peripheral IV site located on the top of the hand is called…
Metacarpal
The peripheral IV site located the forearm is…
Basilic & cephalic
A central line or PICC line is inserted…
Into the subclavian or jugular vein
Central lines are typically used when…
The patient needs large amounts of fluids, rapid medication, infusion of highly concentrated solutions, or long term IV therapy
PICC stands for…
Peripherally inserted central catheter
Signs of infiltration due to and IV can include…
Swelling, discomfort, coolness at the infiltration site, sizeable decrease in flow rate
Signs of phlebitis at the IV site can include…
Pain at or near the site, heat, redness, and swelling at the site
What are the drop factors for a macrodrip?
10gtt/mL, 15gtt/mL, and 20gtt/mL
What is the drop factor for a microdrip?
60gtt/mL
Why even after calculation the flow rate for an IV would we check the IV hourly?
Counting drops is not precise. Rates may need to be adjusted to compensate.
If the patient has continuous IV therapy, how frequently should the tubing and site be changed?
The tubing for the IV should be changed every 72 hours
The site should be changed every 48-72 hours
TKO/KVO-
To Keep Open/ Keep Vein Open
How many mL of NS would you flush an IV line with
10mL
If IV tubing is not primed properly and air bubble can form and lead to a venous air embolism. What are some signs and symptoms for this? What are the treatments?
S & S: sudden dyspnea, tachycardia, heart murmur, hypotension, decreased LOC, CP, circulatory shock, sudden death
TX: place in L lateral Trendelenburg position, 100% O2
What are some signs and symptoms of fluid overload?
S/S: cough, dyspnea, HTN, pulmonary edema, JVD, HA, crackles
When using whole blood for a blood transfusion how many mL are in one unit? What risk factors are associated with blood transfusions?
500mL/unit
Risk factors include volume overload as well as passing on communicable diseases such as HEP B, HIV, West Nile Virus, etc…
What are PRBC’s? What is their unit size? What are they typically given for?
PRBC’s are packed red blood cells
Unit size is 250 to 400mL/unit
PRBC’s are given frequently for blood loss and surgeries
What is the unit size of fresh frozen plasma (FFP)? What is the rate it is given?
Unit size-200-250ml given over 15-30 minutes
What blood product is used to treat hemophilia and Von Willebrand’s disease?
Cryoprecipitate
Albumin is able to increase blood pressure due to its ability to…
Draw fluids into the intravascular space
As an RN it is your responsibility to ensure before an IV is even started that there is an order to transfuse and that the patient has signed what?
A consent form
A blood product should be kept on the unit for no longer than…
30 mins. If not used by then, return the blood product to the blood bank
Before starting the infusion, the nurse should obtain what before administering the product?
A set of vital signs should be obtained before infusion. Make sure to obtain vital signs 5 minutes after starting the infusion as well and remain with the patient for 15 mins to ensure there are no signs of an adverse reaction. After take vitals every hour
What are some signs and symptoms of an acute hemolytic transfusion reaction?
S & SX: chills, fever, LBP, flushing, tachycardia, tachypnea, hypotension, vascular collapse, ARF, shock, cardiac arrest, DEATH
What are some signs and symptoms of an anaphylactic transfusion reaction?
S & SX: anxiety, urticaria, wheezing progressing to cyanosis, shock, cardiac arrest
Reactions that can occur weeks to months after blood product transfusions are called delayed transfusion reactions. Conditions and diseases that can occur with this are…
Delayed hemolytic Hepatitis B and C HIV Iron Overload West Nile Virus
What should be done in the case of a blood transfusion reaction?
STOP THE TRANSFUSION!
Using a different IV line, KVO with NS.
Notify the physicians
Report to the blood bank
Check ID, bag, & bag label
Draw blood for a red top & lavender top tube, (which will be test for coombs) & have it sent to the blood bank with the “post Transfusion” indicated on the label.
Send a urine sample to the blood bank with Post Transfusion” indicated on the label
Venipuncture-
inserting a hollow bore needle into the lumen of a large vein to obtain a specimen.
Vaccutainer tube-
allows the drawing of multiple blood samples
Capillary puncture-
least traumatic, uses sterile lancet to puncture a vascular area a finger, toe, or heel
Arterial blood gas-
diagnosis of respiratory disorder. Arterial puncture (radial or brachial)
Blood cultures-
aid in detecting bacteria in the blood. Two cultures from two different sites. Before antibiotic therapy is started
What is an average lab value for magnesium?
1.5-2.5 mg/dL
What is an average lab value for phosphate?
2.5-4.5 mg/dL
What is an average lab value for potassium?
3.5-5 mEq/L
What is the average lab value for calcium?
8.5-10.5 mg/dL
What is the average lab value for chloride?
95-105 mEq/L
What is the average lab value for sodium?
135-145 mEq/L
What are some major cations?
sodium, potassium, calcium, magnesium, hydrogen ions
What are some major anions?
chloride, bicarbonate, phosphate, sulfate, proteinate ions
Hydrostatic pressure-
exerted on walls of blood vessels
Colloid Osmotic pressure-
exerted by protein in plasma
Osmosis-
area of low solute concentration to area of high solute concentration
Diffusion-
solutes move from area of higher concentration to one of lower concentration
Filtration-
movement of water, solutes occurs from area of high hydrostatic pressure to area of low hydrostatic pressure
Active transport-
physiologic pump that moves a substance (ions, glucose, amino acids) from area of lower concentration of one of higher concentration
Sodium–potassium pump-
maintains higher concentration of extracellular sodium, intracellular potassium. This pump is used in active transport
Osmolarity-
Describes the concentration of solutes or dissolved particles per liter (pertains to measuring fluids outside the body, ex. Urine specific gravity)
Osmolality-
Describes the concentration of solutes per kg of water (pertains to measuring fluids inside the body)
Tonicity-
The tension or effect that a solution with impermeable solutes exerts on a cell size because of water movement across a cell membrane
