Exam 2 - IVF Flashcards
purpose of IVF
maintenance
replacement
administer meds
administer blood products
what are the 3 types of IVF
isotonic
hypotonic
hypertonic
What is the rule of 300?
below = hypotonic above = hypertonic
will a cell change with isotonic solution?
no
what occurs with isotonic solution?
the amount of water transported into the cell is equal to the amount of water transported out of the cell
examples of isotonic solution
NS
LR (blood loss, truma)
when would you give an isotonic solution?
when fluids need to be replaced
when would you give NS?
fluid resuscitation
metabolic acidosis
hypercalemia
mild hyponatremia
too much NS can cause which electrolyte imbalance?
hypernatremia
hyperchloremia
LR contraindication
kidney injury
when would you use LR?
maintenance in postop
hyponatremia
fluid loss
Example of hypotonic solution
0.45 NS
when would you administer a hypotonic solution?
remove waste
replace insensible fluid loss
Can you bolus 1/2 NS?
No, rapid swelling will occur, cardiovascular collapse, or increased ICP
what occurs with hypotonic solution?
water is transported into the cell making the solute concentration higher
what occurs with hypertonic solutions?
water is pulled OUT of the cells making the solute concentration lower
examples of hypertonic solution
3% NS
mannitol
PPN
colloids: dextran, albumin, D5NS, D5LR
indication for 3% or 5% NaCl
critical hyponatremia
what VS to monitor when administering 3% or 5% NaCl
BP
how would you administer 3% or 5% NaCl
slowly; closely monitor
what does administering albumin do?
pulls fluid into the vessels to be excreted
What does Dextran do?
volume expander
-pulls fluid out of cells into vascular space
-reduces clotting ability
increases BP, circulatory volume
when is dextran used?
hypovolemic shock
peripheral parental nutrition (PPN) may be administered through
a large peripheral vein
total parental nutrition (TPN) must be administered throguh
a central line
what to monitor with PPN or TPN administration
glucose imbalance
fluid, electrolyte imbalance
fluid overload
how soon to pull refrigerated IV meds
15-20 minutes to allow it to come to room temperature
fluid overload nursing care
elevate HOB KVO at 10-21 mL/hr assess pt -VS, lung sounds, mental status, O2 SAT, edema administer diuretics
*contact HCP
when air enters the R ventricle, lodges against pulmonic valve and stops the valve action/flow of blood
air embolism
how to prevent an air embolism
use locking ports on tubing
prime all tubing
fill drip chamber half full
IV pump air detection alarm
air embolism s/sx
dyspnea palpitations coughing JVD wheezing chest, shoulder, low back pain shock -weak, rapid pulse; hypotension; decreased LOC
air embolism txment
clamp the line place on L trendelenburg fix air leak administer O2 assess, tx according to orders
infiltration or extravasation (damaged tissue) are used
interchangably
both involve infusion of solution into the surrounding tissue instead of vein
infiltration, extravasation s/sx
swelling around site coolness at site slowed rate leakage from site pump alarm indicating pressure
how to prevent infiltration, extravasation
frequent site monitoring flush for patency prior avoid IV at areas of flexion secure IV to avoid movement give vesicant IV push meds through side port on IV tubing
infiltration treatment
agency policy stop infusion, remove IV start new site above or opposite arm isotonic solution used: warm compress, elevation hypertonic solution used: cool compress
extravasation treatment
agency protocol
common extravasation protocol: stop infusion assess, notify HCP administer antidote through existing cannula remove cannula
common vesicants
vasopressors Ca K Dilantin phenegran vanc chemotherapy
What is phlebitis?
inflammation of the vein
*no clot
phlebitis treatment
DC IV, restart above or other arm
warm compress
NSAIDS
what is thrombophlebitis
clot with inflammation
s/sx of thrombophlebitis
localized pain
redness
warmth
edema
thrombophlebitis treatment
DC IV, restart above or opposite arm
cold compress FIRST
warm compress, elevate LATER
may culture drainage from catheter tip
thrombophlebitis prevention
avoid trauma wash hands aseptic technique monitor hourly flush with saline prior to administering meds
blood leakage into surrounding tissue
hematoma
cause of hematoma r/t IV
cannula goes through the vein
cannula is too big
cannula slips out of vein
-no secure adequately
hematoma treatment
remove cannula
apply pressure
pressure dressing x24 hours
elevate extremity
how to prevent IV clotting/obstructions
do not let bag run dry
do not let tubing kink
maintain adequate flow
flush as appropriate
Bolus
give fluid fast
1 L/hour
500 mL/hour
Maintenance drip
KVO
75 mL/hr
safest, easiest methods of administering IV medications
mixing in large volumes
first step if you were to mix a medication with IVF
make sure they’re compatible
most dangerous method of medication administration
IVP
bolus
IVP should be administered over less than __ minute
1
how an order should be written if IV med is to be given over 1 minute
“IV over x minutes”
IVP advantages
fluid sensitive pt
rapid action
only one stick for multiple doses
IVP disadvantages and safety concerns
most dangerous
acts instantly
ALWAYS VERIFY with another nurse
always check site for patency and placement FIRST
volume-controlled infusions
50-100 mL fluid
3 types of volume-controlled infusions
volume-control admin. set
piggyback sets
syringe pumps
advantage of volume-controlled infusions
reduced risk of rapid-dose infusion (given over 30-60 minutes)
admin. meds that are stable
allows control of IV fluid intake
Piggyback size and connection location
25-250mL
UPPER Y-port
syringe pump is ___ operated
battery
syringe pump allows meds to be given in doses that range from __ to __ mL
5-60 mL
syringe pump container volume
150 mL
intermittent venous access is aka
saline or heparin lock
SAS method
S - saline flush (patency)
A - administer med
S - saline flush (clear med)
IV home therapy education begins when?
while in the hospital
-s/sx of infection
infusion pump
maintain IV admin. equipment
