Exam 3 Flashcards
What type of blood vessel must TPN nutrient solutions be administered within?
a vein with rapid blood flow, such as the superior vena cava
Why is sterile technique especially important in TPN administration?
the high dextrose content creates a environment that can potentially harbor bacterial growth
How soon do TPN solutions have to be hung after mixing?
24 hours
What is a central line?
aka central venous catheter, a tube placed into a large vein near the center of the body
What is refeeding refeeding syndrome?
physiologic response to initiation of nutrient delivery after a period of malnourishment
What is the tonicity of nutrient solutions used in TPN?
hypertonic
How does a lipid solution look like?
milky
How does a TPN solution look like?
lemon-lime Gatorade
What is included in a TPN solution?
vitamins, minerals, electrolytes, and fluids
What is the primary component of a lipid solution?
fatty acids
What is a 0 on the phlebitis scale?
no symptoms
What grade of phlebitis contains erythema at the access site with or without pain?
1
What is a grade 2 phlebitis?
pain at the access site with erythema
A palpable venous cord, streak formation, and pain at the access site with erythema combined represent what level of phlebitis?
grade 3
What are the clinical criteria for grade 4 phlebitis?
purulent drainage, streak formation, pain at access site with pain, and palpable venous cord > 2.54 cm in length
What is extravasation?
when vesicant medication has leaked into the tissue around the cath site, killing the surrounding tissue
What is infiltration?
IV medication not going into vein, and leaking into surrounding tissue
What gauge needle is used for blood transfusion?
20 gauge
How long is a peripheral IV good for?
1 week
How long can a midline catheter be used?
up to 1 month
What type of IV device should be utilized if patient requires for greater than 1 month?
PICC (peripherally inserted central catheter) line
What are examples of isotonic solutions?
NS (0.9% Sodium Chloride/NACl) and LR (lactated ringers)
What type of fluid is 1/2 NS (0.45% NaCl)?
hypotonic
2 and 3 % NaCl are both examples of what type of fluid?
hypertonic
What are some common symptoms of FVD (fluid volume deficit)?
-decreased weight, poor skin turgor, dry mucous membranes, increased pulse and RR, decreased BP, urine output and capillary refill. Flat neck veins
What may be expected for a patient presenting with JVD, increased weight, SOB/crackles, edema, increased BP and decreased pulse?
FVO (fluid volume overload)/ FVE )excess)
What happens to hematocrit for FVD?
increase
What describes fluid in a non-utilizable part of the body, such as fluid in ascites?
3rd spacing
What interventions may be necessary for individuals experiencing fluid volume deficit?
giving isotonic fluids electrolytes orally or IV, IV replacement of blood, removal of third spaced fluids (chest tubes, paracentesis, peritoneal taps)
What describes an IV complication presenting with cold, pale, puffy, but not painful area surrounding the site?
infiltration
What are the symptoms of hyperglycemia?
polydipsia (thirsty), polyuria (frequent urination), polyphagia (hungry)
What may occur to a patient if TPN is discontinued abruptly?
hypoglycemia
What refers to a venous device that terminates in a great vessel?
central line
How many mL are in one ounce?
30 mL
What are some manifestations of speed shock?
facial flushing, irregular pulse, severe headache, hypotension, and may progress to LOC or cardiac arrest
What action should the nurse take if speed shock is suspected?
clamp IV, notify provider, possibly administer O2, and monitor VS frequently
What system is likely to be affected by hypercalcemia?
neuromuscular system (confusion, headache, decreased deep tendon reflex
You are observing a clients b.p. and observe a carpal spasm(Trousseau’s Sign) , which electrolyte imbalance might you expect?
hypocalcemia
What is Chvostek’s Sign, and which electrolyte imbalance is it associated with?
twitch of facial muscles when tapping on cheek related to hypocalcemia
What is the priority nursing intervention for a client who has hyperkalemia?
get an EKG
What is referred to as generalized edema?
anasarca
What may happen to the heart if potassium is too low?
cardiac arrest (sudden loss of heart function)
What is the rate for Iv push potassium?
bruh, you NEVER push potassium, given on pump never quicker than 10 mEq/hour
What are the special considerations for D10 in water (this is a hypertonic solution)?
monitor blood sugar levels
What are good dietary sources of magnesium?
nuts, seeds, cashews, pumpkin seeds, dark chocolate, and fatty fish
What foods are high in calcium?
dairy, tofu, kale, and broccoli
What electrolyte is plentiful in junk food, canned products, and fast food?
Na+ (sodium)
Bananas, cantaloupe, plain yogurt, and potatoes are useful in providing which electrolyte?
K+ (potassium)
If hypoglycemia occurs for a patient on TPN, what should the nurse administer while waiting for a new mix of formula from pharmacy?
D10
What type of solution may be usedfor cerebral edema or hyponatremia?
hypertonic ( 2 and 3 % NaCl)
What type of solution can be utilized in intracellular dehydration, DKA and water replacement?
hypotonic
When are isotonic solutions often used?
hypovolemia, blood transfusions, fluid challenges, and burns
When should 0.45 NaCl never be used?
cerebral edema/increased ICP
With which type of solution should you monitor for hypovolemia (tachycardia)?
hypotonic
This type of fluid has the potential for causing fluid volume excess. It is used in patients with cerebral edema and hyponatremia?
hypertonic ( 2 and 3 % NaCl)
This isotonic fluid is given during blood transfusions, shock and in patients with fluid challenges.
normal saline (0.9% NaCl)
What type of fluid is contraindicated in renal and liver patients and is used in patients with burns, dehydration, electrolyte challenges?
lactated ringers
What is a potential risk for isotonic fluids?
fluid overload, especially in kidney and heart patients
What type of isotonic fluid is given in DKA (metabolic acidosis) because the lactate component can increase blood pH by converting to bicarbonate?
lactated ringers
What type of fluid may be given if there is a high concentration of solutes in the intravascular space, such as in hypernatremia?
hypotonic (0.45% NaCl)
What should be monitored closely in patients receiving hypotonic solutions?
mental status changes (brain swelling), hypovolemia, low blood pressure (water is being pulled into cells, out of intravascular space)
What are the symptoms of hypoglycemia?
dizziness, shakiness, weakness, tachycardia, sweating/clammy
What may indicate a central line infection for an individual receiving TPN?
redness, drainage, increased WBC, fever
What electrolyte imbalance may occur due to diuretics (furosemide), GI losses, Cushing syndrome, and metabolic alkalosis?
hypokalemia
Dysrhythmias, muscle spasms/weakness, and constipation/ileus are effects of which electrolyte imbalance?
hypokalemia
What is a priority assessment in a client who has dehydration?
mental status
