Final Flashcards
What are some disadvantages of IV Therapy?
- Invasive therapy
- Higher Cost
- Increased risk of allergy/anaphylaxis
- Scaring
- Infiltration of tissues
- Circulatory overload
What information should be on all consent forms created for IV Therapy?
- risk and complication review/education for the pt
- explanation of what will happen during tx
- who will be performing the procedure
What should be included in the Objective section of IV Therapy SOAP notes?
- vitals= pre & post
- size of needle
- how pt tolerated tx
- time= start & end
- drip rate
- pH, total osmolarity
- site of needle insertion
- IV site status
- catheter status
- IV contents (nutrients, fluid carrier, total osmolarity)
Know the names of the parts of IV tubing
- spike/piercing pin
- vent
- drip chamber
- roller clamp
- Y-port
- Luer Lock/Hub
Know all of the “best practice” tips listed in week 2 lecture
- ‘Needleless’ dispending devices: use of these devices when mixing solutions. Rationale: reduces contamination and prevents coring of stoppers; also helpful for withdrawing large volumes of Vit C and other viscous fluids
- angiocatheters: safety features preventing needle stick injury, exposure to blood
- UA: perform in office every IV visit to ensure proper kidney function. Will help document safe practices
- Tourniquets: dispose after use with one pt to prevent exposure/contamination
- Transparent semipermeable dressing: best for securing IV catheters. Cover insertion site and hub
Isotonic soln
- has an osmolarity about equal to that of serum. Because it stays in the intravascular space, it expands the intravascular compartment.
- no effect on the volume of fluid w/in the cell
- solution infused remains in the ECF; used to expand the ECF
Examples: `0.9% sodium chloride (N saline), lactated ringer’s solution (a balanced electrolyte solution- hospital rehydration), 5% dextrose in water (D5W is a solution containing 5% dextrose in water)
Lactated Ringers
Isotonic Solution
-used to tx dehydration, the infusion rate can be as high as 500 ml/hr if the patient has N cardiac & renal fxn
Cell in hypotonic soln
- has an osmolarity lower than that of serum
- shifts fluid out of the intravascular compartment, hydrating the cells and the interstitial compartments (into intracellular space)
-water moves into cells, possibly causing them to burst
~contains less solutes than the intracellular space
-hydration of cells may deplete the circulatory system (e.g. plasma vol)
Example: 2.5% dextrose in water, 0.45% NaCl
Cell in hypertonic soln
-has an osmolarity higher than that of serum
-draws fluid into the intravascular compartment from the cells & the interstitial compartments
-will shift ECF from the interstitial spaces into the plasma
-water w/in a cell moves to the ECF, causing cells to shrink
-most of the therapeutic vitamin & mineral solutions administered by naturopaths are hypertonic
-most of the therapeutic vitamin & mineral solutions
Examples: 5% dextrose in 0.9% NaCl, 5% dextrose in lactated ringers, 10% dextrose, colloids (albumin 25%, dextran, plasma protein fraction)
Isotonic Solution Osmolarity
250-375 mOsm/L
Hypotonic Solution Osmolarity
< 250 mOsm/L
Hypertonic Solution Osmolarity
> 375 mOsm/L
Know how infusion of these different solutions affects fluid balance in different compartments: intracellular
fluid within cells; high in K+ and low in Na+
Know how infusion of these different solutions affects fluid balance in different compartments:interstitial, intravascular.
Extracellular fluid – blood, lymph, interstitial fluid, channels of the brain and spinal cord and in muscular and other body tissues, tends to be high in Na+ and low in K+
how to calculate osmolarity
Osm = [total mOsm / Total vol in mL] *1000
Know how to calculate drip rate, infusion rate
-Volume of solution to be infused
-Time frame for infusion of the solution
-Drip factor of specific type of IV tubing you are using
ii
Drip rate = gtts/min= vol (mL) x drop factor (gtts/mL)
Time (min)
Know which solutions need cautious infusion rates and why
- High osmolarity (> 600 mOsm/L) due to potential for irritating the vein, the infusion rate should be btn 150-200 ml/hr
- Solutions that can act on heart or vasculature: IV fluids w Ca++, Mg++ or K+ can cause cardiac irregularities if infused too rapidly, so keep infusion rate between 150-200 ml/hr. Also, Mg++ can cause hypotension due to its vasodilating effects.
- Solns w very high conc of Vit C (>50 grams) are best infused through devices that terminate in the superior vena cava (PICC lines, Groshong lines, port-a-caths)
- HTN can occur if fluid is infused too rapidly, due to incr fluid volume in the circulatory system
Calcium: Adverse side effects, special considerations with calcium gluconate
- loss of appetite, nausea, vomiting, constipation, abdominal pain, dry mouth, third and frequent urination; more severe may result in confusion, delirium, coma and death
- Shell fish allergy
Adverse reactions: hypotension, bradycardia, arrhythmia, tingling sensations, syncope, cardiac arrest due to effect on nerve conditions and muscle contraction
Magnesium: Adverse side effects of magnesium,
flushed w a sensation of heat often in the face, skin, trunk, followed by hypotension, cold sweating and even fainting
Magnesium: common administration rates, researched uses
- DO NOT GIVE MORE THAN 4G PER ADMINISTRATION
- Common push: up to 1500 mg over 20-40 min
- Common drip: up to 3000 mg over 2 hours
Combine Magnesium Chloride with Calcium _____
Combine Magnesium Sulfate with Calcium _____
Chloride
Gluconate
uses of Magnesium
Pts w ST elevation and AMI, migraines, bronchial hyper-reactivity, asthma and headache, mag chloride for cardiac arrhythmia.
How to administer Potassium
Never as a push, always diluted 100ml or more
Give with MTE-4
When to use caution with potassium
- Renal insufficiency
- Endocrine disorders (hypoaldosteronism)
- Potassium sparing/altering medications (diuretics, ACE inhibitors, ARBS, digoxin, beta blockers, etc)
dose and administration of potassium
- 2-5 ml in a drip containing 200-500 ml, given over 1-3 hours.
- Administer at a rate not to exceed 10-20 mEq/hr
- Maximum dose of 100mEq in 24hours
What are the constituents of MTE 4 and MTE 5
MTE 4: Chromium, copper, manganese, zinc
MTE 5: Chromium, copper, manganese, zinc, selenium
Conditions to use caution in with Copper
caution with cholestasis, cirrhosis, Wilson’s dz of copper storage
Conditions to use caution in with Manganese
– caution with cholestasis (toxicity may result if biliary excretion is impaired), may cause neuropsychiatric sxs: irritability, excitement, compulsive behavior
Conditions to use caution in with Molybdenum
– aggravates copper deficiency; avoid in pregnancy
Conditions to use caution in with Selenium – caution with renal dz, decreased excretion
caution with renal dz, decreased excretion
Conditions to use caution in with Zinc
caution with renal dz, biliary excretion conditions, pregnancy, wilson’s dz