FIRST EXAM REVIEW Flashcards
How many different types of IV solutions?
Crystalloid solutions
Colloid solutions
Solutions by tonicity
Oxygen-carrying solutions
Name the three spaces?
intracellular space
Interstitial space
intravascular space
What IV solution is defined as dissolved crystals in water?
crystalloid solutions
can crystalloid solutions cross membranes and alter fluid levels?
yes
what is the 3-1 replacement rule and what IV solution does this apply too?
3 mL of isotonic crystalloid solution is needed to replace 1 mL of blood
crystalloid solutions
can crystalloid solutions carry oxygen?
no
What are some examples of crystalloid solutions?
Normal Saline
Ringers Lactate
D5W-D51/2NS-D10
This IV solution is defined as containing
molecules that are not dissolved and are too large to pass out of capillary membranes
colloid solutions
What are some characteristics of colloid solutions?
molecules that remain in the vascular compartment
high osmolarity
could cause dramatic fluid shifts
short duration of action
Examples of colloid solutions include:
Albumin
Plasmanate/Plasma-Lyte
Destran-Hespan
Name the three types of solutions categorized by their tonicity:
isotonic
hypertonic
hypotonic
this IV solution is defined as the same concentration of sodium as cell
isotonic IV solution
this IV solution is defined as greater concentration of sodium
hypertonic IV solution
this IV solution is defined as lower concentration of sodium
hypotonic IV solution
examples of isotonic solutions include:
lactated ringer’s solution
D5W, 5% dextrose (only considered isotonic in the bag)
Name a few examples of oxygen-carrying solutions
whole blood
PRBC’s
synthetic blood substitutes
Equipment necessary for IV therapy:
elastic tourniquet cleaning wipes gauze tape/adhesive bandage IV catheter IV admin set
IV solution usually come in these two types
normal saline
LR solution
define Microdrip set
60 gtt/mL
define Macrodrip set
15 gtt/mL or 10
other examples administration sets include:
blood tubing: macro drip set
Volutrol: micro drip set
in choosing an IV site you should consider three things:
avoid valves and bifurcations
look for a vein that looks straightest, firm, round, and springs
limit IV access to distal areas
what are three types of IV catheters?
over the needle
butterfly
through the needle
what is the over-the-needle catheter?
inserted over a hollow needle
what is a butterfly catheter?
hollow, stainless steel needle with two plastic wings
through-the-needle catheter?
inserted through a hollow needle
this catheter is inserted over a hollow needle?
over-the-needle catheter
this catheter is a hollow, stainless steel needle with two plastic wings
butterfly catheter
this catheter is inserted through a hollow needle
through-the-needle catheter
these catheters are most preferred and this diameter of catheter should be chosen for vein
over-the-needle; largest diameter catheter
the best gauges for over-the-needle catheters are _____ in treating peds patients. Though _____ are ideal
20-, 22-, 24-, 26-; butterfly catheters
IV locations for peds patients include?
hand veins, scalp veins
What are some considerations for IV therapy in geriatric patients?
use smaller catheters
tape may be damaging
be careful with macro drips
consider poor vein elasticity and avoid spidery/varicose veins
these factors affect IV flow rate
fluid admin set height of bag catheter type constricting band
name local IV site reactions and complications?
infiltration occlusion vein irritation thrombophlebitis hematoma nerve, tendon, ligament damage arterial puncture
escape of fluid into surround tissue
infiltration
Infiltration causes?
edema or necrosis
catheter passes through vein and out other side
patient moves excessively
tape becomes lose or dislodged
catheter is inserted at too shallow an angle
in the event infiltration occurs what should you do?
d/c the IV line
reestablish IV line in opposite extremity
apply direct pressure over the area
do not wrap tape around extremity
blockage of vein or catheter
occlusion
seeing a decrease drip rate or blood in the IV tubing is a sign of?
occlusion
occlusion may develop due to:
positioning of catheter
patient’s blood pressure overcoming the flow
this type of site reaction is caused by too-rapid infusion rate
vein irritation
the steps in handling vein irritation include:
d/c the line
save equipment for analysis
reestablish the IV line in the other extremity with new equipment
inflammation of the vein
thrombophlebitis
causes of thrombophlebitis?
characterized and treated how?
aseptic technique
pain and tenderness along vein, redness, edema; appears after IV therapy. treat by discontinuing the infusion and IV
thrombophlebitis can be prevented how?
disinfecting skin wearing gloves not contaminating site cover site with dressing anchoring catheter and tubing
this is an accumulation of blood in the tissues surrounding an IV site?
hematoma
this site reaction, usually caused by vein perforation and improper catheter removal, is characterized as _____
hematoma
systematic complications include:
anaphylaxis pyrogenic reactions circulatory overload air embolus vasovagal reactions catheter shear
how do you handle an allergic reaction?
d/c line and remove soln leave catheter in place attach saline lock notify med control maintain airway/VS retain soln or medication for evaluation
foreign proteins that produce fever
pyrogenic reaction
steps in handling a pyrogenic fever
stop infusion
*always inspect bag prior to admin
problems may occur in patients with cardiac, pulmonary, or renal dysfunction
circulatory overload
to treat circulatory overload, you should:
slow IV
raise patient’s head
administer high flow O2
monitor VS and breathing adequacy
treating air embolus consists of:
placing patient on left side with head down
admin 100% oxygen
transport to facility
assist ventilations if needed
the brain is deprived of oxygen and fainting occurs is known as?
vasovagal reactions
to treat vasovagal reactions you should?
place patient in shock position
apply high flow oxygen
monitor VS
establish IV line
when the needle slices through catheter creating a free flowing segment
catheter shear
to treat a catheter shear you should:
surgical removal of the tip is often necessary, consider placing the patient in left lateral recumbent position and do not rethread catheter
define the seven R’s
right patient right med right dose right route right time right documentation right to refuse
integrates comprehensive knowledge of pharmacology to formulate a treatment plan intended to mitigate emergencies and improve overall health of the patient
pharmacology
routes of administration
self-administer
peer-administer
assist/administer medications
predefined procedures performed before physician is contacted
standing orders
paramedics must contact medical directors prior to performing procedures
online medical control
procedures for adminsitering medication
- obtain order from medcontrol
- understand physician orders
- repeat any orders for verification
- ask about medication allergies
how many times should read the drug label
three times
in packaging
during prep
before admin
difference between antiseptic and disinfectant?
antiseptics are used before invasive procedure whereas disinfectants are toxic to living tissue and used on nonliving objects
used before invasive procedure?
antiseptic
chemicals toxic to the living tissue?
disinfectant
in preventing contamination of the patient, what are some aseptic techniques?
sterilize the equipment
antiseptic
disinfectant
intended for tissue cleaning
antiseptic
not intended for tissue cleansing, i.e. tissue damage
disinfectant
deconstruction of all living organisms using heat, gas, or chemicals
sterile technique
for a sterile field to exist you should have:
- sterile sleeves or a gown
- wear sterile gloves
- place sterile drapes around procedural area
cells are enclosed by a cell membrane, this is called?
semipermeable membrane
name small compounds that can pass easily through the cell membrane?
water, H+, CO2
what is unique about the phospholipid bilayer?
selective permeability
Total body water (TBW) is what percent of the adult weight?
60%
TBW can be divided into?
intracellular fluid
extracellular fluid
intracellular fluid is what percent of the TBW?
45%
extracellular fluid is what percent of the TBW?
15%
The extracellular fluid can be divided into two
interstitial fluid
intravascular fluid
the remaining 40% of the total body weight is comprised of?
solids
this ion plays a major role in neuromuscular function and the conversion of glucose into glycogen
potassium
this ion regulates distribution of water and major extracellular cation
sodium
major intracellular cation
potassium
this ion is important for bone growth
calcium
this ion metabolizes protein and carbohydrates
magnesium
this electrolyte determines metabolic acidosis and alkalosis, part of the buffer system in regulating acid/base balance
bicarbonate
regulates the pH of the stomach and major extracellular anion
chloride
important component in adenosine triphosphate (ATP), serves as the body’s energy source
ATP
compounds concentrated on one side of a cell membrane move to an area of lower concentration
diffusion
name an example of diffusion
filtration as observed across the kidney
movement of water across a cell membrane and occurs when there are different concentrations on each side of a membrane
osmosis
a healthy person loses approx how many liters of fluid daily?
2-2.5 L
causes of overhydration ?
unmonitored IVs
kidney failure
water intoxication
hypoventilation
these types of medication are given through the digestive or intestinal tract and usually take how long to be absorbed?
enteral medications; 30-90 minutes
the purpose of a gastric tube?
decompress
gastric lavage
route admin
breakable sterile glass containers and carry one of medication
ampules
glass or plastic bottles with rubber stopper top and can contain single or multiple doses
vials
the two types of prefilled syringes?
glass cartridge and syringe, and preassembled prefilled syringes
common sites for SC injections
upper arms anterior thighs abdomen *0.5-1 ml max volume 15-30 min absorption
common sites for IM injection
vastus lateralis rectus femoris gluteal area - limited to 5 ml's deltoid muscle - listed to 2 ml's *10-20 mins absorption
percutaneous medication administration takes how long for absorption to take place?
mins to hours
the absorption rate for sublingual medication administration?
3-5 min absorption, the area is highly vascular
buccal medication absorption rate
30-90 mins absorption
the purpose of ocular medication administration?
for pain relief, allergies, and infections, tetracaine takes 1-2 drops, no more
intranasal medication administration
3-5 min absorption
nebulizer and MDI takes how long to absorb?
2-3 mins absorption for patients with respiratory disorder
ET tube medication administration uses only 4 meds
lidocaine
epinephrine
atropine
nalozone (narcan)
Adult insertion sites for IO
right and left proximal humerus
right and left proximal tibia
right and left distal tibia
pediatric insertion sites for IO
right and left distal femur
right and left proximal humerus
the right and left proximal tibia
right and left distal tibia
Average flow rate achieved for IO via humeral site
5L/hr
indications for IO
any time vascular access is difficult to obtain in emergent, urgent or medically necessary situations for 24 hours
contraindications for IO
fracture of target bone
infection at area of insertion
inability to identify landmarks
IO or attempted IO access in target bone within previous 48 hours
prosthesis or orthopedic procedure near insertion site
IO sterile needle sets
15 gauge, 30 4stainless steel in 3 lengths: 15 mm (pink), 3-39 kg 25 mm (blue), 3 kg or > 45 mm (yellow), 40 kg or >