fluid/electrolyte Flashcards
if creatinine is normalish but BUN is high
dehydrated
caution about fluid with lactose
don’t give to someone with diarrhea
tips for fluid restriction
give half bt 7 am and 3 pm
-remember that ice chips, gelatin, and icecream are fluid
-need frequent mouth care
Parenteral nutrition
in CVC if hypertonic
in peripheral IV for lower osmolality
parenteral potassium
NEVER administer as a push
the body can’t conserve potassium, so its continuously excreted as long as the kidneys are working
burns a little – no more than 10 meq/hr
VADs
vascular access devises
-catheters or infusion ports for repeated access to vascular system
Central catheters are for long term stuff –> good for PN, large amts of fluid, and meds that irritate the veins
IV equipment
ASEPTIC
-VADs, tourniquet, clean gloves, dressing, IV fluid containers, tubing, EIDs
Technique for VADs
Aseptic Non-Touch Technique
-standard precautions, PPE, management of sterile field, non-touch technique, sterile supplies
When NOT to use hand veins
older adults or patients that are ambulatory
Where else not to stick someone
torso
-areas of flexion
-arm on side of masectomy or graft/fistula
-areas of infection, infiltration, or thrombosis
Line maintenance
- use ANTT to keep syst sterile and in tact
- use ANTT to change IV fluid containers, tubing, and contaminated site dressing
- help a patient with self care so system isn’t fucked with
- monitor for complications of IV therapy
Securement devices for VADs
- ASD (adhesive securement device) – sticks to skin and holds VAD in place
- ISD (integrated securement device) – combo of dressing and securement
How often to change stuff
continuous administration sets for crystalloid soln and meds = 96 hrs to 7 days
tubing for intermittent infusions = 24 hrs
blood and blood components = every 4 hrs
IV lipids = every 24 hrs
how often to change dressings
TSM (transparent semipermeable membrane) = every 7 days
gauze = every 48 hrs
MARSI = medical adhesive related skin injury
infiltration vs extravasation
infiltration = IV dislodges or vein ruptures and fluid enters subq tissue
extravasation = IV fluid has stuff that damagess the tissues
both cause coolness, paleness, and swelling of the area
IV substances that have a higher risk for phlebitis
KCL
vancomysin
penicillin
nursing protocol before a blood transfusion
-vitals
-lung assessment
-pertinent conditions (fever, HF, kidney issues)
-pressense of patent VAD
-lab values
3 things to check before blood transfusion
- blood that’s delivered match what was ordered
- blood given to patient matches their blood type
- correct patient gets the blood
NEED BIGGER NEEDLE FOR BLOOD BC ITS MORE VISCOUS
timing of transfusions
usually 2 hrs, but can do longer if risk of fluid volume overload
no more than 4 hrs because risk of infection
Always start slow for early detection of transfusion reaction – if no reaction, increase rate after 15 mins
-if reaction, infuse NS to maintain patent iv access
risk of large volume blood infusion
hyperkalemia
metabolic alkalosis
hypocalcemia
hypomagnesemia
Steps of what to do if transfusion reaction
S1. stop transfusion
2. keep IV open with 0.9% sodium chloride at slow rate
-DONT turn off blood and then start NS —> CHANGE OUT IV TUBING
-notify HCP
-stay with patient and assess every 5 mins
-prep emergency drugs
-prep to do cardiopulmonary resuscitation
-save extra blood and stuff to return
-get blood and urine samples if ordered
TACO
transfusion associated circulatory overload
-old ppl and those with cardiopulmonary disease are at risk
Allen test
press on radial and ulnar arteries until hands go white
release ulnar artery and look for color return
then you can puncture radial artery to get ABG blood
hold pressure for 5 mins to prevent hematoma
put blood syringe in ice and bring to lab
