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Iv Therapy > Fluid, Electrolyte,acid Balance > Flashcards

Fluid, Electrolyte,acid Balance Flashcards

1
Q

IV are used for

A 
Promoting/ replacing body stores of:
Fluid, electrolytes,fats,calories
Restore acid base, volume of blood
Administer meds
Monitor central venous pressure
Provide nutrition
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2
Q

Types of fluid

A

Isotonic
Hypertonic
Hypotonic

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3
Q

Equal to blood plasma

  • Normal saline 0.9%
  • Lasted rangers
  • Plasma
  • Blood components
  • Albumin5%
  • 5% dextrose in water (d5w)
A

Isotonic, exerts same osmotic pressure

= same tonicity in plasma

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4
Q

Hypotonic

A 
Exerts less osmotic pressure than plasma 
Cause dilution of plasma
Forces water movement in cells
-half normal saline 0.45% (1/2NS)
-1/3 sodium chloride 0.3%

= less tonicity in plasma (dehydration)

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5
Q

Exerts higher osmotic pressure than plasma.
Causes in solute concentration
Draws water out of cells

A

Hypertonic

  • 0.45 normal saline
  • dextrose 5% in normal saline
  • dextrose 5% 1/2 normal saline
  • dextrose 5% 1/4 normal saline
  • dextrose 5% lacked ranger

=more than tonicity of plasma (edema)

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6
Q

Smaller molecules clear colored, use of a smaller gauge needle (22,24)

A

Crystalloids

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7
Q

Solution with color use of larger gauge needle (18 inch)

A

Colloids

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8
Q

To prevent bacteria growth and maintain acidity PH of IV have to be what range

A

3.4-6.2

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9
Q

Saline solutions consist of

A

H2O & electrolytes (Na, Ca)

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10
Q

Dextrose consist of

A

H20 or saline and calories

34 calories for each 1% dextrose
( 1liter D5w= 170 calories)

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11
Q

Lacted rangers consist of

A

H2O & different electrolytes

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12
Q

Plasma expanders

A

Albumin
Mannitol
Dextra
Plasma protein

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13
Q

Parental hyperalimentation

A

TPN

Fluid,electrolytes,amino acid and calories

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14
Q

With TPN you want to check

A
  • check glucose q.6.h
  • bag filter change q.24.h
  • taper over 1-2 hours before discontinuing
  • record I&O/ daily weight
  • 2 nurses confirm order and bag
  • hang for 24.h
  • slowly start rate on pump
  • check q.30-60 min
  • never speed up
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15
Q

Uses and caution for :

D5W

A

Replace h2o lost, supply calories, administer medications.

Caution pt. With h20 intoxication and hyponatremia

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16
Q

Uses and caution:

Normal saline

A

Replace saline losses, administer blood components treat hemodynamics shock

Caution isotonic volume excess

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17
Q

Uses and caution:

Lactated rangers

A

Replace isotonic fluid, replenish specific electrolyte lost, moderate metabolic acidosis

Caution renal failure potassium(lactated rangers)
Liver failure can not metabolize lactated

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18
Q

Pt at risk for over load when giving fluids and can not tolerate

A 
Infants
Elderly
Renal failure
Liver failure
Heart failure 
Cardiac
Respiratory
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19
Q

5 rights of med administration

A 
Right pt
Right medication
Right dose
Right route
Right time

Check med as it is removed
Check verify with mar
Check before administration

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20
Q

Tubings

A

Basic solution set

Secondary solution set

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21
Q

Basic solution set

A 
Intermittent and continuous fluids
3 injection sites
-piggyback
-wide connect port
-IV push port
Tubing good for 3-4 days
IV is continuously infusing
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22
Q

Secondary solution set

A 
Short in length, use mini bag
Contains a hanger
Held higher then primary fluids
Administer piggyback when added to primary solution
Given intermittent
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23
Q

Primary infusion is good for only

A

24 hours

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24
Q

Materials needed for setting up IV

A 
IV fluid
IV primary tubing
IV controller or pump
IV lock needle
Extension set
Flush
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25
Material for secondary IV
Mini bag Secondary tubing Alcohol wipe
26
Tubing drip system consist of
Macro drip- larger drops over 80ml/hr delivers 10, 22,15,20 gtt/min Macro/mini drip-small drops used more in pediatrics 60gtt/ml
27
KVO
Keep vein open | 10-20ml/hr
28
Necessary to be ran on electric pump
``` Heparin Infusions Chemo Infant therapy TPN Risk for fluid overload pt Most medications and potassium All central line infusions ```
29
Saline lock
Needle or catherter with resealable rubber injection, flush with saline q.8.h prevent clots maintain venous access
30
Venous access device
Long term therapy,chemo medications and blood transfusions In home therapy Pt withLimited peripheral venous access
31
1-4 lumens, inserted into the femoral, jugular or subclavian veins. Inserted in central vein no longer then 7 days, flush prevent clots. Ex. Hickman, broviae,groshong
Central catherter
32
Inserted in superior vena cava Ex. Port-a-cath, med.port, infuse-a-port,goshong port Dr. Removes
Central implanted port
33
Picc line | Peripherally inserted central catherter
Long term, acute, home care setting Inserted basilic, brachial or cephalic vein. Placement verified with X-ray, site dressing is sterile
34
Central veins are used for:
``` Medications and infusions Rapid high volume dilution Peripheral blood flow deminished Cvp monitoring Moderate/ long term fluid therapy ```
35
When staring a IV what are the gauge sizes for Blood Standard IV Small veins
Blood- 18-20 Standard- 20-22 Small -24
36
Best site to start IV
Basilic- forearm side of little finger | Cephalic veins- forearm thumb side
37
18 gauge needle
Biggest gauge...green...blood transfusion
38
20 gauge needle
Big...pink...blood transfusion
39
22 gauge needle
Blue.. normal saline
40
24 gauge needle
Smallest... yellow....really hard stick, pediatric
41
Documenting IV
``` Date Time inserted Appearance of old dressing Appearance of insertion site Type of dressing applied ```
42
Factors affecting flow rate
Fluid Patient Container height
43
How to prevent fluid affecting flow rate
Properly mix additives to prevent clumping | Blood products gently agitate bag prevent clotting
44
How to prevent Pt affecting flow rate
Pt arm below level of heart above it delays infusion | Bending of extremities may occlude the catheter
45
How to prevent container height from affecting flow rate
Container is above heart level 30-36 inches | Pt IV pole may need adjusting when ambulating
46
When removing a central line have the patient _________ and tell them to ______, kids or elderly tell them to hum. Then place pt on bed rest for ______ min afterwards.
Take a deep breath Bear down 30
47
Never force flush central lines, it can cause _____ to travel. Contact MD, may prescribe ________, to break up clot. wait a few minutes then try flushing
Clots Catheflow
48
Lasted rangers solution contains potassium and should not be given to pt with?
Acute kidney injury | Chronic kidney disease
49
Local complication of IV therapy
Infiltration-leaking of infused fluid into surrounding tissue s/s blanching cold skin,swelling Phlebitis- inflammation of vein wall s/s redness warmth,tender, drainage Infection-microbial contamination s/s same as phlebitis w/ fever Clotting-blockage s/s unable to easily flush IV,tenderness, sluggish flow Local allergic reaction-allergies or sensitivities caused by tape, skin prep, antiseptics s/s redness,hives or rash,swelling,discomfort,itch
50
Systemic complications of IV therapy
CirculatoryOverload-tachypnea, dyspnea, orthopnea Pyrogenic reactions-fever, chills, flushed,NV Pulmonary embolism -chest pain, hemoptysis, restlessness, tachycardia Catherter embolism-hypotension,cyanosis, resp. Distress Air embolism-dyspnea,cough,cyanosis,pallor
51
Normal balance between internal and external forces
Homeostasis
52
Body adjusting to changes
Adaptation
53
Fluid is located in both, inside cells( _____ )and outside cells( ____)
Intracellular | Extracellular
54
Extracellular is divided into 3 types:
* Interstitial – surrounds cells and lymph * Intravascular – blood plasma * Transcellular – CSF, digestive juices, and synovial fluid in joints
55
Potassium
3.5-5.5 Hypokalemia<3.5 -muscle cramps, orthostatic hypotension replace by IV or mouth Hyperkalemia>5.5 -cardiac dysrhythmia, muscle twitching cramps Never given IV push Foods:apricots,avocado,banana,cantaloupe,mangos,spinach,tomatoes
56
Sodium
135-145 Hyponatremia<135 -fatigue,lethargy,NV,neuromuscular symptoms Hypernatremia>145 -decrease urine output,increase thirst Food:canned meat and vegetables,catsup,cheese,delimeat,processed meat,soy sauce,
57
Calcium
8.4-10.6 Hypocalcemia<8.4 -trousseau,chvosteks,tetany,carpal spasms, Give VIT d supplements Hypercalcemia>10.6 -increase HR BP, nausea,anorexia,renal calculi Give fluids, lasix dialysis Food: cheese,broccoli,shrimp,yogurt,oatmeal,milk,salmon,greens
58
Magnesium
1.3-2.1 Hypomagnesium<1.3 -hyperactive reflexes, chvosteks,trousseau,tremors,seizures Food high in mag cereal and milk Hypermagnesium>2.1 -bradycardia,hypotension,lethargic,muscle weakness
59
Check for skin turgor on
``` Forehead Abdomen Sternum Clavical Thigh Forearm ```
60
Most accurate way to check fluid gain or loss is
Weight change | Gain or loss 2.2 lb is 1liter
61
Sense and promote intake of fluid | Thirst mechanism
Hypothalamus
62
Active transport
ATP energy Na moves out of cell K moves into Moves from area of low concentration to high concentration
63
Diffusion
Substance move across membrane till it is evenly distributed | Process of equalization
64
Occur in the kidney movement of water and molecules through semipremiable membrane
Filtration Water and electrolytes move through capillary wall and is filtered
65
Osmosis
Isotonic, hypertonic, hypotonic movement of liquid across membrane Water moves by osmosis
66
Positive cation electrolytes
Potassium Sodium Magnesium Calcium
67
How do electrolytes gravitate Cation....anions
Sodium-chloride Potassium-phosphorus Calcium-bicarbonate Magnesium-sulfate

Iv Therapy (2 decks)

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