Fluids and electrolytes Flashcards
IVs are for people who
are unable to eat or drink properly
Are NPO prior to surgery
have pre-existing electrolyte or fluid imbalances
require IV medications
require blood
require TPN (total parenteral nutrition)
What is the purpose of an IV
supply fluid, salts and electrolytes, provide glucose, restore volume of blood by administerstration of components such as plasma or albumin, administer meds or vitamins.
common places for IV
vein, hand, elbow, foot, head
The smaller the number go cathlon the
bigger the diameter of gauge
What might make you want to choose a larger gauge cathlon over a smaller gauge?
Age/size of vein. What you are infusing.
Larger gauge is better for rapid infusion. 14-24 gauge
when do you replace a IV dressing
damp, loose, soiled or when IV site changed
what is a saline lock
Occasionally an IV infusion is initiated and maintained with a saline lock:
to provide access to the circulatory system in an emergency
to administer medications at intervals
how much do you flush an adults saline lock with
3 mL of Sodium Chloride
When do we flush a saline lock
prior to use (assesses catheter function)
following use
every 24 hours and prn
Flush teqhnique
stop, start
Prior to flush what is important to do
swab with alcohol wipe
how high should the patients bag be
76.2 cm
formula for drip rate
Volume in mL x drop factor divided by time in minutes
Complications
Infiltration
Phlebitis
Infection
Fluid overload
Electrolyte imbalance
Air Embolus
Infection can by caused by
improper insertion technique
Hematoma can be caused by
inserting IC catheter through the vein or by not applying enough pressure at removal
Infilteration
Catheter slips out of the vein and fluid escapes into the subcutaneous tissue causing swelling, pallor, coldness (↓ flow rate)
Infiltration interventions
discontinue IV and restart in different site
elevate – promotes venous drainage and apply warm compresses to ↑ circulation to area and carry away extra fluid
Do not rub or massage area
How to prevent infiltration
Check infusion site several times per shift. Get patients to report discomfort to you. Limit movement of extremity with patients who have an IV.
Phlebitis
inflammation of a vein
Signs and symptoms of phlebitis
redness, heat, warm to touch
a red streak above the needle site which appears to follow the path of the vein
swelling
flow rate of IV may be disturbed
Pain
Interventions for phlebitis
discontinue IV
elevate
warm compresses
DO NOT MASSAGE
3 categories of phlebitis
Mechanical phlebitis is the first category that is caused by the insertion of the IV catheter.
Bacteria phlebitis is caused by a bacterial infection
Chemical phlebitis that may occur as a result of fluids IV catheters or fluids.
Infection signs and symptoms
redness
heat
swelling
purulent exudate
discomfort at site
Interventions for infection
discontinue IV at this site
change tubing and IV site according to hospital protocol
clean area and apply sterile dressing as with any wound
send swab for C&S, according to practitioner order
treat with antibiotic topical ointment, if ordered
signs and symptoms of an electrolyte imbalance
it depends on the type of solution
Interventions for electrolyte imbalance
Notify physician immediately
Monitor VS
Frequently check and monitor rate of flow
Bloodwork, as ordered
Fluid Overload
too large of a volume infused into circulatory system
Signs and symptoms of fluid overload
engorged neck veins, increased BP, dyspnea, headache, crackles in lung
Nurses action to address fluid overload
Slow IV to TKO
Notify physician immediately
Place client in High Fowler’s position
Stay with patient
Monitor vital signs
High fowlers because fluid may be in the lungs and it assists with breathing.
Air Embolus
air in the circulatory system
an air embolus will block blood flow to an area resulting in ischemia and/or infarction
signs and symptoms of air embolus
Respiratory distress, ↑HR, cyanosis, ↓BP, change in consciousness
Potential clinical complications: diminished cardiac output, shock and death
interventions for embolus
Pinch off catheter to prevent air entry
Place pt. on Left side in Trendelenburg (head down)
Call for immediate assistance
Monitor VS, especially pulse oximetry
Air embolus can be prevented by
not allowing any air to enter the vein e.g., be sure all the air is out of the IV tubing within reason when setting up the infusion
when air embolus happens what position should the patient be in
Immediately place the patient in theleftlateral Trendelenburgposition. This helps to preventairfrom traveling through theright side ofthe heart into thepulmonaryarteries, leading toan obstruction in the lungs.
how often should the IV catheter be assessed
every 4 hours
Types of IV solution
Isotonic, hypotonic, hypertonic
Isotonic
causes no fluid shift
Hypotonic
causes fluid shift into cells and interstitial. Lower concentration outside the cell.
Hypertonic
causes shift out of cells. Concentration outside is higher then inner.
Examples of Isotonic
1- 0.9% NaCl (NS)
2- Lactated Ringer’s
3- Blood Component
4- D5W (5% dextrose in
water)
D5W
is initially an isotonic solution, however once the dextrose in the solution is metabolized, making the solution hypotonic. It is used to supply water in a dehydrated patient and in the treatment of high sodium levels.
uses of hypertonic IV solution
temporary treatment of hypovolemia
-expansion of vascular volume
-promotion of normal BP and good urinary output and is often used post operatively
-it is used to treat symptomatic hyponatremia.
who do you not use hypertonic solution on
We do not use it for with patients that have renal or cardiac disease
-must be administered slowly and with extreme caution because it may cause dangerous intravascular volume overload which can lead to pulmonary edema
what is hypotonic solution used for
solutions to “dilute” plasma particularly in hypernatremia
It is commonly used to treats cellular dehydration
Hypotonic solution have potential to
cause cellular swelling, and therefore patients should be monitored for changes in mentation that may indicate cerebral edema.
examples of hypotonic solution include
Examples include ½ Ncand 1/3 NS
Primary tubing is used for
-IV fluids that are primary. Will connect to the primary Iv tubing. Extends from the IV fluid bag all the way to the patients saline lock.
Secondary Tubing is used for
running things like antibiotics, digoxin with primary. The pump should be programmed to run for a certain amount of time
