Intravenous Therapy and Care Flashcards
1
Q
Common sites of IVC
A
Peripheral:
- Inner arm
- Dorsal surface of hand
- Dorsal surface of feet
2
Q
How often should cannulas be replaced
A
Replace cannulas and rotate sites every 48-72 hours (all sites should be dated)
3
Q
Phlebitis
A
Inflammation of vein resulting from
- Chemical reaction of additives
- Position of cannula
- The vein is hard, red skin, swollen, tender and warm
- Action- to remove cannula
- Phlebitis is dangerous as it can lead to thrombophlebitis
- Replacing cannulas and rotating sites every 48-72 hours
4
Q
Infiltration
A
- When IV fluids enter the subcutaneous space around the venipuncture site
- Arm is swollen, tender and cool to touch, no blood return
- The flow rate slows or stops
- Action- discontinue and remove cannula, wrap the extremity in a warm towel and elevate
- This promotes venous return, and reduces pain and edema
5
Q
Indications for IV therapy
A
- Provide water, electrolytes and daily requirements
- Replace water and correct electrolyte imbalances
- Administer medication and blood products
- For nutritional purposes
- Allow life life for emergencies (i.e. trauma)
6
Q
Commencing IV therapy
A
- IV fluids are medications, and require a doctor’s order
- The 6 rights of safe medication administration apply
- A fluid balance chart will be required to monitor input and output of fluids
- Sterile technique
- The IV insertion site must be regularly monitored for signs of infection/inflammation
- 2 RNs are required
7
Q
Complications in IV
A
- Intravenous site
- Respiratory or cardiac alterations
Identifiable by;
- Looking at the patient
- Fluid balance chart
- Urine analysis
- Blood results
8
Q
Types of Fluids
A
Crystalloids
Solutions that contain small molecules
- Classes into 3 subgroups (isotonic, hypotonic, hypertonic solutions)
Colloid
- Blood and blood products/components (plasma, platelets, RBC)
TPN
- Supplies liquid form of carbohydrates, proteins, lipids and micronutrients
9
Q
Crystalloids
A
- Isotonic (ISO) means same (equal both sides)
- Hypotonic- Hypo means less (less solutes outside of cell) puts fluid into cell
- Hypertonic - Hyper means more (more solutes outside the cell) pulls fluid out of the cell
10
Q
Why choose a Isotonic Solution
A
- ECF volume deficient- helpful with patients who are hypotensive or hypovolemic
- The solution is similar to the concentration of Na and Cl in the intravascular space
- Caution; risk of fluid overloading exists, therefore be careful in patients with left ventricular dysfunction, history of CHF or hypertension
11
Q
Hypertonic and Hypotonic Solutions
A
- Used to correct electrolyte disturbances
- Ability to transfer fluids to both intracellular and extracellular compartments
- Monitoring these patients closely is essential
12
Q
Assessing and Maintaining Fluid and Electrolyte Balance
A
- Fluid balance→ difference between the amount of water taken into the body and the amount excreted or lost
- 60% of body weight is water; distributed to extracellular and intracellular
13
Q
What may affect the balances of each department?
A
Diet, illness or environment Dehydration Vomiting Diarrhoea Excessive water consumption IV therapy Medication
14
Q
Fluid, electrolyte and acid-base balance
A
- Essential to maintain health and function in all body systems
- Body fluids and electrolytes play an important role in homeostasis
Healthy environment relies on
- Intake/output of water
- Electrolytes
- Regulation of renal and pulmonary system
15
Q
Functions of body water
A
- Body fluids are in constant motion transporting nutrients, electrolytes and oxygen to cells and carrying away waste products from cells
- Water is essential in the regulation of body temp
- Lubricates joints and is a medium for food
- Cells in the body live in an environment with an electrolyte and acid base balance concentration maintained in narrow ranges
- Changes affect electrical activity of nerve and muscle cells and cause the movement of fluid into or out of cells
- Cellular functions are disrupted
- Fluid fluctuations also affect blood volume and cellular function
16
Q
Body water
A
- Total body water= 60%
- Body muscle is rich in water
- Adipose tissue has a decrease percentage of water content
- Water content varies with age, gender and body mass
- Elderly decreased muscle mass
- Infants greater water percentage
- As body fat increases, water declines, as muscle mass increases water decreases
17
Q
Intracellular Fluids (ICF)
A
- Fluid within all body cells
- Approximately 40% of all body weight
- Cells are the functional basic units of all living tissue
18
Q
2 compartments of extracellular fluid (ECF)
A
- Extracellular fluids (ECF)–> Outside a cell
- Divided into 2 compartments (interstitial fluid and intravascular fluid)
19
Q
Interstitial fluid (compartment of ECF)
A
- 15-16% of all body weight
- Between the cells and outside the blood vessels
- Can be lymph, cerebrospinal fluid
- Greater fluid, -oedema develops
20
Q
Intravascular fluid (compartment of ECF)
A
- 4-5% of all body weight
- In blood plasma (fluid in the blood) and the lymph fluid
- The volume of the intravascular lumen is regulated in part by the hydrostatic pressure (heart pumping causes the pressure in the system which forces plasma to filter out into the interstitial compartment gradients and by reabsorption by the kidneys)
21
Q
Body water contains electrolytes…
A
- Electrolytes are substances that move in and out of compartments of the body
- They carry electrical currents (positive- cation) and (negative- anion) currents
- Varies between fluid compartments and the number of positively charged electrolytes is balanced by the number of negatively charged ions
- Sodium is the greatest extracellular electrolyte
- Potassium is the greatest intracellular electrolyte
22
Q
Purpose of Sodium
A
- Major extracellular electrolyte
- Maintains extracellular osmolality- water volume
- Key determinant of water balance
- Plays a major role in nerve impulse transmission and muscle function
23
Q
Purpose of Potassium
A
- Major intracellular electrolyte
- Maintains intracellular water balance
- Maintains normal functioning of cells, nerves and muscles
- Essential for the proper functioning of the heart, kidneys, muscles, nerves and digestive system
24
Q
Sodium: Hyper and Hypo
A
Hypernatremia
- Cell dehydration
- Vascular fluid volume excess
Hyponatremia
- Muscles twitching
- Seizures
- Brain dysfunction- sluggishness./confusion
- Loss of consciousness/coma
25
Q
Potassium: Hyper and Hypo
A
Hyperkalemia
- Emergency situation; abnormal heart rhythms, heart may stop beating
Hypokalemia
- Muscle weakness
- Cramping
- Abdominal distention
- Abnormal heart rhythms
26
Q
Fluids and solutes move across membranes
A
- Osmosis; movement of water through semipermeable membranes
- Diffusion- movement of molecules
- Filtration - movement of water and diffusible substances (affected by hydrostatic pressure)
27
Q
Osmosis
A
- Semi permeable membrane
- Causes water to move from area of low concentration of solutes to an area of high concentration of solutes
- Water moves freely between intravascular and interstitial fluid compartments
28
Q
Diffusion- even distribution
A
- Movement of a dilute (gas/substance) in aa solution across a semipermeable membrane
- Area of high concentration to low concentration
- Result is an even distribution of a solute in a solution
29
Q
Diffusion
A
- Molecules spread from areas of high concentration to low
- Equilibrium- where the molecules are even throughout a space
30
Q
Active transport
A
- Requires energy input from a cell and enables a cell to move a substance against its concentration gradient
- Cells use active transport to get needed molecules regardless of the concentration gradient to maintain homeostasis
31
Q
Fluid Volume Deficit (FVD)
A
- Loss of body fluid or the shift of fluids into the third space
- Common sources for fluid loss are the GI tract, polyuria and increased perspiration
Causes
- Inadequate fluid intake
- Active fluid loss- abnormal drainage or bleeding, diarrhoea
- Regulatory mechanisms failure
- Increased metabolic rate - fever of infection
32
Q
Fluid Volume Excess (FVE)
A
- Increase in total body sodium content and an increase in total body water
Causes
- Compromised regulatory mechanisms for sodium and water
- Congestive HF, kidney failure and liver failure
- May also be caused by excessive intake of sodium
33
Q
Fluid Overload
A
- Occurs when fluids are given at a higher rate or in a larger volume than the system can absorb or excrete
- Possible consequences include hypertension, heart failure and pulmonary edema
- Monitor vital signs
- Shortness of breath
- Tachycardia
- Crackles in lungs
34
Q
Jugular Venous Pressure (JVP)
A
- Key measure of fluid status
- Normal JVP is 3-4 cm above the sternal angle
- Lower JVP indicates dehydration
- Increased JVP indicates fluid overload
