IV concepts

Question 1

Delivery of medications in solutions and fluids by parenteral route
____________ _______ most common route

Answer 1

Intravenous (IV) therapy

Question 2

Maintain fluid balance (or correct)
Maintain electrolyte or acid-base balance (or correct)
Administer medication
Replace blood or blood products

Answer 2

uses for infusion therapy

Question 3

MOST PEOPLE WILL ALWAYS HAVE A ______ in the hospital

Answer 3

SALINE LOCK

Question 4

_____________ ________ ____ __________ nurses to initiate and maintain infusion therapy
Teams promote cost savings, patient satisfaction and outcomes
RN generalist inserts peripheral IV lines, and is accountable for all aspects of infusion therapy and delegation of associated tasks
may not have a ___________ if you’re at a small hospital

Answer 4

Specialized team of infusion
team

Question 5

What are the types of IV solutions (including parenteral nutrition)?

Answer 5

isotonic
hypertonic
hypotonic

Question 6

What is the normal serum osmolarity of adults?

Answer 6

270 to 300 mOsm/L

Question 7

___________ = Fluids >300 mOsm/L

Answer 7

Hypertonic

Question 8

______ = Fluids <270 mOsm/L

Answer 8

Hypotonic

Question 9

____________ of IV Fluids indicates whether the IV solution will cause shift of fluid into the cell or out of the cell.

Answer 9

Osmolarity

Question 10

Water does not move into or out of body’s cells
Risk for fluid overload, especially older adults

Answer 10

isotonic infusate

Question 11

__________ _________ are good for patients who have FVD, or are coming in for surgery and need maintenance IV fluids

Answer 11

isotonic infusate

Question 12

What are isotonic IV fluids?

Answer 12

lactated ringers -fluid resuscitation -often used for surgery
normal saline (0.9%) -fluid resuscitation -this is the fluid that is used with blood products

Question 13

what should you do for patients receiving isotonic fluids?

Answer 13

Document baseline data. Before infusion, assess the patient’s vital signs, edema status, lung sounds, and heart sounds. Continue monitoring during and after the infusion.
Observe for signs of fluid overload. Look for signs of hypervolemia such as hypertension, bounding pulse, pulmonary crackles, dyspnea, shortness of breath, peripheral edema, jugular venous distention, and extra heart sounds.
Monitor manifestations of continued hypovolemia. Look for signs that indicate continued hypovolemia such as, decreased urine output, poor skin turgor, tachycardia, weak pulse, and hypotension.
Prevent hypervolemia. Patients being treated for hypovolemia can quickly develop fluid overload following rapid or over infusion of isotonic IV fluids.
raise HOB so fluids circulate better
if they have edema, elevate the legs
watch if you patient is having more than 80 cc per hour
Elevate the head of the bed at 35 to 45 degrees. Unless contraindicated, position the client in semi-Fowler’s position.
Elevate the patient’s legs. If edema is present, elevate the legs of the patient to promote venous return.
Educate patients and families. Teach patients and families to recognize signs and symptoms of fluid volume overload. Instruct patients to notify their nurse if they have trouble breathing or notice any swelling.
Close monitoring for patients with heart failure. Because isotonic fluids expand the intravascular space, patients with hypertension and heart failure should be carefully monitored for signs of fluid overload.

Question 14

Document baseline data. Before infusion, assess the patient’s vital signs, edema status, lung sounds, and heart sounds. Continue monitoring during and after the infusion.
Observe for signs of fluid overload. Look for signs of hypervolemia such as hypertension, bounding pulse, pulmonary crackles, dyspnea, shortness of breath, peripheral edema, jugular venous distention, and extra heart sounds.
Monitor manifestations of continued hypovolemia. Look for signs that indicate continued hypovolemia such as, decreased urine output, poor skin turgor, tachycardia, weak pulse, and hypotension.
Prevent hypervolemia. Patients being treated for hypovolemia can quickly develop fluid overload following rapid or over infusion of isotonic IV fluids.
raise HOB so fluids circulate better
if they have edema, elevate the legs
watch if you patient is having more than 80 cc per hour
Elevate the head of the bed at 35 to 45 degrees. Unless contraindicated, position the client in semi-Fowler’s position.
Elevate the patient’s legs. If edema is present, elevate the legs of the patient to promote venous return.
Educate patients and families. Teach patients and families to recognize signs and symptoms of fluid volume overload. Instruct patients to notify their nurse if they have trouble breathing or notice any swelling.
Close monitoring for patients with heart failure. Because isotonic fluids expand the intravascular space, patients with hypertension and heart failure should be carefully monitored for signs of fluid overload.

Answer 14

things to watch out for if your patient is receiving isotonic fluids

Question 15

Decreased concentration of dissolved solutes in intravascular fluids (than in cells)
Water moves into cell

Answer 15

hypotonic infusate

Question 16

Treat hypernatremia and intracellular dehydration

Answer 16

hypotonic IV fluids

Question 17

Monitor closely for hypovolemia, hypotension, confusion

Answer 17

considerations for hypotonic fluids

Question 18

What are the hypotonic fluids?

Answer 18

0.45% sodium chloride

Question 19

Too much fluid can shift into cells- Can cause _______ ________= life threatening
this occurs with ___________ _______

Answer 19

cerebral edema
hypotonic fluids

Question 20

document baseline data
do not administer in contraindicated conditions
risk for increased intracranial pressure
watch for FVD -confusion in older adults
warning on excessive infusion
do not administer along with blood products

Answer 20

considerations for patients receiving hypotonic fluids

Question 21

___________ ___________may exacerbate existing hypovolemia and hypotension causing cardiovascular collapse. Avoid use in patients with liver disease, trauma, or burns.

Answer 21

Hypotonic solutions

Question 22

Should not be given to patients with risk for IICP as the fluid shift may cause cerebral edema

Answer 22

hypotonic solutions

Question 23

Monitor for manifestations of fluid volume deficit. Signs and symptoms include confusion in older adults. Instruct patients to inform the nurse if they feel dizzy.

Answer 23

hypotonic solutions

Question 24

Warning on excessive infusion. Excessive infusion of ______ IV fluids can lead to intravascular fluid depletion, decreased blood pressure, cellular edema, and cell damage

Answer 24

hypotonic

Question 25

Do not administer along with blood products. Most ______solutions can cause hemolysis of red blood cells especially during rapid infusion of the solution. 

Answer 25

hypotonic

Question 26

Corrects fluid, electrolyte, and acid–base imbalances by moving water out of body’s cells Parenteral nutrition is example

Answer 26

hypertonic infusate

Question 27

What are the hypertonic IV fluids?

Answer 27

3% normal saline

Question 28

Used to treat severe hyponatremia and cerebral edema

Answer 28

hypertonic IV fluids

Question 29

Monitor closely for hypernatremia and hypervolemia.

Answer 29

hypertonic fluid considerations

Question 30

IS NOT GIVEN A LOT REALLY IS NOT GIVEN ON THE MED SURG FLOOR

Answer 30

hypertonic iv fluids

Question 31

Document baseline data. Before infusion, assess the patient’s vital signs, edema status, lung sounds, and heart sounds. Continue monitoring during and after the infusion. 

Answer 31

for patients receiving hypertonic fluids

Question 32

Watch for signs of hypervolemia. Since ______ solutions move fluid from the ICF to the ECF, they increase the extracellular fluid volume and increases the risk for hypervolemia. Look for signs of swelling in arms, legs, face, shortness of breath, high blood pressure, and discomfort in the body (e.g., headache, cramping). 

Answer 32

hypertonic

Question 33

Monitor and observe the patient during administration. ______solutions should be administered only in high acuity areas with constant nursing surveillance for potential complications. 

Answer 33

Hypertonic

Question 34

Verify order. Prescription for ___________ _________ should state the specific hypertonic fluid to be infused, the total volume to be infused, the infusion rate and the length of time to continue the infusion. 

Answer 34

hypertonic solutions

Question 35

Assess health history. Patients with kidney or heart disease and those who are dehydrated should not receive ______IV fluids. These solutions can affect renal filtration mechanisms and can easily cause hypervolemia to patients with renal or heart problems. 

Answer 35

hypertonic

Question 36

Prevent fluid overload. Ensure that administration of ______ fluids does not precipitate fluid volume excess or overload.  Do not administer peripherally. ______solutions can cause irritation and damage to the blood vessel and should be administered through a central vascular access device inserted into a central vein. 

Answer 36

hypertonic

Question 37

Monitor blood glucose closely. Rapid infusion of __________ __________ solutions can cause _________. Use with caution for patients with diabetes mellitus. 

Answer 37

hypertonic dextrose hyperglycemia

Question 38

0.9% Normal Saline (0.9% NaCl)

Answer 38

isotonic solution

Question 39

Fluid resuscitation for hemorrhaging, severe vomiting, diarrhea, GI suctioning losses, wound drainage, mild hyponatremia, or blood transfusions.

Answer 39

NS

Question 40

Monitor closely for hypervolemia, especially with heart failure or renal failure.

Answer 40

NS

Question 41

Fluid resuscitation, GI tract fluid losses, burns, traumas, or metabolic acidosis. Often used during surgery.

Answer 41

Lactated Ringer’s Solution (LR)

Question 42

Should not be used if serum pH is greater than 7.5 because it will worsen alkalosis. May elevate potassium levels if used with renal failure.

Answer 42

Lactated Ringer’s Solution (LR)

Question 43

DON’T CAUSE SHIFTS BETWEEN CELLS AND OUTSIDE FLUID

Answer 43

isotonic solutions

Question 44

0.45% Sodium Chloride (0.45% NaCl) 5% Dextrose in Water (D5W)

Answer 44

hypotonic solutions

Question 45

Used to treat intracellular dehydration and hypernatremia and to provide fluid for renal excretion of solutes.

Answer 45

0.56$ sodium chloride

Question 46

Monitor closely for hypovolemia, hypotension, or confusion due to fluid shifting into the intracellular space, which can be life-threatening. Avoid use in patients with liver disease, trauma, and burns to prevent hypovolemia from worsening. Monitor closely for cerebral edema.

Answer 46

0.45% sodium chloride

Question 47

Provides free water to promote renal excretion of solutes and treat hypernatremia, as well as some dextrose supplementation.

Answer 47

5% dextrose in water

Question 48

Monitor closely for hypovolemia, hypotension, or confusion due to fluid shifting out of the intravascular space, which can be life-threatening. Avoid use in patients with liver disease, trauma, and burns to prevent hypovolemia from worsening. Monitor closely for cerebral edema.

Answer 48

5% dextrose in water

Question 49

3% Sodium Chloride (3% NaCl)

Answer 49

hypertonic solution

Question 50

Used to treat severe hyponatremia and cerebral edema

Answer 50

3% sodium chloride

Question 51

Monitor closely for hypervolemia, hypernatremia, and associated respiratory distress. Do not use it with patients experiencing heart failure, renal failure, or conditions caused by cellular dehydration because it will worsen these conditions.

Answer 51

3% sodium chloride

Question 52

Which type of solution is given in the ICU?

Answer 52

3% sodium chloride

Question 53

What are the most common IV fluids?

Answer 53

isotonic

Question 54

What are the three most common IV complications?

Answer 54

Infiltration Phlebitis Hematoma

Question 55

What does this picture indicate?

Answer 55

hematoma

Question 56

Nicking the vein during an unsuccessful insertion Incomplete insertion of the needle into the lumen of the vessel Tourniquet above a previous attempt site Unskilled clinician Lack of pressure over site of discontinued catheter * Large cannula

Answer 56

hematoma

Question 57

With ______ IV attempts, apply direct pressure and elevate extremity until bleeding stops

Answer 57

unsuccessful

Question 58

IV fluid leaks into the tissue around the vein.

Answer 58

infiltration

Question 59

Swelling at or around IV site Pain/burning Numbness/tingling Blanching IV won’t flow

Answer 59

infiltration

Question 60

What are s/s of ilfiltration?

Answer 60

Swelling at or around IV site Pain/burning Numbness/tingling Blanching IV won’t flow

Question 61

What does this picture indicate? (you dont need to know the grades)

Answer 61

infiltration

Question 62

In order to treat IV ______, the site will be elevated to reduce swelling. Also, a warm or cold compress may be applied for thirty minutes every two or three hours to reduce swelling. PALE, COOL TO TOUCH, SHINNY FIRST THING YOU DO IS STOP THE IV

Answer 62

infiltration

Question 63

The IV site is pale, cool to touch, and shinny. What may be occurring with the patency of the IV? What is your first intervention?

Answer 63

Infiltration stop the IV

Question 64

What does this picture indicate?

Answer 64

extravasation

Question 65

It is also due to infiltration of fluid/medication leaving the vein but it causes irritation/tissue damage.

Answer 65

extravasation

Question 66

Often occurs with chemo/vesicants. Those medications are often given through a central rather than a peripheral IV for that reason.F SEE THIS WITH CHEMO DRUGS A LOT IF THERE IS COBAND ON THE IV YOU NEED TO TAKE IT OFF AND ASSESS SEVERAL TIMES A SHIFT TO MAKE SURE THE SITE IS ALRIGHT

Answer 66

extravasation

Question 67

Inflammation of the vein Mechanical- IV not secured properly; too large IV in vein Chemical- due to irritating IV fluids Bacterial- contamination of IV catheter during insertion of IV Erythema at insertion site which can extend or cause a red streak

Answer 67

phlebitis

Question 68

What does this picture indicate?

Answer 68

phlebitis

Question 69

t/f: phlebitis will be red and painfull?

Answer 69

true

Question 70

What are the procedures for phlebitis?

Answer 70

remove catheter culture cannula is infection suspected apply warm moist compress provide comfort measures

Question 71

Answer 71

phlebitis

Question 72

Fluids Type of fluid Rate of administration in mL/hr (or total amount of fluid and hours for infusion) Drugs and dose to be added Drugs (in IV fluids) Drug name Specific dose and route Frequency of administration Time(s) of administration Length of time for infusion (number of doses/days) Purpose

Answer 72

Prescribing Infusion Therapy

Question 73

What is this picture?

Answer 73

portable vein transilluminator for superficial veins

Question 74

What does CRBSI stand for?

Answer 74

catheter related blood stream infection

Question 75

What are some causes of CRBSI?

Answer 75

contaminated infusate Contamination of catheter hub skin organisms (need to cleanse area really well) contamination of device prior to insertion