IV fluid- Unit 3 Exam 3 Flashcards
1
Q
What does the water in your body help do?
A
- Transport nutrients and oxygen to your cells
- Helps remove waste from your cells
- Medium in which electrolyte chemical reactions occur
- Regulate body temp
- Lubricates joints and membranes
- Provides medium in food digestion
2
Q
What percentage of our bodies fluid is made up of water?
A
60 percent
3
Q
True or false: Water is fluid in the body and is is more important to life than any other nutrient?
A
True
4
Q
Fluids in our body are affected by what 3 factors?
A
- Age
- Gender
- Body fat
5
Q
Do men or women have more body fluid due to more muscle mass?
A
Men
6
Q
True or false: Women have a smaller percentage of fat and fat contains more water?
A
False- Women have a greater percentage of fat and fat contains little water. Affecting the fluids in our body
7
Q
Do younger or older people have a higher percentage of body fluid?
A
Younger
8
Q
True or false: Younger people have a lower percentage of body fluid than older people?
A
False: Younger people have a HIGHER percentage of body fluid than older people
9
Q
True or false: Obese patients have less fluid than those who are thin because fat cells contain little water?
A
True
10
Q
True or false: Skeleton (bone) has a lower water content?
A
True
11
Q
Where is the highest amount of water found?
A
- Muscle
- Skin
- Blood
12
Q
What is the most accurate way to measure fluid status in a person?
A
Daily weight
13
Q
What is filtration?
A
- Movement of fluid (water) across cell membrane due to hydrostatic pressure
14
Q
What is diffusion?
A
- Movement of solutes (substances/particles) from higher concentration to an area of lower concentrations resulting in equal distribution.
15
Q
What is osmosis?
A
Fluid moves from areas with more fluid concentration (and fewer solutes) to areas with less fluid concentration (and more solutes)
16
Q
Where is hydrostatic pressure generated?
A
- The cardiovascular system as blood is pumped through the body’s blood vessels
17
Q
Filtration occurs when…
A
- Water and solutes are transported across the cell membrane as a result of hydrostatic pressure
18
Q
The body’s way of trying to reach homeostasis is by doing what 3 things we learned about during this lecture?
A
- Filtration
- Diffusion
- Osmosis.
19
Q
In diffusion, what moves? (DS)
A
Solutes
20
Q
In osmosis, what moves? (OF)
A
Fluid
21
Q
What is a semipermeable membrane?
A
Type of biological or synthetic, polymeric membrane that will allow certain molecules or ions to pass through it by osmosis.
22
Q
What does osmotic balance mean?
A
- Osmotic balance is the CONTROL OF WATER AND ELECTROLYTE BLANCE IN THE BODY.
23
Q
How does hydrostatic pressure work?
A
- Hydrostatic pressure is pressure excerpted by the pumping of the heart which is the pushing force that pushes fluids out of the heart
24
Q
Normal movements of fluids through the capillary wall into the tissues deepened on what two forces?
A
- Hydrostatic pressure
2 Oncotic pressure
25
How does oncotic pressure work?
1. Oncotic pressure AKA colloid osmotic pressure is the ‘pulling force’ pulling fluids from the surrounding tissues into the capillaries.
26
Oncotic pressure is the result of what?
1. The difference in the concentration of solutes in the fluid inside the inside the capillaries as opposed to outside of them, because water will naturally seek a sate of balance in the concentration of solute (particles)
27
Oncotic pressure, think ___1___- pulling fluid in
?
28
Whenever the hydrostatic pressure is greater than oncotic pressure what will happen?
1. Fluid will leave the capillaries
29
Whenever oncotic pressure is greater than the hydrostatic pressure fluid willl…
Enter the capillaries
30
What is third spacing?
1. Condition where fluid accumulates in a pocket that is not serving a purpose.
31
What is ascites?
1. Fluids in the abdominal cavity… peritonitis, pancreatitis
32
Third spacing usually occurs as a result of…..
1. Increased permeability of the capillary membrane or decreased plasma colloid osmotic pressure
33
What are the main causes of edema?
1. Long periods of standing or sitting. Sitting or standing for too long can cause extra fluid to build up in your feet, angles, lower legs,
2. Venous insufficiency
3. Chronic (long-term) lung diseases
4.CHF
5. Pregnancy (normal)
6. Low levels of protien
34
Third spacing can occur from…
1. Intentional obstruction
2. Peritonitis
3. Heart failure- if heart is not pumping well, not enough pushing fluid through capillary so get a build up of hydrostatic pressure which can also lead to edema.
4. Liver failure
5. Low albumin- lab value will be low
6. Starvation- Low protein (albumin) in plasma so low oncotic pressure
35
60% of lean body weight = _____?
Water
2/3 (intracellular)
1/3 (extracellular)
5% blood plasma
36
What is edema?
An accumulation of interstitial fluid within the tissues
37
Extravascular fluid collection in the pleural cavity, pericardial cavity and peritoneal cavity are called what?
1. Pleural cavity: hydrothorax
2. Pericardial cavity: hydropericardium
3. Peritoneal cavity: hydroperitonum or ascites.
38
What is anasarca?
Severe, generalized edema marked by profound swelling of subcutaneous tissues and accumulation of fluid in body cavities
39
sodium & potassium use ATP to move in & out of cells in a form of active transport called the ____-_____ _____?
Sodium-potassium pump
40
The bodies fluid is dived into 2 compartments called?
1. ICF- Intracellular fluid
2. ECF- extracellular fluid
41
Fluid found inside the cells is called what?
1. Intracellular fluid (ICF)
42
ICF makes up how much of the bodies fluid?
1. 2/3 of fluid
43
Fluid found outside of the cells is called what?
Extracellular fluid (ECF)
44
ECF makes up how much of the bodies fluid?
1/3 of fluid
45
To maintain balance or homeostasis fluids in the cells must be balanced with ___1___ fluid and fluids outside the cell must be balanced with ___2___ fluid.
1. Extracellular
2. Intracellular
46
Extracellular fluid can be divided into what 3 divisions
1. Intravascular
2. Interstitial
3. Transcellular
47
What is intravascular fluid?
1. Found in the vascular system that consists of arteries, veins, capillary networks. Intravascular fluid is WHOLE BLOOD volume and also includes red blood cells, white blood cells, plasma and platelets.
48
What is interstitial fluid?
1. Fluid between cells (third space)
49
What is transcellular fluid?
1. Cerebral spinal fluid, peritoneal and pleural fluid. Each of the fluid compartments is separated by a selective permeable membrane that permits movement of water and some solutes. Small molecules like urea and water move freely between compartments but certain substances, like protein do not cross readily.
50
Osmolality is measured in
MilliOsmols/kg
51
What is osmolality used for?
1. Used to assess body’s state of water balance
52
What could a high osmolality indicate
Water deficit
53
What could a low osmolality indicate?
Water excess
54
How is osmolaRity measured?
MilliOsmos/L
55
What is the normal osmolaRity range?
1. 270-300 mOsm/L
56
What is an osmole?
Amount of substance that dissociates in solution to form one mole of osmotically active particles
57
Concentration of solution is measured in…
Osmoles
58
OsmolaRity evaluates serum and urine in clinical practice. A high osmolaRity of using = what?
Concentrated urine
59
True or false: fluids, nutrients and waste products constantly shift within the body’s compartments- from the cells to the interstitial spaces, to the blood vessels and back again?
True
60
True or false: it isn’t important to keep track of shifts of fluids when caring for patients?
False
61
What are three types of osmotic conditions
1. Isotonic
2. Hypotonic
3. Hypertonic
62
What should we know about our Isotonic fluids?
1. Isotonic fluids have the same solute concentration as we do in our blood.
2. NO SHIFTs occur because the solutions are equally concentrated
63
Normal saline (0.9% NaCl) is what type of fluid and why?
1. Isotonic due to the same concentration of sodium in the blood
64
What should we know about our hypotonic fluids?
1. Less concentrated than other solutions; fluid pulled or moved from the bloodstream (veins) into the cells causing them to swell
65
Hypotonic fluids cause what to happen?
Cells to swell
66
HYPO… HYPO….HYPO offf to the …..
Cells we go
67
What should we know about our hypertonic fluids?
1. More concentrated than other solutions: fluid pulled from the cell into the blood stream = shirnk… a solution that contains more dissolved particles (such as salt and other electrolytes) than is found in the normal cells of the body
68
MORE OR LESS:
Hypotonic solutions have ______ solutes and _____ solvent while hypertonic solutions have _____ solutes and____solvents
1. Less
2. More
3. More
4. Less
69
Why do hypotonic solutions cause the cell to swell?
1.because it promotes shifting of water into the cell
70
Why do hypertonic solutions cause the cell to shrink?
1. Because the solution promotes the pulling of water outside of the cell
71
What are some ways that we discussed in lecture that our bodies uses as ways to maintain our fluid balance?
1. Kidneys
2. Anti-diuretic hormone (ADH)
3. Renin-angiotensin-aldosterone system (RASS)
4. Aldosterone
5. Atrial natriuretic Peptide (ANP)
6. THIRST
7. Lymphatic system
72
What are some ways that we discussed in lecture that our bodies uses as ways to maintain our fluid balance?
1. Kidneys
2. Anti-diuretic hormone (ADH)
3. Renin-angiotensin-aldosterone)
system (RASS)
4. Aldosterone
5. Atrial natriuretic Peptide (ANP)
6. THIRST
7. Lymphatic system
73
How does the lymphatic system help maintain fluid balance?
1. By collecting excess fluid and particulate matter from tissues and depositing them in the bloodstream. It also helps defend the body against infection by supplying disease fighting cells called lymphocytes
74
How do the kidneys help regulate the body’s fluid?
1. Regulate fluid and electrolyte balance by adjusting urine volume and the excretion of electrolytes
2. If loss of 1-2 % of fluid, kidneys reabsorbs more water which in turn causes concentrated urine
3. Removes excess wastes from the body
4. Sodium & potassium are also either filtered or reabsorbed by the kidneys.
75
What are the 7 functions of the kidneys? remember A WET BED
1. A- controlling ACID-base balance
2. W- controlling WATER balance
3. E- Maintaining ELECTROLYTE balance
4. T- Removing TOXINS and waste products from the body
5. B- Controlling BLOOD pressure
6. E- Producing the hormone ERYTHOPOIETIN
7. D- Activing vitamin D
76
What should we know about the Anti-Diuretic Hormone (ADH)
1. Produced by the brain: specifically the Hypothalamus and stored in the pituitary
2. Restores blood volume
77
What are the 3 ways that ADH can restore blood volume?
1. Reduces dieresis
2. Increasing water retention
3. Vasoconstriction (increasing our blood pressure)
78
What triggers the body to release ADH?
1. When your body does not have enough fluid and/pr blood pressure drops to low
79
What happens when your brain releases ADH?
It will travel to the kidneys and cause
1. Reduced dieresis
2. Increased water retention
3. Vasoconstriction
So we will pee less, reabsorb more water and constrict our vessels which will help increase our blood pressure and how much water our body is keeping
80
What is vasopressin (desmospressin)?
Medication form of ADH.
- typically given in an if drip
-dosing important as it may be what is keeping the patient alive.
81
True or false: the concentration of our urine and our electrolytes balance can give us an idea on our ADH levels
True
82
What is the process of our RAAS?FIX!!
1. If you have a decreased extracellular fluid RIN is going to produc
2. Which is going to covert into ANGIOTENSIN and this by itself is going to cause a massive constriction of all those vessels
It is also going to stimulate the release of aldosterone which is going to cause retention of sodium and water
3. Both of these things are going to help increase your volume of fluids and your blood pressure
4. This is going to give you similar effects like your ADH but it works differently.
83
When is your RASS activated?
1. Initiated when there is a change in the kidneys or low sodium, low blood pressure, low extracellular fluid.
84
RAAS is activated by your_____ where as ADH is activated by your ______?
1. Kidneys
2. Brain
85
What does aldosterone do in the body?
1. A steroid hormone made by the adrenal cortex (the outer layer of the adrenal gland). It HELPs control the balance of water and salts in the kidney by keeping sodium in and releasing potassium from the body.
86
What can too much aldosterone cause?
1. High blood pressure and a build up of fluid in body tissues
87
ANP is what kind of hormone?
1. Cardiac
88
What is the role of ANP?
1. The atrial natriuretic hormone (ANP)- is a cardiac hormone which gene and receptors are widely present in the body. It’s MAIN function is to lower blood pressure and to control electrolyte homeostasis
89
How does ANP regulate blood pressure?
1. When blood sodium levels and pressure are increased, ANP is secreted from the heart. It binds to its receptor in the kidney and blood vessels, and promotes salt excretion, lowers blood volume and relaxes the vessel.
90
True or false: ANP stops action of RAAS?
True
91
True or false: When your body produces ANP it also produces BNP?
True
92
What are two hormones we learned during this lecture that are secreted from the heart and what should we know about them?
1. Atrial natriuretic peptide (ANP) and B- type natriuretic peptide (BNP) are secreted from the cardiac atria and ventricles, respectively.
2. ANP signals in an endocrine and paracrine manner to decrease blood pressure and cardiac hypertrophy.
3. BNP acts locally to reduce ventricular fibrosis
93
What does a high BNP mean?
BNP levels go up when the heart cannot pump the way it should. A result greater than 100 pg/mL is abnormal. The higher the number, the more likely heart failure is present and the more severe it is.
Sometimes other conditions can cause high BNP
94
What should we know about thirst?
1. Regulated by the hypothalamus
2. Stimulated by increase in ECF and drying mucous membranes
3. Causes a person to drink fluid
This is the simplest method of maintains fluid balance. Thirst occurs as a result in even small losses of fluid. Losing body fluids or eating high salty foods leads to an increase in ECF fluid osmolality (concentration). This leads to drying of mucous membranes in mouth which stimulates the thirst center in the hypothalamus
95
True or false: Thirst causes a person to drink fluids, which are absorbed by intestines which are then moved into th e blood stream & distributed between compartments?
True
96
What depletes our electrolytes? Remember VPPS
V-Vomiting
P- Peeing
P- Pooping
S- Sweating
97
Fluid deficit of isotonic fluid in extracellular space is caused by abnormal…..
1. Fluid loss
2. Fever, excessive perspiration
3. Hemorrhage
4. Vomiting/Diarrhea
5. GI suction
6. Decreased fluid intake
Other causes
1. Diuretics
2. Third spacing fluid shifts (moving into the vascular system with burns, liver dysfunction, burns, crash injuries)
3. Chronic diseases— heart failure, diabetes
98
Fluid volume deficit is also known as….
Hypovolemia
99
What are some clinical manifestations of Hypovolemia?
1. Decreased vascular volume
2. This can develop quickly, severity depends on degree and loss of fluid
100
True or false: Hypovolemia is the same thing as dehydration?
False- Dehydration is loss of water alone causing serum sodium to rise…
Hypovolemia is VOLUME loss… concentration or ratio is the same
101
What patient population is Hypovolemia most likely to effect?
1. Very old and very young
102
Fluid volume excess aka…
Hypervolemia
103
Fluid excess of isotonic fluid (sodium & Water) in the extracellular space caused by:
1. Abnormal retention or water and sodium in about the same proportions which they normally exist in ECF
2. Isotonic fluid overload
3. Excess sodium intake
4. Heart failure, renal failure, liver cirrhosis
104
What are the causes of hypervolemia
ECF volume increase in either the interstitial or intravascular compartment. Usually, the body can compensate and restore fluid balance by fine tuning circulating levels of aldosterone, ADH, and ANP causing the kidneys to release additional water and sodium
105
How do you tx hypervolemia?
1. Treating underlying causes and removing fluid without causing changes in electrolytes or osmolality of ECF
106
What are some S/S of fluid deficit (Hypovolemia)
1. Restlessness, confusion…. Coma (remember the brain is the most sensitive to hypoxia, restlessness may be the FIRST early sign
2. Cold, clammy skin- Adrenalin shunts blood flow away from the periphery to vital organs,
3. Decreased skin turgor- turgor diminished with tending, or a lag in the pinched skinfold’s return to original state- sternum, anterior forearm, abdomen)NOTE: in older people, loss of elasticity to skin, so not a good predictor
4. Weak rapid heart rate- increase in heart rate causes peripheral vasoconstriction to try and keep BP within normal limits—weak and threads
5. Rapid respirations- because of decrease tissue perfusion=hypoxia
6. Blood pressure- orthostatic— changes in position can decrease BP further, then hypotension
7. Oliguria- low urine output— 30mL/hr is acceptable; less output due to poor perfusion to kidneys-concentrated urine - increased urine osmolality.
8. Decreased cap refill, flat jugular veins, weight loss
107
S/S of fluid excess (hypervolemia)
1. Headache, confusion
2. Peripheral edema- edema results from hydrostatic pressure (fluid pushing) in the vessels, and fluid is forced into the tissues. Initially, seen in defendant areas such as sacrum, buttocks, then generalized = anasarca= all over
3. Jugular vein distinction- due to increased volume
4. S3 heart sound
5. Bounding pulse, increased BP, due to fluid volume
6. Dyspnea, tachypnea, -edema can also occur in the lungs; as the left ventricle becomes overloaded and pumping declines, fluid backs up into the lungs; hydrostatic pressure pushes fluid out of pulmonary vessels and into the interstitial & alveolar areas which will cause pulmonary edema results such as cracks… pt will become sob and tachypnic and can develop a pink frothy sputum.
8. Weight gain.
108
What are we doing when we are assess for s/s of fluid deficit?
Monitor patients at risk…. Looking at
1. Gi losses,
2. Hemorrhages
3. Overuse of diuretics
4. inadequate fluid intake
4. Thrid space shifting
109
What are we doing when we are assessing for s/s of fluid excess
Monitor patients at risk… looking at
1. Heart failure,
2. Renal failure
3. Excess isotonic or hypotonic fluids
4. SIADH
5. Long term steroids use
110
Nursing management of fluid imbalances includes what interventions?
1. Give IV fluids and medications as ordered
2. Oxygen therapy as ordered
3. Implement fall precautions
4. Daily weights
5. Accurate I&O’s
6. Elevate edematous extremities
7. Encourage oral fluids when appropriate
8. Elevate edematous extremities (fluid excess)
111
Nursing management of fluid imbalance include giving iv fluids and medications as ordered… with this in mind what we should we except to see/do for a fluid deficit
1. Isotonic IV fluids or oral fluids if able
112
Nursing management of fluid imbalance includes giving IV fluids and medications as ordered… with this in mind what should we expect to see/do for a fluid excess?
1. Fluid restriction
2. Diuretics if kidneys are working properly
113
True or false: Oxygen therapy for patients we are monitoring for fluid deficit or excess can both benefit from it?
TRUE
114
When doing daily weights what should we try and keep consistent?
1. Time, clothes, scale
115
True or false: The most accurate way to measure fluid status in a person is through I&O?
False
116
Hypovolemic shock occurs when there has been a _____ percent or more of intravascular volume loss?
40 percent
117
What happens when a patient goes into hypovolemic shock?
1. Cardiac output drops and metal status deteriorates to unconsciousness
2. Skin may become mottled; urine output drops below 10mL/hr.
118
How can you treat Hypovolemic shick?
1. Fluid replacement: NS, LR; blood transfusions, vasopressor
2. Oxygen therapy
3. Monitor vital signs and mental status
4. Insertion of indwelling urinary catheter may be necessary
5. Monitor lung sounds.
119
Why do we need to monitor lung sounds when a pt is in hypovolemic shock?
1. The patient can have a fluid overload causing crackles in lungs- with rapid and large amounts of fluid replacement, can turn to fluid overload
120
Why is oxygen important for a patient experiencing hypervolemic shock?
1. Helps ensure sufficent tissue perfusion and maintains a patent airway
121
True or false: Dehydration is always hypernatremic?
Trie
122
What are the signs and symptoms of dehydration?
1. Feeling thirsty
2. Dark yellow and strong smelling pee
3. feeling dizzy and lightheaded
4. Feeling tired
5. Dry mouth, lips and eyes
6. Peeing little and fewer than 4 times a day.
123
Intravenous therapy can be done where?
Peripherally or centerally
124
Intravenous therapy timeframe can be....
1. Short and Long term
125
True or false: Intravenous therapy is the slowest delivery method?
False
126
What are the advantages of intravenous therapy?
1. Replace fluid
2. Transfuse blood
3. Deliver medication
4. Correct electrolyte imbalances
127
What are some disadvantages of IV therapy?
1. Adverse reactions- systemic/locally
2. Incompatibilities- to drugs or solutions
3. Infections- local or systemic
4. Damage- to veins and surrounding tissues can happen
5. Fluid overload- if the pt receives too much fluid or if they receive fluids too quickly
6. overdose
7. Hindrance-- annoying
8. Potentiate electrolyte imbalances
128
With IV cannulation you should.... start __1__ and work __2__
1. Low
2. Proximally
129
With IV cannulation you should use caution with what type of skin?
Fragile
130
When considering the inner wrist for iv cannulation what should you take into consideration?
1. it is very sensitive and should not be your first choice
131
What is your last site option for starting an IV?
Antecubital
132
What sites should we avoid for iv insertion?
1. legs, ankles and feet
2. sclerosed or thrombosed veins
3. veins that are knotted or tortuous
4. veins below an infiltrated site or areas of phlebitis
5. areas of inflammation, disease, bruising, or breakdown
6. Veins of surgically compromised or injured extremities
7. Dominant hands (if possible) and extremities with AV shunts.
133
What are some considerations for selecting a vein?
1. Condition of the veins
- it is important to select an IV cath that takes into account the condition of the pts vein.
- fragile veins may blow easily with a large bore catheter
2. Reason for the IV
- Is it a "just-in-case" site, for continuous infusion, or intermittent use for medications.
3. What solutions or meds will be used
- also consider the type of solutions that will be going through it. Some of them are irritating or caustic to vessels; blood parenteral nutrition, vesicants
134
What does vein evaluation include?
1. Palpate
2. Suitable veins should be
-round, firm & elastic
- best palpated when engorged
135
14g or 16g are typically used for what patients?
trauma or surgery when needing a rapid infusions
136
18g is typically used for what patients?
Good for patients going into surgery, receiving blood or caustic meds
137
22g or 20g is typically used for what patients?
Most common size for adult patients
138
24G is typically used for what patients?
1. Most common for pediatric pts
2. Can use for adults with small or fragile veins
139
Why would blood transfusions require a larger catheter?
Prevent hemolysis
140
What are the complications of IV therapy
1. Fluid overload
- Too much fluid overloads the circulatory system.
2. Infection
- Localized or systemic
3. Phlebitis
- irritation to vein
- mechanical or chemical
4. Infiltration
- Fluid seeps into tissue
5. Extravasation
- infiltration of any caustic medication into tissue
141
What is fluid overload?
Fluid overload is when the pt received too much fluid. This can overload the circulatory system and put stress on the heart.
142
What are some s/s of fluid overload?
1. SOB, cramping and headache
2. Assessment findings may include dependent edema, rapid weight gain and crackles in the lung field on auscultation.
143
With infections at the IV site what might the patient experience?
1. redness, irritation and purulence at the site... infection can progress to a systemic problem
144
What is phlebitis?
Irritation to the vein... which can be caused by the IV catheter itself which would be mechanical.... or by the medication infusion which would be chemical
145
What might the patient experience if they are experiencing phlebitis?
Site is often painful and warm to the touch with obvious irritation and redness
146
What is infiltration?
Fluid seeps into surrounding tissue rather than infusing into the vein
147
What is extravastion and what can happen if a patient experiences this?
1. It is when caustic medications infiltrate, or seep, into the surrounding tissue. This can cause permanent damage and even loss of limb... and extreme cases death
148
What are the types of administration of IV fluids/meds?
1. intermittent
2. Continuous
3. Bolus or Push
4. Push
149
What is intermittent administration
1. Medications on scheduled dose daily or several times per day
150
What is continuous administration?
1. IV solutions continuously
151
What is bolus or push administration?
Specified amount of solution to be administered in a specific time frame
152
What is push administration?
Specified amount of medication to be administered in a specific time frame
153
True or false: Continuous administration has fluids continuously infusing. This can be used for hydration, electrolyte replacement or both depending on pts needs?
True
154
A bolus can be administer in what two ways?
IV bag or syringe
155
What is the nurse's responsibilities in regards to IV's
1. Assess IV site
2. Know the medication
3. Assess for adverse effects-- what to watch for and what to report
4. Teach the patient
156
What are some IV medication advantages?
1. Direct access to circulatory system --> instant action
2. Instant drug action and termination
3. Rapid tx
4. Better control rate
5. Great for those with GI tract limitations
6. Good for meds that irritate gastric mucosa
157
What are some IV medication disadvantages and complications?
1. Reconstitution errors
2. Venous spasm
3. Drug incompatibilities
4. Impaired drug absorption
5. Speed shock
6. chemical phlebitis
7. extravasation of vesicants
8. air embolism
158
What are the causes of an air embolism?
1. Solution runs dry, air in tubing, loose connections, improper removal of CVAD, poor technique with dressing or tubing change
159
What are the S/S of an air embolism
1. dyspnea
2. Tachypnea
3. Lightheadedness
4. palpitations
5. Drop in BP
6. Weakness
7. Cyanosis
8. Expiratory wheezes
160
What are some interventions for air embolisms?
DO NOT LEAVE THE PATIENT
1. Call for help- Pt call light or vocera
2. Position the patient in Trendelenburg on their left side
3. Administer oxygen
4. Monitor VS
5. Have emergency equipment ready
161
What are the s/s of extravasation?
1. pain or burning at IV site
2. Skin tightness at site
3. Blanching and coolness of skin
4. Defendant edema
162
What are some preventions for extravasation?
1. Dilute meds as recommended
2. Avoid use of high pressure pumps
3. assess & monitor IV site
4. Teach pt what to report
163
True or false: CVADs are not the safest for administration of vesicant drugs.
False- They are safest
164
What are the causes of a venous spasm?
1. Viscous solutions
2. Too rapid administration
3. Cold or irritating solutions
165
What are the symptoms of venous spasms?
1. Sharp pain at the IV site
2. Pain radiating up the arm with the IV site
166
What are some prevention techniques for venous spasms?
1. Dilute meds as recommended
2. Admin solutions and meds at room temp
3. Admin at recommended rate
4. Restart questionable ivs
5. Consider a warm compress during infusion
167
What are some prevention techniques for venous spasms?
1. Dilute meds as recommended
2. Admin solutions and meds at room temp
3. Admin at recommended rate
4. Restart questionable ivs
5. Consider a warm compress during infusionW
168
What is a venous spasm?
Sudden, brief, tightening of the muscle cells inside the vein
169
What are the causes of chemical phlebitis?
1. Too rapid infusion
2. Presence of particulate matter in solution
3. Improper dilution or reconstitution when preparing meds
4. Administration of irritating meds
170
How can you prevent chemical phlebitis?
1. Use an in-line filter for meds that do not reconstitute completely
2. Increase volume of dilution
3. CVAD or larger peripheral veins for IV site
4. slow rate of infusion
5. Restart any questionable ivs
171
True or false: Prevention is key for preventing chemical phlebits?
True
172
What are the IV push administration steps?
1. Follow 7 rights
2. Verify patient and allergy status
3. Scan pts arm band
4. Scan med vial and verify with eMAR (3rd check)
5. Remove alcohol permeated cap from IV lumen--> clean needleless connector access with alcohol pad for 15 seconds
6. purge air from sterile flush syringe--> attach syringe--> flush lumen and IV catheter with 9mL--> remove syringe
7. Clean needless connector access--> attach medication syringe--> administer med at recommended rate--> remove syringe
8. Clean needless connector access--> attach post aline flush syringe--> flush at same rate as med for the first 2-3 mL then vigorously for total of 9mL
9. Remove flush syringe--> clamp lumen --> attach new alcohol permeated cap
