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Module 2 > IV fluid- Unit 3 Exam 3 > Flashcards

IV fluid- Unit 3 Exam 3 Flashcards

1
Q

What does the water in your body help do?

A
  1. Transport nutrients and oxygen to your cells
  2. Helps remove waste from your cells
  3. Medium in which electrolyte chemical reactions occur
  4. Regulate body temp
  5. Lubricates joints and membranes
  6. Provides medium in food digestion
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2
Q

What percentage of our bodies fluid is made up of water?

A

60 percent

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3
Q

True or false: Water is fluid in the body and is is more important to life than any other nutrient?

A

True

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4
Q

Fluids in our body are affected by what 3 factors?

A
  1. Age
  2. Gender
  3. Body fat
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5
Q

Do men or women have more body fluid due to more muscle mass?

A

Men

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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

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7
Q

Do younger or older people have a higher percentage of body fluid?

A

Younger

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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

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9
Q

True or false: Obese patients have less fluid than those who are thin because fat cells contain little water?

A

True

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10
Q

True or false: Skeleton (bone) has a lower water content?

A

True

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11
Q

Where is the highest amount of water found?

A
  1. Muscle
  2. Skin
  3. Blood
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12
Q

What is the most accurate way to measure fluid status in a person?

A

Daily weight

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13
Q

What is filtration?

A
  1. Movement of fluid (water) across cell membrane due to hydrostatic pressure
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14
Q

What is diffusion?

A
  1. Movement of solutes (substances/particles) from higher concentration to an area of lower concentrations resulting in equal distribution.
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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)

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16
Q

Where is hydrostatic pressure generated?

A
  1. The cardiovascular system as blood is pumped through the body’s blood vessels
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17
Q

Filtration occurs when…

A
  1. Water and solutes are transported across the cell membrane as a result of hydrostatic pressure
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18
Q

The body’s way of trying to reach homeostasis is by doing what 3 things we learned about during this lecture?

A
  1. Filtration
  2. Diffusion
  3. Osmosis.
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19
Q

In diffusion, what moves? (DS)

A

Solutes

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20
Q

In osmosis, what moves? (OF)

A

Fluid

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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.

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22
Q

What does osmotic balance mean?

A
  1. Osmotic balance is the CONTROL OF WATER AND ELECTROLYTE BLANCE IN THE BODY.
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23
Q

How does hydrostatic pressure work?

A
  1. Hydrostatic pressure is pressure excerpted by the pumping of the heart which is the pushing force that pushes fluids out of the heart
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24
Q

Normal movements of fluids through the capillary wall into the tissues deepened on what two forces?

A
  1. Hydrostatic pressure
    2 Oncotic pressure
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25
Q

How does oncotic pressure work?

A
  1. Oncotic pressure AKA colloid osmotic pressure is the ‘pulling force’ pulling fluids from the surrounding tissues into the capillaries.
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26
Q

Oncotic pressure is the result of what?

A
  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)
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27
Q

Oncotic pressure, think ___1___- pulling fluid in

A

?

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28
Q

Whenever the hydrostatic pressure is greater than oncotic pressure what will happen?

A
  1. Fluid will leave the capillaries
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29
Q

Whenever oncotic pressure is greater than the hydrostatic pressure fluid willl…

A

Enter the capillaries

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30
Q

What is third spacing?

A
  1. Condition where fluid accumulates in a pocket that is not serving a purpose.
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31
Q

What is ascites?

A
  1. Fluids in the abdominal cavity… peritonitis, pancreatitis
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32
Q

Third spacing usually occurs as a result of…..

A
  1. Increased permeability of the capillary membrane or decreased plasma colloid osmotic pressure
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33
Q

What are the main causes of edema?

A
  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
  4. Pregnancy (normal)
  5. Low levels of protien
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34
Q

Third spacing can occur from…

A
  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
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35
Q

60% of lean body weight = _____?

A

Water
2/3 (intracellular)
1/3 (extracellular)
5% blood plasma

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36
Q

What is edema?

A

An accumulation of interstitial fluid within the tissues

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37
Q

Extravascular fluid collection in the pleural cavity, pericardial cavity and peritoneal cavity are called what?

A
  1. Pleural cavity: hydrothorax
  2. Pericardial cavity: hydropericardium
  3. Peritoneal cavity: hydroperitonum or ascites.
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38
Q

What is anasarca?

A

Severe, generalized edema marked by profound swelling of subcutaneous tissues and accumulation of fluid in body cavities

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39
Q

sodium & potassium use ATP to move in & out of cells in a form of active transport called the ____-_____ _____?

A

Sodium-potassium pump

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40
Q

The bodies fluid is dived into 2 compartments called?

A
  1. ICF- Intracellular fluid
  2. ECF- extracellular fluid
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41
Q

Fluid found inside the cells is called what?

A
  1. Intracellular fluid (ICF)
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42
Q

ICF makes up how much of the bodies fluid?

A
  1. 2/3 of fluid
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43
Q

Fluid found outside of the cells is called what?

A

Extracellular fluid (ECF)

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44
Q

ECF makes up how much of the bodies fluid?

A

1/3 of fluid

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45
Q

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.

A
  1. Extracellular
  2. Intracellular
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46
Q

Extracellular fluid can be divided into what 3 divisions

A
  1. Intravascular
  2. Interstitial
  3. Transcellular
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47
Q

What is intravascular fluid?

A
  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.
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48
Q

What is interstitial fluid?

A
  1. Fluid between cells (third space)
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49
Q

What is transcellular fluid?

A
  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.
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50
Q

Osmolality is measured in

A

MilliOsmols/kg

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51
Q

What is osmolality used for?

A
  1. Used to assess body’s state of water balance
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52
Q

What could a high osmolality indicate

A

Water deficit

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53
Q

What could a low osmolality indicate?

A

Water excess

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54
Q

How is osmolaRity measured?

A

MilliOsmos/L

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55
Q

What is the normal osmolaRity range?

A
  1. 270-300 mOsm/L
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56
Q

What is an osmole?

A

Amount of substance that dissociates in solution to form one mole of osmotically active particles

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57
Q

Concentration of solution is measured in…

A

Osmoles

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58
Q

OsmolaRity evaluates serum and urine in clinical practice. A high osmolaRity of using = what?

A

Concentrated urine

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59
Q

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?

A

True

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60
Q

True or false: it isn’t important to keep track of shifts of fluids when caring for patients?

A

False

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61
Q

What are three types of osmotic conditions

A
  1. Isotonic
  2. Hypotonic
  3. Hypertonic
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62
Q

What should we know about our Isotonic fluids?

A
  1. Isotonic fluids have the same solute concentration as we do in our blood.
  2. NO SHIFTs occur because the solutions are equally concentrated
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63
Q

Normal saline (0.9% NaCl) is what type of fluid and why?

A
  1. Isotonic due to the same concentration of sodium in the blood
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64
Q

What should we know about our hypotonic fluids?

A
  1. Less concentrated than other solutions; fluid pulled or moved from the bloodstream (veins) into the cells causing them to swell
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65
Q

Hypotonic fluids cause what to happen?

A

Cells to swell

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66
Q

HYPO… HYPO….HYPO offf to the …..

A

Cells we go

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67
Q

What should we know about our hypertonic fluids?

A
  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
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68
Q

MORE OR LESS:
Hypotonic solutions have ______ solutes and _____ solvent while hypertonic solutions have _____ solutes and____solvents

A
  1. Less
  2. More
  3. More
  4. Less
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69
Q

Why do hypotonic solutions cause the cell to swell?

A

1.because it promotes shifting of water into the cell

70
Q

Why do hypertonic solutions cause the cell to shrink?

A
  1. Because the solution promotes the pulling of water outside of the cell
71
Q

What are some ways that we discussed in lecture that our bodies uses as ways to maintain our fluid balance?

A
  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
Q

What are some ways that we discussed in lecture that our bodies uses as ways to maintain our fluid balance?

A
  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
Q

How does the lymphatic system help maintain fluid balance?

A
  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
Q

How do the kidneys help regulate the body’s fluid?

A
  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
Q

What are the 7 functions of the kidneys? remember A WET BED

A
  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
Q

What should we know about the Anti-Diuretic Hormone (ADH)

A
  1. Produced by the brain: specifically the Hypothalamus and stored in the pituitary
  2. Restores blood volume
77
Q

What are the 3 ways that ADH can restore blood volume?

A
  1. Reduces dieresis
  2. Increasing water retention
  3. Vasoconstriction (increasing our blood pressure)
78
Q

What triggers the body to release ADH?

A
  1. When your body does not have enough fluid and/pr blood pressure drops to low
79
Q

What happens when your brain releases ADH?

A

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
Q

What is vasopressin (desmospressin)?

A

Medication form of ADH.
- typically given in an if drip
-dosing important as it may be what is keeping the patient alive.

81
Q

True or false: the concentration of our urine and our electrolytes balance can give us an idea on our ADH levels

A

True

82
Q

What is the process of our RAAS?FIX!!

A
  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
Q

When is your RASS activated?

A
  1. Initiated when there is a change in the kidneys or low sodium, low blood pressure, low extracellular fluid.
84
Q

RAAS is activated by your_____ where as ADH is activated by your ______?

A
  1. Kidneys
  2. Brain
85
Q

What does aldosterone do in the body?

A
  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
Q

What can too much aldosterone cause?

A
  1. High blood pressure and a build up of fluid in body tissues
87
Q

ANP is what kind of hormone?

A
  1. Cardiac
88
Q

What is the role of ANP?

A
  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
Q

How does ANP regulate blood pressure?

A
  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
Q

True or false: ANP stops action of RAAS?

A

True

91
Q

True or false: When your body produces ANP it also produces BNP?

A

True

92
Q

What are two hormones we learned during this lecture that are secreted from the heart and what should we know about them?

A
  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
Q

What does a high BNP mean?

A

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
Q

What should we know about thirst?

A
  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
Q

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?

A

True

96
Q

What depletes our electrolytes? Remember VPPS

A

V-Vomiting
P- Peeing
P- Pooping
S- Sweating

97
Q

Fluid deficit of isotonic fluid in extracellular space is caused by abnormal…..

A
  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
Q

Fluid volume deficit is also known as….

A

Hypovolemia

99
Q

What are some clinical manifestations of Hypovolemia?

A
  1. Decreased vascular volume
  2. This can develop quickly, severity depends on degree and loss of fluid
100
Q

True or false: Hypovolemia is the same thing as dehydration?

A

False- Dehydration is loss of water alone causing serum sodium to rise…
Hypovolemia is VOLUME loss… concentration or ratio is the same

101
Q

What patient population is Hypovolemia most likely to effect?

A
  1. Very old and very young
102
Q

Fluid volume excess aka…

A

Hypervolemia

103
Q

Fluid excess of isotonic fluid (sodium & Water) in the extracellular space caused by:

A
  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
Q

What are the causes of hypervolemia

A

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
Q

How do you tx hypervolemia?

A
  1. Treating underlying causes and removing fluid without causing changes in electrolytes or osmolality of ECF
106
Q

What are some S/S of fluid deficit (Hypovolemia)

A
  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
Q

S/S of fluid excess (hypervolemia)

A
  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.
  7. Weight gain.
108
Q

What are we doing when we are assess for s/s of fluid deficit?

A

Monitor patients at risk…. Looking at
1. Gi losses,
2. Hemorrhages
3. Overuse of diuretics
4. inadequate fluid intake
4. Thrid space shifting

109
Q

What are we doing when we are assessing for s/s of fluid excess

A

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
Q

Nursing management of fluid imbalances includes what interventions?

A
  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
Q

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

A
  1. Isotonic IV fluids or oral fluids if able
112
Q

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?

A
  1. Fluid restriction
  2. Diuretics if kidneys are working properly
113
Q

True or false: Oxygen therapy for patients we are monitoring for fluid deficit or excess can both benefit from it?

A

TRUE

114
Q

When doing daily weights what should we try and keep consistent?

A
  1. Time, clothes, scale
115
Q

True or false: The most accurate way to measure fluid status in a person is through I&O?

A

False

116
Q

Hypovolemic shock occurs when there has been a _____ percent or more of intravascular volume loss?

A

40 percent

117
Q

What happens when a patient goes into hypovolemic shock?

A
  1. Cardiac output drops and metal status deteriorates to unconsciousness
  2. Skin may become mottled; urine output drops below 10mL/hr.
118
Q

How can you treat Hypovolemic shick?

A
  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
Q

Why do we need to monitor lung sounds when a pt is in hypovolemic shock?

A
  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
Q

Why is oxygen important for a patient experiencing hypervolemic shock?

A
  1. Helps ensure sufficent tissue perfusion and maintains a patent airway
121
Q

True or false: Dehydration is always hypernatremic?

A

Trie

122
Q

What are the signs and symptoms of dehydration?

A
  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
Q

Intravenous therapy can be done where?

A

Peripherally or centerally

124
Q

Intravenous therapy timeframe can be….

A
  1. Short and Long term
125
Q

True or false: Intravenous therapy is the slowest delivery method?

A

False

126
Q

What are the advantages of intravenous therapy?

A
  1. Replace fluid
  2. Transfuse blood
  3. Deliver medication
  4. Correct electrolyte imbalances
127
Q

What are some disadvantages of IV therapy?

A
  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
Q

With IV cannulation you should…. start __1__ and work __2__

A
  1. Low
  2. Proximally
129
Q

With IV cannulation you should use caution with what type of skin?

A

Fragile

130
Q

When considering the inner wrist for iv cannulation what should you take into consideration?

A
  1. it is very sensitive and should not be your first choice
131
Q

What is your last site option for starting an IV?

A

Antecubital

132
Q

What sites should we avoid for iv insertion?

A
  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
Q

What are some considerations for selecting a vein?

A
  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
Q

What does vein evaluation include?

A
  1. Palpate
  2. Suitable veins should be
    -round, firm & elastic
    • best palpated when engorged
135
Q

14g or 16g are typically used for what patients?

A

trauma or surgery when needing a rapid infusions

136
Q

18g is typically used for what patients?

A

Good for patients going into surgery, receiving blood or caustic meds

137
Q

22g or 20g is typically used for what patients?

A

Most common size for adult patients

138
Q

24G is typically used for what patients?

A
  1. Most common for pediatric pts
  2. Can use for adults with small or fragile veins
139
Q

Why would blood transfusions require a larger catheter?

A

Prevent hemolysis

140
Q

What are the complications of IV therapy

A
  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
Q

What is fluid overload?

A

Fluid overload is when the pt received too much fluid. This can overload the circulatory system and put stress on the heart.

142
Q

What are some s/s of fluid overload?

A
  1. SOB, cramping and headache
  2. Assessment findings may include dependent edema, rapid weight gain and crackles in the lung field on auscultation.
143
Q

With infections at the IV site what might the patient experience?

A
  1. redness, irritation and purulence at the site… infection can progress to a systemic problem
144
Q

What is phlebitis?

A

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
Q

What might the patient experience if they are experiencing phlebitis?

A

Site is often painful and warm to the touch with obvious irritation and redness

146
Q

What is infiltration?

A

Fluid seeps into surrounding tissue rather than infusing into the vein

147
Q

What is extravastion and what can happen if a patient experiences this?

A
  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
Q

What are the types of administration of IV fluids/meds?

A
  1. intermittent
  2. Continuous
  3. Bolus or Push
  4. Push
149
Q

What is intermittent administration

A
  1. Medications on scheduled dose daily or several times per day
150
Q

What is continuous administration?

A
  1. IV solutions continuously
151
Q

What is bolus or push administration?

A

Specified amount of solution to be administered in a specific time frame

152
Q

What is push administration?

A

Specified amount of medication to be administered in a specific time frame

153
Q

True or false: Continuous administration has fluids continuously infusing. This can be used for hydration, electrolyte replacement or both depending on pts needs?

A

True

154
Q

A bolus can be administer in what two ways?

A

IV bag or syringe

155
Q

What is the nurse’s responsibilities in regards to IV’s

A
  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
Q

What are some IV medication advantages?

A
  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
Q

What are some IV medication disadvantages and complications?

A
  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
Q

What are the causes of an air embolism?

A
  1. Solution runs dry, air in tubing, loose connections, improper removal of CVAD, poor technique with dressing or tubing change
159
Q

What are the S/S of an air embolism

A
  1. dyspnea
  2. Tachypnea
  3. Lightheadedness
  4. palpitations
  5. Drop in BP
  6. Weakness
  7. Cyanosis
  8. Expiratory wheezes
160
Q

What are some interventions for air embolisms?

A

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
Q

What are the s/s of extravasation?

A
  1. pain or burning at IV site
  2. Skin tightness at site
  3. Blanching and coolness of skin
  4. Defendant edema
162
Q

What are some preventions for extravasation?

A
  1. Dilute meds as recommended
  2. Avoid use of high pressure pumps
  3. assess & monitor IV site
  4. Teach pt what to report
163
Q

True or false: CVADs are not the safest for administration of vesicant drugs.

A

False- They are safest

164
Q

What are the causes of a venous spasm?

A
  1. Viscous solutions
  2. Too rapid administration
  3. Cold or irritating solutions
165
Q

What are the symptoms of venous spasms?

A
  1. Sharp pain at the IV site
  2. Pain radiating up the arm with the IV site
166
Q

What are some prevention techniques for venous spasms?

A
  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
Q

What are some prevention techniques for venous spasms?

A
  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
Q

What is a venous spasm?

A

Sudden, brief, tightening of the muscle cells inside the vein

169
Q

What are the causes of chemical phlebitis?

A
  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
Q

How can you prevent chemical phlebitis?

A
  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
Q

True or false: Prevention is key for preventing chemical phlebits?

A

True

172
Q

What are the IV push administration steps?

A
  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

Module 2 (14 decks)

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