IV theory Flashcards
Assessment of pt recieving IV fluids
Infiltration– swelling coolness pallor discomfort. If occurs stop infusion and apply warm compress
Ensure fluid level half full
If clot in tubing do not flush–remove
Change injection caps for lumen hubs on central venous cath every 72 h/per policy
Ck site hourly
Fluid needs of healthy adult
8-10 glasses q day, 2k-2.5k ml q day
Risks for dehydration
Causes– GI fluid loss, diuretics diabete hemmorage sweating fever draining wounds burns, fluid shifts (third spacing)
S/s fluid overload/hypervolemia
htn, tachycardia, full/bounding peripheral pulses, ^ resp rate, cough, dyspnea (difficult or labored breathing) orthopnea (difficulty breathing when supine) moist crackles, wheezes, weight gain, distended neck veins, ^ CVP, dependent edema, rapid bounding pulse
Lab vals– will see a decrease in the following: in serum osmolarity, hematocrit, and urine specific gravity.
s/s dehydration
fatigue, altered mentation, postural hypotension, tachycardia,weak/thready peripheral pulse, weight loss, flat neck veins, decreased central venous pressure, dry skin, poor turgor, decreased urine output
lab vals- will see ^’s in serum osmolarity, hematocrit, and urine specific gravity.
Isotonic solutions- types and actions
Expands blood vol/replaces abn losses. Used in hypotensive hypovolemic supports blood pressure r/t increasing vascular volume
- 9% NaCl (normal saline) restores intravascular volume, replaces extracellular fluid, replaces sodium losses
- lactated ringers (LR) replaces fluid losses maintains intravascular volume
hypotonic solutions– types and actions pg 109
0.2% and 0.45% sodium chloride: useful in conditions of cellular dehydration provides electrolytes/water
has lower osmolarity than serum
-water is rapidly pulled from the vascular compartment into the interstitial/intracellular compartments, can be given to ppl with ^ Na
hypertonic solutions- types and actions pg 109
-d5/0.45 NS and D5/0.9 NS and TPN: has potential to pull fluid from the intracellular and interstitial compartments into the intravascular compartment,
has a higher osmolarity than the serum and can cause celular dehydration and vascular overload.
Technique for admin dangerous meds
Burette–pedi
What parts of IV system (tubing, bag, spike, ect) should be sterile?
Spike, inside all tubing, port
appropriate tubing for glass containers
vented- secondary or primary
microdrop tubing
delivers 60 drops/ml. (used with heparin, pedi, potent meds)
macrodrop tubing
delivers 10,15, or 20 drops/ml
safe admin of IV fluids to pedi pt
Burette
flushing central lines
m
flushing saline locks
Don’t draw blood from peripheral cath
Changed every 72-96 h
Don’t change for pedi unless indicates per policy
flushing heparin locks
Sash method used w picc
Iv push an bolus w sash method
IV pump settings/ selection of catheter
ml/hr
27 gauge 5/8 inch to 14 gauge 2.5in
s/s of IV,central line infections
m
Technique of central line and PICC dressing changes
Cephallic/basilica veins of antecubital space
Flush w saline hep after each use of daily if not in use
Gauze/transparent semipermeable membranes are the two types dressings most often used
Safe use of central lines
Used w meds that irritate vein walls or large vol
Usually inserted subclavian jugular vein
Long term access or emergencies
Ie chemo, tpn
Tunneled central venous cath– types are Hickman broviac groshong
s/s phlebitis
Red warmth swelling burning pain
If occurs, disc and apply warm compress
What is rubber injection portal used for?
route to push meds
Non-volumetric IV controllers
aka the manual/primitive controller. Monitors only the gravity infusion rate by counting the drops that drip through chamber.
Ex of syringe pump
self-admin pain meds.
If you are admin with glass bottle, what type of tubing will you use?
vented
Burotroll/burette
used in pedi pts to prevent fluid overload. The nurse fills drip tube by the hr and closes off bag to avoid chance overload.
Before nurse admin IV therapy, he/she should ask the following…
Does tx law delegate this function to nurse?
Does written policy of the institution through which I am employed permit nurse with my level of education/experience to admin IV therapy? Does institution/agency policy limit the types of fluids and meds that I may administer? Is order written by a hcp for a specific pt?
S/a pulm edema
Dyspraxia cough anxiety rales rhinchi cardiac dysrythmias thready pulse frothy sputum
S/a air embolism
Palpitations Cp Sob Cyanosis Hypotension Weak thready pulse
