iv therapy Flashcards
distribution of fluid
intracellular
extracellular (interstitial
intravascualr)
(trans-cellular)
extracellular and intracellular fluids contain
O2
dissolved nutrients
extractor products of metabolism
charged particles called ions (electrolytes)
electrolytes
sodium chloride magnesium potassium phosphate bicarbonate calcium
movement of body fluids
osmosis
diffusion
filtration
carrier mediated transport
fluid replacement
enteral replacement (oral, NG tubes, g tubes)
parental replacement (isotonic)
(hyper tonic)
(hypotonic)
isotonic
same osmolity as body cells
used fro extracellular volume replacement
expands body fluid without causing a fluid shift
0.9 saline
lactated ringer
5 % dextrose in water
2/3 and 1/3 dextrose and NaCl
hypotonic
Osmotic pressure is lower than plasma
Moves fluid into cells causing them to enlarge
Hydrates cells while reducing fluid in circulatory system
Based on specific fluid & electrolyte imbalance
0.45% NaCl (half normal saline)
0.33% NaCl (one-third normal saline
hypertonic
Osmolality greater than body fluids
Pulls fluid from cells causing them to shrink
Based on specific fluid & electrolyte imbalance
5% Dextrose in normal saline (D5NS)
5% Dextrose in o.45% NaCl (D5 1/2NS)
5% Dextrose in lactated Ringer’s (D5LR)
D10W
factors influencing flow rate
position of forearm position and patency of tubing height of infusion and bottle/container possible leakage or fluid infiltration relationship of size of angiocath to vein
advantages of iv therapy
fluid and electrolyte management
tpn administering
perfred route of medications
disadvantages of iv therapy
infection
hypovelimia if not monitored closely
maintain of iv therapy and client assessment
Assessment Focus: Type of fluid being infused and TBA Drip chamber level & Rate of flow (every hour) Patency of system Appearance of infusion site Response of client (assessments)
infiltration
needle becomes dislodged and fluid flows into the interstitial fluids
Localized swelling, coolness, pallor and discomfort at IV site
Stop infusion and remove catheter
Warm compress to site-promotes comfort, vasodilation, facilitating absorption of fluid
phlebitis
Due to chemical irritation or chemical injury (eg KCL, IV antibiotics)
Redness, edema at IV site and burning pain along course of vein
If phlebitis detected d/c infusion & apply warm compresses as ordered.
potential complications
incorrect flow can result in
hypovelimia
hypervolemia
inadequate medications administer
heath teaching
Avoid sudden twisting or turning movements of extremity with IV site
Avoid stretching or placing tension on tubing
Try to keep tubing from dangling below level of needle
Notify nurse if flow rate suddenly changes, stops, solution empty, blood in tubing, discomfort, swelling
Saline Lock similar
input and output
intake includes all liquids taken by mouth (e.g., gelatin, ice cream, soup, juice, and water) or through nasogastric or jejunostomy feeding tubes, intravenous fluids , and blood or its components.
Output includes urine, diarrhea, vomitus, gastric suction, and drainage from postsurgical wounds or other tubes Daily intake should equal output plus 500 mL (to cover for insensible fluid losses).
recording intake and output
Recording intake and output is essential for obtaining an accurate database to evaluate hydration status. This information helps maintain an ongoing evaluation of the patient’s hydration status to prevent severe imbalances.
serum levels
serum osmolality is 285 to 295 mmol/kg. With dehydration, the serum osmolality will be higher than normal.
Possible nursing diagnoses for patients with fluid, electrolyte, and acid–base alterations
- Actual or risk of deficient fluid volume
- Actual or risk of excess fluid volume
- Decreased cardiac output
- Impaired gas exchange
- Acute confusion
- Impaired oral mucous membrane
- Actual or risk of impaired skin integrity
- Impaired mobility
Crystalloids
most commonly and include dextrose, sodium chloride, and lactated Ringer’s solutions These solutions contain solutes that mix, dissolve, and cross semipermeable membranes.
Colloids
protein or starch, which does not cross semipermeable membranes and therefore remains suspended and distributed in the extracellular space, primarily the intravascular
Colloids have been used to increase the osmotic pressure in the intravascular space to increase vascular volume in critical situations.
Colloids are either semi-synthetic, such as dextran, pentastarch, or hetastarch, or human plasma derivatives, such as albumin, plasma proteins, or blood.
Vascular access devices (VADs)
catheters, cannulas, or infusion ports designed for repeated access to the vascular system.
These devices include peripheral vascular access devices (PVADs) and central vascular access devices (CVADs) and allow for parenteral fluid and electrolyte replacement, parenteral nutrition, and administration of medications.
CVAD
venous access device with a tip that terminates in a great vessel, preferably in the lower third of the superior vena cava; however, the upper right atrium is an acceptable site.
The most common insertion sites are the internal jugular and subclavian veins; the right internal jugular vein is considered the best option
Skin-tunnelled catheters STC
are tunnelled from the entry site, subcutaneously, to the preferred vein, where the catheter is inserted and advanced into the superior vena cava
complications associated with CVADs
pneumothorax, arterial puncture, hemorrhage, cardiac tamponade, air embolus, hemothorax, nerve injury, hydrothorax, infection, catheter occlusion, phlebitis.
Microdrip
60 gtt/ml
Macrodrip
15 gtt/mL or 10 gtt/ml
transfusion reactions
mild response (e.g., faintness, dizziness) to severe anaphylactic shock or acute intravascular hemolysis
Autologous transfusion
The blood for an autologous transfusion can be obtained by preoperative donation up to 5 weeks before the planned surgery (e.g., heart, orthopedic, plastic, or gynecological).
Patients can donate several units of their own blood, depending on the type of surgery and the ability of the patient to maintain an acceptable hematocrit.
blood salvaging
The blood that has been salvaged is then reinfused during the surgery.
Blood can also be salvaged postoperatively from mediastinal and chest tube drainage and after joint and spinal surgery.
blood cathered sizing for adults
A large catheter, such as 18 to 22 gauge, is recommended for adults
unless rapid infusion is required (16–18 gauge)
Acute intravascular hemolytic
Chills, fever, low back pain, flushing, tachycardia, tachypnea, hypotension, hemoglobinuria, hemoglobinemia, sudden oliguria (acute kidney injury), circulatory shock, cardiac arrest, death
Febrile nonhemolytic
Sudden shaking chills (rigors),
fever (rise in temperature 0.5°C [1°F] or more from start), headache,
flushing, anxiety,
muscle pain
Mild allergic
Flushing, itching, urticaria (hives)
Anaphylactic
Anxiety, urticaria, dyspnea, wheezing progressing to cyanosis, severe hypotension, circulatory shock, possible cardiac arrest
Blood Products for Transfusion
Whole blood Red blood cells Autologous red blood cells Platelets Plasma Albumin Clotting factors & cryoprecipitate
TPN Complications
Pneumothorax
Catheter occlusion
Infection
Hyper and hypo glycemia
