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IV therapy Flashcards

1
Q

what are some different purposes of IV therapy

A

-maintenance or replacement of fluids and electrolytes
-provide glucose and nutrition
-access route to administer meds intravenously
-venous access to administer blood products
-venous access for emergencies

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2
Q

are peripheral IVs for short or long term use

A

short term use

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3
Q

how often should peripheral IVs be changed

A

change Q96 hours or according to agency’s policy

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4
Q

what does IID stand for

A

intermittent infusion device

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5
Q

if peripheral IV is capped how often do you flush and assess site

A

-flush Q8 to check patency
-assess site at least Q8

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6
Q

when talking about IV gauges the larger the number…

A

the smaller the needle size

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7
Q

which gauge is most common for peripheral IVs

A

20

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8
Q

what is 16 or 18 gauge large bore used for

A

trauma/surgery

both require a large vein

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9
Q

what is the smallest gauge we generally use for adults

A

22

used for fragile veins, older adults, amd slower infusions, can still give blood products

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10
Q

what is 24 gauge used for

A

slow flow rates, pediatric and elderly

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11
Q

when pushing IV meds, what should you remember to check for?

A

-allergies
-compatibilities (do the meds get along)
-dilution (some meds need reconstituted/diluted)
-rate of adminstration (slow or fast?)

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12
Q

IVP meds

what port do you clean before pushing the med through it?

A

the port closest to the patient

clean with alcohol and connect syringe

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12
Q

IVP meds

what port do you clean before pushing the med through it?

A

the port closest to the patient

clean with alcohol and connect syringe

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13
Q

IVP meds

administer drug at ____ with constant flow

A

recommended rate

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14
Q

IVP meds

how do you flush a peripheral IV

A

SAS method (saline, admin, saline)

use 3-5ml

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15
Q

where should you never administer IVP or IVPB meds

A

TPN or PCA line

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16
Q

when are central venous catheters used

A

long term therapy or tissue toxic meds

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17
Q

describe central venous catheters

A

-can be inserted at bedside as a sterile procedure (PICC)
-some are implanted surgically (port)
-single or multiple lumens
-site can be used immediately after insertion

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18
Q

describe a PICC line

A

-can be inserted by a specially trained nurse
-placement verfiied with chest xray
-follow CVC admin guidelines

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19
Q

describe nursing and nursing assistant care for PICC

A
  • no BP in arm with PICC
  • no venipunctures from the arm with the PICC
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20
Q

describe implanted ports

A

-surgically implanted
-assure initial placement with Xray
-assess site
-access port with noncoring needle
-use CVC admin guidelines

-generally seen with chemotherapy, can be used for years
-when not accessed, low risk for infection

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21
Q

what are the CVC use guidelines

A
  1. verify placement prior to initial use (xray)
  2. assess site
  3. use 10ml flush and syringe
  4. assure blood return before asministration
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22
Q

what do you do if blood return is absent prior to administration according to CVC use guidelines

A

-check clamps/connections
-flush 10ml
-reposition patient/ask pt to cough
-hold therapy
-obtain an order for declotting agent
-confirm proper line placement: xray

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23
Q

IVP meds via central line

remember to check for…

A

-allergies
-compatibilities
-dilution
-rate of administration

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24
# IVP meds via central line what port do you clean
port closest to patient
25
# IVP meds via central line do you check for blood return
yeppers
26
# IVP meds via central line administer drug at ____ with constant flow
recommended rate
27
# IVP meds via central line describe SAS with central line
-saline, admin, saline -10ml peripheral flush -may need heparin in port (sash) (super rare)
28
# IVPB which infusion is lower
primary
29
# IVPB which infusion gets hung higher
secondary
30
describe primary infusion
something running continuously
31
# IVPB what should you akways check
compatibility
32
a patient came to the ER after a car accident. what type of IV should the nurse start? A. 18g peripheral B. 22g peripheral C. port-a-cath D. PICC line
A. 18g *a large bore IV like an 18 would be ideal for a trauma pt. a central line or implanted port are not warrented in this case*
33
before giving an IVP med through a central line which step should the nurse take? A. apply tourniquet B. hang normal saline bolus C. check for blood return D. start peripheral IV
C. check for blood return *always check for blood return with central lines as part of checking patency*
34
# IV fluids crystalloids
clear fluids | saline, LR, D5W
35
# IV fluids colloids
fluids that cannot see through (TPN, blood)
36
# IV fluids tonicity
homeostasis serum = other body fluids how similar it is to body composition
37
# IV fluids isotonic
-same toncity as body fluids -osmolality close to that of ECF and does not cause cells to swell or shrink -good for basic hydration and add fluid volume
38
# IV fluids hypotonic
-fluid shifts out of blood, cells swell -exert less osmotic pressure than ECF -used to replace cellular fluid -used short term, usually for DKA -mainly seen in ICU
39
# IV fluids hypertonic
-pull fluid into vasular system, cells shrink -osmotic pressure greater than that of ECF -used in hyponatremia and cerebral edema -usually seen in ICU
40
name some types of isotonic solutions
-normal saline (0.9% NaCl) -5% dextrose in water (D5W) -lactated ringers
41
name a type of hypotonic solution
0.45% NaCl
42
name a type of hypertonic solution
3% NaCl
43
# electrolyte values sodium
135-145
44
# electrolyte values potassium
3.5-5.0
45
# electrolyte values chloride
95-105
46
# electrolyte values bicarb
24-31
47
# electrolyte values calcium
8.8-10.5
48
# electrolyte values phosphorus
2.5-4.5
49
# electrolyte values mag
1.8-3.6
50
what may cause hyponatremia | sodium <135
-diuretics -N/V/D -overhydration
51
signs and symptoms of hyponatremia
-N/V -HA/**seizures** -dizziness -**muscle cramps/weakness**
52
what may cause hypernatremia | sodium >145
-dehydration -heatstroke -burns
53
signs and symptoms of hypernatremia
-thrist -fever -**seizures** -**muscle twitching**
54
what may cause hypokalemia | potassium <3.5
-diarrhea -gastric suctioning/vomiting -diuretics
55
signs and symptoms of hypokalemia
-weakness/cramps -constipation -**cardiac dysrhythmias**
56
what may cause hyperkalemia | potassium >5
-kidney disease -diuretics -burns
57
what are some signs and symptoms of hyperkalemia
-weakness -paresthesias -**cardiac dysrhythmias**
58
what are some potential causes of hypocalcemia | calcium <8.8
-parathyroid disorder -vit D deficiency -poor absorption
59
signs and symptoms of hypocalcemia
-numbness/tingling -**trousseaus and chvostek +** -seizures
60
potential causes of hypercalcemia | calcium >10.4
-parathyroid disorder -tumor -calcium supplements
61
signs and symptoms of hypercalcemia
-weakness/fractures -constipation -**hypoactive reflexes**
62
potential causes of hypomagnesemia | mag <1.8
-alcoholism -diarrhea -malabsorption
63
signs and syptoms of hypomagnesemia
-trousseau's and chvostek's + -**increased reflexes** -**EKG changes**
64
potential causes of hypermagnesemia | mag >3.6
-adrenal insufficiency -hypothyroidism
65
signs and symptoms of hypermagnesemia
-flushing -**hypoactive reflexes** -**EKG changes**
66
potential causes of hypophosphatemia | phosphorous <2.7
-alcohol use -**low mag** -vomiting/diarrhea
67
signs and symptoms of hypophosphatemia
-muscle weakness -confusion -**seizures**
68
potential causes of hyperphosphatemia | phosphorus >4.5
-kidney disease -dehydration
69
signs and symptoms of hyperphosphatemia
-N/V -muscle weakness -**hyperactive reflexes**
70
potential causes of hypochloremia | chloride <96
-vomiting/suction/sweating -diuretics -addison disease
71
signs and symptoms of hypochloremia
-agitation -muscle cramps -seizures
72
potential causes of hyperchloremia | chloride >108
-excessive NaCl infusion -kidney injury -dehydration
73
signs an symptoms of hyperchloremia
-weakness -edema -seizures
74
reviewing your patients morning labs you note a potassium of 5.6. what nursing intervention whould you take? A. call MD for a tele order B. place seizure pads on bed C. hold AM furosemide D. check for chvostek sign
A. call MD for a tele order *hyperkalemia can lead to fatal heart arrythmias, placing the patient on a monitor would be important in this case*
75
name some different potential complications of IV therapy
-infiltration -phlebitis -infection -occlusion -fluid overload -air embolism
76
what is occlusion
partial blockage of IV access
77
describe prevention of occlusion
-avoid use of AC for IV start -use only "compatable" mixtures -peripheral/central IID sites: use SAS, flush every 8 hours
78
what is inflitration
-swelling (above IV site) -**cool to touch** -**pallor** -tissue has increased firmness -absence of blood return (not diagnostic) -pain or discomfort at site
79
describe prevention of infiltration
-check IV site every hour if infusing -use stabilization device/proper dressing -protect IV tubing and site when ambulating patient -chack patency of access device prior to admin of all meds and fluids -discontinue IV if any signs of infiltration -restart the IV at different site
80
what is extravasation
infiltration with tissue toxic substances
81
what substances may cause extravasation
-vasopressors (dobutamine, dopamine, epinephrine) -chemotherapeutic agents (adruamycin, vincristine, bleomycin) -electrolytes (potassium chloride, calcium chloride, calcium gluconate)
82
describe prevention and nursing considerations of extravasation
-check IV site at least every hour for signs and symptoms -**stop infusion** -discontinue IV if any signs of infiltration -restart the IV at different site -be aware if antidote available -dilute meds like potassium and calcium -suggest a central venous catheter
83
what is phebitis
inflammation of a vein
84
symptoms of phlebitis
-red streak along vein -skin is warm, hot along the vein -vein firm/cord like -pain
85
what are some complications of phlebitis
-clots -infection
86
name some different types of phlebitis
-mechanical phlebitis -chemical phlebitis -post infusion phlebitis -bacterial phlebitis
87
describe mechanical phlebitis
-long periods of cannulation, catheter in a flexed area, catheter gauge larger than vein, poorly secured catheter -usually occurs in AC
88
describe chemical phlebitis
from an irritating med or solution, rapid infusion rate, med incompatibilities
89
describe post infusion phlebitis
generally occurs 48-96 hours after infusion has been discontinued
90
describe bacterial phlebitis
-poor hand hygiene, lack of aseptic, failure to check equipment, or recognize early signs of phlebitis -often occurs during insertion
91
describe prevention and nursing considerations of phlebitis
standard IV precautions: -hand washing -aseotic technique with new IV -**scrub that hub** -follow agency protocols for tubing/site changes buffer irritating meds and hypertonic solutions
92
if phlebitis occurs what do you
-d/c IV and restart -alert MD -culture site/device (as ordered/prtocol) -monitor VS -document
93
where are infections more prevalent
central
94
why do more infections occur with central lines
-poor hand hygiene -frequent disconnection of tubing -poor insertion technique -multi lumens -frequent dressing changes -poor hub care -improper tubing changes
95
describe syetmic infection from central line infections
-sepsis -occurs throughout the body -involves several systems -organisms/toxins in the blood -leading cause of deaths in ICU -CLABSI
96
describe prevention and nursing considerations for CLABSI
-**hand hygiene ** (hand washing, no artificial nails) -**scrub the hub** (15 secs and use disinfecting caps) -sterility of access/equipment -know agency policy -do not use expired solution, tubing, fluids
97
what is fluid overload
inadvertent administration of excess fluid increases blood pressure and central venous pressure
98
signs and symptoms of fluid overload
-moist crackles -edema -weight gain -dyspnea -rapid/shallow respirations
99
describe prevention of fluid overload
-use IV pump, monitor IV rate -check pt every hour (stable adult patient) -keep I and Os -monitor vitals, close assessment -notify MD
100
what is air embolism
air in circulatory system, very rare
101
potential causes of air embolism
-during insertion of large bore IV -accidental removal of large IV -improper removal of central line -air given through line -loose connections
102
classic signs and symptoms of air embolism
sudden - difficulty breathing - chest pain - muscle or joint pain - stroke - mental status change - low BP - cyanosis
103
prevention of air embolism
-prime all tubing -address all bubbles -double check flushes and IVP syringes -proper technique for removing CVC
104
treatment of air embolism
-stop infusion or disconnect tubing to prevent air entry -**place pt in left side lying trendelenburg** (helps prevent air from travelling to right side of heart into pulmonary arteries) -monitor vitals and pulse ox
105
you are assessing your patient IV and find it is cool and swollen. what should you do next?
remove IV and restart *cool and swolen would indicate infiltration. simply remove and start a new one*

adults (51 decks)

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