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NPLEX2 review of modalities > IV therapy > Flashcards

IV therapy Flashcards

1
Q

What gauge needle do you draw up with

A

18-21G

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2
Q

protocol for drawing up material

A

wash hands, clean top of vial
inject air volume equal to volume you want to withdraw
draw up volume
soft recap or hemostat change

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3
Q

areas for IM injections

A

deltoid, vastus lateralus, glute max
kids- side of thigh

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4
Q

how to do IM injection

A

wash hands
glove
clean area
place injecting needle on syringe
remove cap
stabilize pt skin, and dart hold syringe
90 degree entrance of skin , stop 1/2 cm form hub
pull back to ensure not in vessel
inject
withdraw needle, place cotton ball over site
dispose of needle
bandage pt

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5
Q

how to do sub q

A

wash hands, glove, clean area, place needle on syringe
remove cap
pinch up pt skin
enter 30 degrees stop 1/2 cm form hub pull back then inject

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6
Q

intradermal injection

A

only for sensitivity testing or TB, entrance si 5-10 degrees

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7
Q

safe PH range of solutions for IV use

A

5-9

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8
Q

comfortable PH range for IV use

A

6.6-7.6

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9
Q

osmolarity of isotonic solution

A

250-375

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10
Q

risk of phlebitis increases with what

A

increase in osmolarity

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11
Q

how to prevent phlebitis

A

slow rate of IV
use large veins
ensure adequate dilution
use buffers like HCL
awareness of catheter placement

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12
Q

osmolarity of hypotonic solution

A

<250

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13
Q

osmolarity of hypertonic solution

A

> 375

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14
Q

what solutions are isotonic

A

0.9% NS, D5W, ringers lactate

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15
Q

why are isotonic solutions safe

A

no fluid shift occurs - however hypervolemia may still occur

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16
Q

what solutions are hypotonic and concerns with it

A

0.45% NS , can over hydrate cells leading to lysis

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17
Q

what solutions are hypertonic and concern with it

A

D10, D28, most vitamins, and minerals
increase volume overload, irritate the vessels, can cause dehydration
max flow rate is 5mL per minute

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18
Q

causes of abscess and tx

A

dirty stick, contaminated substance,

administer antibiotics, apply heat, I/D

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19
Q

how to avoid broken needle in patient

A

awareness of needle position, inspection before and after

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20
Q

hematoma causes and tx

A

damage to vessel
apply firm pressure post injection , use smaller gauge needle in future, pressure bandage

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21
Q

what populations are predisposed to hematomas

A

elderly, on blood thinners, IV drug users, connect tissue dz

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22
Q

how to address post IV pain

A

movement of limb, contrast, ice

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23
Q

Thrombosis

A

slow or stop flow rate
D/C line
Apply ice and pressure to site

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24
Q

what increases risk of thrombosis

A

longer infusions, too high or low of PH, high osmolarity

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25
Q

infiltration sx and tx

A

sx, swelling, cold, painful

stop the line, apply light pressure, ice, give apis

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26
Q

venous spasms sx and tx

A

pain at the site that travels up the arm

slow the drip rate, warm the solution, flush the line, check PH, heat arm, check position of line

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27
Q

sx of fluid overload and what to do

A

Edema, HTN, SOB, crackles in lungs

slow infusion, heat limbs, give oxygen
call 911 - needs diuretic tx

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28
Q

what predisposes to fluid overload

A

kidney damage, over hydration prior to large volume infusion

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29
Q

common interactions

A

Calcium channel blockers with EDTA, Magnesium- causes HEART BLOCK
rawolfia and reserpine with magnesiu, calcium, or EDTA- causes irreversible hypotension
beta blockers with magnesium - stops response

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30
Q

how to treat syncope

A

place in recumbent position
smelling salts
cover with blanket
watch for reentry seizure and reassure
continue infusion if needed and able

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31
Q

common causes of hypoglycemia

A

high dose Vit C and EDTA chelation

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32
Q

how to antidote hypoglycemia from IV

A

push 5-50ml of D5W

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33
Q

speedshock

A

place in recumbent position, stop infusion, start NS,
Calcium antidotes Mag and vis versa

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34
Q

Rehydration catheter size

A

largest one available ( smallest number)

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35
Q

what solution osmolarity is used for rehydration

A

isotonic solutions of 375 or lower

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36
Q

WHAT SHOULD NEVER BE PUT ALONE INTO A PT

A

sterile water

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37
Q

what volume of fluid repleats for 1 day of loss and how quickly can it be infused

A

1500-2000ml infuse 125ml per hr up to 1,000ml and recheck

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38
Q

osmolarity category of D5W + 0.9% NS

A

isotonic

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39
Q

osmolarity category of 2.5% D5w +0.45% NS

A

hypertonic

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40
Q

osmolarity fo 5% D5W with 0.2% NS

A

hypertonic

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41
Q

osmolarity of electrolyte solutions

A

isotonic

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42
Q

osmolarity of ringers

A

isotonic

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43
Q

what conditions should lactate ringers not be used in

A

addisons and liver dz

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44
Q

antioxidants used in IV

A

vit C
glutathione
ALA
Poly MVA
selenium/manganese
Ozone

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45
Q

what can be used to access a vessel for an IV lasting less than 45minutes

A

butterly, catheter, whatever

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46
Q

what must be used to access a vessel for IV lasting over 45min

A

catheter

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47
Q

how to prep an IV site

A

cholorhexadine
alcohol x3 then iodine

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48
Q

how do you wipe when preparing an access site

A

clean to dirty , middle out

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49
Q

how to minimize infection in IV

A

monitor exp date of materials
look for contamination or sedimentation in vials
ensure use of filter tips when possible
never reuse anything
be aware of your location in relation to cannulas and needles

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50
Q

what is a clean room

A

has ISO 5-8 air filter, low particulate
ante room
buffer room
laminar flow hood

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51
Q

how to set venipuncture

A

prepare skin
assess vein
set access devise
release tourniquet
secure device
start flow
assess site for infiltration

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52
Q

what do catheters decrease

A

chance for vein damage

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53
Q

when are butterflys okay

A

short infusions, pushes
monitor for vein damage

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54
Q

How to set IV catheter

A

clean site
assess vein
Have line preset
traction and insert catheter/needle as whole
watch for flash, if seen advance 1mm further
retract guide needle part way
remove torniquet
occlude vessel and remove guide needle/ dispose
attach line
start drip
observe insertion site

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55
Q

what are considered central venous access devices

A

midline catheter
PICC
implanted port device
tunneled device

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56
Q

what is the only needle to access an implanted port with

A

Huber needle

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57
Q

all implanted ports are access with what kind of site prep

A

sterile

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58
Q

what line is never used for anything but blood draw on a multi lumen device

A

THE RED LINE

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59
Q

when do you flush ports and PICCA lines

A

before and after use

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60
Q

how to assess for medication safety if question in PT treatment

A

dont use
run interdermal test
premedicate patient to negate IgE effect

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61
Q

sign of thrombosis

A

slow or stopped flow rate

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62
Q

texture of a vein that has experienced phlebitis

A

ropy texture , sclerosis

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63
Q

Line flushing how to do it

A

use saline, slow flush through port with IV stopped, no smaller syringe than 10cc

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64
Q

if putting procaine or lidocaine into push how to administer

A

1-2% drug in 9cc NS, push slowly

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65
Q

how much air does it take to kill a human if entering the vessel with IV

A

10-60CC

66
Q

how to treat suspected air embolism

A

place in left lateral decubitus position, give O2 as lungs are block, monitor vitals, ensure EMS is called to transport

67
Q

how to address a catheter embolism

A

save the rest of the catheter
apply pressure proximal to the site or torniquet it
imaging at ER to locate

68
Q

if in metabolic acidosis what should be given

A

bicarbonate 50ml

69
Q

if in metabolic alkalosis what should be given

A

administer NaCl and normalize potassium

70
Q

Signs and treatment for respiratory acidosis

A

tachycardia, diaphoresis, HA
treat with ox and improving ventilation

71
Q

signs and treatment for respiratory alkalosis

A

anxiety, hyperventilation, dizzy, paresthesia’s
Treat with bag breathing, sedatives, visualization

72
Q

DRIP RATE

A

drops/minute divided by ( #mL / drop) = mL/min times 60 = mL per hour

73
Q

what is the molarity of 3% and 5% sodium chloride

A

hypertonic

74
Q

what are saline infusions used for

A

if hypotonic- base solution for additives
isotonic- volume stabilization
hypertonic or isotonic- raise sodium and chloride levels

75
Q

what is D5w or 5% dextrose used for

A

rehydration
solution base for antibiotics
labile blood sugar control

76
Q

what is the osmolarity and function of D10, D20,D50

A

all are hypertonic forms of dextrose in water
they lower potassium and increase glucose in the body

77
Q

what is sterile water used for

A

carrying solution only - MUST HAVE ADDITIVES

78
Q

what are electrolyte solutions used for

A

Isotonic, for volume depletion or dehydration
DOUBLE CHECK INTERACTIONS IF ADDING ANYTHING TO IT

79
Q

Ringers lactate

A

rehydration, acidosis of most kinds
DO not use in addisons or hepatic disease

80
Q

what is in a lactated ringer

A

sodium chloride
sodium lactate
anhydrous
potassium chloride
calcium chloride
hydrochloric acid or sodium hydroxide for PH

is Isotonic and ph of 6.6

81
Q

what disease cause concern for potential fluid overload

A

kidney disease
CHF
liver failure
hypertonic infusions
rapid high volume administrations

82
Q

what solutions are hydrating and which are dehydrating

A

isotonic = hydrating
hypertonic=dehydrating

83
Q

what is the osmolarity of half normal saline and is it safe to infuse alone

A

hypotonic, and yes its safe though at 154mosm it is the lowest one usually its just a base

84
Q

volume of NS or ringers to address hyponatremia

A

<125mEq/L

85
Q

How quickly can you lower sodium levels in hypernatremia

A

15mEq/L in 8hrs

86
Q

what can you use to lower sodium levels

A

D5W, half normal saline, or NS

87
Q

what causes alkalosis

A

volume depletion, thiazide diuretics, acute infection

presents as: tetany, hypertonic reflexes, decreased respiration

88
Q

what causes acidosis or high cl and how does it present

A

causes: head trauma, excess ACTH, severe dehydration

sx: drowsiness, weakness, lethargy, tremor, dysrhythmias, SOB, tachypnea, hyperventilation

89
Q

excess or high phosphate

A

restrict dietary intake or give calcium

90
Q

when is calcium needed in IV

A

chelation, hypocalcemia, high dose vitamin C

91
Q

hyperparathyroid causes what shift in phosphorous and calcium

A

phosphorous goes down
calcium goes up

92
Q

what can too low of calcium lead to

A

laryngospasm
prolonged QT interval

93
Q

what causes low calcium

A

hypoparathyroid
magnesium
vit D deficiency
diarrhea
infection
trauma
burns

94
Q

how to check calcium deficit

A

tap cheek- chovestek sign positive if facial twitch
trousseaus sign- bp cuff on arm

95
Q

how to treat hypocalcemia

A

10cc calcium gluconate in 20cc sterile water or D5W with slow push ) NOT GLUCONATE IN SHELLFISH ALLERGY )
alternative is Ca chloride - IV only though

96
Q

WHAT should never be mixed with calcium in a syringe due to precipitation

A

bicarb

97
Q

how to treat hypercalcemia

A

saline diuresis with NS and oral fluids
give furosemide to act as diuretic
2 nasal sprays calcitonin
phosphate salts

98
Q

magnesium dose , use, precautions

A

1-6 grams in 1/2-1 L bag
sulfate more absorbable
chloride form worsens HTN and CHF
Uses: lower arrhythmias,
CAN CAUSE HEART BLOCK if mixed with CA channel blockers

99
Q

Low magnesium

A

causes by potassium wasting diuretics, laxatives, poor absorption, fluid loss, alcohol abuse
SX: muscle weakness, insomnia, tremor, tetany, seizures

100
Q

Hyper magnesium and how to treat

A

SX: lethargy, low BP, slow pulse, flushing, decreased DTR, heart block, death

Tx: cal gluconate 10% 1 to 10cc IV

101
Q

how fast can you give a Mag push

A

1.5ml/min

102
Q

after what dose is potassium and calcium added to a mag solution

A

3 grams

103
Q

what do we never do with potassium

A

give as push or add to hanging IV bag

104
Q

when is zinc used

A

immune therapies
oxidative therapies
cancer
eye
infectious formulas
1-25mg or up to 100mg

105
Q

when is chromium added

A

immune formulas
blood sugar management
eye problems
20-200mcg

106
Q

selenium

A

immune and antioxidant formulas
400-1600mcg

107
Q

manganese dose and use

A

CT repair, repletion
0.1-1mg

108
Q

molybdenum dose and use

A

bipolar
repletion
sulfite toxicity
25-250mcg

109
Q

B complex

A

must be protected form light
most contain B1, 2,6,5,3
Increases enzyme activity
boosts energy
supports glycolysis
1-5cc

110
Q

when are multivitamin mixtures used

A

nutrient depleted patients

111
Q

B 1- thiamine depleted by what

A

loop diuretics
digitalis

112
Q

B3, niacinamide

A

supports serotonin pathways

113
Q

B5, dexpanthenol

A

for adrenal support
fatigue, allergies
100-2000mg

114
Q

B6 pyridoxine

A

Commonly causes nausea, slow infusion eat during

uses:
interstitial diuretic
amino acid metabolism
CAD
50-200mg

115
Q

B12

A

for megaloblastic anemia
homocystiene reduction
neuropathies
asthma

116
Q

Signs of MTHFR problem

A

developmental delay
motor abnormality
gait abnormality
seizures
psychiatric manifestations
homocystinuria
premature death

117
Q

folic acid

A

ADD VERY FIRST OR VERY LAST TO PREVENT PRECIPITATION
1-20mg

118
Q

what should always be tested for before giving a high dose vitamin C infusion

A

G6PD deficiency
RBC
CBC

119
Q

at what dose is Vitamin C antioxidant

A

lower doses 10g or less
supports immune function helps maintain glutathione

120
Q

at what dose is vitamin C pro oxidant

A

high dose >50g
for chronic infections
cancer treatment

121
Q

side effects of high dose vitamin C

A

shivering , palpitations, HTN

122
Q

how does Vitamin C impact blood sugar

A

false elevation that tricks the glucometer

123
Q

what is carnitine used for

A

mitochondrial functional deficits
200-600mg

124
Q

Arginine uses and dose

A

asthma
ED
angina
HTN
1-20g

125
Q

Glycine contraindication

A

bipolar

126
Q

what is MIC used for

A

lipotrophic compound of methionine, inositol, choline to support the liver
2-10cc

127
Q

NAC

A

push or IV
supports glutathione
mycolytic
500-6000mg

128
Q

Glutathione uses

A

asthma, allergy, infection
neurodegeneration
detox

give alone or in normal saline

129
Q

histadine

A

rheumatoid arthritis

130
Q

where should amino acid mixtures be stored

A

dark place

131
Q

what % amino acid in a mixture should not be exceeded

A

2.5%

132
Q

adverse effects of over dosed amino acids

A

hyperglycemia
increased liver test
metabolic acidosis
flushing
allergic reactions

133
Q

is DMSO lipid or water soluble , other precautions

A

lipid soluble
glass bottles only
add just prior to infusion

for pain and neurodegeneration

134
Q

MSM solubility, use, and dose

A

water soluble
detox, pain, soft tissue repair
10g

135
Q

PTC or phosphatidylcholine

A

helps with concentration, and cognitive support , liver damage and NASH

infuse slow
NEVER ADD ANYTHING TO IT- infuse alone IN d5w

136
Q

ALA

A

INFUSE ALONE
must be filtered either before or during IV
single dose vials

detox and healing of liver

may feel hot flush

137
Q

Hydrogen peroxide

A

dont give with vitamin C
infuse slowly
do G6pd WORK UP PRIOR

se: ACHES, FEVER, CHILLS, anxiety, fatigue, vasculitis, flu symptoms

138
Q

hydrochloric acid

A

Slow push
never with any infection that can’t drain .
give through IV port with immune formulae

139
Q

only IV form of vitamin D

A

calcitriol

140
Q

what is the protocol with calcitriol

A

infuse ALONE in D5w solution

141
Q

WHAT THREE ITEMS must you change the line or flush it prior to administering anything else

A

ALA, PTC, Vit-D

142
Q

IV penicillin G

A

5mil U in 100CC NS or D5W
run over 30min

following dow 2.5milU every 4 hours

143
Q

Ampicillin IV

A

ALWAYS IN NS never D5w DUE TO DEGREDATION
2 grams in 100cc NS
over 30min
no faster than 125mg/min
follow with 1g every 4hr

144
Q

oxacillin
slow push 1 g in 10cc over 10min
follow with 1 g every 4 hours

A
145
Q

clindamycin

A

never faster than 300mg over 15min
follow with 900mg every 8 hours

146
Q

doxycycline

A

200mg in 500cc of NS or D5W
run over 4 hours
follow 100-200mg daily

147
Q

erythromycin

A

250mg per hour max rate
no mixing of meds
follow 500mg every 6 hours

148
Q

vancomycin

A

1g over 1 hr max dose
follow 1 g every 12 hours

149
Q

Iron

A

GIVE ALONE
never give dexferrum form iv AS ANAPHYLAXIS OCCURS
1-1.5hr minimum
100cc NS minimum
iron sucrose safest form

150
Q

fat soluble vitamins

A

A,D,E,K and biotin and are available in water soluble forms

151
Q

vitamin A

A

IM only - otherwise anaphylaxis
never in pregnancy, liver dz, liver cancer

152
Q

vitamin K

A

give subq
protect from light
dilute with NS, D5W, or D5NS
se: muscle cramping , abdominal pain

153
Q

glycyrrhizic acid

A

for liver diz, viral support, elevated liver enzymes
never in HTN, cushings

154
Q

sillibinin

A

slow infusion
D5W or NS
anti viral, anti cancer, liver support
can cause hot flush, SOB, rash

155
Q

artemesinin

A

anti cancer, anti lyme, anti viral

156
Q

curcumin

A

liver support, anti inflammatory

157
Q

Use of single dose vials

A

discard after one use
okay for 4 hours in hood
max punctures 2

158
Q

use of multidose tube

A

28 days max from open date
3 punctures max or dispensing pin used

159
Q

how many things can you put in a syringe

A

3

160
Q

how many things can you put in a bag

A

3

NPLEX2 review of modalities (7 decks)

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