IV therapy

Question 1

Common sizes: Gauges

Answer 1

18, 20, 22 gauge (the
smaller the gauge number the bigger the
needle

Question 2

Diffusion:

Answer 2

: movement of molecules
from area of high concentration to
lower

Question 3

Osmosis:

Answer 3

H2O moves thru
semipermeable membrane from
area of low solute concentration to
high

Question 4

Intra cellular space

Answer 4

(inside the
cells) skeletal muscle mass (2/3
fld)

Question 5

Extra cellular space

Answer 5

divided into 3
areas (makes up 1/3 fld) 1 liter of
water=2.2# (1kg)

Question 6

⮚Intravascular =
⮚Interstitial=
⮚Transcellular =

Answer 6

⮚Intravascular (plasma)
⮚Interstitial (fluid around cells)
⮚Transcellular (cerebral spinal fluid, pleural)

Question 7

■1st spacing-
■2nd spacing-

Answer 7

■1st spacing- normal distribution of fld in ICF and ECF.
■2nd spacing- too much accumulation of interstitial fluid (edema) ■3rd spacing- abnormal accumulation of fluid where there shouldn’t be any
■Such as abdominal cavity(ascites)

Question 8

Purposes of IV Therapy

Answer 8

■Correct/Prevent
■fluid/electrolyte disturbances
■When oral fluid intake is not adequate
■Route for medication administration
■Keep vein open
■Total parenteral nutrition (TPN)

Question 9

Hypotonic Solution

_______solute(cell) concentrations than plasma

Answer 9

Lower

■0.33% NS NaCl (1/3 NS)
■0.45% NS NaCl (1/2 NS)
■0.25% NS NaCl (1/4 NS)
■D5W
0.25% NS NaCl (1/4 NS)
■D5W

Question 10

Purpose of Hypotonic

Answer 10

Shifts fluid from Intravascular(blood) compartment to cells ■Used to treat dehydration
■Maintenance fluid replacement
■NOT used with increased ICP
■NOT used if HRF third spacing

Question 11

isotonic Solutions

Answer 11

Same solute(cell) concentration as plasma
■0.9% NS (NaCl)
■LR
■Expands only ECF
■No net loss or gain from ICF
■Replaces circulatory volume after blood loss (use in postop)

Question 12

Hypertonic Solutions

Answer 12

Higher solute(cell) concentration than plasma
■D5 1/2NS, D5/NS, D5/LR
■3% NaCl, 5% NaCl
■Draw fluid from interstitial spaces to intravascular space ■Draws water out of the cells
(may cause dehydration)
■Expands intravascular compartment and promotes excretion ■Need adequate cardiac/renal function

Question 13

Normal Saline (0.9%NS/ 0.9% NaCl) p. A5

Answer 13

■Isotonic
■No calories
■Replace ECF fluid losses (does not affect ICF)
■Used to expand intravascular(plasma) volume
Replacement for both fluid and sodium losses (ex. Diarrhea) Caution: can increase sodium and chloride levels

Question 14

0.9%NS/0.9% NaCl

Answer 14

■Does not change ICF(cellular) volume
■Only solution to adm with Blood products
■Compatible with most medications
■Preferred fluid for immediate response
■Risk for fluid overload higher
■

Question 15

(0.45%NaCl) Sodium Chloride
■0.45% NaCl (1/2 normal saline)

Answer 15

■Hypotonic
■Good maintenance fluid
■Depletes ECF
■Treat hypernatremia
■Potential to cause cellular
swelling.

Question 16

Sugar

(D) Dextrose
■D10W

D5W

Answer 16

D) Dextrose
■D10W
■10% Dextrose in water
■Hypertonic
■No electrolytes
D5W

■Isotonic but works also as hypotonic ■Provides 170 cal/L
■Provides 50gm dextrose
■Does not provide electrolytes
■Use to replace water losses

Question 17

Electrolytes

■Lactated Ringers
■D5LR
5% Dextrose in Lactated Ringers
■Ringers Injection
■D5R
5% Dextrose in Ringers
■Potassium Chloride (KCL) as an additive 29
5% Dextrose in Ringers

■Potassium Chloride (KCL) as an additive
Lactated Ringer’s

■Isotonic
■More similar to plasma than NS
■Has less NaCl
■Has K, Ca, Phosphate, lactate(metabolized to HCOӡ)
■Expands ECF, does not move into cells

Answer 17

■D5LR
5% Dextrose in Lactated Ringers
■Ringers Injection
■D5R
5% Dextrose in Ringers
■Potassium Chloride (KCL) as an additive 29
5% Dextrose in Ringers

■Potassium Chloride (KCL) as an additive
Lactated Ringer’s

■Isotonic
■More similar to plasma than NS
■Has less NaCl
■Has K, Ca, Phosphate, lactate(metabolized to HCOӡ)
■Expands ECF, does not move into cells

Question 18

D5 ½ NS

Answer 18

■Hypertonic
■Common maintenance fluid
■KCl can be added for maintenance or replacement
■Draws water out of the cells into the ECF (intravascular)

Question 19

Patient has increased swelling in legs and abdomen. Which
solution type would be most beneficial?

1. Hypotonic
2. Hypertonic
3. Isotonic

Answer 19

hypertonic

Question 20

Crystalloids
vs
Colloids

Answer 20

Crystalloids
-true solutions (most IV fluids)
(pass freely through cell membranes, water soluble molecules)

Colloids
-contain protein or starch (Blood and blood products)
(remain in vascular space – increase osmotic pressure- draw more fluid in, larger insoluble molecules)

Colloids

■Stay in vascular space, pulls fluid into blood vessels, restores blood volume and increase osmotic pressure.
■Contains large molecules
■Colloids (protein solutions)
■Albumin
■Fresh frozen Plasma
■Commercial plasmas
■Packed RBCs

Question 21

Assessment (IV therapy)

■Assess
■S&S of fluid overload:

■S&S of fluid deficit:

Answer 21

Assess for overall improving client condition
■S&S of fluid overload: edema, inc. BP, jugular vein distention, bounding pulse, lung congestion(crackles), tachypnea, SOB, wt gain, altered LOC
■S&S of fluid deficit: dec. BP, rapid weak thready pulse, poor skin turgor, dec. urine output, weakness, dizziness, sunken eyes, thirst, headache, confusion

Question 22

Nursing Interventions: fluid volume imbalances

Answer 22

■Daily weights – notify MD of gain of >#3
■I & O – includes oral & IV, urine output
■Labs – monitor BUN, creatinine, sodium, HCT
■Monitor VS, POX
■Chest assessment, apply O2 prn
■Maintain safety – at risk falls (weakness), orthostatic hypotension, change in LOC. Falls Precautions
■Assess skin turgor, edema
■Provide oral care
■T & P

Question 23

When administering IV solution containing NaCl,

Answer 23

Na enters the cell and K is forced out

Question 24

Verify _______ function prior to administering IV solution with K+ ■

Answer 24

Verify kidney function prior to administering IV solution with K+ ■

Question 25

Hyperkalemia (murder)
s/s

Answer 25

M: uscle weakness

U: rine production little or none (renal failure)

R: espiratory failure (due to the decreased ability to use breathing muscles or seizures develop)

D: ecreased cardiac contractility (weak pulse, low blood pressure)

E: arly signs of muscle twitches/cramps…late profound weakness, flaccid

R :hythm changes: Tall peaked T waves, flat p waves, Widened QRS and prolonged PR interval

Question 26

Hypokalemia / Easy way to Remember 7 L’s

LOWWWW N SLOW

Answer 26

Lethargy (confusion)

Low, shallow respirations (due to decreased ability to use accessory muscles for breathing)

Lethal cardiac dysrhythmias *ST depression, shallow T wave, projecting U wave)

Lots of urine (frequent urination…kidneys unable to make the urine concentrated)

Leg cramps/ constipation

Limp muscles (decrease deep tendon reflexes)

Low BP & Heart

Question 27

Health teaching: explain in patient
appropriate terms

Answer 27

■Purpose of IV infusion
■Equipment
■Length of time
■How patient can help self
■Permitted activity/safety

Question 28

Site Dressing Change

■Occlusive dressing q______
■Label with _______ (3)
■Document in chart
. ■Record on

Answer 28

■Occlusive dressing q72hr
■Label with date, time, initials
■Document in chart size of cannula, site, date and time inserted. ■Record on dsg date, time, size of cannula and initials

Question 29

Drip Rate Influenced by:

Answer 29

Drip Rate Influenced by:

■Tubing drip factor (check bag of tubing)
■Tubing patency
■Position change (bent elbow)
■Height of solution
■Viscosity of solution
■Placement in the vein

Question 30

Complications

Answer 30

Infiltration (extravasation)
)
■Phlebitis
■Circulatory overload
■Embolism
■Infection
■Speed Shock
■Allergic Reaction

Question 31

■Infiltration (extravasation) ( Inspection and Palpation)

Answer 31

■Inspection
■Swollen, Blanched
■Fluid leak into interstitial space
■Halo with penlight

Palpation
■Spongy, cool
■Occlude vein 4-6inches above insertion site
■

Question 32

Phlebitis Assessment

■Inspection & palpation

Answer 32

Phlebitis Assessment

■Inspection
■Reddened streak of vein
■Palpation
■Warm to touch
■Palpable cord of irritated vein
■Tenderness/pain, possible swelling

Question 33

Phlebitis Assessment Subjective

Answer 33

■Reports pain especially when:
■IV changed
■IV med hung
■IV flushed

Question 34

Other Complications

Answer 34

■Circulatory overload- crackles, edema, neck vein distention ■Embolism- air, clot at site (dislodge)
■Infection- REED
■Speed Shock- sudden adverse reaction to IV med given too quickly ■Allergic Reaction- facial flushing, hives, swelling tongue

Question 35

Too much infused

Answer 35

■Check pump settings/drip rate
■Decrease to KVO
■Assess for S&S of fluid overload
■Plan intervention prn
■Call MD prn
■Occurrence report
■Patient safety 1st responsibility

Question 36

Too little infused

Answer 36

■Check pump settings/drip rate
■Assess cause- check tubing, check IV site
■Assess for fluid volume deficit
■Re-adjust to prescribed rate

Question 37

Hourly Assessment

Answer 37

■Amount Infused
■Is it “on time”
■Check pump setting/ drop rate
■Check site
(compare to opposite extremity)
■Patency of tubing (container to site)
■Are piggy-back clamped?

Question 38

Nursing Interventions for Hyperkalemia

Remember the word POTASSIUM for food rich in potassium

Answer 38

-Monitor cardiac, respiratory, neuromuscular, renal, and GI status
-Stop IV potassium if running and hold any PO potassium supplements
Initiate potassium restricted diet and remember foods that are high in potassium

Potatoes, pork

Oranges

Tomatoes

Avocados

Strawberries,

Spinach

fIsh

mUshrooms

Musk Melons: cantaloupe

Also included are carrots, cantaloupe, raisins, bananas.

Prepare patient for ready for dialysis. Most patient are renal patients who get dialysis regularly and will have high potassium.

Administer a hypertonic solution of glucose and regular insulin to pull the potassium into the cell

Question 39

Your Body is trying to DITCH potassium”

Answer 39

Drugs (laxatives, diuretics, corticosteroids)

Inadequate consumption of Potassium (NPO, anorexia)

Too much water intake (dilutes the potassium)

Cushing’s Syndrome (during this condition the adrenal glands produce excessive amounts of cortisol (if cortisol levels are excessive enough, they will start to affect the action of the Na+/K+ pump which will have properties like aldosterone and cause the body to retain sodium/water but waste potassium)…hence hypokalemia

Heavy Fluid Loss (NG suction, vomiting, diarrhea, wound drainage, sweating)

Question 40

what not to give for hypokalemia

Answer 40

Don’t give LASIX, demadex , or thiazides (waste more Potassium) or Digoxin (cause digoxin toxicity) if Potassium level low…notify md for further orders)