IV Therapy

Question 1

Goals of IV therapy

Answer 1

Maintain or prevent fluid and electrolyte imbalances
Administer medications
Replenish blood volume
Assist in pain management
Correct or maintain nutritional status

Question 2

What is inserted into the vein to start IV

Answer 2

venous access device

Question 3

IV can be __ or __

Answer 3

peripheral or central

Question 4

Three categories of IV

Answer 4

Isotonic
HYpotonic
HYpertonic

Question 5

Characteristics of Hypotonic Fluids

Answer 5

Provide more water than electrolytes, diluting the extracellular fluid (ECF).

Osmosis drives water movement from the ECF to the intracellular fluid (ICF).

Achieve osmotic equilibrium, resulting in expansion of both ECF and ICF with the same osmolality.

Question 6

Common uses for hypotonic fluids

Answer 6

Often used as maintenance fluids due to normal daily losses being hypotonic

Hypernatremia

Cellular dehydration such as in conditions like DKA and hyperglycemia

Question 7

Consideration for hypotonic solutions

Answer 7

Cellular swelling can occur, requiring monitoring for:

Changes in mentation, may indicate cerebral edema.

Question 8

Explain the special case of D5W

Answer 8

Initially considered isotonic, but quickly metabolized, leaving free water (hypotonic) for:
Equal expansion of the ECF and ICF.

Question 9

Effects on body compartments of isotonic fluids

Answer 9

Isotonic solutions expand only the extracellular fluid (ECF).
There is no net movement of water into or out of the intracellular fluid (ICF)

Question 10

Uses of isotonic solutions

Answer 10

Fluid replacement in patients with an ECF volume deficit, such as those with hypovolemia or dehydration.
(e.g. caused by dehydration, vomiting diarrhea, excessive sweating, etc.)

Commonly used in cases of combined fluid and sodium losses or as vascular fluid replacement during hypovolemic shock.

Question 11

Conditions for using/not using lactated ringer’s

Answer 11

Not suitable for patients with lactic acidosis due to reduced ability to convert lactate to bicarbonate.

Also do not give to a patient with liver disease

Lactate helps increase blood pH by converting to bicarbonate

Monitor for hyperkalemia in renal patients

Question 12

Potential risks of isotonic fluids of excessive administration

Answer 12

Excessive administration of isotonic saline can lead to elevated sodium and chloride levels (hypernatremia and hyperchloremia).

Question 13

Mechanism of action of hypertonic fluids

Answer 13

Hypertonic solutions (e.g., 3% NaCl) initially raise the osmolality of the extracellular fluid (ECF) and expand its volume.

Higher osmotic pressure causes water to shift from the intracellular fluid (ICF) to the ECF.

Question 14

What are hypertonic fluids used to treat?

Answer 14

Useful in treating hypovolemia, hyponatremia, and cerebral edema.

Question 15

Hypertonic solutions require frequent monitoring of:

Answer 15

Blood pressure
Lung sounds
Serum sodium levels

Question 16

Hypertonic solutions should be cautiously due to the risk of:

Answer 16

Intravascular fluid volume excess
Intracellular dehydration

Question 17

What are IV additives used for:

Answer 17

Replace specific electrolyte losses and maintain balance.

Question 18

Safety guidelines for potassium:

Answer 18

Administer potassium at a rate of no more than 10 mmol/L per hour for routine infusion.

Potassium can be safely diluted in a concentration of up to 40 mmol/L

Potassium must never be given undiluted or as an IV push, as this can cause fatal cardiac arrhythmias.

Question 19

What is parenteral nutrition

Answer 19

A specialized form of nutritional support administered intravenously via an infusion pump, typically for patients with significant gastrointestinal (GI) dysfunction.

Question 20

PN is commonly used when __ and __ __ is not possible

Answer 20

Oral and feeding tubes

Question 21

Two ways to do parenteral nutrition

Answer 21

central venous line
peripherally inserted central catheter (PICC).

Question 22

Important to monitor with PN

Answer 22

Electrolytes

I&O

Vital signs (esp. temperature)

Blood glucose levels

Question 23

What are Central Venous Access Devices (CVAD)

Answer 23

Catheters placed in large blood vessels (e.g., subclavian vein, jugular vein) for frequent or continuous vascular access.

Question 24

Advantages of Central Venous Access Devices (CVAD)

Answer 24

Reduced need for multiple venipunctures.
Decreased risk of extravasation injury.
Immediate access to the central venous system.

Question 25

Disadvantages of Central Venous Access Devices (CVAD)

Answer 25

Increased risk of systemic infection.
Invasive insertion procedure.

Question 26

Where are central venous catheters placed

Answer 26

The catheter rests in the superior vena cava near the junction with the right atrium.

Question 27

Indications for Central Venous Access Devices (CVAD)

Answer 27

Used when the GI tract is nonfunctioning or requires rest, allowing for the delivery of nutrients, electrolytes, medications, and fluids.

Question 28

The preferred method for flushing

Answer 28

Push–Pause Technique