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Med Surg 3 > IV Therapy > Flashcards

IV Therapy Flashcards

1
Q

Intravenous

A

existing or taking place within, or administered into, a vein or veins.

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2
Q

Bolus

A

A lot all at once

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3
Q

Fluid overload

A

More common in the young and elderly

Too much fluid

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4
Q

Isotonic

A

Same particles on both sides

Action: replaces volume without disrupting intracellular and interstitial volume. ***Expands vascular compartment.

Indications: Used when bleeding out and we want to replace fluids: Vascular dehydration, Hemorrhages, Replaces NaCl, Dilutes hypernatremia (give slowly), PRN patient

Types: NS, Lactated Ringer’s, D5W, 1/4NS

Isotonic Patient: 275-295 mOsm/L

Isotonic Solution: 250-375 mOsm/L

Concerns: Use cautiously in patients who are fluid-overloaded or who would become compromised if vascular volume would increase such as cardiac/renal patients

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5
Q

Hypotonic

A

Less particles on one side

Action: hydrates cell by pulling h2o into cellular spaces from vascular space. ***Expands intracellular and depletes intravascular

Indications: Therapy of hypertonic dehydration, sometimes used with keto acidosis but we must get their electrolytes and fluid settled before hypotonic therapy

Types: ½ NS, ¼ NS, 33% saline, 2.5% dextrose in water

DO NOT GIVE IF THE PATIENT HAS A BRAIN INJURY: Brains love free water and will absorb it quickly and will lead to brain edema

*can cause cells to burst and can rob blood volume

Hypotonic patient: < 275 mOsm/L

Hypotonic solution: < 250 mOsm/L

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6
Q

Hypertonic

A

More particles on one side

Action –draws fluid out of intracellular space, leading to increased intracellular volume both in the vascular and interstitial space. ***Expands intravascular and depletes intracellular

ICU only
Indications: Tx of hypotonic dehydration, circulatory collapse, increased fluid shift from interstitial space to vascular space

Types:
10% glucoseICU only, (lungs might get fluid), Check CBG
o 3-5% NSICU only (lungs might get fluid)
o D51/2
o D5NS
o D5 in ringers

Watch: BP, Lung sounds, Sodium levels, Very irritating to the vessels, Infuse very slowly

Hypertonic patient: > 295 mOsm/L

Hypertonic solution: > 375 mOsm/L

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7
Q

Infiltration

A

Going into the tissue

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8
Q

Secondary medications

A

Piggyback

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9
Q

Intermittent medication infusion (INT)

A

Heparin-lock or saline-lock, IV in but no fluid going in

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10
Q

Phlebitis thrombosis

A

Inflammation of a vein that turns into a clot

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11
Q

Speed shock

A

Patient goes into shock because of medication going in too fast

Example: Potassium chloride, could kill you because it stops the heart

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12
Q

IV Pump

A

Forces the fluid into the IV to the pt.

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13
Q

IV controller

A

Pinches the tubing so that it only lets in a certain amount of med

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14
Q

Macrodrip

A

Large drops, regular IV tubing

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15
Q

Microdrip

A

Drops small drops

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16
Q

Women have _______-______% of fluid

A

50-52%

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17
Q

Babies have ________-________% of fluid

A

70-80%

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18
Q

What % of fluid is intracellular

A

40%

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19
Q

What % of fluid is extracellular

A

20%

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20
Q

What % of fluid is found in your blood vessels?

A

5%

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21
Q

What % of fluid is found in your interstitial space (CSF, Lymphatic)

A

15%

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22
Q

What % of fluid is trans cellular?

A

too small to measure

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23
Q

The __________ senses your level of fluids and electrolytes and controls your thirst and pituitary gland to put out ADH

A

Hypothalamus

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24
Q

The _______ ________ puts out ADH (antididiuretic Hormone), which tells you not to pee so that you can keep your fluid

A

Pituitary gland

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25
Q

What are the factors that cause you to produce ADH?

A
  • Stressors
  • Drugs (diuretics)
  • Smoking
  • Cancer
  • Steroids (aldosterone)
  • Kidneys , Edema, Too much K, Impacts the heart, too much phosphorus, Acidosis
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26
Q

What are the functions of fluids?

A

o Maintain blood volume
o Helps to regulate temperature (Dehydration=Fever)
o Transports materials to and from cells
o Medium for cell metabolism
o Assists in food digestion thru hydrolysis
o Solvent in which solutes are available for cell function
o Medium for excreting waste

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27
Q

What are the 2 different types of fluids we have in our bodies?

A

Intracellular

Extracellular: Intravascular, Interstitial, Transcellular

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28
Q

Movement of fluid through capillary walls depends on what?

A

Hydrostatic pressure: Pressure exerted on the walls of blood vessels
Osmotic pressure: Pressure exerted by the protein in the plasma

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29
Q

The direction of fluid movement depends on what?

A

the differences of hydrostatic and osmotic pressure

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30
Q

Passive transport

A

Osmosis: Fluid moves from low solute to high solute

Diffusion: Fluid moves from an area of high solute to low solute

Filtration: Hold on to some particles and let go of others

31
Q

Active transport

A

Physiologic pump moves from lower concentrations to one of higher concentration.

Moves against the concentration gradient.

Requires ATP for energy

Against the concentration gradient: Sodium potassium pump maintains the higher concentration of extracellular sodium and intracellular potassium

32
Q

What are the major cations?

A 
♣	Sodium
♣	Potassium
♣	Calcium
♣	Magnesium
♣	Hydrogen ions
33
Q

What is sensible loss?

A

Urination and bowel movements

34
Q

What is insensible loss?

A
  • Skin= 500mL/day (Temperature?)
  • Bowels= 100-200mL/day (diarrhea? C.Diff?)
  • Lungs= 300-500mL/day (Hyperventilates?)

Altogether, we lost between 500-1,000mL per day through insensible loss

35
Q

First spacing

A

Normal distribution of fluids within the body

36
Q

Second spacing

A

Abnormal accumulation in interstitial tissue

Easily exchanges with extracellular fluid

Example: on your feet all day, lay down and swelling goes away

37
Q

Third spacing

A

Fluid accumulation in body not easily exchanged with ECF

Examples: fluid in the lungs, severe burn, peritonitis, fistula. Pancreatitis, bowel extension, OR exposure (extensive)

S/S: Hypovolemia

Treat:
• Slowly administer fluids to avoid hypervolemia
• Look at electrolytes and urine concentration
• Replace electrolytes and fluid if need be
• Look for protein in the blood stream (Low protein- edemitis)

38
Q

Gerontology considerations

A

Reduced homeostatic mechanisms (Cardiac, renal, respiratory)
o Decreased body fluid percentage
o Medication use
o Hormone: decrease in ADH
o Dehydrated more easily
o Lost subcut tissue
o Dry skin
o Do not feel thirsty as often as younger individuals
o *Should be weighed everyday (Best way to measure fluid balance)
o *Will collect fluid in lungs faster than younger pateints, which leads to pulmonary edema
o *Do not depend on tenting to tell you if the patient is older

39
Q

Fluid volume deficit (FVD)

A

Medical diagnosis: Hypovolemia

Definition: Losing fluid and electrolytes in the same proportion
***Different from dehydration: losing fluids only

Can be recovered by administering NS or Ringer’s Lactate

If hemorrhage: administer NS

Causes: 
•	Vomiting
•	Diarrhea
•	GI suctioning
•	Sweating
•	Decreased intake
•	Inability to gain access to fluid 
Risk factors: 
•	Diabetes insipidus
•	Adrenal insufficiency
•	Osmotic diuresis
•	Hemorrhage
•	Coma
•	Third space shifts 
S/S
•	Rapid weight loss
•	Decreased skin turgor
•	Oliguria
•	Concentratied urine
•	Postural hypotension 
•	Rapid and weak pulse
•	Increased temperature
•	Cool and clammy skin due to vasoconstriction

*PC: hypovolemic shock

40
Q

Fluid volume excess (FVE)

A

Medical diagnosis: hypervolemia

Definition: Fluid overload or diminished omeostatic mechanisms

Risk factors:
• Heart failure
• Renal failure
• Chirrhosis of the liver

S/S
•	Edema
•	Distended neck veins
•	Abnormal lung sounds (wheezing)
•	Tachycardia
•	Increased BP
•	Pulse pressure
•	CVP
•	Increased weight
•	Increased UO
•	SOB
•	Wheezing

Treatment:
• Directed at the cause
• Restriction of fluids and sodium
• Administration of diuretics

*PC: pulmonary edema, HTN, electrolyte imbalance, hypoxemia, respiratory alkalosis

41
Q

IV therapy for maintenance

A

Mainly for those who are NPO and/or stressed

Give: 1500 mL fluid/sq meter of body surface

Should include: glucose, sodium, potassium and water
• Supplies calories
• Spares protein
• Minimizes ketone formation (Helps put the patient into ketosis)

42
Q

IV therapy for replacement

A

Given when the body cannot maintain requirements

Usually d/c in 48 hours

Check renal function before administration

Given for: 
•	Diarrhea
•	GI surgery
•	N&amp;V 
•	Loss of electrolytes
•	Wound infection
43
Q

IV therapy for restoration

A

Used for restoration on ongoing basis - greater than 48 hours

Given for:
• Burns
• Wound draining
• Fistula draining

Similar to replacement except you need

  • Strict I & O
  • Daily labs
  • Type of fluid depends of type lost
44
Q

What is the minimum urine output/hour

A

30mL/hour

45
Q

Midline vascular access device

A

Peripheral

3-8” long

Can stay in 6 days – 4 weeks without causing a problem

46
Q

Peripherally Inserted Central Venous Cather (PICC)

A

Peripheral

Specially trained nurses can insert them

***Remove in slow short pulls
o Don’t put pressure on the needle until you see blood because there could be a clot.

Given in the Basilic vein most often
• Sometimes given in the cephalic vein or subclavian vein

Can’t us turnicut so put in Trendelenburg

Ends in the superior vena cava of the heart

47
Q

Central Venous Catheter (CVC)

A

Short term non-tunneled
• 10 days
• Placed in the jugular or subclavian

Long term tunneled 
•	***Must be removed by doctor 
•	Hickman
•	Broviac
•	Groshong
•	Implanted port (Portacath)

Given for: Long term therapy, TPN, Glucose therapy, Chemo, Kidney failure

48
Q

Crystalloids

A

Hypotonic, Isotonic, and Hypertonic solutions

Solutes are totally dissolved and can freely move in and out of membranes.

Takes 3-4X of these to do the same job as Colloids (expanders)

Ringer’s lactate=most balanced solution
• If pt. is allergic to lactose, don’t give lactate
• There is a plain solution for these patients

*Look for kidney failure because potassium is added to many solutions

49
Q

Expanders (Colloids)

A

Solutes don’t dissolve

Need more osmotic pressure

Hypertonic

Can be substitutes for blood transfusions

Types
• Albumin: Plasma protein, 500 mL of blood, Low albumin=edema, High protein=weight loss
• Dextran: 20-40mL/minute, Given for hypovolemia, Substitute for blood transfusion
• Hespan: Heta-starch, Not a blood product, LESS TOXIC THAN THE OTHERS, Substitute for blood transfusion
• Mannitol: EXPANDER USED FOR BRAIN INJURY. It does not cause the brain to swell

*Medications should not be given with or added to these solutions

PC: ALWAYS OVERLOAD

50
Q

What is the formula for patient osmolarity?

A

(2 x Na) + (glucose÷18) +(BUN ÷2.8)

51
Q

What is the formula for Mean Arterial Pressure (MAP)?

A

Diastole+Diastole+Systole/3

*should be above 60!

52
Q

Discontinuing an IV

A

Gloves

Wait until you see blood and then put pressure

Observe catheter for problems
- If part of the catheter is gone, put turnicut on and call physician

53
Q

Removal of Central Lines

A
  • Per agency policy
  • ***Patient in Trendelenburg
  • ***Have patient bear down so blood will come out to prevent air from going in
  • Inspect the integrity of the catheter
  • Document
  • Take precautions to prevent air embolus and catheter breakage
54
Q

What type of solution are blood products compatible with?

A

NS ONLY!

55
Q

What should you do if the patient has a reaction to a blood transfusion?

A

stop the blood immediately, take all of the blood and saline administered with blood away

keep the IV in with the piggy-backed saline.

56
Q

Intrinsic infection

A

An infection that was already in the patient prior to care.

57
Q

Extrinsic infection

A

An infection that we caused through care

58
Q

How often should tubing be changed?

A

72 hours

59
Q

How often should bags be changed?

A

24 hours

60
Q

How often should the IV site be changed?

A

72 hours

61
Q

How can we implement infection control?

A
  • Wash hands before doing anything with the site
  • Good skin prep and technique with start
  • Change tubing/bags/site at proper times
  • Label all above - If no label consider expired
  • Inspect and palpate site daily, change if necessary
  • Dressing are to be left intact until catheter is removed or it becomes damp, loose, soiled
  • Wear gloves for dressing changes if needed
  • Universal precautions
  • Care with flushes, needless systems, additives
Site assessment:
 o	Redness
o	Swelling
o	Tenderness
o	Coolness
o	Warmth
o	Inflitration- pain, coolness, pallor
o	Phlebitis- pain, redness, warmth, red streak 
Monitor: 
o	Length of time hanging
o	Tubing 
o	Flow rates
o	Pumps
o	Dressing 
o	Site
o	Patient response
o	Documentation 
o	Write down patient name and flow rate on the bag so that everyone knows
62
Q

Infiltration

A

Local PC

  • Skin is cool and tight
  • Take IV out
  • Place warm compress
  • Graded from 0-4
63
Q

Phlebitis

A

Local PC

  • Red, warm, swelling, red streak
  • Take IV out
  • Place either cold or warm compress
  • Inform physician and possibly infection control
64
Q

Thrombophlebitis

A

Local PC

• Edema, tender, vein feels like a cord

65
Q

Hematoma

A

Local PC

  • Bruise and swelling, burning pain, discolored
  • Take IV out
  • Apply pressure
  • Elevate
  • Ice
66
Q

Spasms

A

Local PC

• IV too fast or the solution is cold (blood)

67
Q

Extravasation

A

Local PC

  • Infiltration of medicine
  • Burning
  • Try to suck it back out with a syringe
  • Notify, take a picture, elevate, warm or cold compress, incident report, sometimes they even have to have surgery
68
Q

Overload

A

Systemic PC

S/S: Restless, Headache, High pulse, Gain >2 pounds in one day, Cough, fluid in the lungs, Edema, Hypoxia, O2 Sat<90 , Wide difference between I&O

Treat: Report, Give diuretics, Keep HOB up, Daily weight, I&O monitoring, Do not take IV out, Turn down to keep the vein open, Keep patient warm

69
Q

Air embolism

A

Systemic PC

S/S: Palpitations, Confused, Coma, SOB, Tachycardia, Murmurs, Shock

Treat: Call for help, Clamp the line, **Trendelenburg on left side to prevent it from moving into the lungs, **Oxygen, Vasopressors, Fluids, Could go into cardiac arrest

70
Q

Infection/Septicemia

A

Systemic PC

  • Chills
  • Fever
  • Tachycardia
  • N&V
  • Pain
  • Elevated white count
  • Could go into septic shock
71
Q

Speed shock

A

Systemic PC

  • Med too fast
  • Could go into cardiac arrest
72
Q

Catheter embolism

A

Systemic PC

Apply tourniquet and notify provider

73
Q

Catheter occlusion

A

Systemic PC

Find a specialist immediately

Med Surg 3 (14 decks)

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