IV Therapy

Question 1

Examples of Isotonic Solutions

Answer 1

9%NS (Normal Saline in .9% NaCl) Treat dehydration
D5W (Dextrose 5%)
LR (lactated ringers)

Question 2

Examples of Hypotonic Solutions

Answer 2

1/2 NS (.45% NaCl)

1/4 NS (.2 NaCl)

Question 3

Examples of Hypertonic Solutions

Answer 3

D5NS (5% Dextrose in .9%NaCl)
D5LR (5% in Lactated Ringers)
D10W (10% Dextrose in Water)
3% NS (3%NaCl) FOR HYPONATREMIA

Question 4

What are isotonic solutions used for? What do we monitor for?

Answer 4

Expand intravascular volume. Same solute load as ECF.

Blood Loss
Dehydration
Surgery

! Fluid Overload !

Question 5

What are hypotonic solutions used for? What do we monitor for? Who do we NOT give hypotonic solutions to?

Answer 5

To hydrate a cell, Diabetic Ketoacidosis, and hyperglycemia. Shifts fluid into cell. Hypotonic solutions have less solutes than ECF so they draw fluid

CV collapse, inner cranial pressure

burns, hypovolemia, increased cranial pressure patients

Question 6

What are hypertonic solutions used for? What to watch for?

Answer 6

Shift fluid from cells into vessels. More solute than ECF. Intravascular dehydration, hyponatremia, cerebral edema

Pulmonary edema

Question 7

How to prevent CRBSI?

Answer 7

1. Hand Hygiene/staffing
2. Site, Central Line is best
3. Maximum sterile barrier
4. Skin asepsis
5. Daily review of line necessity

Question 8

Nursing responsibilities for TPN?

Answer 8

• Must be administered into large vein via TLC or PICC
• Need CXR after insertion
• Monitor fluid, electrolyte balance (BMP daily)
• Monitor additional labs
• Dedicated TPN line, nothing else goes through it
• keep refrigerated
• check BG q4-6 hours
• if TPN bag runs out before another is available, hang 10% dextrose until new one arrives
• gradually taper when discontinuing
• strict ASEPSIS care ( change IV tubing and bag DAILY)
• need time to adjust to high glucose, wean on and off 1-2 days

Question 9

Does administration of TPN place patient at risk for infection?

Answer 9

Yes, Bag/IV line full of TPN is breeding ground for bacteria

Question 10

Can TPN be used in conjunction with oral diet?

Can I abruptly stop TPN?

Answer 10

Yes.

DO NOT abruptly stop, will bottom glucose

Question 11

IV Therapy Key Points

Answer 11

• Change Peripheral IV q72-96 hours
• line change 3-4 days
• bag changes daily
• IV site monitored q2h
• IV bags for intermittent infusion changed q24hours
• scrub hub ASEPSIS 15 seconds
• maintain integrity of system

IV Therapy CANNOT be delegated to UAP

Question 12

Circulatory Overload Findings and Interventions

Answer 12

Edema, Crackles, Shortness of Breath

Reduce IV rate
Notify HCP
Raise HOB
Monitor VS and labs

Question 13

Infiltration Findings and Interventions

Answer 13

Skin is cool and taught(tight)

Stop infusion/Discontinue line/Start new line
Evaluate extremity
Apply warm or cold compress

Question 14

Phlebitis Findings and Interventions

Answer 14

Redness, Tenderness, Pain, Warm Veins

Stop infusion/Discontinue line/Start new line
Apply warm compress
DO NOT rub or massage area
Contact HCP if needed

Question 15

Local Infection Findings and Interventions

Answer 15

Redness, heat, SWELLING, POSSIBLE DRAINAGE

Culture any drainage
Remove and start new IV
Notify HCP

Question 16

Bleeding Findings and Interventions

Answer 16

Fresh blood, pooling

Asses if IV intact
Apply pressure
Start new line if needed

Question 17

Dehydration S/S?

Answer 17

Increased HR, THREADY pulse
Low BP, urine output, skin turgor, weight
Dry mucosa
Absence of edema
Concentrated, yellow urine. Increased Specific Gravity

LABS: BUN, creatinine, HGB, HCT

Question 18

Fluid Overload S/S?

Answer 18

Increased HR, BOUNDING pulse
Increased BP, weight
UOP normal
Crackles, wheezes, edema. ascites, large abdominal girth
Urine is dilute, decreased Specific gravity
Watch same labs as Dehydration + Albumin