IV therapy and bloods Flashcards
IV therapy
why may a patient need IV therapy? (2)
- prevent/treat fluid or electrolyte imbalance
- deliver medications, nutrition or blood products
IV therapy
What is the goal of IV therapy? (3)
- maintenance or replacement of fluid
- replacement of fluids/electrolytes
- diagnosis or treatment of a disease
IV therapy
RN roles in IV therapy (6)
- inspecting and documenting peripheral IV site (VIP score) each shift
- preparing solutions for administration
- dressing change
- monitoring IV infusion and patient response
- ensuring that the PIV site is changed (72hrly) and documented as per IV policy
- change IV administration set (as per protocol)
IV therapy
Complications
“Always Inspect For Patient Safety”
Air embolism: seen with central venous access devices (s/s: chest/shoulder pain, dyspnea, hypotension, cyanosis, changed LOC)
Infiltration: tip of cannula slips out of/through vein
Fluid Overload: increased BP, pulse, RR and dyspnea
Phlebitis: infection in the vessel wall
Site infection: bacteria in subcutaneous tissue
Blood transfusions
Blood matching revision
A+ can receive A+/- O+-
B+ can receive B+/- O+/-
AB+ can receive A+/- B+/- AB +/- O+/-
O+ can receive O+/-
A- can receive A- O-
B- can receive B- O-
AB- can receive A- B- AB- O-
O- can receive O-
“Rh+” blood can receive Rh- and Rh+
“Rh-“ blood can only receive Rh-
Blood transfusion- considerations
- theoretical and practical training
- understanding the NZBS guidelines
- equipment
- process of obtaining consent
- patient preparation and monitoring
- recognition/actions in the event of a transfusion reaction
IV therapy
COLLOIDS VS CRYSTALLOIDS solutions and examples
Colloid Fluids: Contain large molecules like proteins or starches that stay in the blood vessels longer, increasing osmotic pressure and helping to expand blood volume. They are often used in situations like severe hypovolemia or shock.
ex: albumin
Crystalloid Fluids: Contain small molecules like electrolytes that can move easily between blood vessels and tissues. They are commonly used for hydration, electrolyte replacement, and initial resuscitation in various medical conditions.
ex: lactated ringers, dextrose, saline
IV fluids solution 3 types and definitions
- HYPERTONIC:
- hyper = “high”
- the fluid solute concentration is higher than blood plasma
- outside > inside
- water moves out of the cell = cell shrinks - HYPOTONIC:
- hypo = “low”
- the fluid solute concentration is lower than blood plasma
- outside < inside
- water move into the cell = cell expand and lyse - ISOTONIC:
- iso = “equal”
- the fluid solute concentration matches or is equal to that of the blood plasma
- outside = inside
- overall concentration are equal. cell remain constant
IV fluids- ISOTONIC solutions (indications, forms, considerations)
Indications:
vomiting, diarrhea (need sodium and chloride back), hypovolemic shock, burns, prior surgery
forms:
1. 0.9% normal saline
- replaces water, sodium, chloride.
- only fluid used with blood
- beware of fluid overload (esp. those with kidney and heart failure)
- monitor BP, breathing/lung sounds (crackles) , edema in peripheries
- check sodium/chloride levels
- Lactated Ringers
- contains water, potassium, sodium, chloride, calcium, lactate
- lactate helps increase blood ph by converting to bicarbonate (for acidotic conditions eg metabolic acidosis)
- not for pts with liver disease or lactic acidosis
- monitor for hyperkalemia - 5% Dextrose in water
- replaces water and glucose
- starts as isotonic but ends as hypotonic solution (because sugar is metabolised = left over is low osmolarity)
- not for fluid resus, helps hypernatremia
IV therapy- HYPERTONIC solutions (indications, forms, considerations)
indications: hyponatremia (low sodium), brain swelling (cerebral edema)
forms:
1. 3% saline
- Dextrose 10% in water
- Dextrose 5% in 0.9% Normal Saline
- Dextrose 5% in 0.45% Normal Saline
considerations:
- could overload the extracellular space leading to pulmonary edema
- could cause hypernatremia (high sodium)
- confirm facility’s protocol (central or peripheral line)
IV therapy- HYPOTONIC solutions (indications, forms, considerations)
Indications: too much solute concentration in blood (hypernatremia), provide free water to help kidneys excrete waste, prevent dehydration
forms:
1. 0.45% Saline
2. 0.225% Saline
3. 0.33% Saline
4. 5% Dextrose in water (once inside the body)
considerations:
- causes cell to swell because fluid moves from ECF to ICF
- can lead to brain swelling
- monitor for mental status changes, low BP, hypovolemia
- hyponatremia
- monitor in fluid sensitive patients (heart/renal failure) because they cannot handle extra water
use of opioids: mechanism
presynaptic inhibition
stimulating opioid receptors leads to:
- change in resting membrane potential
- neurons involved harder to stimulate
- inhibits opening of transmitter channels
- less pain neurotransmitter released in spinal cord/brain
postsynaptic inhibition:
- opioid receptors are also located on cell mebranes of postsynaptic neurons in spinal cord
- activation hyperpolarises cell membranes making it less likely to respond to a neurotransmitter released from the presynaptic nerve
Effects of opioids in the CNS and PNS
CNS
short-term: cough suppression, sedation, nausea/vomiting,
long-term: respiratory depression, dependence/addiction
PNS
- constipation, sphincter spasms, itching
Examples of opioids
- morphine
- pethidine
- fentanyl
- methadone
- oxycodone
Opioid antidote
Naloxone and Naltrexone
- opioid antagonists used to reverse opioid induced respiratory depression
Clinical uses of opioids
- perioperatively to control pain
- acute pain management
- cancer pain
- drug withdrawal
At risk groups for opioids
- in elderly and in infants <1yo, opiate doses need to be reduced because of increased CNS sensitivity and decreased clearance
- in patients with hypovolemia e.g. from burns or trauma, IM medications are poorly absorbed (give via IV)
