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Medical Surgical Nursing - First Sem > IV Therapy (SL) > Flashcards

IV Therapy (SL) Flashcards

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1
Q

Do IV medications require doctor’s orders?

A

YES

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2
Q

What is the purpose of IV therapy? (SLB)

A
  1. To supply electrolytes, fluids, glucose, vitamins, medications = restores acid-base balance
  2. To establish lifeline for rapidly needed medications
  3. Restore volumes of blood components
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3
Q

Types of Solutions based on concentration (IHH)

A

Isotonic: D5W, LRS, ,SS
Hypertonic: .45%
Hypotonic: .33%

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4
Q

Types of Solutions based on purpose (NEAAE)

A 
Nutrient
Electrolyte
Alkalizing
Acidifying
Blood Volume Expander
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5
Q

What is the formula for flow rate in ml/hr?

A

total infusion volume / total infusion time

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6
Q

What is the formula for flow rate in gtts/min?

A

(total infusion volume x drop factor) / (total infusion time x minutes)

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7
Q

Factors affecting flow rate (PPHIS)

A 
Position of arm: bend = slow
Patency of tubing
Height of bottle: higher = faster
Infiltration
Size of catheter to vein
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8
Q

Identify the four vein sites on the back of the hand (TSVB)

A

Tributaries of cephalic vein
Superficial dorsal vein
Venous arch
Basilic vein

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9
Q

Vein access sites for infants (SF)

A

Scalp

Top of foot

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10
Q

IV Locations (4, BFEF)

A

Back of hand
Forearm
Elbow / antecubital
Top of foot

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11
Q

What principle do we follow in choosing iv location to preserve veins of px?

A

Distal-proximal, non-dominant hand first

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12
Q

The selected vein must be (PSNL)

A

Easily palpable
Soft
Naturally splinted by bone
Large enough to accomodate catheter

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13
Q

Blood transfusions require G_/G_ because they have ___ bores or diameters

A

18/20

Large

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14
Q

What happens to the veins of patients undergoing chemotherapy?

A

They shrink and become brittle

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15
Q

Give at least 3 things that we need to assess in patients for IV therapy

A 
Duration of IVT
Size of cannula
Skin
Type of Solution
LOC
Activity
Age (pedia/geria = hard)
Dominant Arm
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16
Q

When preparing to initiate iV meds, we must check (ECHOA)

A 
Expiry date
Clarity of solution
Holes in bottle
Doctor's orders: type, amount, infusion rate
Additional meds to be infused
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17
Q

What are the two types of catheter?

A

Intravenous

Butterfly

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18
Q

Match the gauge number to its corresponding color:

  1. 18G
  2. 20G
  3. 22G
  4. 24G
  5. 26G
A. Purple
B. Yellow
C. Pink
D. Green
E. Blue
A 
1D
2C
3E
4B
5A

Green-Pink-Blue-Yellow-Purple (GPiBYPu)

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19
Q

The ____ the gauge number, the ___ the bore/diameter (they are ___ proportional)

A

Smaller
Bigger/wider/larger
Inversely

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20
Q

Match the gauge number to its corresponding use:

  1. 18/20G
  2. 22G
  3. 24G

A. Pediatric patients
B. Blood transfusion or operating room
C. Adults, normal meds

A
  1. B
  2. C
  3. A
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21
Q

Used to direct the flow of fluid through an infusion system while allowing multiple tubings to be connected.

A

Three-way stopcock

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22
Q

How to know which end of a stopcock is closed?

A

Kalbo = closed

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23
Q

What is the format of an IV tag?

A

UPPER LEFT:
Name of px
Room#

MIDDLE:
Name of IV Fluid
Infusion Rate

BOTTOM LEFT:
Date
Nurse:

BOTTOM RIGHT:
Time

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24
Q

What are the six rights? (PMDTRD)

A 
Right
Patient
Medication
Dose
Time
Route
Documentation
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25
Q

What is the drop factor for
Microset?
Macroset?

A

Micro: 60 mcgtts/min, usually for pediatric px
Macro: 10/15/20 gtts/min

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26
Q

As nurses, we must refer to a drug reference for ___ and ___

A

Incompatibilities

Side effects

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27
Q

The patient must be informed on (PRA)

A

Procedure
Reason
Arm preference

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28
Q

Give at least 3 clinical factors that will be affected by IV administration

A 
Urine output
VS
Distended neck veins
Breath sounds
Capillary refill
Skin turgor
Edema
Weight
Mucous membranes
Thirst
LOC
Scheduled surgeries/procedures
Laboratory data
Allergies
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29
Q

3 Patient Identifiers

A

Full Name
Birthday
Bracelet

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30
Q

What are the signs and symptoms of complication in IV administration? (ERPEBI)

A 
Edema
Redness
Phlebitis/inflammation
Extravasation/leak
Bleeding
Infection
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31
Q

(T/F) we do not need to perform hand washing prior to opening tubing set

A

FALSE, we need to wash our hands to maintain aseptic technique

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32
Q

Once the tubing set has been opened, we have to keep the tube ___ and the ___ covered

A

Coiled

Spike

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33
Q

Why do we need to place the roller clamp “OFF” and 1-2 inches below drip chamber

A

To prevent leakage

More accuracy in regulation

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34
Q

Where do we hold when we are going to spike the bottle with our DOMINANT hand?

A

On the wing

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35
Q

What motion are we supposed to do when spiking the IV bottle?

A

Twisting

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36
Q

Roller clamp
UP: ___
DOWN: ___

A

Open

Closed

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37
Q

What are the 3 ways we remove bubbles from the IV tubing?

A

STRETCH-KINK
ASPIRATE
KIDNEY BASIN

Stretch tube or kink and flick and adjust roller clamp if needed
Using 5-10 cc syringe and aspirate air through Y-port
Disconnecting iv tubing and letting fluid flow into kidney basin

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38
Q

(T/F) If the patient has a stopcock, it is okay to keep the port that is not going to be used open.

A

FALSE, if not needed = keep closed to prevent leaks when connecting another line/tubing

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39
Q

How do we prevent snagging of the iv tubing?

A

We create a loose loop and tape it to the patient’s catheter

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40
Q

When do we change iv fluids?

A

When only 50 ml is left in the bottle

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41
Q

How do we shake medications?
A. Shake up and down
B. Roll/invert

A

B. shaking up and down can cause bubbles to form

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42
Q

Every _ days, IV insertion site is changed

A

7

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43
Q

IV tubings are to be changed every _ days/ _ hrs

A

3 days / 72 hrs

Max is 1 week, case to case basis

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44
Q

(T/F) When a patient is ordered for IV discontinuation, we just disconnect the tubing from the catheter

A

TRUE. removal of insertion site requires another order (usually when px is going home already)

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45
Q

How do we change gown on a patient with iv?

A

Start on side that is not connected to the IV

Let old and new gown pass through arm and IV tubings

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46
Q

Volume metric controlled chamber is also known as?

A

Soluset

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47
Q

What is a soluset for? what is its regulation?

A

Piggyback medications (antibiotics) or pediatric pxs

Microdrops

48
Q

How do we prime a soluset?

A

PNSS, fill chamber with 30cc

49
Q

It is usually used to increase the RBC, hemoglobin, or

hematocrit levels

A

Packed RBC

50
Q

Used when patient is bleeding or lacks this component

A

Fresh Frozen Plasma

51
Q

For patients with thrombocytopenia (low)

A

Platelets

52
Q

What makes a BT set different from regular IV tubings? what is its regulation?

A

A blood transfusion set has a filter

10 gtts/ml

53
Q

A phlebotomist will get blood and

A

Type and Cross-match

54
Q

What do nurses need to double check prior to blood transfusion? (CTWMRV)

A 
Crossmatching results 
Tag on blood bag (px and donor name)
Weigh bag to know how much cc
Pre-BT medications
If px needs to go to restroom
Baseline VS
55
Q

For the first 15 minutes of BT, the regulation should be _ ml/min or _ gtts/min

After 15 mins, we get _ and regulate as desired in DO

A

2 ml/min or 20 gtts/min

VS

56
Q

During the first 15 mins of BT, the nurse should assess for the ff reactions (DILT)

A

Difficulty breathing
Itching
Low back pain
Increasing temp

57
Q

How do we dispose of blood bags?

A 
Remove needle
Roll with BT set 
Wrap with paper
Write px name, room#, time and date infused
Return to blood bank
58
Q

For BT, what IV fluid is compatible?

A

Only PNSS

59
Q

Every when do we get VS during BT? (5)

A 
Baseline (before transfu)
First 15 mins
After 30 mins
Every hour during BT
An hour after BT finished
60
Q

How long should blood be transfused?

A

4-6 hours only

61
Q

Crackles during BT indicates?

A

circulatory overload or congestion

62
Q

To avoid spoilage when transfusing blood for pediatric px, request blood bank to

A

Divide the blood already

63
Q

What should we do if px has reaction to BT?

A

Immediately stop transfusion (turn stopcock if have)
Flush mainline with PNSS
Inform doctor

64
Q

Types of reactions to BT

A

Anaphylactic shock
Wheezes
Chest pain
Cardiac arrest
Non hemolytic or not r/t destruction of RBC (headache, muscle pain)
Acute Hemolytic (renal failure, DIC, jaundice)

> 10 bags of BT
Dysrhythmia/low BP
Iron overload
Hypocalcemia

65
Q

For platelets, since it is a __ infusion, we use a special infusion set without a filter and nurse stay at bedside

A

fast

66
Q

Total Parenteral Nutrition is also known as ___ and it is used when a px will be on NPO for more than _ days

A

Central Nutrition

3

67
Q

What gauge number is used for TPN? Why?

A

G20 (used for TPB ALONE)

TPN is thick/viscous

68
Q

Since TPN usually has high dextrose content, doctor may order ___

A

Capillary Blood Glucose (CBG) q4h

69
Q

If concentration is : fat emulsion, we have to change IV tubings every _ hrs because ____

A

3:1
24 hrs
Good environment for bacterial growth

70
Q

TPN regulation for first hr:

after:

A

40-60 ml/hr
desired
still depends on hospital policy

71
Q

Once opened, a bag of TPN is good for how long?

A

24 hrs whether fully consumed or not

72
Q

Where do we place tourniquet for IV access selection?

A

Above antecubital fossa or 4-6 inches above proposed site

73
Q

To protect fragile skin during tourniquet use, we can

A

Place over light clothing
Avoid using too tightly
Can also use BP cuff

74
Q

How do we assess for vein condition? (3)

A

DEPENDENT-PALPATE-STROKE/CLOTH

Place extremity in dependent position or press down
Palpate, should feel soft and bouncy
Stroke vein proximal-distal or use warm washcloth = distention

75
Q

How do we clean insertion site (3)?

A

Vertically
Horizontally
Spiral, circling outwards

76
Q

How do we insert ONC or winged needle (venipuncture)?

A

Gently stretch skin w/thumb
10-30 degrees
BEVEL UP
Wait for backflow

77
Q

ONC stands for?

A

Over-the-Needle Catheter

78
Q

How do we regulate IV fluids? (RCCEED)

A

Review doctor’s orders
Calculate
Count for 1 min
Assess for excess fluid, dehydration, electrolyte imbalance

79
Q

What do we d if drip chamber is too full? (3, PIS)

A

Pinch iv tube below it
Invert bottle
Squeeze and release drip chamber

80
Q

What are the signs of phlebitis with a grade of 4? (PRSD)

A

Pain
redness
swelling
purulent drainage

81
Q

What are the signs of infiltration with a grade of 4? (BBEP) What do we do if these are present?

A

Blanched skin
bruising
pitting edema
pain

DISCONTINUE

82
Q

If there are signs of infiltration or phlebitis, we (EW20)

A

Elevate

wrap in warm towel for 20 mins

83
Q

Flow rate for the ff lipids:

  1. 10% emulsion
  2. 20% emulsion
  3. lipids only
  4. lipids in PPN solution

A. 24 hrs
B. 4 hrs
C. 6-12 hrs
D. 6 hrs

A

1B
2D
3C
4A

84
Q

How long do we apply pressure when removing catheter

A

2-3 minutes or

5-10 minutes if w/hx of coagulopathy

85
Q

What material is not necessary when preparing to start IVF?

A. Arm Splint
B. Mask
C. IV Infusion Set
D. Alcohol swab

A

B

86
Q

Which of the following is the initial action of the nurse prior to starting an IV infusion?

A. Perform hand hygiene
B. Open sterile packages
C. Verify patient’s identity
D. Prepare needed articles

A

A.

87
Q

When securing the hub of the IV cannula to the skin, it is very important to:

A. Ensure that the cannula is taped to the tubing or saline/heparin lock device
B. Ensure that the tape does not cover the insertion site
C. Ensure that the extremity is completely immobilized
D. Ensure that the patient is unable to see the insertion site

A

B

88
Q

(T/F) It is not necessary to wear gloves when discontinuing an IV since there is no risk of exposure to blood or body fluids.

A

FALSE (removal of cannula)

89
Q

Which of the following actions are correct when caring for a patient who is on parenteral infusion?

  1. Review patient’s nutritional history
  2. Assess lung sounds for presence of crackles
  3. Assess the patient’s serum triglyceride level
  4. Monitor VS every 10 mins for the first 30 mins after initiation
A

ALL

90
Q

Used intravenous infusion tubing must be discarded properly. What color of the garbage bin must it be discarded?

A

yellow

91
Q

When should IV dressings be changed?

A

Every 48 hrs / 2 days

92
Q

Within __ mins of release of blood from blood bank, we have to administer this

A

30

93
Q

What is osmolality?

A

Amt of dissolved particles in a fluid

94
Q

Which iv site is prone to infection?

A

Top of foot

95
Q

After we wipe the dressing w/an alcohol swab and remove them ____, we have to support the iV catheter to prevent ____

A

one by one/layer by layer

sudden removal

96
Q

When should pre-BT medications be given?

A

Before getting blood from the blood bank

97
Q

Where can we insert the line for BT?

A

Y-port + tape to main line

Stopcock cleaned with alcohol swab

98
Q

Why do we need to return blood bags to the blood bank for disposal?

A

Blood banks keep it in case a px develops a late reaction, cause can be traced

99
Q

(T/F) It is ok to choose an IV site that may interfere with ADL’s since px can learn to cope with this.

A

FALSE, we can choose other sites

100
Q

(T/F) When dressing an iv site, we should cover the connection of the tubing and catheter hub

A

FALSE, it should be kept visible to check for blockage

101
Q

Do we still need to prime the IV tubing if we will use an infusion pump?

A

Yes, then we connect it to the catheter and set the pump to the desired ml/hr

102
Q

When adding piggyback medications to a NEW container, we should always check for ____

A

Compatibility

103
Q

Before injecting medications in the port, we should always ____

A

Wipe port w/alcohol swab

104
Q

When adding piggyback medications to an EXISTING container, what do we need to check? (APTR)

A

Enough amount of solution to dilute medication

Pause IVT/pump

Turn bottle to prevent administration of bolus (high conc) medication

Reestablish primary infusion after piggyback meds (restarts after naubos na PB)

105
Q

What does MAR stand for?

A

Medication Administration Record

106
Q

When hanging a piggyback medication, it should be placed ____ the primary fluid bag

A

ABOVE

higher = faster

107
Q

After infusion of piggyback medications, we can ____ or ___ the bag and tubing for ____

A

discard or leave

for next piggyback meds

108
Q

Identify the steps in administering IV Bolus through EXISTING LINE (DSWAIP)

A 
Dilute
Use stopcock
Wipe port
Aspirate for backflow
Inject w/watch
Pinch main line when pushing
109
Q

Identify the steps in administering IV Bolus through SALINE LOCK (WS/AARPS)

A 
Wipe port
Inject saline + expel air
Aspirate
If resistance occurs, stop and discontinue
Push within recommended time
Inject second saline
110
Q

What should we check for in a 3-in-1 TPN soln? WHat should we do to troubleshoot this problem?

A

Fat separation

agitate the bag for fat droplets of 1-2 cm

111
Q

What is the initial infusion rate for TPN?

A

40-60 ml/hr

112
Q

Guidelines for TPN infusion (DBIAI)

A 
Different line for IV meds
Do not use same port for blood sample/CVP
Do not interrupt TPN
Follow asepsis
Assess for lipid intolerance
113
Q

What are signs of intolerance to fat emulsion? (TTCHNP)

A 
Increased triglycerides
Increased temp
Chills
Headache
Nausea + vomiting
Chest pain
114
Q

IF TPN bottle is refrigerated, what should we do?

A

Let bottle come to room temp for 30 mins

115
Q

1 gtts = _ mcgtts

1 ml/hr = 1 ___

A

1 gtts = 4 mcgtts

1 ml/hr = 1 mcgtts/min

116
Q

Righty =

Lefty =

A

righty tighty

lefty loosey

117
Q

Aftercare post-IVT includes (CFYGHD)

A

Check if catheter is complete

Throw excess fluid in TOILET

Throw iv catheter, tubings, and bottle in YELLOW trashcan

Remove gloves + handwash

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Medical Surgical Nursing - First Sem (9 decks)

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