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NURS 3530 - Nursing Skills 3 > Lab 1: IV Infusions > Flashcards

Lab 1: IV Infusions Flashcards

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1
Q

list 5 reasons why an IV infusion might be ordered

A
  • NPO (ex. for surgery)
  • replace losses (ex. NVD)
  • diabetes insipidus
  • blood loss (ex. trauma, surgery)
  • insensible losses (ex. burns)
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2
Q

what are 2 types of IV fluid therapy

A
  • maintenance therapy = water & electrolytes

- replacement fluid therapy –> hypernatremia, adding K

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3
Q

what is parental nutrition

A
  • IV feeding
  • delivers nutritonal formula that contains nutrients such as glucose, salts, amino acids, lipids, and added vitamins & dietary minerals
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4
Q

what are 2 types of parental nutrition

A
  1. partial

2. total

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5
Q

what is partial parental nutrition

A
  • supplies only part of daily nutritional requirements

- supplements oral intake

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6
Q

what is total parental nutrition

A
  • supplies all daily nutrient requirements
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7
Q

where can total parental nutrition be used? what is required for it?

A
  • can be used at home or at hospital

- v concentrated & can cause thrombosis of peripheral veins = requires a central venous catheter

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8
Q

what are the 3 types of IV solution

A
  • hypotonic
  • isotonic
  • hypertonic
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9
Q

what are 3 types of isotonic solutions

A
  • 0.9% NS
  • lactated ringer
  • D5W
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10
Q

what is the action of NS and LR (4)

A
  • no fluid shift
  • vascular (blood vessel) expansion
  • replace fluid loss
  • electrolyte replacement
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11
Q

what are indications for NS (5)

A
  • shock
  • resuscitation
  • blood transfusions
  • hyponatremia
  • DKA
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12
Q

what is a risk associated w 0.9 NS

A
  • fluid overload
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13
Q

who should you use caution in with 0.9% NS (4)

A
  • HTN
  • HF
  • edema
  • hypernatremia
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14
Q

what are indications for LR (5)

A
  • dehydration
  • burns
  • GI tract fluid losses
  • acute blood loss
  • hypovolemia
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15
Q

what are 2 risks associated w LR

A
  • hyperkalemia

- fluid overload

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16
Q

who should you use caution in with LR (2)

A
  • liver disease

- cardiac pts

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17
Q

why should you use caution in someone w liver disease r/t LR

A
  • liver cannot metabolize lactate
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18
Q

what are the indications for D5W (dextrose in water) (4)

A
  • fluid loss
  • dehydration
  • hypernatremia
  • hyperkalemia
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19
Q

what is a risk associated w D5W

A
  • vein irritation
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20
Q

who should you use caution in with D5W (3)

A
  • increased ICP pts (head injury pts)
  • renal pts
  • cardiac pts
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21
Q

how does D5W change once it enters the body

A
  • once inside the body, it becomes metabolized & becomes hypotonic
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22
Q

who do isotonic solutions do

A
  • remain in the vasculature = expand blood vessel volume
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23
Q

who do hypotonic solutions do (3)

A
  • shift fluid into cells
  • treats cell dehydration
  • provides free water
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24
Q

who does D5W do

A
  • shifts fluid into cells

- hydrates cells

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25
Q

what are 2 types of hypotonic solution

A
  • 0.45% NaCl (1/2 NS)

- 0.33% NaCl (1/3 NS)

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26
Q

what are the indications for hypotonic solution (4)

A
  • hypertonic fluid imbalance
  • improve renal fnxn
  • fluid loss
  • cellular dehydration
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27
Q

what are risks associated w hypotonic solutions (5)

A
  • hypotension
  • increased peripheral edema
  • increased ICP
  • hyponatremia
  • IV site phlebitis and infiltration
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28
Q

who should you use caution in with hypotonic solution (4)

A
  • stroke
  • head trauma pts
  • increased ICP pts
  • severe burn pts
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29
Q

what is the action of hypertonic solution (2)

A
  • shifts fluid into vessels

- causes cells to shrink

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30
Q

what are 5 types of hypertonic solution

A
  • D5LR
  • D5NS
  • D51/2NS
  • 3 % NaCl
  • 5% NaCl
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31
Q

what are indications for D5LR (7)

A
  • electrolyte replacement
  • dehydration
  • burns
  • GI tract fluid losses
  • acute blood loss
  • nutrition(provide cals)
  • hypovolemia
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32
Q

what are risks associated w D5LR (5)

A
  • fluid overload
  • pulm edema
  • hyperglycemia
  • hyperkalemia
  • IV site phlebitis and infiltration
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33
Q

who should you use caution w D5LR (3)

A
  • DKA
  • cardiac pts
  • renal pts
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34
Q

what are indications for D5NS (3)

A
  • fluid loss
  • hyponatremia
  • nutrition
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35
Q

what are risks associated w D5NS (4)

A
  • fluid overload
  • pulm edema
  • hyperglycemia
  • IV site phlebitis and infiltration
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36
Q

who should you use caution in w D5NS (3)

A
  • DKA
  • cardiac pts
  • renal pts
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37
Q

what are indications for D5 .45 NS (3)

A
  • post-op
  • nutrition
  • rehydration
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38
Q

what are risks associated w D5 .45 NS (4)

A
  • fluid overload
  • pulm edema
  • hyperglycemia
  • IV site phlebitis and infiltration
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39
Q

who should you use caution in w D5 .45 NS (3)

A
  • DKA
  • cardiac pts
  • renal pts
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40
Q

what should you make sure to check before giving IV fluids (2)

A
  • verify physicians order

- right reason?

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41
Q

what are important things to do when giving K+ (which is a high risk med) (2)

A
  • need a 2 nurse check

- recheck any time you change the rate

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42
Q

what effect does hypervolemia have on the cardio system (3)

A
  • increased BP
  • tachycardia
  • irregular HR
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43
Q

what effect does hypervolemia have on the resp. system (3)

A
  • crackles
  • SOB
  • pulmonary congestion
44
Q

what effect would hypervolemia have on body comp/ on observation of the pts body (3)

A
  • peripheral edema (dependent, pitting)
  • weight gain
  • distended neck vein
45
Q

what effect would hypervolemia have on the GI system (2)

A
  • anorexia

- NV

46
Q

what effect would hypervolemia have on the neuro system (4)

A
  • headache
  • changes in LOC
  • confusion
  • seizures
47
Q

what should you do if someone is experiencing signs of hypervolemia (4)

A
  • alert MD
  • assess
  • give O2
  • frequent monitoring
48
Q

what med could you give for hypervolemia

A
  • lasix (slow infusion
49
Q

what effect would hypovolemia have on the cardiac system (4)

A
  • tachycardia
  • low BP
  • thready pulse
  • low CO
50
Q

what effect would hypovolemia have on the GI/urinary system (4)

A
  • low urine output
  • anorexia
  • NV
  • thirst
51
Q

what effect would hypovolemia have on the resp system (2)

A
  • rapid breathing

- shallow resp.

52
Q

what effect would hypovolemia have on the neuro system (5)

A
  • restlessness
  • anxiety
  • lethargy
  • confusion
  • behavioral changes
53
Q

what effect would hypovolemia have on the skin (4)

A
  • decreased skin turgor
  • pale
  • clammy
  • cool
54
Q

what should you do if someone is experiencing hypovolemia

A
  • assess
  • alert MD
  • may need fluids
  • O2
  • identify cause
  • frequent monitoring
55
Q

how often should you change the tubing on a primary infusion

A
  • every 96 hr
56
Q

how often should you change the IV bag on a primary infusion

A
  • every 24 hr
57
Q

what are potential IV complications (7)

A
  • infection
  • phlebitis
  • infiltration
  • extravasation
  • circulatory overload
  • thrombophlebitis
  • hematoma
58
Q

what are signs of infection at the IV site (5)

A
  • red
  • warmth
  • swelling
  • pain
  • purulent drainage
59
Q

what should you do if you suspect/there is infection at the IV site (3)

A
  • d/c the IV line
  • express drainage is present
  • send catheter tip for culture
60
Q

what is important to prevent infection at the IV site

A
  • use aseptic technique when initiating & managing an IV line
61
Q

what is phlebitis

A
  • inflammation of the vein
62
Q

what are 3 categories of causes of phlebitis

A
  • mechanical
  • chemical
  • bacterial
63
Q

what could cause mechanical phlebitis (3)

A
  • movement of cannula
  • poor blood flow around cannula
  • unskilled venipuncture
64
Q

what could cause chemical phlebitis (3)

A
  • low pH
  • high osmolality
  • drugs (concentrated)
65
Q

what could cause bacterial phlebitis (3)

A
  • poor technique
  • contaminated solution or equipment
  • endogenous
66
Q

what are S&S of phlebitis (5)

A
  • pain
  • redness
  • warmth
  • edema
  • vein hard, red, and cord like (streaking)
67
Q

what is Tx of phlebitis (3)

A
  • d/c IV
  • warm moist compress for 20 min, qid
  • restart infusion in opposite limb if possible
68
Q

what is important ti prevent phlebitis

A
  • monitor the IV site every hr for redness and tenderness
69
Q

what is infiltration

A
  • leakage of IV solution or medication (non-vesicant) into the extravascular tissue
70
Q

what causes infiltration

A
  • Iv catheter dislodged & fluid infuses into tissue
71
Q

S&S of infiltration (6)

A
  • edema
  • pallor
  • decreased skin temp around site –> cold, clammy skin
  • pain
  • blanching
  • burning
72
Q

what is Tx of infiltration (3)

A
  • d/c line
  • elevate the extremitity
  • apply warm compress at site to absorb fluid
73
Q

what is extravasation

A
  • leakage of a vesicant (irritating agent that causes blistering)
74
Q

what can cause extravasation(3)

A
  • peripheral catheter erodes thru vessel wall
  • increased venous pressure + leakage around original venipuncture site
  • needle pulls out of vein
75
Q

what are symptoms of extravasation (6)

A
  • pain
  • stinging
  • burning
  • swelling
  • redness at site
  • tissue sloughing
76
Q

what is treatment for extravasation (4)

A
  • stop infusion (d/c IV)
  • may aspirate drug
  • ice/cool compress
  • antidote
77
Q

what is a thombophlebitis

A
  • complication of phlebitis

- clot formation at cannula tip/wall of vein

78
Q

what are S&S of thrombophlebitis (4)

A
  • painful
  • swelling
  • edema of extremity
  • sluggish/stopped IV flow
79
Q

what is treatment of thrombophlebitis

A
  • d/c & restart in opposite limb if possible

- warm compress qid, 20 min

80
Q

what is a hematoma

A
  • blood trapped in the tissues causing a swelling containing blood
81
Q

what can cause a hematoma r/t IV infusion (3)

A
  • not enough pressure post IV removal/poke
  • vein punctured thru ventral wall at time of veni puncture
  • leakage of blood from needle displacement
82
Q

what is treatment for a hematoma (4)

A
  • elevate
  • ice
  • pressure
  • monitor for continue bleeding/deficits
  • remove venipuncture device
83
Q

what is circulatory overload

A
  • systemic complciation of IV infusion

- causes excess fluid in circulatory system

84
Q

what are characteristics of circulatory overload

A
  • dyspnea
  • edema
  • hypertension
  • moist breath sounds on auscultation
85
Q

what are possible causes of circ. overload (3)

A
  • miscalculation of fluid requirements
  • flow rate too rapid
  • roller clamp loosened
86
Q

Tx for circulatory overload

A
  • raise HOB

- O2 & meds per order

87
Q

what is important for prevention of circulatory overload

A
  • use pump controller
  • recheck calculations
  • monitor infusions frequently
88
Q

what can cause thrombophlebitis

A
  • injury to endothelial cells of vein wall = platelets stick & thrombus forms
89
Q

what are signs of a hematoma (3)

A
  • tenderness at venipuncture site
  • bruising around site
  • inability to advance or flush line
90
Q

what is a potential systemic complication of IV infusions

A
  • air embolism
91
Q

what are signs of an air embolism

A
  • unequal breath sounds
  • resp. distress
  • weak pulse
  • increased CVP
  • decreased BP
  • loss of consciousness
92
Q

when changing an IV solution, how far in advance should you have the next solution preppared and accessible? why?

A
  • at least 1 hr

- reduces risk of clot formation in vein caused by an empty IV bag

93
Q

when changing an IV solution, when should you prepare to change the solution? why?

A
  • when less than 50 mL of fluid remains
  • or when a new solution is ordered
  • prevents air from entering the tubing and veing from clotting d/t lack of flow
94
Q

how full should the drip chamber be when changing an IV solution? why?

A
  • at least half full

- provides fluid to vein while bag is changed

95
Q

what can be done to remove large portions of air in IV tubing

A
  • swab injection port below the air w alcohol & let dry

- connect syringe to port and aspirate the air into the syringe

96
Q

when should IV tubing be changed? (4)

A
  • every 96 hr
  • puncture of tubing
  • contamination of tubing
  • occlusions in existing tubing after influsion of packed red blood cells, albumin, whole blood, etc
97
Q

how long should you apply pressure to the site after removing the IV catheter

A
  • 2-3 min

- or until no further bleeding is noted

98
Q

what is important to do at all times while changing a peripheral IV dressing

A
  • stabilize the catheter
99
Q

how full should the drip chamber be during an IV infusion

A

1/3 to 1/2 full

100
Q

how high should the IV bag be above the IV site

A
  • 90 cm
101
Q

how often should a PIV dressing be changed

A
  • gauze dressing q2days
  • transparent semipermeable dressing = 5-7 days
  • if gauze is underneath TSM = every 2 days
  • if wet, soiled, or loosened = change immediately
102
Q

what is the minimal rate for KVO

A
  • approx 10-15 mL/hr
103
Q

how often should an IV infusion be assessed

A
  • every hour

proper infusion rate, infusion site, etc.

104
Q

how often should primary intermittent tubing be changed

A

every 24 hr

105
Q

when should IV solutions be changed

A
  • when new order

- when less than 50 mL in bag

106
Q

what should you label an IV dressing with

A
  • time and date of dressing change
  • time and date of insertion
  • gauge and length of catheter
  • nurse’s initials

NURS 3530 - Nursing Skills 3 (4 decks)

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