Lab 12 IV part 2

Question 1

how is O2 sat affected in darker skinned people

Answer 1

An SpO2 reading is usually overestimated in people with darker skin so always have to use clinical judgment when accessing a patient and not just the pulse oxe reading

Question 2

what does JVT indicate

Answer 2

indicates slow blood flow through the superior vena cave or in the right side of the heart

Question 3

what is a normal JVD measurement

Answer 3

usually 4 cm or less

Question 4

what angle is a JVD measurement taken at

Answer 4

usually with the HOB at 45 degrees (since when people lay down they usually have JVD)

Question 5

what does it indicate if a pt has bilateral JVD

Answer 5

this would indicate RHF

Question 6

what does it indicate if a pt has only one distended jugular vein

Answer 6

means there is an obstruction in that vein

Question 7

what causes an S3 sound

Answer 7

when blood leaks through the atrioventricular valve during diastole usually due to a fluid overload

Question 8

whats another name for an S3 sound

Answer 8

Ventricular gallop

Question 9

in what phase of heart contraction is an S3 heard

Answer 9

heard in early diastole

Question 10

what does an S3 sound like

Answer 10

Lub-Dub-a (the extra “a” sound at the end)

Question 11

what is another name for S4

Answer 11

Atrial gallop

Question 12

in what phase of heart contraction is an S4 heard

Answer 12

heard in late diastole

Question 13

what causes an S4 heart sound

Answer 13

results from the sound of the atria pushing blood into a stiff or hypertrophic ventricle or through narrowed AV valves

Question 14

what are the three main mechanisms that cause edema
*think anything that would cause fluid to leak out of the intravascular space

Answer 14

-increased capillary hydrostatic pressure
-Decreased plasma oncotic pressure (the pressure that the plasma proteins create to draw fluid into the cells)
-increased capillary perm

Question 15

what is one condition that can cause increased capillary permeability

Answer 15

an allergic reaction

Question 16

what are 3 conditions that can cause decreased plasma oncotic pressure
*think anything that decreases solutes in the blood

Answer 16

-malnutrition
-liver failure (decreased production of plasma proteins)
-renal failure

Question 17

what is dependant edema

Answer 17

edema of body parts that are lower than the heart that is affected by gravity and position

Question 18

what is generalized edema

Answer 18

edema that is not effected by gravity or where the body part is in relation to the heart

Question 19

what is generalized edema usually caused by

Answer 19

poor venous return

Question 20

what is peripheral edema

Answer 20

edema that affects the lower extremities

Question 21

what type of iv fluid would you use to treat hypovolemia

Answer 21

Lactated Ringers
0.9% NS
blood
**anything Isotonic since you want the fluid to stay in the intravascular space

Question 22

what kind of IV fluid would you use to treat hypervolemia

Answer 22

you wouldn’t use any IV fluid usually since the pt is already overloaded with fluid

Question 23

what is paracentesis

Answer 23

a procedure to remove fluid from the abdomen if the pt has ascites

Question 24

what is thoracentesis

Answer 24

a procedure to remove fluid or air from the lungs

Question 25

what is normal serum levels of Na with units

Answer 25

135-145 mmol/L

Question 26

what IV fluids could you use to correct hyponatremia

Answer 26

-NS 0.9% -if it is very serious you can use hypertonic solutions (3% Na)

Question 27

would fluid restrictions be indicated for a patient that is hyponatremic

Answer 27

yes since if they are drinking lots it will dilute the blood

Question 28

what is body fluid osmolarity

Answer 28

285 mOsm/L

Question 29

if a patient has severe hypokalemia what would a treatment be

Answer 29

40-60 mmol KCL IV

Question 30

what is the max amount of potassium you can give by IV per hour

Answer 30

10-20 mmol/hr MAXIMUM

Question 31

what are the treatments for hyperkalemia

Answer 31

C-Calcium gluconate B-Bicarb IV (causes K to shift into cells) -Insulin -Glucose -Kayexalate (makes you poop out K) -Dialysis -Salbutamol (causes k to shift into cells)

Question 32

what is osmolarity

Answer 32

the number of solute particles per 1 L of solution Osmol/L *so this is a measurement of volume

Question 33

what is osmolality

Answer 33

the number of solute particles per 1 Kg of solution Osmol/Kg *this is a measurement of weight

Question 34

how much K does LR contain in mmol/L

Answer 34

4 mmol/L

Question 35

what are two things a person can do to prevent catheter occlusion

Answer 35

-Flush IV saline locked catheters every 24 hours -ensure the IV bag is hanging at least 1 meter above the patient

Question 36

what are 4 clinical indicators of an interstitial infiltrated IV

Answer 36

-cool to the touch -pallor -swelling -hardness

Question 37

what would be 3 interventions to treat an interstitial infiltrated IV

Answer 37

-Discontinue IV -Warm compress -Elevation of limb

Question 38

what are 3 ways to prevent phlebitis

Answer 38

-avoid infusing acidic alkaline or high osmolality solutions through a peripheral vein -avoid prolonged use of the same vein -avoid movement near the IV site

Question 39

What are clinical indicators of phlebitis

Answer 39

-warmth redness pain -purulent drainage from the site -red line moving up the vein -the vein becoming palpable and starting to feel like a cord

Question 40

what are 3 interventions to treat phlebitis

Answer 40

-discontinue IV -Warm compress -Elevation of limb

Question 41

what would a leaking IV site look like

Answer 41

fluid or blood would be leaking out around the site but the connections would still be secure

Question 42

what are interventions to treat a leaking IV

Answer 42

often the only thing to do is disconnect the IV

Question 43

what is cellulitis

Answer 43

an infection of the skin

Question 44

what are some ways to treat cellulitis if it occurs

Answer 44

-discontinue IV -Warm compress -elevation of limb -IV antibiotics

Question 45

what are some way to treat a hematoma if it forms at an IV site

Answer 45

-discontinue IV -warm compress -elevate limb

Question 46

what is one intervention to try and treat an air embolism

Answer 46

trendelenburg position (lay on left side so the air bubble moves from right atrium to pulmonary artery)

Question 47

what is a vesicant drug

Answer 47

any drug that can cause tissue damage when it escapes the vein and enters the surrounding tissue

Question 48

what is extravasation

Answer 48

when a vesicant medication gets out of the vein and into the surrounding tissue

Question 49

what is speed shock

Answer 49

a systemic reaction caused by administering an IV med to quickly and it creates toxic levels of medication in the plasma

Question 50

what amount of urine does an adult and an older frail pt have to be retaning before a catheter is indicated

Answer 50

residual volume has to be greater than 500 ml in an adult and greater than 250 mL in a frail older client

Question 51

what is a coude tip catheter

Answer 51

an attachment that is used for males with enlarged prostates which makes it easier to insert the catheter

Question 52

what are indications that it is time to remove a urinary catheter

Answer 52

H-hematuria O-Obstruction U-urology surgery (or general surgery) D-Decubitus ulcer (person is incontinent with stage 3 or 4 pressure ulcer) I-Input output (if you need to track input output in critically ill patients) N-Nursing end of life comfort care I-immobilization

Question 53

what is the houdini decision support tool used for

Answer 53

it gives you a list of conditions and if none of them are present the nurse should remove the urinary catheter

Question 54

can a nurse independently remove a catheter without doctors orders

Answer 54

Yes they can

Question 55

when should a catheter drainage bag be emptied

Answer 55

when it is less than 2/3 full or at least every 8 hours

Question 56

how often should a urinary catheter be changed

Answer 56

every 8-12 weeks

Question 57

how often should a catheter bag be changed

Answer 57

should be changed monthly

Question 58

how far do you pull the syringe back when removing the saline solution from the catheter

Answer 58

pull back 0.5 mL to prevent adherence and create a vaccum so it draws out the liquid from the balloon

Question 59

what would a nurse have to monitor after removing a catheter

Answer 59

have to monitor for the time of first voiding and the amount voided after 8 hours

Question 60

what is normal serum potassium levels

Answer 60

3.5-5.3 mmol/L