Medsurg Exam 1: IV Therapy

Question 1

Patient perspectives and roles

Answer 1

Unpleasant, painful, invasion of space
Patient cant eat or drink
Pre operative, post operative, alterations in mental status, severe physical illness, protracted nausea and or vomiting or both

Question 2

What is the role of the Nurse in IV Therapy

Answer 2

Need to elicit confidence, if you do not succeed go get someone else

Question 3

What do you need to check and monitor for IV medications?

Answer 3

Need to monitor the site and what is needed
Correct solution and the integrity of the solution
clarify/ not expired/ no precipitates
Correct infusion rate
Pump functioning properly
Maintain patency of saline locks

Question 4

Rapid Action of Specific Medications (need it FAST)

Medications that need to administered fast?

Answer 4

Electrolyte imbalances = potassium correction, sodium correction, magnesium, calcium
Cardiac medications
Medications for pain and nausea

Question 5

When would IV therapy be used for rehydration?

Answer 5

Extreme alterations of sodium balance
Heat exhaustion/ heat stroke
Burn injuries
Profound metabolic acidosis

Question 6

When would you use IV therapy in cases of life threatening conditions?

Answer 6

Acute and overwhelming illness: diabetic ketoacidosis, heat stroke, spesis, any variety of other illness/conditions or exacerbations of the same

Vasoactive drips =

IV push critical medications
The only game in town = CroFab Antivenom

Question 7

Vasoactive drips

Answer 7

Vasoactive drips = aka pressors: dopamine, dobutamine, levophed, epinephrine, nipride

Question 8

When would we use IV therapy to deliver blood?

Answer 8

Profound anemia

Hemorrhage / hemorrhagic shock = packed RBC/ FFP/ Platelets

Clotting abnormalities = liver diseases/ hemophilia
I
MPORTANT = IV size is important for these patients
18 gauge angiocath at least for transfusion of blood and blood products in an adult

Question 9

When you need ensuring delivery of the medication ?

Answer 9

Antibiotics
Sepsis
Insulin: IV drip or IVP for diabetic ketoacidosis: versus SQ administration for unusual administration
Anticoagulants and thrombolytics: Heparin, TPA, streptokinase
Chemotherapeutic agents that are IV

Question 10

What are other reasons we would use an IV (Misc.)?

Answer 10

IV access for = Patients comfort (IM vs. IV), rapid delivery of medication, nurses convenience

Emergency department placements, prehospital

Critical care units

Going to the OR

For the What if… especially with a cardiac patient

Question 11

What is the goal of IV therapy ultimately?

Answer 11

Fluid and electrolyte balance, Nutrition status (central lines and PICC lines), Maintain homeostasis via blood and blood product administration, treat numerous conditions with medications

Question 12

What are the 3 steps that are included in a proper IV order?

Answer 12

Specific type of fluid to be administered

Rate of administration must be specific (ml/hr)

TKO and KVO is not considered an appropriate IV rate

Question 13

What does it mean when medications are added to an IVF?

Answer 13

Admixture in the IV it has to be specific (example D5 ½ NS with KCl 40 mEq/l @ 125ml/hr)

IVPB Medications do not consistently list the amount that a drug is mixed in
Ancef 1 gm IV q 8 hours (usually in 50 ml)
Levaquin 750 mg IV daily (usually in 100 ml)
Vancomycin 1 gm IV every 12 hours (often in 250 ml)

Question 14

What are the biggest issues with IV infusion of drugs?

Answer 14

Not all infusions are appropriate for peripheral venous infusions (pH less than 5 or greater than 9 require infusion through a central line)

Proper dilution of medications

Compatibility issues

Rate of insulin? Require a pump? Comfort? Require a cardiac monitor (Dilantin)?

Question 15

Normal blood serum osmolality

Answer 15

290 mOsm/Liter

Question 16

Osmo close to blood is called

Answer 16

Isotonic

Question 17

Over 350 mOsm/L is called

Answer 17

Hypertonic

Question 18

Under 250 mOsm/L is called

Answer 18

Hypotonic

Question 19

4 Types of IV infusions

Answer 19

Volume controlled continuous infusions
IVPB also known as Piggyback infusions
How does it work? 
IV bolus infusions
Blood and blood product infusions: Require a speciality tubing

Question 20

Special Populations

Answer 20

For inpatients = watch serum electrolytes

Ederly patients: less is better, careful with skin

GI losses

Trauma patients: boluses

Burn Patients: volume being infused will be based on the patients percentage burn

Head injuries: infuse less, approx ⅔ of a normal maintenance rate

Question 21

Insensible losses

Answer 21

those we cannot track

Question 22

VADs

Answer 22

Vascular Access Devices

Devices

Question 23

What is a peripheral catheter? 
Insertion site? 
Size Range? 
Placement? 
Pt. History?

Answer 23

Inserted: superficial veins of the hand, forearm
Creative placements are seen when patients lack skin to be pricked (drug abusers)

Size Range
¾ inch to 2 inches 26 gauge to 14 gauge (may be much larger)

Large number of gauge = smaller bore (diameter)
Larger - more irritating

Distal Placement

Patients history: Mastectomy patients, dialysis patients, infants and children

Question 24

What is a midline catheter? 
Insertion site? 
Size Range? 
Placement? 
Pt. History?

Answer 24

6-8 inches long
Antecubital fossa placement
Useful for longer term therapy

Question 25

PICC (Peripherally inserted central catheter) line

Answer 25

Treated as a central line
Who gets these types of catheters?
Who places these catheters?

Question 26

Tunneled Central Catheters

Answer 26

Placed by a physician or NP, have a rough cuff which rests under subcutaneous tissue that forms granulation tissue around same

Distal edge rest in SVC

Physical barrier from microorganism entry

Multiple varieties: Broviac, Hickman, Leonard

Question 27

Implanted Ports

Answer 27

Usually placed in upper chest wall

Require non coring huber needle to access same

Chronically ill patients

May use EMLA cream if protocol

Question 28

Central Lines

Answer 28

Placed by MD or NPs

Rests with distal tip in SVC

At risk for sepsis

Not your first choice for an IV (but think back to why a pH of the drug may require you to use the central line)

Question 29

Dialysis Catheters

Answer 29

DO NOT TOUCH THESE

Question 30

Intraosseous lines

Answer 30

Trauma and children

Question 31

Intraperitoneal infusions

Answer 31

Often chemotx

Question 32

Hypodermoclysis

Answer 32

Subcutaneous infusions

Question 33

Intraspinal infusion

Answer 33

Analgesia, anesthesia

Question 34

Intra-arterial infusions

Answer 34

Some chemotx

Question 35

TPN vs. PPN

Answer 35

PPN patient = unable to eat less than 14 days

PPN infused via a large bore special peripheral line

TPN and PPN combine amino acid solutions with fat emulsions to provide require nutrients

Question 36

TPN

Answer 36

Requires a central line

Is hyperosmotic

Solution is ordered daily and mixed daily based on patients current lab values

Mixed under laminar flow hood

Daily labs: electrolytes and

CBC

Accuchecks

Scrupulous IV site care: TPN IV tubing change daily

Must be filtered: Patient at risk of fluid shifting, risk of sepsis

Question 37

Complications of IV Therapy

11

Answer 37

Alteration of fluid status
Phlebitis = inflammation of the vein 
Thrombosis/Thrombophlebitis
Infiltration
Ecchymosis and Hematoma
Infection: Localize and sepsis 
Allergic rxn 
Vasospasm
Nerve Damage
Extravasation of injurious substances or medications into tissues = tissue necrosis and sloughing
Central Line association and complications