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N242 > Module 4 > Flashcards

Module 4 Flashcards

1
Q

what are the signs & symptoms or tourniquet retention

A

transient pain, edema, parenthesis, leak @ site, may slow rate or may infiltrate, compartment syndrome

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2
Q

what are the signs & symptoms of misconnection

A

Pain, fever, chest pain, dyspnea, anaphylaxis, cardiopulmonary crest, seizure, altered mental status, sepsis, coagulopathies. Varies a lot could be insidious or abrupt

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3
Q

what are the signs and symptoms of phlebitis

A

pain, swell, tender, local or streaking erythema, venous cording

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4
Q

what are the sings and symptoms of air embolism

A

dynode, cough, wheeze, chest/ shoulder pain, agitation, sense of doom, tachypnea, tachycardia, hypotension, stroke type findings, harsh systolic murmur

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5
Q

signs and symptoms of device fragmentation embolization

A

palpitations, arrhythmias, chest pain, SOB, cough, swell, pain, confusion, hypotension, inability to flush or aspirate blood

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6
Q

signs and symptoms cathater associated venous thrombosis

A

mostly asymptomatic, pain edema, venous engorgment, difficulty moving shoulder or neck or chest - PE symptoms

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7
Q

signs and symptoms of infiltration

A

inadvertent admin of nonvesicant solution into SC tissues

Pain, burn @ incision & along Vascular, edema, colonies, blanching, leak & local parenthesis AVOID PRESSURe

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8
Q

signs and symptoms of extravasation

A

blister, slough, necrosis

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9
Q

signs and symptoms of infection

A

local induration, erythema, tender, drainage, systemic. rare but if its attributed to phlebitis then remove.

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10
Q

who is most at risk for tourniquet retention

A

those who are at risk are those who cannot communicate symptoms

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11
Q

what are the contributing factors to tourniquet retention

A

Obesity, decreased pain perception, impaired communication, distracted provider, short tourniquet or poor visibility

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12
Q

how to prevent tourniquet retention

A
  • long/bright
  • don’t roll up sleeve/ place over clothes
  • keep visible
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13
Q

how to recover from tourniquet retention

A

remove, assess, inform provider, document, report, inform family

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14
Q

what is the risk factors for misconnection

A 
OVERCOMPATIBILITY 
-transition/transfer reconnection 
-low recognition of of risk 
poor lighting / don't want to disturb 
proximity 
overcompatility
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15
Q

what is the most common complication

A

phlebitis

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16
Q

when may phlebitis occur

A

up to 48 hours after removal

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17
Q

where is the worst place you could put a PICC

A

antecubital fossa

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18
Q

how often should you change SPC

A

72-96 hours

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19
Q

what are risk factors for phlebitis

A

-Increased age, female, fragile, bad veins, malignant neoplasm, bad pacmenet/mgmt/assess, hand for spa or antecubital fossa for PICC, leg diameter, poorly secured, over 72-96 hours or what material was infused

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20
Q

how should you recover from the phlebitis

A
  • remove
  • assess
  • notify provider
  • culture tip
  • report
  • disclose
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21
Q

Air embolism

A

uncommon but highly lethal - no safe volume
LETHAL = 50ml (or 3-5ml per kg) up to 20ml if rapid
the lungs can filter 0.35ml/kg/min

22
Q

what are the risk factors for air embolism

A 
hypovolemia 
asymptomatic patent foramen oval 
misconnection 
dismiss air in the line 
suboptimal removal/insert 
inserting above the heart
23
Q

how to prevent air embolism

A

don’t leave unprimed tubing out
clamp when puncturing
occlusive dressing

24
Q

what is the recovery for air embolism

A 
stop tx 
left tredndelenberg or left lateral decubitus 
O2 100% face mask 
aspirate air 
contact physician, report, disclose
25
Q

what increases the risk of fragment embolization

A

1) Pico between clavicle & 1st rib
2) Baddly secured
3) Improper storage
4) power injection

26
Q

how to prevent fragmentation embolization

A

don’t remove PICC agains resistance

limit scissors, don’t repair

27
Q

how to recover from fragmentation embolization

A

keep device
chest Xray
report
disclose

28
Q

what are the purposes of IV’s

A

Parenteral nutrition, blood monitoring, fluid, drugs, testing

29
Q

EXPLAIN ISOTONIC SOLN

A

-Same osmolarity as body fluid (250-375 mOsm/L)
-Increased risk fluid overload in renal or cardiac disease
-use because fluid is decreased (hemorrhage, diarrhea, vom)
= fluid resuscitation
-initially will stay intravascular
-no movement into or out of ICF compartment
-FOR INTRAVASCULAR DEHYDRATION
-Ex. NSm LR, D5W

30
Q

EXPLAIN HYPERTONIC SOLN

A
  • shrink cells
  • soln pull fluid out of cells into extracellular b/c soln has more solute than cell does
  • INDICATIONS: hyponatremic (sodium leaves with fluid) or cerebral edema or intravascular dehydration with intracellular or interstitial overload
  • out of ICF & interstitial compartment into intravascular
  • osmolarity >375
  • irritating to vein increases risk of HF & pulmonary edema
  • Examples: D5NS D5 1/2 NS, D5LR, D10W
31
Q

Explain hypotonic SOLN

A
  • exacerbates hypotension
  • pull fluid into the cell (Swell)
  • for intracellular dehydration
  • <250mosml
  • fluid shift into ICF & interstitial
  • 1/2 NS or 2.5DW or o.33 saline
32
Q

when should you use a CVAD

A

-high or low ph
osmolarity 900+
parental nutrition
vesicants

33
Q

what is the steel needle winged butteryfly

A
  • one time for push or phlebotomy

- osmolairty <900

34
Q

what is the short over the needle cath

A

7.5 cm or less than 3 inchest
continuous or intermittent
short term

35
Q

what is the midline cath for

A

7.5-20cm
-continous or intermittent
-1-4 weeks
<900mosml

36
Q

IV gauge 14-18

A

Trauma, surgery, rapid blood transfusion or fluid

37
Q

IV gauge 20

A

Continous or intermittent blood transfusion in adults

38
Q

22-24 gauge IV

A

continuous or intermittent all ages or blood transfusion in kids & elders

39
Q

Symptoms of fluid volume deficit

A

decreased urine output, dry mucuous membrane, decreased cap refill, disparity in central vs. peri pulses, tachycardia, hypotension, shock

40
Q

symtoms in fluid excess

A

dyspnea, edema, crackles, increased urine output,

*otify provider, adjust infusion rate, type of fluid

41
Q

what to do for chemical phlebitis

A

heat, elevate, slow infusion, think about removal

42
Q

what to do about mechanical phlebitis

A

heat, elevate, monitor 1-2 days about removal

43
Q

what to do for bacterial phlebitis or hematoma

A

remove, remove

44
Q

Explain phlebitis scale

A 
1= erythema with or without pain 
2= pain, erythema with out without edema
3= pain with erythema &amp; or edema. Streak &amp; cod 
4= same as 3, a cord larger than 2.5 cm &amp; purulent drainage
45
Q

Explain visual infusion phlebitis scale

A 
1= pain or red
2= pain red or swell 
3= pain along cannula, induration 
4= same as 3 &amp; palpable venous cord 
5) same as 4 but also pyrexia
46
Q

how often check IV & pump

A

once an hr

47
Q

explain paediatric maintenance fluid

A

100ml/kg for first 10kg
50 ml for next 10 kg
20ml/kg kg for the rest

48
Q

signs of deficient fluid

A 
hypotensive with increased HR 
lost more than 1 kg in a day 
decreased output 
inelastic skin 
thirst, weak, dry
49
Q

explain when you would use a PICC

A

LT or vein irritant (1-4 weeks)
limited or poor veins
need large volume

50
Q

Infiltration scale

A

1= blanched, 1 inch edema, cool with or without pain
2= above + 2.54- 15.2 cm edema
3= Increased translucent >15.cm edema, pain & numbness
4=blanches, translucent, leaky, tight, discoloured, bruised, sloweelen, deep pit, impaired circulation ,moderarte to severe pain, infiltrate of blood or vesicant

N242 (6 decks)

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