Nursing techniques Midterm One Flashcards
What are four situations which IVs may be used?
1) Medications to be rapidly infused
2) Repleace fluid loss volume
3) TPN
4) NPO status
5) blood transfusions
What are two disadvantages to IV therapy?
direct invasion to the body, difficult to find vein, cannot be reversed if wrong dose given
What are localized complications of IV therapy?
Phlebitis, infiltration, infection and cellulitis
How often should IV tubing be changed?
q72h
How high should the bag be above the patient’s heart
3 feet
What types of catheter are most likely to have air embolism?
Central lines
What patients are at risk of fluid fluid overload?
ELderly, heart or kidney disease
Why is healing by primary intention preferable to secondary intention?
Primary - edges are closed, healing occurs quickly and decreases risk of infection
Secondary - wound remains open until scar tissue forms. Requires longer to heal thus more chance of infection
What are factors which delay wound healing?
1) Nutritional deficiencies
2) Inadequate blood supply
3) Corticosteroid drugs
4) Diabetes Mellitus
5) Anemia
6) Friction on wound, poor health
What is well approximated?
Incision line is closed with no gaps or leaking fluid.
What are factors which promote wound healing?
proper nutrition, proper wound care, moist, warm environment, keeping blood sugars normal, proper Hgb and oxygenation
When does deheiscence occur?
POD 4-8
Which side do you stand for dressing changes?
Drain side
What is min TKVO rate? Normal?
10-15ml/hr - 30-50ml/hr
How long can IV be clamped for?
2 mins before vein loses patency
What is the appropriate site for intradermal injections? Sub Q? IM?
Intradermal: Forearm, 3-4 fingers below elbow, one handbredth above wrist or upper back
SQ: Vascular areas of upper arm, abdo from costal margins to illiac crest, ant aspect of thighs
IM: Ventrogluteal, vastus lateralis & deltoid
What is the most important precaution when giving injections?
DOn’t recap needle
What IM site is no longer recommended?
Dorsogluteal - irritation of the sciatica nerve
Why is the Z track method used?
To ensure medication remains in deep muscle to prevent irritation
What needle length and gauges are required for intradermal injections, SQ injections and IM injections?
ID: 3/8 - 5/8th inch, 25 - 27 gauge
SQ: 1/2 - 5/8th inch, medium gauge
IM: 1 - 11/2 inch, 22-27 gauge
Where should SQ arm injection be given
3 inches below shoulder
What injections do you aspirate?
IM only
How long are SQ butterflies good for?
3-7days
What is the max amount of medication that can be injected IM in the deltoid? Gluteal?
1 ml
3ml
S&S of hypoglycemia?
Irritability, slurred speach, tachycardia, diaphoresis, confusion, fatigue, restlessness, tremors, clammy, unsteady gait, mood changes
What can cause hypoglycemia in a hospital patient?
Missed meals dt tests, too much insulin given, nutritional deficienct dt N&Vm physiological stress rseponse, new medications, over exertion
Common S&S of hyperglycemia?
Frequent urination, increase thirst and hunger, drowsiness, blurred vision, altered LOC, weakness, smelly urine
When should you do BGM?
before meals
Normal blood sugars?
5-9mmol
What should be given to a hypoglycemia patient?
If just <4, 15g of carbs (juice, jello, apply sauce), cheese, PB
What values should the RN double check?
20
What is a normal blood sugar POD 1?
8-13mmol
How much air should be put in a NG tube before it is rmeoved?
20cc
How long do you have before a specimen is sent to the lab?
15 mins
Reasons for hypotension in post op patient?
blood loss from surgery, decreased circulatory volume, SE of anesthetic, dt preop medication
Major complicatoins from not ambulating?
Paralytic illeus, DVT, pneumonia
When should a hemovac be removed?
After 1-3 days and the wound is draining <50cc/hr
What proportion of fluid is in the intracellular fluid? extracellular fluid?
ICF: 2/3 ECF 1/3
What is Osmolality?
number or osmoles/ L of solute + solvent
What is TOnicity?
relative osmolality of a solution compared to the body
What is osmotic pressure?
Force which draws H2O through a semi-permeable membrane
What is the third shift?
When fluid moves from the intravascular space to a 3rd body (lumen which shouldn’t support circulation
What are examples of internal fluid losses?
Internal hemmorhage, long bone fractures, spleen ruptures
What are examples of external fluid loss?
hemorrhage, vomitting, diarrhea
Which factors increase fluid needs?
restlessness, fever, high ambient temperatures
What causeas decreased fluid requirements?
hypothermia, increased humidity, increased ICP, decreased LOC
What are the osmolalities of hypotonic, isotonic and hypertonic therapies?
Hypo: 400
What are the different types of fluid therapies
Crystalloids, Colloids, lbood components
What is normal human osmolality?
275-300
What are crystalloids?
Fluids which can pass through a semi-permeable membrane (vascular, interstitial & intracellular spaces)
When are isotonic solutions given? What are examples? What do you need to monitor for?
Given to expand extravascular volume (in cases of diarrhea, vomitting, loss of fluid during surgery, waiting for surgery)
ie NaCl .9%, Lactate Ringers
Monitor for fluid overload
When are hypotonic solutions given? What are examples? What do you need to monitor for?
Used to replace intracellular fluid (in cases of hyponatremia, cellular dehydration.
Can cause vascular depletion and increased ICP. Do not use with stroke, head trauma, severe burns, malnutrition or liver disease patients.
ie .45%NS & 2.5% NS w/wo D5Q
When are hypertonic solutions given? What are examples? What do you need to monitor for?
Given to increased ECF. Used in acid-base imbalances and electrolyte imbalances
Incrreases risk of fluid overload.
Do not use in diabetic patients, cardiac or renal conditions
ie. D5NS, 3%NaCl, D10W
WHat is special about >500 mosm (D10W)
Must be admnistered in central line
WHat are colloids? Why are they given
Hypertonic products which contain undissolved particles - protein, sugar etc. Last longer than hypertonic solutions.
Expand plasma. Used in acute situations such as massive bleeding from trauma, shock or surgery
ie. albumin, dextran
