Quiz 5 Practice

Question 0

What is a Hypertonic IV Solution?

Answer 0

• Causes fluid to move out of cells into IV space.
• Cells shrivel and shrink
• Used to shift fluid from intercellular and interstitial spaces into intravascular space in order to reduce cellular edema and vascular volume overload.
• All solutions have dextrose (D): D5/0.45NS (405 mOsm), D10W, D5/NS (560 mOsm), D5/LR, D5/0.2NS, D5/0.33NS
  
  • sugar makes you hyper*

Question 1

What is a Hypotonic IV solution?

Answer 1

• Hypotonic solution causes fluid to move out of the intravascular space and into cells.
• Swell and burst
• Used for cellular dehydration. Fluid goes into cells.
• None of the solutions have dextrose (D): 0.25% NS, 0.33% NS (112 mOsm), 0.45% NS (154 mOsm)

Question 2

What is an Isotonic IV solution?

Answer 2

• Causes fluid to remain in the intravascular (IV) compartment.
• Used to increase intravascular volume during acute blood loss, GI bleeding, to support BP when patient is hypotensive, hypovolemic.
• NS or 0.9% sodium chloride (310 mOsm)
• Lactated Ringers (LR) solution (275 mOsm)
• D5W (250 mOsm): <D5W isotonic in IV bag but quickly becomes hypotonic in body because body uses the glucose, which leaves free water.

Question 3

Explain the basic concept of total parenteral nutrition (TPN)

Answer 3

• This is a last resort feed them this way only if you have tried everything else first.
• High glucose (sugar) content cause complications, prone to infections.
• Get nutrition totally through veins.
• When pt cannot be fed by the other preferred routes, TPN bypass the process of eating and digestion.
• Receives nutritional formulas containing salts, 25%-70% dextrose, amino acids, lipids, added vitamins, minerals, and electrolytes.

Question 4

Peripheral IV Site

Answer 4

• Over-the-Needle catheter for brief use with 1-2 ports.
• Change dressing every 72 hours
• New site Q72H (or 96 hours when stabilization device used) sooner if complications.
• Hand or arm sites

Question 5

Central IV Site

Answer 5

• For longer use (2-6 weeks) with 2-4 access ports.
• When TPN is needed
• When pt has hard to find arm veins or frequent blood draws.
• Change dressing Q7Days unless soiled
• Makes a bigger hole so there is more risk for infection.

Question 6

List types of equipment needed for basic peripheral IV therapy.

Answer 6

• IV solution and tubing
• IV pump
• STAT-Lock (stabilization device)
• Non-sterile gloves
• Sterile antimicrobial wipe
• Transparent dressing
• Tape
• Skin prep (makes tape stick)
• Pen: to date and initial site

Question 7

Basic IV Therapy Equipment: IV Tubing

Answer 7

• Basic and secondary administration set (2 ports coming off)
• Blood tubing (always have normal saline with blood)
• Vented set

Question 8

Basic IV Therapy Equipment: IV Fluid Containers

Answer 8

• Plastic or glass

- Variety of sizes (50ml-1000ml)

Question 9

What is the labeling technique for IV bags and tubing?

Answer 9

• Date/time (write the 5 rights)
• Initial
• Tubing: label either date you put it up or the date it is due to be changed.
• Administering medication: clearly note date, time, medication, and dosage of additive on med label.
• Place label on IV bag so it can easily be read when bag is hung.
• Label IV dressing with the date, time, site, and the type and size of catheter/needle being used for infusion.

Question 10

What is the nurses responsibility in IV therapy?

Answer 10

• Nurse is responsible for imitating, monitoring, and discontinuing the therapy.
• Critically evaluating all patient orders prior to administration.

Question 11

What are the nurses roles for the administration/initiating of IV therapy?

Answer 11

• Understand patients need for IV therapy
• Type of solution used
• Desired effect
• Untoward reactions that may occur
• Fluid treated like medication, checked for clarity, particles or precipitates.
• Peripheral or central line vs. PICC
• Assist with central line insert, specially trained RNs insert PICC.

Question 12

What are the nurses role in management/maintenance/monitoring of IV therapy?

Answer 12

• Monitoring/Maintenance: IV rate; phlebitis; irritation; pain; tubing; dressing and site changes.
• IV site check every hour includes: patient condition, IV site, correct solution, proper flow rate, fluid level as expected, when will IV run dry or expire.
• Solution, Tubing and Dressing changes: IV bag labeled and changed every 24 hours, IV tubing labeled and changed on average every 72 hours, IV site rotated Q72 hours, IV dressing changed every 72 hours and always check agency policy.
• Monitoring IV fluids: volume control device monitors drip rate, time tape on IV bag gives hourly indication of where fluid level should be, check infusion rate every hour.

Question 13

What does nurse document after maintenance/monitoring patients IV?

Answer 13

• Appearance of site
• Length of external part of catheter
• Dates of dressing and cap change
• Flushing frequency and routine
• Any problems
• Type of IV solution
• Infusion rate
• Insertion site location and site assessment
• Document patients reaction to the IV therapy, as well as the absence of subjective reports that he/she is not experiencing any pain or other discomfort (such as coolness or heat associated with the infusion)
• Record that patient is not demonstrating any other IV complications such as signs or symptoms of fluid overload.
• Document the IV fluid solution on the I&O record.

Question 14

What does nurse document after the administration of IV?

Answer 14

• Location where IV access was placed
• Size of IV catheter or needle
• Type of IV solution
• Rate of IV infusion
• Use of securing or stabilization device
• Condition of the site
• Record patients reaction to the procedure and pertinent patient teaching such as alerting the nurse if the patient experiences any pain from the IV or notices any swelling at the site.
• IV fluid solution on the I&O record

Question 15

Techniques/Steps for the administration of an IV (assemble IV equipment according to the principles of asepsis and safety)

Answer 15

• Compare IV container label with MAR (safety; and before going in patients room would do 5 rights and 3 checks, check allergies)
• Remove IV bag from outer wrapper. Check expiration dates.
• Label solution container with the patients name, solution type, additives, date, and time.
• Complete a time strip for the infusion and apply to IV container.
• Maintain aseptic technique when opening sterile packages and IV solution. Remove administration set from package.
  
  • Asepsis is essential for preventing the spread of microorganism*
• Apply label to tube reflecting the day/date for next set change.
• Close roller clamp or slide the clamp on the IV administration set.
• Invert IV solution container and remove cap on the entry site, taking care not to touch the exposed entry site.
• Remove cap from the spike on the administration set.
• Using twisting and pushing motion, insert the administration set spike into the entry site of the IV container.
• Follow manufactures directions for insertion.
• Hang the IV container on the IV pole.
• Squeeze the drip chamber and fill at least halfway.
• Open IV tubing clamp, and allow fluid to move through tubing.
• Follow additional manufactures directions for specific electronic infusion pump as indicated.
• Allow fluid to flow until all air bubbles have disappeared and the entire length of the tubing is primed (filled) with IV solution.
• Close clamp. Maintain its sterility.
• After fluid has filled the tubing, recap the end of the tubing.

Question 16

Techniques for the maintenance/monitoring of IV therapy.

Answer 16

• If an electronic infusion device being used, check settings, alarm, and indicator lights. Check set infusion rate.
• Note position of the fluid in IV container in relation to the time tape.
• If IV infusing via gravity, check the drip chamber and time the drops.
• Check tubing for anything that might interfere with the flow. Be sure clamps in the open position.
• Observe dressing for leakage of IV solution.
• Ask if patient experiencing any pain or discomfort.
• Use sterile technique when changing dressings (24 hours after insertion and 3-7 days thereafter). Also change dressing if soiled or loose.
• When accessing lumens or injection caps for flushing, drawing blood, or changing the dressing, know that many agencies require nurse and patient to wear a mask.
• Keep external portion of catheter coiled under dressing.
• Change catheter caps every 3-7 days based on frequency of assess and facilities policy.
• Flush using normal saline and/or heparin solution according to facility policy.
• Avoid BP measurements in the involved arm.