Random Kaplan

Question 1

If blood transfusion reaction?

Answer 1

1. STOP blood
2. Restart NS (possibly new IV)
   Airway management
   Benadryl, aspirin
3. Save container and tubing to return to blood bank
4. Draw blood sample for plasma, hemoglobin, culture, retyping
5. Collect urine sample and send to lab for hemoglobin determination
6. Monitor voiding for hematuria

Question 2

Isotonic Solutions

Answer 2

0.9% NaCl
LR
5% Dextrose (becomes hypotonic when glucose metabolized)

same concentration as body fluids
so no exchange of fluids

Question 3

Hypotonic solutions

Answer 3

0.45% NaCl

solute concentrate less than body fluids
so pulls fluids into the tissues

Question 4

Hypertonic solutions

Answer 4

10-15% dextrose
3% NaCl
Sodium bicarb 5% (needs to be a in big vein)

solute concentrate greater than body fluids
so pull fluids into the vessels

Question 5

Infiltrated IV

Answer 5

liquid out of vessel and into tissue

Assess - cool skin, swelling, pain, decreased flow rate
(place tourniquet above infusion site - if infusion continues then is infiltrated)

Implementation - DC IV, apply warm compress, apply sterile dressing, elevate arm
start new IV proximal to infiltrated site (may use distal if different extremity/vein)

Question 6

Extravasation of an IV

Answer 6

vesicant solution used and infiltrates causes blisters and tissue sloughing (like burn)

assess- pain, burning, edema, blanching at the site

gentatmicin, penicillin, vancomycin, dilatin, antienoplastics (cancer drugs), calcium, potassium, epinephrine

tx: to prevent - know drugs that cause, place IV in larger veins, assess patency before giving meds, stop IV, aspirate

Question 7

phlebitis/ thrombophlebitis

Answer 7

inflammation of the blood vessels - irritated from the catheter, medication, or movement (because not taped down)

assess - warm, swelling, redness, tender, leukocytosis (increased WBC (over 10,000)

tx - stop IV, warm compress, start new IV

Question 8

hematoma from IV

Answer 8

ecchymosis, swelling, leakage of blood

tx - discontinue IV, apply pressure, ICE packs 24 hrs, restart IV in opposite extremity

Question 9

Clotting IV

Answer 9

assess - decreased flow rate, back flow of blood into tubing

tx - DC IV, do not irrigate, do not milk, do not increase rate of flow or hang solution higher, do not aspirate, inject urokinase (to clear occlusion)

Question 10

complications of PICC

Answer 10

pneumothrorax, dysrhythmias, thrombophlebitis, nerve/tendon damage, respiratory distress, embolism

watch for s/s SOB, pain in upper chest, pain with respirations, decreased movement, and decreased sensation

Question 11

change central venous lines dressings

Answer 11

2-3 times per week, when wet or nonocclusive

Question 12

percutaneous central catheter insertion

Answer 12

inserted through subclavian vein
placed supine in head-low position
turn head away from procedure
perform valsalva maneuver
antibiotic ointment and trasparent sterile dressing
verify position with xray

(dressing changes - pt in low flowers, nurse and pt wear mask, cleaned with alcohol and iodine swabs)

Question 13

Central ports used

Answer 13

distal - blood drawn
middle - TPN, fluids
proximal - blood, medications

Question 14

when flushing central lines

Answer 14

don’t force flush! - notify healthcare provider

should flush easily