Week 1: Intravenous Therapy & Hematologic Function Flashcards
Enteral
going into GI tract; tube feed or mouth
Parenteral
IV (bloodstream); IV or TPN
Peripheral IV
- short or long term use?
- how often should they be changed?
- sizes: most common? which 2 sizes are used for trauma / surgery? what colors are they?
- short term use
- change Q 96 hours OR (according to agency’s policy)
- most common size: 20 gauge (pink); 16 (orange) or 18 (green) are used for trauma / surgery
what does IID mean?
- what are 2 responsibilities of nurses?
Intermittent infusion device
- flush Q8 to check patency (nothing is painful or swelling)
- assess site
what does saline lock mean?
before capping off IV, flush w saline
what does Heplock mean?
if Heparin is being used, the patient just needs a capped off IV w nothing running
what should nurses check before administering IV push medications via a peripheral IV? (4) briefly explain if needed
- allergies
- compatibilities (how do these medications get along?)
- Dilution
- rate of administration
what does SAS mean? when should this be used? how many mL?
saline, administration, saline
- should be used when administering IV push medications through a peripheral IV
- 3-5 ml peripheral flush
give saline at the same rate as flush!
which types of meds should NEVER be administered into a TPN or PCA line? what should be done instead?
IVP or IVPB
- second IV for pt. if on a TPN or PCA!
central venous catheter
- used for short or long term?
- what is it used for?
- what can it also be called?
- should nurses be concerned about compatibility?
- used for long term therapy
- can also be used for tissue toxic meds (going into large vessel): prevents patient’s veins from rotting
- is also called a PICC line
- do not worry about compatibility!!!
PICC lines
- who can it be inserted by?
- how is the placement verified?
- which guidelines are followed?
- list 2 nursing & nursing assistant responsibilities
- can be inserted by a specially trained nurse
- placement verified w chest x-ray
- CVC (central venous catheter) admin guidelines
- nursing & nursing assistant care:
1. NO BP in arm w PICC
2. NO venipunctures from the arm w a PICC
which types of patients are commonly seen w implanted ports?
chemotherapy patients
implanted ports
- how is correct placement assured?
- how do nurses access port?
- which guidelines are used?
- correct initial placement verified w x-ray
- access port using non-coring needle
- use CVC admin guidelines
list 2 CVC use flush guidelines
- use larger flushes than peripheral!!
- use the push, pause method to flush!
list the 4 steps for CVC use
- verify line placement prior to initial use (x-ray)
- assess site
- use 10ml flush & syringe
- assure blood return before admin
what 5 things should be checked before administering an IV push med through a central line?
- allergies
- compatibilities
- occasionally: Heparin is placed through a port (SASH method)
- Dilution
- rate of admin
how many ml should be flushed w IV push medications via a central line? what may need to be in port?
10 ml; may need Heparin in port (SASH)
for what 2 types of meds is IVPB used for?
antibiotics & nausea meds (intermittent use)
describe the position of the primary (maintenance) bag for an IVPB
dropped lower; runs continuously
describe the position of the secondary bag for IVPB; what type of meds are secondary & why?
hangs higher; antibiotics (end up losing quite a bit of product if primary); secondary allows the saline to flush the antibiotic completely
what should always be checked for IVPB meds?
compatibility!!
before giving an IVP med through a central line, which step should the nurse take?
check for blood return
what should always be checked with central lines as part of checking patency?
blood return
describe the differences between crystalloid (give 3 examples) & colloid (give 2 examples) IV fluids
Crystalloid: clear fluids (saline, lactated rings, D5)
Colloids: fluids that cannot see through (TPN, blood)
describe tonicity
homeostasis serum = other body fluids; refers to how similar it is to blood chemistry
describe the difference between isotonic, hypotonic, & hypertonic in terms of tonicity, what they are used for, and how they affect the size of the cell
- give examples
Isotonic: same tonicity as body fluids; used for basic hydration, does not affect size of cell
EX: NS, 5% dextrose in water, lactated ringers
Hypotonic: fluid shifts out of blood; used for short term! (diabetic ketoacidosis patients) - seen mostly in ICU units, used to replace cellular fluid, cell swells (HIPPO)
EX: 0.45% NaCL
Hypertonic: pulls fluid into vascular system; used only in ICU units, causes cells to shrink (used in hyponatremia & cerebral edema)
EX: 3% NaCI
what is a serious S/Sx of hyponatremia? what is the normal range?
seizures; normal range: 135-145
what are 2 serious S/Sx of hypernatremia?
seizures & muscle twitching
what is a serious S/Sx of hypokalemia? what is the normal range?
cardiac dysrhymias; normal range: 3.5-5.0
what are 2 serious S/Sx of hyperkalemia?
paresthesias & cardiac dysrhymias
what are 2 serious S/Sx of hypocalcemia? what is the normal range?
numbness / tingling & seizures; normal range: 8.8-10.5
what is a serious S/Sx of hypercalcemia?
weakness / fractures
what are 2 serious S/Sx of hypomagnesemia? what is the normal range?
EKG changes; normal range: 1.8-3.6
what is a serious S/Sx of hypermagnesemia?
EKG changes
what is a serious S/Sx of hypophosphatemia? what is the normal range?
Seizures; normal range: 2.5-4.5
what is a serious S/Sx of hyperphosphatemia?
muscle weakness
what is a serious S/Sx of hypochloremia? what is the normal range?
seizures; normal range: 98-106
what are 2 serious S/Sx of hyperchloremia?
edema & seizures
describe occlusion; how can nurses prevent it? (2)
partial blockage of IV access
prevention:
- use only “compatible” mixtures or it will turn to a crystal & stop flowing
- flush Q8 & use SAS technique for peripheral / central IID sites
describe infiltration; name 3 S/Sx, how can nurses prevent it? (3)
Infiltration: fluid in subcutaneous tissue
swelling (hand will get swollen above IV site, cool to touch, pallor
prevention:
- check patency of access device prior to admin of all meds
- use stabilization device / proper dressing
- protect IV tubing & site when ambulating patient
describe extravasation; what should always be diluted??
how can nurses prevent this? (5)
infiltration w tissue toxic substances, IV gives out & leaks into subcutaneous tissue
- always dilute potassium!!
prevention:
- check IV site at least every hour!
- stop infusion
- discontinue IV if any signs of infiltration
- be aware if antidote is available
- dilute meds like potassium & calcium
list 3 vasopressors that can cause an extravasation
Dobutamine, dopamine, Ephinephrine
list 3 chemotherapeutic agents that can cause an extravasation
Adriamycin, Vincristine, Bleomycin
list 3 electrolytes that can cause an extravasation
potassium chloride, calcium chloride, calcium gluconate
describe phlebitis; list 4 S/Sx
list 2 complications from phlebitis
Phlebitis: inflammation of the vein
S/Sx: red streak along vein, skin is warm (hot along vein), vein firm / cord-like, pain
complications: clots & infection
describe mechanical phlebitis
long periods of cannulation, catheter in a flexed area, catheter gauge larger than vein, poorly secured catheter
describe chemical phlebitis; what are 2 things that can cause this?
from an irritating medication or solution, rapid infusion rate, medication incompatibilities
describe post infusion phlebitis; when does this generally occur?
generally occurs 48-96 hours after infusion has been discontinued
describe bacterial phlebitis; how can this occur & when does it occur?
poor hand hygiene, lack of aseptic technique, failure to check equipment or recognize early signs of phlebitis
- often occurs during insertion
what types of meds / solutions should be buffered? (2)
irritating meds & hypertonic solutions
if phlebitis occurs, what are 5 important actions the nurse should take?? first 2 are most important!
- discontinue IV & restart
- alert MD! partal for infection
- culture site / device (as ordered/protocol)
- monitor VS
- document
what type of IV is infection more prevalent with?
central lines
what does CLABSI stand for or also known as?
central line associated bloodstream infection (sepsis)
- leading cause of deaths in ICUS
how does fluid overload affect BP & central venous pressure? list some S/Sx (5)
increases them!
S/Sx: moist crackles, edema, weight gain, dyspnea, rapid/shallow respirations
describe an air embolism, potential causes (3), & classic S/Sx (5)
Air embolism: air in the circulatory system, very rare
potential causes: improper removal of central line, during insertion of large bore IV, accidental removal of large IV
S/Sx: difficulty breathing, chest pain, stroke, low BP, cyanosis
how do you prevent an air embolism? (4)
- prime all tubing
- address all bubbles
- double check flushes & IVP syringes
- proper technique removing CVC
how do you treat an air embolism? (3)
- stop infusion or disconnect tubing to prevent air entry
- place patient in left side lying trendelenburg (helps prevent air from traveling to right side of the heart into pulmonary arteries)
- monitor vitals & pulse ox
what 3 things does the bone marrow make?
RBC, WBC, & platelets
whole blood
- what 4 things does it contain?
- how many ml in each unit?
- what does it require?
- is this a preferred treatment?
- RBCs, plasma, WBCs, platelets
- 500 mL
- requires T & C, ABO identification
- not preferred treatment!
what is the most common blood component?
platelets
Describe a platelet blood transfusion
- what can it control or prevent?
- which types of patients is this seen in?
- what can this treat?
- needs to be ___ compatible
- bleeding associated w platelet deficiencies
- seen in cancer patients
- can treat thrombocytopenia
- needs to be ABO compatible
describe fresh frozen plasma (FFP) transfusions
- primary use?
- what does it provide?
- what is it an antidote for??
- needs to be ___ compatible
liquid portion of blood & lymph used for:
- coagulation factor replacement
- provides clotting factors
- antidote for warfarin (emergent) - reverses immediately as opposed to vitamin K!
- needs to be ABO compatible
describe WBCs tranfusion
- what is administered & what for?
- common in which type of patients?
- granulocytes administered for low or abnormal WBC count
- common in cancer / chemotherapy patients
describe albumin transfusions
- what does it restore?
- what does it maintain & in what types of patients?
- restores intravascular volume
- maintains cardiac output in patients w hypoproteinemia
describe packed red blood cells blood transfusion
- what does it improve?
- what does it provide?
- needs to be ___ compatible
- volume?
- administration? (how many hours?)
- improves oxygen-carrying capacity
- provides the same oxygen-carrying capacity as whole blood without the additional volume
- must be ABO compatible
- volume: 250-350 mL
- admin: infuse over 4 hours max
what type of saline is used w blood products?
ONLY 0.9%
during a blood transfusion, what type of tubing prevents clots being sent to the patient?
Y tubing
list & describe the 3 types of transfusion reactions
- allergic: hives, itching, anaphylaxis
- Febrile: fever, chills, HA
- hemolytic: immediate onset, flushing, fever, chills, back pain, shock
what should nurses do if their patient has an abnormal transfusion reaction? (3)
- stop transfusion, start NS
- notify MD
- follow agency protocols
list 3 S/Sx of a transfusion-associated circulatory overload (TACO)
- what should the nurse do?
- is this serious? what is the patient usually given?
SOB, HTN, Hypoxia
- continue to monitor pt, notify MD
- not emergency; patient usually just given a diuretic!
describe Anemia
decrease in RBC count
RBC
- how long do they live?
- what is their role?
- which organs remove old RBCs?
- what percentage of RBC is HGB?
- 120 day lifespan
- role: transport O2 to cells
- organs: spleen & liver
- 95% of RBC is HGB
what 5 things does the bone marrow need to make new RBCs?
- iron
- B12
- Folate
- B6
- Protein
what is the most common symptom of anemia? list a few other S/Sx (5)
fatigue
- malaise / weakness, pallor, jaundice, tongue smooth & red, red sore tongue
list the normal ranges of erythrocytes for both men & women
men: 4.5 - 5.3
women: 4.1 - 5.1
list the normal ranges of HGB & Hematocrit for both men & women
HGB:
men: 13-18
women: 12-16
Hematocrit:
men: 40-50%
women: 38-48%
what is the reticulocyte count? list the normal ranges in adults
% of immature RBCs in blood
normal range: 0.5-2.5
what is the mean corpuscle volume?
average size of a RBC
what is serum B12 & folate needed for?
hematopoiesis
what is hypo-proliferative anemia?
not making enough or making unhealthy RBCs
what 2 things can iron deficiency anemia be caused by?
- blood loss: loss quantity of blood
- Hemolytic: cells were destroyed & died before they should have
list 3 S/Sx of iron deficiency anemia
smooth red tongue, brittle ridged nails, cracks in mouth
list 5 tests / labs used to diagnose iron deficiency anemia
bone marrow aspiration
labs: ferritin, H & H, low iron, elevated transferrin
how to treat iron deficiency anemia
high iron diet & iron supplements
list 3 things to include in pt. education for iron deficiency anemia
- *take iron supplements on an empty stomach & w vitamin C
- do not take it w dairy!
- tell pt. that stools are dark colored & it main strain their underwear or stain teeth if in liquid form
describe normocytic anemia
- what 3 things can it be caused by?
- list symptoms
- treatment
- caused by: chronic inflammation, chronic infection, malignancy
- **symptoms:* few (chronic) HGB rarely >9
- **treatment:* treat underlying disease, supplements not beneficial
describe aplastic anemia
- what does it cause damage to?
- treatment (2)
- causes damage to stem cells & bone marrow, causing decreased RBC production
- treatment: stem cell transplant, immunosuppression
describe megaloblastic anemia
- what is it?
- what is it also called?
- symptoms?
- risk factors
- what may low B12 cause (4)
- abnormally large RBCs due to lack of B12 or folate
- also known as pernicious anemia
- symptoms: abnormally shaped cells
- risk factors: pregnancy, ETOH abuse, pernicious anemia
- low B12 may cause confusion, weakness, N/T, balance issues
treatment for megaloblastic anemia
- folate or B12 replacement
- diet changes
describe blood loss anemia & treatment for it
blood loss anemia: sudden loss of large volume of blood (trauma, surgery, bleeding disorders)
treatment: treat underlying condition, transfuse PRBCs
describe hemolytic anemia
- what is it?
- symptoms
- several types (2)
- red blood cells have a shortened lifespan
- symptoms: decreased O2
- several types: inherited or acquired
describe sickle cell anemia
- what is it?
- symptoms (5)
- complications (4)
- treatment(4)
- severe hemolytic anemia from an inherited sickle cell hemoglobin gene that causes abnormal shape to cell
- symptoms: RBC lifespan 4-10 days, jaundice, tachycardia, mumurs, cardiomegaly, HF, pain, hypoxic damage
- complications: life expectancy (50s), clots, CVA, sickle cell crisis
- treatment: stem cells transfusion, hydroxyurea (chemo drug), blood transfusions, symptom management (hydration, oxygen, pain med)
list complications from anemia (6)
HF, chest pain, paresthesia, confusion, falls, activity intolerance
