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ADN 008 Adv Med Surg > Week 1 IV Therapy > Flashcards

Week 1 IV Therapy Flashcards

1
Q

What are the purposes of IV Fluids?

A

Maintenance
Replacement

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2
Q

Maintenance is when..

A

Oral intake is not adequate or there is a risk

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3
Q

When losses have occurred

A

Replacement

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4
Q

What is the serum osmolarity?

A

270-300 mOsm/L

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5
Q

Serum pH?

A

7.35-7.45

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6
Q

Name the types of body fluids

A

Hypertonic
Isotonic
Hypotonic

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7
Q

More solutes in the cell

A

Hypotonic solution

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8
Q

More solutes outside the cell

A

Hypertonic

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9
Q

Solutes equal inside and outside of cell

A

Isotonic

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10
Q

Made from crystals

A

Crystalloids

Easily pass in and out of pores

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11
Q

Same number of particles as plasma is

A

Isotonic

Do not causes edema in moderation or shrink the cells

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12
Q

Less than 250mOsm is known as

A

Hypotonic

Replaces cellular fluid, provides free water for excretion

More water than electrolytes
Moves from ECF-ICF

Ex 0.45 NaCL, 2.5% Dextrose

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13
Q

250-375 mOsm
Expands only the ECF

No net or gain from ICF

A

Isotonic solution

0.9 NaCl, LRs, D5W

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14
Q

Particles do not break down into smaller pieces

A

Colloids

Tend to stay in the vascular bed- Used for volume expansion

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15
Q

Name the advantage of giving colloids

A

Give smaller amounts and achieve the same effect as crystalloids

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16
Q

Name the disadvantage of colloids

A

Hydrostatic pressure rises in the capillaries

Pores stretch and lets them pass through

Edema that results takes longer to solve

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17
Q

mOsm greater than 375 is known as

A

Hypertonic Solutions

Initially expands and raises the osmolality of ECF out of cells

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18
Q

Hypertonic solutions require frequent what?

A

BP checks
Lung sounds
Serum Sodium Levels

ex: 5% Dextroses in 45 NaCL, 5% in 0.9% NaCL, 5%dectrose in LR, 10% dextrose in water, 3% NS

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19
Q

Normal sodium is

A

135-145

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20
Q

Potassium is 3.5-5

A

True

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21
Q

Calcium is

A

8.6-10-2

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22
Q

Mg is

A

1.3-2.3

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23
Q

Phosphorus is

A

2.5-4.5

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24
Q

pH is between 5 and 9

Final osmolality less than 500 mOsm/L

Infusion not known vesicant

Criteria not met then Central Line

A

Peripheral IV solutions

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25
Tx for Hypernatremia is
Restrict sodium intake Adm hypotonic or isotonic solutions
26
Tx for hyponatremia is
Hypertonic solutions Place pt on seizure precautions Fluid restriction NPO airway protection
27
Tx for hyperkalemia is
Stop potassium intake Adm Sodium Bicarbonate IV Calcium gluconate IV
28
Hypokalemia Tx is
Give K oral or Iv IV go slow d/t burn
29
Hypercalcemia
Stop calcium intake Adm Phosphorus or calcitonin
30
Hypocalcemia Tx
Increase Ca intake Vit D Calcium gluconate Initiate seizure precautions
31
Tx for hypermag. is
Loop diuretics Calcium chloride or gluconate Restrict dietary Mg Avoid laxatives or antacids Use hemodialysis in severe cases
32
Tx for hypomag.
Mag sulfate Place seizure precautions Increase Mg intake with foods
33
Tx for hyperphosphatemia
Decrease PH intake ESRD- Dialysis Control HTN to maintain kidney Fx
34
Tx for hypo is
Increase Ph Oral or IV Reduce diuretic use
35
Central Line Care and Maintenance
Sterile Occlusive dressing - Change wen non-occlusive or 7 days
36
Flush daily or with each intermittent flush
True IVP- Use SASH method Saline Adm Saline Hep
37
Check for blood return before infusion ...
ALWAYS
38
Is some resistance normal with PICC?
Yes
39
Never use a syringe less than how many mL?
10 Always use IV pump
40
Removal of central line need to prevent what?
Air embolism
41
Place the pt in
Trendelenburg or flat CVC exit site below level of heart Clamp all lumens
42
Remove dressings and sutures in removal of central line
True
43
In removal of central line it is important to do what?
Cover the site with gauze and apply gentle pressure while removing slowly in slow contant motion
44
Critical step on removal of central line
Hold breath pt/ Valsalva maneuver until CVC is removed
45
How long does one keep pressure on site?
At least 5 minutes Pt lie flat for 30 min Apply sterile occlusive dressing per policy
46
14 g and 16 g used in
High risk surgery- bolus Emergencies 14- orange 16- gray
47
Used in trauma Surgery Blood transfusion CT Dye
18g- green
48
Common size Suitable for contrast and blood
20 G- Pink
49
Best for adult Iv fluids Abx
22 G- Blue
50
Small and short Used for peds and geriatric pt
24 G- Yellow
51
Posterior IV selections
Cephalic Vein Basilic Vein Dorsal Metacarpal, Venous Arch, Digital veins
52
Anterior IV Site Selections
Accessory cephalic vein antebrachial vein palmar digital veins
53
IV Site maintenance for Peripheral Catheter is
72-96 HR or until bad Sterile Dressing/ Statlock per facility Saline Flushes S.A.S
54
With a Central Catheter flush with what
Heparin unless restricted SASH Sterile Occlusive Dressing 7 days or non-occlusive Biopatch CHG impregnated dressing
55
Name complications of IV Therapy
Fluid Overload Air embolism Phlebitis Thrombophlebitis Hematoma Clotting, obstruction Infiltration Extravasation CLABSI
56
Name common irritants
Hydromorphone 4-4.5 Naficilin Diazepam Phenytoin Gentamycin 3-5.5 Potassium 4-8 Morphine 2.5-7 Vancomycin 2.4-4.5 Promethazine
57
Osmolality/ pH of solution Greater than 600 osmol/ L pH less than 5 or greater than 9
IV Medications Irritants Vesicants- results in extravasation if infiltrates
58
Location Location Location Bigger is not better Know the med Secure the IV device Check IV patency and assess site Policies Stop infusion/ remove catheter - Start new IV Hot or Cold compress/ Elevate Antidote Document Teach pt/ family
Vesicants and Extravasation
59
Parenteral IV Nutrition includes?
-Central or peripheral use - PPN through peripheral line TPN through central catheter whose tip lies in the superior vena cava Also include - Subclavian Jugular or femoral vein PICCs
60
This is through peripherally inserted catheter or VAD - Short term support - Protein and caloric requirements not high - Risk of central catheter is too great - Supplement inadequate oral intake - Peripheral vein can handle up 20% glucose
PPN
61
Procalamine is made up of ?
Amino acid and Glycerin
62
Large Central vein -Hand high glucose from 20%to50% - Has to be central line - Shoud be a "virgin" line Special filter on tubing - Monitor electrolytes daily - TPN ordered daily - Pharmacy may add medication
TPN
63
Complications of TPN include
Infection Gram+/-, Fungus etc
64
TPN must have
Filter
65
TPN with lipids must do what?
Tubing Filter changes every 24 hours
66
TPN with amino acids, dextrose ?
Filter Tubing change every 24-72 hours with bag
67
Metabolic problems of TPN include?
Hyperglycemia, hypoglycemia, prerenal azotemia, fatty acid deficiency, electrolyte disturbances, hyperlipidemia, mineral deficiencies
68
Mechanical problems of TPN include ?
Insertion problems Dislodgement, thrombosis of great vein Phlebitis
69
Name the order of nursing management for TPN
Initial CXR - PN solutions prepared by pharmacist or trained technician under strict aseptic techniques - Use IV pump and change tubing every 24 hours/ filter or each bag - Fat emulsion - Maintain sterile dressing - Blood glucose check initially every 4-6 hr - Electrolytes MD order every day or pharmacy protocol - Nothing is added to solution after prepared - Verify placement with blood return - Taper off
70
Type and Cross includes what?
Blood A, B, AB, O
71
Having the D antigen means what?
Rh +, No D Rh-
72
Type and cross blood and ?
Whole blood PRBCs Platelets FFP
73
Blood/ Products Transfusion administration include:
- Review Pt Hx -Hx of transfusions, health problems, baseline assessment and VS, assess labs - Perform pt teaching and obtain consent
74
Equipment includes?
IV 20 g or greater Blood tubing NS
75
Blood administration also includes
Procedure to identify the pt and blood product, blood band - Assess for additional Pall Filter Monitoring of pt and VS, baseline VS Stay the first 15 min
76
For blood transfusion how long can the unit stay out of fridge?
No more than 30 min - Each unit is administered over 2-4 hours -Monitor for fluid overload- administer possible furosemide - Complete proper paperwork - Dispose of bag in red bag
77
What is the procedure if there is reaction in blood transfusion?
-Stop transfusion immediately - Stay with pt and assess frequently - Initiate NS and new IV tubing - Save the bag and tubing for testing - Contact blood bank - Blood and urine specimen - Follow policy paperwork
78
Student Skills to keep in mind for IV
Ask questions before going in Pt room Know meds and equipment Be sensitive to pt rxn - Be honest with pt - ID patient - Always have licensed nurse - Know calculations - Know dosage calc. and hourly rates - Know legal abbreviations - Be familiar with facility supplies

ADN 008 Adv Med Surg (3 decks)

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