1
Q
names of parts of IV tubing
A
- Spike / Piercing Pin
- Vent (glass requires one!)
- Drip chamber
- Roller Clamp
- Y-port
- Luer Lock / Hub
2
Q
what makes something hypotonic
A
Less than 250
3
Q
range of isotonic
A
250-375 mOsm/L
4
Q
what makes something hypertonic
A
> 375 mOsm/L
5
Q
3 examples of hypotonic solutions
A
- sterile water
- 0.45% sodium chloride
- 2.5% dextrose in water
6
Q
hypotonic fluid affects on body
A
shifts fluid out of the intravascular compartment, hydrating the cells and the interstitial compartments (into intracellular space)
~water moves into cells, possibly causing them to burst
7
Q
hypertonic fluid affect on body
A
draws fluid into the intravascular compartment from the cells & the interstitial compartments
~will shift ECF from the interstitial spaces into the plasma
~water w/in a cell moves to the ECF, causing cells to shrink
8
Q
3 examples of isotonic solutions
A
- 0.9% sodium chloride (normal saline)
- Lactated Ringer’s solution
- 5% dextrose in water (D5W)
9
Q
3 examples of hypertonic solutions
A
- 5% dextrose in 0.9% NaCl
- 5% dextrose in Lactated Ringer’s
- 10% Dextrose
10
Q
hypotonic fluid affects on body
A
body fluids shift out of blood vessels and interstitial spaces
11
Q
isotonic fluid affects on body
A
Expand the intravascular portion of the extracellular fluid compartment
12
Q
2 precautions with hypertonic solution
A
- Irritating to vessel walls
2. May cause circulatory overload
13
Q
3 indications for hypotonic solution
A
- Hypertonic dehydration
- Water replacement
- Diabetic ketoacidosis after initial sodium NaCl replacement
14
Q
3 indications for isotonic solution
A
- Fluid loss
- Dehydration
- Hypernatremia
15
Q
solutions you need to be cautious with
A
- high osmolarity due to potential irritation of the vein
- solutions that can act on the heart (K, Mg, etc)
- Calcium gluconate d/t necrosis and sloughing if extravasion occurs
- B complex, need to go slow d/t GI effects
- Large doses of niacin (never over 2mg) d/t vasodilation and hypotension
16
Q
3 contraindications to hypertonic solutions
A
- CHF
- Pulmonary edema
- Can cause/increase HTN
17
Q
precaution with hypotonic solution
A
Do not give to pts with low BP because it will further aggravate hypotension
18
Q
2 precautions with isotonic solutions
A
- Renal/cardiac dz with increased risk of fluid overload
2. May cause dilution of hemoglobin and lower hematocrit
19
Q
how do you calculate osmolarity
A
Solution Osmolarity = total mOsm/vol x 1000mL/L
20
Q
Drip rate formula
A
[Volume (mL) x drop factor (drops/mL)] / Time (min) = Drops/min (flow rate)
21
Q
solutions you need to be cautious with
A
- high osmolarity due to potential irritation of the vein
- solutions that can act on the heart (K, Mg, etc)
- Calcium gluconate d/t necrosis and sloughing if extravasion occurs
- B complex, need to go slow d/t GI effects
- Large doses of niacin (never over 2mg) d/t vasodilation and hypotension
22
Q
what does magnesium do to blood vessels
A
dilates them
23
Q
Will folate precipitate with other nutrients?
A
Yes
24
Q
Things Mg could help (3)
A
- STEMI
- Migraines
- Bronchial hyperreactivity
25
side effects of calcium
kidney stones, hypercalcemia
26
special consideration with calcium gluconate
Avoid extravasion, could cause sloughing and necrosis
27
caution with potassium (3)
1. renal insufficiency
2. Endocrine disorders
3. Potassium-sparring diuretics
28
what is calcium gluconate the antidote for
magnesium sulfate
29
what does magnesium do to blood vessels
dilates them
30
Who should you not give IV Mg to (4)
1. Neuromuscular diseases like myasthenia gravis
2. Renal insufficiency
3. Heart block
4. Pregnancy
31
Things Mg could help (3)
1. STEMI
2. Migraines
3. Bronchial hyperreactivity
32
common administration rates of Mg
1. Push: Up to 1500 mg over 20-40 min
| 2. Drip: Up to 3000 mg over 2 hours.
33
how to administer potassium
KCl 2mEq/mL, max 100mEq in 24 hours when giving high dose vit C or in solution using D5W as carrier
34
General conditions to caution or not use trace elements with (4)
1. renal disease
2. biliary excretion conditions
3. pregnancy
4. inborn metabolism issues (Wilson's)
35
What must be decided for each patient as you are formulating his or her potential IV therapy? (6)
1. Push v drip
2. carrier solution
3. nutrient to use
4. solution osmolarty
5. Vein to be used
6. Infusion rate
36
3 conditions to caution with copper
1. cholestasis
2. cirrhosis
3. Wilson's disease
37
condition to caution zinc with
copper deficiency
38
condition to caution manganese with
cholestasis
39
How soon must you use uncontaminated multidose vials (Under USP Chapter 51)?
Most use multidose vials within 28 days.
40
what does PICO stand for
1. Patient, Population, or Problem
2. Intervention
3. Comparison
4. Outcome you would like to measure
41
General conditions to caution or not use trace elements with (4)
1. renal disease
2. biliary excretion conditions
3. pregnancy
4. inborn metabolism issues (Wilson's)
42
CPT codes
procedure codes for a medical, surgical, or diagnostic service
43
differences b/w push and drip
Push: use syringe, shorter infusion, lower volume, more concentrated, butterfly needle, involved
Drip: IV bag/bottle, longer infusion, higher volume, less concentrated, angiocatheter, less involved
44
Iv infusion osmolarity for veins
Large 1400, Medium 700, Small 400
45
Compounded IV solutions fall under the USP exemption for Immediate Use if they are used within_____________ of starting the preparation of the solution.
w/in 1 hour
46
How recently must lab tests (CBC, CMP) have been completed in order to be able to administer an IV treatment?
Within the last 6 months or more recently if have any underlying health issues.
47
what does PICO stand for
1. Patient, Population, or Problem
2. Intervention
3. Comparison
4. Outcome you would like to measure
48
J codes are related to
drugs that ordinarily cant be self-administered
49
CPT codes
procedure codes for a medical, surgical, or diagnostic service
50
IV push osmolarity for veins
Large 1200, Medium 950, Small 400
51
Iv infusion osmolarity for veins
Large 1400, Medium 700, Small 400
52
what can be used to alter pH of an IV solution
bicarb
53
How recently must lab tests (CBC, CMP) have been completed in order to be able to administer an IV treatment?
Within the last 6 months or more recently if have any underlying health issues.
54
Review the effects of high dose vitamin C on blood sugar.
will induce insulin and decrease glucose levels
55
meaning of high specific gravity
dehydration
56
meaning of position glucose on UA
glucose is >170
57
meaning of positive protein on UA
renal disease, infection, trauma, HTN, malignancy, poisoning, toxemia
58
What do you do to treat an ecchymosis?
1. apply pressure after catheter/needle is removed
2. elevate extremity above the patient’s head to maximize venous return
3. apply cold pack to the site
4. heme hydro
59
Vitamin C may cause a false negative in what UA test?
blood
60
What should you add to high dose vitamin C due to its weak chelating properties?
0.3-1 ml 10% calcium gluconate for each 10 g of vitamin C to maintain blood calcium levels
61
Review the effects of high dose vitamin C on blood sugar.
will induce insulin and decrease glucose levels
62
What is the ml/kg dosage of Epinephrine given during anaphylaxis for an adult versus a child?
Adult: 0.2-0.5
Children: 0.01
63
What is the Oral versus IV dosage of Diphenhydramine for an adult?
Oral: 25-50 mg every 6-8 hours
IV/IM: 10-50 mg every 2-4 hours
64
If you suspect a patient is experiencing infiltration, what steps to you take to help?
1. stop IV/push and remove catheter/needle immediately
2. apply pressure for at least 1 min with a few drops of rescue remedy on cotton ball- tape and hold area above heart level for 5-10 minutes
3. if the patient is experiencing burning pain, first apply ice for an analgesic effect (if detected w/in 30 min, otherwise apply warm compress), and encourage the patient to then apply heat to allow fluids to dissipate
4. elevate site above heart level
65
What do you do to treat an ecchymosis?
1. apply pressure after catheter/needle is removed
2. elevate extremity above the patient’s head to maximize venous return
3. apply cold pack to the site
4. heme hydro
66
What are the signs and symptoms of a thrombosis?
1. pain at the site
2. site warm to touch
3. sluggish or no infusion rate
67
Possible causes of phlebitis include?
1. trauma to the vein w/ cannula/needle- mechanical phlebitis
2. irritation due to type of fluid infused- chemical phlebitis
3. introduction of pathogens related to contaminated needle/site prior to insertion-bacterial phlebitis
68
If you suspect pulmonary embolism, what are the steps to take?
1. call 911
2. keep patient sitting upright
3. give O2 by mask
4. maintain IV site
5. transport to hospital
69
What are the signs and symptoms of a person in shock?
1. dizziness
2. tightness in chest
3. increased HR
4. H/A
5. hypotension
70
What is the difference between infiltration and extravasation?
Infiltration: seepage of non-vesicant IV fluid into surrounding subcutaneous tissues
Extravasation: infiltration of a vesicant solution in the tissues
71
If you suspect a patient is experiencing infiltration, what steps to you take to help?
1. stop IV/push and remove catheter/needle immediately
2. apply pressure for at least 1 min with a few drops of rescue remedy on cotton ball- tape and hold area above heart level for 5-10 minutes
3. if the patient is experiencing burning pain, first apply ice for an analgesic effect (if detected w/in 30 min, otherwise apply warm compress), and encourage the patient to then apply heat to allow fluids to dissipate
4. elevate site above heart level
72
When do you a filter needle?
Calcium gluconate
73
how to prevent coring of a IV bottle
Use a non-coring needle, spike adapter
74
what information is needed on a IV bag/syringe
Pt initials and DOB, date, time of preparation
75
how to use the roller clamp on the IV tubing.
Roll down to slow/stop flow
IV Therapy
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