Med-Surg Nursing > objective 5 (1) > Flashcards

objective 5 (1) Flashcards

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1
Q

delivers fluids directly into a vein
commonly used to treat many different fluid and
electrolyte imbalances

A

intarvenous therapy

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2
Q

what are the clinical indications of IV therapy?

A
  • Maintain or prevent fluid & electrolyte
    imbalances
     oral intake restricted
     client can’t swallow/absorb med by
    any other route
     GI absorption impaired
  • Administer medications
  • rapid drug effect needed
  • Replenish blood volume
  • Continuous therapeutic blood level
    desired
  • Assist in pain management
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3
Q

what are the risks of IV therapy?

A
  • phlebitis, ecchymosis, extravascular fluid infiltration, infection,
    thrombosis, and venous spasm.
  • Systemic complications may also occur, such as bacteremia and
    sepsis, air embolism, and pulmonary edema.
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4
Q

what are the benefits of IV therapy?

A

Giving drugs IV is rapid and effective
Drugs can also be delivered long term by continuous infusion, or
over short period, directly as single dose.

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5
Q

what are the commonly infused drugs?

A
  • antibiotics
  • thrombolytics
  • histamine-receptor antagonists
  • antineoplastics
  • anticonvulsants
  • cardiovascular drugs
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6
Q

what are the types of IV solutions?

A

isotonic
hypotonic
hypertonic

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7
Q

H2O & molecules suspended
(undissolved) substances i.e. blood cells
& blood products (albumin)

A

colloid

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8
Q

H2O & dissolved crystals i.e. salt
(sodium chloride) or sugar (glucose,
dextrose)

A

crystalloid

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9
Q
  • same concentration of dissolved
    substances as plasma (ECF)
  • RBCs does not shrink or swell
  • Use- clients who can’t eat/drink for short
    time
A

isotonic solutions

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10
Q

what are the types of isotonic solutions>

A
  • 0.9% NaCl (NS -normal saline)
  • 5% dextrose & H2O (D5W - glucose &
    H2O)
  • Lactated Ringer’s (RL: E- solution)
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11
Q

provides more water than electrolytes, diluting the
ECF
* Use
* rehydrating clients (cause body to
retain fluid, draws fluid into cells
causing blood cells to swell)

A

hypotonic solutions

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12
Q

what are the types of hypotonic solutions?

A
  • 0.45% NaCl (half strength saline)
  • 0.33% sodium chloride
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13
Q
  • more concentrated than plasma
  • Draws water from the ICF into the ECF
  • Use:
  • Total Parenteral Nutrition – TPN
  • D10W (Dextrose) or 3% Saline
  • useful in treatment of hypovolemia
    and hyponatremia
A

hypertonic solutions

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14
Q

how do we maintain therapy?

A
  • Nursing responsibility to check continuous IV every
    hour
  • Knowledge of the solutions being administered and
    principles of flow
  • Assess for local and systemic complications
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15
Q
  • Excessive IV fluids causes increased blood pressure and
    central venous pressure
A

pulmonary edema

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16
Q

what are the S&S of pulmonary edema

A

↓SpO2, ↑respiratory rate, dyspnea, coughing up
pink frothy sputum, auscultation of dependent fine
crackles

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17
Q

what is the nsg care for pulmonary edema?

A
  • Prevention: Use IV controller / pump to prevent accidental bolus.
  • Treatment: Must be immediate. ↑HOB, vitals, administer
    oxygen, notify prescriber. Anticipate
  • diuretics and slowed IV rates
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18
Q

at insertion site or systemically

A

infection

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19
Q

what are the S&S of infection?

A

Insertion site may become red, tender, swollen, or have
purulent drainage. Systemic signs and symptoms may
include malaise, fever, hypotension, or tachycardia

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20
Q

what is the nsg care for infection?

A

PVAD-short and midline catheters showing S&S of local
infection should be removed immediately. Monitor for signs
and symptoms of systemic infection

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21
Q

air enters circulatory system via
bubbles in tubing/solution running out
air travels to lungs

A

air embolism

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22
Q

what are the S&S of air embolism?

A

Palpitations, dyspnea, cyanosis,
hypotension, weak rapid pulse, loss of
consciousness, chest pain

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23
Q

what is the nsg care for air embolism?

A
  • Stop infusion, administer oxygen
  • position client on Lt side,
    Trendelenburg position, call doctor
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24
Q

movement of previously stationary blood clot to lungs

A

pulmonary embolus

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25
what are the S&S of pulmonary embolus?
Sudden chest pain, Cyanosis, SOB, decreased B/P, Tachycardia, anxiety
26
IV needle/catheter slips out of vein or not inserted into vein results in fluid build-up in extravascular tissue
infiltration
27
what are the S&S of infiltration?
swelling, pain, redness, decreased infusion rate, coolness at site
28
* Similar to infiltration * Administration of irritant solutions into surrounding tissue
extravasation
29
what are the S&S of extravasation?
Pain, burning, redness, blistering, inflammation, necrosis
30
 inflammation of vein from:  prolonged use of vein irritating solution
phlebitis
31
what are the S&S of phlebitis?
Redness, heat, swelling & pain along vein
32
 inflammation of vein /c blood clot formation  results from blood stasis inside vein at catheter/needle tip
thrombophlebitis
33
what are the S&S of thrombophlebitis?
* Pain & tenderness * Redness & swelling * heat along vein path * Slowed infusion
34
Blood leakage into tissue around insertion site
hematoma
35
what are the S&S of hematoma?
Ecchymosis, swelling, leakage of blood
36
caused by a clot due to inadequate flushing protocol on locked sites or infusion rates too slow to keep vein open
occlusions
37
what are the S&S of occlusions?
Sluggish flow rate. Inability to flush or infuse IV solution or meds. Frequent downstream occlusion alarms on the IV controller / pump
38
Result of kinked tubing, slow infusion rate empty IV bag or failure to flush line after intermittent medication or solution
clotting and obstruction
39
what are the S&S of clotting and obstruction?
Slow infusion and blood back flow into line
40
Caused by microorganisms that are introduced into the blood through the puncture site, the hub, or contaminated IV tubing or IV solution, leading to bacteremia or sepsis
catheter-related bloodstream infection (CRBSI)
41
what are the S&S of catheter-related bloodstream infection?
elevated temperature, flushed, headache, malaise, tachycardia, decreased BP, and additional signs and symptoms of sepsis
42
* Regulate amount fluid over long period * Primary & secondary lines
continuous
43
* Solution (drug) given in shorter period * Piggy back, saline lock, & volume-control set
intermittent
44
allows IV solutions to infuse into client’s subcutaneous fat * For first hour, rate should be set at 30 mls per hour
hypodermoclysis
45
* IV push * Delivers single dose (bolus) of a drug * Into a vein or existing line
direct injection
46
what are the types of IV tubing?
primary secondary Y-admin tubing vented unvented
47
used to admin lg volumes of IV solution over long period of time
primary
48
shorter tube, used to admin sm volumes of solution through port in 1° tubing
secondary
49
- for admin whole blood/packed cells - 2 branches (1 for blood, 1 for N/S) - filter below branches to remove bld clots/cellular debris - N/S infuses before & after blood or during if transfusion reaction occurs
Y-admin tubing
50
- draws air into solution container - used for solutions packaged in glass bottles (lipids, in past) to facilitate flow
vented
51
- used for solutions packaged in plastic - does not draw in air (regular tubing set)
unvented
52
what does tubing consist of?
1)Spike (insertion spike for accessing solution) 2)Drip chamber (holds sm amt fluid) 3)Length of plastic tubing ( connects solution to catheter) 4)One or more ports ( to instill IV meds, additional solutions) 5)Roller clamp (regulates rate of infusion)
53
* Most common sites arm/hand (back of hand, arm, forearm or inner elbow * Avoid veins in foot/lower extremities - IV here restricts mobility &  risk for blood clots * Infants - scalp veins
superficial veins
54
what are the common causes of IV flow interruption?
tubing block faulty pump air vent patency
55
56
how often is a continuous IV changed?
96 hrs
57
how often is an intermittent IV changed?
24 hrs
58
* Parenteral Nutrition, extended IV therapy, solutions with PH > 9 or < 5; removal blood specimens; For clients with limited peripheral veins * Inserted antecubital area through basilic, cephalic, or median cubital * Tip in axilla region * Replace Q 2-4 wks
midline catheter
59
* Providing TPN, Monitor central venous pressure * Administering concentrated or irritating IV solution * Collapsed peripheral veins * Long term IV therapy * Peripherally Inserted Central Catheter * Upper arm (basilic or cephalic vein) * Inserted into jugular or subclavian vein to just above heart (superior vena cava) * Done at bedside; placement verified by * x-ray
peripherally inserted central catheters (PICC's)
60
 External Tunneled catheters  Surgically implanted  Held in place by Dacron cuff
hickman, broviac, groshong
61
* Surgically implanted * Via subclavian or jugular vein * Reservoir attached and placed in subcutaneous pocket * Angle needle inserted through skin for access
implanted venous ports
62
what can infusion rates be affected by?
* Changes in patient position, * Flexion of the IV site extremity * Occlusion of the IV device * Venous trauma * Manipulation of the VAD
63
* delivers a measured amount of fluid over a period of time (e.g., 100 mL/h) * computer system with a drug library and are associated with reduced risk for infusion-related medication errors
electronic infusion devices
64
* include flow regulators (i.e., dial or barrel-shaped) * volume-control devices deliver small volumes with the aid of gravity * height of the IV container, IV tubing size, or fluid viscosity) affect an IV gravity controller.
manual flow-control devices
65
* delivers standard volume of 60gtts/ml * delivers small-sized drops
microdrip
66
* drop size varies * 10, 15 & 20 gtts / ml * 10 is most common - delivers large-sized drops
macrodrip
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