Term
IV Fluids-IV fluid administration is used when patient needs for fluid can’t be met via
route or feeding tube; or when fluids need to be replenished very quickly. Examples: |
|
Definition
a.Patient if NPO
b.Patient unable to ingest oral fluids
c.Life-threatening fluid loss
Other reasons:
d.When a quick response to medication is needed
e.To deliver medication that isn’t possible to deliver orally
f.Some medications are highly alkaline and irritating to muscle and subcutaneous tissue; these medications cause less discomfort when given intravenously |
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Term
| what are the 3 main reasons to have intravenous therapy |
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Definition
a.Maintain daily body fluid requirements
b.Restore previous body losses
c.Replace present body fluid losses |
|
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Term
| When is the 5 times you know you need intravenous therapy |
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Definition
a. Prevent or correct fluid and/ or electrolyte imbalance
b. supply nutrients
c. maintain blood volume
d. administer medication when rapid onset desired
e. assist with specific patient symptoms such as nausea, vomiting and shock |
|
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Term
| what are the 4 advantages of intevenous therapy |
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Definition
1. rapid absorbtion
2. rapis response
3. appropriate when patient is nonresponsive to other routes
4. total drug absorbtion |
|
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Term
| What are the 4 disadvantages of intravenous therapy? |
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Definition
a.Rapid onset of action with inability to recall a drug once it has entered the bloodstream
b.Vascular irritations and subsequent hazards
c.Possible drug incompatibility when one or more drug added to IV solution
d.Speed shock |
|
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Term
| What are the 8 checks to do before giving IV fluids? |
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Definition
a. validate the physicians order
b. compare the patient's age and conditions to medication dose, route, and rate ordered
c. Verify the six Rs, right patient, right medication, right rate, right time, right route, and right documentation
d. Verify patient’s identity and allergies before administration of IV fluids
e.Check the fluid bag for expiration date
f.Inspect the fluid bag for leaks, cracks, or discoloration – IV solutions are usually clear (except TPN lipids)
g.Always read you facility’s procedure manual for specific instructions
h.IV fluid solutions (bags) should be changed every 24 hours – if the solution has not completely infused within 24 hours then a new bag must be hung. Leaving fluid solutions (bags) hanging longer than 24 hours leads to an increased risk of infection. Remember to date fluid bags. |
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Term
| Does IV tubing have to be sterile |
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Definition
|
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Term
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Definition
| delivers a set number of drops (gtts) per mL depends on how it is manufactured.This is called the drop factor and is always listed on the packaging of the tubing – anywhere from 60 drops per milliliter (gtts/mL) (microdrip) down to 10 drops per milliliter (gtts/mL) (macrodrip). Microdrip should be used when the patient is at risk for fluid volume overload. It also has to be used to ensure accurate delivery at rates of less than 30mL/hr. |
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Term
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Definition
|
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Term
|
Definition
| 10 drops per mL (gtts/mL) |
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Term
| what kind of drop factor should be used when patient is at risk for fluid volume overload? |
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Definition
| microdrop 60 drops/mL because it ensures accuratly delivery at rates less than 30mL/hr. |
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Term
| IV tubing guidlines for changing the IV bag is what for primary and secondary continuous administration sets used to administer fluids other than parenternal nutrition, lipds, blood, or blood products should be changed |
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Definition
| c. IV tubing is changed according to institution’s policy, however most institutions follow with recommendations and guidelines from the Infusion Nurses Society (INS) and the Center of Disease Control (CDC). Both organizations, INS and CDC, recommend the following: primary and secondary continuous administration sets used to administer fluids other than parenteral nutrition, lipids, blood or blood products should be changed every 96 hours. This is a new recommendation – the old recommendation was 72 hours – you may see institutions continuing that policy, however there is strong evidence that changing administration sets more frequently does not decrease the risk of infection. |
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Term
| what is the recommendation for tube changing for parenternal nutrition |
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Definition
|
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Term
| Propofol infusions tubing should be changed every |
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Definition
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Term
| and blood/ blood product tubing should be changed every |
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Definition
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Term
| Both INS and CDC state evidence suggests that administration tubing sets can be used us to |
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Definition
| seven (7) days when used in conjunction with antiseptic catheters (discussed in central line module) or if fluids that enhanced microbial growth such as parenteral nutrition or blood is not used. Remember to date all tubing according to institution’s policy. |
|
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Term
| discuss piggyback tubing and when should it be changed? Backflushing or back priming |
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Definition
| d.Secondary medication tubing “piggybacked” into a continuous primary line should also be changed every 96 hours. This is accomplished by “back-flushing” or “back-priming” the tubing prior to each antibiotic use. This is the preferred method because it reduces the need to connect and disconnect secondary intermittent administration sets therefore reducing the risk of infection. This will be demonstrated in lab. |
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Term
| what is the current recommendation from INS on a primary intermirrent administration set? when should it be changed? what about the CDC's recommendations regarding the frequency of replacing intermittently used administration sets |
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Definition
| they should be changed every 24 hours because when an intermittent infusion is repeatedly disconnected and reconnected, there is increase risk of contamination at the catheter hub, needleless connector, and the male luer end of the administration set, therefore possibly increasing the risk for a catheter-related bloodstream infection. However the CDC does not make any recommendation regarding the frequency for replacing intermittently used administration sets. Remember to follow your institution policies and procedures. **Just remember that a new, sterile covering device must be aseptically attached to the end of the administration set after each intermittent use. This will be demonstrated in lab. |
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Term
| Explain how to spike the IV POrt |
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Definition
When spiking an IV bag, remove protective cover from IV solution bag and
check bag for leaks – make sure it is the right solution ordered for patient,
remove tubing from bag/box and close roller clamp, spike bag, being careful
not to touch sterile port or spike, squeeze drip chamber gently and fill with
solution about half way, then open roller clamp clear air from tubing, and close
roller clamp – MAKE SURE ALL AIR IS OUT OF TUBING! Remember to
follow manufacturer’s instruction when priming filters (per institution).
ALWAYS REMEMBER TO WASH HANDS PRIOR TO SPIKING THE IV BAG! |
|
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Term
| Explain electric pumps? Do we have to use them? if so when? |
|
Definition
a. Electric pumps to precisely regulate the flow rate are used most of the time, although it is
possible to regulate the rate by calculating and setting the number of drops per minute by hand. Most pumps are volumetric (nurse sets the number of milliliter per hour (mL/hr) that are to be delivered). Pumps should always be used for infusing solutions containing potassium or other high-risk medications, on all pediatric patients, or any fluid given by central line. With pumps, it is possible to accurately deliver as little as 1 mL/hr. |
|
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Term
| what is the formula for regulating drip by gravity |
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Definition
drops per set delivered/ over time i minutes * amount to be delivered
***c. Monitor fluid rate for accuracy according to physician orders. All fluid containers should be time
taped for ease on monitoring (even those on an electronic infusion device). |
|
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Term
| fluids are classified according to? what is toxicity usually characterized by ? |
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Definition
| according to tonicity (concentration) and pH – tonicity is usually characterized by comparison with normal blood plasma as osmolarity (mOsm/L). |
|
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Term
| what is normal serum osmolarity for adults |
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Definition
| Normal serum osmolarity for adults is between 270 and 300 mOsm/L |
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Term
a. Isotonic – a fluid that has the same osmolarity as body fluids, so infusing it will cause no net
movement of fluid between the interstitial and intravascular spaces
what are the 4 solutions that are concidered isotonic |
|
Definition
1.Normal saline (0.9%) – provides salt and water
2.Ringer’s solution – contains potassium, calcium, and chloride in addition to the 0.9 %
sodium concentration
3.Ringer’s Lactate – adds a substance (lactate) which is converted to bicarbonate in the
bloodstream; otherwise the same as Ringer’s solution
4.5% dextrose in water (D5W) considered isotonic because osmolarity is 272 – contains
water, supplies 170 kcal/liter – also the percentage of the solution express the number of grams of solute of solvent meaning a 100 mL bag of D5W is 5% dextrose in 100 mL
contains 5 grams dextrose in 100 mL of water; a 1000 mL bag of D5W is 5% in 1000 mL contains 50 grams dextrose. |
|
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Term
| what is the osmality of 5% dextrose, and supplies how much kcal/liter |
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Definition
| 272, supplies 170Kcal/ liter |
|
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Term
| explain hypotonic? and what are the two choices of solutions you would use for hyptonic? |
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Definition
less osmolarity than body fluids, “dilutes” the plasma so that fluid tends to movefrom the plasma to the interstitial spaces and into the cells
1.0.45% normal saline (1/2NS), 0.2% normal saline (1/4NS) – provides water and a smaller amount of salt |
|
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Term
| explain hypertonic? and what are the two choices of solutions you would use for hypertonic? |
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Definition
– more osmolarity than body fluids, “concentrates” the plasma so that water
tends to be pulled in from the interstitial and intracellular spaces
1. 3% or 5% saline – given for fluid volume excess (Ex. Pulmonary edema), if kidneys are
functioning, or severe hyponatremia – these patients are usually on a monitored unit
1. 3% or 5% saline – given for fluid volume excess (Ex. Pulmonary edema), if kidneys are
functioning, or severe hyponatremia – these patients are usually on a monitored unit
1. 3% or 5% saline – given for fluid volume excess (Ex. Pulmonary edema), if kidneys are
functioning, or severe hyponatremia – these patients are usually on a monitored unit
2.10% to 50% dextrose – used in total parenteral nutrition |
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Term
| Medications are administered intravenously by the following methods: |
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Definition
| : mixtures within large volumes of intravenous fluids; by injection of a bolus or small volume of medication through an existing intravenous infusion line; or by “piggyback” infusion. |
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Term
| Large volume infusions include ? |
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Definition
| vitamins, potassium chloride, heparin, etc. added to liters of fluid |
|
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Term
| what are intravenous Bolus |
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Definition
| administering a concentrated dose of medication directly into the systemic circulation. This is called “direct push” and is the most dangerous method for administering IV medications because there is no time to correct errors. |
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Term
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Definition
| is a small volume medication bag that is connected to secondary tubing which is connected to the primary infusion set at the upper Y-port. Medications for piggyback delivery are mixed by pharmacy and set to the unit, usually stored in the refrigerator (unless contraindicated) until time for delivery, or mixed by the nurse on the unit at the prescribed time of delivery. |
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Term
| IV medication is given when the patient |
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Definition
| Used when medication can’t be given PO, when medication irritates muscular or subcutaneous tissue, or when rapid onset of action (within 1-2 minutes) is needed. |
|
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Term
| explain the procedure of connecting a piggyback IV |
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Definition
| a small IV fluid bag with the medication added in the solution as a secondary unit and infused over a shorter period of time, or a bag containing the medicine is hooked up and delivered into a saline lock (INT). Always disinfect needleless connector with antiseptic wipe using friction and a scrubbing motion; allow to dry completely before connecting secondary set. If given into a saline lock (INT), always disinfect hub/injection port with antiseptic wipe using friction and a scrubbing motion; allowing to dry completely before flushing with normal saline. Flush with 3 to 5 mLs normal saline before hooking up the medicine bag (to assure patency), and flush with 3mLs normal saline after medication is completed. Always wipe the saline lock with an antiseptic wipe using friction and a scrubbing motion and allowing drying completely before flushing with saline, giving medication, and flushing with saline. |
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Term
| IV Bolus ( direct push ) administration procedure when giving it through a regular line |
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Definition
syringe with medication is hooked up to one of the ports on the line and injected directly by the nurse. Usually done over few minutes (depending upon the medication) – Always check your drug guide before giving IV push medications. Many agencies limit the drugs that a nurse can give by the bolus rate. Always wipe port on tubing before connecting syringe. If given into tubing that has fluid infusing, pinch off the tubing “upstream” from the injection port so that the medicine doesn’t take the “path of least resistance and flow
backwards up the line rather than into the patient”. Flush with normal saline prior to and after medication if indicated (depending upon your primary solution). If given into a saline lock, flush the lock with 1 to 3 mLs normal saline before administering the medication (to assure patency), give medication slowly as recommended by manufacturer or pharmacy, then flush with 3 to 5 mLs normal saline afterwards maintaining positive pressure to prevent reflux of blood back into the catheter hub. |
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Term
| IV bolus guidlines when giving it through a central line |
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Definition
. If infusing via a central line, flush with 5 mLs normal saline before and after medication, followed by heparin per institution’s policy.
Remember to always use a 10 mL syringe when working with a central line. |
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Term
| What are the 8 things that you need to make sure you do when adding a medication to a bag |
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Definition
a.Check medication order
b.Withdraw the medication from the ampule or vial
c.Clean the injection port on the IV bag with alcohol
d.Insert the needle into the center of the port and inject the medication into the bag
e.Withdraw the needle and dispose of appropriately
f.Rotate the bag gently to evenly distribute the medication throughout the bag
g.Write the name and dose of the medication, the date, the time, and your initials on a medication label. Affix the label to the bag
h.Prime the tubing, bring the container to the patient’s room, and hang the solution bag according to standard procedures. Check the drip rate carefully. Follow all procedures needed to monitor IV therapy properly. |
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Term
| Add-Vantage System and Baxter Mini-Bag Plus |
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Definition
Plus require a special type IV bags with a port for
inserting the medication (usually in powder form) contents is mixed into the solution and infused |
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Term
| Flushing needleless connector for intermittent therapy (INT) medication |
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Definition
| [most institutions use a short extension set on all peripheral catheters this keeps the health care worker’s hands from the catheter hub and reduces blood contact as well as decreasing catheter manipulation when converting from a continuous infusion to an intermittent infusion and when giving intermittent medications.] |
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Term
| When flushing needlesless connector for intermittent therapy what are the 4 steps to doing it properly |
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Definition
a.Wear gloves
b.Gather equipment
1.Some institutions offer prefilled 0.9% sodium chloride (normal saline) syringes for flushing needless connectors prior to infusions – if not available draw appropriate amount of normal saline in appropriate syringe (remember 10 mL for all central lines)
c.Clean needleless connector with appropriate antiseptic solution (must institutions continue to use alcohol preps), use friction and a scrubbing motion allowing the needleless connector to dry completely before access. The injection port should be cleaned prior to each access.
d.Open clamp and flush INT with 2-5 mLs of normal saline to assess for blood return and check patency –After medication is completed flush catheter with 2-5 mLs of normal saline using positive pressure, closing the clamp during the final mL of solution and keeping your finger on the plunger of the syringe to maintain positive pressure and to prevent reflux of blood back into the catheter. The theory behind amount of flush needed to maintain patency of the catheter is: the volume of flushing solution is equal to at least twice the volume capacity of the catheter and add-on devices. |
|
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Term
| when do you flush catheters used as intermittent devices |
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Definition
•Following each administration of a medication
•Following the administration of blood and blood products
•Following withdrawal of blood for sampling, etc.
•After converting a continuous infusion to an intermittent device (INT)
•Every 8 to 12 hours (follow institutions’ policies and procedures) if the catheter is not being use (Infusion Nurses Society Infusion Nursing An Evidenced-based Approach – 2010) |
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Term
| how can you educate the patient about their medication |
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Definition
| first you must have consent, patient has the right to refuse treatment, identify patient allergies and document, describe medication schedule (IV antibiotics are usually given round the clock), provide emotional support, and discuss possible side effects of prescribed therapy |
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Term
| IV medications must be compatible to primary IV fluids in order to be given via the same line, and always read manufactures insert on medication carefully |
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Definition
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Term
| Incompatibilities with medication occur three ways: |
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Definition
| Physical – visible haze or precipitate, Chemical – not always visible and usually causes a reduction in the efficacy of the medication, and Therapeutic – occurs within the body and usually produces an undesirable effect |
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Term
| Make sure to check all IV solutions for physical incompatibilities prior to administration |
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Definition
| true, clouding and precipitation |
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Term
| Never give IV medications via the same line as what 5 things |
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Definition
1. blood
2. blood supply
3. TPN solution
4. Mannitol
5. Dextran
6. or sodium bicarbonate |
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Term
| incompatilibilities can be avoided by : |
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Definition
| accessing another IV site if patient is receiving a continuous medication such as heparin or by flushing the IV line with normal saline prior to and after administration of medication. *Follow agency’s policies and procedures and always check with the pharmacy if in doubt or drug’s compatibilities. |
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Term
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Definition
Blood Products – used to increase circulating volume in cases of serious blood loss
or anemia. There are many different blood components that can be extracted and administered, but we’ll focus on whole blood and packed RBC’s. Blood transfusions often result in reactions that can be serious, so they are used only when necessary. |
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Term
| adult population for a blood transfussion needs a what gage needle .. and pediatrics uses a what gage needle |
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Definition
| a #20 gauge or larger to accommodate the transfusion (#18 gauge is recommended). Of course in the pediatric population a #22 or #24 gauge is appropriate. |
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Term
| Blood needs to be administered via a "--" |
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Definition
| “y-setup” along with normal saline. Prime tubing with normal saline FIRST then spike blood bag. ALWAYS WEAR GLOVES WHEN WORKING WITH BLOOD AND BLOOD PRODUCTS. |
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Term
| do you spike the blood bag first or flush the bag |
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Definition
| you prime the tubing first before you spike |
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Term
| is special blood tubing available from the blood bank? |
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Definition
yes,b. Blood needs to be administered via a “y-setup” along with normal saline. Prime tubing with normal saline FIRST then spike blood bag. ALWAYS WEAR GLOVES WHEN WORKING WITH BLOOD AND BLOOD PRODUCTS.
Special blood tubing is available from the blood bank. This tubing has an in-line filter to trap debris. ONLY normal saline should be infused along with blood - most other common solution, including D5W, will hemolyze the cells in the IV tubing (they are hypotonic). Even Lactated Ringer’s though isotonic, will hemolyze red cells. No medications or other additives can EVER be mixed into blood! If transfusion has to be interrupted to give urgent IV medications, clear the line completely with saline from the saline container before giving the medication. |
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Term
| what can only be infused with blood and why? |
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Definition
| . ONLY normal saline should be infused along with blood - most other common solution, including D5W, will hemolyze the cells in the IV tubing (they are hypotonic). Even Lactated Ringer’s though isotonic, will hemolyze red cells. No medications or other additives can EVER be mixed into blood! If transfusion has to be interrupted to give urgent IV medications, clear the line completely with saline from the saline container before giving the medication. |
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Term
| usually what is infused in a blood infusion? what are they made of? and one unit ( 500ml) of whole blood yeilds how much of this? |
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Definition
c. Usually packed red cells (PRBC’s) are infused – they are made from whole blood by centrifuging
and removing plasma. One unit (500 ml) of whole blood yields 250-350 mLs of PRBC’s because
of the smaller volume, fluid overload is less common with PRBC’s than with whole blood. |
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Term
| Approximately 90% of transfusion reactions are caused by improper identification of unit or recipient. |
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Definition
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Term
| blood products must be checked by who:? |
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Definition
| two RNs, LPN and RN (LPN can check with the RN, but the RN must start the infusion). Sometimes RN and MD do the checks together |
|
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Term
| what process happens when blood arrives to the bank to check that everything is okay? |
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Definition
When the blood arrives from the blood bank, a very thorough procedure must be followed to
ensure that the blood is the correct unit for the patient (to avoid transfusion reactions). It varies by agency, so follow policy. Usually involves checking an ID number, patient’s ID band, blood type of both patient and blood unit, and expiration date. Document per policy. Approximately 90% of transfusion reactions are caused by improper identification of unit or recipient. |
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Term
| what do you inspect on blood products |
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Definition
| check expiration date – dark or purple blood may be contaminated – also inspect for gas bubbles. |
|
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Term
| when should blood be administered |
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Definition
as soon as it arrives from the blood bank – one unit
at a time. It should NEVER be put in a refrigerator on the unit. |
|
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Term
| what do you need to make sure you check on the patient before giving the blood |
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Definition
Check your patient’s IV before sending for blood. Also, check recipient’s vital signs. Always get baseline vital signs before starting the blood transfusion (in case of a transfusion
reaction). |
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Term
| after administering the blood do you immediatly leave ? |
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Definition
Remain with recipient and monitor vital signs at least fifteen minutes of infusion. MOST REACTIONS OCCUR WITHIN FIRST FEW MINUTES OF INFUSION! Remember to follow agency’s
policies and procedures – some agencies repeat vital signs after one (1) hour of infusion |
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Term
| packed cells are usually intended to infuse |
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Definition
| over two hours(unless patient is high risk for volume overload) |
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Term
| blood must infuse within how many hours after receiving from the blood bank? |
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Definition
| j. Blood must infuse within four (4) hours after receiving from blood bank. This is to avoid any bacterial growth and red blood cell hemolysis. If not completely infused, it needs to be returned to the blood bank. |
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Term
| what happens when blood is cold from the refrigerator when it arrives on the floor? |
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Definition
| Blood is cold from refrigerator when it arrives on floor, and if infusion rate is to be rapid, it may need to be infused via a blood-warming unit so the patient doesn’t become chilled. NEVER leave it sitting out to “warm up” before starting the transfusion. |
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Term
| how is blood usually delivered by because of what? what is the standard now? |
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Definition
| Blood is usually hung gravity flow, hemolysis may occur to RBCs when blood is infused via an electronic infusion device. However, INS states electronic infusion devices can be used to deliver blood and blood products without significant risk of hemolysis of red blood cells but the electronic infusion device should be analyzed to evaluate the safety and rate of hemolysis. Follow your agency’s protocol. |
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Term
| why do blood tranfussion reactions normally occur |
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Definition
| *Occurs due to antibody / antigen reaction. |
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Term
| anytime a blood transfusion reaction is noted what do you do ? |
|
Definition
| STOP THE INFUSION, OPEN NORMAL SALINE LINE TO KEEP VEIN OPEN AND NOTIFY THE PHYSICIAN! If transfusion reaction occurs – follow agency’s protocol. This usually consists of: notifying the physician, notifying the blood bank – label blood as reaction and return unused portion back to blood bank along with the tubing – then send first voided urine labeled blood reaction to lab. Blood is also usually drawn. Urine output is monitored frequently and documentation done per agency policy. |
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Term
| Febrile (pyrogenic) reaction |
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Definition
| most common transfusion reaction – usually due to recipient’s sensitivity to donor’s WBCs or platelets – observe for fever, headache, flushed face, chills, changes in vital signs. This reaction is nonhemolytic – no hemolysis of red cells, so no free hemoglobin in blood or urine. |
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Term
| what happens when blood is cold from the refrigerator when it arrives on the floor? |
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Definition
| Blood is cold from refrigerator when it arrives on floor, and if infusion rate is to be rapid, it may need to be infused via a blood-warming unit so the patient doesn’t become chilled. NEVER leave it sitting out to “warm up” before starting the transfusion. |
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Term
| how is blood usually delivered by because of what? what is the standard now? |
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Definition
| Blood is usually hung gravity flow, hemolysis may occur to RBCs when blood is infused via an electronic infusion device. However, INS states electronic infusion devices can be used to deliver blood and blood products without significant risk of hemolysis of red blood cells but the electronic infusion device should be analyzed to evaluate the safety and rate of hemolysis. Follow your agency’s protocol. |
|
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Term
| why do blood tranfussion reactions normally occur |
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Definition
| *Occurs due to antibody / antigen reaction. |
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Term
| anytime a blood transfusion reaction is noted what do you do ? |
|
Definition
| STOP THE INFUSION, OPEN NORMAL SALINE LINE TO KEEP VEIN OPEN AND NOTIFY THE PHYSICIAN! If transfusion reaction occurs – follow agency’s protocol. This usually consists of: notifying the physician, notifying the blood bank – label blood as reaction and return unused portion back to blood bank along with the tubing – then send first voided urine labeled blood reaction to lab. Blood is also usually drawn. Urine output is monitored frequently and documentation done per agency policy. |
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Term
| Febrile (pyrogenic) reaction |
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Definition
| most common transfusion reaction – usually due to recipient’s sensitivity to donor’s WBCs or platelets – observe for fever, headache, flushed face, chills, changes in vital signs. This reaction is nonhemolytic – no hemolysis of red cells, so no free hemoglobin in blood or urine. |
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Term
|
Definition
| usually due to a hypersensitivity to antibodies or plasma proteins in the donor blood – observe for hives (urticaria), itching, redness, wheezing, flushing, hypotension (depending on whether the reaction is mild or severe). No free hemoglobin. |
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Term
|
Definition
| heart can’t handle the amount of fluid being infused – observe for cough, dyspnea, anxiety, increase in vital signs (hypertension, tachycardia), distended neck veins (just like Congestive Heart Failure [CHF]). |
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Term
|
Definition
| usually due to ABO incompatibility – recipient receives the wrong blood. Antibodies in the recipient’s blood react with antigens on donor cells causing agglutination and cell destruction. Hemolyzed cells release free myoglobin into the blood, which is filtered into urine by kidneys (this is why blood and urine samples need to go to lab). Hemoglobin may obstruct the renal tubules and lead to acute renal failure (this is why urine output is monitored). Observe for increase in vital signs except blood pressure drops (hypotension), fever, chills, nausea/vomiting, difficulty breathing, back pain, changes in urinary status, and shock. This can range from mild to deadly. KNOW THIS!!!!! |
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Term
|
Definition
| due to contaminated donor unit - observe for high fever and chills, nausea, diarrhea, hypotension. Will not develop as rapidly as other types of reactions. May not be certain about cause until blood cultures from patient and remainder of unit are completed. |
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Term
|
Definition
| – occurs if recipient is IgA deficient – this occurs very quickly after infusion begins (only milliliters have infused) – observe for respiratory distress nausea/vomiting, signs leading to shock and cardiac arrest (fever is not present in this case). |
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Term
|
Definition
person donates his/her own blood some weeks prior to
a planned surgical procedure – very beneficial for patient with rare blood type, and became very popular with the fears resulting from the HIV/AIDS epidemic - avoids any risk of hemolytic, pyrogenic, or allergic transfusion reactions. |
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Term
|
Definition
special equipment for capturing blood loss at surgery and
immediately returning to patient. |
|
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Term
| how often should you assess IV sites on adults ? On children and elderly? |
|
Definition
every two to four hours on
adult patients and every hour on children and elderly.
INS and CDC state IV sites should be monitored frequently according to the institution’s policies and procedures. |
|
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Term
| What do you observe the IV site for ? and what happens if there is a problem |
|
Definition
| b.Observe site for signs of infiltration such as erythema (redness), tenderness, and edema. If exudate or drainage is noted at IV site, culture drainage, discontinue site, using sterile technique, clip cannula tip and place in sterile container, label, notify physician. If physician orders a culture and sensitivity, send to the lab. REMEMBER: You need physician’s order to send to the lab. If dealing with a central line, notify physician of site condition and presence of drainage, culture drainage and send to lab if ordered by the physician. |
|
|
Term
| dressing on the IV site needs to be what? |
|
Definition
| c. Always make sure dressing on site is occlusive. The number one way to prevent infection is to maintain an occlusive dressing over the IV site, both peripheral and central. |
|
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Term
| *Observing the patient, reporting reactions, and taking measures to prevent complications are a nurse's legal and professional responsibilities. |
|
Definition
|
|
Term
|
Definition
| Pain, tenderness, erythema (redness), IV site warm to touch, edema (swelling), induration, purulence, or palpable venous cord |
|
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Term
|
Definition
with indwelling cannula
and postinfusion -phlebitis can occur 48 hours after vascular access device removed |
|
|
Term
| what are the three types of phlebitits |
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Definition
mechanical
chemical
bacterial |
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Term
| what do you do when phebitis occurs |
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Definition
| discontinue IV and restart at a new site in opposite extremity,apply warm compress |
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Term
| what are 5 things you can do to prevent phlebitis |
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Definition
use the smallest guage and length catheter to accomodate the prescribed therapy,avoid placing catheter in areas of flexion,use proper aseptic technique, and stabilize catheter to minimize movement at the
insertion site. Also the CDC recommends rotating IV sites every 72-96 hours to help prevent complications such as phlebitis.
Document condition of site according to institution’s policies and report appropriatetly |
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Term
| According to the Infusion Nurses Society’s Standards, phlebitis should be scored(Infusion Nursing Standards of Practice – 2011) |
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Definition
0 – No symptoms
1 – Erythema at access site with or without pain
2 – Pain at access site with erythema and/or edema
3 – Pain at access site with erythema and/or edema;Streak formation; Palpable venous cord
4 – Pain at access site with erythema and/or edema; Streak formation;
Palpable venous cord > 1 inch in length; Purulent drainage Purulent drainage
NOTE: P3 and P4 required an incident report to be written |
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Term
| Extravasation / Infiltration |
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Definition
*Edema or swelling at site or in surrounding tissue, discomfort at IV site, decrease in
the rate of the infusion or complete stop in flow, and failure to obtain blood return
(sometimes a blood return can be obtained even if the IV is infiltrated) |
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Term
| how do you avoid extravasation/infiltration |
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Definition
| sites must be assessed frequently – refer to institution policies |
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Term
| what do you do when this occurs |
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Definition
discontinue IV and restart at new site, which must be proximal
to infiltrated area or use other extremity. c. Apply warm compresses to infiltrated area – studies have shown that ice applied early on is also beneficial.Document condition of site and record appropriately according to institutions policies |
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Term
| According to the Infusion Nurses Society’s Policies and Procedures for Infusion Nursing (2011), infiltration should be scored |
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Definition
0 – No symptoms
1 – Skin blanched; Edema < 1 inch in any direction; Cool to touch; with or without pain
2 – Skin blanched; Edema 1-6 inches in any direction; Cool to touch; with or without pain
3 – Skin blanched, translucent; Gross edema > 6 inches in any direction; Cool to touch; Mild-moderate pain; Possible numbness
4 – Skin blanched, translucent; Skin tight, leaking; Skin discolored, bruised, swollen;
Gross edema > 6 inches in any direction; Deep pitting tissue edema; Circulatory
impairment; Moderate-severe pain; Infiltration of any amount of blood product,
irritant, or vesicant
NOTE: I3 and I4 require an incident report to be written |
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Term
| *Must remember that the flow of the fluid maintains the patency of the IV line – blood backing up into the tubing can cause clotting if not cleared |
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Definition
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Term
| are there any visible signs of problems with clotting of the IV line? What is an indicator |
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Definition
| no, site appears healthy,Cessation of flow is usually an indicator if fluid is infusing via electronic device the machine will alarm occlusion |
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Term
| what do you access the tubing for if there is a suspectable clotting |
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Definition
| Assess IV tubing for kinks and look to see if roller clamp has been closed d. Attempt to check for blood return – if blood return is obtained then IV is not clotted |
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Term
| when accessing for blood return do you force fluid into the IV line? |
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Definition
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Term
| what do you do once you find out that the site is clotted? what if blood is observed in the tubing when you take it out? |
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Definition
If site is clotted, discontinue IV and restart in another location
g. If blood is observed in IV tubing, replace tubing before restarting IV
*Blood harbors microorganisms! |
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Term
| Are IV infections usually detectable ? what patients are more suseptable? |
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Definition
IV infections are not readily noticeable at IV site. So be aware that an unexplained rise in temperature and an elevated WBC in a patient receiving IV therapy might be related to IV infection. *Remember some patients are just prone to IV infections
such as immunosuppressed patients. |
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Term
| Bacteria and pathogens can enter the bloodstream several ways: |
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Definition
Using poor technique when initiating IV therapy during cannula insertion
2. Not maintaining sterile technique when spiking IV bags, hanging piggybacks,cleaning injection ports, allowing solutions to hang past expiration time, not changing IV tubing appropriately, etc. |
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Term
| what do you do if you inspect an IV infection |
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Definition
. If you suspect an IV infection, discontinue IV and save the solution and components for culturing. Staphylococcus, which is located on the skin as normal
flora, is a common source for IV related infections. |
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Term
| what do you do with the actualy infected area of an IV |
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Definition
If IV site is infected, usually will find purulent drainage at site, tenderness, edema,and warmth. Culture drainage before removing the catheter, discontinue IV catheter, and using sterile scissors clip the cannula tip into a sterilecontainer,label the container. Cover the site with a sterile dressing. Notify physician. Send tip of cannula to lab for studies if the physician orders.
*Remember anytime you suspect a peripheral IV infection discontinue IV
restart IV in new location with new IV solution and tubing! |
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Term
| what do we do regarding Ecchymosis and IV's |
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Definition
| *Avoid bruised areas when starting IVs, bruising at insertion site usually means trauma to the vein caused at the time of initiation |
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Term
| how do you get speed shock |
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Definition
| caused by rapid infusion of solution |
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Term
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Definition
| Patient will complain of pain traveling up the extremity caused sometimes when cannula is small and fluid infusion is fast |
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Term
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Definition
| Caused by air not being cleared from tubing Air has entered into the vascular system Be careful when dealing with central lines chances for an air embolus are increased. |
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Term
| what are symptoms of air embolus? |
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Definition
| respiratory distress, cyanosis, blood pressure decreases, pulse becomes weak and rapid, loss of consciousness, eventually cardiac arrest |
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Term
| how can you prevent air embolus |
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Definition
Inspect IV tubing especially electronic flow devices frequently
and utilize clamps when changing tubing; Use luer-lock connections on
catheter-administration set junctions and use air-eliminating filter on administration sets when appropriate. |
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Term
| what treatment is there for air embolus |
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Definition
Turn patient on LEFT side this helps to trap the air within the
right atrium where it may be broken down into smaller, less harmful bubbles and hopefully stops the advancement of the air to the pulmonary artery, place patient in Trendelenburg's position, initiate O2, and notify the provider. This is more of a problem with central venous access placement than peripheral IV access. |
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Term
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Definition
| patient has recieved to much fluid |
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Term
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Definition
| *Patient is sensitive to IV solutions or admixtures in solutions |
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Term
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Definition
| can occur if nurse reinserts stylet into cannula |
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Term
| How do you document IV complications |
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Definition
| Record in client's/patient's record per employing institution’s protocol |
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Term
| what IV teams are used for infection control? |
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Definition
Composed of specially trained nurses who carry out policies and procedures designed to provide quality IV care utilizing standards established by Centers for Disease Control (CDC), the Infusion Nursing Society (INS) and employing institution. Designed to assist with the prevention of IV related nosocomial infection
c. Evidence supports the utilization of infusion nurse specialists for inserting and
maintaining IV catheters – evidence supports less complications and optimal outcomes as well as greater patient satisfaction. |
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Term
| for infection control when should you wash your hands? |
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Definition
a. Before initiation of IV therapy
b. After initiation of IV therapy |
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Term
| what are other things you can do to reduce the risk of IV infection |
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Definition
3. Gloves
4. Aseptic technique and product sterility
5. Disposal of all blood-contaminated and all sharps in a nonpermeable, tamper-proof container
6. Monitoring
a. Frequent intervals to determine patient's response to IV therapy per employing institution's policy
b. Patient protection minimizes the risk of potential IV complications
c. Quality assurance and risk management tool |
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Term
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Definition
| exerts pressure on tubing and moves fluid |
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Term
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Definition
| uses gravity to maintain a controlled flow rate (sensor monitor rate), but delivers fluids accurately |
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Term
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Definition
these are piston-driven pumps that provide precise infusion by controlling the rate
according to syringe size and drive speed – these are usually found in pediatrics and specialty areas |
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Term
| Patient Controlled Analgesic (PCAs) |
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Definition
Consists of an external infusion pump that delivers a
small dose of opiod Analgesic “on demand” (patient presses a button). The liquid analgesic is in a locked reservoir on the pump. The settings on the pump can’t be altered by the patient, and consists of: the dose that is delivered each time the button is pressed, the number a minutes (“lockout interval”; usually 5-15 minutes) that must elapse between doses, regardless of how many times the patient presses the button. Pumps can be set to deliver a steady “background dose” in addition to the small bolus the patient receives when the button is pressed. PCAs give the patient control, and avoid the long delay that occurs with “PRN” dosing; from the time the patient recognizes need for medication through the many nursing steps until the dose is actually given by the nurse. It also provides a steady level of anesthesia compared with the peaks and valleys that occur with “every 4-hour PRN” dosing. PCAs are not appropriate for the patient without the cognitive or neuromuscular ability to use it. PCAs
can be used with intravenous, intraspinal, or even subcutaneous lines. Allows patient to self administer analgesia agents Lock out intervals are available on all models so patient will not receive too much medication. Remember the drugs delivered via this device are controlled substances and you must follow employing institution's policies and procedures for obtaining, delivering, administering, documenting, and discarding these medications. (Usually morphine, sometimes Demerol) |
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Term
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Definition
| Used for the management of acute and chronic pain. Catheter is placed in the epidural spaces of the vertebrae and medication infused at a prescribed rate.Analgesic diffuses across the dura into the CSF. Used for both acute and chronic pain – can be given intermittent, continuous, or combination. Usually morphine (Duramorph) and fentanyl citrate most common. Bupivacaine (Marcaine) and lidocaine are often used in drug combinations with the opioids to manage postoperative pain. Narcan must be kept at the bedside. All patients receiving epidural must have IV access. |
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Term
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Definition
| Catheter is placed directly into the CSF, between the dura and the spinal cord. The most rapid onset of action of all anesthetic approaches, but the shortest duration. Used for chronic pain not relieved by less invasive methods. Risks and side effects associated with epidural and intrathecal include: respiratory depression, migration of the catheter tip, infection, nausea and vomiting, constipation, urinary retention, sedation, and itching. Side effect incidence is lower that with parenteral route because the doses used are smaller. |
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Term
| What should we know about the IV equipment? |
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Definition
a. Become familiar with IV equipment employing agency utilizes
b. Most models have instructions on devices and all institutions have manuals available on the equipment for staff to access if needed
*Also available are mechanical controllers: manual or flow rate regulators. These mechanisms are attached to the primary infusion sets and they are manually set to deliver fluids at a specific rate (dial-a-flow). |
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Term
| Many institutions require the use of in-line filters on all IV lines. Some institutions require the use of filters on all central lines and with the administration of certain IV medications. Filters are used to filter out particulate matter. |
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Definition
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Term
| what size filteris used for all non-lipid containing solutions |
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Definition
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Term
| what size filter is used for lipid infusion or total perenternal / nutrietn admixtures |
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Definition
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Term
| both filters lipid solution and non lipid solution should contain what?where should they be placed? |
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Definition
| Both of these filters should contain a membrane that is both bacteria/particulate-retentive and air-eliminating. These filters should be placed as close to the catheter insertion site as possible. Filter changes should coincide with IV administration set changes (refer back to tubing changes). Remember all blood and blood component tubing has in-line filters (refer back to blood and blood product section) |
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Term
| The future: focus on prevention? |
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Definition
| 50% of health status is determined by behavior ( diet, wearing, seat belts, ect. ) but only 4% of health care expeditures are on health education |
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Term
| medical savings account and a defined benefits plan? How does it shift the burden to the consumer? |
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Definition
| can only be used for medical issues, if you do not use it it can role over, and it can be used to cover over the counter drugs. So if you get 3000 at the begining of the year, so everytime you go to the doctor the costs come out of the 3000, after 3000 is used up you have to pay out of your pocket.It still provided insurance as well. This makes people thing befoe people go to the doctor. This appeals to the company because this is the cheepest by giving you a budget. |
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Term
| Cocierge "Boutique" medicine |
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Definition
| physiican takes on specific patients so he can be at your beck and call when ever you need them |
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Term
| what three things determine the worth of health care systems |
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Definition
| Access, Cost, and Quality |
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Term
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Definition
47 million uninsured Americans
-Cost shift ( someone is going to have to pay for other people to have heathcare)
- American distrust of "socialized" ,medicine |
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Term
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Definition
- rising again in spite of managed care; consumer backlash
- "Greying" of America
- someone is going to have to pay for this and people do not realize that |
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Term
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Definition
| Given enormous costs, expect increased pressure on health care professionals and organizations to objectively demonstrate and assure the quality of their services |
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Term
| Laws are nothing but ethics that have been formally sanctioned by society |
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Definition
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Term
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Definition
| deals with values and morals; what a person's conduct OUGHT to be |
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Term
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Definition
| – Also concerned with right and wrong, but concentrates on rules of conduct that are enforced by society (“police power”) |
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Term
| Some times things are legal but not ethical |
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Definition
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Term
| Ethics deals with “should” and “may”; law deals with “must” and “shall” |
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Definition
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Term
| Some acts can be considered “legal, but not ethical”, or “ethical, but not legal” |
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Definition
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Term
| Privacy is guarenteed in the constitution that is an example of how this contributes to the health services in the country |
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Definition
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Term
| in the U.S. Constitution most health care issues are based on what ammendment |
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Definition
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Term
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Definition
• US constitution votes and passes law
Rules passed by a legislature (ex. state Nurse Practice Acts) |
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Term
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Definition
power that is delegated to the bord of nursing, people can get in trouble just as much as if they do not follow the actual law.A special case of Statutory Law—agencies of the executive branch (ie
State Board of Nursing), within the limits of the laws that define their
mission, can make rules/regulations which have the force of law. |
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Term
| There is no law that you can not leave their patient to go have a lunch break, but in a court they would get an expert witness and he would say in all his years of nursing he has never seen this as right then the court would use this to make their descion, this is called |
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Definition
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Term
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Definition
–Derived from:
•traditional usage/custom
–For example, nursing standards of practice
• previous court decisions (precedent)
–Stare Decisis (“let the decision stand”) |
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Term
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Definition
| let the descion stand, president |
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Term
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Definition
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Term
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Definition
| illegal act considered to defensive it is considered to be against all of us as a society |
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Term
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Definition
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Term
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Definition
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Term
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Definition
–A “crime is conduct so offensive that it is considered to be an act against all of society
-If guilty, punishment can include fines and imprisonment
-“Minor” crime-misdemeanor; “major” crime-felony |
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Term
| How can nurses encounter criminal law in their practice |
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Definition
–Theft of narcotics/controlled substances
–Physical abuse of patient
–Falsifying medical records
–Medicare billing fraud |
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Term
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Definition
you go to civil court rather than criminal court, the state will not prosequte.
–Deals with disputes between individuals, for example:
•Nonpayment of debts
•Unintentional property damage
Failure to fulfill terms of a contract
–Monetary damages
-Tort – “twisted” a civil wrong committed by one individual against another
-Intentional or unintentional |
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Term
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Definition
| intentional or unintentional |
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Term
| what are 2 types of unintentional |
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Definition
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Term
| in civil court do they put you in jail? |
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Definition
| no they are just trying to make things right |
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Term
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Definition
| failure to act in a reasonable or prudent manner (I.e. starting a barbecue grill with gasoline and setting the neighbor’s house on fire) |
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Term
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Definition
| – a specific type of negligence relating to failure of a specially trained person (I.e. physician or nurse) to act in a reasonable or prudent manner in the practice of his/her profession, professional negligence |
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Term
| if you get sued four things hve to be true for malpractice , what are they? |
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Definition
–Duty to the patient (nurse-pt relationship)
–A “breach” of the duty (“mistake” of omission or commission)—usually requires expert witness to explain the standard of care to the court
–Actual harm to the patient
-“Causation” – a relationship between the breach and the injury
–“but for” test |
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Term
| when is a nurse have a duty to the patient |
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Definition
| when you are assigned to a patient and are getting paid for it. |
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