Term
| Purpose of Parental Fluid Therapy |
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Definition
-Maintenance Needs
NPO
-Replace Abnormal Fluid Losses
Suctioning, Vomiting, Diarrhea
-Correct Electrolytes Disturbances
Hypokalemia, Hyponatremia
-Provide Drug Therapy
Prophylaxis, Infection |
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Term
| Advantages of IV administration of Drug Therapy |
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Definition
-Drug circulates rapidly
-Easier to maintain constant blood levels
-Patient that cannot accept drugs by GI tract
-Patient unable to swallow |
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Term
| Water and Electrolyte Solutions |
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Definition
| Types of IV are categorized according to its concentration (tonicity) & pH to plasma |
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Term
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Definition
same concentration as plasma
0.9% saline |
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Term
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Definition
lower concentration than plasma
-moves water into the cell to expand them
-excessive use can cause water intoxication
-0.45% saline (1/2 normal saline) |
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Term
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Definition
higher concentration than plasma
-used to correct fluid, electrolyte, & acid-base imbalances by moving water out of the body's cell & into the blood stream |
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Term
| Selection of vascular access device |
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Definition
-Short peripheral catheters
-midarm/midline catheters
-central infusion devices
-nonTunneled percutaneous catheter
-Tunneled central catheter
-Implanted venous access ports
-Dialysis catheters |
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Term
| Short peripheral catheters |
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Definition
26 (smallest) to 14 (large bore) gauge
26-24 used for older & pediatric pts
20 most commonly used
18 surgery
16-14 high risk procedures
Best practices:
-place in upper extremities
-use in non-dominant arm
-avoid choosing a site in the joint reflexion
Allowed to stay in place for 72-96h then replaced |
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Term
|
Definition
-6-8 inches in the antecubital fossa
-used for therapies lasting from 1-4 weeks |
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Term
|
Definition
-Peripherally inserted central catheter (PICC)
-18-29in, into antecubital fossa
-Tips of the catheter sits in the SVC & placement is verified by X-Ray
Used for:
-drugs that need to be quickly diluted
-Chemotherapy
-lengthly courses of antibiotics
-parenteral nutrition |
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Term
| Nontunneled percutaneous catheter |
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Definition
place either at the subclavian or internal jugular
short term used |
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Term
| Tunneled Central catheter |
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Definition
Portion of the catheter is placed subcutaneously
long term use |
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Term
| Implanted Venous Access Ports |
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Definition
| Surgically implanted placed in the upper chest or extremities |
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Term
|
Definition
-used for hemodialysis or a phersis procedure
-may be tunnelled for long term use or nontunneled for short term
-used for management for renal failure |
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Term
| Rationale for selecting a central venous access device (CVAD) |
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Definition
-There is a higher blood flow volume in a central venous site
-superior vena cava 2000mL/m
-subclavian 800mL/m
-cephalic and basilic vein of upper arm 40-95mL/m
-Hypertonic solution needs to be administered into an area with high blood flow in order to immediately dilute
-A medication can be very irritating to the vessel may be given via CVAD
Such as: 50% glucose (TPN - Total parenteral nutrition) or 5-10% glucose give via peripheral site (PPN - peripheral parenteral nutrition) |
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Term
| Rationale for determining IV flow rate |
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Definition
-Type of solution: solution may be irritating- give slower or dilute more
-Patient reaction: pt may c/o pain
-Fluid Deficit: higher rates if pt has good cardiac & renal function to prevent fluid overload
-Body size
-Age |
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Term
|
Definition
-Assess IV site to the bag q1h
-Inspect site for redness, swelling, hardness & pain
-Check tubing for kinks
-Change peripheral IV sites every 72-96hrs
-Change primary tubing every 72hrs
-Change fluid containers every 24hrs
-Change dressing if it becomes loose, wet or soiled or when the catheter is removed. |
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Term
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Definition
-Infiltration
-Phlebitis
-Thrombosis/Thrombophlebitis
-Ecchymosis & Hematoma
-Infection at the IV site |
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Term
|
Definition
leakage of IV fluid into the extravascular tissue
s&s: edema at the IV site
NIs: stop the infusion & discontinue the IV, elevate extremity , apply cold compresses |
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Term
|
Definition
Inflammation of the vein
s&s: pain, redness at the site, palpable hard like cord along the vein
NIs: discontinue the IV, warm compresses
Use intravenous nurses society phlebitis scale to document |
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Term
| Thrombosis/Thrombophlebitis |
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Definition
blood clot inside the vein
s&s: slowed or stopped infusion, swollen extremity, tenderness&redness
NI's stop infusion & discontinue the IV, cold compresses, elevate. For thrombophlebitis: apply cold initially then warm compresses |
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Term
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Definition
&secchymosis is from blood infiltrating into the surrounding tissue.
s: swelling, then bruising & pain
NIs: apply proper pressure when removing IV, treatment is the same as for infiltration. |
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Term
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Definition
localized redness & hardness at site
s&s: site is red, swollen, warm, pt c/o tenderness
NIs: clean exit site with alcohol, cover with sterile dressing |
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Term
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Definition
-Circulatory overload
-catheter embolism
-air embolism |
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Term
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Definition
infusing fluids at a rate greater than the pt can accommodate
s&s: decrease amount of solution in the IV bad
-moist breath sounds (crackles)
-increased BP
NIs: slow rate down to KVO, raise the HOB, and call MD. |
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Term
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Definition
caused by a piece of the catheter breaking off & free floating in the vein
s&s: Decreased BP, pain along the vein, pulse becomes weak and thready
NIs: remove catheter, apply tourniquet high on the limb |
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Term
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Definition
air is introduced into the central venous system during catheter insertion.
s&s: hypoxia, hypotension, respiratory distress, cyanosis, dyspnea, cough, changes in cardiac & neurological status, lightheadness
NIs: clamp catheter immediately, place pt in Trendelenburg's position on left side, head down, call MD, ABG's, ECG, administer 02 tape all connectors |
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Term
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Definition
| supplying nutritional requirements by vein |
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Term
| Partial nutritional support |
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Definition
| is administered by peripheral vein (peripheral parenteral nutrition - PPN) that is less then 10% dextrose |
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Term
| Total Parenteral Nutrition (TPN) |
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Definition
10% dextrose & administer via CVC
NIs: gradually increase as tolerated and taper when discontinuing therapy
-ongoing assessment of CVC site
-following hospital policy for dressing changes
-Change bag & tubing every q24h
-pt. may be allergic to fat or protein assess for side effects nausea, exhaustion, diarrhea
-assess for:
-hyperglycemia: fatigue, thirst, polyuria
-hyperosmolar, hyperglycemic, non-ketotic syndrome (HHNS): increase blood sugar, dehydration, increase serum osmolarity, somnolence (prolonged drowsiness, sleepiness), seizure and coma |
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Term
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Definition
consume adequate nutrients even though GI tract is functioning
administered through the GI tract using a tube
-NG, G-Tube, J-tube
Characteristics of formula:
-formulas differ in osmolarity
-protein and CHO sources
-fat content
-caloric density
NIs:-administer formulas at room temp.
-adjust flow rate - start slow
-administer free water with feeding
-change delivery system q24h
-auscultate lung and bowel sounds
Assess:
-Type of feeding being administered
-Lab Values
-Hydration status
-I&O - diarrhea
-skin turgor
-tongue & mucous membrane
-thirst
-daily weight
-lung sounds
-sensory (mental awareness) |
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