Term
| True or False: The CDC mandates that a nurse be on the premises when an IV infusion is in process. |
|
Definition
| True. The MS Board of Nursing states that a RN must be on the premises when an IV infusion is in process. |
|
|
Term
| Who must be aware of the scope of practice for an IV certified LPN? |
|
Definition
|
|
Term
| Who is ultimately responsible for the care given by an LPN under the supervision of an RN? |
|
Definition
|
|
Term
| How many ml of fluid should most adults consume? |
|
Definition
|
|
Term
| Should fluid intake be equal? |
|
Definition
| No, fluids are lost in sweat, respirations, defecation etc. Urine output should be about 1/3 to 1/2 of fluid intake. |
|
|
Term
|
Definition
| Oral fluids, IV fluids, enteral feedings |
|
|
Term
|
Definition
| Urine, wound drainage, tube drainage, diarrhea, vomiting |
|
|
Term
| What do all IV patients need? |
|
Definition
|
|
Term
| What should a patient know about recording I&O? |
|
Definition
- Write down everything they drink and the amount
- Show them how to measure urine or instruct them to call to have it measured
- Ask the family and visitors not to eat off the patient's tray |
|
|
Term
|
Definition
| mass of partially clotted blood that has infiltrated into the tissues, usually accompanied by ecchymosis (bruising) |
|
|
Term
| How can you prevent problems associated with IV's? |
|
Definition
| Hold direct pressure on IV site for 2-3 minutes with a sterile gauze pad, elevate arm over patient's head or on a pillow. Apply ice packs. |
|
|
Term
| What can poorly regulated IV's lead to? |
|
Definition
| Fluid overload, overdosing, underdosing, clogged catheters, phlebitis, and infiltration. |
|
|
Term
|
Definition
| Inflammation of the vein due to mechanical or chemical causes. |
|
|
Term
| What are the mechanical causes of phlebitis? |
|
Definition
| Using a large catheter in a small vein, improper securing of the IV, over-manipulation of the IV catheter, prolonged use of the same IV site. |
|
|
Term
| What are the chemical causes of phlebitis? |
|
Definition
| Irritating or vesicant medications that are acidic or alkaline or that have high osmolarity (Erythromycin, Nafcillin, Vancomycin, Amphotericin B, Potassium) |
|
|
Term
| What is the treatment for extravasation? |
|
Definition
| Stop the infusion immediately, do not remove the catheter because it may be needed to administer antidote into the tissues. |
|
|
Term
| Where is extravasation rated on the infiltration scale? |
|
Definition
|
|
Term
|
Definition
| A localized complication that occurs when the IV catheter is improperly placed or secured or becomes dislodged or because the veins are too thin and fragile. Fluids leak into surrounding tissues. |
|
|
Term
| What are the signs and symptoms of infiltration? |
|
Definition
swelling, discomfort, burning, tightness, cool skin, and blanching.
the iv stops running or slows down
Can lead to nerve and muscle damage if severe. |
|
|
Term
| What are the general rules for site selection for an IV? |
|
Definition
| When choosing a site for insertion of an IV you should start distally and work proximally and avoid the patient's dominant hand. |
|
|
Term
| Which vein is the first choice for an IV site? |
|
Definition
| The dorsal metacarpal veins are the first choice when choosing a site for inserting an IV. |
|
|
Term
| What is the main symptom of hypernatremia? |
|
Definition
|
|
Term
|
Definition
a) High sodium level > 145
b) Caused by water loss, excessive sodium intake, endocrine disorders that cause fluid loss or hyperventilation |
|
|
Term
| What issues you may face when starting an IV in a geriatric patient? |
|
Definition
| The skin of most geriatric patients lack skin turgor and has limited subcutaneous tissue. Superficial veins are weaker and more prone to infiltration. IV infusions must be monitored carefully to avoid fluid overload. |
|
|
Term
|
Definition
| The ability of components of an IV solution to be mixed and administered with no chemical or physical changes and no loss of therapeutic effect. |
|
|
Term
| What factors influence drug IV compatibility? |
|
Definition
| Order of mixing, drug concentration, length of time drugs are in contact with other drugs and solutions, temperature, exposure to light, and pH |
|
|
Term
| Centers for Disease Control and Prevention (CDC) |
|
Definition
| Works to prevent and control infectious and chronic diseases, injuries, workplace hazards-collects information about infections that occur as a result of IV therapy |
|
|
Term
|
Definition
Protects the safety of employees
Was responsible for the Needlestick Safety and Prevention act (2001) that mandated the use of safety devices to reduce needle stick injuries in clinical settings |
|
|
Term
| What are the purposes of IV therapy? |
|
Definition
a) Provide water, electrolytes, and nutrients to meet daily requirements.
b) To replace water and correct electrolyte imbalances
c) To administer medications and blood products |
|
|
Term
|
Definition
| the body's attempt to maintain a steady state |
|
|
Term
| What percentage of an adult body is fluid? |
|
Definition
|
|
Term
| What percentage of an infant's body is fluid? |
|
Definition
|
|
Term
| What are body fluids made up of? |
|
Definition
| Water and solutes (electrolytes & proteins) |
|
|
Term
| What is the purpose of body fluids? |
|
Definition
| Regulate body temperature, transport nutrients throughout the body, transport wastes to excretion sites, preserve cell shape. |
|
|
Term
|
Definition
a) Most abundant extracellular electrolyte
b) Normal range= 135-145 mEq/L
c) Holds fluid in ECF
d) Necessary for muscular contractions and nerve impulses |
|
|
Term
|
Definition
a) Low sodium level < 135
b) Caused by excessive water retention (dilutes the sodium)- losses may be caused by diuretic therapy, renal disease, adrenal insufficiency, loss of GI fluids, inadequate intake of sodium, inappropriate oral or IV fluids |
|
|
Term
| What are the signs and symptoms of hyponatremia? |
|
Definition
| Anorexia, nausea, abdominal muscle cramps, neurologic dysfunctions including headaches, delirium, lethargy, seizures, coma, respiratory arrest, death, papilledema (swollen optic disc), sternal edema |
|
|
Term
| What are the major body fluid electrolytes? |
|
Definition
| sodium (Na+), potassium (K+), calcium (Ca++), chloride(Cl-), phosphate (PO4-3), magnesium (Mg++) |
|
|
Term
|
Definition
| Electrically charged particles that conduct electricity necessary for normal cell function. |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| What are the signs and symptoms of hypernatremia? |
|
Definition
| Thirst, dry mucus membranes, flushed dry skin, hypotension, neurological changes (weakness, lethargy, irritability, twitching, spasticity, seizures, coma, death) |
|
|
Term
| What is the normal range for potassium (K+)? |
|
Definition
| Normal range = 3.5-5.0 mEq/L |
|
|
Term
| What is the purpose of potassium? |
|
Definition
Influences cardiac and skeletal muscle function; cardiac rhythm.
Major intracellular electrolyte. |
|
|
Term
| What alters the level of potassium in the body? |
|
Definition
| Depends on the kidneys to maintain homeostasis. Also passed in sweat, gastric juices and bowel. |
|
|
Term
|
Definition
| Low potassium level < 3.5 |
|
|
Term
|
Definition
| Decreased intake of potassium, alcoholism, excessive excretion due to diuretics, vomiting, diarrhea, renal disease, GI suctioning, sweating, endocrine disorders, alkalosis |
|
|
Term
| What are the signs and symptoms of hypokalemia? |
|
Definition
| a) Malaise, muscle weakness, paresthesias, diminished tendon reflexes, hypotension, cardiac dysrhythmias, chest pain, palpitations, leg cramps, hyperglycemia |
|
|
Term
| What are the food sources of potassium? |
|
Definition
| bananas, oranges, baked potatoes with skin, beets, turnips, rutabagas, peaches, avocado, melons, tomatoes, squash, beans |
|
|
Term
| What hormones help to manage the fluid balance of the body? |
|
Definition
| ADH, kidneys, and adrenal glands |
|
|
Term
|
Definition
| orally through liquids and food, administration of IV |
|
|
Term
|
Definition
| respiration, perspiration, urine, and feces |
|
|
Term
| When does extravasation occur? |
|
Definition
| When vesicant drugs infiltrate into the patient's IV site and surrounding tissue. |
|
|
Term
| What are some common problems associated with IV's? |
|
Definition
| Difficult insertion, IV will not infuse at correct rates, the IV site develops problems after the IV catheter is removed. |
|
|
Term
|
Definition
|
|
Term
| What causes hypocalcemia? |
|
Definition
| Dysfunction of parathyroid glands either from accidental surgical removal, hypothyroidism, or impaired vitamin D metabolism. |
|
|
Term
| What are the signs and symptoms of hypocalcemia? |
|
Definition
| Dysrhythmias, hypotension, tetany (muscle spasms), parestesias, altered mental status, confusion seizures |
|
|
Term
|
Definition
|
|
Term
| What causes hypercalcemia? |
|
Definition
| Cancer, hyperparathyroidism, disorders that cause bone reabsorption such as immobility, endocrine disorders, medications, and abnormal vitamin D metabolism |
|
|
Term
| What are the signs and symptoms of hypercalcemia? |
|
Definition
| Dysrhythmias, hypertension, muscle weakness, depressed reflexes, altered states of consciousness (coma) |
|
|
Term
|
Definition
a) Important in cellular processes, including enzyme reactions, neuromuscular transmission and cardiovascular tone.
b) Normal level 1.8-3.0 |
|
|
Term
| What are the signs and symptoms of hypomagnesemia? |
|
Definition
| Hyperexcitability with muscle weakness, tremors, seizures, dysrhythmias. |
|
|
Term
| What causes hypermagnesemia? |
|
Definition
| Increased intake of antacids and laxatives. |
|
|
Term
| What is the antidote for hypermagnesemia? |
|
Definition
|
|
Term
| What are the signs and symptoms of hypermagnesemia? |
|
Definition
| Hypotension with vasodilation (flushing) |
|
|
Term
|
Definition
| seen in the feet and lower legs |
|
|
Term
|
Definition
|
|
Term
|
Definition
| localized to abdomen due to liver failure |
|
|
Term
|
Definition
| edema around the sacrum from lying on back |
|
|
Term
|
Definition
| lungs (crackles or rhonchi) pink frothy sputum, SOB |
|
|
Term
|
Definition
Overhydration
Retention of water and sodium |
|
|
Term
| What causes fluid volume excess? |
|
Definition
| Excess intake of sodium, increased fluid intake, IVF's infusing too quickly, decreased urine output due to kidney/liver problems, heart failure, stress from surgery or trauma. |
|
|
Term
| What are the signs and symptoms of fluid volume excess? |
|
Definition
| Edema, shortness of breath, bounding pulse, anxiety, wet cough, hypertension. |
|
|
Term
|
Definition
| IV infuses too rapidly or patient cannot tolerate increased amounts of fluids |
|
|
Term
| What are the signs and symptoms of fluid overload? |
|
Definition
| Respiratory distress, neck vein distention, increased BP |
|
|
Term
| What is the treatment for fluid overload? |
|
Definition
| slow the IV rate to KVO and notify physician, place patient in Semi-Fowler’s position, MD may order diuretics to pull off excess fluid and order O2 to improve respiratory status |
|
|
Term
| Your facility recently changed IV infusion pumps. You were not on duty when in-service training was provided. You have been asked to prepare an IV infusion via pump for Mr. Jamison. What should you do? |
|
Definition
| You should not attempt to prepare the IV by yourself. You should ask for the assistance of someone familiar with this piece of equipment. |
|
|
Term
| What are the advantages of IV medications? |
|
Definition
Direct access to circulation
Available if patient is unable to take oral meds
Less painful
Rapid onset of action and therapeutic response
Control over infusion rate
Can discontinue immediately if adverse reaction occurs |
|
|
Term
| What are the disadvantages of IV medications? |
|
Definition
Possibility of incompatibilities
Possibility of absorption by the IV bag or administration set
Possibility of errors in mixing
Speed shock
Phlebitis
Extravasation by vesicant drugs |
|
|
Term
|
Definition
| Universal donor – because this type has no antigens, it can be transfused in an emergency into anyone regardless of blood type |
|
|
Term
| What type blood can type O receive? |
|
Definition
| Can only receive type O blood |
|
|
Term
|
Definition
- A plasma expander
- Natural plasma protein obtained from blood
- Expands circulating volume and increases plasma protein volume |
|
|
Term
| What are the uses for albumin? |
|
Definition
Treatment of shock due to circulating volume deficit
Provide protein
Bind bilirubin |
|
|
Term
| What are the complications associated with albumin? |
|
Definition
Fluid overload
Anemia
Bleeding
Dilution or depletion of electrolytes
Allergic reactions |
|
|
Term
|
Definition
| Major inherited blood antigen |
|
|
Term
| Why should donors be matched for Rh factor? |
|
Definition
• Initial exposure of a Rh-negative recipient to Rh-positive blood generally does not cause a reaction
• Future exposures to Rh-positive blood may result in a hemolytic reaction |
|
|
Term
| What are the three categories of IV solutions, and what is their relationship to serum? |
|
Definition
• Isotonic – same osmolarity or concentration as serum
• Hypertonic – higher osmolarity or concentration than serum
• Hypotonic – lower osmolarity or concentration than serum |
|
|
Term
| What is the purpose of an infusion of blood or blood products? |
|
Definition
• Restore circulating volume
• Improve the ability of the blood to carry oxygen
• Replace blood components such as clotting factors |
|
|
Term
| What is the liquid component of blood? |
|
Definition
|
|
Term
| What are the cellular components of blood? |
|
Definition
Erythrocytes (red blood cells or RBCs)
Leukocytes (white blood cells or WBCs)
Thrombocytes (platelets) |
|
|
Term
| What are the blood components that can be infused? |
|
Definition
Whole blood
Packed red blood cells (PRBCs)
Leukocyte-poor RBCs
Platelets
Fresh frozen plasma (FFP) |
|
|
Term
| What type blood can a type A patient receive? |
|
Definition
| Type A or type O in an emergency. |
|
|
Term
| What type blood can a type B patient receive? |
|
Definition
| Type B or type O in an emergency. |
|
|
Term
| What type blood can a type AB patient receive? |
|
Definition
| Type A, B, AB, or O in an emergency. |
|
|
Term
| What is a type AB person known as? |
|
Definition
|
|
Term
| What are the symptoms of a hemolytic reaction? |
|
Definition
- Rash/Hives
- Headache
- Chest pain
- Chills and fever
- Back pain/flank pain
- Shortness of breath |
|
|
Term
| What should documentation of IV discontinuation include? |
|
Definition
The date and time of discontinuation
The reason for discontinuation
The condition of the catheter
Whether the catheter was intact
Follow-up measures
Any S/S of infection or inflammation |
|
|
Term
| What affects IV flow rate? |
|
Definition
- Raising the height of the container will improve a sluggish flow.
- Flow is directly proportional to the diameter of the IV tubing, IV catheter, and vein.
- The longer the tubing, the slower the flow.
- Thicker solutions like blood require a larger cannula.
- Higher BP makes the infusion go slower
- Warmer solutions go faster than cold solutions |
|
|
Term
| How should you treat infiltration? |
|
Definition
- Stop the IV from infusing and remove the catheter. Elevate the arm and apply cool compresses for the first 24 hours.
- Determine the level of infiltration using the INS Infiltration Scale
- Some healthcare institutions require that an occurrence form (incident report) be filed.
- A new IV should be started in the patient’s other arm if possible. |
|
|
Term
| How do you prevent phlebitis? |
|
Definition
- Slow down the infusion rate
- Dilute the medication
- Start with smallest catheter that will be appropriate for the solution.
- Replace IV catheters every 72-96 hours. |
|
|
Term
| What are the signs and symptoms of phlebitis? |
|
Definition
| erythema (redness), tenderness at the site, warm to touch, elevated temperature, can go into local infection and/or sepsis |
|
|
Term
| What is the treatment for phlebitis? |
|
Definition
| stop the infusion and remove the device, elevate, apply cool compresses |
|
|
Term
| What is the first choice for venipuncture? |
|
Definition
|
|
Term
| What is the order of preferred venipuncture sites for pediatrics? |
|
Definition
• 1st choice – forearm veins
• 2nd choice – tributaries of cephalic and basilic veins, dorsal venous arch
• 3rd choice – ventral surface of wrist on inner aspect of wrist |
|
|
Term
| What is important to know when about accessing alternate sites for venipuncture in pediatrics? |
|
Definition
|
|
Term
| What are alternate sites for venipuncture in pediatrics? |
|
Definition
- Scalp veins for infants less than 1 year old
- Saphenous vein – last resort site |
|
|
Term
| What is a hypersensitivity reaction also known as? |
|
Definition
|
|
Term
| Where should you check for information about allergic reactions? |
|
Definition
| Check with patient and medical record for information about allergies or family history of allergies. |
|
|
Term
| What are the signs and symptoms of a hypersensitivity reaction? |
|
Definition
| rash, itching, tearing eyes, runny nose, bronchospasm (constriction of the airways), wheezing, anaphylaxis |
|
|
Term
| What is the treatment for a hypersensitivity reaction? |
|
Definition
| Stop the infusion, notify the MD, Maintain the IV device by hanging a continuous IV of saline or saline lock, maintain a patent airway, support respirations, May need epinephrine, antihistamines, steroids |
|
|
Term
|
Definition
| Air that has entered the vein and then enters the heart and causes it to work harder. |
|
|
Term
| What is important to know about air embolus risk? |
|
Definition
- Air can enter anytime the IV system when the tubing or catheter become separated.
- More common in central lines than peripheral lines
- Can lead to decreased cardiac output, shock, and death. |
|
|
Term
| What are the signs and symptoms of air embolus? |
|
Definition
| respiratory distress, mid-chest and shoulder pain, nausea, lightheadedness |
|
|
Term
| What is the treatment for an air embolus? |
|
Definition
| Close off the catheter immediately by closing the clamp or kinking the tubing, place the patient on their left side, head down, start oxygen and notify MD |
|
|
Term
| What conditions may lead to difficult venous access? |
|
Definition
| skin lesions, rashes, sclerosing (hard) veins, obesity, edema, elderly fragile veins, dark skin |
|
|
Term
| What can make accessing a vein easier and safer? |
|
Definition
| Use smallest catheter necessary for intention, stabilize the vein by holding the skin taut, remove tourniquets after 1-2 minutes, displace edema by pressing downward, for obese patients you may need a longer cannula, do not apply tourniquet tightly |
|
|
Term
| Before beginning an IV what allergies are important to look for? |
|
Definition
Medications
Tape
Latex
Alcohol or povidone iodine |
|
|
Term
| What conditions affect IV placement/location? |
|
Definition
Do not start distal to edema, cellulitis, burns, injury, etc.
Do not use arm with fistula for dialysis
Do not use extremity with paralysis or poor circulation |
|
|
Term
| What should a safe needle system involve? |
|
Definition
Be needleless
Have the needle built into the device.
Require no activation by the user (a passive device) if user activation is necessary, the safety feature should be activated without exposing the user to the sharp point and should easily enable the user to tell that it is activated.
Be easy to use and practical.
Be safe and effective for patient care. |
|
|
Term
| What are the 3 types of needleless systems? |
|
Definition
- Blunt cannula and resealable ports
- Luer-activated devices
- Pressure –activated safety valve devices |
|
|
Term
| What is the are the uses of dextrose solutions? |
|
Definition
Provide free water
Treat hyperkalemia (high serum potassium)
Treat dehydration |
|
|
Term
| What are the cautions associated with high concentrations of dextrose? |
|
Definition
can cause cellular dehydration by pulling fluid from the cells into the ECF space
must be decreased slowly over 48 hours to prevent an excess of insulin production by the pancreas |
|
|
Term
| What are the uses of multiple electrolyte solutions? |
|
Definition
- Trauma and burns
- GI tract losses and dehydration
- Sodium loss
- Acidosis
- Maintain the patient’s fluid and electrolyte balance
- Replace fluids and electrolytes for losses due to dehydration, hemorrhage, vomiting or diarrhea |
|
|
Term
| What is the normal potassium level? |
|
Definition
|
|
Term
| What is the normal sodium level? |
|
Definition
|
|
Term
| What is the normal chloride level? |
|
Definition
|
|
Term
| What is the normal calcium level? |
|
Definition
|
|
Term
| Multiple Electrolyte Solutions |
|
Definition
aka Ringer’s or Lactated Ringer’s
Isotonic
May contain lactate or acetate in order to prevent or treat disruption of the body’s acid/base balance (metabolic acidosis) |
|
|
Term
| What is important to keep in mind with NaCl and Dextrose Combination Solutions? |
|
Definition
- Prevent some of the adverse effects that occur when each is administered separately
- Observe for fluid overload in patients with heart, kidney, or liver disease |
|
|
Term
| What are the uses for NaCl and dextrose combination solutions? |
|
Definition
| Fluid replacement due to sweating, vomiting, and gastric suction. |
|
|
Term
| What are the uses of a hypertonic solution? |
|
Definition
- Treat patients with low serum electrolyte levels
- Stabilize blood pressure
- Assist in regulating urine output
- Reverse gastric fluid loss from diarrhea, vomiting, NG suctioning
- Reverse the effects of dehydration caused by overuse of hypotonic solutions |
|
|
Term
| What are the cautions of hypertonic solutions? |
|
Definition
- Observe for circulatory overload
- Do not use if patient has cardiac or renal disease |
|
|
Term
| What are examples of hypertonic solutions? |
|
Definition
|
|
Term
| What are the types of incompatibility? |
|
Definition
| Chemical, physical, and therapeutic |
|
|
Term
|
Definition
May or may not be visible
• Change in color |
|
|
Term
|
Definition
Forms a precipitate that may or may not be visible
• Solution may become hazy or cloudy or form gas bubbles |
|
|
Term
| Therapeutic Incompatibility |
|
Definition
Undesirable reaction that occurs when two or more drugs are given together
• One inhibits or increases the effects of the other |
|
|
Term
| What is the difference between peripheral parenteral nutrition and total parenteral nutrition solutions? |
|
Definition
| PPN is used for short-term therapy and provides a minimum of caloric and protein needs. PPN solutions are less concentrated than TPN solutions. TPN restores or maintains nutritional status, can be used for long-term therapy, and must be infused via a central line. |
|
|
Term
| What happens when solutions are incompatible? |
|
Definition
| Incompatibility is a reaction or interaction of additives with each other or with the solution that changes the expected action of the medication or solution and may cause loss of the therapeutic effect. |
|
|
Term
| How can you avoid problems associated with incompatibility? |
|
Definition
Change solutions every 24 hours
Carefully check bags before hanging
Do not infuse if solution is cloudy or has a precipitate
Select correct diluent to reconstitute the drug
Do not mix drugs needing a special diluent with other drugs
Select the correct solution for the infusion
Flush IV line between infusions of incompatible medications
Follow manufacturer’s recommendations |
|
|
Term
|
Definition
| Synthetic plasma expander |
|
|
Term
| What is dextran used for? |
|
Definition
• Trauma
• Burns
• Hemorrhage |
|
|
Term
| What complications are associated with dextran? |
|
Definition
• Anaphylaxis
• Fluid overload
• Dilution of electrolytes |
|
|
Term
|
Definition
synthetic plasma expander
sugar alcohol substitute |
|
|
Term
| What are the uses of mannitol? |
|
Definition
• Diuresis – remove excess body fluids
• Excretion of toxic substances
• Treatment of increased intracranial pressure and cerebral edema |
|
|
Term
| What are the complications associated with mannitol? |
|
Definition
• Fluid and electrolyte imbalances
• Cellular dehydration
• Fluid overload
• Nervous system toxicity |
|
|
Term
|
Definition
synthetic plasma expander
similar to albumin
causes fluid to be pulled into the intravascular space |
|
|
Term
| What is hetastarch used for? |
|
Definition
| treat shock due to decreased circulating volume |
|
|
Term
| What complications are associated with hetastarch? |
|
Definition
• Anaphylaxis
• Altered platelet function
• Volume overload
• Fluid and electrolyte imbalances |
|
|
Term
| What are the uses of isotonic solutions? |
|
Definition
Hydration when the patient is dehydrated
Replacement of extracellular fluid loss, such as blood loss
Treatment of hypernatremia (excess serum sodium) |
|
|
Term
| What are the cautions associated with isotonic solutions? |
|
Definition
Watch for fluid overload
Isotonic solutions do not provide adequate calories
They may lead to protein loss |
|
|
Term
| What are common isotonic solutions? |
|
Definition
D5W
Normal saline (NS)
Lactated Ringer’s (RL) |
|
|
Term
| What are the uses and example of a hypotonic solution? |
|
Definition
- Reverse dehydration caused by overuse of diuretics
- Treat patients with high serum electrolyte levels
- Example: 0.45 NS |
|
|
Term
| What are the cautions associated with a hypotonic solution? |
|
Definition
Should not be used for patient with
Cerebral edema
Increased intracranial pressure
Burns
Trauma
Low protein levels from malnutrition or liver disease |
|
|
Term
| What is the isotonic concentration of NaCl? |
|
Definition
|
|
Term
| What is the hypotonic concentration of NaCl? |
|
Definition
0.45% NaCl
(normal saline)
Supplies normal daily amounts of Na and water |
|
|
Term
| What is the hypertonic concentration of NaCl? |
|
Definition
3% or 5% NaCl
Use to correct severe Na loss % water overload. |
|
|
Term
| What are the uses of NaCl solutions? |
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Definition
Treatment of shock
Treatment of hyponatremia (low serum sodium)
Fluid challenges
Replacement in diabetic ketoacidosis
Resuscitation in trauma emergencies
Infused with blood transfusions |
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Term
| What are the cautions associated with NaCl solutions? |
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Definition
- Can lead to fluid overload
- Observe patients with CHF, edema, and hypernatremia carefully |
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Term
| What is the nurses role in the transfusion process? |
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Definition
Verification
Patient identification
Hanging/starting transfusions of blood or blood products
Monitoring for reaction |
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Term
| What is the nurses part in the Needlestick Safety and Prevention Act? |
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Definition
- Avoid the use of needles when possible.
- Correctly use the safe alterations provided.
- Not recap needles.
- Dispose of used needles promptly and in appropriate sharps containers.
- Report hazards from needles that you observe in the workplace.
- Report needlestick injuries promptly to ensure that you receive appropriate follow-up care.
- Attend training and follow infection control policies and procedures. |
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Term
| What are the signs and symptoms of a blood reaction? |
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Definition
| sudden spike in temperature, hives, rash, shortness of breath, rapid change in BP and/or pulse |
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Term
| What should you do if you notice the S/S of a blood reaction? |
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Definition
Notify MD and lab
Hang an IV of 9%NS
Follow facility P&P after reaction |
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Term
| What is the use of vitamin C? |
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Definition
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Term
| What is the use for folic acid? |
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Definition
| macrocytic (large RBCs) anemia |
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Term
| What are folic acid and thiamine used for? |
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Definition
| vitamin deficiencies associated with alcoholism. |
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Term
| What are B vitamins used for? |
|
Definition
| needed for metabolism of carbohydrates and maintenance of GI function |
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Term
| Is vitamin K included in a banana bag? |
|
Definition
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Term
| What causes metabolic alkalosis? |
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Definition
| excess ingestion or administration of sodium bicarbonate (baking soda), TPN solutions, blood transfusions, GI loss of HCl via vomiting, GI suctioning, bulimia, diuretic therapy, loss of chloride and body fluids |
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Term
| What are the signs and symptoms of metabolic alkalosis? |
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Definition
| ↑ pH, ↑ HCO3, confusion, hyperactive reflexes, tetany, convulsions, hypotension, dysrhythmias |
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Term
| What is the treatment for metabolic alkalosis? |
|
Definition
| Restore KCL or NaCL, watch for S/S of hypocalcemia or hypophosphatemia |
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Term
| What causes metabolic acidosis? |
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Definition
| diabetes mellitus, fasting and starvation (anorexia & bulimia), lactic acidosis, salicylate poisoning (aspirin overdose), alcohol poisoning, kidney dysfunction and failure, loss of intestinal secretions (diarrhea & GI suctioning) |
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Term
| What are the signs and symptoms of metabolic acidosis? |
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Definition
| ↓ pH, ↓HCO3, diarrhea, nausea, vomiting, anorexia, weakness, lethargy, malaise, altered mental status, coma, peripheral vasodilation, shock, bradycardia, cardiac dysrhythmias, warm flushed skin, Kussmaul’s respirations |
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Term
| What is the treatment of metabolic acidosis? |
|
Definition
| Administer bicarbonate (HCO3) via IV or PO |
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|
Term
| What does the blood transport? |
|
Definition
Oxygen
Nutrients
Hormones |
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|
Term
| What does infusing blood or blood products accomplish? |
|
Definition
Restores circulating volume
Improves the ability of the blood to carry oxygen
Replaces blood components such as clotting factors |
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|
Term
| How many liters of blood does an adult normally have? |
|
Definition
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|
Term
| What causes respiratory acidosis? |
|
Definition
| Respiratory center depression (sedative overdose, head trauma), lung disorders (pneumonia, emphysema, asthma, pulmonary edema, respiratory distress syndrome, airway obstruction, airway injury, injury to thorax), extreme obesity, respiratory muscle paralysis, kyphoscoliosis |
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Term
| What are the signs and symptoms of respiratory acidosis? |
|
Definition
| ↓pH, ↑PCO2, hypoventilation, shallow respirations, headache, weakness, altered mental status, behavioral changes (disorientation, confusion, depression, paranoia, hallucinations), tremors, paralysis, stupor, coma, warm dry skin, drowsiness, nausea and vomiting, diarrhea, fruity smelling breath, acidic blood, acidic urine |
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Term
| What is the treatment for signs and symptoms of respiratory acidosis? |
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Definition
| treat the cause, may need Narcan to reverse sedation |
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Term
| What causes respiratory alkalosis? |
|
Definition
| hysteria, hyperventilation, high fever, salicylic poisoning (aspirin), elevated ammonia, encephalitis, and mechanical ventilation |
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|
Term
| What are the signs and symptoms of respiratory alkalosis? |
|
Definition
| ↑pH, ↓ PCO2, deep respirations, rapid breathing, panic, irritability, light-headedness, dizziness, paresthesias, + Chvostek’s sign and + Trousseau’s sign, seizures, nausea & vomiting, diarrhea, muscle twitching, tetany, alkaline urine, ECG changes |
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Term
| What is the treatment for signs and symptoms of respiratory alkalosis? |
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Definition
| Slow down breathing. Get patient to concentrate on breathing slowly and deeply. Have them breathe into a paper bag- re-breathing CO2 will increase CO2 in blood and decrease pH to more normal levels |
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Term
| What is the normal pH of cells? |
|
Definition
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|
Term
| What controls the acid-base balance? |
|
Definition
| cellular buffers, lungs (blows of CO2), kidneys (reabsorb bicarbonate or excrete more bicarb as needed) |
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|
Term
| What are cellular buffers? |
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Definition
| proteins, hemoglobin, bicarbonate, phosphates which attempt to “soak up” acids |
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Term
| What role of the fluid regulation process do the kidneys play? |
|
Definition
| retain or excrete urine as well as metabolic waste products |
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Term
| What role of the fluid regulation process does the heart and the blood vessels play? |
|
Definition
| circulate fluid to kidneys- osmoreceptors detect fluid levels |
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Term
| What role of the fluid regulation process do the lungs play? |
|
Definition
| remove water from body during exhalation |
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Term
| What role of the fluid regulation process does the endocrine system play? |
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Definition
| produces hormones that reg. fluid volume and concentration (ADH & aldosterone) ADH reg. water retention; Aldosterone reg. retention of sodium |
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|
Term
|
Definition
| the fold stays up when released-a sign of dehydration- count the number of seconds it stays tented |
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Term
|
Definition
| push finger into tissue over a bone and count number of seconds it stays pitted |
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|
Term
|
Definition
| listen with stethoscope over all lung fields- crackles or rhonchi indicates fluid excess |
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|
Term
| What is normal urine specific gravity? |
|
Definition
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|
Term
| What is the normal proportion of output from intake? |
|
Definition
| urine will be 1/3-1/2 of intake due to losses through respiration, sweating, etc |
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|
Term
|
Definition
| solutes move from high concentration to area of lower concentration |
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|
Term
|
Definition
| fluids move from high concentration to area of lower concentration |
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|
Term
|
Definition
|
|
Term
|
Definition
| does not indent with slight pressure |
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|
Term
|
Definition
| occurs when part hangs down as in hanging legs down or sitting long periods |
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|
Term
| What can low serum protein levels cause? |
|
Definition
| fluid to leave vascular system and leak into tissues |
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|
Term
|
Definition
| rated +1(mild) to +4 (severe) |
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|
Term
| What are common diuretics? |
|
Definition
- Lasix (furosemide)
- Bumex (Bumetanide)
- Demadex (Toresemide)
- Microzide or Diuril (Chlorothiazide)
- Hydrodiuril (hydrochlorothiazide) HCTZ
- Aldactone (spironlactone) |
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|
Term
| What are the signs and symptoms of dehydration? |
|
Definition
- Dry mucus membranes
- Dry skin
- Poor skin turgor-tenting
- Decreased urine output < 30 cc/hr
- Rapid weak pulse
- Hypotension- ↓BP |
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|
Term
| What is the treatment for dehydration? |
|
Definition
- Restore the fluids- IV, push fluids, TPN
- Good skin care- moisturizers, gentle handling of skin
- Reposition at least every 2 hours
- Strict I&O and daily weight |
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|
Term
| What can cause fluid volume deficit (dehydration)? |
|
Definition
- Inadequate fluid intake or starvation
- Loss of body fluids through sweating, diarrhea, vomiting, excessive urine output (diuresis), excessive drainage from wounds or burns, GI suctioning
- Fever
- Endocrine disorders/renal problems |
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|
Term
| What is the treatment for fluid volume excess? |
|
Definition
- Put patient in semi-Fowlers or Fowlers position to facilitate easier breathing
- Elevate feet and legs above the level of the heart to edema
- Decrease IVF rate (MD order)
- Administer O2 (MD order)
- Reduce sodium in diet (MD order) |
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|
Term
| What should you do for IV administration in pediatrics? |
|
Definition
- Explain carefully if patient is old enough to understand
- Appropriate language
- Be honest
- DO NOT have parent restrain child
- Immobilization – hold or wrap |
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|
Term
| What should you include in the patient chart when starting an IV? |
|
Definition
| size and type of catheter, the number of attempts, the date and time, the site of insertion, the type of solution and additives or medications, the flow rate, the pump information, the type of dressing applied, your name and initials. Include any patient education that you provide. |
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Term
| What two techniques might help if you are unable to access a vein? |
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Definition
| If you are unable to locate a vein, you might try tapping gently over the vein to elicit a mechanical reflex dilation of vein walls or use a warm, moist compress over the site. |
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|
Term
| When should you check the physician’s orders before administering IV medications or solutions? |
|
Definition
You should check the physician’s orders three times before administering IV medications or solutions:
• When you obtain the medication or solution from the pharmacy or from the supply area
• During preparation
• Immediately prior to starting the infusion |
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