2. IV, PN

Question 1

Examples of Isotonic

Answer 1

.9NSS, D5W, Ringer’s Lactate, Normal Saline

Question 2

Hypotonic def

Answer 2

(push fluid into cell) prevent fluid overload

Question 3

Hypotonic examples

Answer 3

.45NSS (1/2 NSS) half strength saline

Question 4

hypotonic complications

Answer 4

intravascular fluid depletion, decreased blood pressure, cellular edema, and cell damage

Question 5

hypertonic def

Answer 5

(pull fluid out of cell) increase blood pressure

Question 6

hypertonic examples

Answer 6

10% Dextrose in water, D5.45NSS, D5.9NSS, DSLR, 50% Dextrose in Water

Question 7

hypertonic complications

Answer 7

extracellular volume excess and precipitate circulatory overload and dehydration

Question 8

What size needle for blood?

Answer 8

18 or larger needle

Question 9

Gauges of needle

Answer 9

14-24 (14 largest, 24 smallest)

Question 10

What affects IV flow?

Answer 10

diameter (bigger than faster flow); height of bag (higher bag, faster flow)

Question 11

When flush IV?

Answer 11

every 8 hours and before and after administration of meds

Question 12

If using iodine for IV insertion ask pt?

Answer 12

if allergic to shell fish

Question 13

How to know if IV inserted in artery?

Answer 13

if bright red blood and blood shooting out with each heart beat

Question 14

How should vein feel once tourniquet is placed?

Answer 14

firm, elastic, engorged, and round; not hard, flat or bumpy

Question 15

degree of angle of needle when inserting IV

Answer 15

10-30 with bevel up

Question 16

What requires own IV site?

Answer 16

Heprin, blood, and TPN

Question 17

change IV tubing and equipment every?

Answer 17

72-96 hours/site & tubing (thick liquids changed every 24 hours - TPN, blood, lipids/24 hours)

Question 18

hematoma?

Answer 18

could be caused by inserting IV at the wrong angel, should be 5-30; results when blood leaks into tissues surrounding the IV insertion site (puncturing the back wall of the vessel)

Question 19

infiltration?

Answer 19

leaking of fluid into interstitial space
- Regular infiltration – noncaustic type of fluids
- Extravasation – Caustic fluids
- Causes: ruptured vessel, dislodge cannula, occlusion
- Assessment: swelling, blanched, cool, pain, occlusion
• Tie tourniquet above IV site to determine if present (tight enough to restrict venous flow, if infusion continues to drip despite the venous obstruction, infiltration is present)
• Will not have blood return

Question 20

level 4 infiltration?

Answer 20

compartment syndrome

Question 21

phlebitis?

Answer 21

inflammation of a vein
- Causes: irritant solution, dehydration, infection
- Assessment: erythema, warmth, pain
• Site – red, warm to touch, painful, burns when touched (“burned the vein”), sometimes red streak
• Can get blood return

Question 22

fluid overload

Answer 22

overloading the circulatory system with excessive IV fluids causes increased blood pressure and central venous pressure (so making the heart work too hard)

• Ex. Albumin (hypertonic) draws more fluid in because of concentrations)
• Causes: Rapid or large volume fluid administration, compromised cardiac function
• Assessment: SOB & crackles, tachycardia, agitation or anxiety
• Intervention: slow infusion, raise HOB to set patient up, monitor VS, notify provider

Question 23

veins used for PN

Answer 23

Typically, a large, high-flow vein such as the subclavian vein or superior vena cava is the preferred site. femoral lines (last resort)

Question 24

TPN

Answer 24

Total Parenteral Nutrition contains glucose, amino acids, vitamins, and minerals all mixed into 1 bag; Does not have fat (lipids), so sometimes have to give pt fat emulsions

Question 25

PPN

Answer 25

Peripheral Parenteral Nutrition; “half dosing”, Can give through midline, Given for supplement, Individualized to the pt by pharm and orders written every 24hrs

Question 26

TNA

Answer 26

Total Nutrient Admixture; Same as TPN but also has lipids

Question 27

Important monitoring of PN

Answer 27

Blood sugar measured every 6-8 hours
Intake and Output – to make sure pt is excreting properly
Daily weight – make sure taken at the same time every day, good time is the morning; every L gain 2.2 lbs

Question 28

complications of PN

Answer 28

Sepsis – because of glucose
Electrolyte imbalance
Hyperglycemia – think about how fast start rate
Hypoglycemia – if stop abruptly 
Hypervolemia
Hepatic dysfunction – because of lipids
Hypercapnea – CO2 in the blood
Lipid intolerance

Question 29

administering PN

Answer 29

Remove TPN and lipids from the refrigerator at least an hour before hanging. TPN solution should be clear, not cloudy.
Lipids will be white. Do not use the fluid if cracking or creaming of the fluid is present because it may indicate fluid separation.

Question 30

Input and Output defined

Answer 30

Defined as the measurement and recording of all fluid intake and output during a 24 hour period

Question 31

1 tablespoon (tbsp) = ___milliliters(ml)

Answer 31

15

Question 32

___ teaspoons(tsp) = 15 milliliters(ml)‏

Answer 32

3

Question 33

1 cup(C) = ___milliliters(ml)‏

Answer 33

240

Question 34

8 ounces(oz) =___ milliliters(ml)‏

Answer 34

240

Question 35

1 teaspoon(tsp) = __milliliters(ml)

Answer 35

5

Question 36

1 cup(C) =__ounces(oz)‏

Answer 36

8

Question 37

16 ounces(oz) = __pound(lb)‏

Answer 37

1

Question 38

1 ounce (oz) = ___milliliters(ml)

Answer 38

30

Question 39

Jello?

Answer 39

120 ml

Question 40

Ice cream/sherbet

Answer 40

120 ml

Question 41

4oz of juice

Answer 41

120 ml

Question 42

1 ice cup

Answer 42

120 ml

Question 43

16 oz milkshake

Answer 43

480 ml

Question 44

popsicle

Answer 44

90 ml

Question 45

120 oz soda

Answer 45

360 ml

Question 46

pudding/yogurt

Answer 46

120 ml