Ch. 15 Flashcards
(81 cards)
1
Q
infusion therapy is the _____
A
- delivery of medications in solutions and fluids by parenteral route
2
Q
the most common route of infusion therapy
A
IV
3
Q
most common invasive therapy administered to hospitalized patients
A
IV therapy
4
Q
types of infusion therapy fluids
A
- IV solutions (including parenteral nutrition)
- blood and blood components
- drug therapy (benadryl, antibiotics, replacements)
5
Q
IV solutions: normal serum osmolarity (adults)
A
270-300 mOsm/L
6
Q
isotonic solution (amount)
A
270-300 mOsm/L
7
Q
hypertonic solution
A
fluids > 300 mOsm/L
8
Q
hypotonic solution
A
fluids < 270 mOsm/L
9
Q
isotonic infusate
A
- water does not move into or out of the body’s cells
10
Q
patients receiving isotonic solutions are at risk for ____
A
fluid overload
- esp. older adults
11
Q
hypertonic infusate
A
- used to correct fluid, electrolyte, and acid-base imbalances by moving water out of the body’s cells and into the bloodstream
12
Q
parenteral solutions is an example of ___ infusions
A
hypertonic infusions
13
Q
hypotonic infusate moves water
A
into cells and expands them
14
Q
hypertonic infusate moves water
A
out of the body’s cells into the bloodstream
15
Q
if osmolarity is > 600 mOsm/L, it is best to infuse in _____ circulation
A
central circulation
- where greater low provides adequate hemodilution
16
Q
TPN (total parenteral nutrition) has osmolarity of
A
> 1400 mOsm/L
17
Q
TPN should never be infused in ___ circulation
A
peripheral circulation
- can damage blood cells and endothelial lining of vein
18
Q
common IVFs
A
- 0.9% Saline
- 0.45% Saline
- D5W
- D10W
- D5/.9%NS
- D5/.45%NS
- Ringer’s Lactated
- D5RL
19
Q
isotonic IVFs
A
- 0.9% Saline
- D5W
- Ringer’s Lactated
20
Q
hypotonic IVFs
A
- 0.45% Saline
- D5RL
21
Q
hypertonic IVFs
A
- D10W
- D5/.9%NS
- D5/.45%NS
22
Q
components of Saline (0.9%), NaCl, 3% or 5% saline
A
Na and Cl
23
Q
indications of Saline (0.9%), NaCl, 3% or 5% saline
A
- alkalosis
- fluid loss
- sodium depletion
24
Q
components of D5W, D10W
A
dextrose in water
25
indications for D5W, D10W
- replace calories as carbohydrates
- prevent dehydration
- maintain H2O balance
- promote Na diuresis
26
components of D5NS, D51/2NS, D10NS
dextrose in saline
27
components of LR or RL
Na, Cl, K, Ca, and lactate
27
indications of D5NS, D51/2NS, D10NS
- promote diuresis
- correct moderate fluid loss
- prevent alkalosis
- provide calories and NaCl
28
indications of LR or RL
- replaces fluid lost d/t vomiting or GI suctioning
- treats dehydration
- restores normal fluid balance
29
blood transfusions: components
- packed RBCs (PRBCs)
- platelets (PLT)
- fresh frozen plasma (FFP) (for clotting d/o)
- albumin (for low protein state)
- several specific clotting factors (for hemophilia)
30
prescribing infusion therapy: fluids
- type of fluid
- rate of administration in mL/hr (or total amount of fluid and hours for infusion)
- drugs and dose to be added
31
prescribing infusion therapy: drugs (in IV fluids)
- drug name
- specific dose and route
- frequency of administration
- time(s) of administration
- length of time for infusion (number of doses/days)
- purpose
32
vascular access device (VAD)
short peripheral catheters
- superficial veins of the hand and forearm
33
VAD can dwell for ____ and then requires removal and insertion into another venous site
72-96 hours
34
complaints of what can indicate nerve puncture during insertion of VAD?
- tingling
- pins and needles feeling in the extremity
- numbness
35
veins cannot be used in patients with
- mastectomy (no blood work in the arm on that side)
- axillary lymph node dissection
- lymphedema
- paralysis of upper extremities
- dialysis graft or fistulas
*usually wearing a bracelet on arm that cannot be used
36
CDC recommends aseptic preparation and technique including _____ (for infection control)
- hand hygiene
- clip hair, do not shave (shave = infection risk)
- ensure skin is clean
- wear gloves
- prepare skin with 70% alcohol or chlorhexidine
37
midline catheter
- 3-8" long, 3-5 Fr, double or single lumen
- inserted through vein in upper arm
38
midline catheters are used for
- hydration
- drug therapy given longer than 6 days, (used up to 14 days)
39
do not use a midline catheter for:
vesicant drugs
- can cause tissue damage if extravasation occurs
parenteral nutrition formulas with low concentrations of dextrose, or solutions with osmolarity > 600 mOsm/L
drawing blood
40
central IV therapy
VAD placed in central circulation, specifically within superior vena cava (SVC) junction with right atrium
*placed by IV team, not regular nurse
*may be ultrasound guided
41
how is the placement of central IV therapy confirmed?
- chest x-ray
- new technologies: magnet tip locator, electrocardiogram
42
peripherally inserted central catheter (PICC)
- length of 18-29" (45-72cm/2-3 ft long)
- single (1), dual (2), or triple (3) lumen available
- can stay in for weeks, months or up to 1 year
43
what determines the placement of a PICC?
- chest x-ray
44
Power PICCs are used for
contract injection
- can also be attached to transducers for CVP monitoring
45
Power PICCs
a wider catheter in comparison to normal PICC
46
complications of PICCs
- phlebitis
- thrombophlebitis
- DVT
- CRBSIs
47
PICC uses
- no limitation on pH or osmolarity of fluids that can be infused (meds, fluids, nutrition)
- can be used for blood sampling (lumen size 4 Fr or larger recommended)
- patients on IV therapy for 6-8 weeks, ie. endocarditis, cellulitis
- limes disease
48
patient teaching: PICC
- avoid excessive physical activity and heavy lifting
49
CRBSI bundle includes
- proper aseptic hand hygiene
- measuring upper arm circumference as a baseline before insertion
- maximal barrier precautions on insertion
- chlorhexidine skin antisepsis
- optimal catheter site selection and post-placement care with avoidance of the femoral vein for central venous access in adult patients
- daily review of line necessity with prompt removal of unnecessary lines
50
nontunneled percutaneous central venous catheter are inserted
through subclavian vein in upper chest or jugular veins in neck
- may require insertion in femoral vein (*rate of infection is high)
51
nontunneled percutaneous central venous catheter
- 7-10" (15-25cm) long
- up to 5 lumens
- tip resides in superior vena cava
- used for long-term infusions (short- not as often, but possible)
52
what confirms the placement of a nontunneled percutaneous central venous catheter?
chest x-ray
53
tunneled central venous catheter
- used for frequent and long-term infusion therapy
- portion lies in subcutaneous tunnel
- has cuff of antibiotic-containing material to help reduce infection
- back up if can't do a PICC line
54
tunneled central venous catheter: Broviac, Hickman, Leonard
the physicians that designed these catheters
55
implanted ports consist of
- a portal body
- a dense septum over a reservoir
- a catheter
56
what houses the port body of an implanted port?
- a subcutaneous pocket
57
where is an implanted port placed?
a subcutaneous pocket in the upper chest or upper extremity
58
how often does a port need to be flushed?
- after each use
- at least once a month between courses of therapy
59
hemodialysis catheters
- very large lumens accommodate hemodialysis or pheresis procedure
- can be tunneled or nontunneled
60
what are common complications of hemodialysis catheters?
- CRBSI
- vein thrombosis (blood clots)
61
hemodialysis catheters are maintained by
specially trained hemodialysis nurses
62
nursing care for patients receiving IV therapy
- educate patient
- perform the nursing assessment: edema, redness, tenderness, heat, signs of infection
- securing and dressing the catheter
- changing administration sets and needleless connectors (change every 72-96 hours)
- controlling infusion pressure
- flushing the catheter (with NS, before and after medication administration)
- obtaining blood samples from CVCs
- removing the vascular access device (VAD)
- documenting IV therapy
63
local complications of IV therapy
- infiltration
- extravasation
- phlebitis and post-infusion phlebitis
- thrombosis
- thrombophlebitis
- ecchymosis and hematoma
- site infection
- venous spasm
- nerve damage
64
systemic complications of IV therapy
- circulatory overload
- speed shock
- allergic reaction
- catheter embolism
65
interventions to reduce infection risk with IV therapy
- clean needleless system connections before use with antimicrobial for 30 seconds
- do not tape connections between tubing sets
- use evidence-based hand hygiene guidelines from CDC and OSHA
66
older adult care with IV therapy
- skin care
- vein and catheter selection
- cardiac and renal changes
67
infiltration
- swollen, tender, cool to touch, fluid outside the site
68
extravasation
occurs due to extricate medication (Ca, IV dopamine)
69
phlebitis
inflammation of the vein
- d/c I/V fluids
- take out site
- warm, red, tender, hard cord-like
70
thrombosis
blood clott in the vein
- d/c IV fluids
- take out site
71
ecchymosis
- bruising
72
hematoma
collection of blood under skin
- hard bump where IV site is
73
s/sx of a site infection
- redness, purulent drainage, edema, warmth
74
venous spasm
insertion of IV
- take out if patient reports numbness and tingling
75
nerve damage
insertion of IV
- take out if patient reports numbness and tingling
76
general measures for local IV
d/c fluid
d/c site
elevate arm (2 pillows)
call HCP to determine further care
cold/warm compress
77
s/sx of circulatory overload
- SOB, crackles
78
speed shock
rapidly infusing drugs through IV and patient becomes light-headed or dizzy
79
allergic reaction
- rash, hives, swelling
- stop what is causing reaction
80
catheter embolism
- small piece of catheter breaks off and travels into bloodstream, and gets stuck
- can cause PE
