Chapter 7: nursing care of patients receiving IV therapy

Question 1

IV therapy

Answer 1

administration of fluids or medication via a needle or catheter (cannula) directly into the bloodstream

Question 2

indications for IV therapy

Answer 2

• hydration
• electrolyte replacement
• parenteral nutrition (PN)
• peripheral parenteral nutrition (PPN)
• medication administration
• blood product transfusions

Question 3

types of IV infusions

Answer 3

• continuous
• intermittent: piggyback
• direct injection/IV push
• patient controlled analgesia (PCA)

Question 4

methods of IV infusion

Answer 4

• gravity drip (if it’s not higher than IV site, not going to drip)
• electronic infusion devices (EIDs)
• mechanical controllers

Question 5

factors affecting flow

Answer 5

• change in cannula position
• height of solution
• patency of cannula
• vein condition

Question 6

types of fluids

Answer 6

• Dextrose solutions (have sugar) —> can burn and cause red rashes, not phlebitis, can enflame veins. Used if someone also is hypoglycemic.
• sodium chloride solutions (most common, 0.9% normal saline solutions)
• combined dextrose and sodium chloride solution
• ringer’s and lactated ringer’s solutions (matches blood volume, no fluid shift)
• balanced electrolyte solutions

Question 7

osmolarity of IV solutions

Answer 7

• osmotic concentration: ionic concentration of the dissolved substances per unit of solvent
• isotonic (osmolarity 250 to 375 milliosmoles / liter). ex: 0.9% sodium chloride
• hypotonic (osmolarity < 250 milliosmoles per Liter). ex: 0.45% sodium chloride
• hypertonic (osmolarity 375 milliosmoles per liter or higher) for ex: dextrose 5% in 0.9% sodium chloride

Question 8

IV access

Answer 8

peripheral
central

Question 9

Gerontological issues

Answer 9

• elevated bp
• increasing weight
• bounding pulse
• shallow, rapid respirations
• jugular venous distention
• increased urine output
• crackles

Question 10

local complications

Answer 10

hematoma
thrombosis
phlebitis/thrombophlebitis
infiltration/extravasation
local infection
venous spasm
nerve injury
septicemia
circulatory overload (air embolism from tubing)
speed shock

Question 11

central venous access devices: types

Answer 11

non tunneled central catheter
tunneled catheter
peripherally inserted central catheter
implanted vascular port

Question 12

rationale for use of central venous access devices

Answer 12

parental nutrition
chemotherapy
long term treatment

Question 13

parental nutrition: contents

Answer 13

• carbohydrates: dextrose most common in PN
• proteins/amino acids
• electrolytes
• trace elements
• vitamins
• lipids: may be administered as a separate solution

Question 14

rationale for parenteral nutrition

Answer 14

• for patients unable to eat or tolerate tube feedings
• promotes wound healing
• achieves optimal weight before surgery
• avoids malnutrition from chronic disease
• treats cancer cachexia (wasting syndrome)

Question 15

nursing care of patients receiving PN

Answer 15

• initial and ongoing assessment
• monitor blood glucose
• monitor daily weights
• monitor signs and symptoms of infection
• initiate SLOWLY

Question 16

Home IV infusion

Answer 16

• fluid replacement
• treatment o infection
• parenteral nutrition
• pain management

Question 17

subcutaneous infusion: hypodermoclysis

Answer 17

• process of administering isotonic solutions and limited medications subcutaneously to treat mild to moderate dehydration, and for patients with poor venous access

Question 18

rationale for hypodermoclysis

Answer 18

low risk
cost effective

Question 19

advantages of hypodermoclysis

Answer 19

slow absorption rate
decreased severity of infection
minimal training

Question 20

disadvantages of hypodermoclysis

Answer 20

risk of edema
limited drug choices