Exam 2 Flashcards
1
Q
Which technique is used for Oropharygeal & Nasopharygeal suctioning
A
Clean technique
2
Q
Ventilation
A
Process of moving gases into and out of the lungs. It requires coordination of the muscular and elastic properties of the lung and thorax.
3
Q
Perfusion
A
Ability of the cardiovascular system to pump oxygenated blood to the tissues and return deoxygenated blood to the lungs.
4
Q
Atelectasis
A
Collapse of the alveoli that prevents normal exchange of oxygen and carbon dioxide
5
Q
Diffusion
A
The process for the exchange of respiratory gases in the alveoli and the capillaries of the body tissues. diffusion of respiratory gases occurs at the the alveolar capillary membrane.
6
Q
Three things influence the capacity of the blood to carry oxygen:
A
- the amount of dissolved oxygen in the plasma
- the amount of hemoglobin
- the tendency of hemoglobin to bind with oxygen.
7
Q
4 Factors that influence adequacy of circulation, ventilation, perfusion, and transport of respiratory gases to the tissues:
A
- physiological
- Developmental
- Lifestyle
- Environmental
8
Q
Physiological factors affecting Oxygenation:
A
Any condition affecting cardiopulmonary functioning directly affects the ability of the body to meet Ox demands: Ex - Respiratory disorders: hyperventilation, hypoventilation, hypoxia. Cardiac disorders: conduction disturbance, impaired valves, myocardial hypoxia. Others: Alterations affecting the O2 carrying capacity of blood, conditions affecting chest wall movement (preggers, obesity, trauma) Influences of chronic disease.
9
Q
Hypoventilation
A
Occurs when alveolar ventilation is inadequate to meet the oxygen demand of the body or eliminate sufficient carbon dioxide. Signs/Sym: mental status changes, dysrhythmias, potential cardiac arrest.
10
Q
Hyperventilation
A
State of ventilation in which the lungs remove carbon dioxide faster than it is produced by cellular metabolism. Induced by: anxiety, infection, drugs, acid-base imbalance.
11
Q
Hypoxia
A
Inadequate tissue oxygenation at the cellular level. Results from deficiency in O2 delivery or oxygen use at cellular level. Signs/sym: apprehension, restlessness, inability to concentrate, decreased level of consciousness, dizziness, and behavioral changes. VS changes : Increased pulse rate and rate and depth of respiration. Blood pressure is elevated during early stages unless caused by shock.
12
Q
Developmental factors affecting Oxygenation:
A
Older Adults: Changes are associated with calcification of heart valves, SA node, and costal cartilages. Arterial system develops atherosclerotic plaques.
Osteoporosis leads to changes in size and shape of thorax. Alveoli enlarge, decreasing surface area. Functional cilia reduced.
13
Q
Lifestyle factors affecting Oxygenation:
A
Nutrition, Exercise, Smoking, substance abuse, stress
14
Q
Environmental factors affecting Oxygenation:
A
Smog, urban areas. Occupational pollutants: asbestos, talcum powder, dust. Allergies.
15
Q
Dyspnea
A
Clinical sign of hypoxia. Sensation of difficult breathing. SOB. Is associated with exaggerated respiratory effort, use of accessory muscles, nasal flaring, increases in rate and depth of respirations.
16
Q
Nursing interventions for acute care pulmonary patients should be directed toward:
A
halting pathological process (respiratory tract infection); shortening the duration and severity of the illness (hospitalization with pneumonia) and preventing complications from the illness or treatments ( HAIs)
17
Q
Humidification is necessary for patients receiving O2 therapy at greater than ____ L/min
A
4
18
Q
Patients with chronic pulmonary diseases upper respiratory tract infections, and lower respiratory tract infections to deep breathe and cough at least every _____ hours while awake
A
2
19
Q
Patients with large amount of sputum to cough every ___ hr while awake and then awaken them at night to cough every ___ to ____ hours.
A
Patients with large amount of sputum to cough every 1 hr while awake and then awaken them at night to cough every _2__ to _3___ hours.
20
Q
After surgery it is recommended that directed cough be performed every ___ to ____ hours while awake to prevent accumulation of secretions.
A
2 to 4
21
Q
Chest Physiotherapy (CPT)
A
Group of therapies for mobilizing pulmonary secretions. therapies include Postural drainage, chest percussion, and vibration. CPT is followed by productive coughing or suctioning of a patient who has a decreased ability to cough.
22
Q
What positions for Postural Drainage (Tbl 40-6)
Lung Segment: Bilateral
A
High- Fowlers
23
Q
What positions for Postural Drainage
Lung Segment: apical segments
A
Sitting on side of bed
24
Q
What positions for Postural Drainage (Tbl 40-6)
Lung Segment: Right Upper lobe- anterior segment
A
Supine with head elevated
25
What positions for Postural Drainage (Tbl 40-6)
| Lung Segment: Left Lower Lobe- lateral segment
Right side lying in trendelenburgs postion
26
What positions for Postural Drainage (Tbl 40-6)
| Lung Segment: right lower lobe- lateral segment
Left side lying in trendelenburgs position
27
What positions for Postural Drainage (Tbl 40-6)
| Lung Segment: right lower lobe- posterior segment
Prone with right side of chest elevated in trendelenburgs position
28
What positions for Postural Drainage (Tbl 40-6)
| Lung Segment: left upper lobe-Anterior segment
supine with head elevated
29
What positions for Postural Drainage (Tbl 40-6)
| Lung Segment: Right upper lobe-Posterior segment
side lying with right side of chest elevated on pillows.
30
What positions for Postural Drainage (Tbl 40-6)
| Lung Segment: right middle lobe-Anterior segment
Three fourths supine position with dependent lung in trendelenburgs position
31
What positions for Postural Drainage (Tbl 40-6)
| Lung Segment: Right middle lobe - posterior segement
prone with thorax and abdomen elevated
32
What positions for Postural Drainage (Tbl 40-6)
| Lung Segment: both lower lobes- anterior segments
supine in trendelenburgs position
33
What positions for Postural Drainage (Tbl 40-6)
| Lung Segment: both lower lobes- posterior segments
prone in trendelenburgs position
34
Oropharyngeal and nasopharyngeal Suctioning is used when...
When the patient is able to cough effectively but unable to clear secretions by expectorating.
35
Orotracheal and nasotracheal Suctioning is necessary when...
When a patient with pulmonary secretions is unable to manage secretions by coughing and does not have an artificial airway present. You pass a STERILE catheter through the mouth or nose into trachea. similar to Oropharyngeal but the tip is farther into the patients trachea. Lasts no longer than 15 seconds.
36
Tracheal Suctioning is performed when...
Through an artificial airway such as an endotrachea (ET) or tracheostomy tube. The size of catheter should be as small as possible but large enough to remove secretions. recommendation is half the internal diameter of the ET tube.
37
Open and Closed suctioning
The two current methods of suctioning. Open involves using a new sterile catheter for each suction session. Wear STERILE gloves and standard precautions.
Closed involves using reusable sterile suction catheter that is encased in a plastic sheath to protect it between suction sessions. Most often used on patients who require mechanical ventilation. Nonsterile gloves recommended.
38
Which suctioning should be performed first when possible
Perform tracheal suctioning before pharyngeal suctioning whenever possible. the mouth and pharynx contain more bacteria than the trachea.
39
Do NOT administer more than ____ L/min of O2 for patients with COPD
Patients with COPD who are breathing spontaneously should never receive high levels of O2 therapy because it results in a decreased stimulus to breathe. do not administer O2 more than 2L/min unless a health care providers order is obtained.
40
What is the most serious tracheostomy complication?
Is airway obstruction, which can result in cardiac arrest.Most tracheostomy tubes are designed with a small plastic inner tube that sits inside the larger one. If the airway become occluded, the smaller one can be removed and replaced with a temporary spare. Important to always have a spare at bedside for emergency.
41
Body fluids
contain electrolytes such as sodium and potassium; they also have a certain degree of acidity.
42
Fluid, electrolytes, and acid base balances within the body
Maintain the health and function of all body systems.
43
Fluid
water that contains dissolved or suspended substances such as glucose, mineral salts, and proteins.
44
Body fluids are located in two distinct compartments
Extracellular fluid and Intracellular fluid
45
Extracellular Fluid
Outside the cells; In adults ECF is approx. 1/3 of total body water.
46
Intracellular Fluid
Inside the cells; In adults ICF is approximately 2/3 of total body water
47
Extracellular fluid has two major divisions
Intravascular Fluid: the liquid portion of the blood and
| Interstitial fluid: Located between the cells and outside the blood vessels.
48
Electrolytes
Mineral salts of the body; compounds that separate into ions (Charged particles) when it is dissolved in water.
49
Isotonic
Fluid with the same concentration of nonpermeant particles as normal blood
50
Hypotonic
Solution more dilute than the blood (Cell swells)
51
Hypertonic
Solution more concentrated than normal blood (Cell shrinks)
52
Human total daily output
consists of hypotonic sodium containing fluid
53
Average fluid intake for healthy adults
approx 2300 mL
54
Patients at risk for dehydration
Infants, patients with neurological or psychological problems, and some older adults who are unable to perceive or communicate their thirst.
55
Fluid Distribution
The movement of fluid among its various compartments. Fluid distribution between the extracellular and intracellular compartments occur by osmosis. Fuild distribution between the vascular and interstitial portions of the ECF occurs by filtration.
56
Healthy Adult Average Fluid intake (Table 41-2)
```
Fluid ingested:
Oral: 1100-1400 mL
From Foods: 800-1000 mL
From Metabolism: 300 mL
TOTAL: 2200-2700 mL
```
57
Healthy Adult average Fluid Output - NORMAL VALUES
```
Skin (insensible and sweat): 500-600 mL
Insensible - lungs: 400 mL
GI: 100-200 mL
Urine: 1200-1500 mL
TOTAL: 2200-2700 mL
```
58
Healthy Adult Average Fluid Output - PROLONGED HEAVY EXERCISE
```
Skin (insensible and sweat) 5350 mL
Insensible - Lungs: 650 mL
GI: 100 mL
Urine: 500 mL
TOTAL: 6600 mL
```
59
Fluid Output Routes
Normally occurs through the skin, lungs, GI tract, and kidneys
60
Fluid Output Abnormal Routes
Vomiting, wound drainage, or hemorrhage
61
Two major types of fluid imbalalce
Volume imbalance and Osmolarity imbalance
62
Extracellular Fluid Imbalance
There is too little or too much isotonic fluid
63
Extracellular Fluid deficit
Output of isotonic fluid exceeds intake of sodium containing fluid. Because ECF is both interstitial and vascular, signs and symptoms arise from lack of volume in both compartments. Body fluids have decreased volume but normal toxicity
64
Extracellular Fluid Deficit Causes
* Severely decreased oral intake of water and salt
* Increased GI output: Diarrhea, vomiting, laxative overuse, or drainage from fistulas or tubes.
* Increased renal output: Use of diuretics, adrenal insufficiency, salt-wasting renal disorders
* Loss of blood or plasma: Hemorrhage or burns
* Massive sweating without water or salt replacement
65
Extracellular Fluid Deficit Signs and Symptoms
Physical: Sudden weight loss, postural hypotension, tachycardia, thready pulse, neck veins flat or collapsing with inhalation when supine, dark yellow urine, dry mucous membranes, inelastic skin turgor, absence of tears and sweat, thirst, restlessness, confusion, hypotension, hypovolemic shock
Lab findings: Increased hematocrit, BUN greater than 25 mg/dL (8.9 mmo/L) caused by hemoconcentration; Urine specific gravity greater than 1.030
66
Hypovolemia
Decreased vascular volume and often is used when discussion Extracellular fluid deficit
67
Extracellular Fluid Excess
Occurs when there is too much isotonic fluid in the extracellular compartment. Intake of soiumd containing isotonic fluid has exceeded fluid output. (ie when you eat more salty foods than usual and drink water, you may notice your ankles swell or rings on your fingers feel tight and you gain two pounds or more overnight.
68
Extracellular Fluid Excess Causes
Excessive administration of sodium-containing isotonic parental fluids
Excessive oral intake of salty foods and water
Decreased renal output caused by elevated aldosterone: Chronic Heart Failure, cirrhosis, aldosterone-secreting tumor
Decreased renal output from other causes: Oliguric acute kidney disease, end stage chronic renal disease, glucocorticoid excess
69
Extracellular Fluid Excess Signs and Symptoms
Physical: Sudden weight gain (overnight), edema, neck veins full when upright or semi-upright, crackles in dependent portions of lung, PULMONARY EDEMA
Lab findings: Decreased hematocrit, BUN less than 10 mg/dL (3.5 mmol/L) caused by hemodilution
70
Hypernatremia
Water deficit, is a hypotonic condition. Causes: loss of relatively more than salt or grain of relatively more salt than water.
71
Clinical Dehydration
Hypernatremia may occur in combination with extracellular fluid volume deficit; this combined disorder is called
72
Hyponetremia
water excess or water intoxication. Arises from gain of relatively more water than salt or loss of relatively more salt than water.
73
Hypernatremia Causes
Diabetes insipidus (ADH deficiency)
Osmotic Diuresis
Greatly increases insensible persperation and respiratory water output without increased water intake
Overuse of salt tablets
Adminitration of tube feedings or hypertonic parenteral fluids
Difficulty swallowing fluids; as in Parkinsons
Lack of access to water or delibrate water deprivation
Inability to respond to thirst (immbolility, aphasia)
Dysfunction of osmoreceptor-driven thirst drive
74
Hypernatremia - Signs and Symptoms
Physical: Extreme thirst, dry and flushed skin, postural hypotension, fever, restlessness, confusion, aggitation, coma, seizures (if develops rapidly or is very severe)
Lab findings: Serum Na+ level greater than 145 mEq/L and serum osmolality greater than 295 mOsm/kg, Urine specific gravity 1.030
75
Hyponatremia Causes
Excessive ADH
Psychogenic polydipsia or forced excessive water drinking
Excessive IV admin of 5% dextrose in water (D5W)
Use of hypotonic irrigating solutions
Tap water enemas
Renal salt wasting disease
Replacement of large body fluid output (diarrhea, vomiting, gastric suction) with water but no salt
76
Hyponatremia - Signs and Symptoms
Physical: Apprehension, nausea and vomiting, headaches, decreased LOC, coma, seizures (if developes very rapidly or is very severe)
Lab findings: Serum Na+ level less than 135 mEq/L and serum osmolality 280 mOsm/kg, urine specific gravity below 1.010
77
Clinical dehydration - Causes
Sodium and water intake less than output, with loss of relatively more water than salt
Often with increase insensible water output through skin with fever.
78
Clinical dehydration - Signs and Symptoms
Physical: Combination of those for EVC deficit plus those for hypernatremia
79
Potassium K+ - Intake and absorption
Fruits, potatoes, Instant coffee, Molasses, Brazil nuts, Absorbs Easily
80
Factors that cause electrolyte imbalances
Diarrhea, endocrine disorders, and medications that disrupt electrolyte homeostasis
81
Plasma electrolyte excess
Electrolyte intake greater than electrolyte output or a shift of electrolytes from cells or bone to the ECF
82
Plasma electrolyte deficit
Electrolyte intake less than electrolyte output or shift of electrolytes from the ECF into the cells or bone
83
Hypokalemia
abnormally low potassium concentration in the blood. Results from decdreased potassium intake and absorption, a shift of potassium from the ECF into the cells, and an increased potassium output.
Causes: Diarrhea, excessive vomiting, use of potassium wasting diuretics, polyuria
84
Hypokalemia - Signs and Symptoms
Bilateral Muscles weakness begins in the quadriceps, which becomes life threatening if it includes respiratory muscles and potentially life threatening cardiac dysrhythmias. Decreased bowel sounds and constipation.
Lab findings: Serum K+ levels less than 3.5 mEq/L, possible ECG abnormalities
85
Hyperkalemia
abnormally high potassium ion concentration in the blood. Generally causes are increased potassium inkate and absorption, shift of potassium ions from cells into the ECF, and decreased potassium output. People who have oliguria are at high risk of hyperkalemia from the resultant decreased potassium output unless their potassium intake also decreases substantially. Understanding this helps you to remember to check urine output before you administer an IV solution containing potassium.
86
Hyperkalemia - Signs and symptoms
Causes bilateral muscle weakness starts in quadricep, potentially life threatening cardiac dysrythmias, and cardiac arrest.
Lab findings: serum K+ greater than 5 mEq/L, possible ECG abnormalities
87
Hypocalcemia
abnormally low calcium concentration in blood. The physiologically active form of calcium in the blood is ionized calcium. Total blood calcium also contains inactive forms that are bound to plasma proteins and small anions such as citrate.
88
Hypocalemia - Causes
Calcium deficiant diet, Vitamin D deficiency, Chronic diahrrea, laxative misuse, steatorrea (pancreatitis), Hypoparathyroidism, rapid admin of citrated blood, hypoalbuminemia, alkalosis, End stage renal disease
89
Hypocalcemia - Signs and symptoms
Physical: Positive Chvosteks signs (contraction of facial muscles when facial nerve is tapped), positive Trousseau's sign (carpal spasm from hypoxia), numbness and tingling of fingers and circumoral (around mouth region), hyperactive relfexes, muscle twitching and cramping, tetany, seizures, laryngospasm, cardiac dysrythmias
Lab findings: Total Ca2+ less than 8.4mg/dL or serum ionized Ca2+ level less than 4.5 mg/dL, ECG abnormalities possible
90
Hypercalcemia
abnormally high calcium concentration in the blood. Results from increased calcium intake and absorption, shift of calium from bones into the ECF, and decreased calcium output.
Causes: Prolonged immobilization, hyperparathyroidism,
bone tumors
91
Hypercalcemia - Signs and Symptoms
bone breakage, decreased neuromuscular excitability, lethargy
92
Hypomagnesemia
abnormally low magnesium concentration in the blood. General causes are decreased magnezium intake and absorption, shift of plasma magnesium into its inactive bound form, and increase magnesium output
93
Hypermagnesium
Abnormally high magnesium concentration in the blood. End stage renal disease causes hypermagnesium unless the person decreases magnesium intake to match the decreased output.
94
True of False: Kidneys compensate for the respiratory acid-base imbalances
True
95
True or False: The respiratory system compensates for metabolic acid-base imbalances
True
96
Respiratory acidosis
arises from alveolar hypoventilation; the lungs are unable to excrete enough CO2. The PaCO, rises, creating an excess of carbonic acid in the blood, which decreases pH The kidneys compensate by increasing excretion of metabolic acids in the urine, which increases blood bicarbonate. The compensatory process is slow, often taking 24 hours to show clinical effect and 3-5 days to reach a steady state. Decreased cerebrospinal fluid pH and intracellular pH of the brain cells cause decreased LOC
97
Respiratory alkalosis
Arises from alveolar hyperventilation; the lungs excrete too much carbonic acid (CO2 and water). The PaCO2 falls, creating a deficit of carbonic acid in the blood, which increases the pH. Respiratory alkalosis is usually short lived; thus the kidneys do not have time to compensate. When the pH of blood, CSF, and ICF increases acutely, cell membrane excitability also increases, giving rise to neurological symtoms such as excitement, confusion, and paresthesias. If the pH rises enough, CNS depression can occur.
98
Metabolic acidosis
Occurs from an increase of metabolic acid or decrease of base (bicarbonate). The kidneys are unable to excrete enough metabolic acids, which accumulate in the blood, or bicarbonate is removed from the body directly as diarrhea. The blood HCO3- decreases and pH falls. Abnormally low pH stimulate the chemoreceptors so the respiratory system compensates for the acidosis by hyperventilation.
99
Metabolic Alkalosis
Occurs from a direct increase of base (HCO3-) or a decrease of metabolic acid, which increases blood HCO3-, by releasing it from its buffering function. Common causes include vomiting and gastric suction. Respiratory compensation for metabolic alkalosis is hypoventilation. The decreased rate and depth of respiration allow carbonic acid to increase in the blood. The need for O2 may limit the degree for respiratory compensation for metabolic alkalosis. Because HCO3- crosses the blood brain barrier with difficulty, neurological signs and symptoms are less severe or even absent.
100
Nursing knowledge base and Fluid, Electrolyte, and Acid-Base balance
Use scientific knowledge base in clinical decision making to provide safe, optimal fluid therapy.
Ask good questions to elicit risk factors for imbalances.
Identify specific clinical assessments for signs and symptoms of these imbalances
Use nursing and collaborative interventions to maintain or restore balances
Stay up to date on skills and techniques safe for IV therapy because they are a vital area of the nursing knowledge base and the focus of much nursing research to support EBP
101
Critical thinking and Fluid, Electrolyte, and Acid base balance
Integrate knowledge of physiology, pathophysiology, pharmocology and previous experiences and information gathered from patients.
102
True or false: Critical thinking attitudes such as accountability, discipline, and integrity assist you in identifying appropriate diagnosis and planning successful interventions
True
103
True or False: For patients with fluid, electrolyte, or acid-base imbalances or those with a high risk of these imbalances, a standard approach is the foundation for safe and effective patient centered nursing care
False - An individualized approach/not standard
104
Risk Factors for Fluid, electrolyte, and Acid-Base imbalances
Age, Environment, GI output, Chronic diseases, trauma, therapies
105
Age related risk factors for F,E,A-B imbalance
Very young: ECV deficit, osmolality imbalances, clinical dehydration
Very old: ECV excess or deficit, osmolality imbalances
106
Environment related risk factors for F,E,A-B imbalance
Sodium-rich diet, ECV excess, electrolyte poor diet, electrolyte deficits, Alcohol abuse, Hot weather, clinical dehydration
107
GI Output related risk factors for F,E,A-B imbalance
Diarrhea, drainage, vomiting
108
Chronic Disease related risk factors for F,E,A-B imbalance
Cancer, Chronic obstructive pulomanary disease, cirrhosis, Heart Failure, Oliguric renal disease
109
Trauma related risk factors for F,E,A-B imbalance
Burns, Crush injuries, Head injuries, Henorrhage
110
Therapy related risk factors for F,E,A-B imbalance
Diuretics and other meds, IV therapy.
111
For patients at risk of fluid imbalances, what should you focus your assessments on?
Body weight changes, clinical markers of vascular and interstitial volume, thirst, behavior changes, and LOC
112
Each kilogram of weight gained or lost is equal to how much fluid lost or retained?
1 L
113
Which patients should you weight daily?
Patients with Heart Failure, , those who are at high risk for or actually have ECV excess, clinical dehydration or other causes or risks for ECV deficit
114
When should you weight the patient?
Same time each day, with the same scale, after the person voids. Patient needs to wear the same clothes or clothes of the same weight.
115
Critical thinking: If intake is greater than output what are two possibilities for this result?
Patient may be gaining excessive fluid or Patient my be returning to normal fluid status by replacing fluid previously lost.
116
Critical thinking: If intake is smaller than output what are the two possibilities for this result?
Patient may be losing needed fluid from his bodyand be developing an ECV deficit or/and hypernatremia OR may be returning to normal fluid status by excreting excessive fluid previously gained.
117
Fluid Output includes
Vomitus, urine, diarrhea, gastric suction and drainage.
118
How do you choose interventions for F, E, A-B imbalance?
Choose interventions that treat or modify the related factor for the diagnosis to be resolved. For example: Deficient fluid volume related to loss of GI fluids from vomiting requires therapies that manage the patients emesis and restore fluid volume with IV therapy.
119
Possible Nursing interventions for F, E, A-B imbalance
* Decreased Cardiac output
* Acute confusion
* Risk for electrolyte imbalance
* Deficient fluid volume
* Excess Fluid volume
* Impaired gas exchange
* Risk for injury
* Deficient knowledge regarding disease management
120
Nursing Process
Educate patient and caretakers on fluid imbalances and how to care for and prevent them
121
Acute care interventions for Fluid, Electrolyte, Acid-Base imbalances
Administer medication, oral and IV fluids to replace fluid and electrolyte deficits or maintain homeostasis.
122
Enteral Replacement of Fluids
Oral replacement of fluids and electrolytes is appropriate as long as the patient is no so physiologically unstabel that the oral fluids cannot be replace rapidly. Oral replacement of fluids is contraindicated when the patient has a mechanical obstruction of the GI tract, is at high risk for aspiration, or has impaired swallowing. A feeding tube is appropriate when the patients GI tract is healthy but the patient cannot ingest fluids. Options for administering fluids include gastrostomy or jejunostomy installations or infusions.
123
Restriction of fluids
Example: patients who ahve hyponatremia usually require restricted water intake.
124
Parenteral Replacement of fluids
Fluids and extrolytes may be replaced through infusion of fluids directly into the veins rather than via the digestive system. Parenteral replacement includes peranteral nutrition, IV fluid and electrolyte therapy (crystalloids), and blood and blood component (colloids) administration
125
Intravenous Therapy (Crystalloids)
The goal of IV fluid admin is to correct or prevent fluid and electrolyte disturbances. It allows for direct access to the vascular system, permitting the continuous infusion of fluids over a period of time.
126
True or False: Urine input should be more than fluid output
False: Fluid input and output should be approximately equal over a 24 hour period.
127
How do you make sure you are providing safe and appropriate therapy to patients requiring IV fluids?
Knowledge of correct ordered solution, the reason the solution was ordered, the equipment needed, the procedure required to initiate an infusion, how to regulate the infusion rate and maintain the system, how to identify and correct problems, and how to discontinue infusion
128
Isotonic Solutions
Have the same effective osmolality as body fluids. Sodium containing isotonic solutions such as normal saline are indicated for ECV replacement to prevent or treat ECV deficit.
129
Hypotonic solutions
Have an effective osmolality less than body fluids, thus decreasing osmolality by diluting body fluids and moving water INTO cells.
130
Hypertonic solutions
Have an effective osmolality greater than body fluids. If they are hypertonic sodium containing solutions, they increase osmolality rapidly and pull water out of cells, causing them to shrivel
131
Potassium Chloride (KCl)
* A common IV additive
* Administer carefully because hyperkalemia can cause fatal cardiac dysrhythmias
* Under no circumstances should it be administered by IV push
* Verify the patient has adequate kidney function and urine output before administering
* Patients with normal renal function who are NPO should have K added to IV solutions
132
Vascular Access Devices
Catheters or infusion ports designed for repeated access to the vascular system. Peripheral catheters are for short term use (fluid restoration after surgery). Devices for long term use include central catheters and implanted ports, which empty into a central vein.
133
Peripherally inserted central catheters (PICC lines)
Enter a peripheral arm vein and extend through the venous system to the superior vena cava where they terminate.
134
True or False: Central lines are more effective than peripheral lines for administering large volumes of fluid, PN, and medications or fluids that irritate veins
True
135
IV equipment includes
VAD's, tournaquets, clean gloves, dressings, IV fluid containiners, various types of tubing, and electronic infusion devices (EID's), also called infusion pumps.
136
True or False: A large gauge indicates a larger diameter catheter
False: Smaller diameter catheter
137
Primary line
The main IV fluid used in a continuous infusion flows through tubing called the...
138
After collecting the equipment for IV insertion at the patients bedside, what should you do?
Assess the patient for a venipuncture site. The most common are on the inner arm. Do not sure hand veins on older adults or ambulatory patients. IV insertion in a foot vein is common with children, but avoid these sites with adults due to increased risk of thrombophlebitis.
139
When is venipuncture contraindicated?
In a site that has signs of infection, infiltration, or thrombosis. Avoid using an extremity with a vascular (dialysis) graft/fistula or on the same side as a mastectomy
140
Venipuncture
a technique is which a vein is punctured through the skin by a sharp rigid stylet. The stylet is partially covered either with a plastic catheter or a needle attached to a syringe.
141
Purpose of Venipuncture
Collect a blood specimin, start an IV infusion, provide vascular access for later use, instill a medication, or inject a radiopaque or other tracer for special diagnostic examinations.
142
Regulating the Infusion flow rate
Make sure to deliver IV fluids at the prescribed rate. An infusion rate that is too slow often leads to further physiological compromise in a patient who is dehydrated, in circulatory shock, or critically ill. An infusion rate that is too rapid overloads the patient with IV fluid, causing fluid and electrolyte imbalances and cardiac complications in vulnerable patients.
143
Electronic Infusion Devices (IV Pumps)
deliver an accurate hourly infusion rate. They use positive pressure to deliver measured amount of fluid during a specific unit of time
144
Artificial Airways
For a patient with a decreased level of consciousness or airway obstruction and aids in removal of tracheobronchial secretions. **Clean technique**
145
Which technique is used in caring for and maintaining endotracheal and tracheal airways
Sterile technique
146
Simplest type of artificial airway, prevents obstruction of trachea by displacement of the tongue into the oropharynx
Oral Airway
147
Endotracheal Tube (ET)
short term artifical airway to administer mechanical ventilation, relieve upper airway obstruction, protect against aspiration or clear secretions.
148
Long term assistance from an artificial airway
Tracheostomy
149
NON Invasive interventions to maintain or promote lung expansion
Ambulation
Positioning
Incentive spirometry (encourages voluntary deep breathing by providing visual feedback to patients about inspiratory volume)
Noninvasive positive pressure ventilation (NPPV)
Continuous Positive Airway pressure (CPAP)- Sleep apnea
Bilevel Positive airway pressure (BiPAP)- Both inspiratory and expiratory airway pressure.
150
Invasive interventions to maintain or promote lung expansion
Chest tube (catheter inserted thru thorax to remove air and fluids from the pleural space to prevent air or fluid from reentering the pleural space, or to reestablish normal intrapleural and intrapulmonic pressures.
151
Pneumothorax
Collection of air in the pleural space. Loss of negative intrapleural pressure causes lung to collapse.
152
hemothorax
Accumulation of blood and fluid in the pleural cavity between parietal and visceral pleura, usually as a result of trauma. Produces a counter pressure and prevents the lung from full expansion.
153
Simple, comfortable device used for precise oxygen delivery
Nasal Cannula
154
Flow rate range for a nasal cannula
flow rate up to 6 L/min (24%-40%)
155
Used for short term oxygen therapy
Simple Face Mask
156
Flow rate range for simple face mask
5 + L/min (35-50%)
157
Capable of delivering higher concentrations of oxygen
Plastic face mask with reservoir bag
158
Flow rate range for plastic face mask with reservoir bag
6-10 L/min (40-70%)
| *When used as a non rebreather mask flow rate is minimum of 10L/min and 60-80%.
159
Delivers high rate O2 AND controls amount of specified O2 concentration
Venturi Mask
160
Flow rate of Venturi Mask
4 - 12 L/min (24-60%)
