Fluids and electrolytes

Question 1

IVs are for people who

Answer 1

are unable to eat or drink properly
Are NPO prior to surgery
have pre-existing electrolyte or fluid imbalances
require IV medications
require blood
require TPN (total parenteral nutrition)

Question 2

What is the purpose of an IV

Answer 2

supply fluid, salts and electrolytes, provide glucose, restore volume of blood by administerstration of components such as plasma or albumin, administer meds or vitamins.

Question 3

common places for IV

Answer 3

vein, hand, elbow, foot, head

Question 4

The smaller the number go cathlon the

Answer 4

bigger the diameter of gauge

Question 5

What might make you want to choose a larger gauge cathlon over a smaller gauge?

Answer 5

Age/size of vein. What you are infusing.
Larger gauge is better for rapid infusion. 14-24 gauge

Question 6

when do you replace a IV dressing

Answer 6

damp, loose, soiled or when IV site changed

Question 7

what is a saline lock

Answer 7

Occasionally an IV infusion is initiated and maintained with a saline lock:
to provide access to the circulatory system in an emergency
to administer medications at intervals

Question 8

how much do you flush an adults saline lock with

Answer 8

3 mL of Sodium Chloride

Question 9

When do we flush a saline lock

Answer 9

prior to use (assesses catheter function)
following use
every 24 hours and prn

Question 10

Flush teqhnique

Answer 10

stop, start

Question 11

Prior to flush what is important to do

Answer 11

swab with alcohol wipe

Question 12

how high should the patients bag be

Answer 12

76.2 cm

Question 13

formula for drip rate

Answer 13

Volume in mL x drop factor divided by time in minutes

Question 14

Complications

Answer 14

Infiltration
Phlebitis
Infection
Fluid overload
Electrolyte imbalance
Air Embolus

Question 15

Infection can by caused by

Answer 15

improper insertion technique

Question 16

Hematoma can be caused by

Answer 16

inserting IC catheter through the vein or by not applying enough pressure at removal

Question 17

Infilteration

Answer 17

Catheter slips out of the vein and fluid escapes into the subcutaneous tissue causing swelling, pallor, coldness (↓ flow rate)

Question 18

Infiltration interventions

Answer 18

discontinue IV and restart in different site
elevate – promotes venous drainage and apply warm compresses to ↑ circulation to area and carry away extra fluid
Do not rub or massage area

Question 19

How to prevent infiltration

Answer 19

Check infusion site several times per shift. Get patients to report discomfort to you. Limit movement of extremity with patients who have an IV.

Question 20

Phlebitis

Answer 20

inflammation of a vein

Question 21

Signs and symptoms of phlebitis

Answer 21

redness, heat, warm to touch
a red streak above the needle site which appears to follow the path of the vein
swelling
flow rate of IV may be disturbed
Pain

Question 22

Interventions for phlebitis

Answer 22

discontinue IV
elevate
warm compresses
DO NOT MASSAGE

Question 23

3 categories of phlebitis

Answer 23

Mechanical phlebitis is the first category that is caused by the insertion of the IV catheter.
Bacteria phlebitis is caused by a bacterial infection
Chemical phlebitis that may occur as a result of fluids IV catheters or fluids.

Question 24

Infection signs and symptoms

Answer 24

redness
heat
swelling
purulent exudate
discomfort at site

Question 25

Interventions for infection

Answer 25

discontinue IV at this site change tubing and IV site according to hospital protocol clean area and apply sterile dressing as with any wound send swab for C&S, according to practitioner order treat with antibiotic topical ointment, if ordered

Question 26

signs and symptoms of an electrolyte imbalance

Answer 26

it depends on the type of solution

Question 27

Interventions for electrolyte imbalance

Answer 27

Notify physician immediately Monitor VS Frequently check and monitor rate of flow Bloodwork, as ordered

Question 28

Fluid Overload

Answer 28

too large of a volume infused into circulatory system

Question 29

Signs and symptoms of fluid overload

Answer 29

engorged neck veins, increased BP, dyspnea, headache, crackles in lung

Question 30

Nurses action to address fluid overload

Answer 30

Slow IV to TKO Notify physician immediately Place client in High Fowler’s position Stay with patient Monitor vital signs High fowlers because fluid may be in the lungs and it assists with breathing.

Question 31

Air Embolus

Answer 31

air in the circulatory system an air embolus will block blood flow to an area resulting in ischemia and/or infarction

Question 32

signs and symptoms of air embolus

Answer 32

Respiratory distress, ↑HR, cyanosis, ↓BP, change in consciousness Potential clinical complications: diminished cardiac output, shock and death

Question 33

interventions for embolus

Answer 33

Pinch off catheter to prevent air entry Place pt. on Left side in Trendelenburg (head down) Call for immediate assistance Monitor VS, especially pulse oximetry

Question 34

Air embolus can be prevented by

Answer 34

not allowing any air to enter the vein e.g., be sure all the air is out of the IV tubing within reason when setting up the infusion

Question 35

when air embolus happens what position should the patient be in

Answer 35

Immediately place the patient in the left lateral Trendelenburg position. This helps to prevent air from traveling through the right side of the heart into the pulmonary arteries, leading to an obstruction in the lungs.

Question 36

how often should the IV catheter be assessed

Answer 36

every 4 hours

Question 37

Types of IV solution

Answer 37

Isotonic, hypotonic, hypertonic

Question 38

Isotonic

Answer 38

causes no fluid shift

Question 39

Hypotonic

Answer 39

causes fluid shift into cells and interstitial. Lower concentration outside the cell.

Question 40

Hypertonic

Answer 40

causes shift out of cells. Concentration outside is higher then inner.

Question 41

Examples of Isotonic

Answer 41

1- 0.9% NaCl (NS) 2- Lactated Ringer’s 3- Blood Component 4- D5W (5% dextrose in water)

Question 41

D5W

Answer 41

is initially an isotonic solution, however once the dextrose in the solution is metabolized, making the solution hypotonic. It is used to supply water in a dehydrated patient and in the treatment of high sodium levels.

Question 42

uses of hypertonic IV solution

Answer 42

temporary treatment of hypovolemia -expansion of vascular volume -promotion of normal BP and good urinary output and is often used post operatively -it is used to treat symptomatic hyponatremia.

Question 43

who do you not use hypertonic solution on

Answer 43

We do not use it for with patients that have renal or cardiac disease -must be administered slowly and with extreme caution because it may cause dangerous intravascular volume overload which can lead to pulmonary edema

Question 44

what is hypotonic solution used for

Answer 44

solutions to “dilute” plasma particularly in hypernatremia It is commonly used to treats cellular dehydration

Question 45

Hypotonic solution have potential to

Answer 45

cause cellular swelling, and therefore patients should be monitored for changes in mentation that may indicate cerebral edema.

Question 46

examples of hypotonic solution include

Answer 46

Examples include ½ Ncand 1/3 NS

Question 47

Primary tubing is used for

Answer 47

-IV fluids that are primary. Will connect to the primary Iv tubing. Extends from the IV fluid bag all the way to the patients saline lock.

Question 48

Secondary Tubing is used for

Answer 48

running things like antibiotics, digoxin with primary. The pump should be programmed to run for a certain amount of time