Get to the point ! Flashcards
(219 cards)
1
Q
What are the different types of IV delivery “CIB”
A
C – Continuous: Large volume over time
I – Intermittent: Small doses at intervals
B – Bolus: Small dose pushed in quickly
2
Q
What is an isotonic solution? Give examples.
A
Same osmolality as body fluid (no fluid shift)
Used for: hypovolemia, dehydration
Examples: 0.9% NS, Lactated Ringer’s (LR)
3
Q
What is a hypotonic solution? Use the “fat man” analogy and give examples.
A
Water moves into cells → cells swell
Used for: hypernatremia, cellular dehydration
Examples: 0.45% NS, 0.33% NS
4
Q
What is a hypertonic solution? Use the “skinny woman” analogy and give
A
“Skinny woman” = pulls water from others
Water moves out of cells → cells shrink
Used for: cerebral edema, hyponatremia
Examples: D5NS, D5LR, 3% NS
5
Q
Why use a hypotonic solution in hypernatremia?
A
To dilute high sodium levels by moving water into cells.
6
Q
Why use a hypertonic solution in cerebral edema?
A
To pull water out of swollen brain cells and reduce pressure.
7
Q
What are the central vein access points?
A
Subclavian vein – under the collarbone
Internal jugular vein – side of the neck
Femoral vein – near the groin area
8
Q
What are the short-term IV lines and their durations?
A
Peripheral Line: 96 hours – 1 week
Non-tunneled central catheter: Days – 2 weeks
➤ Used for short-term hospital stays
9
Q
What is the medium-term IV line and its duration?
A
PICC Line: 4 weeks – 1 year
➤ Tunneled directly into the SVC
10
Q
What are long-term IV lines and their duration?
A
Mediport / Tunneled central catheter: Months – Years
11
Q
Example of mediport
A
Broviac / Hickman
12
Q
What is the final destination for all central veins?
A
The Superior Vena Cava (SVC).
13
Q
Where is the SVC located?
A
The SVC is located above the right atrium of the heart.
14
Q
Where should the tip of all other access points end?
A
The tip of a central line should end in the SVC.
15
Q
Why is the SVC the target for central line tips?
A
Because it’s where medications enter central circulation quickly and safely
16
Q
What’s a memory trick to remember IV needle gauge colors from smallest to largest?
A
YBPGG
17
Q
What color is a 24 gauge needle?
A
Yellow
18
Q
What color is a 22 gauge needle?
A
Blue
19
Q
What color is a 20 gauge needle?
A
Pink
20
Q
What color is an 18 gauge needle?
A
Green
21
Q
What color is a 16 gauge needle?
A
Gray
22
Q
What is the relationship between gauge size and needle size?
A
The larger the gauge number, the smaller the needle size.
23
Q
What gauge range is used for most adult infusions?
A
18-22g
24
Q
What gauge range is used for geriatric and neonatal patients?
A
22-24gauge
25
What gauge range is used for blood transfusions and diagnostic procedures?
18–20 gauge
26
What is Infiltration?
When IV fluid enters the subcutaneous tissue due to catheter displacement.
27
What are the signs of Infiltration?
Cold skin
Pain
Swelling
No blood return
Slowed or stopped infusion
28
What to do for Infiltration?
Stop infusion
Change site
Elevate extremity
Apply heat
Prevent by checking site & moving patient carefully
29
What is Extravasation?
Infiltration of a vesicant (tissue-damaging drug).
30
Signs of Extravasation?
Blanching
Ecchymosis
Edema
Taut, cold, necrotic skin
31
What to do for Extravasation?
Stop infusion
Notify provider
Prevent by flushing catheter & verifying placement
32
What is Fluid Volume Overload?
Too much fluid in the circulatory system.
33
What to do for Fluid Volume Overload?
Stop infusion
Notify provider
Elevate HOB
Give diuretic
Take vitals
34
What is Phlebitis?
Inflammation of the vein.
35
Signs of Phlebitis?
Red, hot, hard vein
Edema
Throbbing or burning
36
What to do for Phlebitis?
Stop infusion
Change site
Warm compress
Elevate extremity
Prevent with hand hygiene, aseptic technique, and diluting meds
37
What is an Air Embolism?
Air enters the vein during IV therapy.
38
What to do for Air Embolism?
Left side in Trendelenburg
Give O₂
Notify provider
Take vitals
Prevent by removing air bubbles & securing tubing
39
What are signs of Infection from an IV?
Local: Drainage at insertion site
Systemic: Fever or high temp
40
What to do for IV Infection?
Change site
Take vitals
Notify provider
Draw cultures
Give antibiotics & fluids
41
What is Thrombosis in IV therapy?
Blood clot in the catheter causing resistance or slow flow.
42
What to do for Thrombosis?
Stop infusion
Change site
Warm compress
Never force flush or massage
43
What is a Catheter Embolism?
A piece of the catheter breaks off and enters the vein.
44
What to do for Catheter Embolism?
Notify provider
Apply tourniquet above the insertion site to prevent movement
45
What are the steps before IV insertion?
Verify order
Gather supplies
ID patient, explain procedure
Check allergies (chlorhexidine, tape, latex)
Check for limb restrictions
46
What supplies are needed for IV insertion?
IV kit
Gloves
Chlorhexidine
Saline flush
Tape
Tourniquet
IV tubing
47
What are the steps to insert an IV?
Place tourniquet 4 in above site
Find bouncy vein (no pulse)
Untie tourniquet & clean skin
Retie tourniquet & pull skin taut
Insert at 15° angle with bevel up
48
How far above the site should the tourniquet be placed?
4 inches
49
How long should you keep a tourniquet on ?
Less then 1 minute
50
What allergies should you asses for before an IV Insertion (Was definitely a test question)
Skin cleaner, tape/adhesive, latex
51
What do you do when you first see a flash of blood in the IV chamber?
Lower the angle and advance just the catheter into the vein.
52
After advancing the catheter into the vein, what do you do next?
Advance the catheter until it reaches the colored hub.
53
Once the catheter reaches the hub, what is the next step?
Release the tourniquet.
54
What do you do after releasing the tourniquet?
Withdraw the needle, leaving the catheter in place.
55
What is the final step after inserting the catheter and removing the needle?
Connect the IV catheter to extension tubing.
56
What is the correct order of blood draw by tube color?
Blood Culture
Light Blue
Red
Gold/SST
Green
Purple
Pink
Gray
57
What is the Blood Culture bottle used for?
Detecting infections in the blood.
58
What is the Light Blue (Citrate) tube used for?
Clotting tests like PT, INR, and D-dimer.
59
What is the Red (Serum) tube used for?
Bacteriology, virology, and toxicology tests
60
What is the Gold/SST (Serum Separator Tube) used for?
Electrolyte tests and liver function tests.
61
What is the Green (Heparin) tube used for?
Ammonia and glycogen testing.
62
What is the Purple (EDTA) tube used for?
Blood counts, platelets, and hemoglobin.
63
What is the Pink tube used for?
Blood type matching and transfusions (crossmatch).
64
What is the Gray (Fluoride Oxalate) tube used for?
Glucose and lactate testing.
65
What are vials made of, and what do they contain?
Plastic or glass; contain liquid or powder (needs dilution)
66
How many doses can a vial hold?
One or multiple doses.
67
How are vials sealed?
With a plastic cap and rubber diaphragm.
68
What are ampules made of?
Glass
69
How many doses does an ampule contain?
Single dose only
70
What are the main types of blood products?
Packed RBCs
Platelets
Fresh Frozen Plasma (FFP)
Plasma
71
What is the purpose of Packed RBCs?
Carries oxygen.
72
When are Platelets given?
hemostasis after injury
or
invasive procedure thrombocytopenia.
73
When is Fresh Frozen Plasma (FFP) used?
In emergencies to replace clotting factors and volume.
74
What are the different types of plasma products?
Cryoprecipitate (CRYO)
Albumin
Gamma Globulins
75
What does Plasma contain?
Clotting factors.
76
What is Cryoprecipitate (CRYO) used for?
To treat bleeding from bleeding disorders like hemophilia and DIC
77
When is Albumin given?
For hypovolemic shock and liver failure.
78
What do Gamma Globulins do?
Provide antibodies to boost the immune system.
79
What is Autologous (Autotransfusion) donation?
When a patient donates their own blood in advance for later use. Needs to be planned ahead.
80
What is Intra-operative Cell Salvage?
The patient's blood is collected during surgery, cleaned, and returned to them. Reduces infection risk.
81
What is Allogeneic blood donation?
Blood donated by another person (a stranger).
82
What is a Direct donation?
Blood donated by a friend or relative for a specific patient.
83
What determines blood type?
Antigens on red blood cells and antibodies in the plasma.
84
What are antigens?
Proteins on red blood cells that trigger an immune response
85
What are antibodies?
Proteins made by the body to fight foreign antigens
86
What is the Rh factor?
A type of antigen. If you have the D antigen, you're Rh+. If not, you're Rh-.
87
Why do Rh-negative pregnant women get Rhogam?
To prevent their body from attacking an Rh-positive baby’s blood cells
88
Who is the Universal Donor?
O-
89
Who is the Universal Recipient?
AB⁺
90
A⁺ What can they receive and donate to?
Receive: A⁺, A⁻, O⁺, O⁻
Donate: A⁺, AB⁺
91
A⁻ What can they receive and donate to?
Receive: A⁻, O⁻
Donate: A⁺, A⁻, AB⁺, AB⁻
92
B⁺ What can they receive and donate to?
Receive: B⁺, B⁻, O⁺, O⁻
Donate: B⁺, AB⁺
93
B⁻ What can they receive and donate to?
Receive: B⁻, O⁻
Donate: B⁺, B⁻, AB⁺, AB⁻
94
O⁺ - What can they receive and donate to?
Receive: O⁺, O⁻
Donate: All the Rh⁺ blood types
95
O⁻ - What can they receive and donate to?
Receive: O⁻
Donate: Universal Donor (to everyone)
96
AB⁺ - What can they receive and donate to?
Receive: Universal Recipient (all types)
Donate: AB⁺
97
AB⁻ - What can they receive and donate to?
Receive: All Rh⁻ blood types
Donate: AB⁺, AB⁻
98
What are the steps for administering a blood transfusion?
Verify order for the transfusion
Verify the consent for the transfusion being signed
Make sure the IV is patent
Get the blood from the blood bank
Verify the blood with a second RN
Get PT vitals before starting the transfusion
Infuse the blood over 15 minutes (stay with the patient)
Adjust the infusion rate per the hospital policy
Document
99
What are the steps for Blood transfusion
Verify the order for the transfusion
Confirm that consent is signed
Ensure IV line is patent
Retrieve blood from the blood bank
Verify blood with a second RN (check type & expiration)
Take baseline vitals
Start transfusion slowly (no more than 2 mL/min for first 15 min)
Stay with the patient for the first 15 minutes
Adjust infusion rate per hospital policy
Monitor vitals (every 15 min for 1 hour, then every 30 min)
Document everything
100
When should vitals be taken for blood transfusion?
Before starting, then every 15 min for 1 hour, then every 30 min.
101
How fast should you start the transfusion?
No more than 2 mL/min for the first 15 minutes.
102
How long can a unit of blood hang?
No more than 4 hours.
103
What must always be at the bedside before transfusion?
An emergency bag of 0.9% Normal Saline.
104
What should you do if a transfusion reaction occurs?
Stop the infusion
Take down tubing and blood bag
Start 0.9% NS
Assess vitals, airway, and breath sounds
Notify provider
Return blood & tubing to lab
Document
105
Can the nurse delegate blood administration?
No, but assistive personnel (AP) can monitor vitals.
106
What must be known before transfusion?
Vitals & temperature
Medical/transfusion history
Allergies
CBC results
107
Can assistive personnel (AP) do a blood transfusion?
No
108
What can AP do to help a blood transfusion
monitor vitals
Every 15 minutes for the first hour
Then every 30 minutes
109
What type of gel should be used when inserting a nasogastric tube (NGT)?
Water-soluble gel
110
What does CVAD stand for and what is it?
Central Venous Access Device — a long, hollow catheter that ends in central circulation (usually the SVC), used to give medications, fluids, or nutrition
111
What is a Non-Tunneled Central Catheter and how long is it used?
Inserted directly through the skin into a central vein
Duration: Days to 2 weeks
Often used in hospital settings for short-term access
112
What is a PICC Line and how long is it used?
Peripherally Inserted Central Catheter
Inserted into a peripheral vein and threaded to the SVC
Duration: 4 weeks to 1 year
Used for long-term home therapy (e.g., chemo)
113
What is the CVAD with the least risk for complications?
PICC Line
114
Example of Tunneled Central Catheter
Broviac, Hickman, Quinton
115
What is a Tunneled Central Catheter (e.g., Broviac, Hickman)?
Inserted under the skin → into muscle → tunneled → into central vein
Insertion site is separate from vein entry point
Used for long-term access with lower infection risk
116
What is a Subcutaneous Port (e.g., Mediport)?
Surgically implanted under the skin in the chest
Catheter tip ends in the SVC
Accessed using a Non coring Huber needle
117
What do you need for every CVAD to confrim placement
Chest Xray
118
Who can insert a CVAD?
Physician
Physician Assistant (PA)
Specially trained or Advanced Practice RN
119
Where can a CVAD be inserted?
At the bedside (e.g., non-tunneled or PICC)
In Interventional Radiology (IR)
In the Operating Room (OR) — usually for ports or tunneled catheters
120
What is the difference between an open-ended catheter and a valved catheter?
Open-ended catheter:
Needs to be clamped when not in use
Higher risk for complications like hemorrhage, infection, and air embolism
Valved catheter:
Does not need to be clamped
Lower risk of complications
121
What might a patient with an implanted port need for comfort before accessing it?
topical anesthetic to reduce pain before accessing the port.
122
What do you flush an implanted port with after each use?
Flush with heparin after each use to prevent clotting.
123
How do you properly access an implanted port?
Use a sterile procedure and a non-coring Huber needle to access the port.
124
What is important patient education for caring for a port?
Keep the site clean and dry and monitor for signs of infection.
125
What is a serious infection complication of CVADs?
CLABSI – Central Line-Associated Bloodstream Infection.
Can be local (redness, swelling, drainage) or systemic (fever, chills).
126
What are other possible complications of CVADs?
Phlebitis
Occlusion
Embolism
Catheter migration
Pneumothorax
127
What precautions should the nurse and patient take when accessing a CVAD?
Nurse: Use sterile technique, wear a mask, perform meticulous hand hygiene
Patient: Wear a mask
128
Why are strict precautions necessary when handling CVADs?
Because CVADs are placed close to the heart, increasing the risk of serious infections and complications.
129
How do you instruct the patient when a CVAD is being removed?
instruct the patient to do the Valsalva maneuver (bear down) during removal to prevent air embolism.
130
What must be done after removing a CVAD?
Measure the catheter to make sure it was fully removed.
131
What are the main purposes of an NG tube?
Gastric lavage
Decompression of the bowel
Short-term enteral feedings
132
What is a fine/small bore NG tube used for?
Medication administration
Enteral feedings
133
What is a large bore NG tube (12 French or higher) used for?
Gastric lavage
Decompression of the bowel
134
What do you do when your patient starts coughing when you are inserting the NGT? What does this mean
This means the NGT Is in the pharynx and you tell them to tuck their head into their chin and swallow water
135
What are the 6 steps of NGT Insertion
Verify order
Gather supplies
Measure from ear to nose to xiphoid process
Insert the tube through the nose, When you get to pharynx have the patient tilt head forward, swallow while inserting
Secure tube with; nasl tape, bridle or clip
Confirm placement
136
When should NG tube placement be verified?
After initial placement
After feedings
Periodically between feedings
137
How is NG tube placement verified?
Chest X-ray (gold standard)
Test gastric pH (should be less than 5.5)
138
What does a gastric pH test help confirm?
Confirms that GI Contents are not being aspirated
139
What is a warning sign that the NG tube may have entered the airway?
Uncontrollable coughing
When you let go of the tube the patient is breathing through the tube
140
If an NG tube becomes dislodged, where can it go?
Lungs (risk of aspiration)
Esophagus (incorrect placement)
141
What is a bolus feeding?
200–400 mL
Given over 15–60 minutes
Delivered with a syringe
142
What is intermittent feeding?
Given at regular intervals
Uses a feeding pump
Allows breaks between feedings
143
What is continuous feeding?
Delivered over a long period (12, 14, or 24 hours)
Administered using a pump
144
What is Gastric Residual Volume (GRV)?
The amount of fluid left in the stomach before or after feeding—if too high, hold feeding.
145
What does it mean if a patient has N/V/D or abdominal pain before feeding?
They may not be tolerating the feeding—do not proceed.
146
What should you check for before starting enteral feeding?
Tolerance & Residual
147
How can nurses prevent aspiration during enteral feeding?
Elevate the head of the bed 30–45° during and for 1 hour after feeding or med administration.
148
How should you flush meds through an NG tube?
Flush with 15 mL sterile water before and after each med
Use 30 mL if meds are crushed
Give meds one at a time, flushing between each
149
150
How often should tubing and formula be changed during enteral feeding?
Regularly, based on facility policy (usually every 24 hours for formula and tubing).
151
What should you do with suction connected to an NG tube during feeding?
Turn off suction for 30 minutes after feeding or med administration.
152
How much sterile water is used to flush the tube before and after feedings?
15 mL sterile water.
153
How often do you flush a tube for continuous feedings?
Every 4–8 hours with 15 mL sterile water.
154
What is an ostomy?
A temporary or permanent opening made in an organ to allow waste to leave the body.
155
What is a stoma?
Part of the ostomy that is attached to the skin
156
What are the two main types of ostomies based on the organ involved?
A: Ileostomy and colostomy.
157
What is an ileostomy and what kind of stool does it produce?
An opening in the ileum; it produces watery or liquid stool.
158
What is a colostomy and what kind of stool does it produce?
An opening in the colon; it produces more formed stool.
159
What diet education should be given to a patient with a new ostomy?
Low-fiber diet for the first few weeks, chew food well, avoid gassy foods, and drink 10–12 glasses of water daily.
160
How big should the wafer opening be in relation to the stoma?
No more than 1/8 inch larger than the stoma.
161
How often should an ostomy pouch be changed?
Every 3 to 7 days
162
When should an ostomy pouch be emptied?
When it is 1/3 full.
163
What must you ensure about the skin around the stoma?
Keep it dry and clean; use a skin barrier if needed.
164
What do you have to wear over the stoma and how often
A pouch at all times
165
What is normal drainage for a new ostomy in the first 24–48 hours?
Minimal to no drainage.
166
What color and appearance should a healthy stoma have?
Beefy red or pink
167
Where should a healthy stoma be located?
On the abdominal surface, 1–3 inches above the skin.
168
What is the purpose of colostomy irrigation?
Colostomy irrigation helps to stimulate/empty the bowel in distal colostomies regularly and may reduce the need for a pouch.
169
Who is a candidate for colostomy irrigation?
Patients with distal colostomies (lower part of the colon).
170
Who should NOT receive colostomy irrigation?
Patients with IBS, Crohn’s, diverticulitis, radiation damage, hernias, or ileostomies.
171
Why is colostomy irrigation not done with an ileostomy?
Ileostomy produces watery stool that cannot be controlled with irrigation.
172
How is colostomy irrigation performed?
Water goes into the colostomy, and then the water and stool come out through a sleeve and go into the toilet.
173
How often is colostomy irrigation done?
Everyday to every other day
174
Who is the oropharyngeal airway for?
Unconscious patients only.
175
How do you measure an oropharyngeal airway?
From the corner of the mouth to the back of the jaw
176
Who can use a nasopharyngeal airway?
Conscious or unconscious patients.
177
How do you measure a nasopharyngeal airway?
From the tip of the nose to the earlobe.
178
Who inserts a tracheostomy or endotracheal tube?
Providers only
179
Where is a tracheostomy inserted?
Directly into the trachea, with or without a ventilator.
180
Where is an endotracheal tube inserted?
Through the mouth into the trachea, usually with ventilation.
181
What extra trach tubes should be kept at the bedside?
One the same size and one smaller.
182
What is an obturator used for in trach care?
For reinserting the trach tube if it comes out (recanalization).
183
How often should trach care be done?
Every 8 hours.
184
What communication tools should be available for a trach patient?
Notepad, phone, or other methods.
185
What technique is used for trach suctioning?
Sterile technique.
186
What should you do before cleaning a trach?
Change soiled linens.
187
What do you use to clean the trach area?
Cotton-tipped applicator or facility approved cleaner.
188
How do you clean the trach site?
From stoma site outward
189
What do you do with a disposable inner cannula?
Replace it
190
How often do you change a reusable inner cannula?
Every 6-8 weeks
191
When should trach ties be changed?
Only if they are wet or soiled
192
How often should you provide oral care for a trach patient?
Every 2 hours
193
What position should the patient be in during trach care?
Sitting upright.
194
When inserting a suction catheter, do you suction while inserting?
No you never suction, you pulse the suction
195
What type of suctioning uses sterile technique?
Endotracheal, tracheal, and nasopharyngeal suctioning.
196
What type of suctioning uses clean (aseptic) technique?
Oral suctioning (Yankauer).
197
What is pleural effusion?
Fluid in the pleural space.
198
What is emphysema (in terms of lung problems)?
Pus in the pleural space.
199
Where is a chest tube inserted?
Into the pleural space of the lungs.
200
Where do you place the chest tube for air vs fluid/blood?
Higher part of lungs for air, lower part for fluid and blood.
201
What size is a typical chest tube?
12-20 French.
202
Why is suction used with a chest tube?
To maintain negative pressure and keep the lungs expanded.
203
What happens if negative pressure in the pleural space is interrupted?
Lung expansion is interrupted.
204
What steps happen after chest tube insertion?
Suture and cover with occlusive dressing, chest x-ray to confirm placement, connect to water seal system.
205
What are the chambers of a chest drainage system?
Suction, drainage collection, water seal.
206
What is normal in the suction section of a chest tube drainage system?
Bubbling in the suction sect
207
What is normal in the water seal chamber when the patient breathes?
Mild fluctuation (Tidiling)
208
What does continuous bubbling in the water seal chamber indicate?
An active air leak.
209
What should you do if there is continuous bubbling in the water seal chamber?
Notify the provider; with order, increase suction to inflate the lung.
210
How should chest tube tubing be positioned?
Looped at patient level.
211
How should the water seal chamber be positioned?
Upright and lower than chest level.
212
What should you document every shift with a chest tube?
Intake and output (I+O) of drainage
213
What to do if the chest tube becomes dislodged?
Cover with occlusive dressing, assess HR, RR, pulse, notify provider.
214
Is suctioning sterile or aseptic
Sterile
215
How does pressure in the pleural space compare to atmospheric pressure?
It’s normally negative compared to atmospheric pressure which helps keep the lungs expanded.
216
What dressing is placed under the trach faceplate after cleaning and drying the stoma area?
A commercially prepared tracheostomy dressing or a prefolded non–cotton-filled 4×4-inch dressing.
217
What does an ECG (Electrocardiogram) measure?
Electrical activity in the heart at a given moment (usually 6 seconds).
218
How many electrodes are typically used in a standard ECG?.
10 electrodes
219
What do ECG electrodes detect?
Voltage changes between cells under the skin.
