Intravenous therapy. P&P cp 40 & Lewis cp 19 (w1&2) Flashcards
(109 cards)
1
Q
what is intracellular fluid (ICF)/ cytosol?
A
includes fluid w/in body cells (accounts for approx 60% of body fluid)
2
Q
what is extracellular fluid (ECF)?
A
all fluid that is outside the cell and is divided in three compartments:
- interstitial fluid
- intravascular fluid
- transcellular fluid
3
Q
what is interstitial fluid?
A
fluid between cells, and outside the blood vessels
-includes lymph
4
Q
what is intravascular fluid?
A
is blood plasma
5
Q
what is transcellular fluid?
A
separated from other fluids by epithelium
- includes cerebrospinal
- pleural
- peritoneal
- synovial fluid
- and fluids in the gastrointestinal tract
6
Q
what does passive transport include?
A
- osmosis
- diffusion
- filtration
7
Q
what is osmosis?
A
movement of water through a semipermeable membrane from an area of lower concentration of solute to a higher concentration of solute
8
Q
what is osmotic pressure?
A
the pressure needed to counter the movement of water (solvent) across a semipermeable membrane from a low concentration to a high concentration of solutes
9
Q
what are the 3 main classes of plasma proteins?
A
albumin, globulins, and fibrinogen
10
Q
what pressure does albumin produce?
A
it exerts colloid osmotic pressure or oncotic pressure.
-oncotic pressure tends to keep fluid in the intravascular compartment by pulling water from the interstitial space back into the capillaries
11
Q
what is diffusion?
A
movement of ions and molecules in a solution across a semipermeable membrane from an area of high concentration to an area of low concentration
12
Q
how is the rate of diffusion affected?
A
by molecule size, concentration, and temperature of a solution
13
Q
what is active transport?
A
it facilitates movement of molecules (solutes) across the plasma membrane across a concentration gradient using chemical energy (ATP)-adenosine triphosphate)
14
Q
what is primary active transport?
A
a protein binds with a solute to carry it against a concentration gradient. there are three pumps
- uniport
- symport
- antiport
- the sodium-potassium pump (NA/K ATPase) is an antiport pump (transport solutes in the opposite direction across the plasma membrane)
15
Q
what is filtration?
A
results of hydrostatic and colloid osmotic pressure
-a passive process whereby water moves into and out of the capillaries
16
Q
what is hydrostatic pressure?
A
the force exerted by fluids w/in a compartment
17
Q
what are the primary hormones that regulate fluid in our bodies?
A
- antidiuretic hormone
- angiotensin II
- natriuretic peptides
18
Q
fluid output occurs with which four of our organs (water loss)?
A
- kidneys
- skin
- lungs
- gastrointestinal tract
19
Q
what is sensible water loss?
A
includes water loss through urine and feces
20
Q
what is insensible water loss?
A
a continuous, gradual loss of water from the respiratory and skin epithelium
- this water loss may increase in response to changes in respiratory rate and depth
- water loss from skin is regulated by our SNS activating sweat glands
- fevers may increase insensible water loss
21
Q
what is paco2?
A
- is partial pressure of carbon dioxide
- measures how well the lungs are excreting CO2 by cells
- high PaCO2 indicates CO2 accumulation in blood (more carbonic acid) caused by hypoventilation; decreased PaCO2 indicates excessive CO2 excretion (less carbonic acid) through hyperventilation.
22
Q
what does HCO-3 do?
A
HCO3– is concentration of the base (alkaline substance) bicarbonate, a measure of how well the kidneys are excreting metabolic acids. Increased HCO3– indicates that the blood has too few metabolic acids; decreased HCO3– indicates that the blood has too many metabolic acids.
23
Q
what does Pa02 do?
A
PaO2 is partial pressure of oxygen (O2), a measure of how well gas exchange is occurring in the alveoli of the lungs. Values below normal indicate poor oxygenation of the blood.
24
Q
what is the goal of intravenous fluid therapy?
A
- maintain fluid, electrolyte, and energy demands when pt’s are limited in their intake
- to prevent or correct fluid and electrolyte disturbances from excess losses
25
when are oral replacements of fluid contraindicated?
- pt has mechanical obstruction of the GI tract
- risk of aspiration
- impaired swallowing
26
what are crystalloids?
Small molecules that diffuse through capillary walls
-Depending on solute concentration, fluids may be:
-Isotonic – most nutrients, most common and least
irritating to the vein
-Hypertonic, hypotonic
-include dextrose, sodium chloride, and lactated Ringer's solutions
27
what are colloids?
-they contain protein or starch which dose not cross semipermeable membranes and therefore remains suspended and distributed in the extracellular space (Larger molecules that can not diffuse through capillary walls)
primarily the intravascular space for several days
-colloids have been used to increase the osmotic pressure in the intravascular space to increase vascular volume in critical situations
-colloids are either semi-synthetic such as dextran, pentastarch, or hetastarch
or human plasma derivatives such as albumin, plasma proteins or blood
28
what are vascular access devices? (VADs)
-are catheters, cannulas, or infusion ports designed for repeated access to the vascular system. These devices include peripheral vascular access devices (PVADs) and central vascular access devices (CVADs) and allow for parenteral fluid and electrolyte replacement, par- enteral nutrition, and administration of medications.
29
name a cannula that is for short-term use?
peripheral cannulas
30
which cannula are used during long-term use?
central venous catheters (CVC)
-peripherally inserted central catheters (PICCs), tunnelled catheters (e.g., Hickman), and implanted ports are for long-term use or for administration of medications or solutions that are irritating to the veins
31
identify hypotonic solutions
- 0.225% sodium chloride (quarter normal saline; 14 0.225% NaCl)
- 0.45% sodium chloride (half normal saline; 12 NS; 0.45% NaCl)
- expands extracellular fluid volume (vascular and interstitial) and rehydrates cells
32
identify isotonic solutions
- Dextrose 5% in water (D5W)
- 0.9% sodium chloride (normal saline; NS; 0.9% NaCl)
- Lactated Ringer’s (LR)
- Expands extracellular fluid (vascular and interstitial); does not enter cells.
33
identify hypertonic solutions
- Dextrose 10% in water (D10W)
- 3% or 5% sodium chloride (hypertonic saline; 3% or 5% NaCl)-
- Dextrose 5% in 0.45% NaCl sodium chloride (D5 12 NS; D50.45% NaCl)
- Dextrose 5% in 0.9% sodium chloride (D5NS; D50.9% NaCl)
- Dextrose 5% in lactated Ringer’s (D5LR)
- dextrose enter cells rapidly and leaving % of fluid behind (i.e 0.45% sodium chloride) or draws water from cells into extracellular fluid by osmosis
34
what is a midline catheter?
- a catheter inserted into the upper arm and terminating distal to the shoulder
- is recommended for intermediate use (1-4 weeks) or when peripheral or central access is difficult or contraindicated
35
how long can transparent dressing remain intact?
5-7 days
36
what to assess at the insertion site?
- inspect for tenderness
- signs of infection
- erythema
- warmth
- edema
- infiltration, inflammation, clots, kinks/knots
- assessment should include palpation
- assess for engorged veins at the chest or neck
- assess any difficulty w/ movement
- assess for systemic infections (fever, chills, hypotension)
37
difference between maintenance fluids and replacement fluids
- maintenance: help to sustain normal levels of fluids and electrolytes- can also be used when pt is NPO
- replacement: ordered for a pt who lost fluid through-vomiting, diarrhea, or hemorrhage
38
what is primary IV line?
main source for IV fluids and electrolytes (i.e potassium chloride, sodium chloride, normal saline)
39
what are secondary IV lines?
- usually used to administer intermittent medication and are attached to the primary line at an injection port
- referred to ass IV piggyback (IVPB)
- must be hung higher than the primary so that it gives greater pressure allowing it to infuse first
40
blood can only be hung with what?
normal saline-to flush before and after the blood transfusion
41
what is the average dose for heparin lock?
10 units and NEVER exceeds 100 units
42
what is dose IV push refer to?
indicates that a syringe is attached to the port and the medication is pushed in
43
what is IV bolus?
indicates that a volume of IV fluid is infused over a specific period of time through an IV administration set
44
what is a CVAD (central vascular access devices)
- venous access device with a tip that terminates in a great vessel, preferably in the lower third of the superior vena cava
- upper right atrium is an acceptable site
45
what are the most common sites for CVAD?
-internal jugular (best option) and subclavian viens
46
what are the complications associated with CVAD?
- pneumothorax
- arterial puncture
- hemorrhage
- cardiac tamponade
- air embolus
- hemothorax
- nerve injury
- hydrothorax
- infection
- catheter occlusions
- phlebitis
47
what are the nursing responsibilities for CVAD?
- careful monitoring
- flushing
- site change
- dressing change to prevent central line associated blood stream infection (CLABSI)
- use aseptic technique and diligent hand hygiene are essential!
48
prior to accessing a CVAD, the nurse should do what?
-a 15-second rub with 70% isopropyl alcohol, povidone-iodine, or >0.5% chlorhexidine in alcohol solution
49
what is osmolarity?
the osmolar concentration in 1L of solution (mOsm/L), is most often used to describe fluids outside the body
50
what is isotonic?
a solution with the same osmolarity as blood plasma
-expands the body's fluid volume (ECF) without causing a fluid shift from one compartment to another
great for pt w/ ECF volume deficit
51
what is a hypertonic solution?
a higher osmotic pressure (such as 3% sodium chloride) pulls fluid from cells causing them to shrink
- rasises the osmolality of ECF and expands it
- great for treatment of hypovolemia and hyponatremia
52
what is a hypotonic solution?
- osmotic pressure lower than plasma (such as 0.45 sodium chloride) moves fluid into the cells, causing them to be enlarged
- provides more water than electrolytes, diluting the ECF. osmosis produces a movement of water from ECF to ICF
53
what solution would you give a dehydrated pt d/t vomiting? (isotonic, hypertonic, hypotonic)
-isotonic
54
what should you be careful/watch out for when giving hypertonic solutions?
pulmonary edema (esp w/ pt in renal or heart failure)
55
pts with normal renal function who are NPO should receive what?
potassium
-the body cannot conserve potassium, and even when the serum level falls, the kidneys continue to excrete potassium. Without oral or parenteral potassium intake, hypokalemia can develop quickly.
56
when are venipuncture sites contraindicated?
- signs of infection (can cause infection into the bloodstream)
- infiltration
- thrombosis
57
why do we avoid the foot for venipuncture site in adults?
-bc of the danger of thrombophlebitis
58
what is an electronic infusion device or infusion pump? (EID)
- are necessary when administering low hourly volumes (eg., less than 20mL/hr)
- for pt who are risk for volume overload, such as neonatal, paediatric, and geriatric pts
- is considered standard in most settings
- delivers the infusion via positive pressure
59
why do we prime (rapid flow of fluid into the drip chamber) the IV line?
-bc it indicates patency (removes air bubbles)
60
microdrip tubing/paediatric tubing is always at-?
-universally delivers 60 gtt/mL
61
what should you never use on an intravenous bag?
- felt-tipped pen
| - permanent marker made of polyvinyl chloride bc the ink could contaminate the solution
62
what does potency of the intravenous need or catheter mean?
-that the tip of the needle or catheter has no clots and that the catheter or needle tip is not against the vein wall
63
what are factors that affect the intravenous flow rates?
- a blocked catheter or needle
- infiltration
- knots or kink
- the height of the solution
- restrictive intravenous dressing
- position of the pts extremity
- flexion of an extremity (wrist or elbow)
64
how do you maintain the system of an intravenous line?
- keeping the system sterile
- changing solutions, tubing, and site dressing
- assisting the pt w/ self-care activities so as not to disrupt the system
65
what does ANTT stand for?
- always wash hands effectively
- never contaminate key parts
- touch non-key parts with confidence
- take appropriate infective precautions
66
what is infiltration?
- occurs when intravenous fluids enter the surrounding space around the venipuncture site
- this manifests as selling (from increased tissue fluid) and pallor and coolness (caused by decreased circulation) around the venipuncture site
- fluid may be flowing through the intravenous line at a decreased rate or may have stopped flowing
- pain may be present d/t edema
67
what do you do when infiltration occurs?
- infusion must be discontinued and if IV therapy is still need, a new catheter is inserted into a vein in another extremity
- to reduce discomfort and edema, the extremity should be raised (promote venous drainage)
- wrapping the extremity in warm, moist towel for 20 mins while keeping it elevated on a pillow, promote venous return, increases circulation, and reduces pain and edema
68
what is phlebitis?
inflammation of the vein
69
what are S/S of phlebitis?
- pain, edema, erythema and increased skin temperature
- some instances, redness travelling along the path of the vein
- dehydration may also be a contributing factor bc of the increase in blood viscosity
70
what do you do when phlebitis occurs?
- intravenous line MUST be discontinued and a new line inserted into another vein
- warm, moist heat on the site of phlebitis can occur some relief to the pt
- phlebitis can be dangers bc of blood clots (thrombophlebitis) can occur, and in some cases, may result in an emboli
71
what are the primary objective for blood transfusions?
- to increase circulating blood volume after surgery, trauma, or hemorrhage
- to increase the number of RBCs & maintain hemoglobin levels in pt's w/ severe anemia
- to provide selected cellular components as replacement therapy (e.g., clotting factors, platelets, albumin)
72
why do we use 0.9 normal saline with blood?
-to prevent hemolysis (breakdown of RBC's)
73
blood transfusion must begin _?
- must begin w/in 30 mins of accessing the blood components from the transfusion medical lab
- must be stopped after 4 hours or two units
- must be discarded in the biohazards waste
74
what are the assessment prior to giving blood?
- obtain pt's baseline vital signs
- ask if they have ever had previous transfusions or any reactions
- explain the procedure
- instruct the pt to report any side effects (chills, dizziness, or fever)
- complete a thorough check of blood product, the pt, the reason for the transfusion, the volume or dose, the rate, and site ensures safe administration
75
what should the nurse inspect during blood transfusion?
- observe for hives
- fevers
- rigors
- dyspnea
- cough
- or back or infusion site pain
76
which is the most serious blood transfusion reaction?
transfusion-related acute lung injury (TRALI),
| -requires critical care
77
what is circulatory overload? or TACO?
- a risk when a pt receives large volumes of whole blood or packed RBC transfusion for massive hemorrhagic shock
- or when a pt w/ normal blood volume receives blood
- highest risk are elders with cardiopulmonary diseases
78
who is at greater risk of having fluid electrolytes, and acid-base imbalances?
-our infants and elders
79
what is extravasation?
Extravasation is the leaking of vesicant drugs into surrounding tissue. Extravasation can cause severe local tissue damage, possibly leading to delayed healing, infection, tissue necrosis, disfigurement, loss of function, and even amputation.
80
what are the S/S of extravasation?
Blanching, burning, or discomfort at the I.V. site
Cool skin around the I.V. site
Swelling at or above the I.V. site
Blistering and/or skin sloughing
81
what is fluid spacing?
used to describe the distribution of body water
82
what is first spacing?
describes the normal distribution of fluid in the ICF and ECF compartments
83
what is second spacing?
refers to abnormal accumulation of interstitial fluid (e.g edema)
84
what is third spacing?
occurs when fluid accumulates in a portion of the body from which it is not easily exchanged with the rest of ECF
- third-spaced fluid is trapped and essentially unavailable for functional use
ex. ascites, sequestration of fluid in the abdo cavity w/ peritonitis, and edema associated w/ burns, trauma, or sepsis
85
what is central venous access devices (CVADs)?
catheters that are place in large blood vessels (subclavian vein, jugular vein) when access to the vascular system is needed frequently
86
what are the 3 different central venous access can be achieved by?
centrally inserted catheters, peripherally inserted central catheters (PICCs) or implanted ports
87
what do CVADs do?
enable frequent, continuous, rapid, or intermittent administration of fluids and medications
- allows for administration of drugs that are potential vesicants, blood and blood products, and parenteral nutrition
- hemodynamic monitory and venous blood sampling
88
why do we use CVADs instead of peripheral IV?
for pt who have limited peripheral vascular access or who need long-term vascular access
89
what are some examples of medication conditions in which CVADs are used?
- cancer (chemo)
- infection (long-term administration of antibiotics)
- pain (long term use of pain meds)
- drugs that increase risk for phlebitis
- nutritional replacement
- blood samples, blood transfusions
- renal failure (hemodialysis)
- shock/burns -infusing high volumes of fluid/electrolyte replacement
90
what are the advantages with CVAD?
reduced need for multiple venipuncture, decreased risk of extravasation injury, immediate access to the central venous system
91
what are the disadvantages of CVADS?
increase risk of systemic infection and the invasiveness of the insertion procedure
92
what are centrally inserted catheters?
-usually inserted at the distal end of the superior vena cava near its junction with the right atrium, other side of the catheter is on the chest or abdo wall
two types: nontunnelled catheters (short term) and surgically placed like Hickman catheters (long term)
-are available as single, double, triple, and quadruple lumen catheters
93
before using a catheter what must the nurses always do?
check accurate placement must be verifies by a chest x-ray
94
what are the care requirements of a CVAD?
- injection cap change
- cleansing
- flushing
- dress change
95
why are multilumen catheters useful (CVCs)?
each lumen can provide different therapy
ex. incompatible drugs can be infused in separate lumens w/out mixing
- third lumen can provide access for blood sampling
96
what are PICCs? Peripherally inserted central catheters
- central venous catheters inserted into a vein in the arm
- basilic vein is preferred d/t its large diameter
- inserted at the antecubtial fossa and advance to the tip ending one third of the superior vena cava
97
when are PICCS used?
for pts who need vascular access for 1 week to 6 months but can be in place for longer periods if needed
98
what are the advantages of PICCS over CVCS?
- lower infection rate
- fewer insertion-released complications
- decrease cost
- ability to be inserted at the bedside/outpatient area
99
what are the complications of a PICC line?
- catheter occlusion
| - phlebitis (usually happens 7-10 days after insertion)
100
what is a nurse consideration with pt that has a PICC line? what should they not do?
obtain blood pressure reading or draw blood d/t the PICC can touch the vein wall, which increases the risk of vein damage and thrombosis
101
what is an implanted infusion port?
a CVC (central venous catheter) connected to a single or double implanted subcutaneous injection port
- catheter is placed into the desire vein, and the other end is connected to a port that is surgically implanted in a subcut pocket on the chest wall
- drugs are injected through the skin into the port into bloodstream
102
what are advantages of implanted ports?
convenient for long-term therapy -can remain in the body for years
-port is hidden =cosmetic advantages
103
what are the care requirements of an implanted port?
-regular flushing
104
complications of implanted ports?
formation of "sludge" (accumulation of clotted blood and drug precipitate) may also occurs w/in the port septum
105
nursing assessment of CVADs?
inspect site for redness, edema, warmth, drainage, tenderness or pain
- observing if the catheter is misplaced or slippage is import
- dressing change (strict sterile technique) - use transparent dressing (preferred-can be left for 1 week) or gauze if pt is bleeding
- cleansing, injection cap changes (sterile technique), and flushing
106
what solution should you use to clean a CVAD?
chlorhexidine-based preparation
-effects last longer than either povidone-iodine or isopropyl alcohol, offering improved killing of bacteria
when using chlorehexidine, cleansing the skin w/ friction is critical for preventing infection
-always allow the skin to air dry completely before applying a new dressing
107
what is the most effective ways to keep the patency of a lumen catheter?
flushing!! (NS)
| -prevents occlusion of CVAD and also keeps incompatible drugs or fluid from mixing
108
how to removal a CVAD
- remove sutures
- gently w/draw the catheter
- pt is instructed to perform the Valslva manoeuvre while the last 5-10cm as the catheter is w/draw
- nurse immediately applies pressure to the site w/ sterile gauze to prevent air from entering and to control bleeding
- inspect tip of catheter to ensure that it is intact
- after bleeding has stopped, an antiseptic ointment and sterile dressing is applied
109
what is the distance between primary and secondary line when you piggy bag
90cm
