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450 Lab > Iv, resp, heart, ped, bag > Flashcards

Iv, resp, heart, ped, bag Flashcards

1
Q

IV therapy (8)

A

-blood, maintenance fluids, medication, TPN, lytes, hemodynamic and diagnostic testing

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2
Q

IV types (5)

A

-peripheral, peripherally inserted central cath, central cath, implantable vascular access device (port), intraosseus

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3
Q

Vein (4)

A
  • cephalic: radial, basilic: ulnar, median: palmar side to ac, metacarpal: dorsal hand
  • preferred on ventral, dorsal, distal surface
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4
Q

Needle size (4)

A
  • smaller number larger the needle diameter, larger the number smaller the needle, 14-26
  • Peds: 22-24
  • Adult: 22-20
  • Blood: 18
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5
Q

IV insertion problems (2)

A

-infiltration: stop infusion, may apply warmth, elevate, monitor, resite and doc, prevention
-phlebitis: tenderness at tip that follows the length of the vein and proximal to insertion device
: puffy over vein, may feel hard, warmth at site, elevated temp

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6
Q

IV complications (5)

A
  • thrombosis, cellulitis, extravasation
  • systemic complications: circulatory overload, excessive fluid accumulates faster than can be excreted and lead to CHF or pulmonary edema
  • air embolism s/sx: sudden chest pain, unequal breath sounds, tachycardia, weak pulse, dec bp, dec LOc, JVD distention–> stay with pt, call for help, 02
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7
Q

S/Sx of fluid overload (7)

A

-crackles, discomfort, neck vein distention, SOB, resp distress, orthopnea, inc BP

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8
Q

IV DO (8)

A
  • know why using IV
  • check the order
  • hand hygeine
  • closed system
  • label bags, tubing, site
  • assess iv
  • cheek fluid for cloudiness, exp date
  • follow safe med practice
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9
Q

site assessment (4)

A
  • site and dressing should be CDI
  • skin around site should be color appropriate for ethnicity’ as rest of skin and same temp
  • no swelling
  • same as other side, or before
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10
Q

bad signs (3)

A
  • swelling, coolness, stopped/slowed infusion, wetness (infiltration)
  • warmth, erythema, burning, tender (extravasation)
  • warmth, tender, red, in line of vein (phlebitis)
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11
Q

Priority for venous access (5)

A
  • severe burns (dehydrated)
  • fluid and lute balance
  • acutely ill
  • npo before and after surgery
  • npo
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12
Q

extracellular fluid (4)

A
  • 40% of our body fluid
  • intravascular and interstitial spaces ex: pleural cavity, synovial joints, eye chamber, plasma
  • rich in NA+, HCO3-, CL-
  • intravascular is rich in protein
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13
Q

intracellular fluid (3)

A
  • 60% of our body fluid
  • fluid within body cells
  • rich in K+, MG+, phosphates, and proteins
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14
Q

isotonic soln (3)

A
  • same osmolality as plasma so fluids remain in extracellular fluid
  • used to replace ecf losses and expand vascular vol quickly
  • NS, LR, R
  • inc vessel vol and doesn’t detract from tissue vol
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15
Q

Normal Saline (8)

A
  • 0.9% NACL
  • fluid of choice for iv resuscitation and only fluid used to give blood products
  • replaces ECF, used in: hypovolemia
  • shock
  • hemmorrhage
  • severe N/V
  • wound drainage
  • use with caution in pt w/ cardiac or renal dz because may lead to vol overload
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16
Q

Lactated Ringers (6)

A
  • 130meq/L NA+, 4 meq/L K+, 3 meq/L calcium, 109 meq/L CL-
  • most physiological adaptable fluid bc lyte content is close to body’s blood serum and plasma
  • metabolized in liver, converts lactate to bicarb, so may be used as an alkalizing soln in pt with met. acid.
  • don’t give to pt who can’t metabolize lactate (liver dz, lactic acidosis)
  • contains some K+ so don’t give to renal failure because can’t excrete acids
  • no dextrose so no cal.w
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17
Q

Ringers soln (3)

A
  • similar to LR
  • no lactate so can be given to those allergic
  • not useful in treatment of met acid
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18
Q

Hypotonic soln (4)

A
  • lower osmolality of blood plasma (lower content/more diluted so goes to cells that have higher concentration and need to be diluted)
  • water is pulled out of vessels into cells
  • causes dec vascular vol and inc volume in cells
  • contraindicated in acute brain injury bc cerebral cells are sensitive to free h20 and picks it up causing cerebral edema
  • D5W, .45% NACL
  • inc cell volume dec circulatory/vessel vol
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19
Q

D5W (9)

A
  • amnt of dextrose makes it initially isotonic but after it gets absorbed then it becomes hypotonic
  • contraindicated in pts with inc ICF
  • not useful as only soln to treat vol deficit bc dilutes plasma electrolyte concentrations
  • not useful in resuscitation bc doesn’t remain in iv space/vessels
  • provides 170 cal/L
  • hydrate cells, deplete fluid in circ system
  • treat DKA and other hyperosmolar states
  • free water helps to hydrate kidneys to help excrete excess fluids and elytes
  • dec fluid in circ volume may worsen hypovolemia, and hypotension
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20
Q

Hypertonic soln (4)

A
  • inc osmolality than plasma
  • inc vascular vol dec tissue vol
  • water is pulled from cells inc circulatory vol
  • 3% saline, d10w, d50w, colloids: 5%, 25%, albumin, synthetic colloids, dextran
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21
Q

colloids (7)

A
  • effects can last several days if cap walls fn well
  • useful to tx hypoproteinemia and malnourishement
  • albumin is considered a blood transfusion product
  • contraindicated in pt with severe anemia, HF, known allergy
  • monitor s/sx for hypervolemia, coags, allergic rxn
  • can interfere with platelet fn and inc bleeding times
22
Q

metabolic alkalosis (9)

A
  • ng suction (loss of HCL, gastric secretions)
  • steroids tx
  • hyperaldosteronism
  • cushings dz (loss of KCL)
  • antacid (bicarb ingestion)
  • prolonged diuretic tx
  • vomiting
  • too much base during code
  • hypokalemia
  • some drugs
23
Q

metabolic acidosis (8)

A
  • diarrhea (loss of base/hco3)
  • DKA
  • lactic acidosis/HF (gain of acid)
  • renal failure (impaired excretion of acid)
  • ASA/poisoning (ingestion of acids)
  • dehydration
  • shock
  • hyperkalemia
24
Q

respiratory acidosis (4)

A
  • copd
  • neuromuscular dz (guillain barre, ale, myasthenia gravis)
  • cns depression (narcotic, barbs, sed)
  • pulmonary edema
  • any cause of hypoventilation (splinting, restrictive dz, wrong ventilator setting)
25
Q

respiratory alkalosis (9)

A
  • pain
  • anxiety/psych disorder
  • CnS stim
  • fever
  • preg
  • cause of hyperventilation (pneumothorax, pul embolism)
  • overventilation on ventilator
  • fear/panic attack
  • hypermetabolic state
26
Q

capnography (3)

A
  • noninvasive measurement of tidal c02
  • correlates well with arterial co2
  • more reliable than pulse ox to detect resp depression, esp w/opiods
27
Q

acid base homeostasis (3)

A
  • buffers
  • resp system (co2)
  • renal system (bicarb)
28
Q

buffers (2)

A
  • when too much acid, kidneys pick up H

- when too much base, H ions are released

29
Q

Lungs/pa02 says (3)

A
  • indicates how effective the reps system is at excreting carbonic acid
  • chemoreceptors sense ph and paco2
  • high acid-inc resp rate and rhythm
  • low acid-dec resp rate and rhythm
30
Q

Kidneys/Hco3- says (3)

A
  • excrete acid
  • if inc acid, excrete metabolic acids
  • HCo3- is a measure of renal regulation of metabolic acids
31
Q

venous co2 (2)

A
  • indirect measurement of Hco3

- 2meq less than arterial bicarb

32
Q

arterial blood gas (3)

A
  • acid/base
  • oxygenation
  • co
33
Q

pulse oximetry (2)

A
  • noninvasive measurement of peripheral arterial hemoglobin 02 sat
  • o2 of 90 is considered arterial hypoxemia
34
Q

cns depressants use (4)

A
  • monitored with continuous pulse ox
  • check resp rate, rhythm, depth
  • monitor entire time of infusion
  • capnography is more likely to detect resp depression than clinical signs
35
Q

pca (5)

A
  • post-op resp failure is inc
  • easily become hypoxic even with ok 02 sat
  • obese and elderly are higher risk for sedation
  • if other push button while pt sleeps its dangerous
  • narcan to reverse but has a short half life and may need to be given multiple times
36
Q

acidemia (7)

A
  • sx: vasodilation
  • dec bp
  • ha
  • confusion
  • coma (drowsy)
  • tachycardia
  • asterixis
  • (dec neural activity)
37
Q

alkalemia (8)

A
  • sx: cns irritability
  • seizure (inc neural excitability)
  • muscle twitch
  • tingling
  • numbness
  • arrhythmia
  • carpopedal spasm
  • (dizzy)
  • (weakness)
38
Q

resp alkalosis s/sx (4)

A
  • vertigo/lightheaded
  • tinnitis
  • paresthesias
  • elyte abnormalities
  • paresthesias
  • cardiac dysrhythmias
  • cns irritability
39
Q

resp acidosis s/sx (8)

A
  • cns depression (co2 narcosis)
  • palpitations
  • flushed skin
  • diaphoresis
  • drop in bp
  • tachycardia
  • ha
  • cardiac dysrhythmias
40
Q

metabolic compensation (2)

A
  • kidneys excrete more acid, more hco3 because less is needed for buffering
  • kidneys excrete more base
41
Q

met acidosis s/sx (6)

A
  • cns depression
  • flushed skin
  • e-lyte abnormalities
  • cardiac arrhytmias
  • ha
  • treat underlying cause
42
Q

met alkalosis s/sx (9)

A
  • inc neuromuscular excitability
  • n/v
  • ekg changes (u wave)
  • confusion
  • seizure
  • e-lyte abmoraliites
  • tx underlying cause
  • cns irritability
  • cardiac dysrhymias
43
Q

inc 02 demand (7)

A
  • fever
  • shivering
  • seizures
  • pain
  • anxiety
  • inc work of breathing
  • mobilization
44
Q

hemoglobin calc (2)

A
  • hgb x o2 sat x 1.34 + pa02 x .0003-3%

- hemoglobin is the major determinant of arterial oxygen content

45
Q

major determinant of o2 delivery

A

co

46
Q

pf ratio (5)

A
  • pa02/fi02
  • ex: 100/.20 =50
  • normal=400
  • need to see at least 300
  • pf goes down with more fi02 then gas exchange is bag
47
Q

complications of 02 tx (2)

A
  • hypoventilation: depresses the hypoxic drive in chronically hypercarbic pt
  • absorption atelectasis: high 02 concentration wash out nitrogen normally filling alveolus, gradual shrinking of alveolar size with hypo vent and receiving high 02. 02 is absorbed into blood faster than can be replaced by ventilation leading to atelectasis
48
Q

oxygen toxicity (2)

A
  • 50% for more than 24 h
  • 02 free radicals are toxic metabolites of 02 metabolism and are normally neutralized by enzymes. during high admin of 02 large number of free radicals exhausts supply of neutralizing enzymes and damage to lunch parenchyma and vascular occur
49
Q

phases of 02 toxicity (2)

A
  • early exudative phase: damage to capillary endothelial cells causing leakage of proteins, flooding
  • late cellular proliferative phase: endothelial repair leads to scarring which causes pulmonary fibrosis
50
Q

s/sx of 02 toxicity (5)

A
  • substernal soreness inc with deep breaths
  • pleuritic pain on inhalation
  • dry cough and tracheal irritation
  • sore throat, nasal congestion
  • eye and ear discomfort
51
Q

complications of et suction (6)

A
  • hypoxemia
  • cardiac dysrhymias (bradycardia from vagal stimulation and hypoxemia, tachycardia from anxiety, hypoxemia, sns)
  • damage to mucous membrane: bleeding, erosion of soft tissue
  • hypotension
  • aspiration
  • infection-cross contamination

450 Lab (3 decks)

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