IV Therapy (SL) Flashcards
(117 cards)
1
Q
Do IV medications require doctor’s orders?
A
YES
2
Q
What is the purpose of IV therapy? (SLB)
A
- To supply electrolytes, fluids, glucose, vitamins, medications = restores acid-base balance
- To establish lifeline for rapidly needed medications
- Restore volumes of blood components
3
Q
Types of Solutions based on concentration (IHH)
A
Isotonic: D5W, LRS, ,SS
Hypertonic: .45%
Hypotonic: .33%
4
Q
Types of Solutions based on purpose (NEAAE)
A
Nutrient Electrolyte Alkalizing Acidifying Blood Volume Expander
5
Q
What is the formula for flow rate in ml/hr?
A
total infusion volume / total infusion time
6
Q
What is the formula for flow rate in gtts/min?
A
(total infusion volume x drop factor) / (total infusion time x minutes)
7
Q
Factors affecting flow rate (PPHIS)
A
Position of arm: bend = slow Patency of tubing Height of bottle: higher = faster Infiltration Size of catheter to vein
8
Q
Identify the four vein sites on the back of the hand (TSVB)
A
Tributaries of cephalic vein
Superficial dorsal vein
Venous arch
Basilic vein
9
Q
Vein access sites for infants (SF)
A
Scalp
Top of foot
10
Q
IV Locations (4, BFEF)
A
Back of hand
Forearm
Elbow / antecubital
Top of foot
11
Q
What principle do we follow in choosing iv location to preserve veins of px?
A
Distal-proximal, non-dominant hand first
12
Q
The selected vein must be (PSNL)
A
Easily palpable
Soft
Naturally splinted by bone
Large enough to accomodate catheter
13
Q
Blood transfusions require G_/G_ because they have ___ bores or diameters
A
18/20
Large
14
Q
What happens to the veins of patients undergoing chemotherapy?
A
They shrink and become brittle
15
Q
Give at least 3 things that we need to assess in patients for IV therapy
A
Duration of IVT Size of cannula Skin Type of Solution LOC Activity Age (pedia/geria = hard) Dominant Arm
16
Q
When preparing to initiate iV meds, we must check (ECHOA)
A
Expiry date Clarity of solution Holes in bottle Doctor's orders: type, amount, infusion rate Additional meds to be infused
17
Q
What are the two types of catheter?
A
Intravenous
Butterfly
18
Q
Match the gauge number to its corresponding color:
- 18G
- 20G
- 22G
- 24G
- 26G
A. Purple B. Yellow C. Pink D. Green E. Blue
A
1D 2C 3E 4B 5A
Green-Pink-Blue-Yellow-Purple (GPiBYPu)
19
Q
The ____ the gauge number, the ___ the bore/diameter (they are ___ proportional)
A
Smaller
Bigger/wider/larger
Inversely
20
Q
Match the gauge number to its corresponding use:
- 18/20G
- 22G
- 24G
A. Pediatric patients
B. Blood transfusion or operating room
C. Adults, normal meds
A
- B
- C
- A
21
Q
Used to direct the flow of fluid through an infusion system while allowing multiple tubings to be connected.
A
Three-way stopcock
22
Q
How to know which end of a stopcock is closed?
A
Kalbo = closed
23
Q
What is the format of an IV tag?
A
UPPER LEFT:
Name of px
Room#
MIDDLE:
Name of IV Fluid
Infusion Rate
BOTTOM LEFT:
Date
Nurse:
BOTTOM RIGHT:
Time
24
Q
What are the six rights? (PMDTRD)
A
Right Patient Medication Dose Time Route Documentation
25
What is the drop factor for
Microset?
Macroset?
Micro: 60 mcgtts/min, usually for pediatric px
Macro: 10/15/20 gtts/min
26
As nurses, we must refer to a drug reference for ___ and ___
Incompatibilities
| Side effects
27
The patient must be informed on (PRA)
Procedure
Reason
Arm preference
28
Give at least 3 clinical factors that will be affected by IV administration
```
Urine output
VS
Distended neck veins
Breath sounds
Capillary refill
Skin turgor
Edema
Weight
Mucous membranes
Thirst
LOC
Scheduled surgeries/procedures
Laboratory data
Allergies
```
29
3 Patient Identifiers
Full Name
Birthday
Bracelet
30
What are the signs and symptoms of complication in IV administration? (ERPEBI)
```
Edema
Redness
Phlebitis/inflammation
Extravasation/leak
Bleeding
Infection
```
31
(T/F) we do not need to perform hand washing prior to opening tubing set
FALSE, we need to wash our hands to maintain aseptic technique
32
Once the tubing set has been opened, we have to keep the tube ___ and the ___ covered
Coiled
| Spike
33
Why do we need to place the roller clamp "OFF" and 1-2 inches below drip chamber
To prevent leakage
| More accuracy in regulation
34
Where do we hold when we are going to spike the bottle with our DOMINANT hand?
On the wing
35
What motion are we supposed to do when spiking the IV bottle?
Twisting
36
Roller clamp
UP: ___
DOWN: ___
Open
| Closed
37
What are the 3 ways we remove bubbles from the IV tubing?
STRETCH-KINK
ASPIRATE
KIDNEY BASIN
Stretch tube or kink and flick and adjust roller clamp if needed
Using 5-10 cc syringe and aspirate air through Y-port
Disconnecting iv tubing and letting fluid flow into kidney basin
38
(T/F) If the patient has a stopcock, it is okay to keep the port that is not going to be used open.
FALSE, if not needed = keep closed to prevent leaks when connecting another line/tubing
39
How do we prevent snagging of the iv tubing?
We create a loose loop and tape it to the patient's catheter
40
When do we change iv fluids?
When only 50 ml is left in the bottle
41
How do we shake medications?
A. Shake up and down
B. Roll/invert
B. shaking up and down can cause bubbles to form
42
Every _ days, IV insertion site is changed
7
43
IV tubings are to be changed every _ days/ _ hrs
3 days / 72 hrs
| Max is 1 week, case to case basis
44
(T/F) When a patient is ordered for IV discontinuation, we just disconnect the tubing from the catheter
TRUE. removal of insertion site requires another order (usually when px is going home already)
45
How do we change gown on a patient with iv?
Start on side that is not connected to the IV
| Let old and new gown pass through arm and IV tubings
46
Volume metric controlled chamber is also known as?
Soluset
47
What is a soluset for? what is its regulation?
Piggyback medications (antibiotics) or pediatric pxs
Microdrops
48
How do we prime a soluset?
PNSS, fill chamber with 30cc
49
It is usually used to increase the RBC, hemoglobin, or
| hematocrit levels
Packed RBC
50
Used when patient is bleeding or lacks this component
Fresh Frozen Plasma
51
For patients with thrombocytopenia (low)
Platelets
52
What makes a BT set different from regular IV tubings? what is its regulation?
A blood transfusion set has a filter
10 gtts/ml
53
A phlebotomist will get blood and
Type and Cross-match
54
What do nurses need to double check prior to blood transfusion? (CTWMRV)
```
Crossmatching results
Tag on blood bag (px and donor name)
Weigh bag to know how much cc
Pre-BT medications
If px needs to go to restroom
Baseline VS
```
55
For the first 15 minutes of BT, the regulation should be _ ml/min or _ gtts/min
After 15 mins, we get _ and regulate as desired in DO
2 ml/min or 20 gtts/min
| VS
56
During the first 15 mins of BT, the nurse should assess for the ff reactions (DILT)
Difficulty breathing
Itching
Low back pain
Increasing temp
57
How do we dispose of blood bags?
```
Remove needle
Roll with BT set
Wrap with paper
Write px name, room#, time and date infused
Return to blood bank
```
58
For BT, what IV fluid is compatible?
Only PNSS
59
Every when do we get VS during BT? (5)
```
Baseline (before transfu)
First 15 mins
After 30 mins
Every hour during BT
An hour after BT finished
```
60
How long should blood be transfused?
4-6 hours only
61
Crackles during BT indicates?
circulatory overload or congestion
62
To avoid spoilage when transfusing blood for pediatric px, request blood bank to
Divide the blood already
63
What should we do if px has reaction to BT?
Immediately stop transfusion (turn stopcock if have)
Flush mainline with PNSS
Inform doctor
64
Types of reactions to BT
Anaphylactic shock
Wheezes
Chest pain
Cardiac arrest
Non hemolytic or not r/t destruction of RBC (headache, muscle pain)
Acute Hemolytic (renal failure, DIC, jaundice)
> 10 bags of BT
Dysrhythmia/low BP
Iron overload
Hypocalcemia
65
For platelets, since it is a __ infusion, we use a special infusion set without a filter and nurse stay at bedside
fast
66
Total Parenteral Nutrition is also known as ___ and it is used when a px will be on NPO for more than _ days
Central Nutrition
| 3
67
What gauge number is used for TPN? Why?
G20 (used for TPB ALONE)
| TPN is thick/viscous
68
Since TPN usually has high dextrose content, doctor may order ___
Capillary Blood Glucose (CBG) q4h
69
If concentration is _:_ fat emulsion, we have to change IV tubings every _ hrs because ____
3:1
24 hrs
Good environment for bacterial growth
70
TPN regulation for first hr:
| after:
40-60 ml/hr
desired
still depends on hospital policy
71
Once opened, a bag of TPN is good for how long?
24 hrs whether fully consumed or not
72
Where do we place tourniquet for IV access selection?
Above antecubital fossa or 4-6 inches above proposed site
73
To protect fragile skin during tourniquet use, we can
Place over light clothing
Avoid using too tightly
Can also use BP cuff
74
How do we assess for vein condition? (3)
DEPENDENT-PALPATE-STROKE/CLOTH
Place extremity in dependent position or press down
Palpate, should feel soft and bouncy
Stroke vein proximal-distal or use warm washcloth = distention
75
How do we clean insertion site (3)?
Vertically
Horizontally
Spiral, circling outwards
76
How do we insert ONC or winged needle (venipuncture)?
Gently stretch skin w/thumb
10-30 degrees
BEVEL UP
Wait for backflow
77
ONC stands for?
Over-the-Needle Catheter
78
How do we regulate IV fluids? (RCCEED)
Review doctor's orders
Calculate
Count for 1 min
Assess for excess fluid, dehydration, electrolyte imbalance
79
What do we d if drip chamber is too full? (3, PIS)
Pinch iv tube below it
Invert bottle
Squeeze and release drip chamber
80
What are the signs of phlebitis with a grade of 4? (PRSD)
Pain
redness
swelling
purulent drainage
81
What are the signs of infiltration with a grade of 4? (BBEP) What do we do if these are present?
Blanched skin
bruising
pitting edema
pain
DISCONTINUE
82
If there are signs of infiltration or phlebitis, we (EW20)
Elevate
| wrap in warm towel for 20 mins
83
Flow rate for the ff lipids:
1. 10% emulsion
2. 20% emulsion
3. lipids only
4. lipids in PPN solution
A. 24 hrs
B. 4 hrs
C. 6-12 hrs
D. 6 hrs
1B
2D
3C
4A
84
How long do we apply pressure when removing catheter
2-3 minutes or
| 5-10 minutes if w/hx of coagulopathy
85
What material is not necessary when preparing to start IVF?
A. Arm Splint
B. Mask
C. IV Infusion Set
D. Alcohol swab
B
86
Which of the following is the initial action of the nurse prior to starting an IV infusion?
A. Perform hand hygiene
B. Open sterile packages
C. Verify patient's identity
D. Prepare needed articles
A.
87
When securing the hub of the IV cannula to the skin, it is very important to:
A. Ensure that the cannula is taped to the tubing or saline/heparin lock device
B. Ensure that the tape does not cover the insertion site
C. Ensure that the extremity is completely immobilized
D. Ensure that the patient is unable to see the insertion site
B
88
(T/F) It is not necessary to wear gloves when discontinuing an IV since there is no risk of exposure to blood or body fluids.
FALSE (removal of cannula)
89
Which of the following actions are correct when caring for a patient who is on parenteral infusion?
1. Review patient's nutritional history
2. Assess lung sounds for presence of crackles
3. Assess the patient's serum triglyceride level
4. Monitor VS every 10 mins for the first 30 mins after initiation
ALL
90
Used intravenous infusion tubing must be discarded properly. What color of the garbage bin must it be discarded?
yellow
91
When should IV dressings be changed?
Every 48 hrs / 2 days
92
Within __ mins of release of blood from blood bank, we have to administer this
30
93
What is osmolality?
Amt of dissolved particles in a fluid
94
Which iv site is prone to infection?
Top of foot
95
After we wipe the dressing w/an alcohol swab and remove them ____, we have to support the iV catheter to prevent ____
one by one/layer by layer
sudden removal
96
When should pre-BT medications be given?
Before getting blood from the blood bank
97
Where can we insert the line for BT?
Y-port + tape to main line
| Stopcock cleaned with alcohol swab
98
Why do we need to return blood bags to the blood bank for disposal?
Blood banks keep it in case a px develops a late reaction, cause can be traced
99
(T/F) It is ok to choose an IV site that may interfere with ADL's since px can learn to cope with this.
FALSE, we can choose other sites
100
(T/F) When dressing an iv site, we should cover the connection of the tubing and catheter hub
FALSE, it should be kept visible to check for blockage
101
Do we still need to prime the IV tubing if we will use an infusion pump?
Yes, then we connect it to the catheter and set the pump to the desired ml/hr
102
When adding piggyback medications to a NEW container, we should always check for ____
Compatibility
103
Before injecting medications in the port, we should always ____
Wipe port w/alcohol swab
104
When adding piggyback medications to an EXISTING container, what do we need to check? (APTR)
Enough amount of solution to dilute medication
Pause IVT/pump
Turn bottle to prevent administration of bolus (high conc) medication
Reestablish primary infusion after piggyback meds (restarts after naubos na PB)
105
What does MAR stand for?
Medication Administration Record
106
When hanging a piggyback medication, it should be placed ____ the primary fluid bag
ABOVE
| higher = faster
107
After infusion of piggyback medications, we can ____ or ___ the bag and tubing for ____
discard or leave
| for next piggyback meds
108
Identify the steps in administering IV Bolus through EXISTING LINE (DSWAIP)
```
Dilute
Use stopcock
Wipe port
Aspirate for backflow
Inject w/watch
Pinch main line when pushing
```
109
Identify the steps in administering IV Bolus through SALINE LOCK (WS/AARPS)
```
Wipe port
Inject saline + expel air
Aspirate
If resistance occurs, stop and discontinue
Push within recommended time
Inject second saline
```
110
What should we check for in a 3-in-1 TPN soln? WHat should we do to troubleshoot this problem?
Fat separation
| agitate the bag for fat droplets of 1-2 cm
111
What is the initial infusion rate for TPN?
40-60 ml/hr
112
Guidelines for TPN infusion (DBIAI)
```
Different line for IV meds
Do not use same port for blood sample/CVP
Do not interrupt TPN
Follow asepsis
Assess for lipid intolerance
```
113
What are signs of intolerance to fat emulsion? (TTCHNP)
```
Increased triglycerides
Increased temp
Chills
Headache
Nausea + vomiting
Chest pain
```
114
IF TPN bottle is refrigerated, what should we do?
Let bottle come to room temp for 30 mins
115
1 gtts = _ mcgtts
| 1 ml/hr = 1 ___
1 gtts = 4 mcgtts
1 ml/hr = 1 mcgtts/min
116
Righty =
| Lefty =
righty tighty
| lefty loosey
117
Aftercare post-IVT includes (CFYGHD)
Check if catheter is complete
Throw excess fluid in TOILET
Throw iv catheter, tubings, and bottle in YELLOW trashcan
Remove gloves + handwash
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