Midterm Flashcards
(98 cards)
1
Q
Accountability
A
- Professionally responsible
- Answerable for one’s actions, inactions, decisions and judgments
- Accountability for: what is ordered, why is it indicated, the intended impact on the patient,possible side effects or adverse reactions, prep of patient
2
Q
Ethics
A
- Infusion nurses both individually and collectively practice with awareness, and that there are principles that guide the infusion nurse’s actions.
3
Q
Ethical and moral decision making are based on the following?
A
- Autonomy (right to self determination, independence)
- Beneficence (doing good for patients)
- Nonmaleficence (doing no harm to patients)
- Veracity (truthfulness)
- Fidelity (obligation to be faithful)
- Justice (obligation to be fair to all people)
4
Q
Legal implications related to IV therapy?
A
- A nurse has a legal obligation to provide a standard of patient care expected of a reasonably competent professional nurse.
- Professional nurses are held responsible (liable) for harm resulting from their negligent acts or their failure to act.
5
Q
What are the gauges available in peripheral IV catheters?
A
24- yellow (peds) 22- blue (peds, adults) 20- pink (adults) 18- green (adults) 16- gray (adults) 14- orange (trauma)
6
Q
What is the most appropriate gauge IV catheter for most situations?
A
18-20 gauge
7
Q
Micro drip set (describe)?
A
60 drops/mL
Slow volume infusions
Rate below 50 mL/hr
Rates ordered at 50 to 75 mL/hr, can use either micro or macro drop tubing.
8
Q
Macro drip set (describe)?
A
10,15, or 20 drops/mL
Large volume quickly, rates above 75 mL/hr,
Rates ordered at 50 to 75 mL/hr, can use either micro or macro drop tubing.
9
Q
Venous spasm
A
A sudden, involuntary contraction of a vein or an artery resulting in temporary cessation of blood flow through a vessel. (local complication)
10
Q
Causes of a venous spasm?
A
Cold solution Dextrose >12.5% Infusates with high or low pH Diazepam (Valium) Nafcillin sodium (Nafcil, Unipen) Phenytoin (Dilantin) Pottassium chloride Propofol (Diprivan) Vancomycin hydrochloride
11
Q
Signs and symptoms of venous spasm?
A
Sharp pain at IV site that travels up the arm.
Slowing of the infusion.
12
Q
Prevention of venous spasms?
A
Dilute the medication additive adequately.
Keep the IV solution at room temp when appropriate.
Deliver the solution at the prescribed rate.
Use a fluid warmer for rapid transfusions.
Allow to reach room temp before admin.
13
Q
Treatment of venous spasm?
A
Apply warm compresses.
If spasm is not relieved, remove catheter, and restart with a new cannula.
14
Q
Infiltration
A
The inadvertent administration of a nonvesicant solution into surrounding tissue. Occurs from the dislodgment of the cannula from the intima of a vein. Can also be caused from phlebitis. (local complication)
15
Q
Causes of infiltration?
A
Puncture of the distal vein wall during venipuncture.
Puncture of any portion of the vein wall by mechanical friction from the catheter or needle.
Dislodgment of the catheter or needle from the intima of the vein.
Poorly secured infusion device.
High delivery rate or pressure (psi) from an electronic infusion device.
Over-manipulation of an IV device.
16
Q
Signs and symptoms of infiltration?
A
Coolness of skin around site.
Taut skin.
Edema at, above, or below the insertion site.
Absence of blood back flow.
A “pinkish” blood return.
Infusion rate slows but the fluid continues to infuse.
17
Q
Prevention of infiltration?
A
Avoid areas of joint flexion.
Do not use veins that have had previous punctures or veins that are very fragile.
Choose the smallest IV catheter that will safely deliver the infusion.
Stabalize catheter.
18
Q
Treatment of infiltration?
A
Warm or cold compresses.
Elevate if it doesn’t cause pain.
Report to physician.
19
Q
Extravasation
A
The inadvertent administration of a vesicant solution into surrounding tissue. (local complication)
20
Q
Causes of extravasation?
A
Puncture of the distal vein wall during venipuncture.
Puncture of any portion of the vein wall by mechanical friction from the catheter or needle.
Dislodgment of the catheter or needle form the intima of the vein.
Poorly stabilized infusion device.
High delivery rate or pressure from an electronic pump.
21
Q
Signs and symptoms of extravasation?
A
Complaints of pain, tenderness, or discomfort.
Edema at, above, or below insertion site.
Blanching of the area around the insertion site.
Change in temp of the skin at site.
Burning at the insertion site or along venous pathway.
Feeling of tightness below the site.
Slow or stopped infusion.
22
Q
Treatment of extravasation?
A
Stop the IV flow; attach an empty 3 to 5 mL syringe and attempt to aspirate fluid from the catheter lumen.
Contact the physician.
Warm compresses and cold compresses.
Elevate arm.
23
Q
Phlebitis
A
An inflammation of the vein. (local complication)
24
Q
Causes of phlebitis?
A
Catheter material. Large bore catheter. Duration of cannula placement (more than 4 days). Frequent dressing changes. Not using aseptic technique.
25
Signs and symptoms of phlebitis?
```
Redness at the site.
Site warm to touch.
Local swelling.
Palpable cord along vein.
Sluggish infusion rate.
Increase in basal temp.
```
26
Prevention of phlebitis?
Choose the smallest cannula appropriate for infusate.
Rotate site every 72-96 hrs.
Stabilize catheter.
Use aseptic techniques.
27
Prevention of extravasation?
Should have knowledge of vesicants.
Should use a pic line or port for patients with small or fragile veins.
Avoiding using the veins in the hands.
28
Treatment of phlebitis?
Discontinue the infusion.
Warm or cold compresses.
Notify physician.
29
Thrombophlebitis
A painful inflamed vein promptly develops from the pint of thrombosis. (local complication)
30
Causes of thrombophlebitis?
Use of veins in the legs for infusion therapy.
Use of hypertonic or highly acidic infusion solutions.
Not using aseptic techniques.
31
Signs and symptoms of thrombophlebitis?
```
Sluggish flow rate.
Edema in the limbs
Tender and cordlike vein.
Site warm to touch.
Visible redline above venipuncture site.
```
32
Prevention of thrombophlebitis?
```
Use veins in the forearm.
Do not use veins in joint flexion areas.
Monitor sight at least every 4 hrs.
Anchor cannula securely.
Infuse solutions at the prescribed rate.
Use the smallest catheter that meets the needs.
Dilute irritating medications.
```
33
Treatment of thrombophlebitis?
Remove entire IV catheter and restart with new equipment in opposite extremity.
Consult physician.
Apply warm, moist compresses.
34
Hematoma
Formation resulting from the infiltration of blood into the tissues at the venipuncture site. (local complication)
35
Causes of hematoma?
Cannula passes through the distal vein wall.
Opening of the flow clamp for the infusion before the tourniquet is removed.
Too large of a cannula.
36
Signs and symptoms of hematoma?
Discoloration of skin.
Site swelling and discomfort.
Inability to advance the cannula all the way into the vein during insertion.
Resistance to positive pressure during the lock flushing procedure.
37
Prevention of hematoma?
Apply the tourniquet just before venipuncture.
| Be very gentle when performing venipuncture.
38
Treatment of hematoma?
Apply direct light pressure over site after removal for 2 to 3 min.
Elevate extremity.
Apply ice.
39
Peripheral thrombosis
A blood clot forms in the vein and occludes the circulation of blood. (local complication)
40
Causes of peripheral thrombosis?
Too slow of a flow rate, which limits the fluid movement.
Damage to the vein during cannulation.
The location of the IV.
IV line pinched.
Blood backing up in the system of a hypertensive patient.
41
Signs and symptoms of peripheral thrombosis?
Fever and malaise.
Slowed or stopped infusion rate.
Inability to flush locking device.
Infusion site pain.
42
Prevention of peripheral thrombosis?
Use an EID for managing rate control.
Use the correct site.
Avoid cannulation of lower extremities.
43
Treatment of peripheral thrombosis?
Never flush a cannula to remove an occlusion.
D/C and restart in a different spot.
Notify physician.
44
Local infections
Microbial contamination of the cannula or infusate. (local complication)
45
Causes of local infections
Aseptic techniques.
Not cleaning injection port before using.
Catheter left in place to long.
46
Signs and symptoms of local infection?
Redness, swelling, or induration at the site.
Temperature changes and drainage at the site.
Possible exudate of purulent material.
Increased quantity of white blood cells.
Elevated temp.
47
Prevention of local infection?
```
Use aseptic techniques.
Use the correct equipment.
Use the correct site.
Assess insertion site often.
Replace catheter every 72 hrs.
```
48
Treatment of local infection?
```
Notify physician.
Obtain a site culture.
Apply a sterile dressing over site.
Warm moist compresses.
Anti-infective medications.
Monitor the site.
```
49
Nerve injuries
When a nerve is penetrated by the pint of the needle. (local complication)
50
Causes of nerve injuries?
Direct puncture of a nerve.
| Compression injury due to subcutaneous hematoma pressing on the nerve.
51
Signs and symptoms of injuries?
Sharp acute pain at the venipuncture site.
Sharp shooting pain up or down the arm.
Pins and needles sensation or an electric shock feeling.
Pain or tingling discomfort in the hand or finger tips.
52
Prevention of nerve injuries?
Avoid using inner surface of wrist and forearm.
Anchor the vein securely.
Use 15 degree needle angle; do not exceed 30 degrees.
Advance the needle into the vein lumen in the direction that the vein is running.
Avoid probing.
Make only 2 attempts at venipuncture.
53
Treatment of nerve injury: direct pressure injury?
Stop immediately and withdrawal the IV device.
Apply pressure to the site to prevent a hematoma.
Document the incident.
54
Treatment of nerve injury: compression injury?
Notify physician immediately.
Discontinue infusion.
Assess for swollen area becoming pale and pulseless: tissue necrosis and nerve compression injury are developing.
Do not elevate.
55
Septicemia
A fibrile disease process that results from the presence of microorganisms or their toxic products in the circulatory system. (Systemic complication)
56
Causes of septicemia?
Patient factors: age, alteration in host defense, underlying illness, presence of other infectious processes.
Dirty equipment.
Lack of aseptic process.
57
Signs and symptoms of septicemia?
Fluctuating fever, tremors, chattering teeth.
Profuse, cold sweat.
Nausea, vomiting, diarrhea (sudden and explosive.
Abdominal pain.
Tachycardia: heart rate greater than 90 bpm.
Increased respirations or hyperventilation: more than 20 breaths/min.
Change in mental status.
Hypoxemia-measured by ABG's.
Elevated lactate levels.
Urine output less than 30 mL/ hr.
Elevated WBC count.
58
Prevention of septicemia?
```
Aseptic techniques.
Check solutions for discoloration, cracks, holes.
Use only freshly opened solutions.
Limit use of add-on devices.
Inspect site often.
```
59
Treatment of septicemia?
```
Consult physician.
Restart a new IV system in opposite extremity.
Obtain cultures.
Administer antibiotics.
Monitor patient closely.
```
60
Fluid overload and pulmonary edema
Caused by infusing excessive amounts of isotonic or hypertonic crystalloid solutions too rapidly, failure to monitor IV infusion, or too-rapid infusion of any fluid. (Systemic complication)
61
Causes of fluid overload and pulmonary edema?
Overzealous infusion of parenteral fluids, especially those that contain sodium.
Compromised cardiovascular or renal systems.
62
Signs and symptoms of fluid overload and pulmonary edema?
Restlessness, headache.
Increase in pulse rate.
Weight gain over a short period of time.
Cough
Presence of edema (eyes, dependent, over sternum).
Hypertension
Hypoxia, with severe respiratory distress.
Oxygen saturation less than 90% on room air.
Rise in cenral venous pressure (cvp).
Shortness of breath and crackles in lungs.
Distended neck veins.
63
Prevention of fluid overload and pulmonary edema?
```
Monitor the infusion.
Maintain flow at the prescribed rate.
Monitor intake and output.
Review the patients cardiovascular history.
Use EID.
```
64
Treatment of fluid overload and pulmonary edema?
Use loop diuretics to cause vasodilatation and decrease pulmonary congestion.
Oxygen therapy that is dose titrated to patient response.
Position patient in a semi-fowlers position.
Obtain daily weight to monitor fluid status.
Intake and output measurements.
Decrease flow rate.
Keep patient warm.
Monitor vital signs.
65
Hypersensitivity reaction
```
Mild to severe.
May effect multiple body systems.
Rapid or delayed.
Rashes, itching, hives toc-> anaphylaxis.
(Systemic complication)
```
66
Air embolism (VAE)
A result of air entering the central veins, which is quickly trapped in the blood as it flows forward. (Systemic complication)
67
Causes of air embolism?
Allowing the solution container to run dry.
Superimposing a new IV bag to a line that has run dry without clearing the line of air.
Loode connections that allow air to enter the system.
Poor technique in dressing and tubing changes for central lines.
Presence of air in administration tubing cassettes of EID's.
68
Signs and symptoms of air embolisms?
Patient complaints of palpations.
Lightheadedness and weakness.
Pulmonary finding: dyspnea, cyanosis, tachypnea, expiratory wheezes, cough, and pulmonary-edema.
Cardiovascular finding: "Mill wheel" murmur; weak, thready pulse; tachycardia; substernal chest pain; hypotension; and jugular venous distention.
Neurologic findings: changes in mental status, confusion, coma, anxiousness, and seizures.
69
Prevention of air embolisms?
Vent all air from administration sets.
Vent air from port using a syringe.
Follow protocol for dressing and tubing changes.
Start new IV solutions before old runs out.
70
Treatment of air embolisms:
Call for help and notify the physician.
Any central line procedure in progress should be terminated and the line clamped.
Place patient in Trendelenburg position promptly on the left side with head down.
Administer 100% oxygen.
Consider transfer to hyperbaric chamber.
71
Speed shock
A foreign substance, usually a medication, is rapidly introduced into the circulation. (Systemic complication)
72
Causes of speed shock?
IV medications or solutions are administered at a rapid rate due to inadequate dilution with the circulating blood.
The flow control clamp is left completely open.
The EID is programmed incorrectly.
A bolus of medication is given to rapidly.
73
Signs and symptoms of speed shock?
```
Dizziness
Facial and neck flushing.
Severe pounding headache (brain freeze).
Tightness in the chest.
Hypotension
Irregular pulse
Progression of shock
```
74
Prevention of speed shock?
Reduce the size of drops by using micro drop sets.
Monitor the infusion rate for accuracy.
Administer bolus medications per manufactures recommendations.
75
Treatment of speed shock?
Call for help.
Give an antedate.
Have naloxone (Narcan) available if giving IV narcotics.
76
What parts of an IV system do you label?
Tubing, bag, and dressing site.
| Date, time, initials, gauge and length of catheter, time strip on bag.
77
What is a primary IV set and when is it used?
A primary IV set is used when you only need to hang one bag.
78
What are PRN (needle less access) devices and why are they used?
They are used to keep IV access when a running IV is no longer needed, also used for medication administration.
79
What is a T-connector, Y-connector, J-connector, or straight (extension) connector and when/why is it used?
They help prevent manipulation of IV site, easier to change tubing, port for medication administration.
80
What is extension tubing and when/why is it used?
Adds length and extra ports to an existing IV. Need to make sure that it's not to long.
81
What is a secondary set and when/why is it used?
Used to piggyback an infusate of 50 to 100 mL. The volume controlled set is designed for intermittent administration of measured volumes of fluid with a calibrated chamber.
82
What is a deadener and when/why is it used?
It's a cap that covers the end of a PRN adapter.
83
What is a Y-site or injection port and when/why is it used?
They are used for administration of medication.
84
How long is an IV site good for?
72-96 hrs or as long as there are no complications
85
How long is IV tubing good for?
- Primary and secondary continuous administration set should be changed no more frequently than every 96 hrs.
- Primary and secondary intermittent administration sets should be chanced every 24 hrs.
- TPN every 24 hrs.
- Lipids every bottle.
- Blood and blood products after each unit of blood or every 4 hrs.
86
How long is an IV solution bag good for?
Check institution policy (usually 24 hrs).
| Blood and blood products- up to 4 hrs.
87
How are central and peripheral lines deferent?
Peripheral lines are most commonly used for short term use 1-7 days, usually placed in the hand or arm.
Central lines are used for long term therapies over weeks, months, or years, usually placed in the neck, chest, or groin.
Change dressing weekly.
88
When do you use filter tubing? Why?
Some medications, blood, TPN, some high risk groups: peds, heart patients.
89
What are the disadvantages of using a filter?
Expensive
| If filter catches bacteria it could spread to the patient and infect them.
90
When do you use vented tubing and why?
Glass bottles and semirigid plastic.
| Infusate will not flow without being vented.
91
How do you flush a medication or saline lock?
Use push/pause technique
92
How often do you do a flush on a medicaiton or saline lock, with what, and with how much?
Q8-12 hrs
Use normal saline
3-5 mL
93
What is the technique for flushing a positive-displacement device (PRN adapter)?
Flush the catheter, disconnect flush syringe, close clamp.
94
What is the technique for flushing a negative displacement device?
Flush the catheter and as the last 0.5-1 mL is flushed, maintain force on the syringe plunger while closing the clamp, disconnect flush syringe.
95
SAS technique to administer a medication through a medication lock?
S: saline 3-5 mL
A: admixture or drug
S: saline 3-5 mL
96
When and why would you use a volume-control set (Volutrol or Buretrol)?
Most frequently used for pediatric patients and critically ill patients when small, well-controlled delivery of medication or solution is needed.
97
When and why would you use a Dial-A-flow?
Control device for gravity flow.
Set in mL/hr.
Must be 3 ft. above level of the heart for adequate flow.
If there's a change in gravity or change in client position the infusion may stop or slow down.
98
Describe the steps for discontinuing a peripheral IV catheter.
- Loosen dressing.
- Withdraw catheter carefully at the same time placing a sterile sponge over insertion site.
- Apply firm pressure to site with the sterile sponge for 60 sec. or until no bleeding.
- Observe catheter: is it intact?
- Document
