Module 4 Flashcards by Isabella Yarrow

what are the signs & symptoms or tourniquet retention

transient pain, edema, parenthesis, leak @ site, may slow rate or may infiltrate, compartment syndrome

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what are the signs & symptoms of misconnection

Pain, fever, chest pain, dyspnea, anaphylaxis, cardiopulmonary crest, seizure, altered mental status, sepsis, coagulopathies. Varies a lot could be insidious or abrupt

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what are the signs and symptoms of phlebitis

pain, swell, tender, local or streaking erythema, venous cording

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what are the sings and symptoms of air embolism

dynode, cough, wheeze, chest/ shoulder pain, agitation, sense of doom, tachypnea, tachycardia, hypotension, stroke type findings, harsh systolic murmur

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signs and symptoms of device fragmentation embolization

palpitations, arrhythmias, chest pain, SOB, cough, swell, pain, confusion, hypotension, inability to flush or aspirate blood

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signs and symptoms cathater associated venous thrombosis

mostly asymptomatic, pain edema, venous engorgment, difficulty moving shoulder or neck or chest - PE symptoms

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signs and symptoms of infiltration

inadvertent admin of nonvesicant solution into SC tissues

Pain, burn @ incision & along Vascular, edema, colonies, blanching, leak & local parenthesis AVOID PRESSURe

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signs and symptoms of extravasation

blister, slough, necrosis

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signs and symptoms of infection

local induration, erythema, tender, drainage, systemic. rare but if its attributed to phlebitis then remove.

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who is most at risk for tourniquet retention

those who are at risk are those who cannot communicate symptoms

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what are the contributing factors to tourniquet retention

Obesity, decreased pain perception, impaired communication, distracted provider, short tourniquet or poor visibility

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how to prevent tourniquet retention

long/bright
don’t roll up sleeve/ place over clothes
keep visible

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how to recover from tourniquet retention

remove, assess, inform provider, document, report, inform family

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what is the risk factors for misconnection

OVERCOMPATIBILITY 
-transition/transfer reconnection 
-low recognition of of risk 
poor lighting / don't want to disturb 
proximity 
overcompatility

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what is the most common complication

phlebitis

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when may phlebitis occur

up to 48 hours after removal

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where is the worst place you could put a PICC

antecubital fossa

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how often should you change SPC

72-96 hours

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what are risk factors for phlebitis

-Increased age, female, fragile, bad veins, malignant neoplasm, bad pacmenet/mgmt/assess, hand for spa or antecubital fossa for PICC, leg diameter, poorly secured, over 72-96 hours or what material was infused

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how should you recover from the phlebitis

remove
assess
notify provider
culture tip
report
disclose

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Air embolism

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uncommon but highly lethal - no safe volume
LETHAL = 50ml (or 3-5ml per kg) up to 20ml if rapid
the lungs can filter 0.35ml/kg/min

what are the risk factors for air embolism

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hypovolemia 
asymptomatic patent foramen oval 
misconnection 
dismiss air in the line 
suboptimal removal/insert 
inserting above the heart

how to prevent air embolism

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don’t leave unprimed tubing out
clamp when puncturing
occlusive dressing

what is the recovery for air embolism

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stop tx 
left tredndelenberg or left lateral decubitus 
O2 100% face mask 
aspirate air 
contact physician, report, disclose

what increases the risk of fragment embolization

1) Pico between clavicle & 1st rib 2) Baddly secured 3) Improper storage 4) power injection

how to prevent fragmentation embolization

don't remove PICC agains resistance | limit scissors, don't repair

how to recover from fragmentation embolization

keep device chest Xray report disclose

what are the purposes of IV's

Parenteral nutrition, blood monitoring, fluid, drugs, testing

EXPLAIN ISOTONIC SOLN

-Same osmolarity as body fluid (250-375 mOsm/L) -Increased risk fluid overload in renal or cardiac disease -use because fluid is decreased (hemorrhage, diarrhea, vom) = fluid resuscitation -initially will stay intravascular -no movement into or out of ICF compartment -FOR INTRAVASCULAR DEHYDRATION -Ex. NSm LR, D5W

EXPLAIN HYPERTONIC SOLN

- shrink cells - soln pull fluid out of cells into extracellular b/c soln has more solute than cell does - INDICATIONS: hyponatremic (sodium leaves with fluid) or cerebral edema or intravascular dehydration with intracellular or interstitial overload - out of ICF & interstitial compartment into intravascular - osmolarity >375 - irritating to vein increases risk of HF & pulmonary edema - Examples: D5NS D5 1/2 NS, D5LR, D10W

Explain hypotonic SOLN

- exacerbates hypotension - pull fluid into the cell (Swell) - for intracellular dehydration - <250mosml - fluid shift into ICF & interstitial - 1/2 NS or 2.5DW or o.33 saline

when should you use a CVAD

-high or low ph osmolarity 900+ parental nutrition vesicants

what is the steel needle winged butteryfly

- one time for push or phlebotomy | - osmolairty <900

what is the short over the needle cath

7.5 cm or less than 3 inchest continuous or intermittent short term

what is the midline cath for

7.5-20cm -continous or intermittent -1-4 weeks <900mosml

IV gauge 14-18

Trauma, surgery, rapid blood transfusion or fluid

IV gauge 20

Continous or intermittent blood transfusion in adults

22-24 gauge IV

continuous or intermittent all ages or blood transfusion in kids & elders

Symptoms of fluid volume deficit

decreased urine output, dry mucuous membrane, decreased cap refill, disparity in central vs. peri pulses, tachycardia, hypotension, shock

symtoms in fluid excess

dyspnea, edema, crackles, increased urine output, | *otify provider, adjust infusion rate, type of fluid

what to do for chemical phlebitis

heat, elevate, slow infusion, think about removal

what to do about mechanical phlebitis

heat, elevate, monitor 1-2 days about removal

what to do for bacterial phlebitis or hematoma

remove, remove

Explain phlebitis scale

``` 1= erythema with or without pain 2= pain, erythema with out without edema 3= pain with erythema & or edema. Streak & cod 4= same as 3, a cord larger than 2.5 cm & purulent drainage ```

Explain visual infusion phlebitis scale

``` 1= pain or red 2= pain red or swell 3= pain along cannula, induration 4= same as 3 & palpable venous cord 5) same as 4 but also pyrexia ```

how often check IV & pump

once an hr

explain paediatric maintenance fluid

100ml/kg for first 10kg 50 ml for next 10 kg 20ml/kg kg for the rest

signs of deficient fluid

``` hypotensive with increased HR lost more than 1 kg in a day decreased output inelastic skin thirst, weak, dry ```

explain when you would use a PICC

LT or vein irritant (1-4 weeks) limited or poor veins need large volume

Infiltration scale

1= blanched, 1 inch edema, cool with or without pain 2= above + 2.54- 15.2 cm edema 3= Increased translucent >15.cm edema, pain & numbness 4=blanches, translucent, leaky, tight, discoloured, bruised, sloweelen, deep pit, impaired circulation ,moderarte to severe pain, infiltrate of blood or vesicant

Module 4 Flashcards

(50 cards)