Nursing techniques Midterm One

Question 1

What are four situations which IVs may be used?

Answer 1

1) Medications to be rapidly infused
2) Repleace fluid loss volume
3) TPN
4) NPO status
5) blood transfusions

Question 2

What are two disadvantages to IV therapy?

Answer 2

direct invasion to the body, difficult to find vein, cannot be reversed if wrong dose given

Question 3

What are localized complications of IV therapy?

Answer 3

Phlebitis, infiltration, infection and cellulitis

Question 4

How often should IV tubing be changed?

Answer 4

q72h

Question 5

How high should the bag be above the patient’s heart

Answer 5

3 feet

Question 6

What types of catheter are most likely to have air embolism?

Answer 6

Central lines

Question 7

What patients are at risk of fluid fluid overload?

Answer 7

ELderly, heart or kidney disease

Question 8

Why is healing by primary intention preferable to secondary intention?

Answer 8

Primary - edges are closed, healing occurs quickly and decreases risk of infection
Secondary - wound remains open until scar tissue forms. Requires longer to heal thus more chance of infection

Question 9

What are factors which delay wound healing?

Answer 9

1) Nutritional deficiencies
2) Inadequate blood supply
3) Corticosteroid drugs
4) Diabetes Mellitus
5) Anemia
6) Friction on wound, poor health

Question 10

What is well approximated?

Answer 10

Incision line is closed with no gaps or leaking fluid.

Question 11

What are factors which promote wound healing?

Answer 11

proper nutrition, proper wound care, moist, warm environment, keeping blood sugars normal, proper Hgb and oxygenation

Question 12

When does deheiscence occur?

Answer 12

POD 4-8

Question 13

Which side do you stand for dressing changes?

Answer 13

Drain side

Question 14

What is min TKVO rate? Normal?

Answer 14

10-15ml/hr - 30-50ml/hr

Question 15

How long can IV be clamped for?

Answer 15

2 mins before vein loses patency

Question 16

What is the appropriate site for intradermal injections? Sub Q? IM?

Answer 16

Intradermal: Forearm, 3-4 fingers below elbow, one handbredth above wrist or upper back

SQ: Vascular areas of upper arm, abdo from costal margins to illiac crest, ant aspect of thighs

IM: Ventrogluteal, vastus lateralis & deltoid

Question 17

What is the most important precaution when giving injections?

Answer 17

DOn’t recap needle

Question 18

What IM site is no longer recommended?

Answer 18

Dorsogluteal - irritation of the sciatica nerve

Question 19

Why is the Z track method used?

Answer 19

To ensure medication remains in deep muscle to prevent irritation

Question 20

What needle length and gauges are required for intradermal injections, SQ injections and IM injections?

Answer 20

ID: 3/8 - 5/8th inch, 25 - 27 gauge
SQ: 1/2 - 5/8th inch, medium gauge
IM: 1 - 11/2 inch, 22-27 gauge

Question 21

Where should SQ arm injection be given

Answer 21

3 inches below shoulder

Question 22

What injections do you aspirate?

Answer 22

IM only

Question 23

How long are SQ butterflies good for?

Answer 23

3-7days

Question 24

What is the max amount of medication that can be injected IM in the deltoid? Gluteal?

Answer 24

1 ml

3ml

Question 25

S&S of hypoglycemia?

Answer 25

Irritability, slurred speach, tachycardia, diaphoresis, confusion, fatigue, restlessness, tremors, clammy, unsteady gait, mood changes

Question 26

What can cause hypoglycemia in a hospital patient?

Answer 26

Missed meals dt tests, too much insulin given, nutritional deficienct dt N&Vm physiological stress rseponse, new medications, over exertion

Question 27

Common S&S of hyperglycemia?

Answer 27

Frequent urination, increase thirst and hunger, drowsiness, blurred vision, altered LOC, weakness, smelly urine

Question 28

When should you do BGM?

Answer 28

before meals

Question 29

Normal blood sugars?

Answer 29

5-9mmol

Question 30

What should be given to a hypoglycemia patient?

Answer 30

If just <4, 15g of carbs (juice, jello, apply sauce), cheese, PB

Question 31

What values should the RN double check?

Answer 31

20

Question 32

What is a normal blood sugar POD 1?

Answer 32

8-13mmol

Question 33

How much air should be put in a NG tube before it is rmeoved?

Answer 33

20cc

Question 34

How long do you have before a specimen is sent to the lab?

Answer 34

15 mins

Question 35

Reasons for hypotension in post op patient?

Answer 35

blood loss from surgery, decreased circulatory volume, SE of anesthetic, dt preop medication

Question 36

Major complicatoins from not ambulating?

Answer 36

Paralytic illeus, DVT, pneumonia

Question 37

When should a hemovac be removed?

Answer 37

After 1-3 days and the wound is draining <50cc/hr

Question 38

What proportion of fluid is in the intracellular fluid? extracellular fluid?

Answer 38

ICF: 2/3 ECF 1/3

Question 39

What is Osmolality?

Answer 39

number or osmoles/ L of solute + solvent

Question 40

What is TOnicity?

Answer 40

relative osmolality of a solution compared to the body

Question 41

What is osmotic pressure?

Answer 41

Force which draws H2O through a semi-permeable membrane

Question 42

What is the third shift?

Answer 42

When fluid moves from the intravascular space to a 3rd body (lumen which shouldn't support circulation

Question 43

What are examples of internal fluid losses?

Answer 43

Internal hemmorhage, long bone fractures, spleen ruptures

Question 44

What are examples of external fluid loss?

Answer 44

hemorrhage, vomitting, diarrhea

Question 45

Which factors increase fluid needs?

Answer 45

restlessness, fever, high ambient temperatures

Question 46

What causeas decreased fluid requirements?

Answer 46

hypothermia, increased humidity, increased ICP, decreased LOC

Question 47

What are the osmolalities of hypotonic, isotonic and hypertonic therapies?

Answer 47

Hypo: 400

Question 48

What are the different types of fluid therapies

Answer 48

Crystalloids, Colloids, lbood components

Question 49

What is normal human osmolality?

Answer 49

275-300

Question 50

What are crystalloids?

Answer 50

Fluids which can pass through a semi-permeable membrane (vascular, interstitial & intracellular spaces)

Question 51

When are isotonic solutions given? What are examples? What do you need to monitor for?

Answer 51

Given to expand extravascular volume (in cases of diarrhea, vomitting, loss of fluid during surgery, waiting for surgery) ie NaCl .9%, Lactate Ringers Monitor for fluid overload

Question 52

When are hypotonic solutions given? What are examples? What do you need to monitor for?

Answer 52

Used to replace intracellular fluid (in cases of hyponatremia, cellular dehydration. Can cause vascular depletion and increased ICP. Do not use with stroke, head trauma, severe burns, malnutrition or liver disease patients. ie .45%NS & 2.5% NS w/wo D5Q

Question 53

When are hypertonic solutions given? What are examples? What do you need to monitor for?

Answer 53

Given to increased ECF. Used in acid-base imbalances and electrolyte imbalances Incrreases risk of fluid overload. Do not use in diabetic patients, cardiac or renal conditions ie. D5NS, 3%NaCl, D10W

Question 54

WHat is special about >500 mosm (D10W)

Answer 54

Must be admnistered in central line

Question 55

WHat are colloids? Why are they given

Answer 55

Hypertonic products which contain undissolved particles - protein, sugar etc. Last longer than hypertonic solutions. Expand plasma. Used in acute situations such as massive bleeding from trauma, shock or surgery ie. albumin, dextran