Pharmacology Week 10: IV Therapy

Question 1

Intravenous Therapy Uses

Answer 1

• correct fluid and electrolyte disturbances
• administer medications
• TPN (total parenteral nutrition), PPN
• administer blood and blood products

Question 2

Components of IV Solutions

Answer 2

• fluid (water, saline)
• electrolytes (KCL)
• nutrients (dextrose, glucose, lipids)
• medication

Question 3

Intravenous Solutions

Answer 3

• Dextrose and Water (D5W)
• Normal Saline (0.9% NaCl)
• Lactated Ringers (LR)
• 0.45% NaCl (half normal saline)

Question 4

IV Orders

Answer 4

-type of solution
-amount of solution
-rate of fluid delivery
ex:
>1000ml q 8 hrs/ 3000ml / 24 hrs
>125 ml/hr

Question 5

Solution D5W solute/solvent

Answer 5

D5W = 5% Dextrose and Water

• Dextrose = solute
• Water = solvent
• 5% = 5 grams dextrose/ 100 ml water

Question 6

D5W

Answer 6

5% dextrose and water

• Dextrose = solute
• Water = solvent
• 5% = 5 grams dextrose/ 100 ml water

Question 7

Types of Solutions

Answer 7

• colloidal solutions

- crystalloid solutions

Question 8

Colloidal Solutions

Answer 8

water and protein (plasma expanders)

Question 9

Crystalloid Solutions

Answer 9

may diffuse out of the vascular compartment

• Isotonic
• Hypotonic
• Hypertonic

Question 10

Osmolarity

Answer 10

fluid type describes the effect the fluid has on the way fluid shifts between the intracellular and extracellular compartments

• fluid concentration (tonicity)
• relationship of solutes + solvents
• measured in mOsm per liter
• blood 290 mOsm

Question 11

Isotonic Solutions

Answer 11

similar concentration (osmotic pressure) as blood

• 250-350 moSm
• stay in the vascular space
• prevent fluid shifts
• extend vascular volume
• 0.9% NS (308 mOsm)
• Lactated Ringers (273 mOsm)

Question 12

Examples of Isotonic Fluids

Answer 12

• 0.9% NaCl NS (308 mOsm)

- Lactated Ringers (273 mOsm)

Question 13

Hypotonic Solutions

Answer 13

less osmotic pressure than blood

• less than 250 mOsm
• fluid shifts out of the vascular space to hydrate cells
• 0.45% NS (154 mOsm)

Question 14

Example of Hypotonic Solution

Answer 14

-0.45% NaCl NS (154 mOsm)

half normal saline

Question 15

Hypertonic Fluid

Answer 15

greater osmotic pressure than blood

• greater than 375 mOsm
• cause fluid shifts from the tissues (intracellular and interstitial compartments) into the vascular space
• D5NS (560 mOsm)

Question 16

Example of Hypertonic Solution

Answer 16

D5NS (560 mOsm)

Question 17

Vascular Access Devices

Answer 17

Peripheral Line Catheters

• butterfly
• angio cath

Question 18

Saline Lock

Answer 18

• intermittent use
• SAS = saline/administration/saline
• once a shift/ day when not in use (check policy)
• 1-5 mL saline (most common 1-3 mL)

Question 19

Angio Catheter Care

Answer 19

• change site and tubing every 72-96 hours
• change bag every 24 hours
• IVPB tubing change every 24 hours
• use occlusive transparent dressing

Question 20

Central Line Catheters

Answer 20

• Percutaneous central venous catheter
• PICC
• Implanted Ports–> Port a cath/ Medi Port

Question 21

Heparin Flush

Answer 21

• 10 units/ mL
• 100 units/ mL
• 3-5 mL flush (minimum check hospital)
• SASH = saline/administration/saline/heparin

Question 22

Complications of IV Therapy (Local)

Answer 22

• Infiltration
• Phlebitis
• Site Infection

Question 23

Local Complication IV Therapy: Infiltration

Answer 23

escape of fluid into the subcutaneous space

-extravasation

Question 24

Signs + Symptoms of Infiltration of IV

Answer 24

cool, pale, edema, decreased heart rate, resistance to flush, pain or burning at site

Question 25

Prevention for Infiltration of IV

Answer 25

- secure site - limit mobility (arm board) - occlusive dressing - assess hourly

Question 26

Interventions for Infiltration of IV

Answer 26

D/C and apply compresses according to agency policy

Question 27

Local Complication of IV Therapy: Phlebitis

Answer 27

inflammation of the vein

Question 28

Signs + Symptoms of Phlebitis of IV

Answer 28

warm, red, thick, cord-like vein, red streaking up the vein, pain and tender at site

Question 29

Prevention of Phlebitis of IV

Answer 29

- change site per policy - assess hourly (occlusive dressing) - dilution of meds (KCL needs to be well diluted)

Question 30

Interventions of Phlebitis of IV

Answer 30

D/C and apply compresses according to agency policy

Question 31

Local Complications of IV Therapy: Infection

Answer 31

Bacterial contamination of the site

Question 32

Signs + Symptoms of Infection of IV

Answer 32

- red - swollen - warm - pain at site - purulent drainage

Question 33

Prevention of Infection of IV

Answer 33

- change site per policy - hourly assessment - occlusive dressing - good aseptic technique

Question 34

Interventions for Infection of IV

Answer 34

- D/C - bleed site - culture tip

Question 35

Systemic Complications of IV Therapy

Answer 35

- Septicemia - Air Embolism - Catheter Embolism - Speed Shock - Circulatory Overload

Question 36

Systemic Complications of IV Therapy: Septicemia

Answer 36

bloodstream infection

Question 37

Systemic Complications of IV Therapy: Air Embolism

Answer 37

air injected into IV line

Question 38

Systemic Complications of IV Therapy: Catheter Embolism

Answer 38

tip of catheter in patients vein

Question 39

Systemic Complications of IV Therapy: Speed Shock

Answer 39

IVPB med infuses too quickly

Question 40

Systemic Complications of IV Therapy: Circulatory Overload

Answer 40

IV fluid infuses too quickly

Question 41

TPN (total parenteral nutrition)

Answer 41

-dextrose (carbohydrate) -amino acids (protein) -lipids (fats) -electrolytes (KCL) -trace elements (vitamins/minerals) -medication (insulin, heparin) TPN for clients in need of calories in excess of 2500 calories

Question 42

Dextrose Calories

Answer 42

1000 mL/ D5W = 5 gm Dextrose/ 100 mL water =50 gms. Dextrose (10x5= 50) 50gms. Dextrose= 170 calories 3 liters/day = 510 calories

Question 43

Caloric Needs

Answer 43

1000 ml/ D10W= 10gms dextrose/ 100 mL water =100 gms. dextrose (10x10= 100) 100gms. Dextrose= 340 calories 3 liters/ day = 1020 calories (TPN for clients in need of calories in excess of 2500 calories)

Question 44

Electronic Infusion Devices

Answer 44

-pumps: exert pressure | >volumetric (ml/hr)