Term
| IV solutions are categorized according to: |
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Definition
| how their osmalality (concentration) compares with plasma's osmalality |
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Term
| Isotonic Fluids: Description |
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Definition
Total osmolality closest to plasma's.
Do not cause RBCs to shrink or swell. |
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Term
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Definition
Solution remains in vascular system.
It does not cause the cells to swell.
Used to treat ECF volume deficit
It is a good volume expander
Used with BLOOD transfusions
Do NOT use in patients with CHF, renal issues or hypernatremia. |
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Term
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Definition
D5W (Dextrose and water)
0.9% NS (Normal Saline)
Lactated Ringers |
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Term
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Definition
Used for:
Fluid loss/dehydration
It is a fluid/volume expander
Do NOT use for a diabetic!
Do NOT use in cases of head injury or increased ICP |
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Term
| Hypotonic Fluids: Description |
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Definition
Total osmolality is LESS than plasma
Used to provide free H2O
Used to treat hypernatremia
Excessive amounts can lead to intravascular fluid depletion |
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Term
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Definition
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Term
| Hypertonic Fluids: Description |
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Definition
Have a total osmolality GREATER than plasma
Cause cells to shrink
Glucose may quickly metabolize and become isotonic
May cause circulatory overload
May cause dehydration |
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Term
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Definition
D10W
D50W - may use with severely low blood sugar
3% Sodium Chloride - rarely used, severe Na depletion
TPN - must be really sick to get this |
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Term
| Total Parenteral Nutrition (TPN) |
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Definition
"WHEN to use TPN?"
W -Weight gain promotion
H - Healing enhanced
E - Establish a positive nitrogen balance
N - Nutritional status needs to be improved! |
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Term
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Definition
Always use infusion pump for administration!
Check I&O and weight daily.
Assess for dehydration.
Monitor glucose regularly even in non-diabetic patients.
Watch albumin levels.
Use a designated line only for TPN.
Usually there will be a glass bottle with fat emulsions to go along with TPN therapy. |
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Term
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Definition
Protein solution: TPN
Fats: Emulsion
Plasma Expander: Dextran
Blood Products: Packed RBCs, FFP
Medications
Fluids |
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Term
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Definition
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Term
| Nursing Assessment of IVs |
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Definition
| Assess site: redness, swelling, patency q 2h |
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Term
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Definition
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Term
|
Definition
Every 96 hours, if continuous
Every 24 hours, if intermittent |
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Term
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Definition
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Term
| Flushing Procedure for Intermittent Use |
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Definition
a. If med is incompatible, flush with 2 X the volume capacity of the catheter (10 cc. or more)
b. Withdraw blunt needle when 1/4 cc left in syringe
c. SAS method
d. Flush chart for reference |
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Term
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Definition
Saline into the site (2-3 cc of 0.9% NS)
Antibiotic into site
Second saline flush
Always use two different syringes for the saline flushes! |
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Term
| Removal of a Peripheral IV |
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Definition
1. Verify order
2. Turn off all IV fluids and clamp tubing (if needed)
3. Remove dressing and tape
4. Remove catheter, make sure the "pointy" end is still on
5. Apply firm pressure to the site |
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Term
| Possible Complications from Removal of a Peripheral IV |
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Definition
a. Bleeding
b. Catheter embolism |
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Term
| Systemic Complications of IV Therapy |
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Definition
FAS
Fluid Overload
Air Embolism
Septicemia and pyrogenic reaction |
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Term
Systemic IV Complication
Manifestation: Fluid Overload |
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Definition
Increased blood volume and BP.
Fluid backs up into the lungs.
S/S -
Moist crackles
Dyspnea
JVD |
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Term
Systemic IV Complication
Nursing Intervention: Fluid Overload |
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Definition
Decrease rate immediately to KVO status
Raise head of bed
Assess VS
Assess O2 sat - if below 92 can put patient on 2L O2
Call MD |
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Term
Systemic IV Complication
Prevention: Fluid Overload |
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Definition
Use control device - pump
Monitor the patient |
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Term
Systemic IV Complication
Further Complications: Fluid Overload |
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Definition
Heart failure
Pulmonary edema |
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Term
Systemic IV Complication
Manifestation: Air Embolism |
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Definition
S/S
Dyspnea
Cyanosis
Hypotension
Weak, rapid pulse
LOC |
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Term
Systemic IV Complication
Nursing Intervention: Air Embolism |
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Definition
CLAMP line.
Place patient on left side
Put patient in Trendelenburg position (air bubbles will go up by gravity)
Call MD |
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Term
Systemic IV Complication
Prevention: Air Embolism |
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Definition
Leur-lok all connections- make sure all connections are tight
Check frequently
Flush air from lines |
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Term
Systemic IV Complication
Further Complications: Air Embolism |
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Definition
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Term
Systemic IV Complication
Manifestation: Septicemia and pyrogenic reaction |
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Definition
S/S
Same as an infection with a fever spike |
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Term
Systemic IV Complication
Nursing Intervention: Septicemia and pyrogenic reaction |
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Definition
Stop infusion
Change IV site and tubing |
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Term
Systemic IV Complication
Prevention: Septicemia and pyrogenic reaction |
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Definition
Good handwashing
Assess site |
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Term
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Definition
PITCH
Phlebitis
Infiltration
Thrombophlebitis
Clotting or obstruction
Hematoma |
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Term
Local IV Complications
Phlebitis |
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Definition
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Term
Local IV Complications
Manifestation: Phlebitis |
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Definition
S/S
Erythema
Pain
Tenderness
Swelling
Palpable venous cord |
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Term
Local IV Complications
Nursing Intervention: Phlebitis |
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Definition
DC site
Restart at new site
Warm, moist compress
Call MD if it is severe |
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Term
Local IV Complications
Prevention: Phlebitis |
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Definition
Aseptic technique
Appropriate catheter size
Change site q 72 hours |
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Term
Local IV Complications
Infiltration |
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Definition
IV dislodges
Solution goes into the tissues
Commonly a build-up of fluid in the hand/arm |
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Term
Local IV Complications
Manifestation: Infiltration |
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Definition
S/S
Edema
Leakage of IV solution
Coolness and discomfort |
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Term
Local IV Complications
Nursing Intervention: Infiltration |
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Definition
DC site
Restart at new site
Elevate extremity
Apply warm compresses |
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Term
Local IV Complications
Prevention: Infiltration |
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Definition
Monitoring
Avoid flexion areas for IV
Smallest catheter possible |
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Term
Local IV Complications
Thrombophlebitis |
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Definition
Inflammation of vein wall with clot formation
More common with central lines |
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Term
Local IV Complications
Manifestation: Thrombophlebitis |
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Definition
S/S
Pain
Swollen extremity
Sluggish IV flow rate - pump will be beeping |
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Term
Local IV Complications
Nursing Intervention: Thrombophlebitis |
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Definition
DC site
May have to scan: arteriogram
May have to start a heparin drip |
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Term
Local IV Complications
Manifestation: Clotting or obstruction |
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Definition
S/S
Decreased flow rate
Backflow into tubing |
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Term
Local IV Complications
Nursing Intervention: Clotting or obstruction |
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Definition
DC site
Restart at new site |
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Term
Local IV Complications
Hematoma |
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Definition
Collection of blood outside a blood vessel caused by perforation of a vein wall.
The needle slips out of the vein and into the tissues. |
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Term
Local IV Complications
Manifestation: Hematoma |
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Definition
S/S
Ecchymosis (bruising)
Swelling
Leakage of blood |
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Term
Local IV Complications
Nursing Intervention: Hematoma |
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Definition
Apply pressure
Apply ice intermittently for 24 hours
After the ice treatment, apply warm compresses |
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Term
Local IV Complications
Risk for: Hematoma |
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Definition
Older people
Those "at risk" for bleeding |
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Term
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Definition
IV Fluid and Rate
Catheter size and location
IV site condition
Amount infused on I & O
Reason for extended access if not changed
Patient education |
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Term
Administration of IV Medications
Double check with 2 RNs |
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Definition
CCAD
Calculated dosages - e.g. Heparin
Chemotherapy
Admixtures to IV solution
Digoxin |
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Term
Administration of IV Medications
Procedure |
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Definition
Check compatability
Check expiration date
Confirm 5 "Rights"
Clean Y site port or adapter with alcohol
For adapter - perform SAS
Administer med over required amount of time
Document drug and patient response |
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Term
Administration of IV Medications
For Mini Bag |
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Definition
Connect bag to 2nd tubing
Prime or back prime current 2nd tubing sufficiently
OR connect primed primary tubing to adapter or Y site
Secure connections
Administer medication over required amount of time |
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Term
Administration of IV Medications
Precaution |
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Definition
| NEVER give unlabeled medication prepared by another person. |
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Term
Administration of IV Medications
Error |
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Definition
Accept responsibility
Assess and carefully monitor the patient
Notify MD ASAP
Document the incident as required by facility policy
Modify personal practice to avoid future errors |
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Term
| Five Rights of Drug Administration |
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Definition
Right client
Right drug
Right dose
Right time
Right route |
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