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An LPN can

-Add a piggyback antibiotic to an infusing line. -Administer furesomide under the supervision of an RN. -Administer an antiemetic to a nauseated pt. -Caculate the rate at which a bag of normal saline is to be infused from a doctors order. -Administer Morphine under the supervision of an RN. -Add a new bag of dormal saline to tubing infusing through a central line.

Can an LPN whi is IV certified remove a peripheral inserted central catheter PICC line?

NO

Essential components of an unusual occurence or varience report or incident report?

Pt Age gender and room number. Nature ot the event and physicial notification of the event. Patients condition before and after the event.

The blood aids in regulating

Body temperature

Funtions of skin include

Protection temperature regulation and sensation.

Uppermost layer of skin that provides a protective cover is the

epidermis

Structural components common to both veins and atereries include

Tunica intima, Tunica media and tunica adventitia

Purvose of valves?

Pupose is to prevent backflow of blood

Function of the pulmonary system

Exchange of gases between organism and environment.

Body compartment that contains the smallest volume of fluid any given time?

Transcellular

Nonelectrolyte

Cratinine, Dextrose

Anion

Phosphate, Bicarbonate

Cation

Sodium, Potassium, Calciium, Magnesium

Base carbonate deficite

Metabolic acidoses

Base bicarbonate excess

Metabolic alkalosis

Carbonic acid excess

Respiratory acidosis

Excessive amounts of sodium and fluid intake is a recognized cause of

Fluid volume excess

2 objectives of parental fluid administration

Maintenace therapy and replacement therapy

Vague muscle weakness, GI hyperactivity, parathesia of face, tongue, feet and hands are signs of

Hyperkalemia

Assessment of renal status before the initiation of electrolyte replacement and maintenance is generally achieved by

Dextrose 5% in .45% sodium chloride

When excessively infused, which of the following parenteral fluids can cause dilutional hyponatremia in persons predisposed to water retention

.45% sodium chloride (1/2 NS)

Signs and symptoms of infiltration

Swelling, coolness and altered flow rate

Nursing intervention for a pt who is experiencing extravasation

Stop drug administration, follow facility extravasion treatment protocol and notify the physician

Inadvertent administration of a non vesicant solution/drug into the tissue

Infiltration

Inflammation of cellular or connective tissue

Infection at site

Localized mass of blood causing a hard painful lump

Hematoma

Inadvertent administration of a vesicant solution/ drug into the tissue

Extravasatopm

Cannula becomes occluded with bood or drug precipitate

Occluded cannula

Obstruction of a blood bessel by a thrombus or foregn material formed or introduced elsewhere in the circulatory system and transported that point through circulation

Embolism

Inflammation of cellular or connective tissue

Cellulitis

Most appropriate nursing intervention or a pt experiencing circulatory overload

Slow infusion to a rate that just keeps the site patentl, place the pt in high Fowlers position, assess vital signs, apply warmth measures and notify the physician.

Factors identified as major contributors to the IV therapy related contamination

Use of outdated parenteral fluids, inadequate preperation of cannula insertion site and inappropriate handwashing

Type of contamination can result from comprised integrity of the venipuncure site dressing

Extrensic

"Gloves should be worn when touching blood and certain body fluids" applys to what standard?

Bloodborne pathogen standard

What factor directly escalateds the degree of anxiety a pt experiences when receiving IV therapy?

Misguided concept that IV therapy is only administered to critically ill pts

Appropriate nursing consideration when caring for an uncooperative IV therapy pt

Closely monitor pt status and use safety mittens when indicated

Definition for lumen

Space within the vascular access device

Definition for length

Length of vascular access device

Purpose of an IV site protector is to prevent which of the following?

Dislodgement of the cannula

Definition of gauge

Diameter size of the vascular access device opening

Pt interation items essental for the nurse to complete priot to insertion of the cannula

Provide privacy for the pt, Ask bout allergies including iodine and latex, Explain the procedure using understadable terms. Address concerns boiced by the pt. Explain restrictions necessitated by the ordered therapy. Demonstrate appropriate ambulation if applicable.

Protective barrier item should be included in the equipment collected for insertion of an IV line?

Gloves

Appropriate height for suspending the fluid container form the IV pole in relationship to the intended IV sites?

3 feet

When verifying the appropriateness of a parenteral fluid for pt infusion, which of the following is an essential factor?

That it corresponds with teh physicains order

Charanteristic of a vein that is appropriate for venipuncture

Feels soft whe palpated

Prime factors to be considered when selecting a vein for venipuncture includes

Characteristics of available veins, objective of ordered therapy and anicipated duration of therapy.

What info should be inscribed on the IV site dressing label?

Date and time, Type, length and gauge of the needle, Nurses initials

Essential component required when documenting patency maintenacne of intermittent infusion devices using a NS flush?

Volume and time span for flushing

What would occur is sterile water were used to flush an intermitten infusion device?

Hemolysis

How many units per ml is the most commonly used concentration of heparin flush solution for peripheral intermittent infusion devices

10

Intermittent infusion devices are used to probide which of the following interavenous related procedures?

Intermittent delivery of IV piggyback infusion andintermittent delivery of IV push drugs

Facors does the physican consider when ordering an infusion flow rate?

Patients clinical status, pt body surface area and fluid composition

Protential complications of an inaccurate infusion flow rate?

Inappropriate drug levels, Cannula occlusion, Pulmonary edema, Dehydration

physican orders 500mL of Lactated ringers to infuse of ver 24 hours. The administration set drop factor is 60 gtt/mL. Calculate the ordered flow rate in gtts/minute.

21 gtt/min

The physician orders 500mL of dextrose 5% /W to infuse over 4 hours. The administration set drop factor is 20 gtt/mL. Calculate the ordered flow rate in gtts/minute

42 gtt/min

Drop factors available in MACROdrip administration sets?

10, 15, 20 gtt/mL

Factors that affect the infusion flow rate

Phlebitis, height of container and viscosity of fluid

Physicial orders 500 mL of NS at 100 mL/hr. The administration set drop factor is 10 gtt/mL. Calculate the ordered floow rate in gtts/ minute.

17 gtt/min

When administering the flow rate of gravity infusion, for how many seconds should a nurse use a watch to time the fluid drops?

60 seconds

Best time to adjust the flow rate on a childs IV to ensure an accurate infusion flow rate?

What the child is resting

When evaluating the general condition of an infant receiving intravenous therapy, the absence of tears when crying is a sign of

Fluid volume deficit

What IV cannula is most frequently used for pediatric vascular access?

ONC

Change in the cardiovascular system secondary to the aging process

Increased fragility of the veins

Impaired homeostases in the elder pt can often be directly attributed to which of the following?

Diminished thirst mechanism

Increased oncotic pressure in which of the follwing sites negatess its use for venipuncture?

Areas of bruising

What is a prime legal consideration applicable to restraint usage?

Restraint use must be congruent with federal and state regulations

Using an armboard when teh IV site is located in an area of flexion prevents what condition?

Mechanical phlebitis

2 elements essential for accurate documentation of the IV therapy monitoring process?

Perinent information regarding observations and actions taken

Done at same time as administration set tubing change

Routine changing of add on devices

Initial remedial action is gental aspiration

Occluded cannula

Dependent upon established facility policy

Routine scheduled change of administration system components

Concentration of heparin flush solution generally used for peripheral intermittent infusion devices

10 units per mL

Intermittent device flushing agents

Normal saline or heparin flush

Requierd to maintain patency of intermittent infusion devices

Flushing of intermittent infusion devices

Included in I&O tabulations

Colume of fluid infused

Goal is to minimize risk of potential phlebitis

Peripheral site rotation

4 hours

Time limit for blood administration sets

Necessitated imediate change of site and administration set

Phlebitis with no sign of cambatant infection

Should not be adjusted upward to compensate for past decreases

IV infusion flow rate

Necessitates emmediate change of entire infusion system

Therombophlebitis, cellulitis or IV related sepsis

Appropriate nursing action after cannula removal?

Determine if the cannula was removed in its entirety

Then cannula hub should be stabilized during tape and dressing removal to prevent what condition from developing?

Discontinuation-generated mechanical phlebitis

Constant drug serum levels can be achieved with which type of IV drug administration?

Continuous infusion

Three types of incompatabilities

Physical, chemical, therapeutic

Objectives of intavenous drug administration

Prophylactive, diagnositc, Therapeutic

Theraputic

Serving to cure

Attachment of one substance to the surface of another

Absorption

Agent of regime that contributes to prevention of disease and inffection

Prophylactic

Serving to relieve or alleviate

Palliative

Having healing or remedial properties

Curative

If an anaphylactic reation is untreated, death occuring within 5-10 minutes and is commonly a resulf of

Convulsions, asphyxia or circulatory collaps

Elements crucial for appropriate documentation of anaphylaxis

Drug causing the reation, Description of the reaction, intervention and patient response, Follow-up monitoring and health teaching

A patients allergy history is communicated to allied health members through which of the following means?

Admitting notes, wrist bracelets, nursing care plan and warning tapes.

Elements comprise the treatment of anaphylaxis?

Admisister pharmacological agents, Establisha s patnet airway, Secure vascular access

A pt weighing 176 pounds is ordered to receive lidocain 0.5mg/kg. What is the correct dose?

40mg

Pt weighs 176 what is their weight in kilograms?

80kg

What should be confirmed before initiating an IVPB infusion?

Identification of teh pt and the patency of the IV site

What of the following should be included in the documentation of an IVPB infusion?

Date, time and signature of the person administering the drug, Drug name and dosage, type and volume of parenteral fluid, Rate of inusion, flushes used either NS of heparin

Normal Saline flushing of the primary IV line before IVPB drug administration is prequently required to prevent

Bioincompatability

Elements essential for appropriate documentation of a drug given IV push

Name of the drug and dosage, Rate of administration and mode of delivery, Time and date

What method may an IV certified LPN use to administer an IV push drug?

Using a safelty syringe and needle to inject into the injection port of an intermittent infusion set.

Infiltration of a drug being administered IV push could result in which of the follwing conditions?

Potential tissue damage

Most vital nursing consideration concerning the use of precalculated, prepackaged system that contains diluent and drug

Follw the manufacturers instructions for the use of a particular system

What priciples applies to precalculated, prepackaged systems

Ensure that the drug is completely dissobed and is within the diluent container

When using a colume control set what is the MOST vital nursing consideration?

Follow the manufacturers instructions specific to the particular volume control set.

A volume control set contains one of two types of filter design interfral to the calibrated chamber

Floating valve and membrane

What measures can be employed to prevent chemotherapy related hemorrhagic cystitis?

Maintaining a high fluid intake of 3-4 liters a day

Parathesia of the hands of feet is usually the first sign of

Neuropathies

The nursing consideration should the IV therapy certified LPN observe when monitoring pts for clinical manifestations of chemotherapy side effects of toxiciteis?

Document and reports observations to physician

Goals of chemotherapy

Cure, control, palliation

Most sever reation cause by leukocyte antibodies

Non-cardogenic pulmonary edema

Rarely associated with transfusions

Air embolism

Treatment is the administration of calcium cholride if pt is sevely symptomatic

Citrate toxicity

Transmission is a predominant concern of potential transfusion recipients

Human T-cell lymphotropic virus

Distinguished by lack of fever and onset after only a few mL of blood or plasma is administered

Anaphylactic reation

Results when pt is transfused to rapidly or when volume administered was excessive

Circulatory overload

Most frequently occuring transfusion reaction

Transfusion related febrile nonhemolytic reaction

Usually characterized by fever, anemia and mild jaundice

Delayed extravascular hemolytic reation

Which of the following transfusion reaction has a high propensity for causing chronic liver disease?

Hepatitis C virus

What can the LPN do in blood transfusion therapy?

Obtain unit from blood bank, cross check identifying data with RN before initiation and monitor during the transfusion.

Source of protein used in TPN

Free amino acids

Appropriate area for preapring TPN solution

Under a laminar flow hood in the pharmacy

Substances generally added to TPN solutions

Electrolytes, trace elements and vitamins

A LPN can change a central line dressing under the supervision of an RN?

TRUE

Threefold purpose of documenting the nursing care provided?

Creating a legal record of care provided. Obtaining reimbursement for services. Communicating pt status

Charting format that leads to greater opportunities for subjective rather than objective entries

Narrative

Define documentation

Written or printed recording of original, official or legal information.

Aids in protecting body against infection

Leukocytes

Erythrocytes

Aids in transporting oxygen and carbon dioxide

IV related factor likely to cause variations in respiratory function?

Fluid and electrolyte imbalances, pH change and emboli

Any contrivance or arrangement that regulates the amount and direction of flow of liquid, gas, vapr or loos material

Valve

Pathophysiology

Disease state that changes the structural or functional state of an organ

Edema

Abnormal accumulation of fluid in tissues

percentage of body weight of a full term newborn is made up of water

70-80%

Condition characterized by pulmonary edema, distended neck veins, peripheral edema and abouncing rapid pulse

Fluid bolume excess

Loos of water and electrolytes as a consequence of abnormal loss of body fluids are identified factors causing

Fluid volume deficit

Assessment parameters is considered to be of the most crucial importance before initiating parenteral fluid therapy

Renal status

Most frequently administered balanced electrolyte fluid?

Lactated ringers

IV therapy complication that has a 40-50% mortality rate?

Air Embolism

Local complications associated with IV therapy

Phlebitis, infiltration, extravasation

Most appropriate nursing intervention for a pt who the nurse finds is currently experiencing an infection at the catheter site?

Discontinue the catheter, culture the cannula tip and drainage, notify the physician and provide theraputic interventions as ordered by the physician

Weeping of tissue may or may not develop in a pt who has whicch of the following complications

Cellulitis

What factors influence bacterial survival?

Presence of specific organism, number of organisms and resitance of host

Main sources of bacteria responsible for IV associated infections

Air, Blood, Skin

Signs and symptoms are typical of a vasovagal reaction consequential to patient stress

Vasoconstriction, syncope and daphoresis

Factors identified as affecting the patients personal psychological resources

Previous experience with illness and pain, family relationships with health care tteam

Important nursing consideration when using resealable injection ports

Integrity may be compromised if subjected to numerous penetrations

Statement correctly reflect the use of microbore extension tubing set

Often used as aadjuvant to a PICC

Needle protective systems are designed to do wich of the following

Reduce resk of needle stick injuries

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