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Med Surg 1 Chapter 13 part 2
Terms in this set (17)
Which is a complication of intraosseous (IO) infusion therapy?
Osteomyelitis is the serious complication of IO therapy. Osteoporosis and osteogenesis are contraindications to IO therapy. Osteoarthritis is not associated with IO therapy.
What is a local complication of intravenous therapy?
Ecchymosis is a local complication of intravenous therapy. Speed shock, catheter embolisms, and circulatory overload are systemic complications of intravenous therapy.
The nurse is monitoring a patient in the instillation phase of intraperitoneal infusion therapy for a pancreatic tumor. What common side effect should the nurse be prepared for during this time?
Increasing pressure on the internal organs from the infusing fluid may cause nausea and vomiting in some patients. Therefore, the nurse should be prepared with antiemetic drugs, emesis basins, and cloths to clean up vomit. Headache, anaphylactic shock, and pruritus, if they do occur, are rarer than nausea and vomiting.
A patient is to receive an IV solution of 5% dextrose and 0.45% normal saline at 125 mL/hr. Which system provides the safest method for the nurse to accurately administer this solution?
Infusion pumps are used for drugs or fluids under pressure. They accurately measure the volume of fluid being infused. A controller is a stationary, pole-mounted electronic device that uses a sensor to monitor fluid flow and detect when flow has been interrupted. Because controllers rely completely on gravity to create fluid flow and do not create pressure, they do not ensure infusion but only control the drip rate. A glass container is necessary to use only with IV solutions that may cling to the plastic bag; this is not an issue with this solution. A syringe pump does not hold sufficient volume to be practical in this situation.
Which type of infusion therapy can be used to treat trauma and burn victims?
Intraosseous infusion therapy
ntraosseous infusion therapy is beneficial to victims of trauma, burns, and other life-threatening conditions because the primary health care provider usually cannot access the patient's vascular system for treatment with traditional intravenous (IV) therapy. An intra-arterial infusion therapy involves the placement of catheters into arteries in order to obtain repeated blood samples. This therapy also helps with the continuous monitoring of various hemodynamic pressures. Subcutaneous infusion therapy is usually used to administer pain medications and insulin therapy. Intraperitoneal infusion therapy is mainly used to administer chemotherapy agents into the peritoneal cavity.
Which infusion therapy route is often used in the administration of chemotherapeutic agents into arterial blood flow?
Intra-arterial therapy is used for infusing chemotherapeutic agents into the arterial blood flow. The radial, brachial, and femoral arteries are the sites of choice for this therapy. Intraspinal therapy is used for infusions in the epidural space of the spinal cord. Infusions to the bone marrow are facilitated by intraosseous therapy. Intraperitoneal therapy involves infusions to the peritoneal cavity.
The health care provider prescribes IV ciprofloxacin to a patient who presents with a systemic infection via a peripheral intravenous catheter. Which complication would most likely occur in this patient?
IV administration of drugs such as ciprofloxacin, vancomycin, and amiodarone most likely cause venous irritation resulting in phlebitis. Extremities in pH and osmolarity of IV infusate may result in thrombosis. Extravasation is a complication associated with the IV infusion of drugs such as vinblastine and dopamine. Fluid overload is a complication associated with the administration of an isotonic solution.
A patient with chronic severe back pain recently had an intrathecal catheter inserted for continuous dosing of morphine. During discharge instructions, the nurse told the patient to immediately report symptoms including headache, stiff neck, and fever. What complication is the nurse concerned about?
Bacterial meningitis is an infection within the spinal column, specifically in the cerebrospinal fluid (CSF). Common symptoms include fever, headache, and stiff neck. Intrathecal catheters increase the risk for meningitis because they allow a track for bacteria to have direct access to the CSF. Catheter migration, intrathecal hematoma, and occlusion of the catheter lumen are all potential complications of intrathecal infusion therapy, but they have different signs and symptoms associated with them.
A patient receiving intrathecal therapy reports a headache, stiff neck, high grade fever, and swelling at the exit site. Based on these symptoms, what should the nurse suspect?
Infection is one of the catheter-related complications of intrathecal therapy. Swelling is evidence of a local infection. Headache, stiff neck, and high grade fever are systemic signs of infection. Phlebitis, hematoma, and ecchymosis are complications of central and peripheral infusion therapies.
Which cadre of nurses is trained and certified in administering infusion therapy?
An RN is trained in the skill of administering peripheral IVs and is also ultimately accountable for all aspects of infusion therapy and its associated tasks. The Infusion Nurses Certification Corporation (INCC) conducts a certifying examination. Nurses who successfully complete the examination along with mastering the skills may use the initials CRNI (certified registered nurse infusion). LPNs, LVNs, and laboratory technicians may also be trained in the skill of peripheral IV insertion and infusion therapy, depending on each state's nurse practice act.
What complication could occur in a patient receiving intraosseous (IO) infusion therapy scheduled for 24 hours if the therapy is continued for longer than this time frame?
The IO route should be used only during the immediate period of resuscitation and should not be used for longer than 24 hours. Prolonged use of the IO route may lead to osteomyelitis, a serious complication of the IO route. Osteoporosis and osteogenesis are contraindications for use of the IO route. Osteoarthritis is not associated with use of the IO route.
What is an expected risk when a 72-year-old patient is receiving normal saline as an intravenous (IV) infusion for dehydration?
Normal saline is an isotonic solution. Older adults receiving isotonic solutions are at risk of fluid overload because the water does not leave the body. As the fluids are infused into the body, the fluids shift into the cells, so this would not lead to cellular dehydration. Acid-base imbalance and electrolyte imbalances are treated using hypertonic solutions.
The nurse inserts an intravenous (IV) line in a patient requiring fluid infusion. Which condition would the nurse document if the IV solution leaks into tissues around the vein?
Infiltration may occur when IV solution leaks into the tissues around the vein. Phlebitis is inflammation of the vein caused by mechanical, chemical, or bacterial irritation. Thrombosis is the formation of a blood clot in the vein. Hematoma occurs from uncontrolled bleeding due to multiple IV insertion attempts or accidental laceration of a large vein or artery during the insertion.
What type of anesthetic is typically used for inserting a catheter for intraosseous (IO) therapy?
Before intraosseous insertion, a lidocaine concentration of 1% is commonly used to anesthetize the skin, subcutaneous tissue, and periosteum to promote comfort. Local anesthetics are also administered epidurally for intraspinal infusion insertion. Topical anesthetic creams are sometimes used for other forms of venous access, such as implanted ports. General anesthesia is not typically used for infusion therapy insertions. Sometimes anesthetic is not needed to establish certain forms of venous access, depending on the type, but anesthetic is typically used to establish IO therapy access.
What is the osmolarity of a hypotonic infusate?
If the osmolarity of IV infusate is less than the serum osmolarity, the infusate is called hypotonic. Normal serum osmolarity is 270 mOsm/L-300 mOsm/L. Therefore, 250 mOsm/L is a hypotonic solution. The osmolarity of 300 mOsm/L is related to isotonic infusate; whereas 350 mOsm/L and 400 mOsm/L are the osmolarities of hypertonic IV solutions.
An active 14-year-old male patient has recently been diagnosed with type I diabetes. He says that he would like to use an insulin pump rather than having to take multiple injections of insulin every day. In order for the patient to remain active, which infusion site should the nurse recommend?
Common sites for subcutaneous infusion therapy include the hips and thighs, upper abdomen, and area under the clavicle. However, for active patients, insertion in the hips and thighs may reduce the ability to ambulate. Therefore, the abdomen is the best site of insertion for an active individual. Upper arms are not preferred for active individuals because of difficulties with tubing placement.
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