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Terms in this set (140)
What two meds need vented tubing?
Nitro & amiodarone
What solution can we give for hyponatremia?
hypertonic (3% NaCL)
*this adds fluid to the vascular space
What kind of tubing does blood need?
Crystalloid solutions that are continuous are changed
q24hr for the bag and 72-96hr for tubing
primary and intermittent administration sets are changed every __________
Change ER IV site after __________
Midline catheters are considered as ________
_________ requires a sterile dressing and is only changed by IV team?
Nontunneled catheter example
Picc line is good for up to ____
nontunneled catheters have a _________ time frame
Powerports are used for _________
Can we draw blood off of central lines?
Yes just NOT tunneled caths
What causes ecchymosis w/immediate swelling and bleeding @ site with a hard painful lump?
*can use warm moist compress
When a thrombus forms at the site causing a hard cordlike vein thats red, warm and tender w/sluggish flow?
pain along vein
weak rapid pulse
S/S of catheter embolism
Sign of air embolism
*left lateral trendelenburg and aspirate out, provide oxygen
Med for catheter occlusion
1L of fluid is equal to _____
osmotic pressure can only occur if we have adequate_______
concentration of our blood stream
concentration of the solution outside of body
D5W is ________ before infusion
Hypertonic solutions need to be on an _________
Patient who has ascites has fluid volume ________
deficit (third spacing of fluids)
Third spacing patient have a loss of _______
*Burn patients & ascites patients
albumin can be transfused to expand ______
Autologous donors can donate ______
q3 days if Hbg is >11 for 5 weeks up until 3 days prior to transfusion
Why do we do a screening when blood typing?
To make sure the patient doesn't have an antibody to the blood products
Type and cross _____
holds blood for specific patient for 72hr
Type and screen _____
doesn't hold the blood for the specific patient
What is the most important step when preparing to administer blood?
Assure consent has been done along w/ type and cross
Optimal IV catheter size for blood?
16-20g but at least 20g
We administer oral meds ________ to transfusion
30 min prior
We administer IV meds ________ to transfusion
Blood must be administered within _________ of getting?
*expires at midnight and runs over max of 4hr
When transfusing a patient, we check vitals when?
Q15 minutes twice, then q30 minutes
*first 15min are most crucial
1 unit of PRBC's should raise Hbg by what?
Acute blood reactions can occur when?
within 5 minutes to 48 hrs after
Delayed blood reactions can occur when?
Acute hemolytic transfusion reaction
life threatening due to donor blood being incompatible and can cause clotting, lower back pain, dyspnea, shaking and chest tightness
when the antibodies to the donor WBC/platelets happens and causes a fever, chills, HA and malaise
*account for 90% of reactions and can possibly restart infusion
Allergic transfusion reaction?
Mild: hives, itching, flushing
Severe: laryngeal spasm, bronchospasm, anaphylaxis and shock
*Transfusion can be restarted if mild symptoms occur
Reaction that happens 6hr after transfusion causing pulmonary edema, hypoxemia and dyspnea
*Maintain airway and support RR and BP
S/S of transfusion reaction in unconscious patient
If a transfusion reaction is occurring, as a nurse we ______
stay with the patient and check vitals q5min
MEDS for transfusion reactions
emergency IV meds, antihistamines, vasopressors, corticosteroids, tylenol (febrile)
As a nurse, what do we do for circulatory overload caused by a blood transfusion?
slow infusion down (dont stop completely)
place patient in sitting up with legs dangling
Provide O2, diuretics (lasix) and morphine sulfate
rapid onset of chills/fever, vomiting, diarrhea, hypotension and shock
*Administer O2, IV fluids, vasopressors, ABX, corticosteroids and then get a blood culture
S/S of iron overload (blood)
vomiting, diarrhea, hypotension, altered hematological status
Med for iron overload?
*warn patient that urine will turn red
Most common disease transmitted during blood transfusion?
S/S of Hep C?
Anorexia, jaundice, dark urine, N/V
*Occurs 4-6 weeks post transfusion
Who should receive fresh blood and why?
Renal patients and patients w/massive hemorrhage because the longer the blood sits, the more concentrated the potassium comes
S/S of hyperkalemia
muscle weakness, EKG changes, bradycardia, paresthesia of extremities
When do we assess glucose levels if patient is on TPN?
Type of nutrition that can be administered peripherally?
PPN (5-10% dextrose)
*0.22 micron filter and is short term therapy
Type of nutrition that requires a CVAD?
*is hypertonic and needs 1.22 micron filter
Stopping TPN can cause ______
hypoglycemia (can use dextrose if we need to stop TPN)
/Hepatic dysfunction with TPN is caused by
the increased amount of lipids and glucose causing liver failure or an increase in enzymes
when the body goes into a shock state because of lack of nutrients for so long causing hypophosphatemia
*Start the TPN slowly and increase as tolerated
TPN cannot be stopped _______
*Causes hypoglycemia; slow the rate and notify doctor if needed
dehydration with TPN can be caused by?
fluid overload in TPN is caused by?
Vitals w/TPN are done
hasnt gotten delivered to the tissues
oxygen that is available to the tissues
When Hbg does not pick up O2 as easily (reluctant to pick up oxygen), the Hbg is more likely to release O2 to the tissues
*No air conditioning in cab
When Hbg picks up O2 easily (likes to pick up oxygen), body is less likely to release oxygen to the tissues
With a left shift, you have _______
With a right shift, you have _______-
Ace inhibitors can cause
visualizes vasculature of the lungs to see if theres an abnormality
*series of xrays are taken
Pulmonary angiogram needs _______ and ___________
at least an 18g IV ask about shellfish and eggs
ventilation profusion scan
checks the perfusion of lungs by outlining the alveoli (no radioactive precautions)
*Patient needs to be able to lay flat for an hour
For a bronchoscopy we have the patient not ____-
eat 6-12 hrs prior and remove dentures
what does meds are toxic to the kidneys are ears?
*Nephrotoxic & ototoxic
Gentamycin and vancomycin (monitor peak and trough)
What to teach a patient who is taking a bronchodilator?
That it may cause them to become jittery
blebs (overinflated alveoli) that burst on the lungs causing scarring
*Don't let the patient overexert
if a pleural effusion is caused by heart failure what do we do?
Diurese them before we do a thoraentesis
for atelectasis, we have the patient do what?
Use IS, cough and deep breathe
air hungry, respiratory distress, anxiety
Nasal cannula low and high flow
Low 6liters High 15
8-11 liters (used with a reservoir bag to where you are still able to breathe oxygen in the air)
10-15liter (delivers high concentrated oxygen and is unable to be rebreathed)
*used for carbon monoxide poisoning
4-10 liters (can still breath room air as well, but delivers specific oxygenation concentrationd)
With a pleural effusion, how do we know it is recovered?
Patient may begin to cough meaning the lung has expanded
Gold standard test for PE
Spiral CT w/contrast dye
Normal D dimer
PE heparin prevention
5000 units SQ
What med can we give to relax vessels for PE
What is the #1 treatment for PE?
Start IV hep.
reversal is vitamin K
platelets if needed
*aPTT is half of this
What do we teach patients on coumadin about vitamin K intake?
Don't decrease or increase your dark leafy greens
What happens during a spontaneous pneumothorax?
Blebs burst thats caused by smoking, tall thin males and excessive ventilation
a type of pneumothorax in which air that enters the chest cavity and pushes the trachea and heart over
How do we verify chest tube placement?
What should we have on hand at bedside for chest tubes?
What is considered as significant bleeding with a chest tube?
*Notify physician right away
Only time we should see significant/vigorous bubbling with a chest tube?
Normal Bicarb (HCO3)
Hydrogen ions are?
what does our respiratory system do to eliminate excess CO2?
decreased cardiac output (vasodilation)
*reversible; can cause oliguria
Causes of pre-renal stage of AKI
renal issues (lupus, glomerulonephritis)
Intra renal causes
Biggest concern with intra renal?
Acute tubular necrosis
lethargy, headache, confusion, apprehension, seizures, coma
Hematologic disorder specific to AKI
*most common cause of death is infection
Med that can help prevent AKI
most serious complication of AKI?
*How do we treat this
How can we confirm CKD?
GFR <60mLvfor >3 months
Leading cause of CKD is
When will a patient will CKD show symptoms
Stage 4 (GFR 15-29)
What meds do we give for CKD?
Meds for hyperkalemia (insulin/glucose)
HTN meds (aces, arbs, diuretics, CCB)
*diuretics if peeing
Vitamin D meds (CKD)
What can we give after dialysis to increase BP?
Why can't we take antacids with aluminum and magnesium?
aluminum causes bone softening and mag. cant be processed through kidneys
With hemodialysis, we should watch for what
hypovolemia due to rapid fluid exchanges
What do we do about antihypertensives when it comes to dialysis?
Post op kidney transplant
give patient lots of fluids to ensure kidney profusion and administer immunosuppressants
S/S of transplant failure
low grade fever and tenderness in flanks
Corticosteroids can cause
bone/joint necrosis; osteopororsis
Drug therapy for hyper thyroid
BB, PPU, tampazole
Manifestation of thyroid cancer
metabolic syndrome meds
statins, antihypertensives, metformin
DKA electrolyte imbalance
hyperkalemia (insulin causes HYPO)
IV FLUIDS and insulin
replace fluids (isotonic) and insulin once stabalized
In HHS, if blood sugar is ____________ we stop fluids and add ______
<250 and add dextrose so we don' wipe them into hypoglycemia
Common manifestation of HHS
cerebral edema (mental status changes)
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