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.
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.
Structural components common to both veins and atereries include
Tunica intima, Tunica media and tunica adventitia
Vague muscle weakness, GI hyperactivity, parathesia of face, tongue, feet and hands are signs of
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)
Nursing intervention for a pt who is experiencing extravasation
Stop drug administration, follow facility extravasion treatment protocol and notify the physician
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
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Use of outdated parenteral fluids, inadequate preperation of cannula insertion site and inappropriate handwashing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
"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
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?
Appropriate height for suspending the fluid container form the IV pole in relationship to the intended IV sites?
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
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
How many units per ml is the most commonly used concentration of heparin flush solution for peripheral intermittent infusion devices
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.
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
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.
When administering the flow rate of gravity infusion, for how many seconds should a nurse use a watch to time the fluid drops?
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
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?
2 elements essential for accurate documentation of the IV therapy monitoring process?
Perinent information regarding observations and actions taken
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
Requierd to maintain patency of intermittent infusion devices
Flushing of intermittent infusion devices
Necessitated imediate change of site and administration set
Phlebitis with no sign of cambatant infection
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?
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
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
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
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
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
Results when pt is transfused to rapidly or when volume administered was excessive
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.
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
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
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
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
What factors influence bacterial survival?
Presence of specific organism, number of organisms and resitance of host
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
Evaluating the appropriateness of a parenteral fluid for infusion includes checking for which of the following?
Fluids expiration date, evaluating the fluid container for cracks or punctures, type and volume fluid
Considered appropriate when stabilizing an IV cannula
Should not interfere with future site assessment
Alternative terms used in reference to an intermittent infusion device
Saline lock, Heparin lock, Locked cannula
Essential component is required when documenting patency maintenance of intermittent infusion devices using a NS flush
Volume and time span for flushing
Physician orders 500 mL of dextrose 5% / NS over 10 hours. The administration set drop factor is 60 gtt/mL. Calculate the ordered flow rate in gtt/minutes.
Physician orders 1,000 mL of dextrose 5% / NS at 100 mL/hr. The administration set drop factor is 20 gtt/mL. Calculate the ordered flow rate in gtts/ minute
Physician orders 500 mL of NS at 100 mL/hr. The administration set drop factor is 10gtt/mL. Calculate the ordered flow rate in gtts/minute.
Physician orders 500mL of dextrose5% / 0.25%NS at 75mL/hr. The administration set drop factor is 15 gtt/mL. Calculated the ordered flow rate in gtts/min
Objective of establishing flow rate?
To ensure that fluid is delivered over the time span specified by the physicians order
Factors the physician considers when ordering an infusion flow rate?
Pt clinical status, body surface area and fluid composition
The physician orders 3,000 mL of lactated ringers of 24 hours. The administration drop factor is 10 gtt/mL. Calculate the ordered flow rate in gtts/minute
3 Common reasons for pediatriv IV therapy
Maintainance of fluid and electrolyte balance, medication administration, administration of chemotherapy, parenteral nutrition
Variable that affect how often infusion flow rates must be monitored for pediatric patients
Age, composition of fluid infusing, anatomical location of venipuncture site and clinical staus of the child
Monitoring factor essential to ongoing assessment of an elder intravenous therapy pt?
Assess for evedence of electrolyte disturbances, accurate I&O monitoring, Frequent assessment of the venipuncture site, Assessing for evedence of the onset of an infection process, Evaluation of therapeutic response to administered drugs
Direct contrast to young pts, disorientation, loss of appetite, confusion and lethargy in elderly pts may be the first sign in which of the following
Onset of an infectious process
Which of the following priciples apply to restraint usage with IV therapy pts
Follow the manufacturers instruction for application
2 elements essential for accurate documentation of the IV therapy monitorying process
Pertinent info regaurding observations and actions taken
Righs of teh pt to receive safe and accurate drug administration?
Drug, Form of drug, Dose, Time, Route, Patient
Advantages of IV drug administration
Provides for instant drug termination if adverse reaction occurs and rapidity of drug action
Nurse is responsible for completing before the administration of the IV drug
Determine any drug allergies the pt may have
Drug classifications are recognized as causing 90% of reported ADRs
Anticoagulants, antimicrobials, bronchodilators, cardiac drugs, cns drugs, diagnostic agents and hormones
Pt is to receive 500mL of D5W containing 20 mEq of potassiom chloride as a continuous infusion for 12 hours. The administration set drop factor is 60 gtts/min. What is the infusion rate in gtt/ min?
Heparin infusion of 25,000 units in 500 mL dextrose 5% water is odered to infuse at 800 units per hour. The infusion pump should be set to deliver how many mL/hr
What should the nurse confirm before initiating an IVPB infusion?
Id of the pt and the patency of the IV site
Elements essential for appropriate documentation of a drug given IV push
Name of drug and dosage, Rate of administration and mode of delivery, Time and date.
Commercially available precalculated, prepackaged systems containing diluent and drug include which of the following systems?
ADD-Vantage and mini-bag plus
Volume control sets are most frequently used to provide therapy to which IV therapy pt classification
Caused by contamination of blood hemolytic reaction during donation, preparation or storage
Nursing intervention inrespose to an acute intravascular hemolytic reaction?
Stop transfusion, keep the vein open with normal saline, disconnect administration set from cannula and initiate NS infusion with new tubing.
Indicators of TPN therapy
Hepatic failure, hypermetabolic states and malabsorption of enteral therapy
Vital nursing consideration when infusing parenteral nutrition solutions
Initial infusions should begin slowly with incremental increases until desired infusion rate is achieved
A solution of three-in-one referes to the combination in one container of which of the following?
Lipids, dextrose and amino acids
Nursing objective in fluid and electrolyte imbalances is to know the importance of Evaluation of the pts fluid and electrolyte status in order to recognize disturbance and initiate appropriate interventions
Nutritional lipid emulsions
Provide a concentrated source of calories and prevent essential fatty acid deficiency
Nursing intervention for a pt who is currently experiencing septicemia
Stop the infusion, aseptically reserve the assembled system for potential future testing reestablish IV at new site with new solution, new administration se and cannula; obtain vital signs notify physician
Nursing intervention for a pt who is experiencing nerve irritation
Cease teh venipuncture attempt, relocate IV site to the other extremity and notify the physician
Condition precipitated by presence of more fluid volume than the circulatory system can manage
Disadvantage of using parenteral fluid plasic containers?
It may be difficult to ascertain the volume of fluid remaining in the container
Intermittent infusion devices are used to provide which of the following intracenous related procedures?
Intermittient delivery of IV piggyback infusions and intermittent delivery of IV push drugs
A peripheral intravenous catherer may be converted to an intermittent infusion device by connecting what type of equipment to the catheter hub?
Elements that comprise the treatmetn of anaphylaxis
Administer pharmacological agents, Establish a patent airway, Secure vascular access
Most appropriate nursing intervention for a pt who is currently experienceing a hematoma
Discontiue the IV immediately, apply direct pressure, elevate the extremity, apply cold compresses