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227 terms

IV therapy 3

STUDY
PLAY
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
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
Appropriate technique for inserting an ONC or winged infusion set
Bevel up at a 10-30 degree angle
Considered appropriate when stabilizing an IV cannula
Should not interfere with future site assessment
Acctions appropriate for site preparation
Allow the antiseptic to dry naturally
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.
50 gtt/min
What factors affect the infusion flow rate?
Phlebitis, hight of container and viscocity of fluid
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
33 gtt/min
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.
17 gtt/min
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
19 gtt/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
21 gtt/min
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
Change in the cardiovascular system secondary to the aging process
Increased fragility of teh veins
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
Modes of IV drug administration
Direct injection, Continuous infusion, Intermittent infusion
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
To prevent a drug error the drug label should be checked against?
Physicians order sheet
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?
42 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
16mL/hr
Volume of fluid commonly used for IV PB drug admixtures
50-100mL
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
Pediatric
Interfere with cell division and growth
Cytotoxic drugs
2 major classifications of advers reaction to a blood trasfusion
Immediate and delayed
Occuring in 1-2% of transfusions administered
Febrile nonhemolytic
Characterized by erythema hives and itching
Uticarial reaction
Caused by administration of incompatible blood
Acute intravascular
Caused by contamination of blood hemolytic reaction during donation, preparation or storage
Bacterial sepsis
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
What function of blood is essential to homeostases
Helps maintain acid base balance
2 factors that can alter normal blood clotting
Certain disease processes and medication
Four major organs involved in homeostasis
Heart, lungs, kidneys, and adrenal glands
Body fluid compartment contains the smallest volume of fluid any give time
Transcellular
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
Any agent capable of producing tissue damage
Vesicant
Escape of blood into the tissues
Ecchymosis
Inflammation of the intima of a vein
Phlebitis
Condition precipitated by presence of more fluid volume than the circulatory system can manage
Circulatory overload
Systemic disease caused by presence of pathofenic microorganisms in the body
Septicemia
Intrinsic contamination may occur during
Manufacture process
Define Lumen
Space within the vascular access device
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?
Injection port
What factors can affect intravenous drug responses?
Pathology, pt age and drug interactions.
Elements that comprise the treatmetn of anaphylaxis
Administer pharmacological agents, Establish a patent airway, Secure vascular access
Statement applies to idiosyncratic reations?
Some are due to unusual enzyme deficiencies
Primary cause of TPN related Sepsis
Migration of microoganism along catheter
Ateries
Compromised circulation to the tissue area it supplies resultant of the injury
Sterile/Chemical, mechanical and septic are subclassifications of
Phlebitis
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
Pottasium is a
Cation
Rash is a sign or symptom
Diuretic??
Weakness ect
Diuretic??
Vasovagal
Stress
Don't call pharmacy
check papers
Epithelial folds
valves
Lactated ringers is isotope
stays where its at
Rigid container or glass?
...
Reg insulin?
...