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What are the indications for IV therapy? (7)
- Maintain fluid & electrolyte balance.
- Fluid Volume Replacement
- Medication Administration
- Transfusion of Blood & Blood Products
- Provide Nutritional Supplemention (TPN)
- Monitor Hemodynamic Functions
- Administer Diagnostic Reagents
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Name the 2 types of IV Nutritional Supplementation:
- 1. Total Parenteral Nutrition (TPN) or Hyperalimentation
- 2. Peripheral Parenteral Nutrition (PPN)
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Name two methods used for Hemodynamic Function Monitoring:
- 1. Swan Ganz Catheter
- 2. ART Line
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Name 3 types of Diagnostic Reagents:
- 1. IVP Dye
- 2. CT Contrast
- 3. Nuclear Medicine Dye
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What are 6 things you would assess to evaluate F&E status?
- 1. Daily weights
- 2. I&O
- 3. Lab Values
- 4. Skin Turgor
- 5. Mucous Membranes
- 6. LOC
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What 6 lab values are important indicators of F&E status?
- 1. Hct
- 2. BUN
- 3. Creatinine
- 4. Serum CO2
- 5. Osmolality
- 6. Specific Gravity
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What is Hematocrit (Hct)?
The # of RBC in 1 ml of whole blood. (% by volume of RBC in whole blood-WB)
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What is the normal Hct level for women?
38--47%
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What is the normal Hct level for men?
40--54%
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Hct levels change how....
....with Dehydration?
....with Fluid Overload & anemia?
- *Increases with dehydration.
- *Decreases with FVO & anemia.
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What do BUN levels reflect?
Protein intake & renal excretory capacity.
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What is the Normal values for BUN?
8--23 mg/dl
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BUN levels do what.....
....with dehydration?
....with fluid overload?
- *Increases with dehydration
- *Decreases with FVO
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What does Creatinine measure?
The glomerular filtration rate.
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What is the normal Creatinine Values?
0.6--1.5 mg/dl
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1. What do increased levels of creatinine indicate?
2. A 50% or > increase would indicate what?
1. Renal disease/dysfunction
2. Nephron damage
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1. What does serum CO2 measure?
2. What is other way it is represented? (i.e. abbreviation)
1. Measures alkalinity or acidity of venous blood supply.
2. TCO2 (total carbon dioxide content)
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Serum CO2 is regulated by what organ(s)?
Kidneys
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What is the normal TCO2 or Serum CO2 values?
23--30 mEq/L
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Serum CO2 increases with what?
vomitting/diarrhea
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TCO2 or Serum CO2 decreases with what?
Dehydration
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What is osmolality?
# of particles in body water which exert osmolar pull
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What is the normal osmolality values?
280--295 mOsm/kg
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Osmolality increases with what condition?
Dehydration
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Osmolality increases with what condition?
FVO: fluid overload
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What does (urine) Specific Gravity measure?
The kidneys' ability to concentrate urine.
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Normal Specific Gravity values
1.001--1.035
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Specific Gravity increases with what condition?
Dehydration
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Specific gravity decreases with what condition?
- Acute Renal Failure (ARF)
- When tubules lose the ability to concentrate urine.
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Explain Isotonic Fluids & what they're helpful in treating:
- Isotonic fluids have a concentration equal to the concentration in the cells.
- They are helpful with hypovolemic/hypotensive pts.
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Name 3 examples of isotonic fluid:
- LR- lactated ringers
- NS- normal saline
- D5W - Dextrose/water
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Explain Hypotonic Fluid & what conditions its used for:
- Hypotonic fluids have solute concentrations lower than in the cells causing fluid to move into the cells to rehydrate.
- Useful in diabetic ketoacidosis. DKA
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Explain why hypotonic fluids can be dangerous if used incorrectly:
Hypotonic fluids can cause a sudden shift from the intravascular space to the cells causing swelling & possible bursting of the cell.
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Name 2 types of Hypotonic Fluids:
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Explain hypertonic fluids & what they are used for:
- Hypertonic fluids have greater solute concentration than that of the cells, it pulls water out of the cells into the intravascular space.
- Can help stabilize Bp, increase urine output, and reduces cellular edema.
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Name 4 examples of Hypertonic Fluids:
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What are crystalloids?
- solutes which when placed in a solvent, homogeneously mix with it, dissove and cannot be distinguished from the resultant solution.
- They are able to diffuse through membranes. May be isotonic, hypotonic, or hypertonic.
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What are colloids?
Glutinous substances whose particles cannot form a true solution because their molecules do not dissolve but remain uniformly suspended & distributed in fluid. They expand volume by raising colloid osmotic pressure.
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Name the 4 types of solutions:
- Carbs in water
- Carbs in NaCl
- NaCl
- Electrolytes solutions
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1. What do "carbs in water" solutions consist of?
2. What is another name for NaCl solutions?
- 1. Dextrose & water
- 2. Normal saline
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Name 3 types of electrolytes solutions & their tonicity:
- 1. D5LR (5% dextrose in lactated ringers) Hypertonic
- 2. LR (lactated ringers) Isotonic
- 3. Ringers Solution, Isotonic
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What are 4 types of special solutions?
- Potassium
- Magnesium
- Vitamins
- Lipids
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What are important considerations when giving KCl via IV?
- *High risk
- *Never administer more than 10 mEq/hr
- *Irritating to veins, must be diluted
- *Check K & Cl levels before administration
- *NEVER give IVP!!!
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What is the antidote for magnesium?
Calcium Gluconate
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Vitamins may be added to IV solutions in what cases?
- Inadequate oral intake causing malnutrition or risk of.
- Vitamine deficiency r/t diet (chronic ETOH, anorexia, etc)
- Increased stress, surgery, burns.
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Why are lipid solutions given?
To increase caloric intake, nutritional supplementation.
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Name examples of methods used for Lipid solutions & availability:
- PPN-Peripheral IV
- TPN-Central Line
- Available in 10% or 20%
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What should you remember about Lipid & TPN solutions?
Never add anything to them!!
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TPN solutions should be stored how?
In the refridgerator.
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What is a common medication added to TPN solution & why?
- Famotidine (Proton pump inhibitor)
- To reduce stomach acid in people who are NPO.
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How long can one TPN bag infuse?
No longer than 24 hours.
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How often should TPN tubing & filter be changed?
q24hrs
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When TPN is initially started, how would the infusion rate be set?
How much would it be increased over time?
- Relatively low (50ml/hr) to avoid hyperglycemia.
- Increased by 25 ml/hr until order rate is reached.
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Rapid infusion of TPN can cause what?
- hyperosmolar diuresis
- Seizures, coma, & death.
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If TPN is stopped abruptly what could happen?
rebound hypoglycemia
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What NOT to do when administering TPN: (3)
- DO NOT....
- 1. play catch up, pitch it & start again
- 2. stop flow abruptly
- 3. interrupt line
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What are 4 benefits of IV drug administration?
- 1. rapid absorption
- 2. immediate action
- 3. continuous administration
- 4. Immediate termination if allergic reaction occurs
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What are IV meds usually mixed with and the normal infusion rates?
- Usually mixed with NS or D5W.
- Rate 50ml/30min or 100ml/hr
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Name the 6 Blood Products available for IV administration:
- 1. PRBC's (packed RBC's)
- 2. FFP (fresh frozen plasma)
- 3. Platelets
- 4. Clotting factors 8 & 9
- 5. Albumin
- 6. WBC's
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What is the purpose of PRBC's?
To increase the O2 carrying capacity of blood, restore circulating volume, to tx shock
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PRBC's should be administered with what size needle?
- 19 ga or larger OR
- a needle in which you can "see" through the lumen
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Blood products can only be given with what solution?
0.9% NS
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What are important assessments to be made/things to do with blood product administration? (5)
- 1. Draw a type & cross match prior
- 2. Monitor VS before, during, & after infusion
- 3. Stay with the pt at least 15 min following infusion to assess for s/s of reaction
- 4. Infuse over NO GREATER than 4 hrs.
- 5. Change tubing after q unit of blood given
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Name the 4 types of IV devices:
- 1. Angiocaths
- 2. Winged "Butterfly" Catheters- portacath insertion
- 3. Midline catheter (MLC)
- 4. Central vascular devices (CVD)
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Name the 5 types of Central Vascular Access Devices:
- 1. PICC- peripherally inserted central cath
- 2. Triple Lumen Central Line
- 3. Hickman (R atrial cath)
- 4. Groshong (R atrial cath)
- 5. Porta-cath- implanted venous access devices
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What needle/cath size would be used for children & elderly?
24-22 gauge
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What needle/cath size would be used for medical & post-op pts?
24-20 gauge
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What needle/cath size would be used for surgical pts?
18 gauge
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What needle/cath size would be used for trauma pts?
16 gauge
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Name 5 ways to dilate veins:
- 1. gravity
- 2. milking
- 3. tapping
- 4. fist clenching
- 5. warm compress
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What will you document when starting an iv? (9)
- Date/Time
- Type/Gauge of needle
- # of attempts
- site(exact location)
- type of dressing applied
- pt's response
- special precautions (positional, armboard, pumps)
- fluid type, amount, & rate
- parenteral fluid sheet I&O
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How long can a solution be hung?
No longer than 24 hrs.
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What pt teaching would you include with IV administration?
- *Do not kink, compress, or lie on tubing
- *Avoid using arm
- *DO NOT adjust clamp or change bag level
- *When walking, call for help
- *Call when bag is low/empty, any wetness/blood, pain, burning, swelling, pump alarms
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What assessments would you make with IV insertion?
- *Site: redness, blood, edema, drainage, leakage
- *Fluid level, pt tolerance, tubing patency q 1-2 hrs
- *Avoid Bp in IV arm, mastectomy side, CVA side
- *Check tubing for kinks, clamped
- *Avoid placing tubing in dominant hand
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S/S of infiltration:
- Pain, blanching or coolness of skin around site,
- pallor, edema, tight skin, damp or wet dressing
- no blood return
- sluggish or no flow rate
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What to do when there is infiltration?
- Stop infusion, remove cath, ice/warm compress if needed,
- restart iv, document everything done
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S/S of Thrombophlebitis:
- sluggish flow rate, edema in limb, sore/hard/cordlike/ warm vein
- may look like red line above venipuncture site
- elavation in temp 1 degree or more above baseline
- throbbing limb pain
- mottling, cyanosis, pallor of limb
- diminished arterial pulses
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Nursing considerations with thrombophlebitis:
- *DC infusion & remove cath
- *Apply warm wet compresses
- *Notify physician
- *Restart iv in another limb
- *document everything
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