Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
57 Cards in this Set
- Front
- Back
reasons for an IV
|
-F&E
-Meds -Blood products -Nutrional formulas (TPN) -Pre-procedure -Just in case |
|
Types of IV solutions
|
*Isotonic
*Hypotonic *Hypertonic |
|
Isotonic IV Solutions
|
i.e. Lactated ringers & NS
-stays in vascular space -used for pts with dehydration -watch for fluid overload -same concentration of solutes as in blood |
|
Hypotonic IV solution
|
i.e. 1/2 normal saline
-goes into the cells -has less solute concentration than blood, so when put in the fluid goes into the cells. |
|
Hypertonic IV solution
|
i.e.D5NS, D5 1/2NS, D5w
-more solute concentration than the blood -Pulls blood from cells into vascular space. -Watch for fluid overload |
|
Peripheral Venous access
|
i.e. medlock, saline lock, hep lock
-short term; temporary; usually less than 72 hrs -flush q shift & with med admin -SAS-->saline, med Admin, saline |
|
Central venous access
|
-short term to long term
-flush per agency poilcy -SASH(eparin) -Flush CVL with min of 10 CC syringe due to pressure |
|
IV complications general
|
-infiltration
-phlebitis -thrombophlebitis -infection -catheter emboli (pt on LEFT side) -speed shock - circulartory overload -air emboli (Put pt on LEFT side) -venous spasm -occlusion |
|
Nursing consideration for IV's
|
-Check MD order & 3 checks
-keep IV fluid & equipment sterile (FEMALE FIRST) -keep tube free of air & contamination -hang fluid at corrcect height -correct flow rate & amount to infuse -assess site for complications -flush per agency protocol |
|
Iv Push/Bolus
|
-small volume <10 mL
-3 checks--> amount, concentration, rate of admis -flush before & after med admin (SAS/SASH) -If IV is infusing, check drugs compatibility, if conpatable occlude line above port when injecting. No flush needed if NS hanging |
|
Indications for a central line
|
-unsuitable peripheral access
- good for pts requiring frequent vein access -for complex tx regimen (analgesics, Abx, chemo, blood, long term IV, vesicant drugs) -administration of TPN |
|
Percutaneous/nontunneled short term CVL
|
-for days to several weeks
-Inserted in subclavian, internal jugular or femoral veins -tip resides in SVC -must be placed by MD -TPN thru dedicated line -Flush with >10mL syringe q8-12 while pulsing. SASH |
|
Peripherally Inserted Central Catheter (PICC Line)
|
-Can be in for several months
-Inserted in antecubital fossa (*Basilic is best; Caphalic 2nd) -Tip in SVC -TPN thru dedicated line -Flush with >10mL syringe q8-12 while pulsing. SASH -By MD or ceritfied RN -Dressing change 24 after in, then q 7 days. WEAR MASK |
|
Tunneled Long-Term CVL
|
i.e. hickman, broviach, groshong
-decreased potention infection from skin exit site -weekly site care -flush with heparin EXCEPT groshong -Surgically inserted ~5" under skin before entering vein |
|
Implanted port-a-cath
|
-single or double lumen
-no dressing change unless accessed -need to use HUBER needle to access it -When accessed change needle & dressing q7 days -flush with heparin monthly when not accessed |
|
pneumothorax
|
collection of air in the pleural space
-high risk for pts getting subclavian CVC's- puncture the pleural covering -When inserting a CT for this, usually placed on top near apex |
|
Hemothorax
|
collection of blood in the pleural space
-high risk for subclavian CVC- hitting subclavian vein/artery -if occurs- remove line & place pressure -place a chest tube at base of lung with this |
|
Cath occlusion
|
-lumen is partially or completely blocked
-caused by: *long term fat emulsion *blood reflux *improper flushing -Prevent by proper flushin techniques |
|
How often does an unused port need to be flushed?
|
Once a month with heparin
|
|
What size syringe is to be used to a CVC?
|
>10 cc (depending on the opening of syringe)
|
|
Why would H2 inhibitors be added to TPN?
|
to reduce the amount of gastric acid the stomach produces and prevent ulcers.
|
|
IV calculation for Gravity
|
am. fluid ordered (ml)x drop factor (gtt/min)/ time in minutes= rate (gtt/min)
|
|
IV calculation with primary pump
|
total ml/total hours= ml/hr
|
|
For a IVPB calculation
|
total ml x (60 min)/total hours=ml/hr
|
|
Contents of TPN
|
-amino acids
-electrolytes -fats -proteins -electrolytes Vitamins -Meds (insulin, heparin, H2 inhibitor) |
|
Advantages to TPN
|
-provides calories
-restores nitrogen balance -replace vitamins, electrolytes & minerals -promotes wound healing -gives bowel a rest & healing time |
|
Total Parenteral Nutrition (TPN) general info
|
-fride until 1 hour prior to use
-must be infused or tossed within 24 hrs (bag & tubing) -must be filtered -Dedicated line! No IVPB/pushes |
|
TPN vs PPN
|
*TPN: needs CVC line.
20-70% dextrose & 3.5-15% AA. Long term *PPN: dont need CVC line. 5-10% dextrose & 2-5% AA. Short term |
|
Indications for a trach
|
-relieve acute/chronic upper airway obstruction
-access for continuous mechanincal ventillation -weakened respiratory muscles -prolonged endotrach tube insertion resulting in pain/erosion -obstructive sleep apnea -congenital disorders |
|
Types of Trachs
|
-Universal/double lumen: for pts with lots of secretions; inner cannula can be removed to clean
-Single Cannula: use for pt with thick necks; slightly longer than universal -Fentrated: allows speech, enables effective cough- used to wean from trach -Cuffed: for mechanical ventillation to keep it in place |
|
Essential bedside equipment for trach pt
|
-Spare trach tube of same size & one smaller
-obturator of exsisting trach -suction equipment -O2, humidification & trach collar -Sterile water, stoma dressings -communication aides, call bell |
|
Trach PC: damage to trach
|
-trach wall necrosis (from balloon in cuffed)
-Trach stenosis (scars & narrows lumen from cuff & irritation) |
|
Trach PC: accidental decannulation
|
-is 1st 72 hrs= EMERGENCY! ventilate with bag-valve-mask & call RRT
-After 72 hrs=use obturator & reinsert (thats why we keep extra at BS!) |
|
Trach Suctioning
|
-required to remove pulmonary secretions & maintain patent airway
-promotes ventillation & oxygenation -Is potentially dangerous so its not performed unless clinically indicated -Suction for 10 sec at a time |
|
Indications for trach suctioning
|
-visible or audible secretion
-subjective feeling of secretions in chest -deteriorating ABGs -altered chest movements -decreased O2 sats -diminshed air entry -change of color -tachypnea -poor/absent cough |
|
Risks for suctioning
|
-Hypoemia D/T O2 desat
-contaimination of the airway leading to nosocomial infection -mucosal trauma -prolonged coughing -bleeding |
|
Hypernatremia
|
>145 mEq/L of Na+ in serum
-Gain of Na or loss of H2O -Causes shift out of cells= cell dehydration |
|
Hypernatremia is caused by...
|
-H2O deprivation
-Excessive Na intake or reabsorption -renal failue -Cushing's -Fluid excess loss (severe diarrhea, burns, osmotic diuresis) -Age related changes |
|
Hypermagnesemia
|
-When levels >2.1
-Excitable membranes are LESS excitably or may not respond to any stiluli -Caused by: renal failure, severe dehydration & ^mag intake/administration |
|
Hypomagnesemia Manifestations
|
-increase nerve impulse transmission= hyperactive deep tendon reflexes, parasthesia, tetany, seizures
-CNS changes can = depression, psycosis, confusion -Reduce GI motility, anorexia, nausea, constipation & abdominal distension -Paralytic ilius |
|
Hypermagnesemia Manifestations
|
*Cardio: Brady, peripheral vasodilation, hypotension. Severe can = cardiac arrest
-CNC: drowsy & lethargic from decreased impulses -Voluntary smooth muscle progressivley get worse until stoppin -Deep tendon reflexes reduced or absent |
|
Interventions for hypermagnesemia
|
-treat underlying cause & symptoms
-Give lasix -stop all Mg drugs -IV fluids -Safety measures |
|
Hypercalcemia Manifestations
|
-decrease persistalsis, constipation, anorexia, N/V, abdominal pain
-Altered LOC: confusion, lethargy, coma, slurred speech -At 1st tachycardia and HTN. -Overtime= bradycardia -increase blood clots -Severe muscle weakness -decrease deep tendon reflex |
|
Interventions for hypercalcemia
|
-weight bearing exercises
-adequate fluid intake & dietary fiber -Prevent injury -Calcium binders |
|
Hypocalcemia Manifestations
|
-Neuro: 1st in hands & feets, tingling & numbness; twitching & cramps will occur--> tetany
- + Trousseau & Chvostek's signs; Spasms -Cardio: bradycardia, hypotension, EKG changes, ab cramps -GI: Increased peristalsis, cramps, diarrhea -decreased bone density -Abnormal clotting |
|
Hypokalemia Manifestations
|
-Muscle cramps & weakness, hypoactive reflex, parasthesia
-Anorexia, abdominal distension, decrease motility, N/V & constipation -EKG changes, dysrhythmias -Respiraratory distress to failure |
|
Hypokalemia Interventions
|
-Treat underlying cause
-Monitor K+ replacement -Encourage foods high in K+ -Oral suppliments *NEVER IV PUSH Potassium!* |
|
Hyperkalemia Manifestations
|
-Musle weakness, tingling & possible paralysis
-EKG changes: bradycardiam hypotention, ectopic beats, ventricular fibrillation -Neuro: early twitched with burning & tingling then turns into weakness and paralysis -GI: increased motility, hyperactive bowel sounds, diarrhea |
|
Hyponatremia Manifestations
|
-Tachycardia, hypotension
-Neuro & musculoskeletal symptoms may occur -water shifts from ECF into ICF, causing cells to swell=CNS symptoms: *Muscle cramps & twitching *Headacche *Dizziness *Seizures *Coma *Weakness *Behavior & LOC change *N/V/D |
|
Hypernatremia Manifestations
|
-Vary depending on severity
-Thirst -dry skin & MM -Hyperthermia -Lethargy & restlessness -Skeletal muscle changes |
|
Interventions for hypernatremia
|
-adminster IV fluids based on severity
-loop diuretics -oral fluid intake -Low Na+ diet |
|
Hypocalcemia is caused by....
|
<8.5 mg/dL
-inadequate dietary intake -lactose intolerance -malabsorption syndromes -inadequate vitamin D - diarrhea -primary or surgical hypothyroidism due to thyroidectomy -drug therapy (corticosteroids, calcium binders, citrate, caffine, ect...) |
|
Hyperkalemia is caused by...
|
>5.0 mEq/L
-Excessive K+ intake -blood transfusion -extracellular shift (acidosis, sepsis, trauma, fever, MI) -decrease excretion (renal failure, severe dehydration, K+ sparing diuretic) -Hypertonic state-->uncontrolled diabetes |
|
Hypokalemia is caused by...
|
<3.5 mEq/L
-GI loss (diarrhea, vomit, NGT) -loop diuretics -corticosteroids -wound drainage -diaphoresis -Not enough diet intake -H2) intoxification -Prolong IV use with no K+ in it -periods of tissue repir -metabolic alkalosis -increased aldosterone |
|
Hypomagnesemia is caused by...
|
-When levels <1.5 mEg/L
poor nutrition -alcoholism -GI & renal loss -Drugs (some diueretics, chemo, amphotericin B) |
|
Hyercalcemia
|
>11 mg/dL
-causes excitable tissue to e LESS sensitve to normal stimuli =stronger stimuli to function |
|
hypercalcemi is caused by...
|
-yperparathyroidism
-hyperthyroidism -Excessive Ca or Vit D intake -cancer -glucocosteroids -immobility -dehydration |