IV information
A burn victim comes to the ER and presents with burns on his RUE, anterior trunk, and RLE, as well as severe dehydration. What kind of IV fluid would be administered?
hypertonic
How long can an IV bag hang for?
no longer than 24 hours
The _____________ IV line is the one that carries the main IV solution and is continuous.
primary
What are the s/s of phlebitis?
-red, warm, tender, puffy, possible fever, palpable veins
What would the nurse do if she suspects the IV site is causing phlebitis?
-stop IV -discontinue -warm compress -don't use that vein anymore -document
What would the nurse do after she finds an infiltrated IV?
-stop infusion -discontinue -elevate extremity -document
The _____________________ IV line is connected to the primary and contains solutions of smaller volumes w/medications
secondary
When selecting a cannula for the IV, the nurse knows the ____________ the gauge number, the bigger the catheter.
smaller
Why should the AC area be avoided for IV's?
they are larger veins, but the pt's bend their arms and it can damage the vein
Fluids with >10% dextrose needs to be administered how?
through a CVAD (central venous access device)
Where should the three pt labels go for a pt with an IV?
-tubing -bag -site
List some areas to avoid for IV insertion
-veins below infiltration -veins below phlebitis -sclerosed/thrombosed veins -areas of inflammation, infection, disease, bruising, tattoos -areas of mastectomy, fistula, shunt -lymph node dissection, edema, blood clot -avoid veins distal to previous IV
What are the two types of hypotonic solutions?
0.33% sodium chloride 0.45% sodium chloride
Never use smaller than a ___ mL syringe for a CAD flush because of resistance.
10
The IV rate for KCl should NEVER exceed:
10 mEq/hr
At what angle should an IV be inserted?
10-15 degrees
How many drips does a macrodrip chamber hold?
10-15 gtt/mL
Never use smaller than a ___ mL syringe for a peripheral flush
3
TRUE or FALSE: KCl can also be given IVP.
FALSE!
How often should the IV site be assessed?
HOURLY
A patient with cerebral edema would most likely be order what type of solution? A. 3% Saline B. 0.9% Normal Saline C. Lactated Ringer's D. 0.225% Normal Saline
3% Saline. A patient with cerebral edema would be ordered a HYPERTONIC solution to decrease brain swelling. The solution would remove water from the brain cells back into the intravascular system to be excreted.
Where should the tourniquet be placed?
3-4 inches above the site you're sticking
What is the maximum concentration amount for KCl infusions?
40 mEq/mL
How many drips does a microdrip chamber hold?
60 gtt/mL
What is the dwell time of an IV?
72-96 hours
What should the nurse do when the pt has fluid overload?
-check inf. pump -raise HOB -slow inf. rate -notify MD -monitor vitals -I&O -labs -diuretics
What are some things the IV solution should be checked for before administering?
-clarity -particulate -leaks -expiration
What are the s/s of infiltration of an IV site?
-cool, pale, swollen -blanching -tightness -burning and pain -slow IV rate
How will the pt with fluid overload be presenting?
-dyspnea -crackles -JVD -moist cough -tachycardia -edema -hypertension
What are some indications for isotonic solutions?
-expand intravascular volume -tx for hypovolemia and hypotension
What are some things a hypotonic solution would be used for?
-cellular dehydration (due to DKA and diuretics)
What are the three types of isotonic solutions?
0.9% normal saline Lactated Ringers D5W
Which patient below would NOT be a candidate for a hypotonic solution? A. Patient with increased intracranial pressure B. Patient with Diabetic Ketoacidosis C. Patient experiencing Hyperosmolar Hyperglycemia D. All of the options are correct
A. A pt with increased intracranial pressure
________ fluids remove water from the extracellular space into the intracellular space. A. Hypotonic B. Hypertonic C. Isotonic D. Colloids
A. hypotonic
Which of the following is not a hypertonic fluid? A. 3% Saline B. D5W C. 10% Dextrose in Water (D10W) D. 5% Dextrose in Lactated Ringer's
B. D5W
What type of fluid would a patient with severe hyponatremia most likely be started on? A. Hypotonic B. Hypertonic C. Isotonic D. Colloid
B. hypertonic
A pt is receiving multiple IV solutions. After shift change at 0730, the day nurse goes to check the fluids and rates and notices one of the bags is not quite done infusing yet with about 50mL left in the bag. It was hung yesterday at 0700. What should the nurse do? A. Let if finish running with the other solutions B. Discontinue the solution and discard C. Notify the physician D. Turn up the IV rate to infuse the rest rapidly
B. it can only hang for 24 hours
When the cell presents with the same concentration on the inside and outside with no shifting of fluids this is called? A. Hypotonic B. Hypertonic C. Isotonic D. Osmosis
C. Isotonic
_______ solutions cause cell dehydration and help increase fluid in the extracellular space. A. Hypotonic B. Osmosis C. Isotonic D. Hypertonic
D. hypertonic
What are the 3 types of hypertonic solutions?
D5 .45% sodium chloride D5 .9 sodium chloride D5 Lactated Ringers
What needs to be closely monitored when a pt is receiving LR's?
K level (normal 3.5-5)
Why should the back of the hand and wrist be avoided for infusion of vesicant drugs peripherally?
Risk for extravasation
What does SAS mean?
Saline-additive-saline -flush the lock with 2-3 mL saline -administer medication -flush again with 2-3 mL saline
D5W solutions are sometimes considered a hypotonic solution as well as an isotonic solution because after the body metabolizes the dextrose the solution acts as a hypotonic solution. True or False?
TRUE! D5W is classified as a ISOTONIC fluid BUT after adminstration the body metabolizes the dextrose and the fluid left over is a hypotonic solution.
What is the best site for an IV?
upper extremity
Why are Lactated Ringer's used?
used frequently during surgery because of blood loss -replaced water and electrolytes
