Clayton's Basic Pharmacology for Nurses Chapter 11

Hypotonic solution

Solute concentration is less than that inside the cell; cell gains water. Used in cellular dehydration.

symptoms of pulmonary embolism

Tachycardia, Pleuritic pain, unexplained hemoptysis

Implanted Central Venous Catheter

consist of an implanted long term venous access port device composed of a catheter and reservoir with a self-sealing septum. Can last for more than a year if properly flushed with saline-heparin solution after every use and once monthly.

D5W

example of a hypotonic solution

TKO

to keep open-minimum rate 10 mL/hr

Groshong catheter

Contains 1-3 rounded valve tips (Lumens). Opens inward for blood sampling, outward for infusion. Remains closed when not in use. Flushed weekly with saline, no need to clamp-remains capped when not in use.

Winged needle IV catheter

- A.K.A butterfly catheter, scalp catheter - SHORT TERM USE! - Blood collection. - Admin of non-irritating meds. - Easy to puncture vessel wall, allowing SQ infiltration. - Plastic wings facilitate placement

Veins of the lower extremities

IV sites at greatest risk for development of thrombi

symptoms of air embolism

Palpations, chest pain, and shortness of breath

hypertonic solution

- They should not be administered in peripheral veins if the osmolalities are more than approximately 600 to 700 mOsm/L - They are administered through central infusion lines, where the solution can be rapidly diluted by large volumes of rapidly flowing blood - They cause cellular dehydration and vascular volume overload, by pulling fluid from the intracellular and interstitial compartments into the intravascular compartment

Infiltration Scale

0: no symptoms; 1: skin blanched, edema <1" in any direction, cool to touch, w/or w/o pain; 2: skin blanched, edema 1-6" in any direction, cool to touch, w/or w/o pain; 3: skin blanched, gross edema >6" in any direction, cool to touch, mild to mod pain, poss numbness; 4: skin blanched, translucent, skin discoulored, bruised, swollen, gross edema >6" in any direction, deep pitting tissue edema; circulatory impairment, mod to severe pain, infiltrate of any amount of blood product, irritant or vesicant

Steps would a nurse follow when discontinuing an intravenous (IV) infusion when the IV site is to be converted to a saline lock?

- Attach the flush syringe to the extension tubing - Stabilize the catheter hub when disconnecting the primary IV tubing - Shut off the infusion equipment after clamping the tubing on the IV line

Physiological fluids through IV device

- Change the administration set every 72 hours - Monitor the patient's intake and output carefully - Report decline in hourly outputs to the primary healthcare provider

Flushing an intravenous (IV) line and are unable to aspirate blood during the procedure

- Check whether the clamp on the IV tubing is open - Remove the injection cap and aspirate the blood clot - Reposition the patient's upper body and help perform Valsalva maneuver

Changing the solution of IV when the same tubing will be used

- Clamp the tubing on the primary IV line before changing the container - Use aseptic technique to change the container quickly for the empty one - Ensure that the compatibility of the new IV solution is checked with the current solution

educating a patient regarding the use of over-the-needle catheters

- Teflon-like plastic is used to make over-the-needle catheters - The metal needle is removed after the catheter is inserted into the veins - Over-the-needle catheters should ideally be changed every 72 to 96 hours

statements that are true about IV administration of medications

-IV administration is the most rapid of all parenteral routes. -Large volumes of fluids can be rapidly infused into a vein -The nurse should always check for drug allergies before administration

midline catheter

3-8 inches long, double or single lumen; inserted through intermediate sized veins and advanced to larger vessels. Used for therapies lasting 1-4 weeks but no recommended optimal dwell time (fluid hydration, long-term antibiotics, heparin infusions for DVT).

Microdrip chamber

60 drops/ml

Application of heat to the site

A patient receiving IV vincristine for the treatment of acute leukemia develops extravasation. Which action does the nurse implement?

Dextrose 5% in water (D5W)

A sterile solution that contains a concentration of 5% dextrose in water. Hypotonic solution.

IV SITES: Infants

Back of the hand, dorsum of the foot, and temporal region of the scalp

Irritation of the vein by the catheter Infection Chemical irritation from medication

Causes of thrombophlebitis

Midline catheter

Devices used for 2-4 weeks of IV therapy

Symptoms of excess IV fluids in elderly

Frothy sputum, thready pulse, cardiac dysrhythmias

Every 24 hours

How often should the nurse change the IV administration set used for TPN?

Intervention in nursing care plan for pt receiving IV therapy

I&O

syringe pump

Infusion control device is used to administer morphine through a patient-controlled analgesia (PCA) pump

Tunneled Central Venous Catheter

Long-term use Implanted into the internal or external jugular or subclavian vein Length of catheter is >8 cm depending on patient size Broviac, Hickman, Groshong

What prevents backflow of blood in implanted venous access device?

Maintaining firm pressure on the plunger of the syringe when withdrawing the needle

Subclavian vein

Most commonly used vein for central venous catheters

What can the nurse do to prevent fungal infection on a IV site?

Refrain from applying topical ointment or cream

SASH guideline

Saline flush first Administer the prescribed drug Saline flush after the drug Heparin flush line

Irritation of the vein by catheter, infection, chemical irritation from the medication

Situations associated with intravenous therapy can cause thrombophlebitis

Midline access catheters

They are used if it is anticipated that IV access will be needed for 7 days or more

Refrain from forcing the flush into the IV catheter

This intervention is essential for preventing a pulmonary embolism.

Implantable infusion ports

Used for long-term therapy when intermittent accessing of the central vein is required for IV fluids, medications, TPN, chemotherapy, and blood products. Provides the most flexibility for patients.

Slow infusion to TKO

Which course of action would the nurse take if a patient with an intravenous (IV) line has signs of pulmonary edema?

0.9% normal saline

Which fluid may be used to maintain vascular volume in a patient who is hypovolemic and hypotensive?

0.9 Normal Saline (NaCl) is an example of

an isotonic solution. May be used to maintain vascular volume in a patient who is hypovolemic and hypotensive

speed shock

caused by rush of IV fluid administered; med races to blood-rich heart and brain and floods them w/toxic levels of med. First priority is stopping the infusion immediately.

Lactated Ringers

isotonic solution Ideal for patients that have intravascular fluid deficit (acute blood loss, as a result of hemorrhage, GI bleed, trauma)

implantable venous infusion ports

placed into central veins for long term therapy

Older adult IV site precaution

refrain from inserting catheter in the hands