Exam 3 Dosage

Signs of phlebitis

Redness, warmth, or swelling at the insertion site Report of discomfort from IV Redness and increased firmness along the cannulated vein

What to do when you suspect fluid overload?

Slow rate of infusion, raise head of the bed, administer O2 if needed, notify provider, document findings and monitor vitals Anticipate a prescription for a diuretic

How to treat mild to moderate allergic reaction

Stop med infusion, replace IV tubing, infuse 0.9% sodium chloride, notify provider

How can nitro be administered?

Sublingual as a tablet or spray Transmucosal tablet Topical ointment Transdermal patch Continuous infsuion

What is speed shock?

Systemic reaction that occurs when an IV medication is administered too rapidly. causing blood levels of the medication to rise to possibly toxic levels

Why are children at high risk of dehydration than adults?

Their greatest portion of body fluid is the extracellular space, which places them at a higher risk for fluid loss

What is the action for labetalol?

Third-generation beta-blocking agent with alpha and nonselective beta activity

What syringe can be used to administer volumes of 1 mL or less?

Tuberculin syringe

What is D5W used for?

Used as a solution to add IV medications for intermittent IV bolus administration Combined with isotonic IV solutions to provide calories for calories for clients receiving continuous IV therapy

What is therapeutic play?

Using dolls or stuffed animals to show the child a procedure

What are large-volume bolus infusions used for?

Usually administered as a one-time prescription

What do alpha blockades cause?

Vasodilation--> decreases peripheral resistance and lowers blood pressure

Chemical causes of phlebitis

irritating solutions and rapid infusion rates

How do you calculate BSA?

m^2=\|((kgxcm)/(3,600))

A child weighs 9 kg. What is the child's daily maintenance fluid requirement?

x= (100x9) + (0x50) + (0x20)=900

An intravenous infusion of 20 mL/kg over a 2 hr periof for a child who weighs 10 kg. Calculate the infusion rate prescribed.

xmL/hr= (20 mL/1 kg) x (10 kg/ 1) x (1/2 hr) (200 mL/2 hr)= 100 mL/hr

A child weighs 23 kg and 121.5 cm tall. What is the child's body surface area?

xm^2=\|((23x121.5)/(3,600))= 0.88

Cefotaxime 1 g by intermittent IV bolus. Available is cefotaxime 1 g in D5W 100 mL to infuse over 30 min. How many mL/hr should you administer?

(100mL/30 min) x (60 min/1 hr) = (6,000/30) = 200 mL/hr

0.9% NaCl 1,000 mL IV to infuse over 10 hr. The drop factor of the manual IV tubing is 10 gtt/mL. How many drops per minute should you administer?

(10gtt/1 mL) x (1,000 mL/10 hr) x (1 hr/60 min) = 10,000 gtt/600= 16.66666 0r 17 gtt/min

Ceftriaxone 1 g by intermittent IV bolus. Available is ceftriaxone 1 g in D5W 100 mL to infuse over 30 minutes. The drop factor of the manual IV tubing is 15 drops/mL. How many gtt/min should you administer?

(15 gtt/1 mL) x (100 mL/30 min) = (1500/30) = 50 gtt/min

What is the bag placement for the tandem infusion?

Bags are placed side by side and both bags infuse at the same time

What is the bag placement for the piggyback infusion?

Primary bag below and secondary bag above

What do hypertonic solutions do to cells?

Pull fluid form interstitial spaces and cells into the veins

A nurse is preparing to administer labetalol 2 mg/min by continuous IV infusion. Available is labetalol 200 mg in 200 mL of D5W. The nurse should set the IV pump to deliver how much mL/hr?

(200mL/200mg) x (2mg/1min) x (60min/1hr) =120 mL/hr

A nurse is preparing to administer dopamine 2 mcg/kg/min by continuous IV infusion for a client who weighs 110 lb. Available is dopamine 400mg in 250 mL of D5W. The nurse should set the IV pump to deliver how many mL/hr administer?

(250mL/400mg) x (1mg/1,000mcg) x (2mcg/1kg) x (110lb/1min) x (60min/1hr) =3.75 mL/hr

Administer nitroprusside o.3 mcg/kg/min by continuous IV infusion. Available is 50 mg in 250 mL of D5W. The client weighs 70kg and has a systolic blood pressure of 210 mm Hg. Increase the dose by 0.3 mcg every 5 min to maintain a systolic BP at 100 to 120 mmHg. Determine how many milliliters per hour to administer initially.

(250mL/50mg) x (1mg/1,000mcg) x (0.3 mcg/1kg) x (70kg/1 min) x (60 min/1hr) =315,000mL/50,000hr = 6.3 mL/hr

Heparin 15 units/kg/hr by continuous IV infusion for a client who weighs 60 kg. Available is 20,000 units of heparin in 500 mL D5W. Determine how many mL/hr to administer.

(500mL/20,000 units) x (15 units/1 kg) x (60kg/1 hr) = (500 x 15 x 60) / (20,000 x 1 x 1) = (450,000) / (20,000) = 22.5 mL/hr

A provider prescribes mag sulfate 0.5 g/hr by continuous IV infusion. Available is mag sulfate 4,000 mg in 50 mL of D5W. Determine how many mL/hr to administer? (Round to nearest whole number)

(50mL/4,000mg) x (1,000mg/1g) x (0.5g/1hr) =6.25 mL/hr or 6 mL/hr

A nurse is preparing to administer 0.45% NaCl 600 mL IV to infuse over 8 hr. The drop factor of the manual IV tubing is 15 gtt/mL. The nurse should set the manual IV infusion to deliver how many gtt/min? Round to nearest whole number.

(8 hr = 480 min) (600 mL/480 min)= 1.25 1.25 x 15= 18.75 = 19

A child weighs 25 kg. What is the child's daily maintenance fluid requirement?

*Use (100 mL/kg x first 10 kg) + (50mL/kg x second 10 kg) + (20 mL/kg x remainder of weight in kg)* x=(100x10)+(50x10)+(20x5) 1000+500+100=1600 mL

What are examples of hypertonic solutions?

- 3% sodium chloride solution -dextose 10% in water -dextrose 5% in lactated ringer's ad dextrose 5% in sodium chloride are hypertonic in the bag but isotonic after the body metabolizes the dextrose

What are the signs of mild dehydration in children?

-3-5% weight loss -Pulse, respirations, blood pressure, activity, mucous membranes, anterior fontanel, skin turgor and capillary refill within expected range -Tears present -Thirst mild

What are the signs of moderate dehydration in children?

-6-9% weight loss -Pulse and respirations slightly increased -Systolic pressure normal to slightly decreased -Activity slightly irritable -Mucous membranes dry -Anterior fontanel level to sunken -Tears decreased -Thirst moderate -Skin turgor decreased -Capillary refill slowed (2 to 4 seconds)

What are some reasons for a pump alarm to go off?

-Air in the tubing -Remaining volume is low -Infusion complete -Low battery -Occlusion

What can cause an IV catheter embolism?

-Catheter breaks off in the vein -Can happen due to damage during insertion or too much force when flushing the catheter or administering a medication

Adverse effects of hypotonic solutions

-Continued infusion can cause cells to rupture -Cerebral edema

Signs and symptoms of severe allergic reaction

-Feeling of apprehension or weakness -hives and itching -erythema and angioedema of the eyes, lips and tongue -Resp. distress -Inc. mucus production -hypotension -tachycardia -diaphoresis -resp. or cardiac arrest

What are contraindications of lactated ringer's?

-Heart failure -Renal failure -Head injury -Liver disease -Respiratory alkalosis

What are contraindications of 0.9% sodium chloride?

-Heart failure -Pulmonary edema -Renal failure -Hypernatremia

What are the four ways IV fluids can be administered?

-Large-volume IV infusions on a continuous basis (for fluid and electrolyte replacement; for administering medications) -Large-volume IV bolus (usually for a one-time prescription) -Intermittent IV bolus infusion (usually a medication mixed in 50 to 250 mL of solution, given over less than 1 hr) -IV bolus (for small amount of medication- either concentrated or diluted; injected over a short time- typically 1 to 2 minutes)

Signs and symptoms of an IV embolism

-Pain in the extremity proximal to the IV insertion site -Signs of shock (SOB, cyanosis, tachy) and cardiopulmonary arrest -Findings depend on where the catheter fragment lodges

What factors can influence flow rate?

-Position of the forearm -Flexion of the wrist or elbow -Kinked or occluded tubing -Back pressure from an infiltrated IV

What are some examples of additives to primary IV solutions?

-Potassium chloride -Magnesium sulfate -Oxytocin -Heparin -Regular insulin

What do you do if you suspect a catheter embolism?

-Remove the catheter to see if it is damaged -Apply a tourniquet above the IV site if a broken piece can be palpated -Notify the provider and anticipate obtaining an x ray

What are the findings of fluid overload?

-SOB -intake greater than urine output -inc. blood pressure, heart rate and resp. rate -crackles in lungs -neck vein distention -extremity edema

How to treat infiltration

-Stop IV immediately and remove cannula -Elevate affected extremity, apply warm, moist or cold compresses -Refer to facility directions -Document size of infiltrated area, estimate the amount of fluid present and monitor the site

How to treat speed shock?

-Stop administering med -Change the IV fluid to an isotonic solution -Notify provider -Treat effects -Carefully monitor vital signs -Document

What do you do for a severe allergic reaction

-Stop the medication -Initiate O2 at 90% to 100% via nonrebreather -Replace IV tubing and infuse saline -Elevate the head to 45 degrees for SOB but place at 10 degrees if there is hypotension -Anticipate administering epi and diphenhydramine

How to prevent Speed shock

-Use an electronic infusion pump or other control device -When administering IV bolus medications, administer over at least 1 minute -Check medication references for medications that require slower administration -Dilute IV bolus medications appropriately -Administer intermittent IV bolus at the recommended rate

How to prevent phlebitis

-Use the correct size IV catheter for the vein -Secure IV catheter and tubing carefully to prevent irritation at the site -Use aseptic technique -Cover the IV site with a clear dressing to allow for frequent monitoring and prevent contamination with micro-organisms -Change the dressing if it becomes wet or dislodged

What are the signs of severe dehydration in children?

-Weight loss greater than or equal to 10% -Tachycardia -Fast and deep respirations -Systolic BP orthostatic to shock -Activity hyperirritable or lethargic -Parched mucous membranes -Sunken anterior fontanel -Absent tears -Tenting present -Cap refill delayed more than 4 seconds

What is an example of a hypotonic solution?

0.45% NaCl or known as half normal saline (1/2NS)

What is the preferred diluent for mixing with IV medications prior to administration?

0.9% sodium chloride

What is the preferred solution to use when administering blood products?

0.9% sodium chloride

What are two common isotonic solutions?

0.9% sodium chloride and lactated ringer's

What size needle should be used on all ages other than infants and toddlers?

1 inch needle

0.9% NaCl 1,000 mL IV to infuse over 8 hr. How many mL/hr should you administer?

1,000mL/8 hr = 125 mL/hr

What are the advantages of IV therapy

1. Medication into vein, effects immediately 2. Allows delivery of precise amount of medication as well as large volumes of IV fluid 3. Can administer meds that are irritating to tissues and thus cannot be administered by other routes 4. Can prevent discomfort that can occur with subcutaneous or intramuscular injection

What are the standard drop factors? (#'s)

10, 15, 20, 60 gtt/mL

How many calories does one liter of D5W povide?

170 calories

What is the osmolarity of isotonic IV solutions?

250 to 350 milliosmoles per liter

What is the osmolarity of hypertonic IV solutions?

350 milliosmoles per liter

In general, which needle should be used for IM injections in infants and toddlers?

5/8 inch

Solutions higher than _______ can irritate veins

500 milliosmoles per liter

What should be used to administer a subcutaneous medication?

A 3/16 inch, 26-30 gauge needle to administer no more than 0.5 mL

What can be used to deliver a dose of less than 0.5 mL?

A low dose syringe

What is piggyback infusion used for?

A method to administer a medication contained within smaller volumes of solution, usually 50 to 250 mL

When can extravasation occur?

A solution that leaks into the tissue contains a vesicant

What does magnesium sulfate treat?

Acute myocardial infarction, cardiac arrest, seizures secondary to eclampsia, preterm labor and magnesium deficiency

What are syringe pumps (mini pumps) used for?

Administer small amounts of solution

How often do you look for signs of phlebitis?

Alert oriented adults: every 4 hrs All other clients: 1-2 hours

What is the action of dopamine?

Alpha and beta adrenergic agonist Activates beta1 receptors in the heart and increases cardiac output, which leads to an increase in tissue perfusion Activates receptors in the kidneys, which dilates the renal vessels and cause an increase in glomerular filtration rate and urinary output

What does magnesium sulfate do?

An electrolyte that activates many intracellular enzymes, helps regulate skeletal muscle contractility and blood coagulation

What does heparin treat?

Anticoagulant following acute myocardial infarction For clients who have venous thrombosis or pulmonary embolism

Is D5W an isotonic or hypotonic solution?

Both This solution contains water and a small amount of carbohydrate Osmolarity is 252 and isotonic before infusion Dextrose metabolizes quickly after infusion, leaving only water, which freely moves into the cells and interstitial spaces

Bacterial causes of phlebitis

Break in asepsis during insertion and a break in the integrity of the dressing covering the insertion site

What needs to be monitored when giving magnesium sulfate?

Cardiac and neuromuscular status, serum magnesium levels, hypotension, depressed cardiac function, depressed or absent deep tendon reflexes and respiratory depression

What are findings of speed shock?

Chest pain and discomfort, lightheadedness, palpitations and tachycardia Could relate to shock and cardiac arrest

What is osmolarity?

Concentration of dissolved particles within a solution (solute within a solvent) Determines if IV solutions are isotonic, hypotonic and hypertonic

What are hypertonic solutions used for?

Correct fluid and electrolyte imbalances

What do beta blockades cause?

Decreases heart rate, myocardial contractility and rate of conduction through the AV node

What are the three major sites for IM injection?

Deltoid muscle, ventrogluteal muscle and vastus lateralis muscle

Treatment of extravasation

Depends on which vesicant medication leaked into the tissues and follow facility policy May be able to leave the peripheral IV catheter in place to allow instillation of an antidote medication

What does Lactated Ringer's contain?

Electrolytes, sodium, chloride, potassium, calcium and lactate

What topical numbing agents can assist with providing atraumatic care?

Eutectic mixture of local anesthetics (EMLA)

(T/F) Droppers are a precise unit of measurement

False

What are hypotonic IV solutions used for?

Fluid electrolyte imbalance (by moving water into cells) Ex. hypernatremia, may have a prescription for a hypotonic solution to dilute body fluids and rehydrate the cells

What is an insensible loss of fluid?

Fluid losses through the skin and respiratory system such as body temperature, respiratory rate, and environmental temperatures

What are the best sites for IV insertion in infants?

Hand, wrist, ankle and foot

Signs and symptoms for mild to moderate allergic reactions

Hives or vesicles, pruritus, edema, rhinitis, excessive tearing, nausea, vomiting, diarrhea, wheezing, and dyspnea Reaction can occur in two minutes to two weeks

What is the route that heparin is administered?

IV only

Signs of extravasation

Initially the same as infiltration but then there is blistering of the skin, tissue necrosis, and ulceration

What are the three categories of fluid loss?

Insensible, urinary and fecal

Mechanical causes of phlebitis

Inserting catheter in an area of flexion, using an excessively large IV catheter, and inadequately stabilizing the catheter after insertion

What are small volume bolus infusions used for?

Involve a small amount of medication, either concentrated or diluted, and last a short time (often about 1 to 2 minutes)

What does the liver metabolize to form bicarb?

Lactated ringer's

What do you administer a large volume bolus with?

Large gauge angiocatheter or central line

What is the osmolarity of hypotonic IV solutions?

Less than 200 milliosmoles per liter

What is in an EMLA?

Lidocaine and prilocaine

What is Phlebitis

Localized inflammation of the vein

What are intermittent infusions used for?

Medication mixed in 50 to 250 mL of solution administered over less than an hour

What are examples of a vesicant?

Medications and solutions include chemotherapeutic medications, vancomycin, dopamine and digoxin

What does lactated ringer's treat?

Metabolic acidosis

What is osmolarity measured in?

Milliosmoles per liter

Atraumatic Care

Minimizing separation from loved ones, promoting control within the child and minimizing injury and pain to the child

What do you monitor for when giving labetalol?

Monitor for hypotension, bradycardia, nausea, dizziness, pulmonary edema and sweating

What is the action for nitroprusside?

Non-nitrate vasodilator agent that causes direct vasodilation of arteries and veins, which results in rapid reduction of blood pressure

What are large volume infusions used for?

On a continuous basis, used for fluid and electrolyte replacement and for medications

What is the action for nitroglycerin?

Organic nitrate that causes direct vasodilation of arteries and veins resulting in rapid reduction of blood pressure and a decrease in venous return

Signs of infiltration

Pallor, swelling, and pain

What are cautions for delivering hypertonic solutions?

Patients that are at risk for: -fluid volume overload -heart or renal failure -older adults -young children