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58 Cards in this Set
- Front
- Back
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Purpose of Intravenous Therapy
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- admin fluids
- electrolyte balance - medications - chemotheraputic agents - transfuse blood - nutrients and supplements - when pt is po - immediate effect |
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Risks of IV therapy
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- bleeding
- blood vessel damage - fluid overload - infiltration - infection - overdose - too fast or to slow - incompatability of drugs and solutions - allergic response - mobility issues |
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Fluids that make up the body
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- extracellular fluid/ECF 19L 20%
- interstitial fluid/ISF 15L 20% - intravascular fluid - plasma - blood and blood products 3.5L 5% - Intracellular Fluid 23L 40% |
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Average adult fluid intake
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2,400 - 3,200 ml p/day
- liquids 1,400 - 1,800 ml - water in foods 700 - 1,000 ml - water of oxidation - resp system- 300 - 400 ml |
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Average adult fluid output
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2,400 - 3,200 ml
- lungs 600 - 800 ml - perspiration 300 - 500 ml - kidneys/urine - 1,400 - 1,800 ml intestines - 100 ml |
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Regulation of fluids
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- antidiuretic hormone(ADH)
- aldosterone - thirst mechanism |
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Signs of Fluid defecit
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- weight loss
- HR up, BP down - poor skin turgor/capp refill, sunken eyes, pale cool skin - thirst, dry mouth, cracked skin - change in mental satus, weakness - decreased urine output - increased HCT, electrolyte, BUN, serum osmolarity |
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Signs of Fluid Excess
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- weight gain
- BP up, bounding pulse - increased JVD/resp rate - crackles, ronchi - edema, puffy eyes - slow emptying of hand veins when arm is lifted - decreased HCT, BUN, electrulyte, serum osmolarity |
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Electrolytes
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- chemical compounds that dissociate in solution into electrically charged particles or ions
- work like wires to conduct electrical currents - used for normal cell function |
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The six major electrolytes
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- calcium, sodium, potassium, phosphorus, chloride, and magnesium
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Osmosis
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- movement of water from igher concentration to lower concentration
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Osmolarity
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- measure of solute concentration 270 - 300
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The effect of IV solution depends on...
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osmolarity of the solution
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Isotonic
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- same osmolarity/tonicity
- stays intravascular - NS, D5W, LR (for low BP) |
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Hypotonic
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- less than 270
- shifts fluids from blood to cells - 1/2 NS |
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Hypertonic
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- over 300
- fluid from cells into blood - D51/2NS, D5LR, 25% albumin - use IV pump - caution with cardiac and renal patients |
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Calcium - normal levels
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- most abundant mineral
- 8.5 - 10.2 mg/dL |
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Potassium - normal levels
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- 98% in ICF
- 3.5 - 5.0 millomoles p/liter |
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Phosphorus - normal levels
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- 2.4 - 4.1 mg p/dL
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Magnesium - normal levels
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- 1.7 - 2.2 mg/dL
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Sodium normal levels
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- 135 - 145 mEq/L
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Chloride normal levels
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-96 - 106 mEq/L
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IV delivery methods
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- primary/continuous infusion
- intermittent/secondary infusion - direct injection - saline lock |
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Primary/Continuous Infusion
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- can give large volumes over a long time period
- constant drug dose - parenteral nutrition - frequently on infusion pump |
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Intermittent/Secondary Infusion
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- add a second infusion to a primary line
- specific time period |
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Direct Injection
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- IV push/IVP
- single dose/bolus |
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Saline Lock
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- used with intermittent IV therapy or IVP
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Macrodrip
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10, 15, 20 gtt/ml
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Microdrip
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60 gtt/ml
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Calculate flow rate
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- divide volume of infusion by time of infusion
- multiply by gtt factor (gtt/ml) |
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Regulation of flow rate
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- assess frequently in critical pts, peds, elderly, and conditions effected by overload, and with drugs that can cause tissue damage
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IV documentation
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- start, maintenance, discontinue, pt teaching
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IV Start documentation
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- device, date, time, location, type of dressing, condition of site, type of solution, rate, flow controller, patient's response, number of attempts, pt teaching/understanding
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IV maintenance documentation
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site condition, site care, dressing changes, tubing and solution change, teaching
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IV discontinue documentation
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- time, date, reason for DC, assesment of site before amd after DC, pt. reaction, integrity of device, dressing
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IV patient teaching documentation
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- procedure and why it's needed, solution and time of infusion, activity restrictions, potential discomfort, pamphlets, videotapes, iv equipment demo
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Possible lawsuits
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- wrong dose or solution
- incorrect route - inappropriate placement - failure to monitor pt and equipment |
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5% dextrose in water
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- G/L 50
- isotonic - free h2o for renal excretion of solutes - replaces h2o loses - treats hypernatremia - admin a variety of meds - 170 kal/L - no electrolytes |
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10% dextrose in water
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- G/L 100
- hypertonic - provides free h2o only, no electrolytes - 340 kal/L |
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0.45 Saline
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- Na 77
- Cl 77 - hypertonic - free h2o, Na, Cl - replace hypotonic fluid loss - maintenance solution, does not replace daily electrolyte losses - no calories - can cause intravascular overload if infused to rapidly |
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0.9% Saline
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- Na 154
- Cl 154 - Isotonic - expands intravascular volume - replaces ECF losses - perioperative fluid - only solution used in admin of blood products - Na/Cl in excess of plasma levels - no free H2O or electrolytes - may cause intravascular overload or hyperchloremic acidocis |
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3% Saline
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- Na 513
- Cl 513 - Isotonic - treat symptomatic hyponatremia - admin slowly w/ extreme caution - may cause intravascular overload and pulmonary edema |
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Dextrose in saline
5% in 0.225% |
- G/L 50
- Na 38.5 - Cl 38.5 - Isotonic - Na, Cl, free H2O - used to replace hypernatremia - 170kcal/L |
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Dextrose in saline
5% in .45% |
- G/L 50
- Na 77 - Cl 77 - hypertonic - replace hypotonic fluid loss - maintenance solution, does not replace daily electrolyte losses - 170kcal/L |
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Dextrose in saline
5% in .9% |
- G/L 50
- Na 154 - Cl 154 - hypertonic - expands intravascular volume - replaces ECF losses - perioperative fluid - only solution used in admin of blood products - Na/Cl in excess of plasma levels - no free H2O or electrolytes - may cause intravascular overload or hyperchloremic acidocis - 170kcal/L |
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Lactated Ringers
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- G/L 130
- Na 4 - K 3 - Cl 109 - Hco3 28 - Isotonic - similar to normal plasma, does not contain Mg - treat mild metabolic acidosis; not lactic acidosis - no free H2O or calories |
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Isotonic
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- same osmoality as body fluids
- expands ECF - does not enter ICF - replacement fluid for intravascular volume |
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Hypotonic Solutions
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- solutions having an effective osmoality greater than body fluids
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Clinical Hypotonicity
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- occurs with abnormal gain in water or loss of sodium rich fluids
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Clinical Hypertonicity
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- occurs with loss of water, loss of hypotonic fluid (sweating, diarrhea)
- occurs with gain of effective osmoles (hyperglycemia, admin of sodium bicarbonate, or mannitol) |
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Colloid Solutions
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- expand only intravascular portion of ECF
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Plasma substitutes
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- dextran or hetastarch
- expand intravascular portion of ECF |
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Signs of Fluid Overload
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edema, lung crackles(posterior base), high BP, elevated/bounding pulse, JVD(jugular vein distention)
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Signs of Infiltration
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cool, pale, swollen, painful
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Phlebitis
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red, swollen, hard, lines up arms
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Signs of Infection
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tenderness, warm , fever, high WBC, purulent drainage/pus, painful, red
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Check/Document IV
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Q 2 hours
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Doctor's order must contain
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rate (ml/hour), solution (type/amount), additives if any
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