Iv

Front 1

Four essentials of IV infusions

Back 1

1) The prescribed volumed to be infused 2) The prescribed time for the infusion 3) The drop factor 4) the mathematical formula needed to calculate the rate

Front 2

IV will be in body

Back 2

w/in 17-25 sec "very rapid"

Front 3

Isotonic solutions

Back 3

have approx. the same % of solute in solution as blood. Same is on both sides. Normal saline (0.9% sodium chloride), Ringer's Lactate, Ringer's acetate, and 5% Dextrosein sterile water (D5W)

Front 4

D5W

Back 4

is isotonic in the bag, it acts like a hypotonic solu. once it enters the bloodstream b/c simple sugars like dextrose are the preferred source of energy for cells. Should be used w/ caution in pt's w/ ICP cuz the liver converts lactate to bicarbonate so don't give if pt's serum blood pH is 7.50 or above b/c won't be able to metabolize it

Front 5

Hypotonic solutions

Back 5

have lower % of solute in solution. 0.45% NaCl or 0.25% NaCl (with or w/out D5W)

Front 6

PICC line

Back 6

14 gauge/is a 50 to 60 cm long vascular access device w/ entry into the basilic, cephalic, or brachial veins of the middle to upper arm and resides in the superior vena cava

Front 7

SAVE acronym "Save that line program"

Back 7

SCRUPULOUS hand hygeine, ASEPTIC technique during catheter insertion and care, VIGOROUS friction to catheter hub prior to access, and ENSURING patency of the device

Front 8

PICC line

Back 8

Dressing changes need to be replaced every 2 days and transparent dressings every 7 days

Front 9

PRBC administration

Back 9

standard blood filter tubing, blood, 18g/standard Y-tubing, may use 20, Adverse rx's: S/S: back pain, chills, dyspnea, cyanosis, temp, rash, hives & itching/stop infusion

Front 10

Blood products

Back 10

NS or 0.9% sodium chloride is the only acceptable solution to be used w/ blood products

Front 11

Acute hemolytic rx

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Most serious but very rare, onset w/ in minutes to 24 hrs. fever, chills, flank pain, reddish or brown urine tachy, and HOTN leading to shock, cardiopulmonary arrest and death, Stop transfusion immed., hydrate w/ NS, Ck vs freq., support airway, BP, HR, UO, usually requires ICU mngment.

Front 12

Each unit of whole bl.or RBC's containes enough hgb to raise the hgb concentration in an average sized adult

Back 12

1g/dL

Front 13

Acute hemolytic rx

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Most serious but rate, fever or chills, flank pain, and reddish brown urine, tach, HOTN,leading to shock, cardiopulmonary arrest and death, Stop transfusion, immed, hydrate w/ NS, check VS, support airway, BP HR, and UO usually requires ICU mngmt., seen 1st 15min, 1st 50ml

Front 14

Transfusion-r/t acute lung injury

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Occurs when donor WBC's antibodies rc to recipients circulating WBC's, life threatening complement mediated rx causig surge of neutrophils into lungs, resulting in pulmonary damage, edema and resp. distress, onset immed. or w/in 24hrs.stop transfusionimmed. the usual....pt. may need to be intubated. prevention: ensure donor screening fro HLA granulocte antibodies when poss,

Front 15

Anthropometric Measurements

Back 15

Skinfolds, Height and wgt
Midarm circumference
Midarm muscle dircumference

Front 16

TCL/Total lymphocyte Count calc/ (used for immunocompromised clients

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% lymph x WB
________________
100

Front 17

A loss of 10% of the usual wgt or current wgt less than 90% of IBW is considered to be a risk factor of nutrition-r/t complications

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Mild malnutrition 85%-95
Moderate malnutrition 75-84%
Severe malnutrition less than 75%-IBW

Front 18

TPN

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The container of nutritional support must not infuse beyond a 24-hr. period of time. The next solution container is not ready, a 10% Dextrose solution must be hung to prevent rebound hypoglycemia

Front 19

TPN infusion

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infused at relatively slow rate (50ml/hr) to prevent hyperglycemia. VS should be monitored q 4hrs. Wean off nutr. support from 24-48hrs.

Front 20

Extravasation

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swelling , erythema, pain at the site, and inability to obtain bl. return (usually). Vein irritation manifests as complaints of achiness and tightness along the vein accompanied by redness and darkness

Front 21

Emergency drugs may be used to treat HSR's

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epinephrine, dipenhydramine, albuterol, Solu-Medrol, Aminophylline, Dopamine

Front 22

What do u cleanse insertion site w/ one of the following solutions

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2% Chlorhexidine gluconate (preferred)

Front 23

PICC line

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14 guage, A flexible 30cm guide wire is threaded thru the needle or peripheral I.V. catheter which is then removed, leaving the guide wire in place to maintain venous access

Front 24

Genetic defect regarding breakdown of medicine

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Genetic cytochrome P-450 (CYP450) enzyme in liver responsible for metabolism and if pt. has a defect in this enzyme then they won't be able to metabolize medicine

Front 25

Meds that are not compatible

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Gentamycin and Heparin
Phenytoin and Dextrose
To avoid incompatibility don't mixmultiple medications in a syringe for I.V bolus adm.

Front 26

Examples of drugs w/ narrow therapeutic margins when given I.V.

Back 26

thrombolytics, antihypertensives, vasodilators, antiarrythmics, K+, and other electrolytes in high concentrations, or drugs w/ toxic diluents such as phenytoin (Dilantin)

Front 27

Continuous infusion

Back 27

occurs when lg.-vol. parenteral solutions of 250 to 1000mL of infusate are administered continuously. An I.V. pump or controller to ensure an accurate flow rate should regulate these infusions. Admixture and bag changes can be performed q 8 to 24 hrs.

Front 28

When adding medication to an infusion container use,

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single-dose vials instead of multiple-dose vials to decrease the potential for infection, complications and medication errors. After adding an administration set, a solution or medication container must be infused or discarded w/in 24hrs.

Front 29

Intermittent infusion

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is any administration of a medication or an infusion that is not continous. Alt. routes are piggybacked thru est. pathway of the primary sol. simultaneous infusion, use of vol. control set, and intermittent infusions thru a locking device

Front 30

Phenytoin and Diazepam

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Both must be delivered over a lengthy period of time; the manufacturer provides specific guidelines for adm.

Front 31

Direct injections or intravenous push

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requires that the drug be drawn into a syringe before adm. or that that the drug be available in prefilled syringe. Dilantin and Valium and Lasix 1mL per min. the drug must be drawn into a syringe before adm. or that the drug be avail. in a prefilled syringe.

Front 32

Tobramycin thru IV

Back 32

given thru a central line at a slow rate of 30-60 and is diluted in 100cc/is very nephrotoxic is given at 17-18 drops is compatible w/ D5W. Not compatible w/ Zantac must discontinue and flush before starting Tobramycin. SE are nephrotoxicity and ototoxicity so monitor inner ear and renal fx

Front 33

FUN FACT

Back 33

Medications w/ a pH less than 5 or greater than 9 or an osmolality greater than 500 shouldn't be administered thru a midline or o/r peripheral catheter

Front 34

What is the usual way K+ is given I.V.

Back 34

Diluted w/ 1,000 mL (10-40mEq)

Front 35

When I.V. K+ causes pain along the course of the vein what nsg intervention can be done to reduce it.

Back 35

Hot pack for 30min
Check for patent IV
Add lidocaine to bag and use topical anesthetic
Fun fact: know K+ level befor ordering via doctor usually ordered if below 3.5

Front 36

Homologous

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transfusion of any bl. component that was donated by someone other than the recipient. must be used w/in 42 days (meaning not frozen)

Front 37

Autologous blood donor collection method

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Collection, storage and delivery of recipient's own blood. has to be used w/in 35 days.

Front 38

Biomechanical assessment for TPN

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Serum albumin and transferrin (iron) levels
Serum electrolytes
Total lymphocyte ct.
Urine assays (creatnine, ht index)

Front 39

o/r requirements for TPN

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Nitrogen balance
Indirect calorimetry
Prognostic nutr. index (PNI)

Front 40

Calculations (for TPN)

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%Ideal body wgt (IBW) = current wgt/IBW x 100
Recent change in body wgt. calc. % of Usual Body Wgt. (UBW)= Current body wgt./UBW x 100

Front 41

Marasmus

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Very thin looking. Decrease in the intake of calories w/ adequate protein-calorie ratio. Gradual wasting of the body fat and skeletal muscle, w/ anthropmetric measurements and energy. assoc. w/ chronic illlness and starvation

Front 42

Kwashiorkor

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Characterized by an adequate intake of calories along w/ a poor protein intake. Causes visceral protein wasting and preservation of fat and somatic muscle. Assoc. w/ liquid diets, fat diets, and long-term used of IV fluids containing dextrose. May appear obese and have adequate anthropometric measurements-depresses immun fx.

Front 43

% of solution that can be safely infused into a peripheral vein

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10% and 20% and above must be infused into a central vein

Front 44

macrodrip set

Back 44

delivers 10, 12, 15, 20 drops/mL

Front 45

Microdrip set

Back 45

usually delivers 50 to 60 drops/mL

Front 46

Calculation for I.V infusion rates

Back 46

gtt/mL of infusion set/60 (min. in 1 hr.) x total hourly volume = gtt/min.
I need an example.....oh well I just brain farted so forget it

Front 47

Speed shock s/s

Back 47

Flushing of head and neck
Feeling of apprehension
HTN
Pounding headache
Dyspnea
Chest pain
Chills
LOC
Cardiac arrest

Front 48

Medications that should be adm. alone b/c they are incompatible when mixed for intravenous infusion

Back 48

Diazepam (Valium)
Phenytoin (Dilantin)
oh so many more but not sure what to memorize...............................

Front 49

Miniinfusion administration

Back 49

The miniinfusion pump is battery opperated. It allows medications to be given in very small amts. of fluid (5 to 60ml) w/in controlled infusion times using standard syringes.

Front 50

Fun Fact:

Back 50

All IV K+ infusions greater than 20mEq/L must be adm. via infusion pump
Peripheral line concentration equal to 10mEq per 100mL of IV fluid
Central line concentration equal to 20mEq per 50mL of IV fluid

Front 51

Fun fact: K+

Back 51

a K+ level must be taken at least after 60mEq of IV K+ adm. before proceeding w/ additional cos. Must doc. urine ouput and serum creatnine. Remember K+ 3.5-5.0mEq/dL

Front 52

Administration of intermittent medication

Back 52

Verify order
educate pt.
wash hands
flush lock w/ 1 to 2 mL of 0.9% sodium chloride
Infuse the drug at the prescribed rate
Alter the drug delivery, flush the lock 0.9% sodium chloride

Front 53

Fun fact:

Back 53

Pt.'s using crutches or walker need catheter placement above the wrist.

Front 54

Balance of Fluid intake and Output in a Healthy State

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FLUID INTAKE
Ingested water 1300
Ingested food 1000
Metabolic oxidation 300
TOTAL 2600
FLUID OUTPUT
Kidney's 1500
Skin
Insensible loss 200-400
Sensible loss 300-500
Lungs 400
Gastrointestinal 100
Total 2500-2900
Output should not be less than 30mL in an hr.

Front 55

Crystalloid

Back 55

are isotonic and remain isotnic and are therefore, effective vol. expander a short period of time. However, both the water and the electrolytes in the solution can freely cross semipermeable membranes of the vessel walls (but not the cell membranes into the interstitial space, and will achieve equilibrium in 2 to 3 hrs. they are ideal for pt.'s who need fluid replacement

Front 56

Crystalloid (con't)

Back 56

Generally a good rule of thumb is that initial crystalloid replacement should exceed three liters before whole blood is institiuted. Continued use of crystalloids runs the ver real risk that the fluid that has leaked into the interstitial space will result in edema, primarily in the lungs (pulmonary edema)
E.g.: Lactated Ringer's (LR), NS Normal Saline

Front 57

Colloid

Back 57

these contain molecules (usually proteins that are too large to pass out of the capillary membranes and therefore remain in the vascular compartment. The lg. protein molecules give colloid solutions a very high osmolarity. As a result, they draw from the interstitial and intracellular compartments into the vascular compartment. They work well in reducing edema (as pulmonary or cerebral edema) while expanding the vascular compartment.
colloids can produce dramatic fluid shifts and place the pt. in considerable danger if they are not administered in a controlled settings.
E.g.: albumin and steroids (HYPERTONIC SOLUTIONS MAY DAMAGE SO R GIVEN THRU A CENTRAL LINE OR PICC LINE.

Front 58

Needle gauges for venipuncture

Back 58

16-18: Trauma
18-20: Infusion of Hypertonic or isotonic solutions
18-20: Blood adm. 18g preferred
22-24: Pediatric patients
22: Fragile veins in elderly person (if unable to place 20g prior to venipunture and AND ONLY TWO ATTEMPTS AT VENIPUNCTURE ARE RECOMMENED

Front 59

What beside lidocaine can anesthesize the site

Back 59

Saline

Front 60

Fun fact: Venipuncture

Back 60

Short peripheral catheters are indicated when the therapy lasts 6 days or less, then the fluids and medications have a pH b/w 5 and 9 and when osmolarity is less than 500mOsm/L

Front 61

Venipuncture facts

Back 61

For most adults, assess veins in hands first, preferrably non-dominant hand. But do not use hand veins for older adults who have lost subq tissue surrounding the veins or in patient shall be getting in an out of bed frequently or using their hands for other activities. Vesicant meds into hand veins is also contraindicated

Front 62

More fun facts on Venipuncture

Back 62

Cephalic/thumb
Bacilic/pinkey
always start w/ most distal site to upper extremities and move up as necessary. The infusion Nurses Societ (INS) recommends that ea/ subsequent cannula be place proximal to the last one.

Front 63

More fun facts on Venipuncture

Back 63

Do not use veins in the antecubital fossa or median cubital vein which is generally used to draw blood.
Starting at a distal site and making subsequent venipunctures proximal to the previous site is crucial. WHEN A COMPLICATION DEVELOPS AT A PROXIMAL SITE, YOU CAN'T USE VEINS DISTAL TO THIS SIT B/C THE FLUIDS AND MEDICATION WOULD INFUSE INTO THE DAMAGED SITE, COMPOUNDING THE PROBLEM. Dont use veins in the wrist for pokes b/c of their close proximity to nerves.

Front 64

More fun facts on Venipuncture

Back 64

Soemtines in an emergency, the dorsum of the foot and the saphenous vein of the ankle in an adult can be used until central venous access is obtained

Front 65

What should a good vein look and feel like

Back 65

soft, elastic, straight, engorged and bouncy. If feels hard and like a cats tail or has had an infection near the area, hard, bumpy or flat avoid and always wear gloves when palpating.....yeh good luck

Front 66

Cephalic vein/thumb

Back 66

lies above the antecubital space and is often difficult to visualize and stabilize. It can accommodate 22-16 catheters, but it should be reserved for a midline catheter or peripherally inserted central catheter

Front 67

Accessory cephalic vein

Back 67

branching off the cephalic vein is loc. on the top of the forearm. Med to lg. sized, it's easy to stabilize and can accommodate 22-18g. Don't place the catheter tip in the bend of the arm!!!

Front 68

Median vein

Back 68

Median vein of the forearm originates in the palm of the hand extends along the underside of the arm, and empties into the basilic vein or median cubital vein. Medium sized and easy to stabilize, this vein can accomodate 24-20 g catheters.

Front 69

Basilic vein

Back 69

lies along the medial (little finger) side of the arm. Although large and easy to see, it rolls and is difficult to stabilize. Often ignored b/c its loc. make it difficult to work w/, it can accommodate 22-26g. Increase ur success w/ this vein by placing the pt's arm across his chest and standing on the opposite side of the bed to perform the venipuncture.

Front 70

Cephalic vein

Back 70

Lying along the lateral pinkey side of arm. is large and easy to access. Accommodating 22-16g, its an excellent choice for infusing chemically irritating solutions and bl. product. B/c the radial nerve is close the this vein, perform venipuncture 4 to 5 inches (10 to 12.5cm) above the level of the wrist, but not in the wrist.

Front 71

Fun fact re: venipuncture

Back 71

The metacarpal and dorsal veins on top of the hand are good sites to begin I.V therapy in some patient's. Easily visualized, they can accomodate 24-20g catheters. DON'T USE THIS SITE FOR VESICANT MEDICATIONS.