Iv Workshop - Day 1 (Nac 1)

Front 1

(def)

nursing intervention relative to the initiation, maintenance, and discontinuance of intravenous fluids and medications administered through a peripheral or central line

Back 1

Intravenous Therapy (as defined by the LSBN)

Front 2

___% of hospitalized patients receive some form of IV therapy.

Back 2

80%

Front 3

The number of IV therapies administered by home health nurses is _______ (increasing or decreasing).

Back 3

increasing

Front 4

What is the yearly estimated number of catheter-related blood stream infections? Of this number, what percent results in death?

Back 4

80,000 estimated cases with a 14-18% mortality rate

Front 5

What is the reasoning for using a vein for IV therapy rather than an artery? (2)

Back 5

- thin and less muscular
- distend easily (allowing for storage of a large volume of blood under low pressure)

Front 6

What are the 3 layers of a vein, from outer to innermost?

Back 6

1. Tunica Adventitia
2. Tunica Media
3. Tunica Intima

Front 7

Which layer of a vein consists of connective tissue that supports and surrounds the vessel?

Back 7

Tunica Adventitia

Front 8

Which layer of a vein consists of muscular and elastic tissue along with nerve fibers used for vasoconstriction and dilation?

Back 8

Tunica Media

Front 9

Which layer of of a vein is innermost, consists of a single cell layer of fragile cells, an allows for easy blood flow?

Back 9

Tunica Intima

Front 10

On average, a person requires ____ mL of water per Kg of body weight for maintenance therapy.

Back 10

30

Front 11

List the requirements for maintenance IV therapy for the following:

carbohydrates
potassium
sodium

Back 11

carbohydrates - 100-150 gm
potassium - 40-60 mEq
sodium - 1-2 mEq per kg of body weight

Front 12

Approximately how many mL of fluid is lost per a day via normal evaporation?

Back 12

400 mL

Front 13

Approximately how many mL of fluid is lost per day via breathing?

Back 13

400 mL

Front 14

Approximately how many mL of fluid is lost per day via feces?

Back 14

100-200 mL

Front 15

Approximately how many mL of fluid is lost per day via urinary output?

Back 15

1000-1200 mL

Front 16

List (7) factors that determine the type and amount of IV solution needed.

Back 16

1. Imbalances identified by laboratory tests
2. weight
3. kidney function and urinary output
4. cardiac function
5. hepatic function
6. disease process and duration
7. hormonal imbalance

Front 17

Describe the rate of absorption with IV administration.

Back 17

total, rapid absorption (therefore therapeutic effect begins almost immediately)

Front 18

True/False:

An exact dosage can be achieved with IV administration of medications.

Back 18

True- IV medications do not enter the hepatic portal system, therefore there is no drug loss due to first pass effect.

Front 19

When medications must be repeated often, why is the IV route preferred over the SQ/IM route?

Back 19

There is less tissue damage with the IV route of administration

Front 20

Which would be preferred when administering a drug with a high concentration, SQ, IM or IV?

Back 20

IV

Front 21

When administering medication with an IV, the dose can be _________ to achieve a therapeutic goal and to sustain continuous control.

Back 21

titrated

Front 22

List 4 disadvantages of IV administration.

Back 22

1. administered dose cannot be withdrawn and the action cannot be terminated
2. drug interaction due to incompatibility
3. leaching from plastic container and tubing
4. adsorption into plastic container and tubing

Front 23

What are (6) factors that affect drug solubility and compatibility?

Back 23

1. drug concentration
2. pH
3. Temperature
4. Light
5. Preparation technique
6. duration of drug-solution contact

Front 24

DEHP, an additive in PVC to make plastic flexible, may leach (be extracted) from the plastic tubing into the medication or substance being administered. What could this phenomenon result in?

Back 24

DEHP-induced toxicity

Front 25

What should you do to avoid DEHP-induced toxicity in a patient receiving lipid (and certain medication) infusions?

Back 25

always use the nonreactive tubing that comes with the medication from the pharmacy

Front 26

In regards to IV tubing, glass, and/or plastic, what is adsorption and how does it affect drug administration?

Back 26

Many drugs attach to glass and/or plastic (especially PVC in plastic IV bags); this results in a lower dose being administered

Front 27

What should you do to deter adsorption of drugs into IV equipment?

Back 27

inject the drug as close to the IV insertion site as possible

Front 28

Are there any risks (to the patient or nurse) associated with IV therapy? Give examples.

Back 28

Yes, there are risks of needlesticks among nurses. Additionally, the patient is at risk for complications such as infection, speed shock, phlebitis, infiltration, and discomfort that may lead to emotional distress

Front 29

When in doubt about IV drug compatibility, what should you do before and after giving each medication?

Back 29

flush the IV tubing with normal saline

Front 30

What should you do if a drug is discolored or has formed a precipitate?

Back 30

Do NOT administer that drug. Notify pharmacy.

Front 31

If you do not have a clear understanding of the compatibility or stability of the solution or medication you are to administer, what are some options to obtaining that information?

Back 31

- check your IV guide book
- refer to manufacturer's recommendation
- call the pharmacist

Front 32

(def)

a set volume of an IV solution delivered over an ordered time range (ex. infuse NS @ 100 mL/hr)

Back 32

continuous infusion

Front 33

(def)

a set amount of medication delivered at a regular interval, often administered as a piggyback (ex. Ceftazidime 1 Gm in 50 ml D5W IVPB Q 8 hours)

Back 33

intermittent infusion

Front 34

(def)

administration of a prescribed concentration of medication by injecting through a Y port of primary administration tubing or through a saline lock (ex. Digoxin 0.25 mg IVP Q AM)

Back 34

intravenous push

Front 35

How fast do you deliver an IV push?

Back 35

Varies with the drug, refer to IV med book for rate of administration

Front 36

For an IV push, which method is preferred: Sharp needle or Blunt cannula? Why?

Back 36

Blunt cannula, as it reduces the risk of needlestick injury to the nurse

Front 37

(def)

the minimal volume of IV solution on continuous infusion to lessen possibility of occlusion and to maintain an IV access available (ex. D5W or NS at 10-20 ml/hr)

Back 37

KVO (keep vein open)

Front 38

(def)

method of IV administration where the pump delivers a fixed hourly dose, basal dose, or a combination of both, and the patient is able to self administer a preset amount in addition to the fixed hourly dose

Back 38

Intermittent/continuous dosing (ex. PCA)

Front 39

(def)

a dose of a medication or a contrast material injected all at once intravenously; rapid delivery of an IV medication or solution

Back 39

bolus

Front 40

What tool should be used when administering an IV fluid bolus to ensure accurate dosage?

Back 40

IV pump

Front 41

What should be evaluated when administering a fluid IV bolus?

Back 41

monitor for signs of fluid overload or the need for additional fluids

Front 42

True/False:

You should closely monitor a patient who receives an IV medication bolus, however an IV fluid bolus does not require close attention.

Back 42

False- both should be monitored closely

Front 43

What factors may influence IV flow rate? (10)

Back 43

- position of the arm or forearm
- position and patency of the tubing (bent, taped, etc.)
- use of a pressure bag
- height of the infusion bag
- fluid viscosity
- patient's BP
- clamp position
- amount of fluid in the IV container
- size of vein in relation to the size of the catheter
- condition of the infusion site (infiltration, extravasation, clotted cannula, location of cannula)

Front 44

Water accounts for ___% of total body weight.

Back 44

60%

Front 45

____ % of total body weight is water residing in the intracellular fluid compartment, and ___% if water residing in the extracellular fluid compartment.

Back 45

40%=ICF
20%=ECF

Front 46

What are the 2 divisions of ECF, and what percent of total body weight does each account for?

Back 46

intravascular = 5%
interstitial/transcellular = 15%

Front 47

What are 6 functions of body fluids?

Back 47

1. maintains blood volume
2. transports oxygen, nutrients, electrolytes, and hormones to cells
3. carries waste products away from the cells
4. keeps cell shape
5. temperature regulation
6. lubricates membranes and joints

Front 48

(def)

movement of water through a semipermeable membrane from an area of lower concentration to an area of higher concentration

Back 48

osmosis

Front 49

The tunica intima, capillary walls, and cell membranes of RBCs all have what in common?

Back 49

they are all semi-permeable membranes

Front 50

(def)

the pressure of intravascular fluid against the wall of a blood vessel

Back 50

hydrostatic pressure

Front 51

(def)

osmotic pressure exerted by plasma colloids (keeps plasma in the intravascular space)

Back 51

colloid oncotic pressure

Front 52

What is the osmolarity of normal serum?

Back 52

275-295 mOsm/L

Front 53

Isotonic solutions have an osmolarity range of what?

Back 53

240-340 mOsm/L

Front 54

Hypertonic solutions have an osmolarilty range of what?

Back 54

Above 340 mOsm/L

Front 55

Hypotonic solutions have an osmolarity range of what?

Back 55

below 240 mOsm/L

Front 56

What effect does an isotonic solution have on the intravascular volume?

Back 56

it expands the volume in the intravascular space

Front 57

What effect does a hypertonic solution have on the intravascular space?

Back 57

it expands the volume in the intravascular space by shifting fluid from the intracellular and interstitial spaces

Front 58

Isotonic, Hypertonic, or Hypotonic:

D5 1/2 NS

Back 58

hypertonic

Front 59

Isotonic, Hypertonic, or Hypotonic:

D5NS

Back 59

hypertonic

Front 60

Isotonic, Hypertonic, or Hypotonic:

D5LR

Back 60

hypertonic

Front 61

Isotonic, Hypertonic, or Hypotonic:

25% Albumin

Back 61

hypertonic

Front 62

Isotonic, Hypertonic, or Hypotonic:

3% NaCl

Back 62

hypertonic

Front 63

Isotonic, Hypertonic, or Hypotonic:

Normosol M

Back 63

hypertonic

Front 64

Isotonic, Hypertonic, or Hypotonic:

TPN

Back 64

hypertonic

Front 65

Isotonic, Hypertonic, or Hypotonic:

PPN

Back 65

hypertonic

Front 66

What are 3 examples of situations where a hypertonic solution may be ordered?

Back 66

1. postoperatively to stabilize BP
2. to maintain urine output
3. to reduce edema

Front 67

What are 2 examples of patients who may have problems with hypertonic solutions?

Back 67

Patients with heart and renal problems may not be able to handle the increased intravascular volume

Front 68

What effect does a hypotonic solution have on the intravascular space?

Back 68

fluid is shifted OUT of the intravascular space into the interstitial and intracellular space

Front 69

Isotonic, Hypertonic, or Hypotonic:

0.45% NaCl

Back 69

hypotonic

Front 70

Isotonic, Hypertonic, or Hypotonic:

0.25% NaCl

Back 70

hypotonic

Front 71

Isotonic, Hypertonic, or Hypotonic:

2.5% dextrose in water

Back 71

hypotonic

Front 72

Isotonic, Hypertonic, or Hypotonic:

5% dextrose in water

Back 72

Isotonic (however it becomes hypotonic upon admission due to the metabolic breakdown and resulting water byproduct)

Front 73

Isotonic, Hypertonic, or Hypotonic:

0.9% NaCl

Back 73

Isotonic

Front 74

Isotonic, Hypertonic, or Hypotonic:

Lactated Ringer's

Back 74

Isotonic

Front 75

What is an example of a situation that would require the administration of hypotonic IV fluids?

Back 75

to correct cellular dehydration caused by hyperglycemia and excessive diuresis due to diuretics

Front 76

What are things that should be monitored when administering hypotonic fluids?

Back 76

- monitor for edema
- monitor neurological status
- could worsen 3rd spacing
- monitor for lowered BP

Front 77

Hypotonic fluids should be used cautiously in what type of patients?

Back 77

- burns
- liver disease
- renal failure
- trauma

Front 78

(def)

a solution of sterile water with added electrolytes and non-electrolytes which diffuse across a semi-permeable membrane; can be hypertonic, hypotonic, or isotonic

Back 78

crystalloid

Front 79

(def)

a solution that contains proteins or synthetic sugar/starch which remains in the intravascular space for several days

Back 79

plasma expanders

Front 80

What are 4 types of plasma expanders?

Back 80

1. colloids (albumin, plasmanate)
2. dextran
3. hetastarch
4. Mannitol

Front 81

What are 3 adverse effects of plasma expanders?

Back 81

1. allergy
2. prolonged bleeding time
3. lowered platelet and hematocrit levels

Front 82

What are 7 examples of blood/blood products?

Back 82

1. whole blood
2. packet RBC
3. fresh frozen plasma
4. platelets
5. clotting factors
6. albumin 5%
7. albumin 25%

Front 83

A unit of PRBC increases hematocrit by ___-___%.

Back 83

2-3%

Front 84

(def)

fat emulsion made from soybean or safflower oil, eggyolk, phospholipid, and glycerol; used in conjunction with TPN

Back 84

lipids

Front 85

(def)

decrease in ECF volume or and increase volume in interstitial space; aka dehydration

Back 85

Fluid volume deficit

Front 86

A fluid volume deficit is indicated with an osmolality greater than _____.

Back 86

295

Front 87

What are signs/symptoms of fluid volume deficit? (12)

Back 87

1. hypotension
2. low urine output
3. tachycardia
4. weak, thready pulse
5. restlessness
6. confusion
7. lethargy
8. flat neck vein
9. excess thirst
10. poor skin turgor
11. dry mucous membranes
12. weight loss

Front 88

What effect would you expect to see on urine SG with a fluid volume deficit?

Back 88

it would be greater than 1.035

Front 89

What effect would you expect a fluid volume deficit to have on BUN, sodium, and HCT values?

Back 89

normal or high values

Front 90

What are 3 orders than may be given in attempt to correct a fluid volume deficit?

Back 90

1. increase IV rate
2. give an IV bolus
3. increase oral intake as tolerated

Front 91

(def)

an increase in ECF with an osmolality less than 275

Back 91

fluid volume excess (fluid overload)

Front 92

What are signs/symptoms of fluid volume excess? (14)

Back 92

1. irritated cough
2. SOB
3. crackles/wheezing
4. drop in O2 saturation
5. pulmonary edema
6. distended neck vein
7. tachycardia
8. bounding pulse
9. increased BP
10. polyuria
11. moist, taut skin
12. headache
13. confusion
14. weight gain in a short time

Front 93

What value would you expect urine SG to be with a fluid volume excess?

Back 93

urine SG less than 1.01

Front 94

Would you expect an increase or decrease in sodium, BUN, and HCT with a patient experiencing fluid volume excess?

Back 94

decrease

Front 95

What type of MD order should you anticipate with a patient experiencing fluid volume excess?

Back 95

restrict oral/IV fluids

Front 96

What are some general uses for dextrose solutions?

Back 96

1. provide calories for energy
2. prevent ketosis
3. spares body proteins
4. flush the kidneys to excrete solutes
5. decrease Na+ and K+
6. treat dehydreation
7. improve liver function

Front 97

Can dextrose solutions be given to diabetic patients?

Back 97

yes, provided that serum glucose is monitored

Front 98

How many grams of dextrose are in 100 mL of water for a D5W solution?

Back 98

5 grams

Front 99

Given that 100mL of D5W has 5 grams of dextrose, how many calories does one liter provide?

Back 99

170 (200)

Front 100

Prolonged therapy with D5W may cause what 3 conditions?

Back 100

1. hypokalemia
2. hyponatremia
3. water intoxication

Front 101

What are 3 signs/symptoms of hypokalemia?

Back 101

1. cardiac arhythimias
2. lethargy
3. decreased bowel sounds

Front 102

What are 3 signs/symptoms of hyponatremia?

Back 102

1. lethargy
2. confusion
3. encephalopathy

Front 103

(def)

water gained in excess of electrolytes; results in abdominal craps, nausea, vomiting, lethargy, and dizziness

Back 103

water intoxication

Front 104

What are some general uses for NaCl solutions? (6)

Back 104

1. used with blood transfusions
2. trauma and shock resuscitation
3. fluid challenges (dehydration/lack of intake, check output/kidney function)
4. acidifying solution
5. conservative treatment for metabolic alkalosis
6. to correct sodium loss

Front 105

What is a common use for Dextrose combined with NaCl?

Back 105

to replace fluid loss (vomiting, gastric suctioning, profuse sweating)

Front 106

What is a common use for Ringer's solution?

Back 106

to replace fluid loss (diarrhea, fistula drainage, drastically reduced water intake)

Front 107

What are some general uses for Lactated Ringer's solution?

Back 107

1. replace fluid loss (from burns, diarrhea, bile loss)
2. alkalizing solution
3. salicylate overdose

Front 108

An order for Lactated Ringer's should be clarified for a pH of more than ____.

Back 108

7.5

Front 109

(def)

most common IV access method, consisting of a short catheter that utilizes the arm and hand veins

Back 109

Peripheral IV line

Front 110

What is the average length of a peripheral IV line?

Back 110

3/4 to 1 1/4 inches

Front 111

How often should a peripheral IV line be rotated?

Back 111

every 96 hours or per hospital policy

Front 112

(def)

an adapter fitted to an IV catheter with a resealable, injectable port for peripheral venous access

Back 112

saline lock

Front 113

What is the purpose of a saline lock?

Back 113

- minimizes restriction in ambulation
- access for emergency medication / intermittent medication
- limits IV intake

Front 114

What is SAS?

Back 114

a code word for flushing a saline lock; stands for (s)aline, (a)dminister, (s)aline.

Front 115

What is the purpose of SAS?

Back 115

- moves the medication to main circulation
- clears catheter of residual medication
- prevents occlusion

Front 116

Describe in detail the procedure for SAS.

Back 116

- Wash hands and don gloves
- disinfect the port with alcohol and let it dry
- aspirate blood to check patency (only when drawing blood)
- slowly administer 2-3 mL saline in 3mL syringe while feeling above catheter tip (stop if resistance or pain/leak noted)
- administer medication
- flush with saline, using push-pause/ pulsatile technique

Front 117

How long should a port be cleaned with alcohol?

Back 117

15 seconds

Front 118

When flushing a line, why should you never push against resistance?

Back 118

b/c it could push a clot into circulation

Front 119

What is done to confirm placement of a central IV line?

Back 119

Chest X-ray

Front 120

What must be obtained prior to using a newly placed central line?

Back 120

a doctor's order

Front 121

Where is the tip of a central line located?

Back 121

the Superior Vena Cava

Front 122

What is the average liter/min blood flow in the superior vena cava?

Back 122

1.5 to 2.5 liter/min

Front 123

What is the length of a central line?

Back 123

depending on type, the length can range from 8 to 30+ inches

Front 124

What may be used to keep the patency of a central IV line?

Back 124

Heparin (verify MD order)

Front 125

A central line is coated with what?

Back 125

an antimicrobial/antiseptic agent

Front 126

How long does a central line stay in place?

Back 126

from several days to months

Front 127

How often should a clear dressing covering a central line be changed?

Back 127

every 6 day or PRN (or per hospital policy)

Front 128

How often should a gauze dressing covering a central line be changed?

Back 128

every 2 days or PRN (or per hospital policy)

Front 129

What is the ml/min blood flow in the cephalic and basilic veins?

Back 129

45-95 ml/min

Front 130

What is the ml/min blood flow in the subclavian vein?

Back 130

150-300 ml/min

Front 131

On average, what is the ml/min blood flow in the SVC?

Back 131

2000ml/min

Front 132

What are 6 examples of central venous devices?

Back 132

1. non-tunneled
2. tunneled
3. pulmonary artery catheter
4. PICC
5. Midline catheter
6. totally implanted device

Front 133

What is the purpose of a pulmonary artery catheter?

Back 133

to monitor cardiac function

Front 134

What are 3 reasons for flushing a Central line?

Back 134

1. to move medication to main circulation
2. to clear the catheter of residual medication
3. to prevent occlusion

Front 135

Describe in detail the procedure for flushing a central line.

Back 135

- wash hands and don gloves
- disinfect port with alcohol and let dry
- administer saline 5-10 mL in a 10 mL syringe (stop if leak, resistance or pain noted)
- administer medication IVPB or IVP
- flush with saline 5-10 mL using push-pause technique
- flush with heparin 10-100 units per mL (total volume twice volume capacity of central line plus any extension/ or manufacturer inst./ or hospital policy)

Front 136

What is SASH?

Back 136

code word for central medication administration
(s)aline
(a)dminister medication
(s)aline
(h)eparin (based on MD order)

Front 137

How fast do you administer saline following a medication administration in a central line?

Back 137

the same rate as the given medication

Front 138

According to the Infusion Nurses Society, how much heparin should be used for a central line flush?

Back 138

twice the total volume capacity of the catheter plus any extension device

Front 139

What should be monitored in patients who have a central line that is flushed with heparin?

Back 139

- PTT (partial thrombolytic time)
- petechiae
- bleeding gums
- bruising

Front 140

Heparin may be contraindicated if a patient has what type of disorder?

Back 140

a clotting disorder (aka coagulopathy)

Front 141

Heparin may trigger a condition known as what?

Back 141

Heparin-induced thrombocytopenia (thrombocytopenia=not enough platelets in the blood)

Front 142

What is a normal platelet count?

Back 142

150000-400000

Front 143

Who developed the infusion nursing standard of practice and what is the purpose of this standard?

Back 143

The Infusion Nurses Society - designed to protect nurses and patients

Front 144

What is the preferred method of hand sanitizing, soap and water or alcohol-based gel?

Back 144

soap and water

Front 145

In addition to checking the physicians order, what are 3 additional questions you should ask the patient prior to initiating IV therapy?

Back 145

inquire about allergies to medications, iodine, and/or latex

Front 146

If a client is allergic to iodine, what should be used as a skin preparation prior to administering IV therapy?

Back 146

70% isopropyl alcohol and 2% chlorhexidine

Front 147

If the client is allergic to latex, what is your next step?

Back 147

-order non-latex gloves
-order non-latex torniquet (if not available, use a stockinette to place a barrier between skin and latex)

Front 148

How long should you wash your hands with soap and water before equipment preparation?

Back 148

20 seconds

Front 149

True/False:

You should wipe down the IV pole and pump with disinfectant solution prior to using.

Back 149

True

Front 150

What is the protocol for an IV bag that does not have an outer wrap?

Back 150

Do not use - return to pharmacy or dispose of per hospital policy

Front 151

True/False:

If an IV bag is moist when you remove it from the outer wrapping, you should dispose of it immediately.

Back 151

False- The bag may be moist due to the process of sterilization (or humidity). Squeeze the bag to check for leaks

Front 152

What are some things you should do to help prepare the patient for IV therapy?

Back 152

- explain the procedure
- educate them re: the purpose, reasons, and possible signs/symptoms of complications
- Provide privacy
- Check for allergies

Front 153

What is the rule of thumb when selecting the size of the cannula that will be used for IV therapy?

Back 153

use the smallest cannula that will accommodate the vein and will achieve the purpose of the infusion

Front 154

If a fluid is hypertonic (such as KCl), what type of location is preferred?

Back 154

a large vein in the forearm, as distal as possible

Front 155

If IV treatment is for a life threatening condition, what type of vein location is preferred?

Back 155

a vein that will remain open during hypoperfusion

Front 156

True/False:

A soft, straight vein is the ideal choice for IV therapy.

Back 156

True

Front 157

True/False:

The veins in the hands of the elderly are the ideal location for IV therapy.

Back 157

False- the veins in the hands of the elderly are a poor choice b/c hematomas occur readily in these small, thin veins

Front 158

The veins of the hand should only be used for what types of solutions?

Back 158

Those that are non-irritating b/c of the proximity of the tendons and ligaments that control its function

Front 159

True/False:

A doctor's approval is required to attempt a venipuncture on the lower extremities. Why or why not?

Back 159

True- this increases the risk of thrombophlebitis and embolism

Front 160

Where should a cannula be placed for patients using walkers/crutches?

Back 160

above the wrist so that the hands can still be used

Front 161

Can you ever administer IV therapy into a vein in an area of flexion?

Back 161

yes, although it is undesirable, you can immobilize the area; additionally, these should be reserved for peripheral, central and midline access as well as blood drawing

Front 162

List examples of ways to dilate veins. (7)

Back 162

1. position the extremity lower than the heart for several minutes
2. open and close fist several times
3. using thumb and second finger, flick the vein (releases histamine)
4. apply warm towel on vein for 10 minutes
5. pump a BP cuff up slightly (30mmHg)
6. apply a tourniquet 6-8 inches above the site
7. use penlight / venoscope for dark skin

Front 163

Which presents a greater risk for injury, a plastic or steel cannula?

Back 163

steel

Front 164

How often do peripheral IV catheters need to be changed?

Back 164

every 96 hours or per hospital policy

Front 165

How many attempts at venipuncture are recommended?

Back 165

2

Front 166

Why is stabilization of the catheter important?

Back 166

reduces the risk of infiltration, catheter migration, phlebitis, and sepsis

Front 167

How often must gauze dressing over an IV site be changed? How about a clear dressing?

Back 167

gauze = every 2 days
clear = every 6 days

(or PRN)

Front 168

What are the 3 spots an IV setup must be labeled?

Back 168

1. venipuncture site (date/time, gauge/length of catheter, initials)
2. tubing (per hospital policy)
3. IV solution container (solution type, additive, initials of nurse, date/time of infusion)

Front 169

Documentation of an IV procedure generally consists of what 10 parts?

Back 169

1. date and time of insertion
2. name, gauge, and length of device
3. specific name and location of the assessed vein
4. name of solution and rate of flow
5. infusing by gravity or pump
6. number of attempts
7. condition of extremity prior to procedure
8. patient's comments re: procedure
9. assessment findings with each nurses round
10. signature

Front 170

How long do you apply direct, firm pressure after removing a peripheral IV catheter?

Back 170

2 minutes (5 if patient is on an anticoagulant)

Front 171

What should you do if you remove a peripheral IV catheter and notice that it is chipped?

Back 171

Notify MD STAT

Front 172

What must be maintained during insertion of IV access, during its use, and upon discontinuing IV access?

Back 172

asepsis

Front 173

True/False:

If a sterile cap is unavailable, the next best option is to loop the tube into another port of the same tubing

Back 173

FALSE- looping is not acceptable. A sterile cap must be obtained

Front 174

How often do you assess a patient receiving an IV fluid with an additive? without an additive?

Back 174

with additive = every 1-2 hours
without additive = every 2 hours

Front 175

How long should you remain at the bedside of a patient who is receiving an IV antibiotic they have never received in the past?

Back 175

10 minutes to observe for any adverse reactions

Front 176

What is the formula for calculating a patient's plasma osmolality?

Back 176

(2NA) + (Glucose/18)

Front 177

How is a patient's fluid status assessed?

Back 177

- weight
- intake and output

Front 178

A gain of 1 kilogram is equal to a gain of ___ liters of fluid.

Back 178

1

Front 179

If an ordered IV rate is equal to or greater than ____ ml/hour closely monitor

Back 179

125

Front 180

What type of glove should be used for peripheral IV care? central?

Back 180

peripheral = clean
central = sterile

Front 181

True/False:

You should never administer medication into a TPN line.

Back 181

True

Front 182

Why should you avoid giving Lactated Ringer's if the pH exceed 7.5?

Back 182

b/c the liver converts lactate to bicarbonate

Front 183

Why would you avoid giving D5W to a patient at risk for intracranial pressure?

Back 183

b/c it acts as a hypotonic solution and could swell the cells in the brain further increasing pressure (cerebral edema)

Front 184

Why would you not administer a hypotonic solution to a patient at risk for third-space fluid shift (ex. burns, trauma, low serum protein, uncontrolled diabetes, kidney disease, malnutrition)

Back 184

b/c these solutions have the potential to cause cellular swelling

Front 185

Why would you avoid giving a hypertonic solution to a patient experiencing cellular dehydration?

Back 185

b/c these solutions pull fluid out of cells and into the intravascular space

Front 186

Why would you avoid giving a hypertonic solution to a patient with impaired heart and kidney function?

Back 186

their system cannot handle the excess fluid pulled into the intravascular space

Front 187

What measurement unit is used for the pressure exerted by IV pumps?

Back 187

PSI (lbs per square inch)

Front 188

When infusing by gravity, the IV pole should be ___ inches above heart level.

Back 188

36

Front 189

IV fluid must be replaced every ____ hours.

Back 189

24

Front 190

IV tubing must be replaced every ____ hours.

Back 190

72