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103 Cards in this Set
- Front
- Back
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When discussing complications of IV therapy, it is fair to say that local problems can become ______ problems.
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systemic
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(def)
leakage of a nonvesicant solution into surrounding tissues when an IV catheter is no longer inside the lumen of a vein. |
infiltration
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Infiltration Scale: (what grade?):
No signs or symptoms |
0
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Infiltration Scale: (what grade?):
skin blanched, edema less than 2 inches in any direction |
1+
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Infiltration Scale: (what grade?):
with/without pain; cool to touch, skin blanched; edema 2-3 inches in any direction |
2+
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Infiltration Scale: (what grade?):
With/without pain; cool to the touch, skin blanched/translucent; gross edema 3-6 inches in any direction |
3+
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Infiltration Scale: (what grade?):
Cool to touch; mild-severe pain; skin blanched/tranluscent, tight and/or leaking, discolored and/or bruising; deep, pitting edema greater than 6 inches, circulatory impairment |
4+
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(def)
leakage of a vesicant solution into surrounding tissue outside of a vein |
extravasation
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What are 3 possible consequences of infiltration and/or extravasation?
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1. blister formation, ulceration, or possible tissue necrosis
2. compartment syndrome 3. reflex sympathetic dystrophy syndrome |
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(def)
inflammation of the inner most lining of the vein |
phlebitis
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What are 3 types of phlebitis?
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1. mechanical
2. chemical 3. bacterial |
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Phlebitis can lead to what 2 problems?
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1. thrombophlebitis
2. sepsis |
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What is the most common complication of peripheral infusion? What is the second?
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1st = infiltration
2nd = phlebitis |
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Phlebitis Scale: (what grade?):
no clinical symptoms |
0
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Phlebitis Scale: (what grade?):
redness at site, with/without pain |
1
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Phlebitis Scale: (what grade?):
redness at site, with pain, with/without edema |
2
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Phlebitis Scale: (what grade?):
redness at site, with pain, with/without edema, streak formation, palpable venous cord |
3
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Phlebitis Scale: (what grade?):
redness at site, with pain, with/without edema, streak formation, palpable venous cord, purulent drainage |
4
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Which grades of the phlebitis scale require that you call the MD?
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3 and 4
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True/False:
Ecchymosis and hemotoma result from infiltration of blood around the IV site |
true
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(def)
clot results from vein trauma |
thrombosis
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(def)
presence of a clot and inflammation of the vein |
thrombophlebitis
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(def)
redness, swelling, purulent exudate at the IV site; fever and elevated WBC |
local infection
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(def)
sudden contraction of a vein due to cold/irritating/viscous solution or rapid infusion |
vasospasm
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What are 3 possible systemic complications caused by IV administration?
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1. fluid overload and pulmonary edema
2. air embolism 3. speed shock |
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If fluid overload/pulmonary edema are not correct, it could lead to _____ and _____.
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CHF and shock
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What is the outcome of an air embolism?
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causes obstruction to the blood flow to the right ventricle; lethal
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What is speed shock?
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rapid infusion of an IV medication that leads to toxic proportions
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(def)
a piece of catheter breaks off, travels through the circulatory system, and reaches the heart |
catheter embolism
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(def)
an immediate, hypersensitve reaction (often unpredictable) |
anaphylaxis
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Practitioner-related factors that lead to IV therapy complications are numerous, however all of them are related to a lack of following what standard?
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Standards of Care
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What should be documented if a complication arises?
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1. type of vascular access device
2. date of insertion and site of insertion 3. appearance of site (color, temp, capillary refill, size, etc.) 4. name of med/solution, amount, how given, and rate 5. describe how patency was assessed 6. time of complaint and when infusion was stopped 7. treatment measures 8. reassessments 9. picture of site at time of complication and follow up pictures as treatment progresses 10. time MD was notified and additional treatment ordered 11. incident report according to policy & notify supervisor |
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True/False:
administering undiluted KCl is fatal. |
True
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What should you know prior to administering KCl replacement therapy?
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serum K levels
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How is KCl diluted for peripheral IVs?
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10meq in 100ml of D5W or NS over 1 hour
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What type of monitor should be observed during the administration of KCl replacement therapy?
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cardiac monitor
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How is KCl diluted for central lines?
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10 or 20 meq in 100 ml of D5W or NS over 1 hour
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(def)
administration of nutrients by a route other than the GI tract |
Parenteral Nutrition
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(def)
type of parenteral nutrition where nutrients are delivered using a central venous route |
Central parenteral nutrition
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What are the 3 primary goals of parenteral nutrition?
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1. meet the patient's nutritional needs
2. to allow growth of tissues 3. to provide calories for resting energy expenditure (REE) |
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Parenteral formulations of nutrition are _____ (more/less) nutritional than enteral formulations?
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less
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Parenteral Nutrition is known by what other 2 names?
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TPN (total parenteral nutrition)
intravenous hyperalimentation |
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What are 7 common indications for a person to be on TPN?
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1. chronic severe diarrhea and vomiting
2. complicated surgery or trauma 3. gastrointestinal obstruction, anomalies, and fistula 4. severe malabsorption 5. severe burns 6. malnutrition 7. severe wounds (decubitus, etc.) |
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Commercial prepared base solutions of TPN contains dextrose in a range of what percent? and amino acids in a range of what percent?
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dextrose = 5-70%
amino acids = 2.75-15% |
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What are 4 things that pharmacies add to commercially prepared base solutions of TPN?
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- electrolytes
- vitamins - trace elements - regular insulin |
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Where do pharmacists typically prepare TPN solutions?
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under a laminar flow hood
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A ___% dextrose solution and amino acids ____-_____% is the highest concentration that can be infused through a large peripheral vein.
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10% dextrose
2.75-3.5% amino acids |
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True/False:
A dextrose solution of 20% and higher must be infused through a peripheral vein. |
False- a dextrose solution of 20% or more must be infused through a central vein.
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Regardless of whether the patient is receiving TPN or PPN, both lines require what special adaptation?
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a 0.22 micron filter
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TPN starts with hypocaloric delivery of dextrose. Why is this done?
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To avoid refeeding syndrome and caloric overload
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True/False:
TPN therapy usually begins slowly with a hypocaloric delivery, and it is gradually increased. |
True
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How are daily fluid requirements met when a person is on TPN?
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the total calories are administered in a volume consistent with total fluid needs
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What are the minimum caloric needs of a normal adult for basic physiologic function?
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1200-1500 cal/day
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Patients with severe injury/malnutrition have _________ (increased/decreased) nutritional needs.
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increased
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Carbohydrates are given in the form of what substance for TPN?
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dextrose
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Fats are given in the form of what substance for TPN?
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fat emulsion
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For TPN therapy, what is the daily calorie distribution (in percentage) of amino acids, glucose, and fat?
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15-20% from amino acids
30-70% from glucose 15-30% from fat |
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For TPN therapy, amino acids should be tapered _____ (up or down) with a rising BUN.
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down
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For TPN therapy, amino acids should be tapered _____ (up or down) with a rising blood ammonia.
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down
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Glucose administered via TPN is adjusted to blood glucose level until what point?
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until blood glucose levels are persistently euglycemic
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What are 3 advantages of lipids as a calorie source in TPN therapy?
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1. fewer problems with glucose metabolism/controls hyperglycemia
2. CO2 production is lower 3. hepatic tolerance is improved |
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What concentrations of lipids are available for TPN therapy, and how can these be infused?
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10% and 20%, can be infused peripherally or centrally
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10% lipids provide ___cal/ml.
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1
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What are the contents of lipid infusions?
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safflower or soybean oil, egg yolk phospholipids, glycerol
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What should be monitored with lipid infusions? (4)
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triglyceride levels
nausea fever vomiting |
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Lipid infusions should be used with caution for what 2 types of patients?
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- allergies to egg
- those at risk for danger of a fat emboli (such as a fractured femur) |
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What are 12 possible adverse reactions to lipid infusions?
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1. back pain
2. chest pain 3. dizziness 4. dyspnea 5. headache 6. flushing 7. fever 8. nausea 9. vomiting 10. lethargy 11. sweating 12. seizure |
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Lipid infusions require the use of what type of tubing?
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non-reactive tubing
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When inspecting a bag of lipids prior to infusion, what is a good indicator that the contents are good?
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contents are milky, uniform
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When you must piggyback into a TPN, the piggyback must be _______ (above/below) the TPN filter so not to cause occlusion.
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below
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What type of patient is at risk for complications from TPN infusions containing aluminum? What are these complications?
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patients with impaired kidney function are at risk; complications include CNS and bone damage
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What does it mean if you see that "oiling out", "breaking out", or any identifiable yellowish streaking/drops in a lipid container?
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It means that the fat emulsion is separating. Do not use.
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A normal, healthy adult requires ___-___ grams of protein daily.
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45-65
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Protein intake levels of ___-___ gm/kg/day is suggested for patients with moderate to severe stress.
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1.5-2
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A nutritionally depleted patient's requirement can exceed ____ gm of protein daily to ensure a positive nitrogen balance.
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150
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What determines any changes a physician will make to electrolytes added to TPN?
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daily serum chemistry and the patient's condition
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What are 3 general complications to parenteral nutrition?
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1. infections
2. metabolic problems 3. mechanical problems |
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What are 2 types of 'infections' seen with parenteral nutrition?
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bacterial and fungal
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What type of metabolic problems are seen with parenteral nutrition?
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1. hypo/hyperglycemia
2. prerenal azotemia 3. essential fatty acid deficiency 4. electrolyte/vitamin deficiency 5. trace mineral deficiency 6. hyperlipidemia 7. refeeding syndrome |
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True/False:
TPN bags must be refrigerated and administered immediately after removing them. |
False- they must be refrigerated, however they need to be removed from the refrigerator one hour prior to administration
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How often must a new bag, new tubing, and new filter be administered when a patient is on TPN?
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every 24 hours
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How often must an accucheck be done when a person is on TPN?
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every 4 hours (check against an insulin sliding scale)
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How often must blood chemistry be drawn for a person on TPN?
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daily
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How often must CBC, triglyceride, and liver function tests be drawn for a person TPN?
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3x's a week or as ordered
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Describe the procedure when drawing blood from a central line. What is the importance of following this procedure exactly as described?
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1. stop the pump for a minute
2. aspirate 10mL of blood and discard 3. aspirate the require mL of blood as ordered If this is not done properly, the lab results will not be accurate due to the presence of IV additives. The MD will be treating erroneous results with probable fatal consequences |
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What should be done if the next TPN bag is not available? (3)
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1. hang 10% dextrose in water
2. follow up call to pharmacy 3. fingerstick glucose every 4 hours |
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The MD has discontinued TPN for your patient. Why is it important to wean the patient over several hours rather than stopping abruptly?
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to prevent rebound hypoglycemia and hyperinsulinemia
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Once TPN is discontinued, it is important that you monitor your patient closely. What things will you be observing/looking for?
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- monitor oral/enteral intake
- monitor for complication - look for signs of infection @ the site - look for signs of systemic infection (hypo/hyperthermia, elevated WBCs, chills) |
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There are many complications that may arise from IV therapy. While some are unavoidable, the nurse is at risk for accused negligence when these actions occur?? (8)
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1. failure to assess patient in a timely manner
2. failure to foresee outcome of action or inaction 3. failure to supervise and/or monitor patients 4. incorrect and improper administration of medication/fluid 5. error or lack of reporting and documentation 6. failure to question medical orders that are incorrect or inappropriate 7. failure to provide patient safety 8. lack of updated knowledge and skill |
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True/False:
If an act of negligence does not cause injury, legal action cannot occur and the nurse cannot be terminated. |
False-
Although legal action cannot be initiated, the employer can terminate the employee. |
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An RN delegating IV therapy to an LPN must verify what 5 things?
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1. LPN is certified in IV therapy
2. LPN has been adequately trained 3. LPN can verbalize the intervention learned 4. LPN can perform intervention safely 5. Patient is stable |
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As an RN delegating IV therapy function to an IV certified LPN, you must do what 3 things?
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1. assess the patient every 8 hours
2. be available to supervise the performance of the delegated task 3. be available to assess the patient's response to therapy |
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What 7 things "can" a LPN certified in IV therapy (with sufficient IV experience) do re: IV therapy?
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1. start a peripheral access
2. flush a peripher line and central line with NS 3. hang a solution/calculate rate 4. hang IV piggyback 5. change tubing and dressings 6. discontinue a peripheral IV 7. verify blood product with another nurse |
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What 3 things can a LPN not do regarding IV therapy?
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1. hang a blood transfusion, TPN, PPN, Procalamine, chemotherapy, investigational drug, or a drug requiring titration
2. access a portacath 3. IV push |
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Regarding IVs, what are 3 common reasons fluid will not infuse?
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1. clamp closed
2. catheter dislodged/kinked 3. clot |
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In reference to IVs, what are 3 common causes for fluid leaking?
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1. loose connection
2. tear in catheter or dislodged 3. lymph fluid leaking |
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In reference to IVs, what are 4 common causes when you are unable to aspirate blood?
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1. clamp closed
2. catheter dislodged/kinked 3. clot 4. catheter pressing against the vein wall |
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In the elderly, homeostatic mechanisms become _______ (more or less) efficient.
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less
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What are 3 reasons that the elderly are predisposed to deficient fluid volume?
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1. 6% less fluid than a young adult
2. decreased thirst sensation 3. decreased ability to concentrate urine |
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True/False:
The elderly have a decreased ability to adapt to rapid increases in intravascular volume. |
True
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In the elderly, the tunica intima thickens. What effect does this have on the vein?
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increases resistance and decreases compliance
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The loose skin seen in the elderly predisposes them (and allows space for) to what condition related to IV therapy.
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infiltration
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How could short term memory loss (as seen in the elderly) relate to fluid problems?
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memory of fluid intake is impeded
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