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15 Cards in this Set

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What are the goals of Intravenous Therapy-
1. Prevent and/or correct fluid (dehydration or fluid overload)

2. Maintain immediate IV access for medication administration (potential code or code symptoms,

IV antibiotic administration).

3. Treat electrolyte disturbances (Smith, 2000, 842)

( Potassium, Calcium, Magnesium, Sodium, Chloride, Bicarbonate and Phosphate)

4. Administer nutrition (Dextrose, Total Parenteral Nutrition)
RN Role
in intravenous therapy
1. Initiating IV access for peripheral IV sites or assisting with insertion of central lines. (PICC, {peripherally inserted central catheter} lines are inserted by specially trained RNs. )

2. Administering prescribed IV solutions, medications and blood products

3. Evaluating patient's response to prescribed therapy.

4. Maintain and observe for complications
list the different gauges that an IV catheter can be and what are they used for
A. 16: trauma; people giving blood donations

B. 18: patients receiving multiple blood transfusions; ER patients; surgery patients

C. 20: large volume IV fluids; diagnostic procedures

D. 22: adults with small veins; geriatric patients receiving IV fluids or medications

E. 24: pediatric; geriatrics
Intravenous Therapy-
Nursing Implications
1. Not on side of a mastectomy

2. Not on extremity of hemodialysis access

3. Distal end of vein should be selected first, reserving more proximal sites for future IV therapy.

4. Elderly have thin skin and lack of support tissue.
Define these three solution types and give examples
Isotonic -

Hypotonic -

Hypertonic -
Isotonic solutions have the same number of solutes when compared to another solution. In the body, an isotonic solution would have the same osmolality (concentration of solutes) as body fluids. Isotonic solutions are used to expand the extracellular fluid compartment
example: 0.9% Normal saline

Hypotonic solutions have a lower number of solutes when compared to another solution. In the body, a hypotonic solution would have the lower osmolality (concentration of solutes) as body fluids. Fluids that have an osmolality of lower than 250 mOsm/L are hypotonic fluids
Fluid will move into cells
If too much hypotonic fluid is given, it can deplete the circulatory system
Hypotonic solutions are given to lower sodium levels
Examples: 0.45% normal saline and 0.33% normal saline.

hypertonic solutions have a higher number of solutes when compared to another solution. In the body, a hypertonic solution would have the higher osmolality as body fluids. Fluids that have an osmolality of higher than 375 mOsm/L are hypertonic fluids. These fluids should be given slowly because they can lead to circulatory overload and are contraindicated for patients with cardiac and renal disease because of the risk of heart failure
Examples: 5% dextrose in 9% normal saline; 5% dextrose, and lactated ringers.
What are some Complications that can happen from giving Intravenous Therapy-
Complications-

Infection- Redness at site, warmth at site, tenderness at site

Change tubing and site q 72 hours, Change IV solutions q 24 hours, may use filters

Phlebitis – Pain along the vein, tenderness, erythema – red streak at vein site. Edema at insertion site

Sluggish flow rate, area is warm to touch

Infiltration of fluid – Edema around insertion site- blanching of infusion site – coolness of skin around site - no backflow of blood

Extravasation of medication
Which of the following solutes is the greatest contributor to the osmolality of a fluid?
Sodium
Water
Potassium
Calcium
Sodium
Solutes found in the osmolality of a fluid include sodium, glucose, and urea. Sodium comprises the major part of the osmolality of a fluid.
Which of the following solutions has a greater concentration of solutes than blood?
Isotonic
Hypertonic
Hypoosmolar
Hypotonic
Hypertonic
Normal plasma is isotonic. Hypertonic solutions have a greater concentration of solutes than plasma.
Which of the following mechanisms is the most important regulator of fluid intake?
Thirst
Electrolytes
Renin-angiotensin
Kidneys
Thirst
Thirst is the most important regulator of fluid intake
Which of the following solutions is used to correct hypovolemic shock secondary to severe burns?
Ringer's Lactate
Albumin
Dextran 40
Plasma protein
Dextran 40
Dextran, a synthetic polysaccharide, doubles the plasma volume within hours and acts as a volume expander.
Which of the following nursing interventions is most important when caring for a client receiving a plasma volume expander? C. result from lack of good situational support
Assess the client for a deep vein thrombosis
Observe for signs of fluid overload
Encourage fluid intake
Monitor arterial blood gases
Observe for signs of fluid overload
Dextran 40, a plasma volume expander, causes fluid to rapidly move from the tissues to vascular spaces which places the client at risk for fluid overload.
The client's serum sodium value is 149 mEq/L. Which of the following nursing interventions is most appropriate for this client?

Encourage the client to eat a low-salt diet
Administer a 0.45%NaCl intravenous solution
Hold all doses of glucocorticoids
Advise that the sodium values are within normal limits
Encourage the client to eat a low-salt diet
Hypernatremia is defined as serum sodium levels > 148 mEq/L. A slight increase in sodium can be managed by diet.
Which of the following solutions would be administered intravenously to manage a client with a serum sodium level of 130mEq/L?
5% D5W
0.9% NaCl
Lactated Ringers
D5W with KCl
0.9% NaCl
Hyponatremia is defined as serum sodium levels < 136 mEq/L. Mild hyponatremia is usually treated with intravenous infusions of NaCl
The client complains of muscle cramping in the calves, paresthesias of the toes and the sensation of the heart skipping a beat. These symptoms can be symptoms of which of the following imbalances?
Hypernatremia
Hypercalcemia
Hypoglycemia
Hyperkalemia
Hyperkalemia
Hyperkalemia, serum potassium level >5mEq/L, predisposes the client to cardiac and muscle irregularities.
The client's arterial blood gases (ABG) reveal metabolic acidosis. Which of the following medications is indicated?
Sodium chloride
Ammonium chloride
Sodium bicarbonate
Potassium chloride
Sodium bicarbonate
Sodium bicarbonate acts by directly raising the pH of body fluids. It is the drug of choice to restore the pH of the plasma to normal limits.