Nursing 112 Final

Front 1

reasons for an IV

Back 1

-F&E
-Meds
-Blood products
-Nutrional formulas (TPN)
-Pre-procedure
-Just in case

Front 2

Types of IV solutions

Back 2

*Isotonic
*Hypotonic
*Hypertonic

Front 3

Isotonic IV Solutions

Back 3

i.e. Lactated ringers & NS
-stays in vascular space
-used for pts with dehydration
-watch for fluid overload
-same concentration of solutes as in blood

Front 4

Hypotonic IV solution

Back 4

i.e. 1/2 normal saline
-goes into the cells
-has less solute concentration than blood, so when put in the fluid goes into the cells.

Front 5

Hypertonic IV solution

Back 5

i.e.D5NS, D5 1/2NS, D5w
-more solute concentration than the blood
-Pulls blood from cells into vascular space.
-Watch for fluid overload

Front 6

Peripheral Venous access

Back 6

i.e. medlock, saline lock, hep lock
-short term; temporary; usually less than 72 hrs
-flush q shift & with med admin
-SAS-->saline, med Admin, saline

Front 7

Central venous access

Back 7

-short term to long term
-flush per agency poilcy
-SASH(eparin)
-Flush CVL with min of 10 CC syringe due to pressure

Front 8

IV complications general

Back 8

-infiltration
-phlebitis
-thrombophlebitis
-infection
-catheter emboli (pt on LEFT side)
-speed shock
- circulartory overload
-air emboli (Put pt on LEFT side)
-venous spasm
-occlusion

Front 9

Nursing consideration for IV's

Back 9

-Check MD order & 3 checks
-keep IV fluid & equipment sterile (FEMALE FIRST)
-keep tube free of air & contamination
-hang fluid at corrcect height
-correct flow rate & amount to infuse
-assess site for complications
-flush per agency protocol

Front 10

Iv Push/Bolus

Back 10

-small volume <10 mL
-3 checks--> amount, concentration, rate of admis
-flush before & after med admin (SAS/SASH)
-If IV is infusing, check drugs compatibility, if conpatable occlude line above port when injecting. No flush needed if NS hanging

Front 11

Indications for a central line

Back 11

-unsuitable peripheral access
- good for pts requiring frequent vein access
-for complex tx regimen (analgesics, Abx, chemo, blood, long term IV, vesicant drugs)
-administration of TPN

Front 12

Percutaneous/nontunneled short term CVL

Back 12

-for days to several weeks
-Inserted in subclavian, internal jugular or femoral veins
-tip resides in SVC
-must be placed by MD
-TPN thru dedicated line
-Flush with >10mL syringe q8-12 while pulsing. SASH

Front 13

Peripherally Inserted Central Catheter (PICC Line)

Back 13

-Can be in for several months
-Inserted in antecubital fossa (*Basilic is best; Caphalic 2nd)
-Tip in SVC
-TPN thru dedicated line
-Flush with >10mL syringe q8-12 while pulsing. SASH
-By MD or ceritfied RN
-Dressing change 24 after in, then q 7 days. WEAR MASK

Front 14

Tunneled Long-Term CVL

Back 14

i.e. hickman, broviach, groshong
-decreased potention infection from skin exit site
-weekly site care
-flush with heparin EXCEPT groshong
-Surgically inserted ~5" under skin before entering vein

Front 15

Implanted port-a-cath

Back 15

-single or double lumen
-no dressing change unless accessed
-need to use HUBER needle to access it
-When accessed change needle & dressing q7 days
-flush with heparin monthly when not accessed

Front 16

pneumothorax

Back 16

collection of air in the pleural space
-high risk for pts getting subclavian CVC's- puncture the pleural covering
-When inserting a CT for this, usually placed on top near apex

Front 17

Hemothorax

Back 17

collection of blood in the pleural space
-high risk for subclavian CVC- hitting subclavian vein/artery
-if occurs- remove line & place pressure
-place a chest tube at base of lung with this

Front 18

Cath occlusion

Back 18

-lumen is partially or completely blocked
-caused by:
*long term fat emulsion
*blood reflux
*improper flushing
-Prevent by proper flushin techniques

Front 19

How often does an unused port need to be flushed?

Back 19

Once a month with heparin

Front 20

What size syringe is to be used to a CVC?

Back 20

>10 cc (depending on the opening of syringe)

Front 21

Why would H2 inhibitors be added to TPN?

Back 21

to reduce the amount of gastric acid the stomach produces and prevent ulcers.

Front 22

IV calculation for Gravity

Back 22

am. fluid ordered (ml)x drop factor (gtt/min)/ time in minutes= rate (gtt/min)

Front 23

IV calculation with primary pump

Back 23

total ml/total hours= ml/hr

Front 24

For a IVPB calculation

Back 24

total ml x (60 min)/total hours=ml/hr

Front 25

Contents of TPN

Back 25

-amino acids
-electrolytes
-fats
-proteins
-electrolytes
Vitamins
-Meds (insulin, heparin, H2 inhibitor)

Front 26

Advantages to TPN

Back 26

-provides calories
-restores nitrogen balance
-replace vitamins, electrolytes & minerals
-promotes wound healing
-gives bowel a rest & healing time

Front 27

Total Parenteral Nutrition (TPN) general info

Back 27

-fride until 1 hour prior to use
-must be infused or tossed within 24 hrs (bag & tubing)
-must be filtered
-Dedicated line! No IVPB/pushes

Front 28

TPN vs PPN

Back 28

*TPN: needs CVC line.
20-70% dextrose & 3.5-15% AA. Long term
*PPN: dont need CVC line. 5-10% dextrose & 2-5% AA. Short term

Front 29

Indications for a trach

Back 29

-relieve acute/chronic upper airway obstruction
-access for continuous mechanincal ventillation
-weakened respiratory muscles
-prolonged endotrach tube insertion resulting in pain/erosion
-obstructive sleep apnea
-congenital disorders

Front 30

Types of Trachs

Back 30

-Universal/double lumen: for pts with lots of secretions; inner cannula can be removed to clean
-Single Cannula: use for pt with thick necks; slightly longer than universal
-Fentrated: allows speech, enables effective cough- used to wean from trach
-Cuffed: for mechanical ventillation to keep it in place

Front 31

Essential bedside equipment for trach pt

Back 31

-Spare trach tube of same size & one smaller
-obturator of exsisting trach
-suction equipment
-O2, humidification & trach collar
-Sterile water, stoma dressings
-communication aides, call bell

Front 32

Trach PC: damage to trach

Back 32

-trach wall necrosis (from balloon in cuffed)
-Trach stenosis (scars & narrows lumen from cuff & irritation)

Front 33

Trach PC: accidental decannulation

Back 33

-is 1st 72 hrs= EMERGENCY! ventilate with bag-valve-mask & call RRT
-After 72 hrs=use obturator & reinsert (thats why we keep extra at BS!)

Front 34

Trach Suctioning

Back 34

-required to remove pulmonary secretions & maintain patent airway
-promotes ventillation & oxygenation
-Is potentially dangerous so its not performed unless clinically indicated
-Suction for 10 sec at a time

Front 35

Indications for trach suctioning

Back 35

-visible or audible secretion
-subjective feeling of secretions in chest
-deteriorating ABGs
-altered chest movements
-decreased O2 sats
-diminshed air entry
-change of color
-tachypnea
-poor/absent cough

Front 36

Risks for suctioning

Back 36

-Hypoemia D/T O2 desat
-contaimination of the airway leading to nosocomial infection
-mucosal trauma
-prolonged coughing
-bleeding

Front 37

Hypernatremia

Back 37

>145 mEq/L of Na+ in serum
-Gain of Na or loss of H2O
-Causes shift out of cells= cell dehydration

Front 38

Hypernatremia is caused by...

Back 38

-H2O deprivation
-Excessive Na intake or reabsorption
-renal failue
-Cushing's
-Fluid excess loss (severe diarrhea, burns, osmotic diuresis)
-Age related changes

Front 39

Hypermagnesemia

Back 39

-When levels >2.1
-Excitable membranes are LESS excitably or may not respond to any stiluli
-Caused by: renal failure, severe dehydration & ^mag intake/administration

Front 40

Hypomagnesemia Manifestations

Back 40

-increase nerve impulse transmission= hyperactive deep tendon reflexes, parasthesia, tetany, seizures
-CNS changes can = depression, psycosis, confusion
-Reduce GI motility, anorexia, nausea, constipation & abdominal distension
-Paralytic ilius

Front 41

Hypermagnesemia Manifestations

Back 41

*Cardio: Brady, peripheral vasodilation, hypotension. Severe can = cardiac arrest
-CNC: drowsy & lethargic from decreased impulses
-Voluntary smooth muscle progressivley get worse until stoppin
-Deep tendon reflexes reduced or absent

Front 42

Interventions for hypermagnesemia

Back 42

-treat underlying cause & symptoms
-Give lasix
-stop all Mg drugs
-IV fluids
-Safety measures

Front 43

Hypercalcemia Manifestations

Back 43

-decrease persistalsis, constipation, anorexia, N/V, abdominal pain
-Altered LOC: confusion, lethargy, coma, slurred speech
-At 1st tachycardia and HTN.
-Overtime= bradycardia
-increase blood clots
-Severe muscle weakness
-decrease deep tendon reflex

Front 44

Interventions for hypercalcemia

Back 44

-weight bearing exercises
-adequate fluid intake & dietary fiber
-Prevent injury
-Calcium binders

Front 45

Hypocalcemia Manifestations

Back 45

-Neuro: 1st in hands & feets, tingling & numbness; twitching & cramps will occur--> tetany
- + Trousseau & Chvostek's signs; Spasms
-Cardio: bradycardia, hypotension, EKG changes, ab cramps
-GI: Increased peristalsis, cramps, diarrhea
-decreased bone density
-Abnormal clotting

Front 46

Hypokalemia Manifestations

Back 46

-Muscle cramps & weakness, hypoactive reflex, parasthesia
-Anorexia, abdominal distension, decrease motility, N/V & constipation
-EKG changes, dysrhythmias
-Respiraratory distress to failure

Front 47

Hypokalemia Interventions

Back 47

-Treat underlying cause
-Monitor K+ replacement
-Encourage foods high in K+
-Oral suppliments

*NEVER IV PUSH Potassium!*

Front 48

Hyperkalemia Manifestations

Back 48

-Musle weakness, tingling & possible paralysis
-EKG changes: bradycardiam hypotention, ectopic beats, ventricular fibrillation
-Neuro: early twitched with burning & tingling then turns into weakness and paralysis
-GI: increased motility, hyperactive bowel sounds, diarrhea

Front 49

Hyponatremia Manifestations

Back 49

-Tachycardia, hypotension
-Neuro & musculoskeletal symptoms may occur
-water shifts from ECF into ICF, causing cells to swell=CNS symptoms:
*Muscle cramps & twitching
*Headacche
*Dizziness
*Seizures
*Coma
*Weakness
*Behavior & LOC change
*N/V/D

Front 50

Hypernatremia Manifestations

Back 50

-Vary depending on severity
-Thirst
-dry skin & MM
-Hyperthermia
-Lethargy & restlessness
-Skeletal muscle changes

Front 51

Interventions for hypernatremia

Back 51

-adminster IV fluids based on severity
-loop diuretics
-oral fluid intake
-Low Na+ diet

Front 52

Hypocalcemia is caused by....

Back 52

<8.5 mg/dL
-inadequate dietary intake
-lactose intolerance
-malabsorption syndromes
-inadequate vitamin D
- diarrhea
-primary or surgical hypothyroidism due to thyroidectomy
-drug therapy (corticosteroids, calcium binders, citrate, caffine, ect...)

Front 53

Hyperkalemia is caused by...

Back 53

>5.0 mEq/L
-Excessive K+ intake
-blood transfusion
-extracellular shift (acidosis, sepsis, trauma, fever, MI)
-decrease excretion (renal failure, severe dehydration, K+ sparing diuretic)
-Hypertonic state-->uncontrolled diabetes

Front 54

Hypokalemia is caused by...

Back 54

<3.5 mEq/L
-GI loss (diarrhea, vomit, NGT)
-loop diuretics
-corticosteroids
-wound drainage
-diaphoresis
-Not enough diet intake
-H2) intoxification
-Prolong IV use with no K+ in it
-periods of tissue repir
-metabolic alkalosis
-increased aldosterone

Front 55

Hypomagnesemia is caused by...

Back 55

-When levels <1.5 mEg/L
poor nutrition
-alcoholism
-GI & renal loss
-Drugs (some diueretics, chemo, amphotericin B)

Front 56

Hyercalcemia

Back 56

>11 mg/dL
-causes excitable tissue to e LESS sensitve to normal stimuli =stronger stimuli to function

Front 57

hypercalcemi is caused by...

Back 57

-yperparathyroidism
-hyperthyroidism
-Excessive Ca or Vit D intake
-cancer
-glucocosteroids
-immobility
-dehydration