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53 Cards in this Set

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Balanced solution:
parenteral solution that contains electrolytes in portions similar to those in plasma; also contains bicarbonate or acetate ion.
Catabolism:
The breakdown of chemical compounds by the body; an energy-producing metabolic process.
Colloid:
A substance that forms a true solution and is not capable of passing through a semipermeable membrane.
Crystalloid:
A substance that forms a true solution and is capable of passing throug a semiperbeable membrane (e.g,. lactated Ringers solution, isotonic saline)
Dehydration:
A deficit of body water; can involve one fluid compartment or all three.
Hydrating fluid:
A solution of water, carbohydrate, sodium, and chloride used to determine adequacy of renal function.
Hypertonic solution:
A solution with an osmolarity lower than that of plasma
Isotonic solution:
A solution with the same osmolarity as plasma
Maintenance therapy:
Fluids that provide all nutrients necessary to meet daily patient requirements.
Normal saline:
Solution of salt (0.9% sodium chloride)
Plasma subsitute:
A solution of synthetic substance, such as dextran, used as a subsitute for plasma.
Replacement therapy:
Replenishment of losses when maintance cannot be met when patient is in a deficit state.
Restoration therapy:
Reconstruction of fluid and electrolyte needs on a continuin bais until homeostasis returns.
Hypotonic solutions are used to:
Hydrate cells-
Hypotonic fluids move from the vascular space to the interstitial and intracellular spaces hydrating cells. This follows the principles of osmosis and the movement of water.
Before a patient is started on replacement therapy, the first thing that should be checked is the patients:
Kidney function
-The first concern for a patient requiring replacement is whether the kidneys are functioning well enough to permit the therapy.
A patient is admitted with 40% second-degree burns, which of the following IV solutions would be anticipated?
-Lactated Ringers
Lactated Ringer's closely resembles the body's extracellular fluid; it may be used to replace fluid loss from burns and is useful in mild acidosis. The lactate ion contained in the solution metabolized in teh liver to bicarbonate to assist with metabolic acidosis.
A parenteral solution that contains portions of electrolytes similar to plasma, as well as bicarbonate or acetate ion, is called:
Balanced solution
-Hypotonic, isotonic, and hypertonic solutions refer only to those solutions whose osmolarity is, respectively, less than, equal to, or greater than that of plasma--not to their electrolyte or ionic contents.
A patient is hypvolemic and plasma volume expanders are not available. Which of the following solutions can the nurse anticipate will be ordered for this patient?
5% Dextrose and 0.45% sodium chloride
-A hypertonic solution, such as 5% dextrose and 0.45% sodium chloride, may be used to treat hypovolemia when plasma volume expanders are not readily available. Hypertonic solutions pull water from intracellular and interstitial spaces into the vascular space; thus they expand the plasma space.
The expected outcome of admistering a hypertonic solution is to:
Shift ECF from intracellular space to plasma
-Hypertonic fluids have osmolarities over 375 mOsm, which shifts fluids from the interstitial and intracellular spaces into the vascular space. This follow the principles of osmosis and the movement of water and solutes.
Which of the following solutions are considred colloid solutions:
Albumin
-Albumin is a natural plasma protein prepared from donor plasma. Colloid solutions contain protein or starch molecules that remain distributed in the extracellular space and do not form a "true" solution.
The first symptom of venous vasospasm is:
Sharp pain extending from the site of infusion
-Because of the spasm of the vein wall, sharp pain is the first symptom. Apply warm compresses to relieve the spasm if possible, and continue the infusion once the spasm has subsided.
What complication is suspected if the patient has a fluctuating fever, chills, malaise, tachycardia, tachycardia, tachypnea, hypotension, and altered mental status?
Septicemia
Speed shock that is related to infusions is:
A systemic reacton that occurs when a foreign substance is rapidly introduced into the circulation
Which of the following are considered local complications of IV therapy?
Phlebitis, venous spasm, and hematoma
-Local complications of IV therapy occur as adverse reations or trauma to the surrounding venipunture site. These complications can be recognized early by objective assessments. Phlebitis,venous spasm, and hematoma are common local complications. Speed shock, septicemia, pulmonary edema, and air embolus are systemic complications.
The first symptom of venous spasm is:
A sharp pain extending from the site of infusion
-Venous spasm can occur suddenly and for various reasons. The spasm usually results from the adminstraion of a cold infusate, an irritating solution, or a too rapid admistration of IV solution.
A patient who has a central venous tunneled catheter for adminstration of chemotherapy presents to the hospital with a flunctuating fever, profuse sweating, nausea, and lower than normal blood pressure, and explosive diarrhea. The nurse suspects:
Septicemia
-Septicemia is related to poor aseptic technique and contaminated equipement. Central venouse access devices are at high risk for septicemia. Signs ans symtoms include a fluncuating fever tremors, a profuse cold sweat, nausea and vomitting, explosive diarrhea, abdominal pain, and tachycardia.
The nurse assesses the insertion site of a peripheral IV catheter and notes that the site is redish, warm, and slightly edematous proximal to the IV cannula, and that the patient displays discomfort when the site is touched. The nurse interprets that this is most likely due to:
Phlebitis
-Phlebitis at the IV site can be distinguised by patient discomfort at the site, as well as by redness, warmthm, and swelling proximal to the catheter. The line should be discontinued and a new line should be inserted at a different site.
Signs and symptoms of an air embolus include:
-cardiac dysrhthmia, hypotension, anxiety, substeranal pressure, localized decreased breath sounds, chest pain with inhalation and exalation, pleural friction rub, and a cogwheel murmur, dyspnea, tachypnea, cough, and diaphoresis.
The initial signs and symtoms of an air embolus are related to trapped air that is carried against the pulmonary valve ad blocks the flow of blood from the ventricle into the pulmonary arteries. Less blood is ejectected from the right ventricle, causing the right heart to overfill. The force os the right ventricle contractions icrease in an atempt to eject blood past the occluding air pocket. These forceful contractions break small air bubbles loose for the air pocket. Pulmonary hypoxia results in vasoconstriction in the lung tissue, while it further increases the workload of the right ventricle an reduces blood flow from the right heart. This lead to dimished cardiac output, shock, and death.
During initial venipuncture, the nurse has dificulty advancing the cannula into the vein and observes ecchymosis over and around the insertion area. The area is also raised and hard. The nurse concludes that:
A hematoma has formed
-Signs and symptoms of hematoma include immediate or slow discolaration of the sking surrounding the venipuncture, swelling of the site, and discomfort
On assessment of a patient with an IV that is infusing intermittent vancomycin hydrochloride, the nurse finds warmth, edema, area of induration and red streaking on the skin, peau d' orange skin, and vessicles. The nurse suspects:
Ectravasation
-The term extravasation refers to the infiltration of vessican medication into the tissue. A vessicant solution is a fluid or medication hat causes the formation of blisters. Signs and symtoms of extravasation include complaints of pain or burninig by the patient, sking tightness at the venipuncture site, blanching and coolness of the skin, slowed or stopped infusion, dependent edema of the affected extremity, and peau d' orange skin. Immediate interventions are necessary.
Which of the following solutions is recommended to flush the Groshong tunneled catheter?
Sodium Chloride
-The Groshong differs from other central venous catheters in that it has a patented three-position pressure-sensitive valve, which allows fluids to flow in or out, but stays closed when not in use. The Groshong central venous catheter there virtually eliminates the need of heparin flushing to maintain catheter patency because only sodium choloride is needed aftter use.
The drug of choice for declotting short- or long-term devices is:
Alteplase
-Alteplase is a thrombolytic agent that coverts pasminogen to plasmin, which is then able to degrade fibrin present in clots. Alteplase lyses thrombi and is used to clear clots in catheters.
A midline catheter is any peripheral catheter that is placed:
Between the antecubital fossa an the head of the clavicle, with optimal tip location with the axilla
-The midline catheter is intended for intermidiate term therapy of 1 to 6 weeks
Intermittent catheter malfunction, difficulty drawing blood, and positional IV in conjuction with radiologic evidence of catheter compression defines:
Pinch-off syndrome
-Catheter pinch-off is the anatomic compression of a vascular access device between the clavicle and the first rib. It can occur when the central venous catheter enters the costoclavicular space medial to the subclavian vein and is positioned outside the lumen of the subclavian veing in the narrow area bounded by the clavicle, first rib, and costoclavicular ligament.
The advantage when tunneled catheters are used is that they:
Can be used for multiple purposes
-Tunneled catheters can be used for the admistration of hypertonic solutions, TPN, blood administraiton, and blood drawn for laboratory analysis. These catheters must be flushed to maintain patency, are more difficult to place that peripheral catheters, and do have a potential for some body image alterations.
The Groshong catheter differs from other CVCs in that it
Has a closed-end tip with three-position pressure-sensitive valve that stays closed when not in use.
-The Groshong catheter is constructed with a two-way valve placed near teh distal end, which restricts backflow of blood, but can be purposefully overridden to obtain venous blood samples. The valve eliminates the need for flushig with heparin
Complications associated with the insertion of peripherally inserted central catheters include:
Bleeding, catheter malposition, and cardiac arrhthmias
The nurse has difficulty withdrawing blood from a central tunneled catheter but is able to infuse fluids through the line. The nurse would anticipate that this difficulty is due to:
The formation of a fibrin sheath
-Fibrin deposition may completely encase the surface of the catheter and form a sac around its distal end. The sac caused retrograde flow of infusate up the catheter. The fibrin tail does not usually interfere with infusion but may occlude the catheter on aspiration. This is commonly known as "ball valve action."
When irrigating a CVC, the barrel capacity of the syringe should be a minimum of:
10mL
-A 10 to 20 mL syringe barrel must be used to maintain a psi of approximately 7. The catheter burst pressure is 25 to 40 psi. The psi exerted by a 1 mL syringe is greater than 300, and that exerted by a 3 mL syringe is greater than 25. Use a push-pause technique.
The nurse is to draw blood sample for a labratory analysis from a multilumen CVC. Which of the following is the first step in theis procedure?
Infusates containing glucose or electrolyte should be turned off 10 minutes prior to the blood draw.
-So teh blood sample will not be contaminated with solutions containing dextrose and electrolytes.
The declotting agent of choice for lipid deposits from a central line is:
70% Ethanol
-Nonthrombotic occlusions are caused by mineral an fat precipiates. 70% ethanol is used for lipid occlusions. Hydrochloric acid is indicated for mineral deposits. Sodium bicarbonate is effective for drugs with a high pH to restore patency. Alteplase is used for throbotic occlusions.
Complications related to the insertion of PICCs include:
Bleeding, malposition of the catheter, and nerve damage.
When flushing a central line, which of the following barrel sizes must be used to prevent rupture of the catheter?
10 mL
-A 10 mL syringe barrel can be used to safely flush central lines. A barrel sized smaller than 6 mL increases the pressure in the catheter and could rupture it
The major complications that can occur during placement of a central venous access device are:
Intravascular and extravascular malpositioning
-Central venous catheter tips can migrate during insertion; thus, both intravascular and extravascular malpositioning have been reported. Extravascular malpositioning can occur when the introducer slips out of the vein and the catheter is passed into the pleural space or the mediastinum. Intravascular malpositions are more common. The catheter may coil in the vessel and advance into the right atrium or one of the smaller venous tributaries.
The following complication is specifically associated with implanted ports:
Displacement of septum
-Implanted ports have a septum, which is also called "port migration" The port is sutured but can move out of position if the sutres become loose of if the patient hand manipulates the port.
The following are acceptable sites for an implanted catheter:
Epidural space
Pleural cavity
Peritoneum
The advantages of the PICC include:
-preserves peripheral vascular system in the upper extremity
-decreases risk of pneumothorax and air embolism on insertion
-eliminates the pain of frequent venipuntures
The declotting agent of choice for the removal of blood clots from a central line is:
Urokinase
-Urokinase is a thrombolytic agent that dissolves the clot. Urokinase is the only medication the FDA has cleared for the market for declotting catheters.
Which is the best site selection for a PICC?
Basilic vein
-The peripheral veins in the antecubital fossa are the usual sites for PICC access. The basilica veing is larger than the cephalic, and passes upward in a smooth path along the inner side of the biceps muscle, terminating in the axillary vein.
Implanted ports, when not in use, can be flushed every:
4 weeks
-For a port not in use, 5 mL of sterile heparinized sodium chloride is used one every 4 weeks. The concentration of heparin is 100 U/mL
When changing a PICC dressing, the old dressing should be detached from the:
Distal to the proximal edge
-When removing a PICC dressing, detach it from the lower part toward the shoulder while securing the catheter. This action prevents inadertent removal of the catheter from its positon in the vein.
A nurse is to change the injection cap of a multiple-lumen central line. Which is the most appropriate technique?
Hold the connector above the patients heart and change teh cap.
-The fluid in the catheter dros when the catheter connector is held above the level of the patient's heart and opened to air. To prevent a drop in fluid level and entry of air into the system while changing injection caps, it is important to clamp and hold the connector below the level of the patient's heart before removing the injection cap.
The purpose of instructing a patient to preform the Valsalva maneuver is to:
Prevent air from entering the circulation
[Intrathoracic pressure changes allow for pulmonary ventilation that is responsible for air emboli associated with central lines. Pressure in the central veins decreases during inspiration and increases during expiration. If an opening into the central vein exposes the vessel to the atmosphere during the negative ispiratory cycle, air can be sucked into the central venous system is much the same manner that air is pulled into the lungs. The Valsalva maneuver stops the negative inspiratory cycle.