Unit 2 IV Therapy and TPN 1. What are 4 indications for IV therapy?

These werent listed in our pharm book but there are only three according to our med/surge book. They are: To provide water, electrolytes, and nutrients to meet daily requirements; to replace water and correct electrolyte deficits; and to administer medications and blood products. How do crystalloid solutions differ from colloidal solutions? Crystalloids are IV solutions that contain electrolytes and other agents that closely mimic the bodys extracellular fluid. Crystalloids solutions are capable of quickly diffusing across membranes and entering the interstitial fluid and ICF. Crystalloids could be isotonic, hypotonic, or hypertonic solution. Colloids are proteins, starches, or other large molecules that remain in the blood for a long time because they are too large to easily cross the capillary membranes. They act as hypertonic solutions, drawing water molecules from the cells and tissues into the plasma, sometimes called plasma volume expanders. They are particularly important in treating hypovolemic shock due to burn, hemorrhage, or surgery. What category of crystalloid is used to treat dehydration? Hypotonic solutions such as: hypotonic saline (0.45% NaCl), or Plasma-Ltye 56. However, clients who are dehydrated with low blood pressure should be given normal saline (isotonic), clients who are dehydrated with normal blood pressures should be given a hypotonic solution. What fluid is used most often to maintain fluid in the vasculature, increasing BP and urine output? Normal saline (0.9% NaCl).

2.

3.

4.

5. 6.

What is the significance of SOB, cough, and JVD in a client receiving any IVF? These are all signs of fluid overload or hypervolemic signs. When is vented tubing required in IV therapy? A method for allowing air to enter the vacuum of the IV bottle and displace the IV solution as it flows out. You dont need this with bags of solution because those bags are collapsible. When are in-line filters required in IV therapy? When administering TPN, when phlebitis is likely to occur, immunodeficient client, when usinf rubber injection ports or plastic diaphragms repeatedly. These filter out pathogens and bacteria. Why is it necessary to ask about a history of mastectomy or stroke before starting peripheral IV therapy? Because there could be impaired lymphatic flow which could lead to edema in that extremity.

7.

8.

9.

When initiating IV therapy, how high above the insertion site should a tourniquet be placed? 4-6 inches above where the insertion will be 10. Place the following in correct order: a. apply tourniquet b. insert angiocath at 15-30 degree angle c. select vein d. attach primed tubing to access e. gather supplies e, a, c, b, d 11. Before administering any drug into an infusing maintenance line, the nurse should check? Pretty much everything: The doctors orders, perform the five rights, the EMAR. This is a broad question. 12. What are indications for central venous catheter (CVC) placement? Long term therapy requiring IV access, drugs that are very concentrated and toxic to the veins, or TPN. 13. All CVCs terminate in _the superior vena cava above the right atrium and need to be verified by X-Ray. 14. Into which infusion port should a piggy-back infuse? To the port nearest to the solution or above the IV pump. Where does the piggy back hang in relation to the maintenance infusion? Above the maintenance fluid. From where is the flow-rate of a piggy-back regulated? The lowest clamp on the tubing. 15. What is the fastest rate that KCl can be infused intravenously? 40mEq an 1 hr. this is the maximu m rate. Outside of ICU it is 10mEq/hr. 16.___Dextrose____ (IV solution) should be used with caution in diabetes. The paper says that they should not receive this at all. 17. Sodium IV solutions or sodium containing solutions should be used with caution in CHF and renal failure. 18. Potassium additives in IV solutions should be used with caution in renal failure.

19. Lactated ringers (IV solution) should be used with caution in hepatic disease. Because of possible lack of ability to convert lactate to bicarbonate. 20. What is the significance of a fever in a client with a CVC? What is the nurses role in preventing this event? Use strict aseptic technique when working with IVs. Use sterile technique for dressing changes. Change IV solution at least every 24 hrs. Apply occlusive dressing when removing CVC. Monitor site for s/sx of infection. Infection or sepsis

21. How can the nurse minimize risk of embolism in clients with CVCs? When changing tubing, reflux valves on CVADs w/o Groshong valves or when D/C CVC, have client perform the Valsalva maneuver (forcefully exhale with glottis, mouth and nose closed).-its what the article says

22. What is the advantage of a Groshong catheter over a Hickman catheter? Groshong is a closed it catheter that has a valve on its internal tip that prevents backflow of blood. Routinely flushed with double volumes of NS, but do not require heparin flush solution. They decrease the risk of air emboli and bleeding. Eliminate need for catheter clamping. Hickman is an open tipped end of catheter that opens directly into the bloodstream. If flushing techniques are not preformed correctly blood can back up into the catheter causing occlusion of the catheter. They must be flushed with NS and then followed by a Heparin solution flush 23. How much blood should be discarded from a CVC before laboratory sampling? 3-5 mL. 24. What equipment is necessary to access a port-o-cath or intravenous access device (IVAD)?

I could not find this anywhere in the article or online. I know its a sterile procedure so you would need sterile gloves, mask, and a cleaning solution such as iodine or chloroprep. A Huber point needle or winged needle may be used. Again, this is just from what I have seen. 25. Which lumen of a multi-lumen CVC is recommended for blood sampling? Proximal- FYI I could not find this in the article and had to look it up online. 26. What volume of saline flush should follow medication administration in central lines? Volume of flush solution should be at least twice the internal volume of the catheter. Groshong should have flushing volume doubled. No specific volume was stated.

27. What volume of heparin should follow NS flushes? 10 units/mL or 100 units/mL solutions

1.

Blood Transfusions What are the indications for infusing: a. Whole blood: Most of the indications for use are identical to those for RBCs, and Whole Blood is not used because the extra plasma can contribute to transfusion associated circulatory overload (TACO), a potentially dangerous complication. Whole Blood is sometimes "recreated" from stored red blood cells and FFP for neonatal transfusions. This is done to provide a final product with a very specific hematocrit (percentage of red cells) with type O red cells and type AB plasma to minimize the chance of complications. b. Packed red blood cells (PRBCs) Low Hgb/Hct or correct low blood levels in anemic patients. This increases the amount of hemoglobin in the blood that can carry oxygen perfused from alveoli of the lungs to tissues

c. Fresh frozen plasma (FFP) Treatment of deficiencies of coagulation proteins for which specific factor concentrates are unavailable or undesirable. (multiple coagulation protein deficiencies in the uncontrollably bleeding patient) d. Albumin: regulate blood volume by maintaining the oncotic pressure
2. 3. 4. 5. 6. 7. 8. 9. 10. 11. Cryoprecipitate: Haemophilia, von Willebrands disease, low fibrinogen levels, bleeding from excessive anticoagulation, massive hemorrhage, DIC Which of the above REQUIRE ABO matches? Whole Blood & PRBCs. What size IV access is recommended for transfusions? 20 G or larger What IV solution is used to prime tubing for transfusions? Normal Saline How much should Hgb/Hct increase after each unit of blood? Hct: 2-3%, Hgb: 1 gm/dL A unit of blood should hang at room temperature no longer than _4 hrs___. How often should blood tubing be changed? Q 24hrs or after 2 units of blood, whichever comes first. Why shouldnt blood be administered while a client is febrile? You will be unable to detect and early sign of a transfusion reaction. Which blood type is considered the universal donor? 0A person with __AB+____blood is considered the universal recipient. What patient assessment should be done before beginning a transfusion? 1.Base line data regarding blood pressure, temperature, pulse and respiration. 2.Any previous reaction to a blood transfusion. 3.The request for blood transfusion form has been completed and send specimen for typing and cross matching What assessment should be part of the on-going assessment? Vital Signs: BP, HR, T, RR, Start infusion slowly at 2 ml/min. Remain at bed side for 5-30 minutes. If there are not sign of circulatory overloading, the infusion rate may be increased. Observe the patient closely for chilling, nausea, vomiting, skin rashes tachycardia as they early sign and symptom reaction and check vital sign at least hourly until 1 hour post transfusion. Report sign and symptoms of reaction immediately to physician to minimize consequences. Acute reaction may occur at anytime during the transfusion.If any reaction: close clamp & run normal saline, report to doctor, save urine and observe. What adverse effects should clients be taught to report during transfusions? chilling, nausea, vomiting, skin rashes, tachycardia, palpitations, increased temperature, anxiety, shortness of breath What is the most common adverse effect of transfusions and how might it prevented? Febrile Nonhemolytic Reaction: sxs are chills, muscle stiffness, fever (usually within 2 hours after infusion is begun). Nonlife threatening and can be prevented with acetaminophen (Tylenol) and/or diphenhydramine (Benadryl). How can nurses prevent hemolytic reactions in clients receiving transfusions? Best way is to ensure that patient is receiving correct type. Double check!! What should the nurse do if the client develops a reaction to a transfusion? close clamp & run normal saline, report to doctor, save bag to send back to blood bank, observe client for further needed interventions. What electrolyte should be carefully monitored after transfusions in clients with renal failure? K+ mainly, also Na. TPN What are the components of total parenteral nutrition (TPN)? Amino acids, dextrose for carbohydrate , vitamins, minerals, trace elements, electrolytes, and water. Why are lipids added to TPN solutions? They provide up to 30% of calories and prevent or treat deficiency of fatty acids. What are the client goals for TPN therapy? To prevent catabolism of protein from muscle stores and fat from subcutaneous tissue. Improve nutritional status and meet metabolic needs. Maintain fluid and electrolyte balance. Gain wait according to nutrition plan or maintains current weight. Remain free of complications of TPN therapy. What is the greatest glucose concentration that can infuse through a peripheral line? 10% What is the maximu m duration of infusion through a peripheral line? 2 weeks. Where should TPN doses be stored? Refrigerator until 30 to 60 minutes prior to use. What are 2 reasons that medications should not be added to TPN? Most medications are not compatible with TPN. The nurse cant check medications if they are in the mixture. (?) How often should glucose be checked in clients receiving TPN? Usually every 6 hours. What solution should be hung if the replacement dose of TPN hasnt arrived on the unit by the time the prior TPN is finished? 10% dextrose. What may happen if TPN is abruptly discontinued? hypoglycemia What is re-feeding syndrome and who is likely to get it? Electrolyle imbalances in severely malnourished patients. What are the manifestations? Low phosphate levels, hypokalemia, edema, congestive heart failure. How can this syndrome be avoided? Start low and go slow. Recognize patients at risk. Correct electrolytes before starting TPN. Monitor pulse, I/O, electrolytes closely. Why shouldnt nurses try to catch-up TPN that has fallen behind schedule? It throws a patients metabolism and electrolytes off. Flow rates are calculated so to not shock a persons system with high electrolyte concentrations. e.

12. 13.

14. 15.

16. 1. 2. 3.

4. 5. 6. 7. 8. 9. 10.

11.