Fluid Volume and IV Administration Quiz

IV Therapy Overview

• Intravenous therapy (IV) involves administering substances directly into a vein.
• Purposes of IV therapy include correcting or preventing fluid and electrolyte imbalances, providing hydration, enabling continuous fluid infusion and medication administration, and providing venous access for nutritional support.

IV Therapy SLOs, Competencies, and Concepts

• SLO: Provide safe, patient-centered, evidence-based nursing care to adults with diverse needs, guided by Caritas philosophy.
• Competency: Apply the nursing process to deliver patient-centered care to diverse populations experiencing common health conditions.
• Concepts: Caring Interventions, Fluid and Electrolytes, Tissue Integrity, Clinical Decision Making.

Unit Outcomes IV Therapy Part 1

• Understand principles of safe preparation, administration and documentation of IV therapy, including equipment, primary infusions, and secondary infusions.
• Demonstrate ability to prepare and administer primary IV infusions.
• Demonstrate ability to administer IV medications via a secondary line.

Fluid Volume Deficit (Hypovolemia)

• Describes loss of water and electrolytes from the extracellular fluid compartment (ECF).
• Intravascular fluid may also be lost.
• Dehydration: loss of water without electrolyte loss.

Causes of Hypovolemia

• Gastrointestinal (GI) losses (vomiting, nasogastric suction, diarrhea)
• Diaphoresis
• Diuretics, kidney disease
• Third spacing (ascites, burns)
• Hemorrhage
• Altered intake

Causes of Dehydration

• Hyperventilation
• Prolonged fever
• Diabetic ketoacidosis (DKA)
• Enteral feeding without sufficient water intake

Assessment of Fluid Volume Deficit

• Vital Signs: Hypothermia, hypotension, tachycardia, thready pulse, tachypnea
• Neurological: Dizziness, syncope, confusion, weakness, fatigue
• Gastrointestinal (GI): Thirst, dry mucous membranes, nausea, vomiting, anorexia, weight loss
• Genitourinary (GU): Oliguria (decreased urine output)
• Other: Diminished capillary refill, cool, clammy skin, decreased skin turgor.

Fluid Volume Excess (Hypervolemia and Overhydration)

• Isotonic retention of water and sodium results in increased blood volume.
• Overhydration: gain of more water than electrolytes.

Causes of Fluid Volume Excess

• Hypervolemia: Chronic stimulus to kidneys to conserve sodium and water (heart failure, cirrhosis), kidney failure, age-related changes to the cardiovascular system and kidneys, excessive sodium intake.
• Overhydration: Strenuous exercise with profuse diaphoresis, head injuries (excess ADH release), anesthetics

Assessment of Fluid Volume Excess

• Vital Signs: Tachycardia, bounding pulse, tachypnea, hypertension
• Neurological: Confusion, weakness
• Gastrointestinal (GI): Weight gain, ascites
• Respiratory: Dyspnea, orthopnea, crackles
• Other: Edema

IV Therapy in Older Adults

• Increased risk for dehydration due to decreased total body mass, including total body water content.
• Assessment of skin turgor may not be reliable as a result of natural loss of skin elasticity.
• Increased risk of fluid volume excess due to: age-related changes in cardiovascular and kidney function; disease processes; heart failure; and kidney failure.

IV Catheters - Types

• Peripheral: Short-term, hand/forearm insertion by nurses, LPNs, paramedics. Common catheter types include over-the-needle catheters (e.g., Teflon polyurethane), and angiocatheters. CDC recommends changing IV insertion site every 72-96 hours.
• Midline: Less risk of complications; 3-8 inches long; inserted from antecubital fossa; intermediate-term therapy (up to 6-8 weeks).
• PICC (Peripherally Inserted Central Catheter): 13 to 23 inches long; inserted by physicians, specially trained RNs; typically inserted above the antecubital fossa; indicated for IV therapy duration likely exceeding 6 days; can be used in home settings.
• Central: Site of insertion: internal jugular, subclavian or femoral veins; 1 to 3 lumens; inserted by physicians. Common potential complication pneumothorax, infection.

IV Solutions

• Isotonic: Similar electrolyte content to body fluids (e.g., 0.9% NaCl [Normal Saline], D5W [5% dextrose in water], Lactated Ringer's solution)
• Hypotonic: Lower electrolyte content than body fluids (e.g., 0.45% NaCl [1/2 NS])
• Hypertonic: Higher electrolyte content than body fluids (e.g., D5 0.9% NaCl [D5NS], D5 0.45% NaCl [D5 1/2 NS], D5 Lactated Ringer's)

Solution Containers

• Bags: Sterile, collapse as they empty; sizes between 50 mL and 1000 mL
• Bottles: Sterile; sizes between 50 mL and 500 mL; use vented tubing

IV Solution Containers - What to Check

• Name of solution
• Size/amount of solution
• Expiration date
• Color/clarity of solution
• Presence of foreign material
• Signs of leakage

IV Solutions - Hang Time

• Follow CDC recommendations
• Adhere to hospital policy and manufacturer's suggestions.
• Total Parenteral Nutrition: 12 to 24 hours
• Lipids: 12 to 24 hours
• Blood: 4 hours

IV Administration Sets (Tubing)

• Primary: Administering the main IV fluids.
• Secondary (IVPB or Piggyback): Administering supplementary fluids or medications; typically 25–250 mL.
• Extension: Adds length to the IV line
• Blood Administration: Uses two spikes; one for blood and one for saline.

IV Line Preparation steps

• Healthcare provider order
• Hand hygiene
• Introduce self and patient; explanation of procedure
• Focused Assessment (Insertion site)
• Assess for infiltration, phlebitis (color, swelling, pain, leaking, temperature).
• Gather Equipment, correct IV solution and tubing, IV pole/hanger, and know desired drop rate
• Prepare Solution Container (tear perforated corner of outer packaging; check solution name, volume, label as necessary; apply time tape, if needed).
• Prepare Tubing (check type and sterility, close roller clamp, prime tubing, label tubing, initials, date, time hung).
• Connect Tubing to bag. Maintain Sterility, Spike port on bag
• Squeeze the drip chamber approximately 1/2 full - Flush/prime tubing to eliminate inline air bubbles
• Attach tubing to bag and prime- Maintain Sterility, Spike port on bag, Squeeze the drip chamber Approximately 1/2 full - Flush/prime tubing, Label tubing, Date, time hung
• Attach tubing to the container. Maintain Sterility, Spike port on bag, Squeeze the drip chamber Approximately 1/2 full - Flush/prime tubing, Label tubing, and Document Date, and time hung

Assessing IV Insertion Site

• Infiltration: IV fluid leaks into surrounding tissues; symptoms may include coolness, paleness, and swelling.
• Phlebitis: Inflammation of the vein; symptoms may include heat, erythema, pain, and tenderness.
• Infection: Infection at the catheter entrance site; symptoms may include erythema, warmth, swelling, pain, and possible purulent drainage.

Secondary IV Line Setup

• Check provider order (MAR)
• Confirm solutions/medications are compatible.
• Gather equipment.
• Correct solution, where stored properly labeling, check for compatibility with primary IV solution, performed 3 checks and rights, and correct tubing length for IVPB.
• Calculated drip rate, drop factor of equipment, time interval, volume to be infused.
• Check solutions for compatibility with the primary IV solution
• Attach tubing to the container. Maintain Sterility, Spike port on bag, Squeeze the drip chamber Approximately 1/2 full - Flush/prime tubing, Label tubing, and document Date, and time hung and compatibility
• Determine if using gravity flow or pump if using pump Calculate mL/hour

Documentation IV therapy

• E-Mar: details about the solution, time initiated/ replaced, rate of flow, any rate changes during the shift.
• Site: location of catheter insertion site, assessment (no redness, swelling, pain, drainage, pallor).
• Intake&output record.

Test your knowledge on fluid volume deficits and excesses, as well as intravenous (IV) administration techniques. This quiz covers key concepts, signs, and equipment related to fluid management in clinical settings. Perfect for nursing students and healthcare professionals.