Podcast
Questions and Answers
Which of the following factors most significantly influences the decision to administer medications intravenously rather than via other routes?
Which of the following factors most significantly influences the decision to administer medications intravenously rather than via other routes?
- The availability of a skilled healthcare provider to administer the medication.
- Patient preference for intravenous administration due to reduced discomfort.
- The need for rapid absorption or administration of a large volume of fluid. (correct)
- Medication cost, with intravenous medications typically being less expensive.
A patient receiving continuous intravenous fluid therapy suddenly develops chills, and the nurse observes that the IV insertion site is red and warm to the touch. Which complication should the nurse suspect, and what is the most immediate nursing action?
A patient receiving continuous intravenous fluid therapy suddenly develops chills, and the nurse observes that the IV insertion site is red and warm to the touch. Which complication should the nurse suspect, and what is the most immediate nursing action?
- Phlebitis; discontinue the IV and apply a cool compress. (correct)
- Speed shock; slow the infusion rate and monitor vital signs.
- Extravasation; elevate the affected extremity and apply a warm compress.
- Air embolism; place the patient in Trendelenburg position and administer oxygen.
In the context of intravenous therapy, how does the extracellular fluid compartment contribute to maintaining overall fluid balance in the body?
In the context of intravenous therapy, how does the extracellular fluid compartment contribute to maintaining overall fluid balance in the body?
- It primarily functions to store excess fluids, preventing hypervolemia during rapid IV infusions.
- It acts as an intermediary, facilitating fluid and electrolyte exchange between the intravascular and intracellular compartments. (correct)
- It directly regulates the production of antidiuretic hormone (ADH) in response to dehydration.
- It actively transports nutrients and waste products across cell membranes.
A physician orders an intravenous infusion of 1000 mL of 0.9% sodium chloride to be administered over 8 hours using a macrodrip IV administration set with a drop factor of 15 drops/mL. What is the correct flow rate in drops per minute (gtts/min) to deliver this infusion?
A physician orders an intravenous infusion of 1000 mL of 0.9% sodium chloride to be administered over 8 hours using a macrodrip IV administration set with a drop factor of 15 drops/mL. What is the correct flow rate in drops per minute (gtts/min) to deliver this infusion?
What is the primary role of infusion control devices, such as volumetric pumps, in ensuring patient safety during intravenous therapy?
What is the primary role of infusion control devices, such as volumetric pumps, in ensuring patient safety during intravenous therapy?
For a patient requiring long-term intravenous therapy, which type of venous access device is typically the MOST suitable to minimize the risk of infection and vessel damage?
For a patient requiring long-term intravenous therapy, which type of venous access device is typically the MOST suitable to minimize the risk of infection and vessel damage?
Why is it generally contraindicated to draw blood samples from a peripheral intravenous access device site?
Why is it generally contraindicated to draw blood samples from a peripheral intravenous access device site?
5% dextrose in water (D5W) is categorized as an isotonic solution, but it has a unique characteristic when administered intravenously. What BEST describes this characteristic?
5% dextrose in water (D5W) is categorized as an isotonic solution, but it has a unique characteristic when administered intravenously. What BEST describes this characteristic?
During the administration of intravenous fluids, a nurse observes that the patient's IV insertion site is swollen, pale, and cool to the touch. The patient reports discomfort at the site. What condition is the patient MOST likely experiencing, and what is the MOST appropriate initial nursing intervention?
During the administration of intravenous fluids, a nurse observes that the patient's IV insertion site is swollen, pale, and cool to the touch. The patient reports discomfort at the site. What condition is the patient MOST likely experiencing, and what is the MOST appropriate initial nursing intervention?
When administering intravenous medications to older adults, which physiological change is MOST likely to affect the rate of infusion and drug metabolism, potentially leading to adverse reactions?
When administering intravenous medications to older adults, which physiological change is MOST likely to affect the rate of infusion and drug metabolism, potentially leading to adverse reactions?
A patient receiving intravenous amphotericin B, a vesicant medication, complains of pain at the insertion site. Upon assessment, the nurse notes redness and swelling. The nurse suspects extravasation. Beyond discontinuing the infusion, what is the next MOST critical step?
A patient receiving intravenous amphotericin B, a vesicant medication, complains of pain at the insertion site. Upon assessment, the nurse notes redness and swelling. The nurse suspects extravasation. Beyond discontinuing the infusion, what is the next MOST critical step?
A nurse is preparing to administer an IV medication via the SASH method. What does this acronym stand for, and why is this technique important in IV medication administration?
A nurse is preparing to administer an IV medication via the SASH method. What does this acronym stand for, and why is this technique important in IV medication administration?
A patient receiving intravenous fluids develops sudden dyspnea, cough, and crackles in the lungs. The nurse suspects circulatory overload. Which initial nursing intervention is MOST appropriate?
A patient receiving intravenous fluids develops sudden dyspnea, cough, and crackles in the lungs. The nurse suspects circulatory overload. Which initial nursing intervention is MOST appropriate?
Which strategy is MOST effective in preventing air embolus during intravenous administration?
Which strategy is MOST effective in preventing air embolus during intravenous administration?
A patient with a history of heart failure is prescribed an intravenous infusion of normal saline. What is the MOST important nursing consideration when administering this infusion?
A patient with a history of heart failure is prescribed an intravenous infusion of normal saline. What is the MOST important nursing consideration when administering this infusion?
After discontinuing an intravenous infusion, the nurse notes bleeding from the insertion site. What is the MOST appropriate nursing action?
After discontinuing an intravenous infusion, the nurse notes bleeding from the insertion site. What is the MOST appropriate nursing action?
The physician orders IV fluids to infuse at 125 mL/hr. The drop factor is 20 gtt/mL. How many drops per minute should this IV infuse?
The physician orders IV fluids to infuse at 125 mL/hr. The drop factor is 20 gtt/mL. How many drops per minute should this IV infuse?
When administering IV fluids, the nurse understands that the fluid will distribute into specific compartments within the body. What is the approximate distribution of total body water between the intracellular and extracellular compartments?
When administering IV fluids, the nurse understands that the fluid will distribute into specific compartments within the body. What is the approximate distribution of total body water between the intracellular and extracellular compartments?
A patient is scheduled to receive an IV infusion through a glass bottle. What action must the nurse take when administrating the IV fluids?
A patient is scheduled to receive an IV infusion through a glass bottle. What action must the nurse take when administrating the IV fluids?
A nurse is caring for a patient with a central venous catheter. To maintain patency, the nurse must flush unused ports on a regular basis. What size syringe is recommended to administer the solution?
A nurse is caring for a patient with a central venous catheter. To maintain patency, the nurse must flush unused ports on a regular basis. What size syringe is recommended to administer the solution?
A patient is in the hospital after a surgical procedure. The intake and output collection at the end of the shift indicates that the IV bag should have 500 mL left, but there is 900 mL. What should the nurse do first?
A patient is in the hospital after a surgical procedure. The intake and output collection at the end of the shift indicates that the IV bag should have 500 mL left, but there is 900 mL. What should the nurse do first?
A nurse is preparing to administer an IV medication using a piggyback setup. What is the primary reason for using this method for certain medications?
A nurse is preparing to administer an IV medication using a piggyback setup. What is the primary reason for using this method for certain medications?
When converting from an IV infusion of normal saline to an oral fluid intake for a patient, what key assessment should the nurse prioritize to ensure adequate hydration?
When converting from an IV infusion of normal saline to an oral fluid intake for a patient, what key assessment should the nurse prioritize to ensure adequate hydration?
In the event that a patient displays symptoms of 'speed shock' during intravenous drug administration, what is the initial nursing intervention?
In the event that a patient displays symptoms of 'speed shock' during intravenous drug administration, what is the initial nursing intervention?
A patient receiving intravenous fluids begins to exhibit signs of pulmonary edema, including dyspnea and crackles in the lungs. Which classification of intravenous solutions is most likely contributing to this condition?
A patient receiving intravenous fluids begins to exhibit signs of pulmonary edema, including dyspnea and crackles in the lungs. Which classification of intravenous solutions is most likely contributing to this condition?
What primary advantage does the usage of plastic IV solution containers offer over the previously common glass containers?
What primary advantage does the usage of plastic IV solution containers offer over the previously common glass containers?
A patient is receiving a continuous infusion of heparin. The IV pump malfunctions, causing a rapid bolus of heparin to be administered. What is the MOST critical assessment the nurse should immediately perform to detect potential complications?
A patient is receiving a continuous infusion of heparin. The IV pump malfunctions, causing a rapid bolus of heparin to be administered. What is the MOST critical assessment the nurse should immediately perform to detect potential complications?
A nurse is preparing to administer a medication intravenously that is known to cause severe tissue damage if extravasation occurs. Which intervention is MOST crucial to prevent this complication?
A nurse is preparing to administer a medication intravenously that is known to cause severe tissue damage if extravasation occurs. Which intervention is MOST crucial to prevent this complication?
A nurse is teaching a patient about the signs and symptoms of phlebitis to monitor for at home after discharge. Which of the following should the nurse include?
A nurse is teaching a patient about the signs and symptoms of phlebitis to monitor for at home after discharge. Which of the following should the nurse include?
A nurse is preparing to administer a unit of packed red blood cells intravenously. Which of the following intravenous solutions is compatible with blood products and should be used to prime the IV tubing?
A nurse is preparing to administer a unit of packed red blood cells intravenously. Which of the following intravenous solutions is compatible with blood products and should be used to prime the IV tubing?
A nurse is preparing a hypertonic solution to treat a patient with severe hyponatremia. Understanding the actions of hypertonic solutions, what outcome indicates effective treatment?
A nurse is preparing a hypertonic solution to treat a patient with severe hyponatremia. Understanding the actions of hypertonic solutions, what outcome indicates effective treatment?
A patient with cerebral edema is prescribed a hypertonic intravenous solution. What physiological change is expected following administration?
A patient with cerebral edema is prescribed a hypertonic intravenous solution. What physiological change is expected following administration?
A male patient with a history of intravenous drug abuse is admitted with septicemia. The health provider orders that a peripherally inserted central catheter (PICC) line be inserted for long-term antibiotic therapy, what is the rationale behind using a PICC line over a standard IV catheter:
A male patient with a history of intravenous drug abuse is admitted with septicemia. The health provider orders that a peripherally inserted central catheter (PICC) line be inserted for long-term antibiotic therapy, what is the rationale behind using a PICC line over a standard IV catheter:
During an assessment of a patient's peripheral IV site, the nurse notes that the surrounding area is pale, cool to the touch, and slightly swollen. The patient denies pain, the nurse should...
During an assessment of a patient's peripheral IV site, the nurse notes that the surrounding area is pale, cool to the touch, and slightly swollen. The patient denies pain, the nurse should...
A nurse is administering an intravenous medication via a peripheral IV line. During the infusion of the medication, the patient suddenly complains of shortness of breath, and a sudden sharp chest pain. What is the priority action by the nurse?
A nurse is administering an intravenous medication via a peripheral IV line. During the infusion of the medication, the patient suddenly complains of shortness of breath, and a sudden sharp chest pain. What is the priority action by the nurse?
During the insertion of a central venous catheter (CVC), the patient starts to cough and complains of chest discomfort. The patient's blood pressure drops, and the heart rate increases. The nurse suspects an air embolus. What is the FIRST action?
During the insertion of a central venous catheter (CVC), the patient starts to cough and complains of chest discomfort. The patient's blood pressure drops, and the heart rate increases. The nurse suspects an air embolus. What is the FIRST action?
A nurse is preparing medications for intravenous administration. Which action is most ESSENTIAL to ensure patient safety during this process?
A nurse is preparing medications for intravenous administration. Which action is most ESSENTIAL to ensure patient safety during this process?
Flashcards
Intravenous (IV) Therapy
Intravenous (IV) Therapy
Injection of a solution directly into a vein.
Advantages of IV Therapy
Advantages of IV Therapy
Administered directly into the vein via syringe injection or infusion.
Disadvantages of IV Therapy
Disadvantages of IV Therapy
Requires skill, can decrease mobility and increases risk of infection.
Intravascular compartment
Intravascular compartment
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Intracellular compartment
Intracellular compartment
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Interstitial compartment
Interstitial compartment
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IV administration set
IV administration set
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Macrodrip
Macrodrip
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Infusion-Control Pumps
Infusion-Control Pumps
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Peripheral access devices
Peripheral access devices
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Midline catheters
Midline catheters
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Central devices
Central devices
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Implantable venous infusion ports
Implantable venous infusion ports
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Isotonic solutions
Isotonic solutions
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Hypertonic solution
Hypertonic solution
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Hypotonic solution
Hypotonic solution
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Large-Volume Solution Containers
Large-Volume Solution Containers
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Small-Volume Solution Containers
Small-Volume Solution Containers
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Administering IV Medications
Administering IV Medications
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General Principles of IV Medication Administration
General Principles of IV Medication Administration
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Nursing Responsibilities (IV)
Nursing Responsibilities (IV)
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Monitoring IV Therapy
Monitoring IV Therapy
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Phlebitis
Phlebitis
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Infiltration
Infiltration
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Extravasation
Extravasation
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Septicemia
Septicemia
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Air Embolus
Air Embolus
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Circulatory Overload
Circulatory Overload
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Pulmonary Embolism
Pulmonary Embolism
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Speed Shock
Speed Shock
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Study Notes
Intravenous (IV) Therapy
- IV therapy involves injecting a solution directly into a vein
- It is more effective when large fluid volumes are administered or medications need fast absorption
- A physician's written order is required for IV therapy
- The order must include the date, solution/medication type, dosage, rate, and frequency
Advantages of IV Therapy
- Drugs can be administered directly into a vein via syringe injection
- Drugs can be administered either intermittently or by continuous infusion
- Administration can occur through a peripheral or central IV line
- Drug administration through IV is usually more comfortable than intramuscular (IM) or subcutaneous routes
Disadvantages of IV Therapy
- Administration requires extended time
- A skilled healthcare provider is required
- Patient mobility decreases
- Chance of infection increases
- There is a higher possibility of severe adverse drug reactions
Intravascular Compartments
- There are three main fluid compartments
- Intravascular: Located within blood vessels (arteries, veins, capillaries)
- Intracellular: Located inside the cells
- Interstitial: Located between the cells
- The extracellular compartment consists of intravascular and interstitial fluids and makes up 1/3 of total body water
- The intracellular compartment accounts for 2/3 of the total body water
Equipment Used for IV Therapy
- IV administration sets connect large-volume solutions (IV bags) to the patient's IV access device
- Sets include spikes, drip chambers, tubing with control clamps, and needle adapters
- Macrodrip delivers 10, 15, or 20 drops per mL
- Microdrip delivers 60 drops per mL
Types of Infusion-Control Pumps
- Devices for administering IV fluids and drugs have safety features
- Alarm systems
- Automatic stop capability
- Programmability
- Controllers include gravity-based systems
- Delivery pumps are nonvolumetric and volumetric
- Syringe pumps are another type of infusion-control pump
Intravenous Access Devices
- Peripheral access devices are for short-term use in peripheral veins of the hand or forearm
- Midline catheters are for 2-4 week use; inserted into intermediate-sized veins and advanced into larger vessels
- Central devices are inserted into intermediate-sized vessels
- Implantable venous infusion ports are surgically placed into central veins for long-term therapy
Peripheral Access Device
- Sites for peripheral IVs are the hand or forearm
- This is common for infants or geriatrics
- Extension tubes with an injection port will be attached to the catheter when IV therapy is not required, but venous access is ("saline lock" or "medlock")
- Blood samples should not be drawn from this site
Central Access Devices
- Insertion sites include the subclavian, jugular, or femoral veins
- Tunneled central venous catheters have a surgically placed proximal catheter end that exits on the chest
- Implantable infusion ports for long-term central vein therapy are used for IV fluids, medications, TPN, and chemotherapy, and accessed with a 90-degree Huber needle
Types of IV Solutions
- IV solutions consist of water and dissolved particles (solutes)
- The concentration of dissolved particles is the osmolality
- Solutions replace body fluid/electrolyte losses due to various conditions
- Electrolytes included Sodium (Na+), Chloride (Cl-), and Potassium (K+)
Isotonic Solution
- Isotonic solutions have the same osmolality as body fluids
- These expand intravascular fluid volume and replace fluid loss
- Examples
- 0.9% sodium chloride (normal saline)
- 5% dextrose in water (D5W)
- Lactated Ringer’s (LR)
- Indicated for blood loss, dehydration, fluid maintenance, and diabetic ketoacidosis
Hypertonic Solution
- Hypertonic solutions contain more salt and less water
- The vessel becomes more concentrated than the cell, causing water to leave the cell and resulting in cell shrinkage
- Hypertonic solutions are "hyper salt" and include
- 5% saline
- 3% saline
- 5% dextrose in 0.9% saline
- 5% dextrose in LR (D5LR)
- Indicated for cerebral edema, hyponatremia, metabolic alkalosis, or hypovolemia
Hypotonic Solution
- In hypotonic solutions, fluid moves out of the vessel and into the cell
- Hypotonic solutions contain less salt and high water
- This results in cell swell
- Examples are
- 0.45% saline
- 0.33% saline
- 0.225% saline
- 5% dextrose in water
- These are indicated for helping kidneys excrete fluids or hypernatremia
- Should not be given to clients with increased intracranial pressure (ICP), burns, or trauma
Large-Volume Solution Containers
- Plastic and glass containers are vacuum sealed
- Glass containers are sealed with hard rubber stopper and metal disk; remove cap and disk before use
- Volumes range from 100 to 2000 mL
Small-Volume Solution Containers
- Administered through a tandem setup, piggyback, or IV rider for intermittent infusion
- Infused over 20-60 minutes
Administration of Medications
- Medications for IV administration are available in ampules, vials, prefilled syringes, and large-volume IV solution bags
- Administration can be through peripheral or central intravenous access
General Principles of IV Medication Administration
- Know the purpose and use the seven rights
- Determine compatibility issues
- Perform with aseptic technique
- Apply the SASH method
- Calculate drip rates
Nursing Responsibilities
- Provide care to insertion sites and implanted ports
- Perform dressing changes and flushing catheters
- Discontinue IV infusion
- Know which medications can be infused IV
- Check carefully for drug orders, dose, and recommended rates of infusion for IV medications
Monitoring IV Therapy
- Assessment of insertion site and equipment
- Perform flushing, medication administration, and dressing changes
- Discontinue IV line when appropriate and provide patient teaching
Complications of IV Therapy
- Potential complications include:
- Phlebitis, thrombophlebitis, and infection
- Septicemia, infiltration, and extravasation
- Air embolus
- Circulatory overload and pulmonary edema
- Pulmonary embolism
- "Speed shock"
Phlebitis and Thrombophlebitis
- Irritation of the vein can be caused by the catheter, chemical irritation from medicine, or improper aseptic technique
- Thrombo + phlebitis results in clot and inflammation
Infiltration vs Extravasation
- Infiltration occurs when IV fluid leaks into the surrounding tissue
- Discontinue the IV and inserting a new IV line with new equipment will rectify this
- Extravasation occurs when potent and corrosive medications infiltrate the surrounding tissues
- Discontinue the IV, leaving the catheter in place
Septicemia
- Pathogens invade the bloodstream to other body parts, which can trigger an inflammatory response
- Indicated if flushing, fever, vomiting, nausea, headache, malaise, hypotension, weak, rapid pulse are present
- Treatment is to discontinue the IV catheter, get a blood culture, and administer antibiotic therapy
Air Embolus
- Air bubbles enter the cardiovascular system
- Signs and symptoms include palpitations, tachycardia, chest pain, shortness of breath, cyanosis, hypotension, and weak, thready pulse
- Nurse should place the patient on their left side with the head in a dependent position and administered O2. Notify HCP stat
- Prevent by clamping catheters and syringes, or performing Valsalva's maneuver during tubing and injection to not allow any air by injection
Circulatory Overload and Pulmonary Edema
- Too much and rapid infusion of fluids in patients with cardiovascular disease contribute
- Signs and symptoms: engorged neck, dyspnea, reduced urine output, edema, bounding pulse, and rapid respiration
- Nurse should slow the IV infusion immediately, position the client to the High Fowler position, start 02, obtain VS, and call HCP stat anticipating orders of diuretics, vasodilators, and morphine sulfate
Pulmonary Embolism
- Caused by foreign materials entering the vein through injection, or a blood clot breaks loose and travels to the lungs
- Symptoms include apprehension, dyspnea, pleuritic pain, sweating, tachycardia, cough, hemoptysis, low-grade fever, or cyanosis
- Immediately administer O2, obtain VS, and notify HCP.
- Prevent with in-line filter, ensure proper diluents for reconstitution and medications is fully dissolved
Speed Shock
- This is a systemic reaction to a foreign substance that is given too rapidly (IV push) and creates a concentrated plasma that might result in shock, syncope, and cardiac arrest
- Prevent by timing medication administration through direct visual clock observation and frequent checks of IV rate
- Assess the patient for dizziness, flushing, tightness in the chest, rapid, irregular pulse, hypotension, and anaphylactic shock
- Immediately stop the infusion and maintain IV patency at a TKO rate, obtain VS, and notify a healthcare professional
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