IV Fluids and Their Applications
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Questions and Answers

Which fluid type is contraindicated in fluid overload?

  • Hypertonic fluid
  • Isotonic fluid (correct)
  • Hypotonic fluid
  • None of the above
  • What is the primary clinical indication for administering hypotonic fluids?

  • Cerebral edema
  • Hyponatremia
  • Fluid overload
  • Dehydrated cells (correct)
  • What can occur if hypotonic fluids are administered to patients with increased ICP?

  • Brain swelling (correct)
  • Fluid overload
  • Hypernatremia
  • Cell expansion
  • Which of the following fluid types does NOT change the size of cells?

    <p>Isotonic fluid (B)</p> Signup and view all the answers

    Which solution is commonly ordered as a hypotonic fluid?

    <p>0.45% NS (A)</p> Signup and view all the answers

    What is a critical reason for using hypertonic fluids in an ICU setting?

    <p>To pull water into the bloodstream (C)</p> Signup and view all the answers

    What effect do hypertonic fluids have on the cells?

    <p>Cells shrink (A)</p> Signup and view all the answers

    Which condition is a target for hypotonic fluid therapy?

    <p>Dehydrated cells (B)</p> Signup and view all the answers

    Which scenario is appropriate for selecting an IV insertion site?

    <p>An arm with no previous complications (A)</p> Signup and view all the answers

    What is the recommended action when applying a tourniquet for IV insertion?

    <p>Ensure it is applied for no more than 2 minutes (B)</p> Signup and view all the answers

    What type of IV fluid remains within the intravascular compartment and does not cause cells to change shape?

    <p>Isotonic (C)</p> Signup and view all the answers

    Which medication is associated with treating Blue Man Syndrome?

    <p>Amiodarone (C)</p> Signup and view all the answers

    Which of the following represents the correct order of the nine rights of medication administration?

    <p>Right dose, right patient, right drug (A)</p> Signup and view all the answers

    What causes cellulitis at an IV insertion site?

    <p>Inadequate aseptic techniques (C)</p> Signup and view all the answers

    Which statement accurately describes the use of extension tubing in IV therapy?

    <p>It connects the IV catheter to a saline lock (D)</p> Signup and view all the answers

    What is the primary purpose of IV fluid administration?

    <p>To correct imbalances of fluids and electrolytes (A)</p> Signup and view all the answers

    What is the primary effect of hypotonic fluids on cells?

    <p>Cells swell due to water influx (A)</p> Signup and view all the answers

    Which medication is classified as a guanosine analog used to treat herpesvirus infections?

    <p>Valacyclovir (A)</p> Signup and view all the answers

    What mechanism of action does valacyclovir utilize to halt viral replication?

    <p>It inserts into the replicating viral DNA (C)</p> Signup and view all the answers

    Which of the following is NOT a common side effect of valacyclovir?

    <p>Cardiac arrhythmia (C)</p> Signup and view all the answers

    Which term describes the condition caused by valacyclovir leading to a severe rash and potential organ involvement?

    <p>Stevens-Johnson syndrome (C)</p> Signup and view all the answers

    What is the main difference between hypotonic and hypertonic fluids?

    <p>Hypertonic fluids have a higher concentration of solutes than the cells (B)</p> Signup and view all the answers

    What should be performed before administering antiviral medication like acyclovir for genital herpes?

    <p>Conduct a baseline assessment of symptoms (B)</p> Signup and view all the answers

    Which serious but rare side effect can occur from the use of acyclovir and valacyclovir?

    <p>Hemolytic uremic syndrome (B)</p> Signup and view all the answers

    What is the primary purpose of the antiviral medications used to treat herpesviruses?

    <p>To inhibit viral DNA replication (C)</p> Signup and view all the answers

    Which of the following is NOT a recommended nursing consideration when caring for a client prescribed antiviral medication for herpes?

    <p>Immediately increase the medication dosage if symptoms worsen (D)</p> Signup and view all the answers

    Why is it important for clients to refrain from sexual activity during herpes outbreaks?

    <p>It helps reduce the risk of transmission to others (B)</p> Signup and view all the answers

    Which of the following side effects might indicate a serious reaction to antiviral medication in patients?

    <p>Nephrotoxicity and hemolytic uremic syndrome (C)</p> Signup and view all the answers

    What should clients be instructed to do to ensure optimal effectiveness of their antiviral medication?

    <p>Stay well-hydrated and take medication on a regular schedule (A)</p> Signup and view all the answers

    Which of the following laboratory tests would be expected to be reviewed for a patient undergoing treatment for herpes simplex virus?

    <p>Both B and C (A)</p> Signup and view all the answers

    Which of the following best describes the action of guanosine analogs in treating herpesviruses?

    <p>They inhibit the replication of viral DNA (C)</p> Signup and view all the answers

    In which situation is it inappropriate to choose a vein for IV insertion?

    <p>In an arm with a recent mastectomy (B)</p> Signup and view all the answers

    What is the primary physiological effect of administering hypotonic intravenous fluids?

    <p>Pulls body water into the cells (C)</p> Signup and view all the answers

    Which clinical problem is primarily targeted by the administration of hypotonic fluids?

    <p>Hyperglycemic conditions like DKA (D)</p> Signup and view all the answers

    What is the antidote for opioid overdose?

    <p>Naloxone (D)</p> Signup and view all the answers

    Which of the following conditions should contraindicate the use of hypotonic IV fluids?

    <p>Dehydration (D)</p> Signup and view all the answers

    What complication can arise from improperly performed IV insertion that leads to cellulitis?

    <p>Inflammation of loose connective tissue (D)</p> Signup and view all the answers

    What is the mechanism by which hypotonic fluids affect cellular structure?

    <p>They cause water to move into the cells, potentially leading to swelling (D)</p> Signup and view all the answers

    Which of the following is NOT a purpose of establishing an IV?

    <p>To provide therapeutic hypothermia (D)</p> Signup and view all the answers

    Which of these intravenous solutions is commonly considered hypotonic?

    <p>0.45% NaCl (C)</p> Signup and view all the answers

    Flashcards

    IV Insertion Precautions

    Avoid inserting IVs in areas with infections, scarring, burns, surgeries, dialysis shunts, AV fistulas, or recent infiltrations/phlebitis. Choose a site distal to prior punctures and avoid the affected side of a CVA.

    IV Insertion Technique

    Follow strict aseptic technique using proper antiseptic solutions (e.g., alcohol or chlorhexidine), properly position the tourniquet, and possibly massage or clench the fist to improve vein visibility.

    IV Cellular Effects (Isotonic)

    Isotonic fluids have the same concentration inside and outside the cell, so the cell's volume remains unchanged. They are used for hypovolemia and hypotension (too little fluid in circulation).

    Cellulitis Symptoms

    Cellulitis is an infection around the IV site, marked by redness, swelling, and outward spread from the insertion point in a circular pattern. It's caused by poor aseptic technique during insertion.

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    IV Push Adverse Reactions

    Monitor patients closely before, during, and after medication administration. Be prepared for adverse reactions like Red Man Syndrome (vancomycin) or Blue Man Syndrome (amiodarone) and know how to intervene safely.

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    Rights of Medication Administration

    Crucial steps in safe medication administration: the Right patient, drug, dose, route, time, documentation, assessment, education, and right to refuse.

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    IV Fluid Types

    Intravenous fluids are categorized as isotonic, hypotonic, and hypertonic, based on their concentration compared to blood.

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    IV Fluid Administration

    Used for replacing fluids, electrolytes, and other nutrients needed to correct fluid and electrolyte imbalances (e.g. dehydration, vomiting, diarrhea).

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    Isotonic Fluids

    Solutions with the same solute concentration as body fluids.

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    Hypotonic Fluids

    Solutions with a lower solute concentration than body fluids; water moves into cells.

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    Hypertonic Fluids

    Solutions with a higher solute concentration than body fluids; water moves out of cells.

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    Isotonic Fluid Example

    Normal saline (0.9% NaCl) is a common example of an isotonic fluid.

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    Hypotonic Fluid Example

    0.45% NS is a common type of hypotonic fluid.

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    Hypertonic Fluid Example

    D5 0.9% NS is an example. Others include D5 LR, D10W

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    Contraindication of Hypotonic Fluids

    Avoid in increased intracranial pressure (ICP) because of potential brain swelling.

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    Contraindication of Hypertonic Fluids

    Not recommended for general use because of potential fluid overload side effects

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    Valacyclovir MOA

    Valacyclovir, a guanosine analog, stops viral DNA replication by inserting into viral DNA.

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    Common Valacyclovir Side Effects

    Headache, nausea, skin rash, and possible kidney problems (nephrotoxicity).

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    Valacyclovir Severe Side Effects

    Neurological issues (agitation, confusion), hallucinations, seizures, blood clots, and kidney failure are possible.

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    Guanosine Analogs

    A class of antiviral medications used to treat herpesviruses.

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    Herpesviruses

    A group of DNA viruses including simplex, varicella-zoster, and cytomegalovirus.

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    Baseline Assessment (Valacyclovir)

    Initial evaluation of herpes symptoms (location, pain, etc.) when starting antiviral medication.

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    Why are IV meds given?

    Intravenous medications are given to replenish fluids, correct electrolyte imbalances, provide nutrition, deliver medications, transfuse blood products, and facilitate diagnostic testing.

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    Hypotonic IV fluids: What they do?

    Hypotonic fluids have a lower solute concentration than our cells causing water to move into the cells, making them swell.

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    What are Hypotonic fluids used for?

    Hypotonic fluids are used to treat dehydration, especially situations where fluid has been drawn out of the cells, like in hyperglycemic conditions like DKA or HHNS.

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    Examples of Hypotonic Fluids

    Commonly used hypotonic solutions include 0.45% NS (half-normal saline), 0.33% NS, and 0.2% NS.

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    When are Hypotonic IVs contraindicated?

    Hypotonic solutions are contraindicated in patients with increased intracranial pressure (ICP) as they can worsen brain swelling, as well as in dehydration and trauma.

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    Cellulitis: What is it?

    Cellulitis is an inflammation of the loose connective tissue around an IV insertion site, caused by poor aseptic technique during IV insertion.

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    How is cellulitis treated?

    Cellulitis is treated with antibiotics.

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    What are antidotes?

    Antidotes are substances that counteract the effects of poisons or drugs.

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    Acyclovir's Effect

    Acyclovir, a guanosine analog, helps control herpes symptoms by inhibiting viral DNA replication, but it doesn't eliminate the infection or stop spreading.

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    Herpes Client Education

    Teach clients about safe practices like avoiding sexual activity with sores, consistently using condoms, and promptly reporting persistent side effects or worsening symptoms.

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    Acyclovir Side Effects

    Common side effects include headaches, fatigue, nausea, and vomiting. More serious ones include kidney damage, blood clots, and a rare syndrome affecting blood cells.

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    Nursing Considerations for Antivirals

    Assess baseline health, monitor for side effects, and evaluate for the desired therapeutic effect (absence of lesions and herpes symptoms).

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    IV Insertion: No-Go Zones

    Never insert an IV in areas with infections, dialysis shunts, AV fistulas, scarring, burns, surgeries, paralysis from stroke, or recent IV problems.

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    IV Insertion: Safe Sites

    Select veins for IV insertion that are free from infections, scarring, burns, surgeries, dialysis shunts, AV fistulas, and recent IV issues.

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    IV Insertion: Follow-up

    After inserting an IV, monitor for signs of complications like cellulitis (redness, swelling, pain), phlebitis (inflammation), or infiltration (fluid leakage).

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    Study Notes

    IVs

    • Never choose veins in an arm that has a mastectomy, extremity with dialysis shunts or AV fistulas, signs/symptoms of infection, extensive scarring, burns, or surgeries, CVA paralysis, or distal to previous puncture.
    • Technical pointers for IV insertion procedure:
      • Prepare equipment using strict aseptic technique (alcohol or chlorhexidine).
      • Apply a tourniquet 6-8 inches above the intended insertion site.
      • Massage the vein as needed.
      • Use heat as needed.
    • Extension Tubing connects to patient's IV catheter to make a saline lock.
    • Setting up an IV involves applying a tourniquet, palpating the vein, scrubbing the hub, using a saline flush to connect the tubing, and connecting the cap to the extension tubing.
    • Cellulitis is an inflammation of loose connective tissue around the insertion site, caused by poor aseptic technique. It's treated with antibiotics. The area spreads in a diffuse circular pattern.
    • 9 Rights of medication administration:
      • Right patient
      • Right drug
      • Right dose
      • Right route
      • Right time
      • Right documentation
      • Right to refuse
      • Right assessment
      • Right education

    Monitoring/Nursing Interventions (IV Push)

    • Assess the patient before, during, and after medication administration, observing for adverse reactions.
    • Know what to do if an adverse reaction occurs (support airway, give oxygen, administer antidote).
    • Medications for Blue Man Syndrome: Amiodarone
    • Medications for Red Man Syndrome: Vancomycin

    Types of IV Fluids

    • Isotonic Fluids: Remain within the intravascular compartment, maintaining the same concentration inside and outside cells.
      • Examples: 0.9% Sodium chloride (Normal Saline), Lactated Ringers (LR).
    • Hypotonic Fluids: Have a lower solute concentration than cells, causing water to move into cells, potentially causing them to swell.
      • Examples: 0.45% NS, 0.33% NS, 0.2% NS
    • Hypertonic Fluids: Have a higher solute concentration than cells, causing water to move out of cells, potentially causing them to shrink.
      • Examples: D5 0.9%NS, D5 0.45%NS, D5 LR, 3% NS, D10W

    IV Complications

    • Infiltration: Fluid leaking into surrounding tissue, causing swelling, discomfort, and blanching.
    • Phlebitis: Inflammation of a vein, causing redness, pain, and tenderness.
    • Cellulitis: Inflammation of tissue around the insertion site, often caused by poor aseptic technique.
    • Extravasation: Leaking of vesicant drugs into surrounding tissue. Results in tissue damage.
    • Overload: Excessive fluid intake, potentially leading to shortness of breath, increased blood pressure, and edema.
    • Air Embolism: Air entering the vein. Signs include sudden dyspnea and chest pain.

    Other Information

    • IV insertion sites should avoid areas with shunts/fistulas, burns/scars or sites distal to previous punctures.
    • Medication administration and appropriate dosages:
    • Drug, dose, route, time, patient, documentation, right to refuse, assessment, education

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    Watkins FINAL EXAM PDF

    Description

    This quiz covers critical concepts related to intravenous (IV) fluid types and their appropriate usage in clinical settings. It addresses hypotonic, hypertonic, and isotonic fluids, along with their effects on cells and specific patient conditions. Test your knowledge on IV insertion practices and medication administration.

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