IV Insertion and Fluid Management Quiz

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Questions and Answers

Which condition would prevent you from choosing a vein for IV insertion?

History of frequent blood donations

Presence of an AV fistula (correct)

Aspirin use within the past week

Temporary phlebitis in the opposite arm

What is the primary purpose of using a tourniquet during IV insertion?

To increase the temperature of the vein

To prevent contamination of the insertion site

To reduce pain during the procedure

To engorge the vein for easier access (correct)

What is the significance of maintaining strict aseptic technique during IV insertion?

To minimize discomfort for the patient

To ensure quick access to the vein

To reduce the risk of bruising around the insertion site

To prevent inflammation like cellulitis (correct)

Which of the following fluids is considered isotonic and commonly used for treating hypovolemia?

0.9% Sodium chloride Signup and view all the answers

Which intervention should be taken during monitoring after administering IV medication?

Observe the patient for any signs of adverse reactions Signup and view all the answers

What effect does a hypotonic fluid have on body cells?

It pulls water into the cells, causing them to swell. Signup and view all the answers

In which clinical situation are hypertonic fluids mainly indicated?

Cerebral edema and hyponatremia. Signup and view all the answers

Why are isotonic fluids contraindicated in patients with fluid overload?

They can exacerbate heart failure symptoms. Signup and view all the answers

Which of the below fluids is considered hypotonic?

0.45% NS Signup and view all the answers

What is a potential risk of administering hypertonic fluids?

Phlebitis if given peripherally. Signup and view all the answers

What effect does hypotonic fluid have on cells?

Water moves into cells, causing them to swell Signup and view all the answers

Which of the following is a characteristic of hypertonic fluids?

Water moves out of cells, causing them to shrink Signup and view all the answers

What is the mechanism of action of valacyclovir?

Inserts into replicating viral DNA, halting its synthesis Signup and view all the answers

Which side effect is NOT typically associated with valacyclovir?

Hair loss Signup and view all the answers

Which of the following conditions can occur as a rare side effect of acyclovir and valacyclovir?

Thrombotic thrombocytopenic purpura Signup and view all the answers

What is the recommended first step when administering acyclovir to a client?

Perform a baseline assessment of current symptoms Signup and view all the answers

Which of the following best describes the fluid concentration in hypotonic fluids compared to the cells?

Lower concentration than cells Signup and view all the answers

Which suffix is characteristic of the class of antiviral medications used to treat herpesviruses?

-clovir Signup and view all the answers

What common nursing consideration should be taken when infusing multiple lines of fluids?

Keep all lines untangled and clearly labeled Signup and view all the answers

What possible neurological side effect may result from valacyclovir?

Hallucinations Signup and view all the answers

Study Notes

IV's

Never choose veins in an arm with mastectomy, dialysis shunts, AV fistulas, infection, extensive scarring, burns, surgeries, CVA paralysis on the same side, or sites distal to previous punctures.
Technical pointers for IV insertion include strict aseptic technique (alcohol or chlorhexidine), a tourniquet 6-8 inches above the insertion site, vein massage as needed, and heat application as needed.
Extension tubing connects the IV catheter to a saline lock with a cap for IV infusions.
Setup involves applying a tourniquet, palpating the vein, practicing hub scrubbing, connecting extension tubing with a saline flush, and discussing IV removal with the partner.
Cellulitis is inflammation of loose connective tissue around the insertion site, caused by poor aseptic insertion technique, and treated with antibiotics; the area spreads from the insertion point in a circle pattern.

Medication Administration

The 9 rights of medication administration: right patient, right drug, right dose, right route, right time, right documentation, right to refuse, right assessment, and right education must be followed.

Monitoring/Nursing Interventions (IV Push)

Assess the patient before, during, and after medication administration, and observe for adverse reactions.
Know what to do if an adverse reaction occurs (e.g., support airway, administer oxygen, administer antidote).
Monitor for the development of side effects of prescribed medications and evaluate for a therapeutic response by the absence of lesions or herpes simplex symptoms.

Parental Fluid Replacement

Fluids, electrolytes, medications, and nutrients are provided for intravenous fluid imbalances.
The types of intravenous fluids include isotonic, hypotonic, and hypertonic solutions, and are used to correct fluid and electrolyte imbalances, including cases of nausea and vomiting (N/V/D).
Isotonic fluids remain within the intravascular compartment, maintain the same concentration inside and outside the cell, and treat hypovolemia, hypotension.
Examples include 0.9% sodium chloride (normal saline), Lactated Ringers (LR), and D5W. D5W is both isotonic and hypotonic; not suitable for rapid infusion.
Hypotonic fluids have a lower solute concentration compared to cells, causing water to enter the cells, and are used for dehydration and increased intracranial pressure (ICP).
Hypertonic fluid has a higher solute concentration compared to cells, causing water to leave the cells and shrinking the cells. They are used to treat cerebral edema, hyponatremia, and excess fluid.

Treatment for Genital Herpes

Treatment involves antiviral medications (e.g., acyclovir, valacyclovir, famciclovir) to decrease symptoms of herpes simplex virus (HSV) but does not eliminate or stop the virus's spread to others.
Patients should refrain from sexual activity if they have sores, and use condoms during all sexual activity to avoid transmission, even if no sores are present.
Education about medication dosage, consistency in taking the medicine, adequate hydration, possible side effects, and when to contact a healthcare provider is essential.

IV Therapy PPT (Key sites for insertion)

Never choose veins in an arm with mastectomy, dialysis shunts, AV fistulas, infection, extensive scarring, burns, surgeries, CVA paralysis, or sites distal to previous punctures.

Reasons Why IV Meds Are Administered (IV Therapy PPT)

Expanding intravascular volume.
Correcting imbalances of fluids and electrolytes to compensate for ongoing problems (e.g., N/V/D).
Providing nutrition
Administering medications (both routine and emergency)
Transfusing blood products
Performing diagnostic lab tests

Antidotes For Drugs Reviewed in Class

Benzodiazepines: Flumazenil
Opioids: Naloxone (Narcan)
Heparin: Protamine sulfate
Acetaminophen: N-acetylcysteine (Mucomist)
Warfarin: Vitamin K

Hypotonic Intravenous (IV) Fluid

Hypotonic fluids pull body water into cells, causing cells to expand.
Used for dehydration and hyperglycemic conditions.
Common solutions include 0.45% NS, 0.33% NS, and 0.225% NS.
These fluids are contraindicated in Increased ICP, dehydration and traumatic injuries..

Crystalloid Solutions Adverse Effects

Crystalloid solutions contain small particles that dissolve easily in a solvent and pass through capillary membranes. Common constituents include electrolytes (sodium, potassium, calcium, and magnesium) and non-electrolytes (glucose, amino acids, oxygen, and carbon dioxide).
Possible adverse effects include edema and fluid overload.

IV Complications

Infiltration: Leakage of fluids into surrounding tissues, characterized by swelling, coolness, and pain at the IV site.
Phlebitis: Inflammation of the vein, presenting as redness and pain along the vein near the insertion site.
Cellulitis: Infection in the surrounding tissue due to poor aseptic technique, marked by redness, swelling, and streaks radiating outward from the insertion site.
Extravasation: Leakage of vesicants (irritating medications) into surrounding tissues, resulting in severe tissue damage with delayed healing, infection, tissue necrosis, and possible disfigurement or amputation.
Air embolism: Air in veins, marked by sudden onset dyspnea, chest pain, and hypotension.

Treatment for genital herpes

Antiviral medications (including acyclovir, famciclovir, and valacyclovir).
Prevention measures:
- Avoid sexual activity with sores.
- Use condoms (latex or polyurethane).
- Take medication with water, with or without food, on a regular schedule.

Administration of an intravenous bolus

Verify the medication order, dose, route, and patient identity.
Check for allergies and contraindications.
Prepare the medication aseptically.
Explain the procedure and obtain consent.
Position the patient appropriately.
Cleanse the injection port/cap with alcohol
Inject the medication slowly (1-3 minutes).
Monitor the patient for reactions.
Flush the IV line with normal saline before and after.
Document administration with time, dose, route, site, and reactions.

Clinical findings of cellulitis (IV Therapy PPT)

Red swollen area spreads from the insertion site outwardly in a diffuse circular pattern.
Redness, warmth, swelling, pain, streaks radiating out from the site and/or drainage might be observed.

Correct procedure, correct patient, correct body site, and informed consent required.

Purpose of Team Steps

Improve communication
Increase patient safety
Enhance team performance
Promote effective collaboration among healthcare providers.

Safety concerns of epidural catheter

Infection risk (strict aseptic technique).
Bleeding/hematoma (coagulopathy and anticoagulant therapy timing).
Catheter complications (occlusion, migration, cerebrospinal fluid leakage).
Medication errors (knowing specific catheter location).
Respiratory depression (if opioid medications administered epidurally).
Nerve damage (hypotension, post-dural puncture headache, catheter migration, medication errors, local anesthetic systemic toxicity [LAST], allergic reactions, patient falls, and bradycardia).

Patient safety strategy to prevent and treat PE after surgery

Methods to prevent include:
- Patient hydration status monitoring
- Early ambulation
- Prevention of leg crossing
- Encouragement to use compression stockings or sequential compression devices.
Medications may be prescribed to prevent VTE and PE.
Prompt intervention with correct treatment necessary for all possible symptoms of PE.

How do street drugs affect the effects of anesthesia?

Tobacco and substance use can increase the risk of pulmonary complications and alter patient responses to anesthesia and pain medications.
Alcohol withdrawal can lead to delirium tremens.
Prescribed or over-the-counter drugs and herbal supplements can also impact the operative experience.
Street drugs affect anesthetic and analgesic effectiveness differently (cocaine, marijuana, and opiates).

Dronabinol

Used to treat severe nausea and vomiting associated with chemotherapy (especially in non-responsive patients).
Mechanism of action is unknown but likely related to cannabinoid receptors near the vomiting center, activating them.

Promethazine

A dopamine antagonist that is an antiemetic.
It has antihistaminic and anticholinergic properties.
Uses include nausea, vomiting, anxiety reduction or sedation in patients, but is used with caution.

MOA of Ondansetron

Blocks serotonin receptors in the chemoreceptor trigger zone and vagal nerve terminals, suppressing nausea and vomiting.
Does not block dopamine receptors, so does not cause extrapyramidal symptoms.

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Description

Test your knowledge on IV insertion techniques and fluid management principles. This quiz covers essential topics such as aseptic technique, fluid types, and indications for fluid use in clinical situations. Perfect for nursing students and healthcare professionals.