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Questions and Answers
What is a common electrolyte imbalance that can occur with excessive IV fluid administration?
What is a common electrolyte imbalance that can occur with excessive IV fluid administration?
Which process is primarily responsible for regulating extracellular fluid volume?
Which process is primarily responsible for regulating extracellular fluid volume?
Which of the following IV tubing types delivers the highest drip rate?
Which of the following IV tubing types delivers the highest drip rate?
What is a significant local complication of IV fluid therapy?
What is a significant local complication of IV fluid therapy?
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Which of the following statements best describes the nurse's role in IV therapy maintenance?
Which of the following statements best describes the nurse's role in IV therapy maintenance?
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What is the primary goal of fluid balance in the body?
What is the primary goal of fluid balance in the body?
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What is the normal range of osmolality in humans?
What is the normal range of osmolality in humans?
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Which type of IV solution has a higher osmolality than blood?
Which type of IV solution has a higher osmolality than blood?
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Which component primarily controls osmolality in the body?
Which component primarily controls osmolality in the body?
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Which of the following actions is not part of clinical validations for IV therapy?
Which of the following actions is not part of clinical validations for IV therapy?
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What is one of the primary causes of hypovolemia?
What is one of the primary causes of hypovolemia?
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Which sign is associated with dehydration during a physical assessment?
Which sign is associated with dehydration during a physical assessment?
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Which laboratory result would indicate dehydration?
Which laboratory result would indicate dehydration?
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What nursing intervention is critical for managing fluid volume deficit?
What nursing intervention is critical for managing fluid volume deficit?
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What does hypervolemia primarily involve?
What does hypervolemia primarily involve?
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Which condition is primarily associated with fluid volume excess?
Which condition is primarily associated with fluid volume excess?
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What is one of the common symptoms of fluid volume deficit?
What is one of the common symptoms of fluid volume deficit?
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Which assessment finding might indicate circulatory overload?
Which assessment finding might indicate circulatory overload?
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What condition is indicated by increased deep tendon reflexes and a positive Chvostek sign?
What condition is indicated by increased deep tendon reflexes and a positive Chvostek sign?
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Which of the following is NOT a management strategy for chronic hypocalcemia?
Which of the following is NOT a management strategy for chronic hypocalcemia?
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What is a common indicator of hypercalcemia?
What is a common indicator of hypercalcemia?
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Which of the following is true regarding calcium as it relates to neuromuscular function?
Which of the following is true regarding calcium as it relates to neuromuscular function?
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Which of the following conditions is associated with hypocalcemia?
Which of the following conditions is associated with hypocalcemia?
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In cases of severe hypercalcemia, which management strategy is advised?
In cases of severe hypercalcemia, which management strategy is advised?
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What effect does hypercalcemia have on deep tendon reflexes?
What effect does hypercalcemia have on deep tendon reflexes?
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Which of the following must be monitored closely in patients with acute hypocalcemia?
Which of the following must be monitored closely in patients with acute hypocalcemia?
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Which of the following is a sign of hypervolemia?
Which of the following is a sign of hypervolemia?
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Which of the following complications is characterized by inflammation of the vein?
Which of the following complications is characterized by inflammation of the vein?
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What is the purpose of IV therapy?
What is the purpose of IV therapy?
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What is a common cause of hyperkalemia?
What is a common cause of hyperkalemia?
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Which of the following IV complications can lead to tissue necrosis?
Which of the following IV complications can lead to tissue necrosis?
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How should a patient be positioned in the case of an air embolism?
How should a patient be positioned in the case of an air embolism?
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What should be done in case of a circulatory overload due to excess fluid?
What should be done in case of a circulatory overload due to excess fluid?
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What is a common sign of hyponatremia?
What is a common sign of hyponatremia?
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Which type of catheter is used for long-term intravenous access?
Which type of catheter is used for long-term intravenous access?
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What fluid imbalance is characterized by a serum potassium level of greater than 5 MEQ/L?
What fluid imbalance is characterized by a serum potassium level of greater than 5 MEQ/L?
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What is a potential risk when using butterfly catheters?
What is a potential risk when using butterfly catheters?
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Which lab result indicates hemodilution in patients experiencing hypervolemia?
Which lab result indicates hemodilution in patients experiencing hypervolemia?
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What should be monitored in patients with signs of dyspnea due to hypervolemia?
What should be monitored in patients with signs of dyspnea due to hypervolemia?
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Study Notes
Physical Assessment of Hypervolemia
- Pitting edema, non-pitting edema, weeping, pulmonary edema, dyspnea, jugular vein distention, weight gain of 1 kg (2.2 lbs)
- Lab results: HCT below 30, BUN below 10
Nursing Interventions for Hypervolemia
- Monitor daily weights, sodium restriction, I/O, administer diuretics, assess lung sounds, monitor for dyspnea
- Position for comfort
Purpose of IV Therapy
- Maintain or replace body fluids
- Restore acid-base or electrolyte balance
- Medication administration
- Provide nutrition (PN)
Peripheral Catheters
- Butterfly catheters and quick catheters
Saline Locks
- Used to maintain IV access
Pro & Con of Peripheral IV
- Pro: Easy to access, easy to insert, RN skill
- Con: Easily dislodged, interferes with mobility, risk of infection
Vascular Access Devices
-
PICC Line: Peripherally-inserted central catheter
- Indications: long-term antibiotics, TPN, vesicant medications
-
Subcutaneous Port:
- Pro: Deliver large volumes, deliver vesicant solutions, long-lasting
- Con: Additional training, expensive, systemic risk of injection
IV Complications
- Infiltration: Edema, pain, decreased IV flow rate, pale color, cool, no blood return
- Extravasation: Infiltration of vesicant into subcutaneous tissue, tissue damage, tissue necrosis
- Thrombophlebitis: Blood clot formation at end of catheter, pain, redness, warmth, decreased IV flow rate
- Phlebitis: Inflammation of vein, pain, redness, warmth, edema
- Circulatory Overload: Cause: Excess fluid in vascular system. S/S: HTN, SOB, Cyanosis, Crackles. TX: Reduce IV Flow Rate, Notify MD, Monitor VS, Diuretics
- Air Embolism: Cause: Air into vascular system leads to vascular collapse. S/S: Hypotension, Tachycardia, Weak Pulse, Coughing. TX: Left side, Trendelenburg position, Notify MD
Infusion Pumps
- Used to deliver IV fluids at a constant rate
Clinical Validation
- Station 1: Identify tubing, state drop factor
- Station 2: Measure remaining fluid, change IV bag
- Station 3: Assess IV site, discontinue IV
- Assess IV site, identify local complications: Infiltration, extravasation, thrombophlebitis
Potassium
- Source: Muscle contraction, cardiac tissue response, acid-base balance
- Normal range: 3.5-5.0 mEq/L
Hypokalemia
- Causes: NPO, diuretics, N/V, diarrhea
- Nerve and muscle cells are less excitable
- K+ level less than 3.5 mEq/L
Hyperkalemia
-
5 mEq/L
- Causes: Kidney disease, medications
- Ask if the serum level is accurate
Fluid and Electrolyte Objectives
- Describe processes that regulate fluid distribution, extracellular fluid volume, and body fluid osmolality.
- Identify common fluid and electrolyte imbalances.
- Apply the nursing process when caring for patients with fluid and electrolyte imbalances.
- Discuss purposes of IV therapy.
- Describe equipment used for administration of IV fluids.
- Differentiate various IV tubing and the drip rate each delivers.
- Describe local and systemic complications of IV fluid therapy.
- Compare advantages and disadvantages of peripheral and central IV sites.
- Describe the role of the nurse in assessing and maintaining an IV infusion.
- Demonstrate how to assess, change and discontinue intravenous solutions.
Thinking Points
- What electrolytes are important for homeostasis?
- What could affect a patient's safety with an IV?
- What sterile principles are important to remember in IV therapy?
Media Resources
- Changing intravenous tubing and fluids
- Discontinuing intravenous therapy
- Troubleshooting intravenous infusions
- Using an infusion pump
Clinical Validations
- Change an IV bag (hang new IV bag)
- Determine fluid level in IV bags
- Identify various IV tubing types and their components
- Assess IV site, identifying local complications
- Discontinue an IV infusion
Fluid Compartments
- Intracellular: 2/3 of body fluids
-
Extracellular: 1/3 of body fluids
- Interstitial
- Intravascular (Plasma)
- Transcellular
Goal of Fluid Compartments
- Homeostasis: Balance of fluids throughout the body
Osmolality
- Concentration
- Normal range in humans: 285-295 mOsm/kg
- Largely controlled by sodium
- Hypertonic: Higher osmolality
- Isotonic: Same tonicity as blood
- Hypotonic: Lower osmolality
Osmolality vs Osmolarity
- Both are units of measurement
- Consider them
Patients with Fluid Imbalances
- Consider patients with fluid imbalances
Fluid Volume Deficit
- Hypovolemia
- Extracellular problem
- Cause: Hemorrhage or third spacing
- Shock
Fluid Volume Deficit (Continued)
- Causes: Severe vomiting and diarrhea
- Dehydration
- Intracellular problem
Physical Assessment of Dehydration
- Daily weights, I/O, dry mucus membrane, postural hypotension, tachycardia, thready pulse, tenting skin turgor, confusion, irritability, oliguria
Lab Results with Dehydration
- HCT elevated (>50%), BUN elevated (>25 mg/100mL), NA elevated (>145)
Nursing Interventions for Dehydration
- Give oral or IV fluids as ordered
- Monitor lab results
- Check vital signs, orientation
- Skin and oral care
Fluid Volume Excess
- Hypervolemia
- Overhydration
- Circulatory overload
- Extracellular volume excess
Hypervolemia: Who's at Risk?
- Heart failure, kidney failure
- Excess sodium intake, ages 9-18, pregnant women need more
Causes of Hypocalcemia
- Malnutrition, Vitamin D deficiency (renal disease), malabsorption, chronic diarrhea, pancreatitis
Hypocalcemia Indicators
- Paresthesias, increased deep tendon reflexes (DTRs), Chvostek sign, Trousseau signs, cardiac dysrhythmias- VTach
- Remember: Calcium is a calming agent on neuromuscular tissue, a deficit will lead to excitability
Chronic Hypocalcemia Management
- Give calcium carbonate orally with food, calcium citrate absorbed with or without food
- Encourage gentle walking, weight-bearing exercise for chronic issue
Acute Hypocalcemia Management
- Give IV calcium
- Calcium is a vesicant
- Monitor ECG
Hypercalcemia
-
10.5 mg/dL
- Causes: Hyperparathyroidism, cancer, milk-alkali syndrome
Hypercalcemia Indicators
- Bradycardia, fatigue/ confusion, decreased deep tendon reflexes, constipation
- Remember: Calcium is a calming agent, an excess will lead to depression of responses
Hypercalcemia Management
- Decrease calcium intake
- Push oral fluids to dilute and excret calcium
- Handle gently to prevent fractures
- Dialysis if necessary
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Description
This quiz covers the physical assessment of hypervolemia, including clinical signs and laboratory results. Additionally, it explores nursing interventions like monitoring weights and administering diuretics, as well as the purpose and types of IV therapy. Test your knowledge on peripheral catheters and vascular access devices.
