Nursing Quiz on IV Complications
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Questions and Answers

What potential adverse outcome is commonly linked to phlebitis?

  • Improved kidney function
  • Thrombophlebitis (correct)
  • Increased appetite
  • Decreased heart rate
  • According to the Infusion Nurses Society Visual Infusion Phlebitis Scale, what clinical criteria defines a Grade 2 phlebitis?

  • Slight erythema at access site
  • No clinical symptoms
  • Pain along cannula path and induration
  • Pain, erythema, or swelling at access site (correct)
  • What is the primary difference between infiltration and extravasation?

  • Extravasation is always intentional, while infiltration is always accidental.
  • Infiltration occurs with central lines, while extravasation occurs with peripheral lines.
  • Extravasation involves a vesicant solution, while infiltration involves a non-vesicant solution. (correct)
  • Infiltration causes blisters, while extravasation causes redness.
  • Which clinical manifestation is indicative of infiltration at an IV site?

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

    What immediate action should a nurse take upon suspecting an extravasation during an infusion?

    <p>Stop the infusion immediately (B)</p> Signup and view all the answers

    Which of the following complications is specifically associated with central venous infusion therapy?

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

    During central line insertion, which of the following vascular complications might occur?

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

    What pulmonary complication is directly associated with central line placement?

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

    For what condition would a patient most likely require a transfusion of fresh frozen plasma?

    <p>Emergency reversal of elevated prothrombin time and international normalized ratio (PT/INR) (B)</p> Signup and view all the answers

    A patient with neutropenia and a persistent infection despite antibiotic treatment may benefit from a transfusion of which blood component?

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

    What is the primary reason blood components are stored according to strict guidelines?

    <p>To maintain their viability and efficacy as “living transplants” (B)</p> Signup and view all the answers

    Before obtaining a blood component from the laboratory, what critical information must be confirmed?

    <p>Patient's informed consent and the administration order (C)</p> Signup and view all the answers

    A patient with blood type A requires a platelet transfusion. According to ABO compatibilities, which donor blood types are suitable?

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

    When crystalloid solutions are not adequate for volume expansion, which blood component is most appropriate?

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

    A physician orders a blood transfusion for a patient experiencing symptomatic anemia. Which blood component is most appropriate for this condition?

    <p>Packed Red Blood Cells (C)</p> Signup and view all the answers

    A patient with disseminated intravascular coagulation (DIC) is most likely to require which blood component?

    <p>Fresh frozen plasma (A)</p> Signup and view all the answers

    What is a primary disadvantage associated with centrally-inserted venous access devices that requires vigilant monitoring?

    <p>Easy dislodgement from the insertion site, necessitating securement and occlusive dressings. (D)</p> Signup and view all the answers

    What is the main purpose of specifying lumens as proximal, medial, or distal in multiple-lumen central venous catheters?

    <p>To denote the location of the fluid path's end on the catheter, corresponding to exit ports. (B)</p> Signup and view all the answers

    What is a key characteristic of tunneled catheters that contributes to their stability and infection resistance?

    <p>They feature a Dacron cuff that promotes tissue adherence, stabilizing the catheter and forming an infection barrier. (A)</p> Signup and view all the answers

    What is the primary benefit of implanted ports (Mediports) compared to other types of central venous access devices?

    <p>They require minimal care when not in use, enhancing patient convenience and quality of life. (C)</p> Signup and view all the answers

    Why is the upper chest wall considered the preferred site for implanted port reservoir placement?

    <p>It allows the patient to have maximum ease of use and makes self-care easier. (B)</p> Signup and view all the answers

    What is the key feature of noncoring needles used to access implanted ports, and why is it important?

    <p>A different bevel angle that allows multiple punctures of the port septum without causing damage. (B)</p> Signup and view all the answers

    After accessing an implanted port with a noncoring needle, what are the essential maintenance requirements to ensure its functionality?

    <p>Maintaining a continuous infusion or performing periodic flushes as per institutional policy. (C)</p> Signup and view all the answers

    In what type of setting are tunneled catheters typically inserted, and why?

    <p>Operating or procedure rooms, to maintain a sterile environment during insertion. (C)</p> Signup and view all the answers

    Why is the transfusion of whole blood considered rare in modern medical practices?

    <p>Because administering specific blood components is more efficient and can benefit multiple recipients from a single donation. (D)</p> Signup and view all the answers

    What is the primary reason for performing ABO blood typing before a blood transfusion?

    <p>To identify the presence of antibodies in the patient's plasma that could react with antigens on the transfused red blood cells. (A)</p> Signup and view all the answers

    What is the significance of the Rh factor in blood transfusions?

    <p>It identifies the presence or absence of the Rh antigen on red blood cells, which can cause complications if incompatible. (C)</p> Signup and view all the answers

    Why is it crucial for healthcare providers to perform independent identification and specimen labeling during blood sample collection?

    <p>To minimize the risk of errors in patient identification, leading to incorrect blood transfusions and potentially fatal consequences. (C)</p> Signup and view all the answers

    Which of the following is a potential consequence of HLA incompatibility in blood transfusions and organ transplants?

    <p>Activation of the immune system, leading to transfusion reactions and organ rejection. (B)</p> Signup and view all the answers

    Which blood component is LEAST likely to be administered as a whole blood transfusion, but rather as a separated component?

    <p>Red Blood Cells (RBCs) (A)</p> Signup and view all the answers

    What is the rationale behind administering specific blood 'component' rather than whole blood?

    <p>Components allow for targeted treatment of the patient's specific deficiency or need. (C)</p> Signup and view all the answers

    Why are volunteer donors and multiple screening tests considered 'modern practices' that contribute to the current blood's safety?

    <p>Screening and volunteer donors reduce the risk of transmissible diseases. (C)</p> Signup and view all the answers

    Why is it necessary for the nurse to verify adequate IV access and availability of transfusion supplies before blood component retrieval from the lab?

    <p>To minimize the time the blood component is outside controlled storage, reducing the risk of compromising its integrity. (C)</p> Signup and view all the answers

    What information must be verified by two licensed staff members before initiating a blood product transfusion?

    <p>Blood product type and volume/number of units, patient's full name and another identifier, and ABO/Rh compatibility. (B)</p> Signup and view all the answers

    According to the National Quality Forum, what type of event is a mismatched blood transfusion considered?

    <p>An event that should never happen. (B)</p> Signup and view all the answers

    Immediately prior to starting a blood transfusion, what patient assessment is most crucial?

    <p>Completing baseline vital signs and respiratory status assessment. (B)</p> Signup and view all the answers

    What should the nurse do immediately following observation of a suspected acute hemolytic reaction?

    <p>Stop the transfusion, notify the provider, and maintain blood pressure. (B)</p> Signup and view all the answers

    Why is patient identification considered the most important process in the safe administration of blood components?

    <p>It helps preventing errors due to unlabeled specimens or components, preventing fatal outcomes. (B)</p> Signup and view all the answers

    What is the recommended frequency of patient assessments during a blood transfusion, after the initial 15 minutes?

    <p>At least every hour. (C)</p> Signup and view all the answers

    Which action best demonstrates the nurse's role in addressing the anxiety a patient may experience prior to a blood transfusion?

    <p>Providing detailed explanations of the procedure and allowing time for questions. (C)</p> Signup and view all the answers

    What is the primary reason blood products not fully infused within a 4-hour period should be returned to the laboratory?

    <p>To maintain the integrity of the blood product. (D)</p> Signup and view all the answers

    What is the purpose of the 170- to 260-micron filter in the administration set used for packed RBCs?

    <p>To stop small clots and debris while allowing RBCs to pass. (D)</p> Signup and view all the answers

    What is the purpose of priming the administration set tubing with 0.9% sodium chloride before a blood transfusion?

    <p>To prevent hemolysis of red blood cells. (B)</p> Signup and view all the answers

    Why is the intravenous route for providing nutrition only indicated when oral or enteral routes are not possible?

    <p>Intravenous nutrition is associated with increased risks and costs. (C)</p> Signup and view all the answers

    What is the primary carbohydrate source used in TPN solutions to provide energy for the body?

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

    Why might lipid emulsions be included in a TPN solution or infused separately?

    <p>To provide an additional source of energy and essential fatty acids. (B)</p> Signup and view all the answers

    Which healthcare professional is LEAST likely to be involved in the interprofessional approach to TPN program design?

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

    Why are total parenteral nutrition solutions prepared in the pharmacy under special conditions?

    <p>To reduce the risk of bacterial contamination. (A)</p> Signup and view all the answers

    Flashcards

    Phlebitis

    Inflammation of a vein that can lead to complications.

    Infusion Nurses Society Scale

    A scale used to grade the severity of phlebitis.

    Grade 0

    No clinical symptoms of phlebitis.

    Grade 1

    Slight erythema or pain at the IV site.

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    Extravasation

    Leakage of IV fluid into surrounding tissue.

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    Vesicants

    Medications that can cause blistering if they infiltrate.

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    Complications of Central Lines

    Problems that arise from central venous infusion therapy.

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    Assessment Intervals

    Regular checks for IV insertion site based on various factors.

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    Dislodgement of CVAD

    Dislodgement refers to the accidental displacement of the Central Venous Access Device (CVAD) from its intended position.

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    Multiple-lumen catheter

    A type of catheter that contains multiple channels (lumens) allowing simultaneous delivery of different solutions.

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    Lumens in catheters

    Lumens are the individual channels in a catheter, named proximal, medial, or distal based on their location.

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    Tunneled catheters

    Catheters that exit the skin away from the insertion site, providing stability and infection prevention.

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    Dacron cuff

    A part of tunneled catheters that helps stabilize the catheter and reduces infection risk by allowing tissue adherence.

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    Implanted ports

    Devices used for long-term therapy that are placed under the skin, requiring minimal maintenance when not in use.

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    Noncoring needle

    A special needle used to access implanted ports without damaging the septum, allowing multiple punctures.

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    Central vasculature

    The major blood vessels in the body where a catheter tip is positioned to deliver medications directly into circulation.

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    Blood donor screening

    A process of testing volunteers to ensure blood is safe.

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    Component therapy

    Transfusion of specific blood components instead of whole blood.

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    ABO blood type

    Classification based on antigens on RBC surfaces.

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    Hemolytic transfusion reaction

    Destructive reaction when incompatible blood is transfused.

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    Rh factor

    Antigen indicating positive or negative blood type.

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    HLA system

    Proteins on white blood cells crucial for immune response.

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    Patient identification

    Critical process ensuring correct blood samples are matched.

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    Blood component benefits

    One unit of blood can help multiple patients through separation.

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    Packed Red Blood Cells

    Used for symptomatic anemia and blood loss.

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    Fresh Frozen Plasma

    Replaces missing coagulation factors for bleeding risks.

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    Indications for Platelet Transfusion

    Bleeding caused by low platelet count or dysfunction.

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    Granulocyte Transfusion

    Given to neutropenic patients with infections unresponsive to antibiotics.

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    Albumin Indication

    Used for volume expansion when crystalloid solutions aren't enough.

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    Blood Component Storage

    Stored according to strict standards before transfusion.

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    ABO Compatibility for RBCs

    O type can donate to anyone; AB receives from all.

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    Informed Consent for Transfusion

    Required confirmation before transfusion orders are placed.

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    IV access confirmation

    Ensure adequate IV access and necessary supplies are ready before transfusion.

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    Two-person verification

    Verification of blood product by two licensed staff members before administration.

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    ABO and Rh compatibility

    Confirming blood type compatibility between donor and recipient before transfusion.

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    Transfusion reaction observation

    Close monitoring for reactions, especially in the first 15 minutes.

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    Acute hemolytic reaction

    Reaction caused by infusing ABO-incompatible blood, leading to fever and chills.

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    Baseline patient assessment

    Assessment of vital signs and respiratory status before starting transfusion.

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    Post-transfusion assessment

    Ongoing evaluation of vital signs and patient comfort every hour during transfusion.

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    Blood Product Infusion Time

    Blood products must be infused within 4 hours to remain effective.

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    Blood Filter Type

    Filters used for blood infusion are 170-260 microns to catch debris.

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    IV Catheter Gauge for Blood

    The minimum recommended gauge for blood transfusion is 18.

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    Total Parenteral Nutrition (TPN)

    Intravenous nutrition when oral routes are inadequate, risks involved.

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    Macronutrients in TPN

    TPN solutions provide proteins, carbohydrates, and lipids.

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    Proteins in TPN

    TPN provides proteins as amino acids for tissue repair.

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    Lipid Emulsions in TPN

    T získ provide energy and essential fatty acids in TPN.

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    Interprofessional TPN Approach

    TPN requires collaboration between healthcare professionals for effective management.

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    Study Notes

    Introduction to Infusion Therapy

    • Infusion therapy is delivered across various healthcare settings, including hospitals, extended care facilities, clinics, and patient homes.
    • Advancements in techniques, equipment, and technologies are constantly improving patient outcomes and reducing costs.
    • Specialized "IV resource teams" are showing better outcomes and lower costs.
    • Generalist nurses need current knowledge and competency in infusion therapy.

    Infusion Nurses Society (INS)

    • The INS has established evidence-based practice standards for infusion therapy (revised 2021).
    • Standards are based on ranked evidence.
    • The INS provides a national certification program called Certified Registered Nurse Infusion (CRNI©).

    Patient Needs for Infusion Therapy

    • Patients require IV therapy for various reasons, such as fluid/electrolyte replacement, medication administration, blood products, and nutritional support.
    • Duration can range from hours to a lifetime.
    • IV fluids are given to maintain/restore fluid and electrolyte balance, especially when oral intake is insufficient.
    • Sensible and insensible fluid losses must be accounted for.
    • IV medication administration is used when oral or other routes are not suitable. Some medications are only given intravenously to get to target blood levels quicker.
    • Nutritional support can be given intravenously if the gastrointestinal tract cannot absorb sufficient nutrients.

    Types of IV Solutions

    • Two major types are crystalloids and colloids.
    • Crystalloids are electrolytes dissolved in water, and include dextrose solutions, sodium chloride, and balanced electrolyte solutions
    • Colloids contain larger molecules (usually proteins or starch) suspended in fluid, also called plasma volume expanders.
    • Colloids are used to maintain intravascular volume and prevent shock.

    Osmolarity

    • Osmolarity (mOsm/L) and Osmolality (mOsm/kg) measure solution concentration.
    • Isotonic solutions (250-375 mOsm/L) have similar osmolarity to plasma and cause no fluid movement into or out of cells.
    • Hypotonic solutions (less than 250 mOsm/L) cause fluid to move into cells, hydrating cells but depleting intravascular fluid volume.
    • Hypertonic solutions (greater than 375 mOsm/L) cause fluid to move out of cells and into the intravascular space.

    Blood Products

    • Blood products are administered intravenously.
    • They can include packed red blood cells, platelets, plasma, albumin, and clotting factors.

    Veins for Infusion Therapy

    • Veins return deoxygenated blood to the heart.
    • Vein walls are composed of tunica intima, tunica media, and tunica adventitia.
    • Valves in veins prevent backflow.
    • Larger veins closer to the heart are appropriate for higher volumes.
    • Choosing the correct vein size and gauge is critical to avoid complications.

    Types of IV Access Devices

    • Peripheral venous access (short over-the-needle catheters, steel-winged devices/butterfly).
    • Central venous access (CVA: Nontunneled percutaneous, tunneled catheters, implanted ports, PICCs).

    Infusion Systems

    • Infusion systems deliver solutions and medications to the IV access device.
    • OSHA mandates needleless access to reduce needle-stick injuries.
    • Different tubing (macro/micro-drop) are used to control rate delivery and measure drops per minute.

    Infusion Complications

    • Phlebitis (inflammation of the vein) and infiltration (fluid leaking into surrounding tissue) are common.
    • Chemical, mechanical, and bacterial factors all contribute to complications.
    • Monitoring for signs/symptoms of infiltration and phlebitis is essential.
    • Correct flushing of equipment and catheters is required for avoiding complications.
    • Incompatibility of medications during administration can negatively impact infusion therapy.

    Nursing Management

    • Nurses should monitor fluid balance, vital signs, and administer medications safely.
    • Nurses should monitor patients for complications, such as phlebitis, infiltration, and air embolism.
    • Nurses must correctly flush and use compatible solutions when administering intermittent infusions or using other medical equipment.

    Blood Component Transfusions

    • Blood products (RBCs, plasma, platelets) are used in treatment for anemia and other critical situations.
    • Blood component transfusion requires meticulous adherence to procedures and close patient monitoring due to risks and complications.
    • Proper patient identification and matching (ABO and Rh) are essential.

    Total Parenteral Nutrition (TPN)

    • TPN is used when the gastrointestinal tract cannot deliver sufficient nutrition.
    • TPN solutions contain amino acids, dextrose, lipids, and electrolytes.
    • TPN therapy necessitates gradual initiation to address patient's glucose and fluid tolerance.

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    Infusion Therapy Chapter 10 PDF

    Description

    Test your knowledge on the nursing management of intravenous (IV) complications including phlebitis, infiltration, and extravasation. This quiz covers critical concepts relevant to infusion therapy and central venous access. Enhance your understanding of the complications that may arise during IV therapy and the appropriate nursing interventions.

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