Exam 1 Medsurg 2 PDF - Nursing Care: Vascular Access, Infusion Therapy

Care of Patients with Vascular Access 1.​ State the reasons for giving intravenous fluids. Hydrate the body. Balance electrolytes (e.g., sodium, potassium). Increase blood volume in cases of shock or blood loss. Deliver medications. Provide nutrition when...

Care of Patients with Vascular Access 1.​ State the reasons for giving intravenous fluids. Hydrate the body. Balance electrolytes (e.g., sodium, potassium). Increase blood volume in cases of shock or blood loss. Deliver medications. Provide nutrition when oral intake is not possible. Support specific medical conditions like dehydration or DKA. 2.​ Explain the criteria for selecting the size and site of a peripheral IV (PIV). Identify patients with varying circumstances and the PIV you would use. The size and site of a Peripheral IV (PIV) are selected based on: Vein size: Larger veins (e.g., cephalic or basilic veins) are used for bigger gauge catheters. Patient condition: Patients with fragile veins may need smaller, softer catheters. Infusion type: For rapid fluids or medications, a larger gauge (e.g., 18-20 gauge) is needed. Duration of use: Short-term use may require a smaller catheter (e.g., 22-24 gauge), while long-term use needs more secure veins. Examples: Healthy adult: 20-22 gauge in forearm. Pediatric or elderly: 22-24 gauge, often in hand or lower arm. Trauma or surgery patient: 18 gauge, often in larger veins like the antecubital. 3.​ Know the steps for starting and discontinuing a PIV. Starting a PIV:  Verify the order and explain the procedure to the patient. Select the site (choose a vein, typically in the arm). Prepare the equipment (IV catheter, tourniquet, antiseptic wipes, dressing). Apply the tourniquet and clean the site with antiseptic. Insert the needle at a 15-30° angle, advance the catheter, and secure it. Check for blood return to ensure correct placement. Flush with saline to confirm patency. Secure the catheter with a dressing and label the site. Discontinuing a PIV: Explain the procedure to the patient. Clean gloves and remove any tape or dressing. Withdraw the catheter gently while applying pressure above the site to stop bleeding. Inspect the catheter to ensure it is intact. Apply a bandage and monitor the site for signs of complications (e.g., bleeding, infection). 4.​ List routine care of a PIV and when it must be replaced. Routine Care of a PIV: Check the site regularly for redness, swelling, or infection. Change dressing if it becomes wet, soiled, or loose. Flush the IV with saline every 8-12 hours to maintain patency. Monitor for complications like phlebitis or infiltration. When to Replace: Signs of infection or inflammation at the site. Catheter displacement or malfunction.  End of therapy or when the IV becomes uncomfortable. Every 72-96 hours (or per facility policy) to reduce infection risk. 5.​ Differentiate between the different PIV complications and the nursing actions taken. Phlebitis (inflammation of the vein) Signs: Redness, warmth, swelling, pain along the vein. Nursing Action: Remove the IV, apply warm compresses, and monitor for further signs of infection. Infiltration (IV fluid leaks into surrounding tissue) Signs: Swelling, pallor, coolness, and pain at the site. Nursing Action: Discontinue the IV, elevate the limb, apply warm or cold compresses, and monitor the area. Extravasation (IV fluid leaks with damaging substances, e.g., chemotherapy) Signs: Pain, swelling, redness, blistering, or tissue damage. Nursing Action: Stop infusion, remove IV, follow facility protocol for specific medication, and monitor for tissue injury. Hematoma (bruising or blood collection around the site) Signs: Swelling and bruising at the insertion site. Nursing Action: Apply direct pressure, elevate the limb, and monitor for further bleeding. Infection (local or systemic) Signs: Redness, swelling, warmth at site, fever. Nursing Action: Remove IV, clean the site, apply sterile dressing, and report to the healthcare provider. Air Embolism Signs: Sudden shortness of breath, chest pain, or dizziness.  Nursing Action: Clamp the IV line, place the patient in the left lateral Trendelenburg position, and notify the healthcare provider immediately. 6.​ Compare and contrast the different central venous access devices (CVADs) and when one is used over the other. PICC is less invasive and good for medium-term use. CVC is used for short-term, critical care. Implanted Port is best for long-term use, especially for chemotherapy. Tunneled CVAD is ideal for patients requiring frequent long-term access. 7.​ Distinguish the benefits and risks between different CVADs. Peripherally Inserted Central Catheter (PICC) Benefits: Less invasive: Inserted through a peripheral vein, no need for major surgery. Suitable for medium-term use: Can remain in place for weeks to months. Outpatient use: Can be used outside of a hospital setting for ongoing therapy (e.g., antibiotics, nutrition). Lower risk of complications compared to more invasive central lines. Risks: Risk of thrombophlebitis: Inflammation or clot formation in the vein. Limited flow rate: Not ideal for rapid infusions or blood draws. Infection: Requires careful care to avoid infection, particularly at the insertion site. Central Venous Catheter (CVC) Benefits:  Immediate access to large central veins for critical care (e.g., high-volume fluids, medications). Quick insertion: Suitable for short-term needs like emergency care. Versatile: Can be used for a variety of treatments, including blood products and fluids. Risks: Higher infection risk: Direct insertion into a central vein increases the chance of bloodstream infections. Pneumothorax or bleeding: Risk associated with improper insertion, particularly with subclavian or jugular insertion. Short-term use: Typically not for long-term therapy due to discomfort or risk. Implanted Port Benefits: Minimal infection risk: No external components, reducing exposure to bacteria. Long-term use: Ideal for frequent treatments, like chemotherapy. Less maintenance: Requires less frequent dressing changes. Risks: Requires surgical placement: Insertion is more invasive and requires anesthesia. Difficult to access: Not as readily accessible for frequent use compared to other CVADs. Risk of clotting or malfunction: Ports can sometimes fail, or blood clots may form in the catheter. Tunneled Central Venous Catheter (e.g., Hickman, Broviac) Benefits: Long-term access: Ideal for patients needing frequent or ongoing treatments like dialysis or chemotherapy.  Lower infection risk: Because it is tunneled under the skin, there is less risk of infection compared to external catheters. Secure: The catheter is stable, reducing movement and irritation. Risks: Requires surgical insertion: More invasive than non-tunneled CVADs. Higher risk of infection if not properly cared for: Proper maintenance is critical. Discomfort: Some patients find the external catheter or the insertion site uncomfortable. 8.​ Know the routine maintenance for CVADs and how to change dressings. Routine Maintenance Flush the line: Use saline (and sometimes heparin) to flush the catheter every 8-12 hours to prevent clotting and ensure patency. Monitor the site: Check for signs of infection (redness, swelling, or pain). Secure the catheter: Ensure the catheter is well-secured to prevent movement or accidental dislodgement. Check for complications: Look for signs of thrombosis, phlebitis, or infiltration. Change administration sets: Change IV tubing and filters as per protocol (usually every 72 hours or after blood product administration). How to Change Dressings: Prepare the supplies: Gather sterile gloves, sterile dressing, antiseptic solution (e.g., chlorhexidine), gauze, and tape. Wash hands and wear gloves: Perform hand hygiene before starting. Remove old dressing: Carefully take off the old dressing without contaminating the site. Clean the site: Use an antiseptic solution to clean around the insertion site, starting from the center and working outward.  Apply new dressing: Place a sterile dressing over the site, ensuring it’s secure but not too tight. Secure catheter: Tape or use a securement device to keep the catheter in place. Document: Record the dressing change and any site observations. Change the dressing every 7 days or if it becomes wet, soiled, or loose. 9.​ Identify fluids that must be administered via CVAD. Hypertonic solutions (e.g., 3% saline, D10W) – can irritate veins. Parenteral nutrition – requires a central line for safe infusion. Chemotherapy – may be too caustic for peripheral veins. Long-term antibiotics – to avoid vein irritation or infiltration. Blood products – often require a larger, central vein for rapid infusion. Total parenteral nutrition (TPN) – requires a CVAD for safe delivery. 10.​Enumerate the complications associated with CVADs, how the nurse can recognize them, when they are likely to occur, and the nursing actions to be taken. Infection ​ Recognition: Redness, swelling, fever. ​ When: Anytime during use, especially with poor site care. ​ Actions: Remove CVAD, clean the site, administer antibiotics. Thrombosis (Clot) ​ Recognition: Pain, swelling, difficulty flushing. ​ When: During use, especially with poor blood flow. ​ Actions: Notify provider, may need anticoagulants. Phlebitis (Vein Inflammation) ​ Recognition: Redness, warmth, tenderness. ​ When: Prolonged use or irritation.  ​ Actions: Discontinue CVAD, apply warm compresses. Infiltration (Leakage into Tissue) ​ Recognition: Swelling, coolness, pallor. ​ When: Catheter moves out of the vein. ​ Actions: Discontinue infusion, apply warm/cold compress. Air Embolism ​ Recognition: Shortness of breath, chest pain. ​ When: Air enters the line, often during insertion. ​ Actions: Clamp line, place patient in Trendelenburg position, call for help. Catheter Migration ​ Recognition: Change in catheter length, no blood return. ​ When: Patient movement or improper securing. ​ Actions: Verify placement, secure catheter, notify provider. Occlusion (Blockage) ​ Recognition: Resistance when flushing, difficulty infusing. ​ When: Due to clots or drug buildup. ​ Actions: Attempt to flush, notify provider if unsuccessful. You will want to review the following components of the textbook. Table Box Figure Safety 15.2 15.1 15.2 291 15.3 15.2 15.3 293 15.4 15.3 15.4 296 15.5 15.5 300 15.6 302 15.7 309 15.9 15.10 15.12 15.14 15.15 Care of Patients with Hematologic Disorders 1.​ Explain the proposed and critical values of RBCs, hemoglobin (HBG), hematocrit (HCT), WBCs, and neutrophils. RBC HBG