IV Therapy and Parenteral Nutrition PDF

IV Therapy and Parenteral Nutrition WEEK 9 – NURS 125 Parenteral Replacement of Fluids and Electrolytes Primary care providers (PCPs) prescribe fluids and electrolytes based on what their clinical presentation, vital signs, and laboratory results Intravenous fluid (IVF) is considered a medicatio...

IV Therapy and Parenteral Nutrition WEEK 9 – NURS 125 Parenteral Replacement of Fluids and Electrolytes Primary care providers (PCPs) prescribe fluids and electrolytes based on what their clinical presentation, vital signs, and laboratory results Intravenous fluid (IVF) is considered a medication The PCP needs to order a specific type of IVF, how much, and how fast do they want it administered Accurate IVF intake is important Do not disconnect IVF for routine care As with any medication you as the nurse need to assess Is it appropriate Is my patient responding appropriately Is my patient having a complication Types of IVF Administer prescribed IV fluids based on client’s condition. ◦ Isotonic ◦ Hypotonic ◦ Hypertonic Action of Different Types of IVF Isotonic Fluids Osmolality is similar to blood serum Used to treat: Hypotension Hypovolemia Common fluids: 0.9% sodium chloride (0.9% NaCl), also called normal saline (NS) Lactated Ringer’s (LR) Monitor patients at risk of fluid overload  Hypotonic Fluids Osmolality is < that of blood serum Used to treat: Cellular dehydration Hyperglycemic conditions, such as diabetic ketoacidosis, in which high serum glucose draws fluid out of the cells and into the vascular and interstitial compartments Common fluids: 5% dextrose in water (D5W). Recall that D5W is isotonic in the bag, with an osmolality of 253 mOsm/L, but becomes hypotonic in the body. 0.45% NaCl (1/2 normal saline, ½ NS) 0.33% NaCl (1/3 NS) 0.2% NaCl (1/4 NS) Do not use patients at risk for increased ICP because they can cause/exacerbate cerebral edema  Hypertonic Fluids Osmolality is higher than that of blood serum Used to: Decrease edema, increases urinary output Increase circulatory volume Common fluids: D5 NS, D5 ½ NS, D5 LR 3% NaCl and 5% NaCl—highly hypertonic; used only in critical situations 10% dextrose in water (D10W) D20W: used as an osmotic diuretic to promote diuresis Parenteral Nutrition (PN) Method of feeding for clients who cannot be nourished sufficiently through the GI tract Severely malnourished Extensive burns Trauma Cancer GI issues required the bowel to rest Step 1 of the nursing process what should you assess? IV access Lab values Daily caloric needs PN components Water Glucose Amino acids Essential fatty acids Vitamins Minerals Trace elements Lipid emulsion* (essential fatty acids, triglycerides, & kcals) PN Bags and Order Sheet PN Labels PN cont. Delivery of nutrition intravenously into a large, central vein via an infusion pump Central venous access catheter Peripherally inserted central catheter (PICC) Peripheral line Complications Infection or septic shock Blood clots Liver dysfunction Gallbladder disease Altered blood glucose Check your knowledge Which of the following orders does the nurse need to clarify with the provider? a) Administer D5W with 20 mEq of KCL IV at 125mL/hr continuously b) Administer Vancomycin IV piggyback in 100mL NS c) Administer 1000mL Lactated Ringers IV at 75mL/hr d) Administer Lasix 40 mg IV push twice daily IVF Matching 0.45% NaCl Hypertonic 0.9% NaCl Isotonic D5NS D5W Hypotonic Lactated Ringers A HCP has ordered the following for your client: Ringer’s Lactate at 130mL/hr IV continuously. 1. What is the hourly rate if the fluid is hung to gravity using a 15gtts/mL tubing set? 2. How much fluid should the client receive over the course of a 12 hour shift? 3. How much fluid should the client receive over the course of a day? A new prescription for your client reads, “5% dextrose in water/0.45% saline solution (D5 ½NS) with 20 mEq KCl; infuse 1 liter in 5 hours.” 1. Calculate the hourly rate. 2. Calculate the drip rate using a macrodrip administration set with 15 gtts/mL and a microdrip set. A client has an order for continuous insulin infusion. The provider has also ordered Cefoxitin 2 grams in 50mL NS IVPB Q6H. The Cefoxitin is not compatible with the insulin so it cannot be piggybacked into the primary IV line. How should the nurse administer the IV antibiotics? A client is receiving 2500mL of D25 plus additives over 14 hours daily. For the last three days the client’s blood sugar has dropped to 70mg/dL one hour after disconnecting from the infusion. What intervention should the nurse recommend to the provider to prevent this problem? Why? The provider has written an order for a client to receive a continuous infusion of D10W with additives at 150mL/hr. The client has an angiocatheter in the right forearm and a port-a-cath as available infusion sites. 1. Which site would you use? 2. What lab values need to be monitored for this client? 3. What would be some possible complications to assess this client for?