Watkins FINAL EXAM PDF

IV’s -Never choose veins in an arm that has… In extremitiss with the same side on a masecotoomy, Any extremity that has dialysis shunts or AV fistulas, Present signs/ symptoms of infection, Areas with extensive scarring, burns, or surgeries, CVA paralysis side, Extremities that have previous recent...

IV’s -Never choose veins in an arm that has… In extremitiss with the same side on a masecotoomy, Any extremity that has dialysis shunts or AV fistulas, Present signs/ symptoms of infection, Areas with extensive scarring, burns, or surgeries, CVA paralysis side, Extremities that have previous recent infiltration,extravasation, phlebitis, Site distal to previous puncture -Technical Pointers for IV Insertion procedure: - Prepare equipment - Strict aseptic technique (alcohol vs chlorhexidine) - Tourniquet- 6-8 inches above intended site - Massage vein prn - Clench fist prn - Use heat prn -Extension Tubing: Connects to patient’s IV catheter to make a saline lock (with a cap on the end) -Setting up an IV: Apply Tourniquet – palpate your partners vein, do not leave tourniquet on for more than 2 mins at a time. Practice scrubbing the hub. Use saline flush to connect Extension Tubing. Connect curos cap to extension tubing. Discuss with your partner how you would remove an IV (easy open knot) -Celluliitis: Inflammation of loose connective tissue around insertion site. Caused by poor aseptic insertion technique. Treated w/antibiotics. Red swollen area spreads from the insertion site outwardly in a diffuse circular pattern - 9 rightss of medication administration: 1. Right patient 2. Right drug 3. Right dose 4. Right route 5. Right time 6. Right documentation 7. Right to refuse 8. Right assessment 9. Right education -Monitoring/Nursing Interventions (IV Push): - Assess pt before, during, and after medication administration - Observe for signs of adverse reactions - Know what to do if adverse reaction occurs (support airway, give o2, administer antidote if available) -For Blue Man Syndrome: Medication- Amiodarone -For Red Man Syndrome: Medication- Vancomycin -Parental Fluid Replacment: -Administration of Fluids, electrolytes, Medications, and Nutrients IV fluids are used to: -- Expand intravascular volume -- Correct imbalances of fluids and electrolytes -- Compensate for an ongoing problem that is affecting pts fluid & electrolytes: i.e. N/V/D -Typess Of Intravenous Fluidss: - -- Isotonic: - -- Hypotonic - -- Hypertonic -Isotonic Fluids: *Remain within the intravascular compartment (i.e. blood vessels) same concentration inside & outside of the cell —cell stays the same) *Clinical problems targeted by Isotonic fluids: Hypovolemia & hypotension *Commonly ordered fluids: *0.9% Sodium chloride aka Normal Saline *Lactated Ringers (LR) *what about D5W? Classified as both isotonic & Hypotonic: its isotonic in the bag and but hypotonic in body due to rapid metabolism. Clinically cannot be rapidly infused *Contraindicated in Fluid overload *Nursing dx: Deficient Fluid Volume *Fluid overload and who is at risk? Fluid volume excess; CHF *An isotonic fluid is a solution that has the same concentration of solutes (like salt or sugar) as the fluid inside your cells. This balance helps maintain normal cell function and prevents fluid from entering or leaving cells. Examples include normal saline and lactated Ringer's solution. *An isotonic fluid has the same concentration of solutes as your cells, so it doesn’t change their size. -Hypotonic Fluid: *Pull body water into the cells (net inflow – cell expands) * Clinical problems targeted by Hypotonic fluids: Dehydrated Cell * i.e. hyperglycemic conditions such as DKA/ HHNS (which draws fluid out of the cells & into the intravascular space) * Commonly ordered fluids: * 0.45% NS * 0.33% NS * 0.2% NS *Contraindicated in Increased ICP (shifts fluid into brain tissue and cause brain swelling), Dehydration, or Trauma *A hypotonic fluid has a lower concentration of solutes than your cells, causing water to enter the cells and make them swell. *A hypotonic fluid has a lower concentration of solutes (like salt or sugar) compared to the fluid inside your cells. When you put cells in a hypotonic solution, water moves into the cells to balance the concentration, which can cause the cells to swell or even burst. -Hypertonic Fluid: *pull body water into intravascular compartment (pull fluids & electrolytes from the intracellular & interstitial compartments into the intravascular compartment) cell shrinks fluid out of cell * Typically given in ICU setting and require Central line d/t high risk phlebitis and close monitoring * Clinical problems targeted by Isotonic fluids: Cerebral edema, Hyponatremia * Commonly ordered fluids: * D5 0.9% NS * D5 0.45% NS * D5 LR * 3% NS (only used in critical situations, highly hypertonic) * D10W *Hypertonic fluid has a higher concentration of solutes compared to the fluid inside the body's cells. This causes water to move out of the cells into the bloodstream, shrinking the cells. Break Down of Differentt Fluids Simply: -Isotonic Fluids: What they are: Fluids with the same concentration of solutes as the cells and blood. Effect: No net water movement; cells stay the same size. Example: Normal saline (0.9% NaCl). -Hypotonic Fluids What they are: Fluids with a lower concentration of solutes than the cells. Effect: Water moves into cells, causing them to swell. Example: 0.45% NaCl (half-normal saline). -Hypertonic Fluids What they are: Fluids with a higher concentration of solutes than the cells. Effect: Water moves out of cells, causing them to shrink. Example: 3% NaCl. Difference: The key difference lies in the solute concentration compared to the cells, which determines whether water moves into, out of, or stays balanced around the cells. -Managing multiple lines *Label each line to identify solution infusing *Label tubing close to patient *SBAR what is infusing where *Keep lines untangled *Know where main IVF is in case of Emergency (ALREADY COMPLETED FLASHCARD ON ALL OF THESE UPP ^^) 1&2. mechanism of action of valacyclovir, & side effects of valacyclovir Herpesviruses are a group of DNA viruses which include the herpes simplex virus, varicella-zoster virus, and cytomegalovirus. A group of antiviral medications called guanosine analogs are used to treat herpesviruses. -Certain herpesvirus infections can be treated with a class of antiviral medications called guanosine analogs, which include medications that end in the suffix -clovir. The main drugs used to treat herpes infections include valacyclovir, valganciclovir, and famciclovir, which are given orally MOA of Valacyclovir:Once administered, guanosine analogs (valacyclovir) acts by inserting into the replicating viral DNA. As a result, viral DNA synthesis is halted, ultimately stopping viral replication Side Effects:headache and nausea, skin rash, pruritus, nephrotoxicity, and hypersensitivity reactions like Stevens-Johnson syndrome and angioedema. Other More severe Side effects can include, can cause neurological side effects, including agitation, tremors, confusion, and myoclonus; more rarely, clients can develop hallucinations, and even encephalopathy or seizures. Acyclovir and valacyclovir can also lead to thrombotic thrombocytopenic purpura, and hemolytic uremic syndrome. Nursing Considerationss/Education: Okay, now, when your client with a genital herpes simplex virus infection is prescribed an antiviral medication like acyclovir, first perform a baseline assessment, noting their current symptoms, including lesion location, as well as the presence of pain, itching, or drainage. Then, review recent laboratory test results, including renal and hepatic function, CBC, and polymerase chain reaction, or PCR for short, and herpes culture test. Alright, moving on to client education. Explain to your client that their medication will help decrease symptoms caused by the herpes simplex virus; however, it does not eliminate the infection or stop the virus from spreading to others. Emphasize the importance of refraining from sexual activity if they have sores or other signs of herpes and to always use latex or polyurethane condoms during sex, even if no sores are present. Then, instruct them to take their medication with plenty of water, with or without food, on a regular schedule, and remind them to stay well hydrated during treatment. Next, review with your client some of the side effects they could experience including headaches, fatigue, nausea, and vomiting. Prompt your client to contact their healthcare provider if these side effects are persistent or their herpes symptoms do not resolve or get worse. Finally, during treatment with an antiviral like acyclovir, monitor for the development of side effects, and evaluate for the therapeutic response of an absence of lesions and herpes simplex symptoms. Recap: A group of antiviral medications called guanosine analogs are used to treat herpesviruses. These medications include acyclovir, ganciclovir, valacyclovir, valganciclovir, and famciclovir, and they work by inhibiting viral DNA replication. Potential side effects include headache and nausea, as well as more serious side effects such as nephrotoxicity, thrombotic thrombocytopenic purpura and hemolytic uremic syndrome. When caring for a client prescribed an antiviral medication to treat herpes viruses, nursing considerations include performing a baseline assessment, as well as monitoring for side effects and evaluating for the desired therapeutic effects. Client education is focused on safe self-administration, as well as learning to recognize side effects, and when to notify the healthcare provider. 3. sites safe for IV insertion. (IV Therapy PPT) (already above) -Never choose veins in an arm that has… In extremitiss with the same side on a masecotoomy, Any extremity that has dialysis shunts or AV fistulas, Present signs/ symptoms of infection, Areas with extensive scarring, burns, or surgeries, CVA paralysis side, Extremities that have previous recent infiltration,extravasation, phlebitis, Site distal to previous puncture 4. Clinical findings of cellulitis (IV Therapy PPT) (already above) -Celluliitis: Inflammation of loose connective tissue around insertion site. Caused by poor aseptic insertion technique. Treated w/antibiotics. Red swollen area spreads from the insertion site outwardly in a diffuse circular patter 5. Reasons why IV meds are administered (IV Therapy PPT) IV fluids are used to: -- Expand intravascular volume -- Correct imbalances of fluids and electrolytes -- Compensate for an ongoing problem that is affecting pts fluid & electrolytes: i.e. N/V/D Purpose of Esstablishing and IV: -Helps maintain or restore the fluid volume and electrolyte balance of the body -Provide a way to nourish and feed a patient calories -A way to give needed medication (both routine and emergent) to a patient – such as pain meds -To transfuse blood products -To provide avenue for diagnostic lab testing 6. Antidotes for drugs reviewed in class. Medication: Benzodiazepines Antidote: Flumazenil Medication: Opioids Antidote: Naloxone (also known as Narcan) Medication: Heparin Antidote: Protamine sulfate Medication: Acetaminophen Antidote: Acetylcysteine (also known as Mucomist) Medication: Warfarin Antidote: Vitamin K 7. hypotonic intravenous (IV) fluid Powerpoint-Hypotonic Fluid: (alrready on flashcards) *Pull body water into the cells (net inflow–cell expands) * Clinical problems targeted by Hypotonic fluids: Dehydrated Cell * i.e. hyperglycemic conditions such as DKA/ HHNS (which draws fluid out of the cells & into the intravascular space) * Commonly ordered fluids: * 0.45% NS * 0.33% NS * 0.2% NS *Contraindicated in Increased ICP (shifts fluid into brain tissue and cause brain swelling), Dehydration, or Trauma *A hypotonic fluid has a lower concentration of solutes than your cells, causing water to enter the cells and make them swell. *A hypotonic fluid has a lower concentration of solutes (like salt or sugar) compared to the fluid inside your cells. When you put cells in a hypotonic solution, water moves into the cells to balance the concentration, which can cause the cells to swell or even burst. Chat GPT -Hypotonic Fluids: (Already on flashcards) What they are: Fluids with a lower concentration of solutes than the cells. Effect: Water moves into cells, causing them to swell. Example: 0.45% NaCl (half-normal saline). - (not on flashcards yet)Sherpath:Tonicity of Solution and Osmolality: Hypotonic (