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IV Final Review- (100 questions; 71 multiple choice & 29 matching)

11 questions complications of IV therapy:


Local complications:

o Infiltration- from poor taping , non-vesicant solutions, coolness,


edema, NO REDNESS
o Extravasation- vesicant solution into the tissues, causes blisters,
necrosis- sentinel event, give medical antidote
o Local infection- redness, warmth. From poor aseptic technique
o Venous spasm- infuse cold solutions or too fast- stop IV, let
solution warm, warm compress to site, flush before restarting.
o Phlebitis- red streak, palpable cord, pain. Chemical , bacterial,
post infusion, mechanical- s/s use the scale (like 0-4)
o Thrombosis- dont force the plunger when flushing because the
clot will release
o Thrombophlebitis- palpable red cord (0-4 scale)
o Hematoma- nicked the vein on the way in, blood leaks out. Dont
re-site below re-site above or on other side.
Systemic complications
o Septicemia- profuse, cool sweating, WBC, Nausea, vomiting,
diarrhea, tachycardia, respirations, fever.
o Air embolism- hypotension, extreme SOB, tachycardia,
impending doom.
o Speed shock- s/s of shock
o Catheter fragment
o Catheter malposition- from changing the dressing. X-ray
confirmation, tip needs to rest in the lower 1/3 of superior vena
cava
o Fractured catheter- Dr. does exchange over wire

24 questions- math:

mL/ hr = amount of solution/ time


Gtt/ min = (mL/hr X drop factor) / 60 (amount of time)
o Macrodrip = 10 (blood), 15, 20
o Microdrip = 60 (peds)
< 1 hour and its in mL/ hr?
o Example: amoxil 1G in 0.9 100mL over 30min.
100mL/ 30min = 200mL/60min
Know how to find out how much has infused over a certain amount of
time

Know how to find out what time the infusion will be done, etc.

8 question- administration and set up:

Intermittent set: hang ATB, change q 24hr


Continuous set: good until compromised
o Compromised- change immediately upon discovery
Blood tubing good for 4hrs
Roller clamp closed until pump is set
Closed glass system- needs vented tubing ( trap door on the drip
chamber)
Change central line dressings q 7days, unless compromised

10 questions- Fluids (solutions, FVE, FVD):

FVE:
o JVD, HCT, bounding pulse, moist skin & lungs, pedidal/
periorbital edema, warm skin, crackles, SOB, pitting edema,
daily weights, Bp
o Rx: D5.45 & Diuretics (maybe 2)
FVD:
o Bp, orthostatic hypotension, weak & thready pulse, dry mucus
membranes, poor skin turgor, sunken eyes, clear lungs, temp,
HCT, pulse.
Isotonic: 250-375 mOsmo/L NO NET SHIFT
o Nacl 0.9 (only solution compatible to run with blood)
o LR (Na, Cl, K+, Ca+, lactate)
o Ringers (Na, Cl, K+, Ca+)
o D5W (only on the self; changes to hypotonic once infused)
o Give for burns & nausea
Hypotonic: <250mOsmo/L FLUID SHIFTS INTO CELL; cell swells
o Watch for dehydration & hypotension; short term solution
o 0.45 Nacl
o 0.33Nacl
o D2.5W
o D5W (once infused into pt)
o Give is sodium is high, DKA, hypotension
Hypertonic: >375mOsmo/L FLUID PULLED INTO INTRAVASCULAR
SPACE; cell shrinks
o Watch for FVE
o D5.45Nacl
o D5.09 Nacl
o D5 LR

o
o
o
o

D10, D20 or higher


0.9Nacl w/ KCL 10 mEq/L
Colloids (albumin, mannitol, dextran, hetastart)
Give for blood/ volume loss, shock, dehydration, and maintained

6 questions- Scope of practice:

Scope Can:
o PIV < 3in antecub, forearm, hand
o Flush NS or heparin
o Hang ATB, crystalloids
o Change central line dressings
o Check vital signs
o Age of pt. +18
o Get orders from MD, DDS, podiatrist, NP, RN
o Hang second bag MVI
o Draw blood peripherally
o Stop blood transfusion if s/s of reaction
o Aspirate P & C
Scope Cant:
o Hang anything higher than D10 or drugs
o Hang TPN, chemo, blood, investigative
o D/C central lines, PICC
o Maintain blood
o Hang on central lines
o PCA
o IV push
Other infusion methods:
o Interosseous- in the bone (typically in anterior tibia) NOT in a
broken bone
o Intra- Arterial- good for super high doses of chemo. Not to be
confused with arterial line for abgs
o PCA- basal, on demands, bolus, in a fluid (through IV)
preprogrammed to avoid OD
o Sub Q- insulin pumps, end of life palliative care (Haldol,
antinausea)
o Epidural and intradural- pain meds, steroids. Monitor respiratory,
numbness, paresthesia.
TPN
o Peripheral IV can handle up to D10. >D10 has to go in to central
line in a dedicated port.
o Can be continuous or cyclic.

o Can have all nutrition, vitamins, fats, etc that you need to
survive
4 questions- ABGs

pH acidosis 7.35-7.45 alkalosis


pCO2 alkalosis 35-45 acidosis
HCO3 acidosis 22-26 alkalosis
o Hyponatremia= muscle weakness & twitching, poor skin turgor,
headache, tremors, seizure, coma
o Hypernatremia= marked thirst, edema, swollen tongue, red, dry
sticky membranes
o Hyperkalemia= muscle weakness, bone pain, constipation, N/V,
polyuria, polydipsia
o Hypokalemia= rapid, weak irregular pulse, EKG changes,
decreased reflexes, decreases BP, weak muscles, fatigue, N/V
o Hyperkalemia= EKG changes (peaked T), oliguria, muscle
cramping, diarrhea. Treat with Calcium gluconate
o Hypochloridemia= tetany, low resp, increased muscle excitability
o Hyperchloridemia= stupor, rapid deep breathing, muscle
weakness

6question- Central venous catheters

Short Term:
o Non- tunneled aka percutaneous CVC
Subclavian, external jugular & femoral and tip of catheter
advanced into `the superior vena cava.
Disadvantages:
Highest rate of infection of the four types of CVADs*
Sterile Dressing
Use from 7-10 days
Verified by chest x-ray
Ultrasound guidance placement by physician
Complications:
Arm edema
Bleeding
Tendon and nerve damage
Cardiac dysrhythmias
Catheter malposition or embolism
Phlebitis
Catheter sepsis
Thrombosis

Air embolism
o PICC
Inserted/DC by certified RN with ultrasound guidance
Use up to 1 year
Inserted median cephalic, brachial, and median basilic or
external jugular veins
Lies in lower 1/3 of superior vena cava
Advantages:
Decreased pain and discomfort
Cost effective and time efficient
Reduces risk of infiltration and phlebitis
May be used for lab draws
Carries a low risk for infection
Disadvantages:
Bruising around insertion site
Special training required
Sterile Dressing*
45 mins- 1hr. to insert*
Daily or weekly care
Potential for vein thrombosis and catheter occlusions
o PIV
< 3 inches in length
Inserted in veins on forearm or hand
o Nursing Care
Dressing replaced every 7 days or when damp, loosened,
or soiled
Sterile technique required
Gauze dressing changed every 24-48 hrs.
Biopatch covered with TSM changed every 7days
Long Term:
o Tunneled
Broviac, Hickman, and Groshong; Dacron cuff anchored
Leaks or breaks use nonserrated clamp and gauze, call
physician, and do not use hemostats
Use for months to years
Lower infection rate
1-2 lumens
Inserted by physician as surgical procedure
o Implanted port
Nay remain in place for years
Single or double lumen with rubber top and use of special
non-coring needle

Can withstand 2000 punctures


No dressing changes required
Monthly heparin flushes
No activity restrictions
Reduced risk of infection
Surgically inserted by physician
Nursing Care:
o Dressing management ( do not normally require a dressing after
insertion site is healed)
o TSM dressing changed every 7 days using sterile dressings
initially
o Catheter / skin should be visually inspected daily through the
dressing
1 question- phlebotomy:
Order of the draw
1. Yellow blood culture (see if they have infection) * Must remain
sterile
2. Light blue- coags (PT, PTT, INR)
3. Red- plain, nonadditives, SST, chemical (no liquids inside)
4. Additives- Green (therapeutic monitoring), Purple (CBC/
hematology), Pink (type and cross), Gray (glucose/ alcohol). * Invert
& not shake.
o Butterflies, vaccutainers
Most common device used for blood collection
Used for veins that are difficult to access
Butterflies good for severely burned pts.*
o Sites and cleaning are the same. Always use 2 identifiers
Needles
o 16-18 gauge: used to collect donor units of blood
o 21-22 gauge: used for collecting specimens
o Lancets: heel sticks for infants
18 Blood administration:

Blood
o Antigen: A substance capable of stimulating the production of an
antibody and then reacting with that antibody in a specific way
o Antibody: Protein produces by the immune system that destroys
or inactivates an particular antigen produced as a result of
antigenic reactions found in plasma.

Recipient

Donor Unit
First Choice

Donor Unit
Second Choice

Donor Unit
Third Choice

A+

A+

O+, A-

O-

B+

B+

O+, B-

O-

AB+

AB+

AB-, A+, B+

O+, A-, B-, O-

O+

O+

O-

----

A-

A-

O-

A+, B+

B-

B-

O-

B+, O+

AB-

AB-

A-, B-, O-

AB+, A+, B+,


O+

O-

O-

O+

---

RBCs
o Removes the plasma from whole blood and the RBCs
remain
o Must be ABO compatible
o Volume 1 unit is 250 cc (approx.)
o Advantages: Decreased plasma volume, decreased
risk of circulatory overload, less citrate, potassium,
ammonia, and other metabolic byproducts are
transfused
o Uses: Improve oxygen-carrying capacity in patients
with symptomatic anemia, hemorrhage
o Use for chronic symptomatic anemia and restoration
of blood volume
o Raises Hgb 1 g/dL and Hct 3%
Leukocyte reduced RBCs
o Indicated for the prevention of recurrent febrile
nonhemolytic transfusion reactions