IV Therapy Final Exam & graded A+ updated 2022.

IV Therapy Final Exam A bag of intravenous solution should not hang longer than how many hours? ans: 24 hours A physician's order for IV therapy must contain what components? ans: date of order, type of fluid solution, volume, and length of infusion time A tourniquet should be left no longer than how many minutes? ans: 2 minutes According to the CDC, when should hands be washed, or an alcohol-based hand rub be used during the venipuncture procedure? ans: before and after palpating IV sites, before and after inserting IV catheter, and before and after accessing IV system for any purpose After medication is added to a solution, it must be infused or discarded within how many hours? ans: 24 hours After performing venipuncture, when can you let go of the catheter? ans: after the IV catheter is secured After the fluids are connected and started, what do you look for? ans: redness, edema, skin, pain, any other complaints that the patient has Are gloves required during venipuncture? ans: yes At what point in the procedure is the tourniquet removed? ans: Either when blood is present in the catheter hub or after the nurse has advanced the cannula but before the stylet is taken out. Besides the tourniquet, identify four ways to further dilate veins. ans: Position arm in a dependent position, rub or stroke arm, cover entire arm with warm, moist towels for 5 - 10 minutes, and after applying tourniquet, have patient open and close fist Define the following local complications and list the signs and symptoms for: extravasation ans: infiltration of a vesicant Define the following local complications and list the signs and symptoms for: infection ans: redness, edema, exudate at siteredness, edema, exudate at site Define the following local complications and list the signs and symptoms for: infiltration ans: nonvesicant solution leaks out of vein into surrounding tissue, IV site edematous and cool Define the following local complications and list the signs and symptoms for: pain ans: discomfort at or above IV site Define the following local complications and list the signs and symptoms for: phlebitis ans: inflammation of vein; can result in thrombophlebitis leading to an emboli, pain, erythema at site Define the following systemic complications and list the signs and symptoms: air embolism ans: *Gas bubble in the vascular space *Venous - small - usually stopped at heart, large - stops blood flow (death) *Arterial - stops blood flow (brain, heart) - shock, decreased LOC, (death) Define the following systemic complications and list the signs and symptoms: Circulatory overload (fluid volume excess; FVE ) ans: *Vascular space, heart and kidneys are unable to handle the excess fluid volume, Especially children and elderly resulting in heart failure and pulmonary edema *S&S - coughing, wheezing, dyspnea, cyanosis, tachycardia, hypertension, pulmonary edema, anxiety, restlessness Define the following systemic complications and list the signs and symptoms: incompatability ans: *IV drugs may not be compatible with other IV drugs or solutions. Drug incompatibility is a true risk to the patient because it can cause crystallization of the solution. This precipitation at the least will clog the IV line and at the worst present as emboli. *S&S: Same as pulmonary and air embolism. Define the following systemic complications and list the signs and symptoms: infection ans: *When micro-organisms occur in the bloodstream, this is called sepsis. Sepsis is a very serious condition, the body's response to this is called systemic inflammatory response syndrome (SIRS). *S&S - chills, fever, confusion, delirium, hypotention (shock), tachycardia Define the following systemic complications and list the signs and symptoms: pulmonary embolism ans: *a blockage of the main artery of the lung or one of its branches by a substance, usually a blood clot, that has travelled from elsewhere (extremity) in the body through the bloodstream. *S&S - chest pain, dyspnea, tachypnea, cyanosis, shock state Define the following systemic complications and list the signs and symptoms: speed shock ans: *a sudden adverse reaction to IV medications or drugs that are administered too quickly *S&S - causing, irregular heart rhythm, tight feeling in chest, changes in the LOC, headache, cardiac arrest Describe a vein that is suitable for venipuncture. ans: Round, firm, elastic, engorged with blood; not hard, bumpy or flat Describe how to dress a catheter site using a transparent dressing. ans: Insertion site clean and dry, DON'T cover tubing and cannula hub, Place transparent dressing over insertion site and up to cannula hub, don't stretch dressing, and "tuck" transparency dressing around hub to keep out microorganisms Describe how to immobilize the vein. How long should you maintain immobilization during venipuncture? ans: Use thumb of nondominant hand to stretch skin downward to anchor vein. Do not apply too much pressure or you will flatten vein. Describe how to regulate an IV infusing by gravity. How high should the solution be positioned above the infusion site? ans: The nurse has to first figure out how many gtt/min to deliver the specific amount of fluid or the dose of medication. Using a watch with a second hand and using a manual controller to either speed up the gtt/min or the slow the gtt/ml. IV bag should be 36 inches above insertion site Describe one method for systematic assessment of IV therapy and list its components (i.e, what are you doing and what are you looking for?) ans: start at IV insertion site and work toward IV solution Assess for signs and symptoms of fluid overload daily weight I & O skin turgor moist mucus membranes VS LOC lung sounds - new or increased crackles Assess IV site redness edema dressing intact date of insertion rubing connections tight, unkinked fluid, type, rate amount Describe OSHA guidelines regarding the use of tourniquets among clients. ans: Occupational Safety and Health Administration (OSHA) establishes enforced guidelines to assist employers in implementing safety standards for employers. Tourniquets are single patient use only. IV sylets are to have safety shields to reduce the possibility of needle sticks. Dispose of IV stylets in sharps container. Dispose of sharps container when ½ to ¾ full. Know your "needle stick" protocol in your hospital. Describe the procedure for site care of an IV with a transparent dressing. ans: *Wash hands *Glove *Remove old dressing in direction of insertion site while stabilizing catheter *Leave stabilizing tape in place *Discard materials, wash hands and glove *Inspect IV site *Cleanse out from IV site in a circular motion, allow to dry *Remove told tape; retape *Apply new dressing using sterile technique; avoid covering hub/tube connection. *Write date, time, gauge and your initials on new dressing *Discard used materials, wash hands *Document Do you need a physician's order to start an IV in the lower extremity of an adult? Why or why not? ans: Yes. Blood likely to pool or clot which may result in an embolism. Only a RN or primary health care provider should start an IV in a foot. Do you use a circular or a back and forth motion to cleanse the site? Why? ans: Cleansing should go back and forth not in a circle. Use increased friction to allow antimicrobial solution to penetrate to lower layer of the epidermis Fill in the blank. __________ fluids have fewer solutes (are less concentrated) than body fluids. These fluids __________ the more highly concentrated cells and are used in the client with cellular ___________. ans: hypotonic; hydrate; dehydration Fill in the blank. ___________ fluids have more solutes (are more concentrated) than body fluids. These fluids ___________ the plasma volume by pulling water from body cells. They are used in the treatment of __________ clients and to replace electrolytes. ans: hypertonic; increase; hypovolemia Fill in the blank. ___________ fluids have the same concentration of solutes to water as body fluids. These fluids ___________ the extracellular fluid volume without entering or pulling water from the cells. ans: isotonic; expand Fill in the blank. The use of ___________ precautions and ___________ technique is required at all times in IV therapy. ans: standard; sterile Fill in the blank. Water moves from areas of __________ concentration to areas of ____________ concentration. ans: lesser; greater How do you palpate a vein? ans: Use index and middle fingers over anticipated site How far above the intended venipuncture site should the tourniquet be applied? ans: 4 to 6 inches above anticipated IV site How many catheters should be used for each cannulation attempt? ans: 1 How often should a bag of IV solution be changed? ans: every 24 hours How often should a gauze dressing be changed? ans: 48 hours How often should a IV site be changed? ans: every 72 hours How often should a site check be performed? ans: every 4 hours How often should a transparent dressing be changed? ans: 7 days How often should a volume check be performed? ans: every 1-2 hours How often should intravenous tubing be changed? ans: 72 to 96 hours How often should IV sites be changed? ans: 96 hours How often should IV tubing be changed? ans: every 24-72 hours How often, should a patient receiving IV therapy be assessed? ans: *IV site should be assessed every 4 hours *Volume infusion should be assessed every 1-2 hours Identify preventative measures and the treatment for these local complications: extravasation ans: *check patency before and during infusions *Tx - Stop infusion immediately. Follow hospital policy. Does this medication have an antidote?? Some antidotes must be infused into the same IV line to go into the surrounding tissue that the vesicant went into (ie vassopressors - levophed, dopamine - these meds destroy tissue cells) Identify preventative measures and the treatment for these local complications: infection ans: *aseptic technique at all time, inspect fluids *Tx - discontinue infusion, remove cannula, clip cannula tip with sterile scissors into sterile cup and send to lab for culture and sensitivity, initiate new IV site (other extremity) with all new sterile tubing and solution Identify preventative measures and the treatment for these local complications: infiltration ans: *monitor patency, check for blood flow *Tx - stop and discontinue, warm compresses, elevate, restart new IV site Identify preventative measures and the treatment for these local complications: pain ans: *Check manufacture for medication dilution, check IV site for infiltration, extravasation, close proximity to nerves, check musculosensory aspects of extremity, etc *Tx - slow down infusion rate, dilute medication, stop infusion. Identify preventative measures and the treatment for these local complications: phlebitis ans: *anchor well, avoid joints, dilute meds, use large veins, use filter, *Tx - Remove and restart new IV site Identify preventative measures and the treatment for these systemic complications: air embolism ans: *Preventative measures: Ensure that all IV lines are cleared of air Ensure that all IVP meds have no air in syringe *Tx: Monitor VS Monitor LOC Monitor respiratory status Support cardiovascular and respiratory systems Provide supplemental O2 Identify preventative measures and the treatment for these systemic complications: circulatory overload ans: *Preventive measures: Watch for the total amount of solutions infusing Do not infuse solutions too rapidly Caution with fluids for children and elderly *Tx: reduce or stop IV infusion expect order of Lasix monitor lung sounds monitor VS monitor LOC head of bed elevated slow down IV to KVO rate notify primary health provider foley catheter monitor I & 0 Identify preventative measures and the treatment for these systemic complications: incompatability ans: *Preventative measures: Review IV compatibility charts for drugs that have interactions with each other. When in doubt, use a buffer of normal saline between IVP meds. *Tx: Monitor VS Monitor LOC Monitor respiratory status Support cardiovascular and respiratory systems Provide supplemental O2 Identify preventative measures and the treatment for these systemic complications: infection ans: *Preventive measures: handwashing clean gloves follow aseptic technique change dressings and tubing according to facility's policy *Tx send tip of cannula to lab for culture and sensitivity initiate new IV in another extremity anticipant order for IV antibiotics monitor VS monitor LOC prepare for septic shock situation prone position if shock occurs support cardiovascular and respiratory systems Identify preventative measures and the treatment for these systemic complications: pulmonary embolism ans: *Preventative measures: Follow facility's policy on IV site changes Ensure IV patency *Tx: Monitor VS Monitor LOC Monitor respiratory status Support cardiovascular and respiratory systems Provide supplemental O2 Identify preventative measures and the treatment for these systemic complications: speed shock ans: *Preventative measures: Review in an IV medication resource book the correct dilution of medications and the correct infusion rate for the specific medication *Tx: Monitor VS Monitor LOC Monitor respiratory status Support cardiovascular and respiratory systems Provide supplemental O2 Identify the concentration and solution for D5 1/2NS. ans: 5% dextrose in 0.45% sodium chloride Identify the concentration and solution for D5 1/4NS. ans: 5% dextrose in 0.225 sodium chloride Identify the concentration and solution for D5LR. ans: 5% dextrose in Ringer's lactated solution Identify the concentration and solution for D5NS. ans: 5% dextrose in 0.9% sodium chloride Identify the concentration and solution for D5W. ans: 5% dextrose in water Identify the concentration and solution for LR. ans: Ringer's lactated solution Identify the concentration and solution for NS. ans: 0.9% sodium chloride If alcohol is used, how long should it be applied with friction? ans: 30 seconds to 1 minute If both alcohol and providone- iodine are used, in what order should they be applied and why? ans: alcohol, then providone (must be wiped off, irritating to skin), alcohol inactivates providone If medication is added to a solution, the label must also contain the following: ans: Medication, dosage, date, time If medication is ordered, identify what additional components to the order must be present. ans: date, drug, dose, frequency of drug, length of infusion time, and dilution strength If the venipuncture site is excessively hairy what should you do? ans: clip, do not shave In adult patients, how large of surface area from the intended venipuncture site should be cleansed? ans: 2 to 4 inches Is it acceptable to blot any excess solution? ans: No, allow area to air dry List at least five venipuncture site contraindications. ans: arm of a mastectomy patient, arm with an ateriovenous shunt or fistula, arm being treated for numbness, arm that has experienced trauma, and avoid legs - circulation is easily impaired, DVTs,