Parenteral Meds and therapy
Terms
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- What is meant by isotonic?
- when a solution has an osmolarity equivalent to that of blood
- What is meant by hypertonic?
- intravenous solutions that have greater osmolarity than blood
- What is meant by hypotonic?
- intravenous solutions that have lower osmolarity than blood
- purpose of isotonics
- to replace circulatory volume
- purpose of hypertonics
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to promote excretion
to draw off fluid - Purpose of hypotonics
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to replace fluids
to hydrate - Clinical use for isotonics
- dehydration
- Clinical use for hypertonics
- replace plasma loss
- Clinical use for hypotonics
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overhydration
fluid shift
SIADH - What can hypertonic and hypotonic solutions do?
- may cause damage to red blood cells, pain, and tissue irritation
- What is an ampule?
- an elongated sealed glass container with a neck that must be snapped off
- What is the lumen of the needle?
- the hollow bore of the needle
- Define Intradermal (ID)
- Injection into the dermis just under the epidermis.
- Define Subcutaneous (Sub-Q)
- Injection into tissues just below the dermis of the skin.
- Six "Rights" of Medications
-
Medication
Dose
Client
Route
Time
Documentation - How can you differentiate between a syringe intended for oral use, and one inteneded for parenteral use?
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Oral syringes dont have a luerlock hub, but do have a cap.
Parenteral have a luerlock hub that is used to securely attach a needle. - When using a prefilled, single dose syringe, and it contains more than the ordered dose, what action should the nurse take?
- Discard the extra amount BEFORE injecting the patient.
- What type of syringe is used for U-100 insulin?
- ONLY a U-100 Insulin Syringe.
- In a U-100 Insulin Syringe 100U=____ mL?
- 100U = 1 mL
- What are the calibrations used in a 1ml syringe?
- 0.01mL
- What is another name for a 1ml syringe?
- A TB Syringe.
- When aligning the plunger in a syringe to a callibration, what is used as the marker?
- The Top Ring of the black rubber tip.
- Are all syringes marked in mL?
- No, some use cc, which are interchangable.
- Routes of 4 parenteral drug administration (know degrees of needle entry)
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1. subcutaneous 45
2. IM 90
3. IV 25
4. ID 10 - 25 - What are the goals of Intravenous Therapy
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1. Prevent and/or correct fluid (dehydration or fluid overload)
2. Maintain immediate IV access for medication administration (potential code or code symptoms,
IV antibiotic administration).
3. Treat electrolyte disturbances (Smith, 2000, 842)
( Potassium, Calcium, Magnesium, Sodium, Chloride, Bicarbonate and Phosphate)
4. Administer nutrition (Dextrose, Total Parenteral Nutrition) - RN Role in intravenous therapy
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1. Initiating IV access for peripheral IV sites or assisting with insertion of central lines. (PICC, {peripherally inserted central catheter} lines are inserted by specially trained RNs. )
2. Administering prescribed IV solutions, medications and blood products
3. Evaluating patient's response to prescribed therapy.
4. Maintain and observe for complications - list the different gauges that an IV catheter can be and what are they used for
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A. 16: trauma; people giving blood donations
B. 18: patients receiving multiple blood transfusions; ER patients; surgery patients
C. 20: large volume IV fluids; diagnostic procedures
D. 22: adults with small veins; geriatric patients receiving IV fluids or medications
E. 24: pediatric; geriatrics -
Intravenous Therapy-
Nursing Implications -
1. Not on side of a mastectomy
2. Not on extremity of hemodialysis access
3. Distal end of vein should be selected first, reserving more proximal sites for future IV therapy.
4. Elderly have thin skin and lack of support tissue. - What are some Complications that can happen from giving Intravenous Therapy
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Complications-
Infection- Redness at site, warmth at site, tenderness at site
Change tubing and site q 72 hours, Change IV solutions q 24 hours, may use filters
Phlebitis – Pain along the vein, tenderness, erythema – red streak at vein site. Edema at insertion site
Sluggish flow rate, area is warm to touch
Infiltration of fluid – Edema around insertion site- blanching of infusion site – coolness of skin around site - no backflow of blood
Extravasation of medication - Why is it important for the nurse check the expiration date on the bag and assess for cloudiness or leakage?
- to ensure the solution is sterile
- What is it important to unroll tubing and close roller clamp with opening a new infusion set?
- Prevents fluid from leaking after IV bag is spiked
- Why is it important to spike bag with tip of new tubing and compress drip chamber to fill halfway?
- This promotes rapid flow of solution through new tubing without air bubbles.
- What is it important when opening roller clamp to remove protective cap from the end of the tubing, and slowly flush solution completely through tubing?
- This removes air from tubing. Prevents entry of air into the venous system, a cause of air embolus. If fluid enters tubing too rapidly air bubbles occur.
- Why is it important to close roller clamp and replace cap protector?
- This prevents fluid from leaking and maintains sterility of tubing.
- When removing old tubing and replacing with new tubing, why is it important to place sterile 2x2 gauze under IV catheter or heparin lock?
- Absorbs fluids that may drip during the procedure, preventing contamination of surrounding areas.