Chapter 7 Nursing Care of Patients Receiving Intravenous Therapy

Answers CHAPTER 7 NURSING CARE OF PATIENTS RECEIVING INTRAVENOUS THERAPY AUDIO CASE STUDY Mrs. Andrews’s Complications of IV Therapy 1. Gloves, chlorhexidine pads, a tourniquet, various sizes of cannulas, tape, a transparent dressing, intravenous (IV) tubing, a pole, and IV solution bag. 2. The indirect method is useful for small, rolling veins. 3. Mrs. Andrews has heart failure and cannot tolerate rapid fluid infusions. 4. Mrs. Andrews gained 6 pounds, is edematous, is short of breath, and has basilar crackles. VOCABULARY 1. (1) 2. (6) 3. (7) 4. (2) 5. (5) 6. (8) 7. (4) 8. (3) “positional.” Check the tubing for kinks and the clamp to be sure it is open. If the infusion is still not running, the catheter may be occluded with a fibrin or blood clot. The catheter may need to be discontinued. Never attempt to flush the catheter, because this could dislodge a clot into the circulation. 2) The role of the licensed practical nurse/licensed vocational nurse varies by state. 3) In many states, the registered nurse (RN) would need to be consulted before discontinuing and restarting a new IV site. The RN may attempt to withdraw a clot by aspiration. CALCULATION PRACTICE 1. 83 mL 1 hour 1 hour 60 minutes 2. 50 mL 20 minutes 15 gtt 21 gtt = mL minute 10 gtt 25 gtt = mL minute 3. 1 L 12 hours 1,000 mL 83 mL = 1L hour 4. 800 units 1 hour 500 mL 8 mL = 50,000 units hour 5. 1,000 mL 24 hours 1 hour 60 minutes 60 gtts 42 gtt = mL minute COMPLICATIONS OF IV THERAPY 1. phlebitis 2. a local infection 3. extravasation 4. circulatory overload 5. infiltration 6. septicemia 7. venous spasm 8. venous air embolism CRITICAL THINKING 1) Begin by observing the infusion site. Look for redness and signs of infiltration (such as coolness and swelling), compare extremities, and check catheter/administration hub connection to make sure it is secure. Next assess for mechanical problems such as position of the catheter by moving the extremity around to see if the IV is simply REVIEW QUESTIONS—CONTENT REVIEW The correct answers are in boldface. 1. (1) is correct. A clot could be flushed from the cannula into the circulation and lodge in a pulmonary artery, causing a pulmonary embolism. (2) is incorrect. Air, not a clot, causes an air embolism. (3) is incorrect. Arterial spasm is caused by injecting medication. (4) is incorrect. Extravasation is caused by infiltration of vesicant drugs. 2. (3) is correct. Leakage of intravenous fluid into tissues causes puffiness. (1, 2, 4) indicate infection or inflammation. 3. (1) is correct. Phlebitis, an inflammation of a vein, has signs and symptoms of redness, warmth, swelling, and pain at the infusion site. (2) is incorrect. Thrombosis is manifested by a slowed-to-stopped infusion, fever, and malaise. (3) is incorrect. Hematoma evidenced by 1 2 Chapter 7 Answers swelling and bruising. (4) is incorrect. Signs of infiltration are swelling and a resistance or inability to advance or flush the catheter. 4. (4) is correct. A peripherally inserted central catheter, or PICC, is inserted in the arm and terminates in the central circulation. (1, 2, 3) are incorrect. REVIEW QUESTIONS—TEST PREPARATION The correct answers are in boldface. 5. (4) is correct. Fluid overload could be worsened with the use of continuous fluids. (1, 2, 3) are incorrect. All would benefit from continuous fluid administration. 6. (2) is correct. Intravenous medications act rapidly because they are instantly in the bloodstream. (1) is incorrect. Furosemide (Lasix) can be given orally. (3) is incorrect. Intravenous dosing is not necessarily more accurate. (4) is incorrect. Oral furosemide does not cause more side effects. 7. (3) is correct. (1, 2, 4) are incorrect. 1,000 mL 8 hours = 125 mL hour 8. (3) minute is correct. (1, 2, 4) are incorrect. 50 mL 1 hour 60 gtt 1 hour 60 minutes 1 mL = 50 gtt minute 9. (2) is correct. An occlusion may be caused by a kink or closed clamp. (1) is incorrect. There is no need to notify the health care provider. (3) is incorrect. Flushing can dislodge a blood or fibrin clot into the patient’s bloodstream. (4) is incorrect. This would require an order from the health care provider.