Intravenous Therapy - 2014

7/23/2019 Intravenous Therapy - 2014

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P O T T E R & P E R R Y , C H A P T E R 4 1 , P A G E S 9 0 4 -

9 3 8B R U N N E R C H A P T E R 1 3 , P A G E S 2 7 2 - 2 8 4

Intra!n"#$ T%!ra'


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I( T%!ra'

IV fluid and electrolyte therapy (crystalloids)

Blood and blood component (colloids)


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T'!$ ") I( S"*#t+"n$

Isotonic: Osmotic pressure is same

Hypertonic: Water drawn out of the cell

Hypotonic: Water drawn into the cell


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I$"t"n+ *#+.$

Dextrose ! in Water

"#$! sodium chloride

%actated &in'ers


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I$"t"n+ I( *#+.$/ 09 NaC*

I$"t"n+/ "#$! sodium chloride ses

*xpand fluid +olume Only solution administered with blood Does not pro+ide free water, no calories, or electrolytes

-pecial considerations -ince it replaces *./, monitor patients with .H/ for /V* Dilutes hemo'lobin concentration

.an cause hyperchloremic acidosis

0onicity matches that of the serum, fluids stay in the +ascularspace

SHOC


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I$"t"n+ I( *#+.$/ atat!. R+n!r5$

I$"t"n+/ %actated &in'ers ses

*xpand intra+ascular +olume 1 replace extracellular fluid losses .an be used to treat mild metabolic acidosis, burns, and lower 2I

losses Does not pro+ide free water or calories

-pecial considerations -imilar to serum, but without ma'nesium .ontains potassium, careful use with renal failure

0onicity matches that of serum, fluids stay in the +ascular space


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H'"t"n+ *#+.$

"#3! sodium chloride

"#44! sodium chloride

Dextrose ! in Water 5 a special case

(isotonic, but physiolo'ically hypotonic, pro+idin' freewater)


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H'"t"n+ *#+.$/ 046 $".+# %*"r+.!

H'"t"n+/ "#3! sodium chloride ses

&eplace hypotonic fluid losses 6aintenance solution but does not replace daily electrolyte losses

except sodium 1 chloride 7ro+ides free water 7ro+ides no calories

-pecial considerations .an cause increased intracranial pressure

.an cause circulatory collapse 0onicity is less than that of serum, fluids help maintain daily

fluid loss# 0he free water 'oes from *./ to I./


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&eturn to homeostasis:


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H'!rt"n+ *#+.$

Dextrose in "#$!sodium chloride

Dextrose 8"!

9! -aline


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I( *#+.$ & U$!$/ +nt!r!$t+n +n)"

H'!rt"n+/ Dextrose in "#$!sodium chloride sed in

Hypotonic dehydration 0emporary treatment of circulatory insufficiency 1 shoc if

plasma expanders arent a+ailable -I;HD (or use 9! -odium .hloride) ;ddisonian crisis

-pecial considerations increased circulatin' +olume can tri''er con'esti+e heart failure 1

pulmonary edema 0onicity is hi'her than serum, fluid is pulled from the cells,

into the +ascular spaces


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&


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0reatment .omplications

/luid Volume *xcess

.ellular *dema

.ellular Dehydration


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!*+!r' !t%".$

P!r+%!ra* *+n!$ S%"rt t!r or intermittent fluids Vein in ar, %an., le' or foot

C!ntra* *+n!$ /or +na.!:#at! !r+%!ra*+eins or *"n t!r

-ub


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C"*+at+"n$ ") I( T%!ra'

Infiltration

Infection

7hlebitis 1 thrombophlebitis

*xtra+asation


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C"*+at+"n$ ") I( T%!ra'

-e+ered catheter

;ller'ic reaction

;ir embolism

/luid o+erload

-peed shoc


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B*"". A.+n+$trat+"n


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B*"". R!*a!!nt

;dministration of Whole blood .omponent of blood

Ob=ecti+es 0o increase circulatin' blood +olume 0o increase > of &B.s 1 maintain H'b le+el 0o pro+ide selected cellular components


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B*"". Gr"# T'!$

Blood must be matched ;, B, O, and ;B blood types &h factor

0ransfusion reaction

http:??fi#edu?biosci?blood?types#html


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A#t"*""#$ Tran$)#$+"n

.ollection of clients own bloodObtained up to wees before planned e+entDonation of up to units dependin' on time and

sur'ery-al+a'ed blood Durin' sur'ery /rom chest


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N#r$!5$ R"*!

A$$!$$!nt -i'ns of infection or infiltration at IV site What 'au'e needle is in place filter present 0ubin' filled with "#$! @a.l

Is any reason that the client should not recei+e;nxiety about transfusion *xplain the procedure and tell them symptoms they should report#;ssess whether the client has 'i+en a si'ned consent#;ssess +ital si'ns for baseline before 'i+in' the blood# /ollow a'ency protocol licensed personnel who will chec off on the

blood to be administered and the clients information# T%! n#r$! +$ r!$"n$+;*! )"r ;!+n $#r! t%at t%! ;*"".

.!*+!r!. +$ "at+;*!


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In+t+at+n t%! In)#$+"n

Be'in slowly to allow for early detection of a transfusionreaction#

6aintain the infusion rate (usually o+er 4 hours) If se+ereblood loss, the blood may be administered more rapidly#Warm in blood warmin' de+ice to pre+ent dysrhythmia#

6onitor for side effects;ssess +ital si'ns and promptly records all findin's# &eport

as indicated#-tay with the client durin' the first 8 minutes (time most

liely to ha+e a reaction)6onitor and obtain +ital si'ns periodically durin' the

transfusion accordin' to a'ency policy# If a transfusionreaction is suspected, obtain +ital si'ns more freAuently


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Tran$)#$+"n R!at+"n$

-ystemic body response to incompatible blood;ller'ic sensiti+ity to the components of the transfused

blood or to the potassium or citrate preser+ati+e in theblood#

0ransmission of infection by blood donors who areasymptomatic:

.irculatory o+erload 6ost at ris: older adults and those with cardiopulmonary disease#

Blood transfusion reactions are *+)! t%r!at!n+n, promptnursin' inter+ention is important

St"the transfusion immediately if a blood reaction issuspected#

If "#$! is ordered to be infused, dont =ust start it from theline used with the blood transfusion 5 !t a n!< *+n!


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Tran$)#$+"n R!at+"n$/ A*!rt=

.hills, fe+er, low bac pain, flushin' tachycardia,tachypnea, hypotension, +ascular collapse,bleedin', acute renal failure, shoc, cardiac arrest,death

Itchin', rise in temperature;nxiety, urticaria, wheein', cyanosis, shoc,

cardiac arrest.ou'h, dyspnea, pulmonary con'estion, headache,

hypertension, tachycardia, distended nec +einsVomitin', diarrhea, mared hypotension, shoc


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N#r$+n Int!r!nt+"n )"r r!at+"n

Ceep "#$! @a.l 'oin' in an IV line "n5t #$! t%! Y t#;+n +n)#$+"n $!t

@otify the physician immediately

Obser+e si'ns 1 symptoms, monitor V- e+ery minutes;dminister emer'ency dru's as ordered7repare to perform .7&

Obtain urine specimen, send to lab-end blood container, tubin', attached labels,

transfusion record to laboratory


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I.!nt+)'

Identify physical assessment findin's andpossible causes#


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>#!$t+"n$ t" a$? '"#r$!*)

What am I doin' for this clientWhy am I performin' this inter+entionDo I need to re+iew the standard for this sill

Does the inter+ention mae 'ood common sense forthis particular clientWill it harm the clientDoes my instructor or &@ now what Im about to do

for the client


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Str!$$ T!$t

In the followin' slide, you are to identify differencesin the dolphins# By bein' able to identify whetherthere are any differences and countin' the number ofdifferences that you find, we will be able todetermine the amount of stress you are under# @ow

+iew the slide and eep your number to yourself#


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-tress 0est &esults

" differences 5 .on'ratulationsE Fou ha+eabsolutely no stress in your lifeE

8 5 4 differences 5 Fou are stressed out and need to

relax a bit as soon as you can9 or more differences 5 Fou are totally stressed to

the max# 0he dolphins are identical in e+ery way# Ifyou detected differences, you need a +acationE


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P#** '"#r "


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I .+. *!arn t" #** ' "

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Intravenous Therapy - 2014