Escolar Documentos
Profissional Documentos
Cultura Documentos
24 questions- math:
Know how to find out what time the infusion will be done, etc.
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
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
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
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+
O+
O-
----
A-
A-
O-
A+, B+
B-
B-
O-
B+, O+
AB-
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