PHARMOCOLOGY IV MEDS

Adnantages of IV Therapy

• IVs administer medication directly into a vein, so the medication takes effect almost immediately.

• IV administration allows for the delivery of precise amounts of medication and large volumes of fluid infusion.

• The IV route can administer medications that are irritating to tissues and thus cannot be administered by other routes.

• IV administration can prevent the discomfort that can occur with subcutaneous or intramuscular injection.​​​​​​​

RISKS of IV fluid

Local and systemic reactions. Local reactions include phlebitis, infiltration, and extravasation. Systemic risks of IV therapy include speed shock, fluid overload, catheter embolism, and allergic reactions.

Systemic

involving the entire body or organism, rather than a specific part or location.

Phlebitis

Inflammation of a vein, often causing pain and redness at the site. Excessively large IV cathater can cause mechanical causes.

• Skin darkening or redness, warmth, or swelling at the insertion site

• Client report of discomfort from the IV

• Skin darkening or redness and increased firmness along the cannulated vein

Infiltration

Leaking of lfuid from the vein in to subcutaneous space.

• Pallor

• swelling

• pain

• 
  

extravastation

condition in which tissue-damaging intravenous medicatin enters tissues.

• Blistering

• Tissue necrosis

• Ulceration

Embolism

A blood clot or foreign object… catheter tip, that lodges in a blood vessel.

Intfiltration and Extravasion

Occurs when an IV catheter slips out of the vein or when fluid leaks from another nearby puncture site into the tissues. (Vesicant: medication that can damage tissue)

Speed Shock

systemic reaction that occurs when an IV medication is administered too rapidly, causing blood levels of the medication to rise to possibly toxic levels

Finiding

• Light headedness, palpitations, chest pain, and discomfort, rapid pulse rate

Fluid overload/circulatory overload

rate of administration of IV fluid is faster than the client can tolerate.

• Shortness of breath

• Intake greater than urine output

• Increased blood pressure, heart rate, and respiratory rate

• Crackles in the lungs

• Neck vein distention

• Extremity edema​​​​​​​

Allergic reactions

• Generalized rash that can consist of hives or vesicles

• Pruritus: Itching

• Edema

• Rhinitis: Inflammation of the mucus membranes in the nasal passagesNA

• Excessive tearing

• Nausea

• Vomiting

• Diarrhea

• Wheezing

• Dyspnea​​​​​​​

Anaphylaxis

Runny nose, swelling (eyes, lips, tongue), hypotension, tachycardia, feelings of apprehension, weakness, respiratory or cardiac arrest.

IV catheter embolism

Part of IV catheter breaks off in a vein (Too much force or flushing the catheter)

A nurse is caring for a client who is receiving norepinephrine by continuous IV infusion. During a routine assessment of the IV site, the nurse notes that the catheter is no longer in the vein and the vesicant medication has infused into the subcutaneous tissue. Which of the following actions should the nurse take?

Stop the infusion and prep to administer an antidote

A nurse is planning care for a client who is receiving IV therapy. Which of the following measures should the nurse include to prevent phlebitis?

Use a small-gauge catheter when initiating IV therapy

A nurse is caring for a client who is receiving an antibiotic by intermittent IV infusion. The client reports feeling short of breath and is wheezing. Which of the following actions should the nurse take?

02, call the rapid response team

Hypotonic

Intravenous solutions are less concentrated than blood and other body fluids. Used to treat electrolyte imbalance by moving water into the cells.

Hypertonic

intravenous solutions are more concentrated than bodily fluids. They pull fluid from interstitial spaces and cells into the veins

Isotonic IV solutions

Similar to body fluids. Used to mainain or increase the volume within the vascular system. Can cause fluid overload.

Stays in the intravascular space
Remains in the intravascular space.

.45% NaCl

Contradications: HF, pulmonary edema, renal failure, hypernatremia

uses: Increase intracellular fluid volume, administer blood transfusions, replace fluid losses.

Lactated Ringer’s LR

normal saline .9%… Contains electrolytes: sodium, chloride, potassium, calcium, and lactate.This can be used to treat acidosis because the liver metabolizes lactate to from bicarb.

USES: Provides fluid resuscitation, correct metabolic acidosis

Contradictions: HF, Renal Failure, head Injury, Liver disease, respiratory alkalosis

Hypotonic IV Solutions

osmolarity of less than 200 mOsm/L. They are less concentrated than blood and other body fluids. These solutions are used to treat a fluid and electrolyte imbalance by moving water into the cells. A client who has hypernatremia might have a prescription for a hypotonic solution to dilute body fluids and rehydrate the cells.

0.45% intravascular to intracellular

moves fluid from the veins to the cells and interstitial spaces.

hemolysis

cell rupture

Bolus

Intravenous administration of a concentrates dose of a medication or fluid

Hypertonic IV Solutions

Osmolarity greater than 350 mOsm/L. Solutions with greater than 500 mOsm/L can irritate veins. Hypertonic solutions are used to correct fluid and electrolyte imbalances.

3% NaCl-goes into interstitial to intracellular
Pulls fluid out of the cells and into the veins

They pull fluid from the interstitial spaces and cells into the veins. Administer hypertonic fluids with caution to clients at risk for fluid volume overload—including clients who have heart or renal failure, older adults, and young children.

1L of 5% dextrose in water

170 Cals

NaCl .9% is used when?

administering a blood transfusion

Primary Tubing

For adminestring a contiuous IV infusion (longer tubing)

Secondary IV tubing

Used to administer a small IV bag or bottle of medication (shorter tubing)

Signs of infiltraton in IV TUBE

Electronic infusion devices typically infuse fluids using a lower pressure than a gravity infusion. These devices might not detect a change in pressure, which can be associated with an infiltration of an IV site. The nurse should monitor the site frequently for signs of pain, change from usual skin color, coolness, or swelling, which are associated with an infiltration.

Secondary Intermittent Medication

Administration of a small volume of intravenous solution, connected to and hung higher than the primary intravenous solution

Common additives to primary IV solutions

Heparin, dopamine, nitroglycerin, potassium, magnesium, dobutamine

Large-Volume IV infusions on a continuous basis

• For fluid and electrolyte replacement

• For adminestering medications

Large-volume IV bolus

• Usually for a one-time prescription

Intermittent IV bolus infusion, also known as IV piggy back

• Usually a medication mixed in 50-250mL of solution, given over 30-60 min

IV bolus, also known as IV push

• For a small amount of medication either concentrated or diluted

• Injected over a short time, typically 1 to 5 min