Foundations Exam 4

What is used for temporary intravenous access? Can be inserted by an RN.

Peripheral IV

*goes into a vein (hand, wrist, forearm, etc)

Who is a 22-24 gauge IV used for? Smallest needle size. (COD)

- Children

- Older adults

- Difficult to access veins

Who is a 20-22 gauge IV used for? (ABF)

- Adults

- Blood/Fluid Administration

Who is a 18 gauge IV used for? (RLBH)

- Rapid fluid/medication administration

- Labor

- High risk of bleeding

- High risk for hemodynamic instability

Who is a 14-16 gauge IV used for? Largest needle size. (THO)

- Trauma

- Hemorrhaging

- OR procedures

What should you NOT do during the insertion of the IV? To the arm.

Do NOT wrap or bandage all around the arm or have the IV site covered

*The insertion site needs to be visible

What can occur if the IV bandage is completely wrapped around the arm?

Can cut off blood flow

What should we assess for at the insertion site of the IV? We need to be able to see IV. (RSP) (DCF)

- Redness, Swelling, Pain

-Draining

- Color

- Feeling

What is the purpose of flushing a peripheral IV?

- Make sure the IV is patent

*No infiltration or kinks in tubing

What is a peripheral IV flushed with?

Normal Saline

What do we need to ensure the dressing is at the IV site? (CDI)

- Clean

- Dry

- Intact

If a dressing starts to peel, get wet, or rips, what should we do?

Change it

What are potential complications that can occur from an IV? Need to be reported ASAP. (IIP)

- Infection

- Infiltration

- Phelbitis

What are signs of infection? Can be seen at an IV site. (RSP)

- Redness

- Swelling

- Purulent (clear) drainage

What is the leakage of fluid into the extravascular tissue known as? Can be see at an IV site.

Infiltation

What are signs of infiltration? Can be seen at an IV site. (EPTP)

- Edema

- Pallor

- Decreased skin temperature (cool)

- Pain

What are signs of phlebitis? Can be seen at an IV site. (PTR)

- Pain

- Increased temperature (hot)

- Redness along vein

If your IV is running a fluid and infection, infiltration, or phlebitis occurs, what should you do? (SRR)

- Stop running the fluid

- Remove IV

- Replace IV in new site

If your checking the patency of an IV and infection, infiltration, or phlebitis occurs, what should you do? (RR)

- Remove IV

- Replace IV in new site

If infiltration occurs, where does the new IV need to be placed? (P)

- More proximal than the first IV

*if infiltration occurs in the right forearm, the new IV goes into the upper right arm or left arm; more proximal

Where does a central venous catheter (central line) end at? It is a larger and more stable catheter. (SR)

- Right atrium

- Distal 1/3 of the superior vena cava

What is a very strong vasodilator medication? It is really hard on the tissue.

Vesicants

What way is Vesicant given?

Central Line ONLY

*Will cause severe tissue damage if used in a peripheral IV and infiltration occurs

What are some reasons a central line would be used? (SLVMBPH)

- More stable, larger

- Longer-term use (can be permanent)

- Can infuse vesicants

- Able to infuse multiple medications (3 at one time)

- Can draw blood without sticking the client

- Can use if a peripheral IV can't be accessed

- Patients can go home with them (instead of staying in hospital)

What type of patients might a central line be used on? (LCIBPV)

- Long-term medications/ antibiotics

- Chemotherapy

- Frequent infusions

- Frequent blood draws

- Difficult to obtain a peripheral IV

- Vesicants

What veins can a central line be inserted into? Inserted by a physician into a large vein. (JSF)

- Internal jugular vein

- Subclavian vein

- Femoral vein (huge risk of infection; near groin)

What type of monitoring can be used with a central line? Up to 3 medications at one time. (CT)

- Cardiac output monitoring

- Temperature monitoring

What should dressings look like for a central line? The dressing should be sterile and changed with a sterile procedure. (CDIOSI)

- Clean

- Dry

- Intact

- Occlusive

- Sticking to skin

- See insertion site

*change dressing if soiled or non-adhesive

What is a major risk with central lines and PICC lines? Need sterile dressings.

Infection

*report signs of fever, chills, malaise

*Need to come out if not needed anymore

What is a peripherally inserted central IV? Typically seen in the arm.

PICC line

*can be inserted and removed by an RN

What vein is a PICC line inserted into? Typically shorter-term use than a central line, and placed into the arm instead of a large vein.

Basilic vein

*in arm

What type of patients are PICC lines used in? Not permanent. (AHMC)

- 6 weeks or less of antibiotic therapy (main)

- Home medication therapy

- Multiple/frequent IV medication infusions (up to 3)

- Critically ill clients (used instead of central line due to lower infection risk)

What is a surgically implanted venous access port? It is implanted under the skin (able to palpate through the skin) .

Port-a-Catheter

*gets accessed and de-accessed

What is used to access a Port-a-Catheter under the skin? What degree angle is used? (H)

- Huber needle

- 90* angle needle

The port-a-catheter had access to what vein from the reservoir? Can be temporary or permanent

Access to subclavian vein

Who is a Port-a-Catheter common in? (CFD)

- Chemotherapy (main)

- Frequent medication or blood draws

- Difficult IV access clients

Who places a Port-a-catheter? Nurses can activate and deactivate it using the Hubor needle.

Surgically placed by a surgeon

A patient with a central line who has lumens on the OUTSIDE is at a high risk of what? C

Infection

*more lumens = higher risk of infection

What cannot be done if a patient has a central line with lumens on the OUTSIDE? (SW) Higher risk of infection.

- No swimming

- Can't be wet

What CAN be done if a patient has a surgically implanted port? (SR). Lower risk of infection since it can be de-accessed.

- Shower (can be wet)

- Run

How often does a central line need to be assessed?

AT LEAST every 12 hours

*12 hours or less

Every 12 hours or when a central line is being accessed what needs to be done?

- Check for blood return

*when accessed or every 12 hours

How often are transparent dressings changed for a central line? Done sterile.

Every 7 days

How often is gauze changed for a central line? Can harvest pathogens. Done sterile.

Every 24 hours

How often are caps changed on lumens for a central line?

Every 3 days

What is used at the insertion site for a central line? It is used to reduce the risk of infection. (C)

Chlorhexidine-impregnated dressing/disk

*reduces infection risk

Large-volume infusions (500-1000mL) can be administered through IVs. What is there a risk of if infused too quickly? (OO)

- Risk of fluid overload or overdose

*if infused too quickly

What types of patients do we need to be careful of when administering large-volume insertions through IVs? (HK) Fluid overload can occur.

- Kidney failure

- Heart issues

What is a concentrated dose of medication that enters systemic circulation through an IV?

IV bolus or push

How safe is an IV bolus or push? Has to be done at the correct rate and correctly. Goes straight into circulation; can't fix an error.

The most dangerous method of IV administration

What is the FIRST thing you should do with administering an IV bolus or push? (P)

- Confirm IV placement

How do we confirm IV placement? Must be done before medication administration. (F)

- Flush with Normal Saline

*Check for patency of line

When checking for patency of a central line by flushing normal saline into it, what are 2 signs the IV needs to be REPLACED? (PI)

- Normal saline cannot be pushed through IV (can't be flushed)

- Infiltration occurs

*remove IV and replace

Before you flush normal saline into the IV site, what should be the VERY FIRST thing done to lumen/saline lock.

It needs to be wiped with an alcohol wipe

*before any use

How do you administer an IV bolus or push?

At the determined rate

*Don't slam medication

What needs to be done after administration of medication through an IV bolus or push?

- Flush with normal saline

*Clear line of medication

Where is an IV bolus or push administered?

At the side closest to the patient

*if not done; patient won't get medication at correct rate

What is a small IV bag connected to a short tubing connected to the upper part of the primary infusion line?

Piggy Back

When is piggybacking commonly seen? The primary infusion line will stop running until the piggyback line is empty. (AA)

- Adults

- Antibiotics

What allows medications to be given in small amounts within controlled infusion times? (S)

Syringe Pumps

*Can use Burrets to contro

What do syringe pumps use that help control the rate and amount of medication given? (B)

Burretts

Who is a syringe pump commonly seen in?

- Children

*children are more sensitive to medications

What are the three functions of the kidneys? (EBF)

- EPO

- Blood pressure

- Filter

What gender is at a higher risk of UTIs?

Females

*urethra is shorter

How does pregnancy influence urination? (F)

- Increase frequency of urine

*can't hold as much urine; bladder is pushed on.

What type of patient would be more likely to have incontinence?

Older Adults

*Can't make it to the bathroom

How does stress and anxiety cause with urination?

Increased urgency of urination

*Feel like they have to go right at that second

What things cause you to have to pee more? Excess intake = increase urination. (AFC)

- Fluids (water)

- Alcohol

- Caffeine

What diseases can affect urination? (PASUDT)

- Paralysis

- Arthritis

- Spinal cord injury

- Urinary obstruction (Can't pee; pain)

- Diabetes (Excess pee; polyuria)

- Trauma to urinary tract structures (may need a catheter)

What drug type is used to induce urination? When is it given?

- Diuretics

- Given in AM (prevent nocturia)

What is the inability to partially or completely empty the bladder?

Urinary retention

*holding onto urine

What are some signs of urinary retention? Can't use the bathroom. (STDPP)

- Stomach pain

- Tenderness

- Abdominal distension

- Palpation of the bladder (in skinny patients)

- Very little peeing

What test is used to look at how much retention a patient is having? (P) It sees how much urine is left in the bladder.

Postvoid residual (PVR)

When should the post-void residual scan be done? (I)

Immediately after the patient voids

What are UTIs commonly caused by? More common in females.

- E.Coli

What are the signs of an UTI? (DFCCF)

- Dysuria (Burning while urinating)

- Increased frequency (SMALL volumes of urine)

- Confusion (older adult)

- Cloudy urine, foul smell

What is a Catheter-associated UTI? It occurs when an indwelling catheter becomes infected?

CAUTI

*never event; never should happen

What is the involuntary loss of urine known as?

Incontinence

What type of incontinence is when bladder function is normal but there is another issue affecting urination?

Functional Incontinence

Who is at risk of Functional Incontinence? (SAMD)

- Sensory impairment

- Arthritis

- Dementia

- Immobility

What are some interventions to help prevent functional incontinence? (PWLC)

- Help patients pull down pants

- Increase lighting and access

- Have walker near patient

- Respond to call lights ASAP

What type of incontinence occurs when the pelvic floor muscles are weakened? Occurs with increased belly pressure such as laughing, coughing, sneezing, exercise.

Stress Incontinence

What patient is at risk of stress incontinence? (P)

- Post-partum woman after birth

*huge decrease in pressure

What exercises are used for patients during stress incontinence? (P)

Pelvic floor exercises

*Keagle

What type of incontinence occurs when a patient has an overactive bladder? Inflammation also occurs.

Urge incontiencne

What needs to be avoided with ANY incontinence? It can irritate the bladder. (CA)

NO

- Caffeine

- Alcohol

What treatments can be used to help with urge incontinence? (PBM)

- Pelvic floor exercises

- Bladder training

- Medications

What type of incontinence occurs from a spinal cord injury? It causes the involuntary loss of urine when bladder is full.

Reflex incontinence

What can be inserted into a patient experiencing reflex incontinence? It helps decrease tachycardia seen. (I)

Intermittent Catheterization

*Straight catheter

What is it known when you bypass the urinary tract and urine goes to an external source? Stoma will be seen (D)

Urinary Diversion

What are some assessments to look at/ask for urination? (PCBPUAF)

- Pressure

- Color of urine

- Pain/Burning

- Urgency, amount, frequency (patterns)

If a patient comes to the hospital with a straight catheter, what are some things to find out? STERILE! (SOR)

- What size catheter do you use?

- How often do they catheter themselves?

- Home routine (keep it as similar as possible)

*have to use the same size catheter as the patient uses

What can occur if a catheter is small?

Urine leakage

*skin breakdown, redness, swelling

Where would kidney pain be seen?

Bank pain (flank pain)

What are some things we should look for around the external genitalia and urethra meatus? As well as the perineal skin. (IIS)

- Infection

- Inflammation (redness, swelling, heat, pain)

- Skinbreakdown

What is the minimum output for the patient?

Less than 30 ML/HR of urine.

What type of patients need strict I&O? (CKHO) Need I

- Children

- Kidney issues

- Heart issues

- Older adults

What does clear urination indicate? Seen more during the night.

Overhydration (1)

*Clear (1) - Dark Yellow (8)

What does dark yellow urination indicate? Only the first time during the morning?

Normal

What does dark yellow urination indicate? If it occurs throughout

Dehydration (6-7)