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IV Fluid/Therapy
Fluids, IV Therapy, Blood Transfusion
| Question | Answer |
|---|---|
| What is the purpose of IV fluid therapy? | Maintenance, to replace or correct deficiets, to restore ongoing loss, for meds, nutrition, phlebotomy, transfusions or blood products. |
| What is Oncotic pressure? | Colloids, plasma proteins, Albumin |
| What is hydrostatic pressure? | Blood Pressure |
| What can expand the intravascular compartment? | Hypertonic fluids. |
| What is the problem with using hypertonic solutions? | If done to fast will draw to much fluid into the intravascular, dehydrating intracellular, especially the brain. |
| What is a S/SX of fluids administer to fast? | Decreased LOC/Confusion |
| What happened if you expand the intracellular compartment to fast? | Deplete the intravascular, decreasing BP and causing Edema. |
| Whate are two basic type of parentral fluid? | Cyrstalloid and Colliod. |
| What is a crystalloid? | And electrolytic containing solution. |
| Whate are the three basic types of crystalloid fluids. | Isotonic, Hypotonic, Hypertonic. |
| Wy are crystalloids fluids called true solutions? | Because they can pass through semipermeable membranes. |
| What is a Colloid? | Containe proteins and starches. |
| What can a colloid fluid do? | Pass between compartment. They draw the fluid to them. |
| Name four problems with IV fluid therapy? | Phlebitis, infiltration, extravasation and incompatibilities. |
| S/SX of Phlebitis? | Pain,tenderness, erythema-red streaks at vein, edema, hardness of vein, increased temperature. Slow flow rate, area warm to touch. |
| What is Phlebitis? | Inflammation of the vein. |
| What phlebitis damages a vein it is permanent or temporary? | Permanent |
| If phlebits show erythema where is it usually? | Localized, at tip of catheter and on. |
| Causes of Phlebitis? | Poor blood flow around cath, friction, IV left in too long, clotting, motion frequency. |
| What is TX for Phlebitis? | D/C IV and remove, apply warm, start IV in another site, large vein for irritating agents, anchor cannula to prevent movt, do not use positive irrigation with sluggish flow rate-may force clot in bloodstream. Reposition extremity. Watch for infection. |
| Infection causes? | Severe phlebitis, equipment contamination, outdated solutions, poor technique |
| S/SX of infected IV? | Pain, tenderness, warmth, redness, elevated temp, chills, purulent drainage, elevated WBC |
| Infected IV TX? | D/C IV, culture tip, call DR. |
| S/SX of infiltration? | Swelling, coolness, pain, tight, hard, blanch or red, maybe leaking due to pressure. No backflow of blood when tubing pinched |
| Infiltration causes? | Loss of vein integrity, catheter dislodgement |
| TX for Infiltration? | DC IV, warm soaks, elevate, check pulse and cap refill. |
| Prevention of Infiltration? | Tape IV site well, special attentioin if on a pump, and educate pt to watch for signs. |
| Patient education for Infiltration? | Watch for cool, swollen hard or painful site. |
| Extrasavation is? | Administration of a vesicant (blistering) solution into surround tissue. It is infiltration that results in tissue damage and necrosis from the product admin. |
| An irritant? | An agent capable of causeing pain at the site. Potassium chloride and hypertonic solutions are particularly irriting to vein. |
| S/SX of extravasation? | Pain, stinging, or burning, redness swelling. |
| TX of extravastion? | Discontinue IV, attempt aspirate drug, apply ice, research antidote, Call Dr., Admin irr/vesicant through Central Venous Device |
| Who are at particular risk for IV site problems? | Who receive hypertonic, acidic, or irritating agents; geriatric w/fragile veins; pediatric who are active. |
| Client dvlps unexplained fever with chills and rising pulse? | possible catheter related sepsis. Notify Dr., assess IV site, Ensure solution has not hung longer than 24hr. Check VS usally above 100F IV related Sepsis. Pyrogenic reactions(N&V, Backache, HA, malaise. Stop infusion. Obtain Blood specimen. |
| What three things can and LVN NOT do? | cannot hang, flush or change bags on a central line even if certified. |
| What can an RN NOT due with a central line? | Cannot assign LVN or supervise LVN with anything to do with Central line. |
| How do you determine whether it is a central line or a peripheral line. | Ask the doctor for an xray to determine. |
| Name some Isotonic fluids? | D5W, LR, and .9 % NS. Used for replacement or maintenance. Cells remain unchanged. |
| Why do you need to be careful with LR and dehydration? | It is hard for the renal system to process the electrolytes. |
| What does the liver do to lactate (LR)? | It metobolizes the lactate to bicarbonate which buffers acidosis. |
| What are two common uses for Normal Saline (NS)? | To treat hyponatremia and intravascular dehydration. |
| Name a Hypotonic solution? | .45NS, .2% normal saline, 2.5% dextrose. Hydrates cells, causes them to expand, Used to correct dehydration. |
| What makes HYPER tonic fluids different than the others? | It has more dissolved particles than bodly fluid. |
| What does a hypertonic fluid do? | It moves fluid out of the intracelluar and interstitial compartment into the intracascular. |
| What are hypertonic used for? | Hydration and nutrition. Solution causes cells to shrink. Used in severe salt depletion (very rare) |
| What is dangerous about hypertonic dextrose saline solutions? | They can move fluids very quickly. |
| What is a hypertonic dextrose saline fluid solution used for? | TPN and PPN. Nutrition. |
| What type IV line do you use with Hypertonic dextrose saline? | 10% solutions can go peripheral but all others 20% and above must use a central line. |
| Why must most hypertonic dextrose saline solutions be used iwth a central line? | The fluids are very irritating to veins. |
| How do you infuse hypertonic dextrose saline solutions. | You must use an infusion pump. |
| Plasma expanders are not considered what? | Blood products. |
| What do you NOT have to do with plasma expanders | Type and cross match. |
| Which of the two main catergories of fluids do plasma expanders fall under? | Colloid. |
| Whate are Colloids used for? | Maintenance of blood volume, hypovolemic shock, dialysis. |
| In which pt do you need to use colloid products cautiously? | Renal insuffiency and CHF |
| PPN is used in what type of line. | Peripheral |
| TPN is used in what type of line? | Central |
| What are components of TPN? | H20, PRO, CHO, Fat, vitamins, trace minerals. |
| TPN usually come in a _______hour supply? | 24 hr supply. |
| Name some indications for TPN? | Non function GI, bowel obstruct, acute infla, colitis, chrons, malabsoroption, chemo, burns, sepsis, onocology, pancreatitis |
| How do you know TPN is working? | By weighing daily. |
| What is the consideration with IVS and glucose? | Must use the appropriate IV acess for concentration of glucose, must use pump, don't play cathc up, taper TPN, accu-checks, used micro filters. |
| What should you monitior with TPN? | I&O, weight liver and renal function and electrolytes. |
| Why do you monitor liver and renal function with TPN? | To make sure they are exreting electrolytes. |
| Why do you use micron filter with TPN | To filter out bacterial growth. |
| Why do taper TPN? | To avoid hypoglycemic shock from cutting of the sugar. |
| Can you run other things in the TPN IV tubing? | No, dont mix with anything. |
| What is an important consideration with albumin? | may cause anaphylaxis. |
| What are some potential complications with TPN? | Fluid imbalances, metabolic, acidosis, liver dysfunction, hyperglycemia and infection. |
| What lab can you use to monitor liver function? | BUN |
| WHat is the first thing you assess with a patient? | IV |
| Whate are some items of IV that you should assess? | What type line, correct solution according to MAR, what time hung, how much to infuse, correct rate, everything current? |
| How long is the IV bag good for? | 24 Hrs |
| How long is IV tubing good for? | 72-96 hrs |
| How long is a peripheral site good for? | 72-96hrs |
| Why do you want to know how much infusion time is left? | So you can be prepared and have the next bag ordered from pharm and ready. |
| Why inspect blood return? | Good indication of patent IV but not always. |
| When you look up and IV drug what is important item that you will check? | Y site compatability with other drugs you may be administering. |
| If you add another drug in and it becomes cloudy what is happening and what do you do? | It is incompatable. Stop IV and throw away tube. |
| What determines what is compatible in an IV? | Use the drug book, call pharmacy. |
| How do you continue a "continuous or maintenace infusion? | Until the DR has ordered it stopped. |
| How is an IV push administered. | Usually by syringe. |
| Where can you find drip factor? | Printed on the bag. |
| How is gravity and free flow regulated? | By roller clamp or clip. |
| Does the IVPB hang higher or lower or equal to the regular IV? | Higher |
| Name and important act you must do with contious infusion? | Time tape the bag. |
| Continous infusion limits what and what type of risk? | It limits mobility becuase you have to take it withy you and it is a fall risk. |
| What method of infusion should you not use with central line? | Gravity or free flow. |
| What anti-biotic can you NOT use with gravity/free flow infusion. | Vancomycin |
| Name three things you cannot use gravity free flow with... | TPN, periperal line and medication administration |
| What does primary rate mean with a pump? | The running rate of the IV |
| What is does secondary rate mean with a pump? | Running medication or antibiotics. |
| One ml of Heperain for IV contains how many heparin units? | 100 units. |
| What is an important check that you do with Heparin? | you check the dose with a second person. |
| What must you be careful about with the secondary rate of an IVPB? | You must check to make sure that the rate hase been changed back to the primary rate when the secondary rate is finished. |
| What is positive pressure technique? | Closing slide clamp at the same time as flush. |
| Infusion time on an IVPB is regulated by what? | The roller clamp of the primary bag. |
| PCA administration can be programmed fro what three things? | intermittent (PCA), continuous (basal) or both rates. |
| What does the DR order for PCAs? | dose/ml, delay time, lockout, patient admin, dose, basal rate and loading or PRN dose. |
| Name six types of IV Access? | peripheral, central, hickman catheter, quinton, implated ports and PICC |
| What is the routine flush time for a peripheral line? | Q8hrs and before and after meds. |
| Why do you flush a line before giving the medication. | To check patency. |
| How much is a routine flush of NS for a peripheral line? | 2-3ml |
| Skin disinfectant? | Chlorhexidine gluconate. |
| Usually not associated with bloodstream infections? | Peripheral venous Cath. |
| What is the most common complication associated with peripheral vein catheter? | Phlebitis and infiltration. |
| Phlebitis is at higher risk when used as an IV site. | Lower limbs. (If done in hand lower risk than those inserted higher up on wrist & arm) |
| What should youdo to IV solutions that have been out of the refrigerator? | Allow to warm to room temp. This will reduce the number of air bubbles in the IV solution. |
| If the solution has a "RED LABEL" | If potassium or other drugs are pre-added to the solution. |
| If bag has dark/light background, cloudiness or particulate, what should you do. | Any change discard. |
| Why should you not use felt tip pens to mark directly on IV plastic bag. | May leach through and contaminate. |
| In an emergency sitiuation peripheral IV was started w/o proper asepsis, Emergency or outside. When should it be replaced? | Earliest opportunity within 24 hrs. |
| When do you NOT use cholorhexidine gluconate when preparing IV Site. | On infants under 1000 grams. |
| General tubing changes? | Primary&Secondary-72hrs, Primary intermittent tubing-24hrs, TPN & lipids-every 24hrs, blood or blood product tubing-every 4hrs or after 2units of blood. |
| When should a catheter site be evaluated. | At least once a shift. |
| What do you do if the Venipuncture is unsuccessful for needle/catheter insertion. | Remove Cath, apply pressure at site until bleeding stops, prevents ecchymosis). Small pressure if on anticoagulant. Avoid one step entry. Two failed seek somone else to perform. Put clients extremity in dependent position. Warm Compress. |
| Vein rolls and is difficult to enter what do you do? | Apply traction with thumb and index finger to stablize; maintain traction until venipuncture is complete. Select smaller gauge cath. Advance catheter slowly. |
| Vein is fragile and "ballons" around needle on vein entry? | Release tourniquet as soon as vein entry is evident. Avoid use of tourniquet if fragle or on anticoagulant. Enter vein with needle bevel down. |
| Infiltration occurs? | moist warm pack, using warm towel, enclose area from fingertips to elbow. Place extremity in plastic bag with open end at elbow. Leave no more than 10 minutes. |
| Vesicant drug infuses into tissue? | Clamp tubing, infuse antidote for specific medication, according to Dr's order. |
| Troubleshooting alarm sounds. | Infusion comp.-machine goes to KVO Keep open. Occulsion-check site, pinching, closed clamp, turned stopcock or clogged filter or position prob. "Air in line", Low Battery, cassette (improperly loaded), free flow-check trouble spot, readjust and restart. |
| How often do you Managing a IV when site has site-related complications? | Evaluate every 2 hours. |
| When D/C cath site client complains of symptoms related to infection, what do you do? | Cut tip of catheter with sterile scissors, place in sterile container and send to lab to culture. |
| TX of FVE | HOB high fowlers, decrease EV rate temporarily, call Dr. |
| Prevention of FVE with IVE | Monitor rate, know risk populatiopn, watch out if you have position IV. |
| What is a positional IV | One that has multiple positions for drip rate on it. Check all positions for the drip rate to avoid FVE. |
| Who is at risk for FVE with IV? | CHF, valve replacement surg, new valves, bad valves |
| S/SX of air embolism? | Weak, rapid pulse, chest pain, SOB, cyanosis, decrease in BP, anxiety. |
| Air embolism is a problem with what type of line and not with what type of line? | Problem with Central line, very hard to get on a periperhal line as you need lots of air bubbles. |
| TX for Air Embolism? | Clamp IV, place with right side up to trap air in right atrium, (left side down) trendelenburg, give O2, call DR. |
| Prevention of Air Embolism? | #1 is carefully priming of IV tubing, DC central lines properly, careful clamping during tube changes, valsalve maneuever during changes. |
| Speed Shock is? | Sudden increase in plasma level of a drung after admin. |
| S/SX of speed shock? | Syncope (transient sudden loss of conciousness with inability to maintain upright posture) cardiac arrest and shock. |
| Prevention of speed shock? | Know what you are giving and how fast you can administer it, rate of administration. |
| Name a drug that speed shock can come from? | Vancomyacin |
| Home care considerations with IV therapy? | Care plan, clean house, safe, support, family, who do you teach. |
| Most common line for home therapy? | PICC line. |
| Some Drugs that are incompatible with saline solutions? | diazepam (valium), Chloridiazepoxide hydrochloride (librium), amphotericin B. |
| It may be possible to not get a blood return with what guage? | DFfeeling for resistance. |
| Words to use in documentation? | "observed" not noted...Write "no IV related complicateion observed...Document catheter length when removing. DO NOT write client tolerated procedure well - provide statement from client. |
| What do you do if medication is incompatible with primary IV solution? | Temp discontinue primary infusion, flush client's injection port, initiate NS (or what compatible) solution as the primary, proceed with "PB" into the "new" compatible primary. When done, restart original primary solution, use a new needleless cannula. |
| LAB Values? | NA+ 136-145 MEq/l CL- 98-106 Meq/l K+ 3-5.0 MEq/l CA++ 9-10.5 Mg/dl (total) |
| HGB/HCT Values? | HGB 12-16 (F) 14-17 (M) HCT 36-48% (F) 42-52% (M) |
| BUN | 10-20-mg/dl |
| Hyperkalemia Cause? | Cells crused or damaged, rapid transfusion of old blood giving blood through to small of IV, acute insulin deficiency or uncontrolled Diabetes. |
| S/SX of Hyperkalemia? | Abdom. cramping, diarrhea, Increase GI motility, muscle twitching & cramps (early phase or mild), paresthesias (early or mild), muscle weakness, leading to paralysis (late or severe) Weakness noticed 1st in legs, Cardiac most severe (V Fib, C arrest) |
| Medication for Hyperkalemia? | Kayexalate (sodium polystyrene), potassium excreting diurectics (lasix), IV sodium bicarbonate, calcium gluconate. |
| Hyokalemia causes? | NPO, Diurectics, diarrhea, vomiting |
| S/Sx of Hypokalemia? | Muscle weakness does not start until less than 2.5 Meql, can lead to resp failure, leg cramps, weak thready pulse, postural hypotens, decreased GI, N&V, Gastric emptying. Increased digoxin sensit. Watch Pt if on dig or lasix. Prone to PVC or C arrest. |
| TX of Hypokalemia? | Oral potassium. IV potassium is NEVER given IV Push.!!!! To irritating for a continuous IV infusion into a peripheral IV site. Do not give more than 20meE in one hour. Never give IM or Sub!! |
| FYI regarding Potassium | Persons with normal potassium levels do no need a cariac monitor just because the are receiving supplemental K+. Think of all pts you care for with KCL added to their IV. Few are on C. monitors. Do frequent assess of the IV site. K+ is irritating. |
| Hypernatremia causes? | Increase in sodium (3% NS IVs), high NA+ meds, salwater drowning. Watery diarrhea. Renal failure. |
| S/Sx of Hypernatermia? | Neuroligcal symptoms-LOC. Agitation, confustion, seizures, spontaneous muscle twitches, muscle weakness and reduced or absent DTRS (sever or late). Thirsty not good indicator in elderly. Decrease urine ouput, dry swollen tongue, edema, increase CVP & BP |
| TX of Hypernatermia? | Treat the cause. Hypotonic IVS (D5w or 0.225% NaCl or 0.45% NaCl. Diuretics if problem is sodium gain. Low sodium diet. Patient safety, daily weights, monitor Neuro, limit high sodium. |
| Hyponatremia Causes? | GI loss, prolong vomiting, NG suction, diarrhea, laxative abuse. Burns. Prolonged use of diuretics. Hypotonic IV solutions: (D5W) NPO, SIADH |
| S/Sx of Hyponatremia? | Neuro, HA, depressed or excessive sometime both, diminished Deep tend reflex. Hypovelmia (sodium loss) tach, thready pulse, Post.Hyper.,weight loss. Hypervolemia(water gain) weight gain, increased BP & CVP, rapid bounding pulse. Pitting edema. |
| TX of hyponatremia | Fluid restriciton. Initially if not severe give LR or NS. When neuro symp give 3% NaCl. Hypertonic saline must be use CAUTIOUSLY. Pt safetly, Elevating HOB, Daily Weights. |
| If a pt has an elevated sodium >145 mE/q/l and appropriate IV type is? | hypotonic, 0.45NS, D5W, D5 and 0.33NS |
| Hypercalcemia cause? | Cancer most common, immobility, antacids, thiazide diuretics, dehydration, use of lithium |
| S/SX of Hypercalcemia? | Things slow down. GI-anoxeria, N, constipation, ileus, thirst, neuromuscular strenth-decreased strength, depressed reflexes, letheragy. Increased HR early decreased HR late. Heart never seems to follow the rules. C. Arrest Late. Clots form more easily. |
| TX of Hypercalcemia? | Fluid Volume Replacement: saline IV's, lasix, calcitonin inhibits bone resorption. Flush it out keep in the bones. |
| Hypocalcemia causes? | Rapid infusion of citrated blood causes temporary removal of circulating ionized calcium. Malnutrion. |
| S/Sx if Hypocalcemia? | Numbness & tingling, carpopedal spasms, twitches, cramps, tetany, seizure, jitteriness, laryngeal spasm and resp arrest from muscle tetany, bruising petechiae, hypotension, decreased HR, diminshed pulses, Increase GI, abdomial cram0ping, anxiety |
| TX of hypocalcemia? | Seizure precautions, Endotracheal tray. IV calcium drip. Can be given IVP slowly. Infiltration could cause sloughing. To Irritating to give IM. |
| Types of blood products? | Whole Blood, packed RBC's, leukocytes, platelets, Fresh frozem plasma, Albumin, and cyoprecipates & WBC's. |
| Reasons for Blood Transfusions? | To increase circulating blood volume, to increase oxygen carrying capacity, to provide cellular components as replacement therapy. |
| How is blood transfusions used to increase circulating blood volume? | After surgery, trauma, or hemorrhage use whold blood and albumin to increase ciruclating blood volume. |
| What type of blood transfusion would one use to increase oxygen carrying capacity for severe anemia? | Packed Red Blood cells. |
| When time does not allow ABO determination, what Red Blood cells may be given. | Group O |
| What blood needs to be ABO identical? | Whole blood must be given ABO identical. |
| What type of blood transfusion would one use to provide cellular components as replacement therapy? | Clotting factors, platelets, albumin, fresh frozen plasma, cryoprecipitate. |
| Blood transfusion as replacement therapy for Neutorpenic patients? | WBC's |
| Amount of Whole Blood products | 300-550mls |
| Amount of Packed RBC's | 300-350mls |
| Amount ot leukocyte-poor RBC's | 200-250mls |
| What do Leukocyte-poor RBC's Prevent? | Febrile, non-hemolytic transfusion reactions. |
| Non-hemolytic | Not breaking down of red blood cells. |
| One unite has to be infused within how many hours? | 4 hrs |
| Blood must be started within how many minutes after leaving the blood bank? | 30 minutes |
| BT must be completed within what amount of time? | 4 hours...After two hours blood rapidly deteriotes and increase risk of bacterial. |
| What is the controlled temperature that blood must be stroed in the refrigerator? | 4 degrees C. |
| What solution does the nurse hang with blood administration set? | 0.9% Normal Saline |
| What size gauge catheter does the nurse use to connect to the current IV or star an IV with? | 18-19-20 gauge |
| What are the identification and checks a nurse must complete before blood transfusions? | Pt name, ID#, Pt blood type & RH type are compatible with donors group and RH type, expiration date, inspect for blood clots, empty urine draingate or have patient void. hospital # match number on record on the blood bag. |
| When can blood not be returned to blood bank? | It can not be returned after being checked out for 20 minutes. Once warmed cannot be returned to blood bank. |
| When is blood normally warmed for BT? | Normally it is not- more common in maternity and postanesthia care. Hemolysis of the blood occurs at 104F |
| Clients usually can tolerate 1 unit of packed in in how many hours. | 1.5-2hrs. Elderly clients and those with respiratory or cardiac conditions may need to adjust flow. |
| When looking at the blood what determines bacterial contamination? | Blood with bubbles, cloudiness, dark color or sediment. |
| For baseline vitals before a blood transfusion, the physician should be notified if the patient has a temperature of? | 100 degrees F or higher. |
| When starting an infusion of blood product the frist thing the nurse does is? | Prime in-line filter with blood. |
| The nurse must start the administraion slowly, nor more than ____for the first 15 minutes. | Max of 5ML/min |
| When does most reactions occur in? | The first 15 minutes |
| How often do you take VS for BT? | Take VS 5 min before, and 5 minutes, 15 minutes and every 30 minutes after starting the transfusion and record on transfusion record. |
| S/SX of Adverse reactions of Blood transfusion? | Chilling, backache, headache, N&V, tachycardia, tachypnea, respiratory distress, skin rash, itching or hypotension. |
| When do you agitate blood bag? | Each time the client is checked. |
| What is a venous spasm, and what do you do? | It is when a client is having cold blood infusion, apply warm pack to site to improve flow rate. |
| When do you report to the physician when temperature rises. | If it rises 2 degrees F, this could be indicative of a transfusion reaction. |
| What are transfusion reactions? | Hemolytic or incompatibilty - most severe reaction, bacterial contamination, allergic reaction. |
| Hemolytic S/SX | Severe pain in kidney region and chest, pain at site, fever, chills, flushing, dyspnea & cynanosis, oozing of blood at IV site, HA, hypotension, hematuria, nausea |
| TX of Hemolytic? | Stop transfusio immediately & removing blood tubing. Start NS infusion at "Keep Open" rate with a new IV tubing. Obtain VS, notify Blood Bank STAT, administer O2, Notify Dr. Monitor VS every 15 mins for shock & urine output hourly for acute renal failure |
| TX of Hemolytic continued? | Get order for IV expansion and diuretic or vasopressor to dilate renal blood vessels to prevent acute renal tubular necrosis. Complete transf. reaction form. Send two blood samples (different sites), urine specimen,blood and tubing & transfusion record. |
| Bacterial Reaction during Blood Transfusions S/SX? | Sudden increase in temperature, hypotension, dry,flushed skin, abdominal pain, HA, Lumbar pain, sudden chill |
| Bacterial Reaction TX? | Stop Infustion immed. & remove blood tubing. Keep IV site; change tubing and start infusion of NS. Observe for shock, monitor every 5 minutes. Insert foley cath & monitor urine output hourly. Notify Dr., get order for antib. & steriods/shock managment. |
| Bacterial Reaction TX Continued? | Draw blood culture before antibiotic administration. Send remaining blood and tubing to lab for culture and sensitivity. |
| Allergic Reaction during Blood Transfusions S/SX? | Stop transf immed., if symptoms are severe-immediate resuscitation necessary. VS for possible anaphylatic shock. If symp are mild, stop transf. or follow hosp. policy and obtain Dr's order. for signs of progress. allergic reaction as trans. continues. |
| Potential circulatory overload TX? | Sudden dyspnea/tachypnea/tachycardia, chest discomfortmoist crackles/rales, restlessness/ sudden increase in BP. Stop transf, place client in Fowlers post. Start O2 @ 2L/min per nasal canula. Be prepared for ECG and chest x-ray & admin lasix and morphine. |
| What emergency meds should a nurse be prepared to give if necessary when a pt has a reaction to a blood transfusion? | Antihistamines, vasopressors, fluids, steroids. |
| What should the nurse be prepared for if a pt has a reaction to a blood transfusion? | Be prepared for CPR. |
| What can cause RBC's to lysis. | Room temperature and old blood. |
| What is a citrate reaction caused by during a blood transfusion? | interaction of the citrate with the inonized calcium in the recipents blood, resulting in low ionized calcium levels. Calcuim binds with citrate. |
| What can a Citrate reaction do during a blood transfusion do to the pt.? | Effect clotting mechanism of the pt. |
| What can happen if a pt has a citrate reaction during a blood transfusion? | It can cause hypocalcemia. |
| What is the drop factor for blood tubing? | 10 drops/ml |
| The nurses resposiblities for IV skills and IBPB meds are? | Initiate, montior and discontinue. |
| What responsibilities doe the nurse have during the initiation phase? | Correct solution, equipment, select site & start infusion, and calculate & regulate the rate. |
| What responsibilities do the nurse have during the monitoring phase? | Maintain the system, identify and correct problems, monitor the pt, and watch for complications. |
| How often should you monitor IV? | Every two hours. |
| Don't put tape on what? | Tegaderm |
| What are ways to assess for patency? | Lowering the IV bag below the level of the IV insertion site and observing for blood. Compare the size of arms. Applying light pressure over the IV cannula and observing for decrease flow of IV fluid. |
| When do you use whole blood? | Frequently used in hemorrhage or shock. |
| How many percent Hbg and Hct when transfuse 1 unit of whole blood? | The hemoglobin by 1 gram and the HCT by 3% |
| What is the minimum gauge IV needle used for transfusion? | 20 |
| How many ml in 1 unit of Packed RBC? | 250-300mls |
| What portion of blood contains clotting factors? | Plasma |
| How many ml in 1 unit of whole blood? | 500ml |
| How many ml in 1 unit of platelet? | 50-70ml |
| How low of platelet level to consider transfuse? | under 100 |
| Whed do use Packed RBC's? | Anemic patients, chronic renal failure. |
| What is the most concern for low platelet? | Cerebral Hemorrhage |
| What indicates to use Platelets transfuse? | Used to treat bleeding d/t thrombocytopenia; functionally abnormal platelets. |
| How long it needs to separate plasma from blood and frozen to have Fresh Frozen Plasma | 6 hrs. |
| How many ml in 1 unit of packed fresh frozen plasma? | 200-500ml |
| How long can Fresh Frozen Plasma can be stored? | 1 year |
| How long Fresh Frozen Plasma after thawing can be used? | Within 1-2 hours |
| When do you use albumin transfusion? | Used to treat hypovolemia, shock and chronic liver failure. |
| How many ml in 1 unit of albumin? | 50ml bottles commercially manufactured. |
| How long can ablumin be stored for? | Stored up to 5 years. |
| When do you use cryoprecipatates transfusions? | It is given to treat Viii deficiency, low fibrinogen and factor 13 deficiency; used to treat hemophilia & congenital or acquired fibrinogen deficiency. |
| How long cryoprecipatates after thawing can be used? | 6 hrs. |
| How many ml in 1 unit of cryoprecipatates? | 15ml/unit |
| Rapid administraion of cold blood can result in? | Cardiac dysrhythmias. |
| Platelet transfusion should be transfused over | 15 minutes |
| If a patient has a history of platelet transfusion reaction what should the nurse do? | premedicate with an antipyretic nd or an antihistamine. |
| Avoid giving a platelet transfusion if the patient is? | Febrile |
| When a patient has burns, hypoprotenemia what is transfused? | Albumin |
| PT & INR values | 11-12.5 seconds PT, 0.8-1.1 INR |
Created by:
tlarsen14