Skip to content
CramShare
FreePractice exam

Saunders 2026–2027 Clinical Judgment and Test-Taking Strategies: Passing Nursing School and the NCLEX® Exam

HEAL100 Health Care — exam and revision material · Other

Updated today

Health Care exam material, 14 pages. Originally published on StudyMerit.

Pages
14
Academic year
2025/2026
Language
English

What’s included

Preview 3 of 14 pages

See the first 3 pages exactly as they appear in the document.

Read page 1 as text

Fundamentals C H A P T E R 13 Intravenous Therapy PRIORITY CONCEPTS Fluids and Electrolytes; Safety CRITICAL THINK ING W hat Should Y ou Do? A client with a peripherally inserted central catheter (PICC) in the right upper extremity suddenly exhibits chest pain, dys- pnea, hypotension, and tachycardia. The nurse suspects an embolism related to the PICC line. What should the nurse do? Answer located on p. 153 . I. Intravenous Therapy A. Purpose and uses 1. Used to sustain clien ts who are unable to take substances orally 2. Replaces water, electrolytes, and nutrients m ore rapidly than oral adm inistration 3. Provides im m ediate access to the vascular system for the rapid delivery of specific solutions with- out the tim e required for gastrointestinal tract absorption 4. Provides a vascular route for the adm inistration of m edication or blood com ponents B. Types of solutions ( Table 13-1 ) 1. Isotonic solutions a. Have the sam e osm olality as body fluids b . Increase extracellular fluid volum e c. Do not enter the cells because no osm otic force exists to shift the fluids 2. Hypotonic solutions a. Are m ore dilute solution s and have a lower osm olality than body fluids b . Cause the m ovem ent of water into cells by osm osis c. Should be adm inistered slowly to prevent cellular edem a 3. Hypertonic solutions a. Are m ore concentrated solutions and have a higher osm olality than body fluids b . Cause m ovem ent of water from cells into the extracellular fluid by osm osis 4. Colloids a. Also called plasm a expanders b . Pull fluid from the interstitial com partm ent into the vascular com partm en t c. Used to increase the vascular volum e rapidly, such as in hem orrh age or severe hypovolem ia Administration ofan intravenous (IV) solution or med- ication provides immediate access to the vascular system. This is a benefit of administering solutions or medications via this route but can also present a risk. Therefore, it is critical to ensure that the health care provider’s (HCP’s) prescriptions are checked carefully and that the correct solution or medication is administered as prescribed. Always follow the 6 rights for medication administration. II. Intravenous Devices A. IV can nulas 1. Butterfly sets a. The set is a wing-tip needle with a m etal can- nula, plastic or rubber wings, and a plastic catheter or hub. b . The needle is 0.5 to 1.5 inch es in length, with needle gauge sizes from 16 to 26. c. Infiltration is m ore comm on with these devices. d . The butterfly infusion set is used com m only in children and older clients, whose veins are likely to be sm all or fragile. 2. Plastic cannulas a. Plastic can nulas m ay be an over-the-n eedle device or an in-n eedle catheter and are used prim arily for short-term therapy. b . The over-the-needle device ispreferred for rapid infusion and is m ore com fortable for the client. c. The in-needle cath eter can cause catheter embolism if the tip of the cannula breaks. B. IV gauges 1. The gauge refers to the diam eter of the lum en of the needle or can nula. 2. The sm aller the gauge num ber, the larger the diam eter of the lum en; the larger the gauge num - ber, the sm aller the diam eter of the lum en. 144 messages.downloaded_by lOMoARcPSD|6879242

Read page 2 as text

Fundamentals 3. The size of the gauge used depends on the solu- tion to be adm inistered and the diam eter of the available vein. 4. Large-diam eter lum ens (sm aller gauge num bers) allow a higher fluid rate than sm aller diam eter lum ens and allow the adm inistration of higher concentration s of solution s. 5. For rapid em ergency fluid adm inistration , blood products, or anesthetics, preoperative and post- operative clients, large-diam eter lum en needles or cann ulas are used, such as an 18- or 19-gauge lum en or cann ula. 6. For peripheral fat emulsion (lipids) infusions, a 20- or 21-gauge lum en or cann ula is used. 7. For standard IV fluid and clear liquid IV m edica- tions, a 22- or 24-gauge lumen or cannula is used. 8. If the client has very sm all veins, a 24- to 25- gauge lum en or cannula is used. C. IV contain ers 1. Con tainer m ay be glass or plastic. 2. Squeeze the plastic bag to ensure intactness and assess the glass bottle for any cracks before hanging. 3. Recon stitute any m edications per agency proto- col and pharm acy instruction . Do not write on a plastic IV bag with a marking pen because the ink may be absorbed through the plastic into the solution. Use a label and a ballpoint pen for writ- ing on the label, placing the label onto the bag. D. IV tubing ( Fig. 13-1 ) 1. IV tubin g contains a spike end for the bag or bot- tle, drip cham ber, roller clam p, Y site, and adapter end for attach m ent to the cannula or needle that is inserted into the client’s vein. 2. Shorter, secon dary tubin g is used for piggyback solution s, connecting them to the injection sites nearest to the drip cham ber ( Fig. 13-2 ). 3. Special tubin g is used for m edication that absorbs into plastic (ch eck specific m edication adm inistration guidelines when adm inistering IV m edication s). 4. Ven ted and nonvented tubin g are available. a. A vent allows air to enter the IV container as the fluid leaves. b . A vented adapter can be used to add a vent to a nonvented IV tubing system . c. Use nonvented tubin g for flexible contain ers. TABLE 13 - 1 Types of Intravenous Solutions Solution and Type Uses 0.9% saline (NS): Isotonic Extracellular fluid deficits in clients with low serum levels of sodium or chloride and metabolic acid-base imbalances. Used before or after the infusion of blood products. Ringer’s lactate solution: Isotonic Extracellular fluid deficits, such as fluid loss from burns, bleeding, and dehydration from loss of bile or diarrhea. 5% dextrose in water (D 5 W): Isotonic at the time of administration; within a short time after administration, dextrose is metabolized and the tonicity decreases in proportion to the osmolarity or tonicity of the nondextrose components (electrolytes) within the water (may become hypotonic). Replaces deficits of total body water. Not used alone to expand extracellular fluid volume because dilution of electrolytes can occur. 5% dextrose in 0.225% saline (5% D/ 1/ 4 NS): Isotonic at the time of administration; within a short time after administration, dextrose is metabolized and the tonicity decreases in proportion to the osmolarityor tonicityof the nondextrose components (electrolytes) within the water (may become hypertonic). Used as initial fluid for hydration because it provides more water than sodium. Commonly used as maintenance fluid. 5% dextrose in 0.9% saline (5% D/ NS): Hypertonic Extracellular fluid deficits in clients with low serum levels of sodium or chloride and metabolic alkalosis. 5% dextrose in 0.45% saline (5% D/ 1/ 2 NS): Hypertonic Used as initial fluid for hydration because it provided more water than sodium. Commonly used as maintenance fluid. 5% dextrose in Ringer’s lactate solution: Hypertonic Extracellular fluid deficits, such as fluid loss from burns, bleeding, and dehydration from loss of bile or diarrhea. S pike e nd for IV ba g or bottle Drip cha mbe r Rolle r cla mp Ada pte r e nd of tubing to ne e dle Y s ite FIGURE 13 - 1 Intravenous (IV) tubing. 145 CHAPTER 13 Intravenous Therapy messages.downloaded_by lOMoARcPSD|6879242

Read page 3 as text

Fundamentals d . Use vented tubin g for glass or rigid plastic containers to allow air to enter and displace the fluid as it leaves; fluid will not flow from a rigid IV container unless it is vented. Extension tubing can be added to an IVtubing set to provide extra length to the tubing. Add extension tubing to the IV tubing set for children, clients who are restless, or clients who have special mobility needs. E. Drip cham bers ( Fig. 13-3 ) 1. Macrodrip cham ber a. The cham ber is used if the solution is thick or is to be infused rapidly. b . The drop factor varies from 10 to 20 drops (gtt)/m L, depending on the m anufacturer. c. Read the tubing package to determ ine how m any drops per m illiliter are delivered (drop factor). 2. Microdrip cham ber a. Norm ally, the cham ber has a short vertical m etal piece (stylet) where the drop form s. b . The cham ber delivers about 60 gtt/ m L. c. Read the tubin g package to determ ine the drop factor (gtt/m L). d . Microdrip cham bers are used if fluid will be infused at a slow rate (less than 50 m L/h our) or if the solution contain s potent m edication that needs to be titrated, such as in a critical care settin g or in pediatric clients. F. Filters 1. Filters provide protection by preventing particles from entering the client’s veins. 2. They are used in IV lines to trap sm all particles such as undissolved substances, or m edications that have precipitated in solution. 3. Check the agency policy regarding the use of filters. 4. A 0.22- μ m filter is used for m ost solution s; a 1.2- μ m filter is used for solution s containing lipids or album in; and a special filter is used for blood com ponents. 5. Change filters every 24 to 72 hours (depending on agency policy) to prevent bacterial growth. G. Needleless infusion devices 1. Needleless infusion devices include recessed nee- dles, plastic cannulas, and 1-way valves; these system s decrease the exposure to contam inated needles. 2. Do not adm inister parenteral nutrition or blood products through a 1-way valve. H. Interm ittent infusion devices 1. Interm ittent infusion devices are used when intravascular accessibility is desired for interm it- tent adm inistration of m edications by IV push or IV piggyback. 2. Patency is m aintained by periodic flushing with norm al saline solution ( sodium chloride and nor- mal saline are interchangeable nam es). 3. Depending on agency policy, when adm inister- ing m edication, flush with 1 to 2 m L of norm al saline to confirm placem ent of the IV cann ula; adm inister the prescribed m edication and then flush the cannula again with 1 to 2 m L of norm al saline to m aintain patency. I. Electronic IV infusion devices 1. IV infusion pum ps control the am ount of fluid infusing and should be used with cen tral venous lines, arterial lin es, solution s contain ing m edica- tion, and parenteral nutrition infusions. Most agencies use IV pum ps for the infusion of any IV solution. 2. A syringe pum p is used when a sm all volum e of m edication is adm inistered; the syringe that con- tains the m edication and solution fits into a pum p and is set to deliver the m edication at a controlled rate. 3. Patien t-controlled analgesia (PCA) IV ba g with me dica tion FIGURE 13 - 2 Secondary bag with medication. IV, Intravenous. Ma crodrip 10-20 gtt/mL Microdrip 60 gtt/mL FIGURE 13 - 3 Macrodrip and microdrip sizes. 146 UNIT III Nursing Sciences messages.downloaded_by lOMoARcPSD|6879242

That’s the free preview

You’ve read 3 of 14 pages. The whole document is yours with a free account, and it stays in your library.

Others on this course also opened

Free

With a free account