Client is receiving norepinephrine

(Levophed) by continuous IV infusion.

Nurse notes that the catheter is no
longer in the vein and the vesicant med
has infused into the subcutaneous
tissue. What should the nurse do?

Common IV solns.

Goals of IV fluid therapy

Stop the infusion and prepare to

administer an antidote- Nurse should
administer phentolamine. It is an
antidote for extravasation ischemia due
to norepinephrine and prevents
damage to the surrounding tissue

5% dextrose in water (D5W)

0.9% sodium chloride (NaCl)
Lactated Ringer's (LR)
Maintain/regain fluid, electrolyte
balance
Medium for delivery of meds
Advantages:
rapid onset
precise control of dose
reduced discomfort, irriation

How many calories does a

liter of D5W provide?

170 calories

hypertonic iv soln.

pulls fluid out of the cells and

into the veins

hypertonic Iv solns.

hypotonic iv soln.

Hypotonic IV solns.

isotonic

Isotonic IV soln.

osmolarity greater than 350 mOsm/L

if osmolarity is greater than 500 administer through central line
pull fluid into vascular space
use if client is dehydrated
caution b/c patient is at risk for fluid volume overload
ex. 3% NaCl
10% dextrose in water
D5 lactated ringer's
d5 0.9% NaCl

moves fluid from the veins to

the cells and interstitial
spaces

osmolarity less than 200 mOsm/L

treats dehydration
moves water to cells
can cause cell rupture, hemolysis
ex. half normal saline

remains in the intravascular

space

osmolarity of 200-350 mOsm.L

use for volume expansion of
vascular system
can cause fluid overlaod
ex. 0.9% NaCl
lactated ringer's

Isotonic to Hypotonic IV soln.

D5W
isotonic in bag
dextrose metabolizes quickly
leaves only water (hypotonic)
solution to administer IV meds
increases blood glucose

nurse administers D5W, after

dextrose is metabolized what
type of soln is it

hypotonic- only free water

remains

nurse administers lactated

ringer's by continuous IV
infusion- what type of soln is
this?

isotonic- osmolarity of 273

mOsm/L

nurse administers soln of 3%

NaCl what type of soln is
this?

hypertonic- has osmolarity

greater than 1000 mOsm/L

A nurse is caring for a client

who has developed fluid
overload following continuous
IV infusion of 200 mL/hr. What
do you do?

reduce IV rate to 30 mL/hr

(slow the rate of the IV fluid
to keep the vein open)

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. What action should the
nurse take?
A nurse is monitoring a client who is
receiving an IV med. The client
reports dizziness and tight feeling in
his chest. The nurse notes that the
client's face is flushed. These
findings indicate what complication?

Initiate oxygen, call the rapid response team,

elevate the head of the client's bed 45 degrees
b/c client is experiencing anaphylaxis- also:
prepare to administer epinephrine, & leave
catheter in place to adminster emergency
meds

Speed shock. Due to a toxic

level of the med in the body

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. Use
the smallest gauge possible to
prevent irritation of the vein

A nurse should administer

lactated ringer's, which
contains lactate, to treat a
client who has what disorder?

acidosis- the liver forms

bicarbonate, which helps
correct the acidosis

Risks of IV fluid therapy

Local reactions at IV site

Phlebitis
Infiltration and/or
extravasation
Systemic Rxns

rupture or hemolysis of cells

occurs with which soln?

hypotnic soln.

treatment for catheter

embolism

remove IV catheter, inspect for

damage to tip, apply tourniquet
above insertion site, notify provider,
anticipate obtaining x-ray

treatment for extravasation

facility policy

Treatment for fluid overload

treatment for infiltration

slow infusion rate of IV fluids

elevate head of bed
administer oxygen
notify provider for diuretic
document findings

stop IV, remove cannula,

elevate extremity, cold
compress

treatment for phlebitis

treatment for speed shock

What are the steps to

calculate electronic IV pump
rates?

What is catheter embolism

What is extravasation

stop infusion, remove IV

catheter, change vein
warm compresses
document using phlebitis scale,
monitor site

stop meds, change IV to

isotonic soln., notify provider,
treat effects, monitor vitals
step 1: what is the unit of measurement to calculate?
step 2: what is the volume needed?
step 3: what is the total infusion time?
step 4: should the nurse convert the units of
measurement?
step 5: set up eq. and solve for x
step 6: round if necessary
step 7: reassess to det. whether IV flow rate makes
sense

findings: reflect location where embolism lodges

pain proximal to IV insertion site
shortness of breath, cyanosis, tachycardia, other
signs of shock
caused by: shearing off portion of IV catheter
catheter damage during insertion
excessive force

finding: varying tissue

damage caused by vesicant
medication leaking outside
infiltrated IV

What is fluid overload

What is infiltration

What is osmolarity?

What is phlebitis

What is speed shock

aka circulatory overload

findings: shortness of breath, intake greater
than output, increased BP, pulse, respir. rate,
crackles in lungs, neck vein distention,
extremity edema caused by infusion at rate
client can't tolerate
usually in older adults, infants, & children

findings: pallor, swelling, pain

caused by IV catheter slipping
out of vein, fluid leaks from
previous IV

conc. of dissolved particles

(solute) within soln. (solvent)

inflammation of a vein
caused by excessively large IV
catheter, infusion of irritating
solutions, bacterial
findings: lightheadedness, chest
pain, palpitations, rapid pulse,
shock, cardiac arrest caused by
IV meds administered too
quickly

What is the common name

for the IV soln 0.9% sodium
chloride?

Which is the correct

abbreviation for the IV soln.
half normal saline?

Which IV soln should a nurse

use when preparing to
administer a blood
transfusion?

normal saline

0.45% NaCl

NaCl to prevent hemolysis of

the RBCs