Upload
cody
View
222
Download
0
Embed Size (px)
Citation preview
7/23/2019 Intravenous Therapy - 2014
1/33
P O T T E R & P E R R Y , C H A P T E R 4 1 , P A G E S 9 0 4 -
9 3 8B R U N N E R C H A P T E R 1 3 , P A G E S 2 7 2 - 2 8 4
Intra!n"#$ T%!ra'
7/23/2019 Intravenous Therapy - 2014
2/33
I( T%!ra'
IV fluid and electrolyte therapy (crystalloids)
Blood and blood component (colloids)
7/23/2019 Intravenous Therapy - 2014
3/33
T'!$ ") I( S"*#t+"n$
Isotonic: Osmotic pressure is same
Hypertonic: Water drawn out of the cell
Hypotonic: Water drawn into the cell
7/23/2019 Intravenous Therapy - 2014
4/33
I$"t"n+ *#+.$
Dextrose ! in Water
"#$! sodium chloride
%actated &in'ers
7/23/2019 Intravenous Therapy - 2014
5/33
I$"t"n+ I( *#+.$/ 09 NaC*
I$"t"n+/ "#$! sodium chloride ses
*xpand fluid +olume Only solution administered with blood Does not pro+ide free water, no calories, or electrolytes
-pecial considerations -ince it replaces *./, monitor patients with .H/ for /V* Dilutes hemo'lobin concentration
.an cause hyperchloremic acidosis
0onicity matches that of the serum, fluids stay in the +ascularspace
SHOC
7/23/2019 Intravenous Therapy - 2014
6/33
I$"t"n+ I( *#+.$/ atat!. R+n!r5$
I$"t"n+/ %actated &in'ers ses
*xpand intra+ascular +olume 1 replace extracellular fluid losses .an be used to treat mild metabolic acidosis, burns, and lower 2I
losses Does not pro+ide free water or calories
-pecial considerations -imilar to serum, but without ma'nesium .ontains potassium, careful use with renal failure
0onicity matches that of serum, fluids stay in the +ascular space
7/23/2019 Intravenous Therapy - 2014
7/33
7/23/2019 Intravenous Therapy - 2014
8/33
H'"t"n+ *#+.$
"#3! sodium chloride
"#44! sodium chloride
Dextrose ! in Water 5 a special case
(isotonic, but physiolo'ically hypotonic, pro+idin' freewater)
7/23/2019 Intravenous Therapy - 2014
9/33
H'"t"n+ *#+.$/ 046 $".+# %*"r+.!
H'"t"n+/ "#3! sodium chloride ses
&eplace hypotonic fluid losses 6aintenance solution but does not replace daily electrolyte losses
except sodium 1 chloride 7ro+ides free water 7ro+ides no calories
-pecial considerations .an cause increased intracranial pressure
.an cause circulatory collapse 0onicity is less than that of serum, fluids help maintain daily
fluid loss# 0he free water 'oes from *./ to I./
7/23/2019 Intravenous Therapy - 2014
10/33
&eturn to homeostasis:
7/23/2019 Intravenous Therapy - 2014
11/33
H'!rt"n+ *#+.$
Dextrose in "#$!sodium chloride
Dextrose 8"!
9! -aline
7/23/2019 Intravenous Therapy - 2014
12/33
I( *#+.$ & U$!$/ +nt!r!$t+n +n)"
H'!rt"n+/ Dextrose in "#$!sodium chloride sed in
Hypotonic dehydration 0emporary treatment of circulatory insufficiency 1 shoc if
plasma expanders arent a+ailable -I;HD (or use 9! -odium .hloride) ;ddisonian crisis
-pecial considerations increased circulatin' +olume can tri''er con'esti+e heart failure 1
pulmonary edema 0onicity is hi'her than serum, fluid is pulled from the cells,
into the +ascular spaces
7/23/2019 Intravenous Therapy - 2014
13/33
&
7/23/2019 Intravenous Therapy - 2014
14/33
0reatment .omplications
/luid Volume *xcess
.ellular *dema
.ellular Dehydration
7/23/2019 Intravenous Therapy - 2014
15/33
!*+!r' !t%".$
P!r+%!ra* *+n!$ S%"rt t!r or intermittent fluids Vein in ar, %an., le' or foot
C!ntra* *+n!$ /or +na.!:#at! !r+%!ra*+eins or *"n t!r
-ub
7/23/2019 Intravenous Therapy - 2014
16/33
C"*+at+"n$ ") I( T%!ra'
Infiltration
Infection
7hlebitis 1 thrombophlebitis
*xtra+asation
7/23/2019 Intravenous Therapy - 2014
17/33
C"*+at+"n$ ") I( T%!ra'
-e+ered catheter
;ller'ic reaction
;ir embolism
/luid o+erload
-peed shoc
7/23/2019 Intravenous Therapy - 2014
18/33
B*"". A.+n+$trat+"n
7/23/2019 Intravenous Therapy - 2014
19/33
B*"". R!*a!!nt
;dministration of Whole blood .omponent of blood
Ob=ecti+es 0o increase circulatin' blood +olume 0o increase > of &B.s 1 maintain H'b le+el 0o pro+ide selected cellular components
7/23/2019 Intravenous Therapy - 2014
20/33
B*"". Gr"# T'!$
Blood must be matched ;, B, O, and ;B blood types &h factor
0ransfusion reaction
http:??fi#edu?biosci?blood?types#html
7/23/2019 Intravenous Therapy - 2014
21/33
A#t"*""#$ Tran$)#$+"n
.ollection of clients own bloodObtained up to wees before planned e+entDonation of up to units dependin' on time and
sur'ery-al+a'ed blood Durin' sur'ery /rom chest
7/23/2019 Intravenous Therapy - 2014
22/33
N#r$!5$ R"*!
A$$!$$!nt -i'ns of infection or infiltration at IV site What 'au'e needle is in place filter present 0ubin' filled with "#$! @a.l
Is any reason that the client should not recei+e;nxiety about transfusion *xplain the procedure and tell them symptoms they should report#;ssess whether the client has 'i+en a si'ned consent#;ssess +ital si'ns for baseline before 'i+in' the blood# /ollow a'ency protocol licensed personnel who will chec off on the
blood to be administered and the clients information# T%! n#r$! +$ r!$"n$+;*! )"r ;!+n $#r! t%at t%! ;*"".
.!*+!r!. +$ "at+;*!
7/23/2019 Intravenous Therapy - 2014
23/33
In+t+at+n t%! In)#$+"n
Be'in slowly to allow for early detection of a transfusionreaction#
6aintain the infusion rate (usually o+er 4 hours) If se+ereblood loss, the blood may be administered more rapidly#Warm in blood warmin' de+ice to pre+ent dysrhythmia#
6onitor for side effects;ssess +ital si'ns and promptly records all findin's# &eport
as indicated#-tay with the client durin' the first 8 minutes (time most
liely to ha+e a reaction)6onitor and obtain +ital si'ns periodically durin' the
transfusion accordin' to a'ency policy# If a transfusionreaction is suspected, obtain +ital si'ns more freAuently
7/23/2019 Intravenous Therapy - 2014
24/33
Tran$)#$+"n R!at+"n$
-ystemic body response to incompatible blood;ller'ic sensiti+ity to the components of the transfused
blood or to the potassium or citrate preser+ati+e in theblood#
0ransmission of infection by blood donors who areasymptomatic:
.irculatory o+erload 6ost at ris: older adults and those with cardiopulmonary disease#
Blood transfusion reactions are *+)! t%r!at!n+n, promptnursin' inter+ention is important
St"the transfusion immediately if a blood reaction issuspected#
If "#$! is ordered to be infused, dont =ust start it from theline used with the blood transfusion 5 !t a n!< *+n!
7/23/2019 Intravenous Therapy - 2014
25/33
Tran$)#$+"n R!at+"n$/ A*!rt=
.hills, fe+er, low bac pain, flushin' tachycardia,tachypnea, hypotension, +ascular collapse,bleedin', acute renal failure, shoc, cardiac arrest,death
Itchin', rise in temperature;nxiety, urticaria, wheein', cyanosis, shoc,
cardiac arrest.ou'h, dyspnea, pulmonary con'estion, headache,
hypertension, tachycardia, distended nec +einsVomitin', diarrhea, mared hypotension, shoc
7/23/2019 Intravenous Therapy - 2014
26/33
N#r$+n Int!r!nt+"n )"r r!at+"n
Ceep "#$! @a.l 'oin' in an IV line "n5t #$! t%! Y t#;+n +n)#$+"n $!t
@otify the physician immediately
Obser+e si'ns 1 symptoms, monitor V- e+ery minutes;dminister emer'ency dru's as ordered7repare to perform .7&
Obtain urine specimen, send to lab-end blood container, tubin', attached labels,
transfusion record to laboratory
7/23/2019 Intravenous Therapy - 2014
27/33
I.!nt+)'
Identify physical assessment findin's andpossible causes#
7/23/2019 Intravenous Therapy - 2014
28/33
>#!$t+"n$ t" a$? '"#r$!*)
What am I doin' for this clientWhy am I performin' this inter+entionDo I need to re+iew the standard for this sill
Does the inter+ention mae 'ood common sense forthis particular clientWill it harm the clientDoes my instructor or &@ now what Im about to do
for the client
7/23/2019 Intravenous Therapy - 2014
29/33
Str!$$ T!$t
In the followin' slide, you are to identify differencesin the dolphins# By bein' able to identify whetherthere are any differences and countin' the number ofdifferences that you find, we will be able todetermine the amount of stress you are under# @ow
+iew the slide and eep your number to yourself#
7/23/2019 Intravenous Therapy - 2014
30/33
7/23/2019 Intravenous Therapy - 2014
31/33
-tress 0est &esults
" differences 5 .on'ratulationsE Fou ha+eabsolutely no stress in your lifeE
8 5 4 differences 5 Fou are stressed out and need to
relax a bit as soon as you can9 or more differences 5 Fou are totally stressed to
the max# 0he dolphins are identical in e+ery way# Ifyou detected differences, you need a +acationE
7/23/2019 Intravenous Therapy - 2014
32/33
P#** '"#r "
7/23/2019 Intravenous Therapy - 2014
33/33
I .+. *!arn t" #** ' "