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Human cells can exist only in a balanced environment. ◦ Cells are enclosed by a cell membrane. Small compounds can pass through easily. Larger charged compounds need assistance. ◦ Cell membrane is phospholipid bilayer. Allows selective permeability
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Total body water (TBW) is 60% of adult weight ◦ Intracellular fluid (ICF): 45% ◦ Extracellular fluid: 15% Interstitial fluid Intravascular fluid Fluids are composed of solutions (solvent and solute).
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Electrolytes ◦ Carry charges ◦ Reactive and dangerous if left to circulate Water stabilizes electrolytes charges. ◦ Cation: positively charged ◦ Anion: negatively charged
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Electrolytes (cont’d) ◦ Measured by milliequivalent (mEq) 1 mEq of a cation can react completely with 1 mEq of an anion. ◦ Singly charged: monovalent ◦ Doubly charged: bivalent
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Electrolytes (cont’d) ◦ Sodium: regulates distribution of water ◦ Potassium: major role in neuromuscular function and conversion of glucose into glycogen Sodium-potassium pump helped by insulin and epinephrine Hypokalemia: low serum levels Hyperkalemia: high serum levels
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Electrolytes (cont’d) ◦ Calcium: needed for bone growth Hypocalcemia: low serum levels Hypercalcemia: high serum levels ◦ Magnesium metabolizes proteins and carbohydrates.
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Electrolytes (cont’d) ◦ Bicarbonate: determines metabolic acidosis and alkalosis ◦ Chloride: regulates the pH of the stomach ◦ Phosphorus: important component in adenosine triphosphate (ATP) ATP: the body’s energy source
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A healthy body maintains a balance between intake and output of fluids and electrolytes. ◦ Homeostasis: internal environment’s resistance to change ◦ A healthy person loses approximately 2 to 2.5 L of fluid daily.
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Dehydration is an inadequate total systemic fluid volume. ◦ Causes: Diarrhea Vomiting Gastrointestinal drainage Infections Metabolic disorders
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Overhydration occurs when the body’s systemic fluid volume increases. ◦ Causes: Unmonitored IVs Kidney failure Water intoxication in endurance sports Prolonged hypoventilation © Medical-on-Line/Alamy Images
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Each bag of IV solution is individually sterilized. ◦ Altering IV concentration can move water into or out of fluid compartment
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IV solutions are categorized by their tonicity. ◦ Isotonic: same concentration of sodium as cell ◦ Hypertonic: greater concentration of sodium ◦ Hypotonic: lower concentration of sodium
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Oxygen-carrying solutions ◦ Whole blood is the best replacement for lost blood. ◦ Synthetic blood substitutes are being researched.
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Intravenous (IV) therapy involves cannulation of a vein with a catheter. ◦ Keep the IV equipment sterile!
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Assembling your equipment ◦ Gather and prepare in advance Elastic tourniquet Cleaning wipe or solution Gauze Tape or adhesive bandage Appropriate size IV catheter IV administration set
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Choosing an IV solution ◦ Usually limited to normal saline and LR solution ◦ IV solution bags must be used within 24 hours once opened. ◦ IV bags come in different fluid volumes.
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Choosing an administration set ◦ Must be used once piercing spike is exposed ◦ Number indicates number of drops it takes for a milliliter of fluid to pass into the drip chamber Microdrip set: 60 gtt/mL Macrodrip set: 10 or 15 gtt/mL © Jones & Bartlett Learning.
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“Six rights” of medication administration ◦ Right patient ◦ Right drug ◦ Right dose ◦ Right route ◦ Right time ◦ Right documentation
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Obtain order from Physician. Understand the physician's orders. Repeat any orders for verification. Ask the patient about medication allergies.
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Verify the proper medication and prescription. ◦ Read the drug label three times. When it is in the original box When preparing the drug Before administering Verify form, dose, and route of medication.
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Check the expiration date and condition of the medication. Confirm medication compatibility. Dispose of syringes and needles safely. Notify and advise the physician of any changes in the patient condition.
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Monitor the patient for adverse side effects. Document actions and patient’s response. ◦ Name of the drug ◦ Dose of the drug ◦ Time administered ◦ Route of administration ◦ Name of person who administered the drug ◦ Patient’s response to the medication
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Standard precautions ◦ Treat any bodily fluid as being potentially infectious. ◦ Handwashing is an effective way to prevent the spread of disease. Handwashing alone will not prevent infection.
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Disposal of contaminated equipment ◦ After an IV catheter or needle has penetrated a patient’s skin, it is contaminated.
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Disposal of contaminated equipment ◦ Immediately dispose of all sharps in a sharps container.
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Choosing an IV site ◦ Avoid areas that contain valves and bifurcations. ◦ Locate vein that looks straightest, firm, round, and springs when palpitated ◦ Limit IV access to distal areas of extremities. Courtesy of Rhonda Beck
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Choosing an IV site (cont’d) ◦ Bulging veins can roll from side to side. Pull skin over vein taut with thumb of free hand. Flex patient’s hand. Stabilize wrist.
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Choosing an IV site (cont’d) ◦ Consider the patient’s opinion. ◦ Avoid extremity if it shows signs of: Trauma Injury Infection ◦ Some protocols allow IV cannulation of leg veins.
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Choosing an IV catheter ◦ Over-the-needle: inserted over a hollow needle ◦ Butterfly: hollow, stainless steel needle with two plastic wings ◦ Through-the-needle: inserted through a hollow needle
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Inserting the IV catheter ◦ Keep the beveled side up. ◦ Maintain adequate traction. ◦ Use a constricting band above the site. Remove the band while assembling IV equipment. Courtesy of Rhonda Beck
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Inserting the IV catheter (cont’d) ◦ Prep site. ◦ Apply lateral traction, while holding catheter bevel side up. ◦ Insert at a 45-degree angle. ◦ Push through the skin until the vein is pierced.
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Inserting the IV catheter (cont’d) ◦ Drop angle to 15 degrees and advance catheter a few centimeters. ◦ Slide sheath off needle into vein. ◦ Apply pressure to the vein. ◦ Remove needle. ◦ Dispose needle in sharps container
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Securing the line ◦ Tape the area to secure the catheter and tubing. Double back the tubing to create a loop. ◦ Cover the site with sterile gauze and secure with tape. See Skill Drill 11-2.
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Changing an IV bag ◦ Stop the flow by closing the roller clamp. ◦ Prepare the new IV bag. ◦ Remove the piercing spike, and insert it into the port on the new bag. ◦ Ensure the drip chamber is filled, and open the roller clamp.
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Discontinuing the IV line ◦ Shut off the flow. ◦ Peel tape back. ◦ Stabilize the catheter. ◦ Do not remove IV tubing from hub. ◦ Pull catheter and IV line from patient’s vein. ◦ Apply pressure.
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Saline locks ◦ Maintain active IV site without running fluids through vein ◦ Attached to end of IV catheter ◦ Filled with approximately 2 mL of saline ◦ Also called intermittent sites (INT)
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Catheters ◦ The best gauges for over-the-needle catheters are: 20-, 22-, 24-, 26- ◦ Butterfly catheters are ideal. Courtesy of Rhonda Beck
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IV locations ◦ Explain your actions to child and parent ◦ Hand veins remain the location of choice. ◦ Technique for starting pediatric IV line: Use penlight to illuminate veins through back of hand ◦ Scalp vein cannulation can be difficult.
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Checks to perform after IV administration: ◦ Fluid ◦ Administration set ◦ Height of bag ◦ Catheter type ◦ Constricting band
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Infiltration: escape of fluid into surrounding tissue ◦ Causes area of edema ◦ Causes include: Catheter passes through vein and out other side Patient moves excessively Tape becomes lose or dislodged Catheter is inserted at too shallow an angle
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Infiltration (cont’d) ◦ If infiltration occurs: Discontinue the IV line. Reestablish IV line in the opposite extremity Apply direct pressure over the area. Do not wrap tape around extremity
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Occlusion: blockage of vein or catheter ◦ First sign: decreasing drip rate or blood in the IV tubing ◦ May develop due to: Position of catheter within the vein Patient’s blood pressure overcoming the flow ◦ If occlusion does not dislodge: Discontinue. Reestablish IV in opposite extremity
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Vein irritation ◦ Often caused by too-rapid infusion rate ◦ If redness at the IV site occurs: Discontinue the IV line. Save the equipment for analysis. Reestablish the IV line in the other extremity with new equipment.
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Thrombophlebitis: inflammation of the vein ◦ May be caused by lapses in aseptic technique ◦ Pain and tenderness along the vein and redness and edema at the venipuncture site ◦ Appear several hours after IV therapy ◦ Stop the infusion and discontinue the IV at that site.
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Hematoma: accumulation of blood in the tissues surrounding an IV site ◦ Often caused by: Vein perforation Improper catheter removal ◦ Develops while inserting catheter: stop and apply direct pressure ◦ Develops after inserting catheter: evaluate the IV flow ◦ Develops as a result of discontinuing the IV: apply pressure Courtesy of Rhonda Beck
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Nerve, tendon, or ligament damage ◦ Results in sudden and severe shooting pain ◦ Remove catheter and select another IV site. Arterial puncture ◦ Bright red blood will spurt through the catheter. ◦ Withdraw the catheter and apply direct pressure for at least 5 minutes.
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Allergic reactions ◦ Anaphylaxis must be treated aggressively. ◦ If an allergic reaction occurs: Discontinue the line and remove the solution. Leave the catheter in place. Attach a saline lock. Notify medical control. Maintain an open airway; monitor vital signs. Retain the solution or medication for evaluation.
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Circulatory overload ◦ Problems may occur in patients with cardiac, pulmonary, or renal dysfunction. ◦ To treat: Slow the IV rate. Raise the patient’s head. Administer high-flow oxygen. Monitor vital signs and breathing adequacy.
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Air embolus ◦ Avoid by properly flushing an IV line and replace empty IV bags with full ones ◦ To treat: Place patient on left side with head down. Administer 100% oxygen. Transport to closest facility Assist ventilations if needed.
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