Transcript Chapter 21

Brenda McLoud BSN, RN, CGRN
Learning Objectives
 Describe the Nurse’s role in IV therapy care
 Explain IV supplies, type of vascular access devices,
and administration of IV therapy
GI nurse’s role in IV therapy
 Assessment
 Planning
 Implementation
 Evaluation.
Competencies in IV Therapy for the GI Nurse
 Knowledge of Vascular Access Devices (VAD) used
 Skill in performing procedure competently & safely
 Skill in inspecting insertion site
 Ability to problem solve
 Knowledge to monitor patient’s condition & report
changes
 Proper documentation and record-keeping skills
Basic Principles of
Fluid & Electrolytes
 Water is 60% of the average adult’s total body weight
 In infants, body water represents about 80% of total
body weight
 Solutions – liquids (solvents) containing dissolved
substances (solutes) – are classified according to their
concentration or tonicity and include
 Isotonic Solutions
 Hypotonic Solutions
 Hypertonic Solutions
 Body fluids are isotonic solutions
Basic Principles of
Fluid & Electrolytes
 Body water is contained in two major body
compartments
 Intracellular fluid (ICF)
 Extracellular fluid (ECF)
 Fluid balance is maintained when water intake
equals water output
 Solutes are substances dissolved in a solution
Basic Principles of
Fluid & Electrolytes
 Solutes are classified as
 Nonelectrolytes
 Electrolytes


Cations
 Na, K, Ca, Mg, H
Anions
 Cl, P, HCO3
 Electrolytes perform four essential functions
 Promote neuromuscular irritability
 Maintain body fluid osmolality
 Regulate acid-base balance
 Regulate distribution of body fluids among body fluid
compartments
Fluid & Electrolyte imbalances
 Imbalances may result from
 Vomiting, diarrhea, suction, draining wounds,
intestinal obstructions, draining fistulas,
hemorrhage, infections, fever or prolonged use
of enemas &
 Infants are more vulnerable because of their
higher proportion of body fluid, immature
kidneys, increased heat production & rapid growth
 Excessive loss of body water can lead to
dehydration
Administration of
Fluids & Electrolytes
 All IV solutions are considered medications
 Requires a Dr.’s order
 Types of Solutions
 Isotonic Solutions

0.9% NS or LR
 Hypotonic Solutions

0.45% NaCl
 Hypertonic Solutions

3% NaCl or 10%Dextrose
Risks for the GI Nurse
 Primary risks due to needlesticks
 Injury
 Disease transmission
 Spills
 Splashes
 Because universal precautions require use of gloves
when dealing with blood and body fluids,
development of latex allergies pose a concern for
health care workers and patients
Latex allergies
 Individuals who develop burning or tingling around mouth
after blowing up latex balloons
 Known allergy to
 Bananas
 Avocados
 Potatoes
 Tomatoes
 Poinsettias
 History of contact dermatitis
 History of asthma
 History of eczema
Vascular Access Devices (VAD)
 Steel winged infusion set (butterfly winged device)
 Peripheral short IV catheters
 Peripheral long or midline catheters
 Peripherally inserted central catheters (PICC)
 Nontunneled central venous catheters (CVC’s)
 Tunneled central venous catheters
 Totally implanted devices or ports
IV Insertion sites
 Preferred sites
 Dorsum of hand
 Upper arm
 Avoid Extremities with
 Lymphedema, postop swelling, recent trauma, dialysis
shunt, hematoma, axillary lymph node dissection, local
infection or cellulitis, phlebitis or open wounds
 Best to begin with distal veins and proceed proximally
towards the body
 Cannulation of lower extremities should be avoided in
adults
Complications
 Infiltration/extravasation
 Hematoma
 Phlebitis
 Pyrogenic reactions
 Air embolism
 Catheter embolism
 Pulmonary edema
 Speed shock/overload
 Nerve injury
IV Medication Administration
 Techniques & routes of administration
 Appropriateness of the prescribed therapy
 Patient’s age and condition
 Any medication allergies
 Dose, route and rate of the medication ordered
 Medications
 Indications
 Actions
 Side effects
 Appropriate nursing interventions with adverse reactions
Indications for IV meds in GI
 Moderate sedation/analgesia
 Control of variceal hemorrhage
 Treatment of opioid-induced respiratory depression
 Treatment of benzodiazepine-induced respiratory
depression
 Treatment of cardiac dysrhythmias
 Reducing peristalsis or intestinal spasms
 Treatment for increased risk of infection
Blood & Blood Components










Whole blood
Packed red blood cells
Leukocyte-poor blood
Platelets
Fresh frozen plasma (FFP)
Cryoprecipitates
Factor VIII
Factor IX
Human albumin
Autologous transfusion
Adverse Reactions
 Circulatory overload
 Allergic reactions
 Hemolytic reactions
 Hepatitis B, hepatitis C and human immune
deficiency viruses
 Other transfusion-related infectious agents
 Citrate toxicity
When Adverse Reaction Occurs






Stop the transfusion
Keep vein open with normal saline
Asses vital signs
Notify Dr.
Notify blood bank
Send all transfusion containers & administration sets
to blood bank
 Treat patient symptomatically & supportively
 Patient Education
 Documentation
Review
 Salts that dissociate in solution into positive and
negative ions are called:
 A. Anions
 B. Cations
 C. Electrolytes
 D. Colloids
Review
 Drugs should never be added to blood transfusions
because:
 A. They are incompatible.
 B. It complicates determination of the source of any
adverse reaction.
 C. Drugs can cause clotting.
 D. The rate of infusion is too slow.
Review
 The following may indicate a higher risk for latex
allergy except,
 A. History of asthma.
 B. Use of powder-free gloves.
 C. Allergy to bananas
 D. History of multiple surgical procedures.
Review
 Hemolytic reactions to blood transfusions usually
occur :
 A. Immediately
 B. Within the first 5 to 15 minutes of the transfusion.
 C. Within 24 hours.
 D. As long as 6 months after the transfusion.