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.