Editing Nursing Skills and Procedures – RN Flashcards (section)

== Intravenous and Central Venous Therapy ==

;What is the immediate nursing action for suspected venous air embolism?
:Clamp the catheter, place the client in left lateral Trendelenburg, the Durant maneuver, to trap air in the right ventricular apex, administer 100 percent oxygen, and notify the provider.

;How does infiltration differ from extravasation, and how does management differ?
:Infiltration is leakage of a nonvesicant into tissue: stop, remove the catheter, elevate, apply a compress. Extravasation is leakage of a vesicant such as a vasopressor or chemotherapy agent: stop the infusion but leave the catheter in place, aspirate residual drug, notify the provider, and give the specific antidote, for example phentolamine for norepinephrine.

;What are the signs of phlebitis, and what is the nursing response?
:Redness, warmth, tenderness, and a palpable venous cord. Discontinue the catheter, apply a warm compress, and restart in the opposite extremity.

;Which intravenous solutions are hypertonic, and what is the key monitoring priority?
:3 percent sodium chloride, dextrose 10 percent in water, and dextrose 5 percent in 0.9 percent sodium chloride or in lactated Ringer. Infuse slowly through a large vein with frequent neurologic checks, serum sodium monitoring, and assessment for fluid overload.

;Why is dextrose 5 percent in water unsuitable for a client with cerebral edema?
:Once the dextrose is metabolized, only free water remains, so the solution behaves as hypotonic and shifts water into cells, worsening cerebral edema.

;What is the absolute rule for intravenous potassium chloride?
:Never give by intravenous push or bolus. Always dilute and infuse by electronic pump within institutional concentration and rate limits, monitoring the cardiac rhythm, the site, and urine output. Also check magnesium, since hypomagnesemia makes hypokalemia refractory.

;What gauge catheter is preferred for blood product administration in an adult?
:An 18 gauge is preferred; a 20 gauge is generally acceptable. Prime only with 0.9 percent sodium chloride using filtered Y-tubing.

;Why must a small volume syringe never be used to force a flush on a central line?
:A smaller barrel generates much higher pressure per unit of force and can rupture the catheter or dislodge a thrombus. Absent blood return may indicate a fibrin sheath and is reported, never forced.

;List the core elements of the central line infection prevention bundle.
:Hand hygiene, maximal sterile barrier precautions at insertion, chlorhexidine antisepsis with full air drying, optimal site selection with the femoral site avoided in adults, scrubbing the needleless connector before every access, sterile dressing changes on schedule or whenever damp, loose, or soiled, and daily review of line necessity with prompt removal.

;What must be confirmed before the first use of a newly placed central venous catheter or peripherally inserted central catheter?
:Radiographic confirmation of tip position in the lower superior vena cava.

;What complication is assessed for immediately after subclavian or internal jugular central line insertion?
:Pneumothorax. Watch for sudden dyspnea, chest pain, diminished or absent breath sounds on the affected side, and tracheal deviation.

;What client teaching applies to an arm with a peripherally inserted central catheter?
:No blood pressure measurement and no venipuncture in that arm, keep the dressing dry and intact, and report swelling, pain, redness, drainage, or an increase in external catheter length.

;Describe the immediate response to a suspected acute hemolytic transfusion reaction.
:Stop the transfusion, disconnect the blood tubing and maintain the line with 0.9 percent sodium chloride through '''new''' tubing, assess and obtain vital signs, notify the provider and blood bank, and return the unit and tubing with post-transfusion blood and urine specimens.

;How are transfusion-associated circulatory overload and transfusion-related acute lung injury distinguished?
:Circulatory overload produces dyspnea, crackles, jugular venous distension, and hypertension and responds to slowing the rate and diuretics. Transfusion-related acute lung injury produces acute hypoxemia with bilateral infiltrates but without volume overload or hypertension and requires respiratory support.