Summary
Summary RNSG 1533 Exam 1 Study Guide
- Course
- RNSG 1533
- Institution
- San Antonio College
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1Exam 1 RNSG 1533
1. Complications of IV Therapy
Systemic:
Fluid Overload (FVE): Too much fluid given. Increased BP and CVP.
o Crackles , distended neck veins, weight gain, ( SOB), rapid and shallow respiration.
Nursing Interventions
o BP, HR, Rhythm
o I&O, urine volume, color
o Skin assessment for edema, turgor
Air Embolism: Air enters central veins and enter Right Ventricle and blocks pulmonary valve hindering blood
flow.
o Palpitations, dyspepsia, continued cough, JVD, wheezing, cyanosis, hypo tension, weak rapid pulse,
altered mental status, chest, shoulder and back pain, Tachycardia.
Infection: Pyogenic substance enter infusion solution or IV administration causing blood stream infection.
o Temp elevation shortly after infusion started. Backache, HA, increased pulse and respiratory, N/V/D,
chills, shaking, malaise. Erythema, edema, in duration or drainage at insertion site.
Local:
Infiltration – The unintentional administration of a non-vesicant solution or medication into surrounding tissue.
o Edema around the insertion site, Leakage of IV fluid from the insertion site
o Discomfort and coolness in the area of infiltration, Significant decrease in the flow rate
Extravasation - The leakage of intravenously (IV) infused potentially damaging medications into the
extravascular tissue around the site of infusion.
o Blistering, Inflammation, Necrosis
Phlebitis – Inflammation of a vein
o Tender area at insertion site, Reddened along the pathway of the vein, Chemical, Mechanical
o Bacterial
Thrombophlebitis – presence of a clot plus inflammation in the vein
Hematoma – Blood leaks into tissues surrounding the IV site
Clotting and obstruction – Blood clots may form in the IV line as a result of kinked tubing, slow infusion rate,
empty IV bag, or failure to flush the IV line after intermittent medications or solutions.
2. Age related considerations – Fluid & Electrolyte Balance – Dehydration. Increased sensitivity to fluid and
electrolyte changes in older patients requires careful assessment of I&O of fluids from all sources.
I&O of fluid from all sources, daily weight, side effects/interactions of medications.
Skin turgor is good for most elderly pts., but it is not always valid because of the loss of elasticity.
Slowness in filling of veins of the hands and feet becomes more useful.
Perform functional assessment to assess pt. ability to determine fluid and food needs (cognitively intact, able to
ambulate, able to use both arms and hands, able to swallow?)
Some pts. will deliberately restrict their fluids to avoid episodes of incontinence help deal with incontinence.
Decreased % of total body water, increase adipose and decrease muscle mass, decreased renal function,
diminished thirst perception
Clinical manifestations of imbalance may be subtle
3. Dehydration – Teaching/Management
, 2
Dehydration – (loss of water alone) Results when the volume of body fluid is significantly reduced in both ECF and ICF.
In dehydration all fluid compartments have decreased volumes.
Teaching: Teach clients the importance of remaining hydrated, and to increase fluid intake during warm and
humid weather.
Management: Management is dependent on reasons for dehydration/hypovolemia. Non-severe deficits can be
managed with oral intake of fluids (if patient can drink). Encourage patients to drink frequently. A gerontological
consideration may be that older clients will restrict fluids to avoid incontinent episodes. Offer solutions to said
episodes like protective clothing or devices, travel urinals, or pacing fluid intake depending on access to
restrooms.
I&O at least every 8 hours, sometimes hourly, Daily weight, Vital signs closely monitored
Skin and tongue turgor, mucosa, urine output, mental status
Measures to minimize fluid loss, Administration of oral fluids, Administration of parenteral fluids
4. Hypermagnesemia – Assessment - >3.0 mg/dL – Neuromuscular, Alcoholism, Decreased BP, DKA, Renal
Failure, Peaked T Waves
S/S - Flushing, hypotension, muscle weakness, drowsiness, hypoactive reflexes, depressed respirations,
diaphoresis (sweating). (Cardiac arrest and coma) Decreased deep tendon reflexes
Can occur in untreated DKA, adrenocortical insufficiency, Addison’s disease, or hypothermia.
5. Hypokalemia – Dietary Management <3.5 mg/dL
Consumption of foods high in potassium should be encouraged; bananas, melon, citrus fruits, fruit juices, fresh and
frozen vegetables (avoid canned vegetables), lean meats, milk, and whole grains. Dietary intake 50 to 100 mEq/day.
Monitor: I&O every shift.
6. FVD/Dehydration – Assessment – decrease in ECF (thirst), urine output and an increase in urine specific
gravity. Blood volume is low. (Oliguria, Tachycardia, Tachypnea)
Abnormal fluid losses - Vomiting, diarrhea, sweating, GI suctioning
Decreased intake - Nausea, lack of access to fluids
Third-space fluid shifts - Due to burns, ascites
Additional causes - Diabetes insipidus, adrenal insufficiency, hemorrhage
May occur alone or in combination with other imbalances - Loss of extracellular fluid exceeds intake ratio of
water - Electrolytes lost in same proportion as they exist in normal body fluids
Dehydration - Not the same as FVD - Loss of water alone, with increased serum sodium levels
The BUN to creatinine ratio is above 20:1 in hypovolemia because of dehydration or decreased renal perfusion and
function.
7. Hypocalcemia – Assessment – <8.5 mg/dL Medication: calcitrol, calcium carbonate
When evaluating serum calcium levels, serum albumin level and arterial pH must also be considered. Because
abnormalities in serum albumin levels may affect interpretation of the serum calcium level, it may be necessary
to calculate the corrected serum calcium
When arterial pH increases (alkalosis), more calcium becomes bound to protein
Tetany (increased neural excitability), circumoral numbness, paresthesias (tingling of fingers or toes),
hyperactive DTRs, Trousseau sign (carpopedal spasm, about 20 mm Hg above systolic BP), Chvostek sign (facial
tap over the facial nerve in front of the ear), seizures, irritability, depression, impaired memory, confusion,
delirium, hallucinations. Bronchospasms, respiratory symptoms of dyspnea and laryngospasm, abnormal
, 3
clotting, anxiety, decreased prothrombin, diarrhea, hyperactive bowel sounds, dry and brittle hair and nails.
Decreased BP. Osteoporosis. ECG: prolonged QT interval and lengthened ST, ventricular tachycardia
Labs indicate decreased magnesium
Hypocalcemia is common in patients with kidney injury, because these patients frequently have elevated serum
phosphate levels. Hyperphosphatemia usually causes a reciprocal drop in the serum calcium level. A patient may have a
total body calcium deficit (osteoporosis) but a normal serum calcium level. Older adults and those with disabilities, who
spend an increased amount of time in bed, have an increased risk of hypocalcemia, because bed rest increases bone
resorption.
8. Hypernatremia/DI – Assessment/Communication - > 145 mEq/L – ICF water deficit and cellular dehydration
(D5W) Monitor for cerebral edema
The disease cannot be controlled by limiting fluid intake, bc the high-volume loss of urine continues even
without fluid replacement. Attempts to restrict fluids cause the pt to experience insatiable craving for fluid and
to develop hypernatremia and severe dehydration
The inability to increase the specific gravity and osmolality of the urine is characteristic of DI. The pt continues to
excrete large volumes of urine with low specific gravity and experiences weight loss, increasing serum
osmolality, and elevated serum sodium levels
Thirst, elevated temperature
Monitor changes in behavior, such as restlessness, disorientation, and lethargy
Provide access to water
Educate pt, family, and other care givers about follow up care, prevention of complications, and emergency
measures. Include instructions about dose, actions, side effects, and administration of all medications and the
signs and symptoms of hyponatremia.
Pt should wear a medical identification bracelet, carry required meds and info about DI at all times
Desmopressin (synthetic vasopressin – vasoconstriction) longer duration and has less adverse effects. It is given
intranasally, the pt sprays the solution into the nose through a flexible calibrated plastic tube, dialy every 12-24
hrs. caution with coronary artery disease
Chlorpropamide (Diabinese) and thiazide diuretics are also used in mild forms of the disease bc they potentiate
the action of vasopressin. Hyperglycemia is possible
If DI is renal in origin. Thiazide diuretics, mild salt depletion, and prostaglandin inhibitors (ibuprofen [Advil,
Motrin], indomethacin [Indocin], and aspirin) are used to treat the nephrogenic form of DI
Nursing Management
o Gradual lowering of serum sodium level via infusion of hypotonic (D5W) electrolyte solution
o Diuretics
9. Diabetes Insipidus (DI) Assessment & Diagnostic Studies
Polyuria/Large amounts of diluted urine – Inadequate production of ADH
Excessive Thirst, Tachycardia, Dizziness, Fatigue
Increased sodium osmolality
Hypertonic dehydration
Craving for ice water
Hypernatremia and hypokalemia
Low urine osmolality
Urine specific gravity less than 1.005
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