Math
How do you calculate Flow Rate?
Flow rate (mL/Hr) = Volume (mL)/time (hr)
What is DW5?
•ISOTONIC
•PROVIDES 170 CALORIES/L
•FREE WATER
•MOVES INTO ICF DUE TO DEXTROSE CONCENTRATION IN BLOOD STREAM
•BODY QUICKLY METABOLIZES, TURNING IT TO A HYPOTONIC SOLUTION
•INCREASES RENAL SOLUTE EXCRETION
•USED TO REPLACE WATER LOSSES AND TREAT HYPERNATREMIA
•DOES NOT PROVIDE ELECTROLYTES
•CAREFUL WITH ICP
What are the key components of postop?
Regulate VS
ins and outs monitoring
postop wound management
mobilization and physiotherapy
pain management
You are ordered to infuse 280 mL over 30 minutes. What is the flow rate?
Flow rate= mL/hr
= 280mL/0.5hrs
=560
What does "FRIES" stand for in hypernatremia?
Fever and flushed skin
Restlessness/irritable
Increased blood pressure
Edema/fluid retention
Slow urinary output
How do you calculate Drip Rates?
What is Normal Saline?
•ISOTONIC
•NO CALORIES
•MORE NACL THAN ECF
•30% STAYS IN IV (MOST)
•70% MOVES OUT OF IV
•EXPANDS IV VOLUME
•PREFERRED FLUID FOR IMMEDIATE RESPONSE
•RISK FOR FLUID OVERLOAD HIGHER
•DOES NOT CHANGE ICF VOLUME
•BLOOD PRODUCTS
•COMPATIBLE WITH MOST MEDICATIONS
What is Atelectasis? When does it occur?
collapse of the alveoli
occurs with first 48hrs postop
affects 25% of patients who had abdominal surgery
You need to give 500mL over 3 hours. The drip factor on the tubing package is 15. What is the drip rate?
Drip rate (gtt/min)
= 500mL X 15gtt/ 180min
=42
IN A PATIENT WITH PROLONGED VOMITING, THE NURSE MONITORS FOR FLUID VOLUME DEFICIT BECAUSE VOMITING RESULTS IN WHICH OF THE FOLLOWING CHANGES?
1. FLUID MOVEMENT FROM THE CELLS INTO THE INTERSTITIAL SPACE AND THE BLOOD VESSELS
2. EXCRETION OF LARGE AMOUNTS OF INTERSTITIAL FLUID WITH DEPLETION OF EXTRACELLULAR FLUIDS
3. AN OVERLOAD OF EXTRACELLULAR FLUID WITH A SIGNIFICANT INCREASE IN INTRACELLULAR FLUID VOLUME
4. FLUID MOVEMENT FROM THE VASCULAR SYSTEM INTO THE CELLS, CAUSING CELLULAR SWELLING AND RUPTURE
1.
•FLUID VOLUME DEFICIT OCCURS WHEN THERE IS LOSS OF BOTH SODIUM AND WATER; INTRACELLULAR FLUID MOVES INTO THE INTERSTITIAL SPACES AND BLOOD VESSELS.
What is the formula to Reconstitute Medications?
Dose order/Dose on hand
What is Lactated Ringers?
•ISOTONIC
•MORE SIMILAR TO PLASMA THAN NS
•HAS LESS NACL
•HAS K, CA, PO43-, LACTATE (METABOLIZED TO HCO3)
•EXPANDS ECF
•LIVER CONVERTS LACTATE INTO BICARBONATE…WATCH PH LEVELS AS THEY MAY RISE = ALKALOSIS
What is phase 1 of postop?
The immediate post anesthesia period
-when the patient is emerging from anesthesia and requires 1-on-1 care.
-PACU nurse assesses the patients LOC, breath sounds, respiratory effort, O2 stats, BP, cardiac rhythm, and muscle strength.
-patient being prepared to be transferred to phase 2 or transfer to an ICU or inpatient unit
Instructions on a 2.5 g vial of Diuril reads to reconstitute with 20 ml of sterile water. This will provide a concentration of _________ mg/ml.
125 mg/ml
For a patient who has a cardiovascular condition, what do you do in your nursing assessment Postoperatively?
-ECG monitoring
-Frequently monitor vital signs, usually every 15 minutes until stable
-Compare to baseline
-BP
-Assess apical–radial pulse carefully and report irregularities
-Assess skin colour, temperature, and moisture
What is Gravity?
•Fast way to delivery fluids in emergency situations
•If done correctly, can be a safe alternative when pumps are not available
•Rate may fluctuate depending on IV location and patient’s position
What is D5 1/2 NS?
•HYPERTONIC
•COMMON MAINTENANCE FLUID
•KCL ADDED FOR MAINTENANCE OR REPLACEMENT
What is Phase 2 of Postop?
Continued recovery, when the patient's consciousness returns to baseline and the patient has stable resp, cardiac, and renal functioning.
-many patients can go from the OR and go straight into phase 2 in process known as fast-tracking.
-patient then moves to phase 3, home, or an extended care facility
Administer 50 ml over 30 minutes. What’s the rate?
•50 ml ÷ 0.5 hours = 100 ml/hr
How do you know when a patient is ready for discharge and what do you go over with the patient before they are discharged?
-Patient must be mobile and alert and able to provide a degree of self-care.
-Pain must be controlled.
-Patient must be at or near preoperative functioning.
-Instructions are specific to type of anaesthesia used.
-Verbal and written directions
-Patient may not drive.
-Accompanied by a responsible adult
-Follow-up by phone
What is Pump?
•Best practice and safest option
•Automates processes to reduce errors.
•Soft and hard limits for programming drug rates and amounts.
•Alarms to notify of air and resistance.
What is D10W?
•HYPERTONIC
•PROVIDES 340 KCAL/L
•FREE WATER
•LIMIT OF DEXTROSE CONCENTRATION MAY BE INFUSED PERIPHERALLY
What is Phase 3 of Postop?
Ongoing care for patient needing extended observation and interventions after phase 1 or 2.
-can be 24-hr observation unit or inpatient hospital unit
-care continues until the patient completely recovers from anesthesia and surgery and ready for self-care
•You need to infuse 500 ml of Ringer’s Lactate over 3 hours. Your drop factor is 10 gtt/ml. What’s your drip rate?
•Convert hours to minutes: 3 x 60 = 180 minutes
•(500 ml x 10 ) ÷ 180 min = 27.77
•Round up to 28 gtt/min
You need to give 1000 ml of normal saline over 2 hours. Your drop factor is 20 gtt/ml. What’s the drip rate?
•Convert hours to minutes: 2 x 60 = 120 minutes
•(1000 ml x 20 gtt/min) ÷ 120 minutes 166.66
•Round up to 167 gtt/min