IV Lab
Diagnosis
Priority
Assessment
Medications
Patient Education
100
A nurse needs to calculate the manual IV infusion rate for 250 mL of isotonic solution using microdrip tubing with a drop factor of 60 gtt/mL, with orders to infuse over 2 hours. What should be the rate in gtt/min?
125 gtt/min
100
- A patient reports high fever, myalgia, extreme fatigue and dry cough.
o What is Influenza?
§ Virus (A, B, C) that affects the nose, throat, lungs and spreads through respiratory droplets
§ CM: high fever, chills, myalgia, dry cough, sore throat
§ Diagnostics: viral culture, rapid flu test
§ Medications: antivirals, antipyretics
§ Patient Education: rest, hydration, isolation (droplet) patient wears mask outside of room, hand hygiene, report worsening SOB
100
• A patient who has stage III breast cancer comes in for a live influenza vaccine.
• What is stop the medication administration, f/u with provider, educate patient?
• Inactivated influenza injection: contraindicated for those with an egg allergy
• Live nasal spray: contraindicated for:
• Pregnant
• Ages: <2, >50
• Immunosuppression (HIV, chemo)
• Chronic disease (asthma)
• Recent live vaccine admin
• Aspirin therapy
100
• This lung sound is described as high pitch and indicates obstruction.
• What is stridor?
• Stridor is a medical emergency and indicates obstruction
• Crackles indicate fluid (crackling, popping sound)
• Rhonchi indicates secretions (low pitched snoring)
• Wheezing indicates a narrowing of the airways (high pitched, musical, whistling sounds)
100
• Class AND name of medication given first during an asthma attack.
• What is bronchodilators, short-acting beta agonists?
• Albuterol
• Immediate relief
• Side effects: heart racing, jittery, shaky, dry mouth as the result of an increased sympathetic response
100
• HAP interventions:
• What is:
• IS use
• Increase HOB
• Oral care at least twice per day
• Ambulation 3x per day
• Eating meals at chairs
• Pulmonary hygiene to promote airway clearance
• CAP: hand hygiene, avoid sick contacts, rest, small frequent meals, medication compliance, avoid irritants, follow up with MD
200
The nurse is planning to change the IV solution for a client whose solution bag currently runs at 50 mL/hr using a volume-controlled pump. The goal is to increase to 75 mL/hr. How much additional fluid would be infused over the next 6 hours?
150 ml/hr
200
· A long term, irreversible lung disease that obstructs airflow and makes breathing progressively harder.
o What is chronic obstructive pulmonary disease (COPD)?
§ Irreversible lung damage caused by smoking, air pollution, occupational hazards or genetics
§ Types: Chronic bronchitis: inflammation of bronchioles and bronchi, emphysema: destruction of alveoli over time
§ CM: chronic cough with thick sputum, increased WOB, SOB on exertion, tripod position, wheezing, fatigue, barrel chest, finger clubbing
§ NI: smoking cessation, reduce risk factors, vaccinations avoid sick people, medication compliance, activity vs rest gradual activity paced breathing pulm rehab rest and sleep, nutritional support small frequent meals, high calorie, high protein and healthy fats, avoid bloating and gas producing foods
200
• Patient who has COPD is reporting SOB. When assessing the patient, the patient is lying flat with oxygen saturation at 90%.
• What is lift the head of the bed?
• Semi to high fowlers
• Increasing the HOB helps open the airway and expand lung volume
200
• This is one example of a sign of early hypoxia. This is one example of a sign of late hypoxia
• Early: restlessness, anxiety, tachycardia
• Late: bradycardia, extreme restlessness, dyspnea, cyanosis, confusion
• NI: apply oxygen, raise HOB, stay with patient, notify MD
200
• Name 2 main classes of medications for COPD and the reason why a patient takes them.
• Bronchodilators- relax smooth muscle bronchioles and bronchi
• Inhaled corticosteroids-reduce inflammation and exacerbations
• Anticholinergics- relax and open bronchi airways (preventing airway constriction by blocking acetylcholine
200
• What is postural drainage/chest physiotherapy?
• Airway clearance to help loosen up mucus and remove from lungs
• Patient is encourage to cough
• Needs to be done daily, multiple times
• Be cautious of clothing (zippers, buttons)
• Encourage hydration
300
A client’s IV infusion rate is ordered at 200 mL/hr but needs adjustment to 150 mL/hr based on clinical conditions. After 4 hours at the new rate, how much fluid will the client have received in total?
600 ml
300
· Patient reports frequent respiratory infections, poor weight gain and foul smelling stools.
o What is cystic fibrosis?
§ Genetic disorder that affects exocrine glands causing sticky mucous production in lungs, pancreas and other organs
§ CM: chronic cough with thick sputum, wheezing, frequent lung infections, SOB, increased WOB, possible clubbing, fatty stools/steatorrhea, poor weigh gain, constipation, intestinal blockages, discomfort, bloating, salty tasting skin
§ Treatment: medication compliance, early diagnosis, chest physiotherapy multiple times daily before meals to loosen mucus,
o What is cystic fibrosis?
§ Genetic disorder that affects exocrine glands causing sticky mucous production in lungs, pancreas and other organs
§ CM: chronic cough with thick sputum, wheezing, frequent lung infections, SOB, increased WOB, possible clubbing, fatty stools/steatorrhea, poor weigh gain, constipation, intestinal blockages, discomfort, bloating, salty tasting skin
§ Treatment: medication compliance, early diagnosis, chest physiotherapy multiple times daily before meals to loosen mucus,nutritional support (high calorie, high protein, vitamin supplements), infection prevention
300
• Your new patient diagnosed with community acquired pneumonia has this medication due on their MAR.
• What is IV antibiotics?
• Given after sputum culture (morning collection, no eating before, rinse mouth)
• Early initiation
• Medication admin rights, allergies
300
• A patient has this GI condition placing them at risk for laryngeal cancer.
• What is GERD?
• RF: long term tobacco, ETOH abuse, GERD
300
• Name 2 classes of medications for patients with cystic fibrosis.
• Bronchodilators
• Mucolytics
• Pancreatic enzymes
• CFTR modulators- target specific defects caused by the mutation in the CFTR gene
• Anti-inflammatories
• Antibiotics
• Fat soluble vitamins
300
• Patients with TB are considered not infectious after this.
• What is 3 negative AFB sputum cultures?
• Typically 2-3 weeks after consistent treatment; must take medications as prescribed to avoid drug resistance
• Avoid crowded places, use respiratory hygiene
• Keep windows open, ensure proper ventilation at home
400
A nurse is infusing IV fluids through a peripheral IV site and notices the surrounding tissue is puffy and swollen, the skin is taut, and the infusion pump shows no occlusion alarm. The patient rates pain as a 2/10 at the site. What complication is occurring and what should the nurse do first?"
Complication: Infiltration-IV fluid leaking into surrounding tissue.
Action: Stop IV infusion, DC IV, restart at a new site. Elevate the extremity and apply warm or cold compresses per facility policy.
400
· A patient who is s/p extubation develops a fever, tachypnea, pleuritic chest pain and a productive cough.
o What is hospital acquired pneumonia?
§ CAP, HAP (48 hours after admission), VAP (s/p ventilation), aspiration pneumonia (s/p aspiration)
· RF: recent antibiotics, poor oral cleaning, chronic disease, treatment in a healthcare facility, immunosuppression, chronic disease
· Viral, bacterial
§ CM: fever, chills, tachypnea (higher the number the worst it is), productive cough (green, purulent, yellow, white), chest pain, crackles, fatigue, elderly present with confusion
§ Treatment: diagnostics (sputum sample collected in morning after rinsing out mouth THEN IV antibiotics, pulmonary hygiene, ambulation (meals at chairs), rest, small frequent meals, HOB propped up, finish antibiotics, f/u MD
400
• A patient who tested positive for TB 3 weeks ago is slotted for admit in room 375A.
• What is implement airborne precautions?
• Negative pressure room. UNLESS they have 3 negative AFV sputum cultures.
400
• Name 2 respiratory clinical manifestations of cystic fibrosis
• What is:
• Chronic cough
• Thick sputum
• Wheezing
• Frequent lung infections
• SOB
• Increased WOB
• Possible clubbing
• Other: salty skin, steatorrhea, poor weight gain, constipation, discomfort, bloating
400
• Name the 2 classes of medications a patient with TB takes AND for how long.
• Antibiotics, antitubercular, 9-12 month therapy
• Table 24.11
400
• This device helps patients monitor asthma control at home.
• What is peak flow meter?
• Need to measure daily
• Less than 20% of best indicates possibility of airway variation
• Utilize personal best and current reading (ex. 500 is personal best, reading today is 450, 90%)
• Read as L/min
• If less than 20% of best, utilize rescue inhaler then reassess
500
A nurse is assessing a patient's peripheral IV site and notes redness, warmth, and tenderness tracking along the vein above the insertion site. The site is not swollen and the fluid is infusing well. What complication should the nurse suspect and what is the priority action?"
This is phlebitis — inflammation of the vein wall. The nurse should discontinue the IV and restart at a new site. Apply a warm compress to the affected area, document the finding, and monitor for signs of infection.
500
· A patient with latent TB now reports weight loss, night sweats, chronic cough with hemoptysis, SOB, chest pain and a fever. These symptoms are a result of:
o What is immune system compromise?
§ HIV, DM, sepsis, renal disease, malnutrition, corticosteroid use
§ Primary (initial infection) inhaled bacteria in which the immune system responds, latent with live bacteria but inactive, active contagious
§ NI: airborne precautions, medication compliance, nutrition, patient education
500
• You check on your patient with asthma who just had a breathing treatment
• What is relisten to lung sounds?
• Recheck lung assessment, vital signs after intervention
• Silent lung sound is BAD, no airflow movement
500
• A 10 mm or greater Mantoux Test reading is positive for?
• What is:
• Immigrants from high prevalence countries, healthcare workers, IV drug users
• >15mm: positive for all
• >5mm: HIV, recent contact with HIV, immunosuppressed
• Indicates exposure, not if the TB is active
• Read 48-72 hours after intradermal insertion
500
• MDI steps
• Remove cap.
• Shake inhaler.
• Breath out and place lips sealed on mouthpiece.
• Press the canister once.
• Take a deep, slow breath.
• Hold for 10 seconds, breath out.
• Breath in again.
• Wait 1 minute in between puffs.
• Rinse mouth out (especially for corticosteroid)
• Replace cap.
500
• When providing dietary recommendations to a patient with COPD, the nurse encourages this diet.
• What is high calorie, high protein, healthy fats?
• Helps with energy and muscle maintenance
• Avoid gas producing foods for bloating
• Small, frequent meals to reduce dyspnea during eating