Case Study: IV Therapy Today you are assigned to care for Mrs. Billing who is admitted with dehydration and sepsis. She is 75 years old and has been a resident at an extended care facility for 2 years. She has a history of diabetes and heart failure. She is pale and looks very frail. Her blood pressure is 88/52, pulse is 102, respirations 22, temperature is 100.4. The physician has ordered intravenous fluids and antibiotics. Answer the following questions. Orders: Start an intravenous infusion of 0.9% sodium chloride at 100 ml per hour for 12 hours, then change to 5% dextrose in .45 sodium chloride with 20 meQ KCL at 75 ml per hour. Cefotoxin 1 gm IVPB Q 8 H
What type of solution is being started initially? A. Isotonic B. Hypotonic C. Hypertonic
What is the rationale for this solution? A. To lower blood pressure and improve vascular volume B. To increase vascular volume and raise blood pressure C. To help lower the temperature D. To help hydrate the cells
What size catheter should the nurse use to initiate the intravenous solution? A. The largest one that fits the vein B. No larger than a 25 or 26 gauge C. For elderly usually a 20 or 22 gauge D. Any size is appropriate
During the initial attempt at cannulation, the nurse notices swelling and bruising at the insertion site. This is called: A. Infiltration B. Extravasation C. Hematoma D. Phlebitis
The most appropriate intervention by the nurse is to: A. Apply direct pressure B. Call the physician C. Apply ice D. Call the IV start team
The nurse suspects hypersensitivity after administering the IV medication. The most appropriate action is: A. Stop the infusate, discontinue the IV and call the physician B. Slow the infusate and administer epinephrine C. Discontinue the IV and restart in the other arm, document D. Stop the infusate, keep the vein open, call physician and monitor vitals
After several days of therapy, Mrs. Billing recovers and the infusion is converted to a saline well.
The purpose of this is to:A. Maintain an access without fear of fluid overload B. To keep a route for antibiotics C. To keep a route for prn meds D. All the above
