The nurse is caring for a very low–birth-weight (VLBW) newborn with a peripheral intravenous infusion. Which statement describes nursing considerations regarding infiltration?

a. Infiltration occurs infrequently because VLBW newborns are inactive.
b. Continuous infusion pumps stop automatically when infiltration occurs.
c. Hypertonic solutions can cause severe tissue damage if infiltration occurs.
d. Infusion site should be checked for infiltration at least once per 8-hour shift.


ANS: C
Hypertonic fluids can damage cells if the fluid leaks from the vein. Careful monitoring is required to prevent severe tissue damage. Infiltrations occur for many reasons, not only activity. The vein, catheter, and fluid used all contribute to the possibility of infiltration. The continuous infusion pump may alarm when the pressure increases, but this does not alert the nurse to all infiltrations. Infusion rates and sites should be checked hourly to prevent tissue damage from extravasations, fluid overload, and dehydration.

Nursing

You might also like to view...

What guideline should an adult follow when speaking to a toddler?

a. Be at eye level with the child. b. Hold by the shoulders to keep the child's attention. c. Seat the child to focus on conversation. d. Speak in a firm strong voice.

Nursing

A patient is admitted to the critical care unit with the diagnosis of massive head trauma caused by an MVA. The patient is unresponsive and on mechanical ventilation. EEG is negative for brain waves. The family has agreed to organ donation

The nurse turns the patient's head quickly from side to side. The eyes do not move. The nurse knows this is the result of a loss in the a. oculovestibular reflex. c. oculocephalic reflex. b. corneal and jaw reflexes. d. pupillary reflexes.

Nursing

The nurse is caring for a child who is complaining of chronic pain. Which of the following is the priority nursing assessment?

A) How the pain impacts the child's and family's stress level B) The pain's history, onset, intensity, duration, and location C) The child's and parents' feeling of anxiety and depression D) The child's cognitive level and emotional response

Nursing

An associate nurse is educated at which of the following levels?

A) Doctoral level B) Master's level C) Baccalaureate level D) Associate level

Nursing