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Example test question for 2nd year Health Priorities in Nursing subject (any ideas???)

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Author Example test question for 2nd year Health Priorities in Nursing subject (any ideas???)

Koukla

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  • Joined: Apr 2011
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Wed Jun 01, 2011 1:06 am

Studying Bachelor Year 2, this week studying for next week exam.I have a question typical of the type I will get in the exam and was wondering if anyone had any advice in how to answer it.

Question:You are preparing a new IV infusion for a patient with congestive cardiac failure. The order states Normal Saline 1000ml with 2g of Potassium Chloride over 24hrs. Your preceptor instructs you to put a burette into the line as there are no infusion pumps available. Why would she ask you to do this? Please explain the underlying rationale with regard to the infusion and the patient diagnosis?

Answer: (this is what I think, but wondering if anyone can elaborate/give me another idea/further clarification)Burette allows mixing and dilution of drug before administration, burette is a reservoir that is either incorporated into / added to the administration set, it holds 100 - 150mls, some hospital policies require pumps / burettes be used in certain situations, eg infusion running over >12hhrs / infusion with additives.

Was wondering if this added safety measure has anything to do with fluid restriction and congestive heart failure or perhaps I'm completely off track and I'm not sure what to add regarding the Potassium Chloride why is it necessary to use a burette with this medication?

ANY HELP MOST WELCOME!!!

Schizo

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  • Joined: Jan 2009
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Jun 01, 2011, 10:20 am

Koukla, you are partially correct but if you read your question, the order is for 2g potassium in 1000 mls which means you CANNOT dilute potassium to the desired order since the burette only holds just over 100 mls.

It is not uncommon for us to re-constitue medication into 10-20 mls of fluids (water for injection or Saline), draw out the same amount from the bag of saline to be discarded and then inject the re-constituted solution back into the bag to make up to the exact volume.

Patents with congestive heart failure are USUALLY on fluid restriction to reduce cardiac workload and hypertension. Also because Potassium is a dangerous electrolyte when infused too quickly, your answer would be for the burette to control volume of infusion. All the more so when there's no infusion pump to titrate the rate. Drip rates are notoriously difficult to set AND MAINTAIN consistently at the set rate. The absence of a burette could allow for rates to be titrated too quickly and the burette with the air intake unclamped will ensure that it will not continuously draw down on the solution. I would say that the burette serves as a safety device in the absence of an infusion pump. Also with titrating potassium, it is very very rare to include any other additives to the burrete during the infusion. If the pt has a PICC line, then start another bag and hook the additional meds to the unused bungs (different lumen, different exit point in the PICC line)

As to why potassium is dangerous, potassium is required for muscle activity and in heart failure it is required to "assist" the heart in maintaining contractility, however overdosing would cause hyperkalemia which in turn can cause arrhythmias, last thing you want to do for a cardiac failure pt.

Sometimes we use subcut fluid orders for patients not sufficiently hydrated and in these cases we do not use infusion pumps, instead we use a burette and titrate to 14 dpm which equals to 42 mls per hour, the optimum rate for fluids to absorb via the subcutaneous layer. Because as i have mentioned, controlling drip rate is a pain in the nether world, we use the burette to prevent excessive overload.

Hopes this helps...all the best dude..lol

Koukla

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  • Joined: Apr 2011
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Jun 02, 2011, 01:12 am

Schizo, you're more than a gem! Thanks heaps :)

MissChezz

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  • Joined: May 2011
  • Location: Brisbane
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Jun 02, 2011, 02:24 pm

Listen to you guys - I can't wait to learn all this stuff. Schizo - I may be stalking you next year for help lol. Koukla - good luck on your exam, I'm sure you'll do fine.

Cheers,

Cheryl

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