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CLINICAL FOCUSES – WEEK 4 CLINICAL PREP: (This top section should be completed prior to your first clinical day.) 1. Download Clinical Homework Forms from Canvas. 2. Get patient assignment. 3. Complete Patient Data form and Trending Sheet. Complete timeline for day one. (Day two will need to be completed for Friday morning.) 4. Complete a Medical or Surgical Diagnosis sheet for this patient’s primary diagnosis. 5. Complete a Secondary Diagnosis sheet for other patient diagnoses for which the patient is receiving medications. 6. Begin Assessment Booklet (if applicable). 7. Bring all of the above, your clinical packet, and the Gulanick Nursing Care Plans book to clinical each week. _____________________________________________________________________________________ CLINICAL FOCUSES: Continue previous focuses. IVs/Fluid Balance: 1. Monitor and/or discontinue IV infusion. 2. Describe hospital policy regarding IV infusions and student nurse responsibilities. POST-CONFERENCE TOPICS Discuss SN role with observing IV sites, review IV pumps, etc. Complete IV fluids review exercise (handout). Complete IV Therapy rate calculations (handout). Practice locating and identifying the s/c & IM sites 3. Identify and report signs and symptoms that may indicate an IV infiltration or phlebitis. 4. Describe the rationale for the type of IV fluid your patient is receiving. 5. Evaluate adequacy and balance of I & O based on related principles of fluid balance. 6. Assess for symptoms of fluid volume deficit and fluid overload. 7. Determine the correct IV pump settings for the IV therapy ordered for your patient -----------------------------------------------------------------------------------------------------------------------------------------HOMEWORK (due the Monday of Week 4 by 0959) 1. 2. 3. 4. 5. 6. 7. 8. Journal per “Clinical Journal Guidelines”. Skill’s List – updated. Patient Data Form and Trending Sheet completed on this patient. Medical or Surgical Diagnosis sheet(s) completed on this patient. Secondary Diagnoses sheet completed on this patient. Assessment Booklet completed on this patient (if applicable). Teaching care plan (if applicable). Students completing surgical and other observations for this week: - Objectives for each day - Journal per “Clinical Journal Guidelines” - Article summary with attached article NUR 1021 IV THERAPY POST-CONFERENCE ACTIVITY General Questions: 1. Why are IV fluids given? 2. Differentiate between peripheral IV lines and discuss central lines that may be seen on the medical-surgical unit. 3. What are nursing assessments associated with patients receiving IV therapy? 4. What does the word osmolarity mean? 5. What is meant by the word hypotonic? 6. What is meant by the word hypertonic? 7. What is meant by the word isotonic? 8. What is phlebitis and what are the signs of phlebitis? 9. What is infiltration? Isotonic Fluids Hypotonic Fluids Hypertonic Fluids Other D5W: 0.45% NS: Remember that the dextrose in this solution is rapidly metabolized, then the solution becomes hypotonic. That is why this is usually contraindicated in patients with actual/risk for increased intracranial pressure. The most commonly used hypotonic solution. D5/LR, D5/NS: Colloids—have large molecules and do not pass through semipermeable membranes. (D5W is also contraindicated for routine fluid resuscitation, since giving large volumes can cause hyperglycemia.) Normal Saline (0.9% NaCl): Often used to increase ECF volume. Not used for patients with actual/risk for fluid volume excess, such as CHF and pulmonary edema. Other Isotonic Solutions: Include Lactated Ringer’s (LR)—contains sodium chloride, potassium, and calcium. Often used to correct dehydration and sodium depletion. It replaces intracellular fluid and helps provide extra water to help the body rid itself of wastes. Because it pulls fluid out of intravascular spaces, it can cause decreased BP. Because it pulls fluid into body cells, it can cause cell edema and cell damage. Combining the D5 with the LR or NS makes these solutions hypertonic. But remember the dextrose in the D5 is rapidly metabolized. D50 (50% dextrose in water): Very hypertonic and used for rapid elevation of blood glucose. Include dextran and artificial blood substitutes. Blood products: Whole blood, packed red cells, albumin, cryoprecipitate. TPN: Contains hypertonic dextrose, electrolytes and other minerals. May contain multivitamins. Insulin may be added if needed to keep the patient’s blood sugar within normal ranges. Lipids are usually combined with other TPN solutions in adults but given as a separate (and simultaneous) infusion in pediatrics. Children metabolize the lipids more slowly and may be at increased risk for TPNinduced cholestasis, so the lipid infusion in children is carefully calculated for each patient. MARION TECHNICAL COLLEGE NUR 1021 IV THERAPY WORKSHEET Name ______________________________ Instructor _______________________________ Please turn in with homework by date determined by clinical instructor. Obtain this information from an IV on your patient or another patient on your unit. 1. Location of IV ________________________________ 2. Type of IV Peripheral _____ Central Venous Catheter ___ PICC ___ Implanted port____ Other ______ 3. Is the IV access a PRN adaptor?_________________ a. Find the hospital’s policy for care of a prn adaptor site and describe the routine of care: ____________________________________________________________ 4. Write the physician orders for the IV as found in the chart (Orders or MAR) on the line below. ___________________________________________________________ 5. What is the present IV fluid infusing (include any additives) _______________________ 6. Calculate the following: (Show your work using the formulas) a. Rate in mL/hr____________________ b. Rate in gtt/min if the drop factor is 10______________________c. Is the IV on a pump? ______________ d. If on a pump, what is the rate set at? ______________ (should be mL/hr.) 7. Inspect and describe the IV site and the dressing in place over the IV site. 8. Is the IV fluid? Hypotonic _____ Isotonic _____ Hypertonic _____ 9. Describe hypotonic fluid. What is/are the purpose(s) of hypotonic IV fluids? 10. Describe isotonic fluid. What is/are the purpose(s) of isotonic IV fluids? 11. Describe hypertonic fluid. What is/are the purpose(s) of hypertonic IV fluids? IVPB (IV Piggyback) CALCULATION 1. Write the doctor’s order for an IVPB medication (as an antibiotic) from the doctor’s orders. ___________________________________________________________________ 2. Check the IV medication bag in that is being administered on the patient’s IV pump. How many mL’s are in the IV medication bag? __________________________ 3. Describe the correct set-up for the IV Primary & Secondary bags when administering an IVPB medication: __________________________________________________________________________ __________________________________________________________________________ 4. Calculate the following for the IVPB medication: (Show your work using the formulas) a. What is the rate in mL/hr? _________________ b. What is the rate in gtt/min if the drop factor is 20? ______________ MARION TECHNICAL COLLEGE NUR 1021 IV THERAPY WORKSHEET – SCORING RUBRIC Name ______________________________ Instructor _______________________________ Criterion Points available Location of IV 1 Type of IV 1 PRN Adaptor care routine 1 Correctly transcribes the physician order for the IV 1 IV fluid infusing including any additives 1 Calculation of IV rate: mL/hr; gtt/min 2 Describes the appearance of the IV site and the dressing in place over the IV site. 1 Indicates whether the IV fluid is hypotonic, isotonic, or hypertonic 1 Describes hypotonic fluid and its purpose(s) 2 Describes isotonic fluid and its purpose(s) 2 Describes hypertonic fluid and its purpose(s) 2 Correctly transcribes the doctor’s order for an IVPB medication 1 Identifies the correct amount of fluid IVPB med is prepared in 1 Set-up of Primary & Secondary IV bags 1 Calculation of IVPB rate: mL/hr; gtt/min 2 Points given Comments Overall score: _____________ S ___ U ___ This assignment is scored for a maximum of 20 points. These points are not added to the course grade but are used to determine if the assignment is satisfactory or unsatisfactory. 15 points must be earned for the assignment to be satisfactory.