Download NUR 1021Week 4 Clin Focus and all IV forms

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.
NUR 1021
IV THERAPY WORKSHEET
Name___________________________________
Instructor___________________________________
Please turn in with homework by date determined by clinical instructor.
A.
IV Rate Calculation:
1. Write doctor’s order for IV as found in the chart (Dr’s Order page)
(This is IV solution, such as LR, D5/W, .45 NS, etc.)
2. Write IV transcription for the same order on the med sheet.
3. Calculate the following: (Show your work using the formulas.)
What is the rate in mL/hour?
What is the rate in gtt/min if the drop factor is 20?
Does the patient have the IV on a controller or pump? Yes
No
If on a controller, what is the rate set at? (This should be mL/hr.)
B.
IVPB Rate Calculation (IV piggyback):
1. Write the doctor’s order for an IVPB medication (such as an antibiotic) from the Doctor’s
Order page in the chart.
2. Write the transcription for that same order as written on the med sheet.
3. Look at the IVPB bag in the patient’s room. How many mL’s are in the bag?
4. Calculate the following: (Show your work, using formulas.)
What is the rate in mL/hour?
What is the rate in gtt/min if the drop factor is 20?