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Advanced SkillsFluid & Electrolytes and Medication SafetyC. IV Initiation and Management1. IV start 2. IVPB administration3. Volume Control4. PCA Pumps5. VenipunctureLearning Objective-Demonstrate the correct procedure of collecting blood by venipuncture.Describe the nursing responsibilities for processing blood specimens after collection.Identify the proper tubes to be used for specific laboratory tests.Discuss conditions and potential complications of IV therapy.Describe considerations to be included in selection of a venipuncture site including common veins used for insertion.Identify types of cannulas used for venipuncture and describe considerations in the selection of each.State variations in venipuncture technique, site selection, equipment and stabilization.Discuss types of equipment and solutions used for IV infusion.Discuss various intravenous access devices, PICC lines, central lines, and peripheral lines.Describe special precautions for maintaining the integrity of IV systems with infants and children.Demonstrate the procedure for initiating and managing IV infusions, including changing bag and tubing, adding medication, time taping, and calculating drip rate.Calculate the drops per minute and milliliters per hour of IV solutions and small volume IV piggybacks.Demonstrate the procedure for calculating dosages of medications delivered by infusion over a specified time period. Identify compatibility considerations in preparing and administering IV fluids and medication.Identify the rationale for difference in rate of infusion for IV solutions containing medications.State the purpose of a controlled volume administration set.Apply the nine cardinal rules of safety in preparing and administering IV drugs:Five patibility.Length of administration time.Amount of medication added.Dilution of solution.State the advantages and disadvantages of using intermittent infusion devices/peripheral lock.Explain the rationale for flushing the heparin lock with saline or with a heparin solution.Demonstrate the procedure for administering and managing and IVPB medication through a peripheral lock or existing IV line.Required Text and Resources: Yoost & Crawford (2016) Fundamentals of Nursing, Chapter 34, 35 & 39Burchum & Rosenthal (2016). Lehne’s Pharmacology for Nursing Care. Applicable chapters.Lehne’s Pharmacology Online for Nursing Care (2016). Drug Handbook. Applicable sections.Mosby video series. Nursing Concepts Online. Advanced Skills – Medication Safety and Fluid & Electrolyte, IV TherapyPracticum:Practice collecting blood via venipuncture on the blood task trainers in the Skills Lab.Practice starting IVs on blood task trainers in the Skills Lab.Practice using an IV pump to administer IV fluids.A drug book with IV considerations is required for check-off and in clinical.Have two peers review your ability to start and discontinue a peripheral IV and calculate administration rates for IV fluids using ml/hr and gtts/hr.Have an instructor evaluate your ability to start and discontinue a peripheral IV and calculate administration rates for IV fluids using ml/hr and gtts/hr.Have two peers review your ability to administer IV medication via a peripheral lock device and IV infusion line.Have an instructor evaluate your ability to administer IV medication via intermittent infusion device and/or IV infusion line in a group.Have two peers review your ability to convert an IV infusion line to a peripheral lock.Have an instructor evaluate your ability to convert an IV infusion line to a peripheral lock in a group.Document the IV start in the EHR.D. Blood Administration and IV PushLearning Objective-State four purposes for administering a medication IV Bolus.Explain why IV bolus is the most dangerous method of drug administration.Identify how to administer IV bolus medication through a peripheral lock and existing IV line.Identify potential complications for patients receiving IV bolus medications. Identify actions to correct complications for patients receiving IV bolus medications.State the result of too rapid infusion of an IV push medication. State key nursing considerations for IV administration of the following medications:Digoxin (Lanoxin).Furosemide (Lasix).Meperidine (Demerol).Metoclopramide (Reglan).Methylprednisolone (SoluMedrol).Morphine sulfate (Morphine).Phenytoin (Dilantin).Please include: Generic and Trade names; Classification; Actions; Indications; Dosage; Adverse effects/Contraindications; Interactions with labs and other drugs; Nursing Interventions/Considerations and Patient teaching needs. List risks associated with blood transfusions.Describe safety precautions in checking blood products prior to administration.Identify compatibility considerations in administering blood products.State the protocol necessary to obtain blood products in the hospital setting.State the baseline data to be obtained prior to transfusion.State signs and symptoms that can indicate adverse reactions to blood.Identify nursing actions to be done if an adverse transfusion reaction is suspected.Explain the indication for use of pressure sleeves and blood warming devices in administering blood products.Required Text and Resources: Yoost & Crawford (2016). Fundamentals of Nursing, Chapter 35 and39Burchum & Rosenthal (2016). Lehne’s Pharmacology for Nursing Care. Applicable chapters.Lehne’s Pharmacology Online for Nursing Care (2016). Drug Handbook. Applicable sections.Mosby video series. Nursing Concepts Online. Advanced Skills – Medication Safety and Fluid & Electrolyte, IV Therapy and Blood TransfusionPracticum:Practice administering IV bolus medications via a peripheral lock device and an IV infusion line.Be prepared to answer specific questions listed on sample IV push order page in syllabus.Document the procedure in EHR for evaluation.Review procedure for patient controlled analgesia and have a peer review your understanding.Practice inspection of blood products and administration of blood products using the Y-set.Have two peers review your technique in administering blood using checklist in syllabus.Have an instructor evaluate your techniques in blood administration in a group.Answer blood transfusion questions provided in syllabus and be prepared to answer these questions during the instructor checkoff.Document the procedure in the EHR for an instructor to evaluate.E. Central Lines1. TPN2. Flushing portsLearning Objective-Define Total Parenteral Nutrition (TPN) and hyperosmolarity.Describe clinical situations in which hyperalimentation may be indicated.Identify potential complications for patients with subclavian or jugular lines.Identify complications for patients receiving TPN or hyperalimentation and nursing actions to prevent these complications.Describe the purpose and complications of flushing unused ports in a multi-lumen catheter.Demonstrate care of a central line catheter including changing solution, tubing and dressing changes. Change the IV solution and Tubing for Central Venous Catheter.Flush unused ports.Required Text and Resources: Yoost & Crawford (2016). Fundamentals of Nursing, Chapter 30 and 39Lewis (2014). Medical-Surgical Nursing (9th ed.), Chapters 17, 40Mosby video series. Nursing Concepts Online. Advanced Skills – Fluid & Electrolyte, Parenteral NutritionPracticum:Practice changing a central line catheter dressing and changing the IV solution with new tubing/ports and flush unused ports.Have two peers review your technique in changing a central line catheter dressing and changing the IV solution, tubing/ports, and flush unused ports, using checklist in syllabus.Have an instructor evaluate your technique in changing a central line catheter dressing, changing the IV solution, tubing/ports, and flush unused ports.Document the solution, tubing/ports and dressing changes in the EHR. ................
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