Online Module

I. Title: Intravenous therapy, preparing, maintaining and discontinuing

II. Introduction: Fluids and electrolytes maybe replaced through the infusion of fluids directly into
the veins (intravenous) rather than via digestive. Parenteral replacement may include
parenteral nutrition, IV fluid and electrolytes and blood or blood components. In this model,
the learners will attain knowledge in setting up, maintaining and discontinuing IV therapy.
Learning Objectives: At the end of the module, the learners will be able to:
 Discuss purpose and procedure in the initiation and maintenance of IV fluid therapy
 Calculate the intravenous flow rate.
 Explain how to change intravenous solution and tubing and how to discontinue and
infusion.
 Describe potential complications of intravenous therapy and interventions to
prevent them.

III. Instruction to the user: The Self-instructional module serves as a tool that provides guidance on
the learners in acquiring knowledge and skills in assessing clients with abnormal skin, hair and nails
finding. This module consists of discussions, evaluation tests and learning activities to guide you all
throughout the process of learning. It is important to do all the tasks under this module to achieve
better understanding of the topic.

IV. Pretest: (Enumeration)

1. Identify 5 complications of intravenous therapy and its appropriate nursing intervention.
(5 points)
2. Identify 5 equipment for setting-up an IV. (5 points)
3. Identify the different IV Fluids and its purpose. (6 points)

V. Discussion

Case: A 64-year-old Johnson County man went to a Brookside spa for an intravenous infusion
of vitamins — a holistic treatment that’s becoming trendy despite skepticism from the medical
establishment.

It was the 12th infusion he’d had in the previous three months. But this time was different.

About 10 minutes after the IV started the man felt like his skin was crawling. He started
throwing up. The IV was stopped and he went home, where the vomiting continued and he spiked
a fever of 103 degrees. The next morning he was admitted to the University of Kansas Hospital
with symptoms of organ failure.Three days later he died.
Definition:

 The goal of intravenous therapy is to correct or prevent fluid and electrolyte imbalance
disturbance.
 It allows for direct access to vascular system permitting the continuous infusion of fluids over a
period of time.
 To provide safe and appropriate therapy, nurses need to be knowledgeable about the solution,
the reason why the solution was ordered, equipment needed, procedures required, how to
regulate infusion, maintaining the system and discontinuing the IV

Types of solution
isotonic solution 
 Have the same effective osmolality as body fluids.
 Often used to restore vascular volume
Hypotonic solution
 Have a lesser concentration of solutes
Hypertonic solution 
 Have an effective osmolality greater than body fluids.
D5n5, d5/2ns, D5LR
Equipments:

 
 

Needle Gauge:
  16 Gauge: This size is mostly used in the ICU or surgery areas. This large size enables many
different procedures to be performed, such as blood administration, rapid fluid administration,
and so forth.
 18 Gauge: This size allows you to do most tasks that the 16 gauge can, but it large and more
painful to the patient. Some of the common uses include administering blood, pushing fluids
rapidly, etc. 
 20 Gauge: This size is better for patients with smaller veins.
 22 Gauge: This small size is good for when patients won’t need an IV long and aren’t critically ill.
 24 Gauge: This size is used for pediatrics and is usually only used as a last resort as an IV in the
adult population

Tubing Lines:
 Main IV line, used in continuous infusion flow through the tubing and connects directly into the
IV tubing.
 Secondary intravenous (IV) infusions are a way to administer smaller volume-controlled
amounts of IV solution (25-250 mL). ... 
 The secondary solution bag is typically hung higher than the primary infusion bag and is
subsequently "piggybacked" on top of the primary IV infusion
IV Sites:

 Site chosen for venipuncture includes:

 Client’s age
 Length of time
 Type of solution used and the condition of veins

Regulation of the IV flow rate:

Number of drops delivered per milliliter of solution varies with different brands and type of infusion set.
The rate is called Drip factor or sometimes called drop factor.
2 methods:
Number of ml to be administered in 1 hour (ml/hr)
Number of drops to be given for a minute (gtt/min)

Factors influencing flow rate:

 Position of the forearm
 Position and patency of the tubing
 Height of the infusion bottle
 Infiltration of fluid leakage
Maintaining the IV line:

 Keeping the system intact and sterile

 Changing IV Fluid containers, tubing and contaminated site
 Helping client with self-care activities
 Monitor complications of IV
Changing IV fluid and tubing:
  Patients receiving IV therapy over several days required periodic change.
 A sterile dressing over an IV site reduce the entrance of bacteria
Complications of IV therapy:
1. Circulatory Overload
2. Extravasation
3. Infiltration
4. Phlebitis
5. Local infection
6. Bleeding venipuncture site
Procedure:

See attached Checklist

Nursing diagnosis

 Ineffective Health Maintenance related to lack of hygienic care of the skin, hair and nails
 Impaired skin integrity related too immobility and decreased circulation
 Impaired skin integrity related to poor nutritional intake
 Disturbed body image

VI. Learning Activities: Draw and label the IV set-up.

VII. Summary:
Many adult hospital inpatients need intravenous (IV) fluid therapy to prevent or correct problems with their
fluid and/or electrolyte status. Deciding on the optimal amount and composition of IV fluids to be
administered and the best rate at which to give them can be a difficult and complex task, and decisions must
be based on careful assessment of the patient’s individual needs.

VIII. Self-check test and Evaluation

Post-test:
1. A nurse assesses pain and redness at a vascular access device site. Which action is taken first?
a. Apply a warm, moist compress c. Monitor the patient’s BP
b. Aspirate the infusing fluid form the site d. Stop and discontinue the infusion
2. Which assessment does a nurse interpret as a transfusion reaction?
a. Crackles in the lungs c. High fever and anxiety
b. Itching and confusion d. Chills tachycardia and flushing
3. Place the following steps for discontinuing IV access in the correct order:
a. Perform hand hygiene c. Explain procedure to the client
b. Remove IV site dressing and tape d. stop infusion and clamp tubing
e. check physicians order f. Clean the site and withdraw the catheter to
apply pressure.
4. Order: 3000 mL is infused in 24 hours, the number of milliliter per hour is?
5. Order: 1000 mL in 8 hours and the drip factor is 20 drops/ mL the drops per min should be?
(label)

IX. Answer sheet

Pretest:

Complications:

1. Circulatory Overload
2. Extravasation
3. Infiltration
4. Phlebitis
5. Local infection
6. Bleeding venipuncture site
Fluids:

isotonic solution 
 Have the same effective osmolality as body fluids.
 Often used to restore vascular volume
Hypotonic solution
 Have a lesser concentration of solutes
Hypertonic solution 
 Have an effective osmolality greater than body fluids.
D5n5, d5/2ns, D5LR

Multiple choice:

1. A and D
2. D
3. E A C D F