IV Therapy & Course Orientation—Comprehensive Bullet-Note Guide nur for 172 lec

Course Platform Navigation & Study Aids

CAMS ➜ “Course Hyper-links”
- 5–10 min micro-videos: acid–base balance, electrolytes, IV complications, sepsis, fluid volume, tonicity.
CAMS ➜ “Course Documents”
- Lab check-off sheets (also in workbook).
- Syllabus, lesson plans, extra lab values.
AI Tip
- Highlight weeks in syllabus, paste into ChatGPT: “Create a comprehensive study guide.”

Workbook Overview

Identical to previous editions.
Front matter
- Table of contents, scope of practice chart, IV terminology, complete lab values, National Patient Safety Goals (NPSG).
Back matter
- Case studies, practice questions, med-math review, assorted helpful inserts.
Homework
- Workbook pages for each week; scan & upload via CamScanner.
- Week 1 pages not graded but HIGHLY encouraged—info appears in lecture & quizzes.

Assessment Schedule

All quizzes & exams taken during LAB; quizzes are 20 Q / 30 min.
- Quiz 1 Week 3
- Quiz 2 Week 4
- Exam 1 Week 5
- Quiz 3 Week 6
- Exam 2 Week 8
- Quiz 4 Week 9
- Final Week 10
“100 % on anything ⇒ instructor buys you a handle.”

Evidence-Based Practice & Professional Bodies

INS = Infusion Nurses Society → sets IV standards; LPNs can become members once licensed.
Evidence-Based Practice = current, best-quality research; reject “this is how we’ve always done it.”

Scope of Practice (Ohio LPN, IV-Certified)

Adult (> 18 yr)

- Oral meds: ALL.

SubQ & IM meds: ALL.
Rectal meds: ALL.
Peripheral IV insertion
- Site: ante-cubital fossa ↓ to hand.
- Catheter ≤ 3 inch (7.6 cm).
Maintain central access (PICC/Port/CVL)
- May flush (NS or heparin), change dressing, hang approved fluids/antibiotics.
Multivitamin/electrolyte bags
- RN must hang 1st bag; LPN may hang subsequent bags if no reaction.
May stop ANY infusion that harms patient (e.g., blood, chemo, narcotics) even if not within LPN hanging scope.

Pediatric (< 18 yr)

CAN: oral, SubQ, IM, rectal meds.
CANNOT: start or hang ANY IV solutions.
May remove a peripheral IV (same length/site limits) if complication present.
May adjust pump RATE with specific MD order (e.g., 100 → 150 mL/hr) but may not spike/prime/hang.
May stop harmful infusion.

What LPNs NEVER do

Insert/remove central lines, PICCs, ports.
IV push meds, titrations (“no pushes, no drips”).
Blood products, TPN, chemo, hyperalimentation, investigational meds.

Quick Scope Quiz Answers (from lecture)

Hang antibiotic for 18-yr-old ✓
Insert IV into bicep ✗ (upper arm = off-limits)
Hang NS for 20-yr-old ✓
Remove PICC ✗
Insert IV in metacarpal of 70-yr-old ✓

Nursing Process (ADPIE)

Assessment – LPNs cannot do INITIAL admission assessment but perform ongoing.
Diagnosis – cannot assign NANDA Dx but use critical thinking to hypothesize.
Planning – cannot craft initial care plan; can contribute & update.
Implementation – carries out ordered plan.
Evaluation – reports effectiveness, suggests revisions.

National Patient Safety Goals (NPSG 2023 extract)

Correct patient identification (name + DOB).
Improve staff communication (read-back, teach-back).
Safe medication use.
Alarm safety.
Infection prevention.
Identify patient-specific risks.
Improve health-care equity.
Prevent surgery mistakes.
Created by Joint Commission (oversees Medicare/Medicaid facilities).

Sentinel Events

Definition: death, permanent harm, or severe temporary harm requiring life-sustaining intervention while under facility care.
Common examples
- Wrong patient/site/procedure.
- Retained foreign object.
- Delay in treatment.
- Suicide in facility.
- Major fall with serious injury.
- Operative/post-op complications.
NOT sentinel: minor fall with small bruise; IV not checked but no injury (near miss → incident/occurrence report).

Risk Management & Reporting

Risk Management Department: identifies potential hazards, analyzes trends, implements prevention.
Unusual Occurrence / Near-Miss Report: captures events that COULD have caused harm but did not.

Informed Consent

Physician responsibility to disclose: procedure, risks, benefits, alternatives, provider qualifications.
Nurse role: witness signature, reinforce teaching, assess understanding; may NOT obtain consent for procedures they perform.

Medical Malpractice (4 Elements)

Duty: Nurse accepted patient assignment.
Breach: Failure to meet standard (act/omission).
Injury: Patient harmed.
Causation: Harm directly linked to breach.

Strategies to avoid claims
- Current license & CEUs.
- Maintain competency; use equipment correctly.
- Frequent assessment & documentation.
- Strict infection control; protect from foreseeable harm.

Collaboration & Delegation Chain

LPN collaborates with: MD/DO, RN, PharmD, Lab, Radiology, PT/OT/ST, Dietician, Case Mgmt, Family.
Delegation DOWN to UAP/CNA/STNA only tasks that are:
- She told Non-invasive, routine, predictable.
- No assessment, interpretation, evaluation=—
- Vital signs, capillary glucose, ADLs, catheter bag empty, observe fall-risk pt.

Antiseptics in IV Therapy

Preferred: Chlorhexidine in alcohol (ChloraPrep®) – vigorous 30 s scrub, dry 30 s.
Alternatives
- Povidone-Iodine (for alcohol allergy) – scrub 30 s, dry.
- 70 % Isopropyl pads – quick tasks, ports.

Tonicity of IV Solutions

Clinical Pearls

Avoid hypotonic fluids in:
- Hypotension (↓ BP worsens)
- Increased intracranial pressure / head trauma.
Avoid hypertonic fluids in:
- Hypertension, CHF, renal failure (risk overload).
Lactated Ringer’s = burn resuscitation gold standard.
NS = trauma, blood transfusion compatible.
Dextrose-containing solutions → contraindicated when glucose critically high.

Quick Identification Trick

Memorize isotonic “anchor” list (0.9 % NS, LR, D5W, 5 % Albumin).
Any % < 0.9 % NS or < D5W ⇒ hypotonic.
Any combo/added solute (e.g., D5 NS) or % > anchor ⇒ hypertonic.

CHF Caution Question (lecture)

Which solutions to question in CHF?
- D5 & LR
- D5 NS & LR (both hypertonic or high-volume isotonic)

Special Solutions Outside LPN Scope

Blood components: whole blood, PRBC, platelets, FFP, albumin > 5 %.
TPN (Total Parenteral Nutrition): lipid-rich, $, central line only.

Basic IV Math Refresher

Formula: \text{mL/hr} = \frac{\text{Total Volume (mL)}}{\text{Time (hr)}}

2 L (2000 mL) over 12 h ⇒ \frac{2000}{12}=166.6\overline{6}\;\text{mL/hr}
1500 mL over 24 h ⇒ \frac{1500}{24}=62.5\;\text{mL/hr}
100 mL over 30 min (0.5 h) ⇒ \frac{100}{0.5}=200\;\text{mL/hr}$$
(Pumps accept ONLY mL/hr.)

Ethical Principles Glossary

Autonomy – patient self-determination.
Beneficence – act for patient benefit.
Non-maleficence – “do no harm.”
Veracity – truthfulness.
Fidelity – faithfulness/keeping promises.
Justice – fairness to all.

Beneficence Examples Quiz (answers)

Chlorhexidine scrub before IV insertion ✓
Read-back abnormal lab value ✓
Other listed items ✗

Summary of Key “NEVERs”

NEVER perform procedures beyond training.
NEVER silence alarms without assessing.
NEVER chart in advance.
NEVER bypass hand hygiene or two-identifier rule.

Week-1 To-Do Checklist

Complete Workbook Week 1 (not graded but vital).
Review scope-of-practice chart; draw adult & “Timmy” visual.
Memorize isotonic anchor solutions & tonicity rules.
Organize NPSG & ethical principles flashcards.
Pre-read math chapter; practice mL/hr problems.