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)

1. Duty: Nurse accepted patient assignment.
2. Breach: Failure to meet standard (act/omission).
3. Injury: Patient harmed.
4. 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:
  • 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

| Category | Effect on Fluid Shift | Examples |
|———|——————————————|————————|
| Isotonic | No net shift; expands intravascular volume | 0.9 % NS, Lactated Ringer’s, D5W (initial), 5 % Albumin |
| Hypotonic | Fluid INTO cells → cell swells; ↓ BP | 0.45 % NS, 0.225 % NS, 2.5 % Dextrose W |
| Hypertonic | Fluid OUT of cells → cell shrinks; ↑ BP | D5 ½ NS, D5 NS, D5 LR, 3 % NS, 10 % Dextrose, 5 % Albumin + NS |

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.