Question

The first patient the nurse sees is a 37-year-old landscaper who is brought to the ED after collapsing on a job at the local country club. He is slightly confused but is able to state that he feels dizzy and weak. His skin is flushed, dry, and with poor turgor. He has dry, sticky mucous membranes. The preceptor identifies a nursing diagnosis of deficient fluid volume.The ED provider orders IV fluids for this patient. The preceptor initiates an IV site and starts the fluids. The fluid order is to start 1000 mL of NS as ordered at 150 mL/hr. The infusion tubing has a drop factor of 15 gtt/mL. When the IV flow is checked, the nurse finds that it is not dripping. List at least 5 things the nurse should do to troubleshoot the IV flow. The nurse is able to restore the IV flow. After 30 minutes of the infusion, the patient states, "My arm where the needle is feels funny." What are the nurse’s priority actions? What further data should the nurse collect from the patient?The patient is discharged after adequate hydration. Discharge teaching includes ways to prevent this from happening again on the job. What key points should the nurse include in the individualized teaching applicable to the job site?

Answer 1

List at least 5 things the nurse should do to troubleshoot the IV flow:

• Assess the type of solution and the rate of infusion.
• IV tubing must be checked frequently for any block, if a block is present then pinch the tube and release.
• IV tube insertion site should be checked for any swelling.
• If there is a block and the drip is not moving, then flush the skin so that the block is removed.
• If drip doesnot move forward because of prescence of air in the IV bottle, then prick the bottle with a needle.

What are the nurse’s priority actions?

• Maintain hand hygiene as it leads to sterile environment.
• Assess the IV insertion site and the dressing on the IV site.
• Check for signs of phlebitis and also fluid leakage or dripping out.
• Check if the tubing is not caught up in the IV equipment.
• Gravity at which the IV bottle is kept has to be checked.
• Ensure whether the right solution is inserted.

What further data should the nurse collect from the patient?

The nurse should collect information on:

• Patients past history of any allergies to an solutions or medicines.
• Assess patients type of job done.
• Assess for any complications or diseases patient had earlier.
• Determine patients vitals and weight of the patient so that medication can be calculated accordingly.

What key points should the nurse include in the individualized teaching applicable to the job site?

• Advice the patient to eat good healthy food to survive to tough job environment.
• Drink lots of water so that the individul is well hydrated.
• BP and vitals to be documented immediately by any companion who is with the patient.
• Always check for skin turgor.
• Monitor closely for symptoms for any dehydration and in such case take patient immediately to nearby hospital.
• Maintain oral hygiene.