IV Case Studies
Case Studies for Class Discussion
Case Study #1
Patient in ED received Vitamin K IV Push (10 mg IV); after which time the patient
became unresponsive. A code was called and CPR attempted, however the patient expired.
Initially thought to be an adverse drug reaction, however, after further analysis and
a drug reference search it was realized that the drug should only be given via IV
piggyback (prepared in the pharmacy) and also orally, subcutaneously or intramuscularly.
Case Study #2
An insulin infusion was ordered and started pre-operatively on a patient going
to the OR for a kidney transplant. Post-op the patient was received in the ICU
without the insulin infusion. Patient’s blood glucose was 443 mg/dl with other
significant electrolyte abnormalities documented. Dialysis was reinstituted on
patient, who required a lengthened ICU stay.
Case Study #3
Diabetic patient in ICU was receiving an IV of Regular Insulin 1unit/mLat a rate of
10 units/hour titrated per sliding scale. Upon changing to a new bag of insulin, IV
pump reset manually to clear prior totals and to enter the new volume to be infused.
Shortly after the new bag was hung, a nurse noticed that the infusion pump was
incorrectly set at 150 mL(i.e., 150 units) per hour.
Case Study #4
Pharmacy prepared IV piggyback of alteplase innormal saline using a 250 mL
viaflex bag removed150 mL of diluent to make final volumeof 100 mL.Label did
not indicatethe finaltotal volume. Nurse read the 250 mL total volume on the
viaflexbag and programmed the pump to deliver 25 mL/hour.Correct rate should
have been 10 mL/hour.
Case Study #5
ER patient given heparin bolus then started on heparin infusion. Transferred
to CCU where another MD ordered enoxaparin. Later, an on-call MD, unaware that
the patient was receiving enoxaparin, re-ordered another heparin infusion. Nurse
receiving MD call did not inform him of the patient’s other medications. Patient
received both heparin and enoxaparin for 15 hours.
NUR151 Nursing Theory and Science I
IV Assessment/Administration Core Competencies - Tie Back to General Course Competencies
- Demonstrate caring behaviors using therapeutic communication skills and techniques. (NUR151 #2)
- Describe normal and abnormal assessment data related to care of clients with selected health alterations. (NUR151 #7)
- Evaluate effects of nursing interventions during client care. (NUR151 #8)
- Describe nursing interventions that provide basic care and comfort measures. (NUR151 #12)
- Apply principles of safe medication administration for adult and geriatric clients. (NUR151 #15)
- Calculate medication dosages safely and accurately. (NUR151 #16)
- Apply elements of technology and information management to practice to include documentation, use of online databases, web-based enhancements, and library resources. (NUR151 #21)
- Document client findings and conditions through recording and reporting. (NUR151 #22)
Assignments
INTRAVENOUS THERAPY VENIPUNCTURE TECHNIQUE
Upon completion of this learning unit the student should be able to:
Knowledge Competencies
Describe the proper technique for adult and pediatric intravenous therapy.
- Patient assessments
- Proper authority
- Patient preparation
- Equipment assembly
- Site selection
- BSI precautions
- Site selection
- Venipuncture performance
- Site maintenance
- Documentation
Performance Competencies
Demonstrate on a mannequin or live model intravenous venipuncture technique for an adult and pediatric patients
- Patient assessments
- Patient consent
- Patient preparation
- Equipment assembly
- Site selection
- BSI precautions
- Site selection
- Venipuncture performance
- Site maintenance
- Documentation
DRIP RATE CALCULATION
Knowledge Competencies
- Describe how to convert pounds to kilograms using long division Explain how to convert cc/ml to liters, kg to grams, mg to micrograms
- Explain how to calculate amount of medication to patient weight in a acute patient environment
- Describe how to calculate physician orders to gtts per minute with macro, micro and blood pump administration sets
- Describe the conversion process for a known dose of a medication on hand to desired dose
Performance Competencies
- Demonstrate how to convert pounds to kilograms using long division and the three AM rule
- Demonstrate how to convert cc/ml to liters, kg to grams, mg to micrograms
- Calculate amount of medication to patient weight in a acute patient environment
- Calculate physician orders to gtts per minute with macro, micro and blood pump administration sets
- Convert known dose of a medication on hand to desired dose
MAINTENANCE OF INTRAVENOUS THERAPY
Knowledge Competencies
- Describe the need to obtaining vital signs before and after application of the IV
- Name three critical changes that occur from fluid administration and the associated changes in the patients vital signs
- Explain how and where to listen to breath sounds
- Identify the breath sounds
- Rales
- Rohchi
- Wheezes
- Absent breath sounds
- List three indication of fluid overload
- Describe three ways to confirm the patency of an IV
- List three reasons why an IV should be immediately discontinue an IV
- Explain how to correct the flow of an IV that has discontinued flowing
Performance Competencies
- Demonstrate the ability to obtain vital signs before and after application of the IV
- Recognize three critical changes that occur from fluid administration and the associated changes in the patients vital signs
- Demonstrate listening to breath sounds
- Demonstrate three ways to confirm the patency of an IV
- Perform the proper documentation of a IV administration
- Demonstrate how to correct the flow of an IV that has discontinued flowing
General Study Questions