Clinical Assessment Preparation

CPNE Study Guide

Parenteral fluids, when assigned: Perform the following within 20 minutes after beginning of implementation: • Assess: 1. Inspect insertion site for complications using both Count calculated drops per minute for gravity flow 4. Verify IV solution is the same as noted on PCS Assignment 5. Inspect integrity of system:  Dressing intact  Tubing secured 6. Inspect tubing for kinks and air • Implement: 1. Notify CE and/or assigned nurse immediately if any of the following is present:  IV insertion site has evidence of complications  mL per hour are not the same as noted on PCS Assignment  Request CE change mL per hour on infusion control device if a change is needed 4. Regulate drops per minute to within +/- 5 drops per minute (regular or microdrops) of calculated drops per minute when gravity flow is assigned 5. Administer/maintain assigned IV solution Discontinue IV fluid, when assigned: • Remove cannula • Cover site with dressing Convert continuous IV to IVAD, when assigned: • Attach cap to present IV site after removing the IV line • Flush IVAD with prescribed solution If new IV solution needs to be hung during PCS, perform the following: • Determine flow rate in mL/hour if delivered via ICD or drops per minute via gravity flow • Prime IV tubing, if necessary • Ensure there is no air in tubing • Ensure there is no kinks in tubing • Verbally identify the patient immediately before administration of new IV solution by verifying two of the following pieces of information on the patient’s identification band against the PCS Assignment Air is noted in tubing 2. Remove kinks from tubing 3. of the following methods:  Observe surrounding skin for changes in color  Palpate surrounding skin for edema 2. Determine drops per minute if IV solution is delivered via gravity flow 3. Verify the flow rate is the same as noted on PCS Assignment by one of the following:  Observe mL per hour setting on infusion control device 

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