NURS 150: Clinical Reasoning Activity (CRA) Lab #5 Print this document or save it to your laptop.
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NURS 150: Clinical Reasoning Activity (CRA) Lab #5

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to your laptop.  Complete the reading assignments and view assigned videos.  Review the scenario and assessment, then complete the questions. The CRA must be completed and available to participate in lab.

Lab 5 Skills:

·      IV bolus (push) medication administration via a central line

·      Central line dressing change 

Unit: Surgical 

Patient assignment: Maxwell, Sam   MRN:930862                              

Age: 78 years   Sex:  Female  

Height: 5' 1" Weight: 78 kg on admission                                

Allergies: Penicillin

Primary Diagnosis: Ventral hernia 

Secondary Diagnoses: Hypertension (HTN), diabetes mellitus type 2 and anemia.

The Patient Care Profile and SUNY Morrisville Vascular Access Protocol are on Blackboard in the NURS 150 Lab #5 folder.  The medication administration record (MAR) is on page 7.


Scenario: 

Day 1: Admitted to the surgical unit and had ventral herniorrhaphy.  Wound to heal by primary intention.

Day 2: Returned to OR to have penrose drain inserted. 

Day 4: Diagnosed with dehydration and IV fluids prescribed.

Day 6 Dehydration resolved and IV fluids discontinued.

Day 7: Diagnosed with wound infection and antibiotic prescribed.

Day 9: Wound dehiscence occurred; wound to heal by secondary intention. 

Day 10: Diagnosed with dehydration and IV fluids prescribed.

Day 12. Blood glucose levels elevated and subcutaneous insulin prescribed.

Day 14: Diagnosed with fluid volume excess.  Diuretic prescribed and continuous IV fluids discontinued.

Day 15: Fluid volume excess resolving.  Indwelling urinary catheter inserted due to urinary retention.

Day 16: Diagnosed with partial SBO; NG tube inserted. Serum K+ levels low; IV fluids with potassium chloride prescribed. 

Day 18: Central vascular access device inserted due to repeated complications with peripheral IV's.  SBO resolved; NG tube removed and soft, low fiber diet begun.

Day 19: Weight 78 Kg (increase of 1 Kg since Day 14), BP 146/84, 2+ dependent edema, lungs remain clear.  Diuretic dosage increased. 

Day 20: Fluid volume excess resolving.


It is now Day 20 at 0830:

VS and assessment findings from your 0830 assessment:

T98.8° F  P78 strong  R18 regular, unlabored, depth normal  BP146/86 (left arm, sitting)  O2SAT on RA 95%    

  • Alert and oriented x3
  • Breath sounds clear in all lobes bilaterally 
  • Abdomen rounded, symmetrical; bowel sounds active x4 quadrants; soft, non-tender
  • Skin intact, warm, dry; 2+ pitting edema to feet bilaterally
  • Central line dressing loose; integrity is compromised




Pre-care clinical reasoning questions:

1.    


Based on Ms. Maxwell's history, what was the rationale for inserting a central vascular access device on Day 18?

2.   


What type of central vascular access device was inserted? (Refer to the Patient Care Profile)

3.     List at least one advantage and one disadvantage of having a central vascular access device instead of a short peripheral catheter. 







 Advantage:                                                                    Disadvantage:

4.     Educating the patient has an important role in the prevention of catheter-related bloodstream infection (CRBSI).  According to the Joint Commission, patients and their families must have education on which six topics before a central line is inserted in a hospital setting?




















5.     Match the type of central vascular access device to the diagrams.

A.    External tunneled

B.    Nontunneled percutaneous

C.     Peripherally inserted

D.    Implanted infusion port

                                                                        


 

 

                                                                                         


  

                                                                             


    

 

                                                                                                                                                                                                   




                                           Which device does Ms. Maxwell have, and how many lumens are there?  



6.     The primary IV is infusing into which port? (Refer to the MAR)






The IV push medication is to be administered using which port? (Refer to the MAR)








7.     The proper functioning of the catheter is assessed by the ability to aspirate blood and flush the catheter without resistance.  What is the rationale for using no less than a 10 mL syringe to flush a central vascular access device? 











Clinical reasoning questions for (bumetanide) Bumex; refer to your Intravenous Medications Handbook to answer questions #8-16.

8.     What is the classification of the medication, and why has it been prescribed for Ms. Maxwell?





9.     Is Ms. Maxwell's Penicillin allergy a contraindication to receiving the medication?


   



10.  

  

The usual dose of this medication for the IV push (IV injection) route is



11.  What is the prescribed dose, and is it within the usual range? 





12.  Based on the MAR and this label, calculate the volume of medication that you will administer.


Bumex (bumetanide)

0.25 mg per 1 mL

Exp. 10/21

FOR PRACTICE USE ONLY

NOT FOR HUMAN CO NSUMTPTION 



Volume of medication: 




May this medication be given undiluted, or is further dilution required? 











13.  You must determine if the bumetanide (Bumex) is compatible with the NS flush.



Is it compatible?





We will discuss why compatibility of the primary infusion and the bumetanide not an issue during lab - leave this space blank to fill in later! 

14.  The rate of administration for the IV push (IV injection) route is:






                You will administer the medication at a rate of:







15.  What information must be included on the label?


    Medication: 

Prescribed dosage: 




Rate of administration:

Volume: 

                              

















16.  The "SASH" sequence is used to administer an IV push medication via a central line.  

SASH stands for:

             S: Saline (aspirate for blood return and use pulsatile flushing to determine patency of the catheter     

                  and to clear the line)

             A: Administer the medication 

             S: Saline (prevents occlusion and ensures that all of the medication is delivered - reminder - this  

                  flush is to be delivered at the same rate as the medication)

             H: Heparinized saline (to prevent clotting of the tip of the catheter)

                          

             Complete the following chart.  Refer to the SUNY Morrisville Vascular Access Maintenance 

             Protocol to identify the flush solutions for a percutaneously placed (nontunneled) vascular access 

             device.  

             

Solution

Volume

Saline



(bumetanide) Bumex



Saline



Heparinized saline 

Note: include both the volume and concentration














 

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