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Thursday, May 24, 2007

Intravenous Therapy

A. Indications Of Intravenous Therapy:
1. Establish or maintain a fluid or electrolyte balance
2. Administer continuous or intermittent medication
3. Administer intravenous anesthetics
4. Administer fluid to keep vein open (KVO)
5. Administer blood or blood components
6. Administer bolus medication
7. Maintain or correct a patient's nutritional state
8. Administer diagnostic reagents
9. Monitor hemodynamic functions

B. Intravenous Devices :
1. Steel Needles, Example; Butterfly catheter. Mostly used to deliver small quantities of medicines, to deliver fluids via the scalp veins in infants, and sometimes to draw blood samples.

2. Over the Needle Catheters, Example; peripheral IV catheter. This is the kind of catheter you will primarily be using. Catheters (and needles) are sized by their diameter, which is called the gauge. Obviously, the greater the diameter, the more amounts of fluid can be delivered.

C. Intravenous Fluids :
IV fluids are usually an intervention to provide volume replacement, administer medications, including electrolytes, monitor cardiac functions. For example, a patient comes into the ED with gastroenteritis and is dehydrated from vomiting and diarrhea.

There are three main types of fluids:
1. Isotonic fluids, close to the same osmolarity as serum. They stay inside the intravascular compartment, thus expanding it. This fluid can be helpful in hypotensive or hypovolemic patients and alsoc an be harmful. There is a risk of fluid overloading, especially in patients with CHF and hypertension such as Lactated Ringer's (LR), NS (normal saline, or 0.9% saline in water).

2. Hypotonic fluids, it's less osmolarity than serum. This fluid dilutes the serum, which decreases serum osmolarity. Hypotonic fluids is helpful when cells are dehydrated such as a dialysis patient on diuretic therapy, also be used for hyperglycemic conditions like diabetic ketoacidosis, in which high serum glucose levels draw fluid out of the cells and into the vascular and interstitial compartments.

Can be dangerous to use because of the sudden fluid shift from the intravascular space to the cells. This can cause cardiovascular collapse and increased intracranial pressure (ICP) in some patients. Example: .45% NaCl, 2.5% dextrose.

3. Hypertonic fluids, have a higher osmolarity than serum. Pulls fluid and electrolytes from the intracellular and interstitial compartments into the intravascular compartment. Can help stabilize blood pressure, increase urine output, and reduce edema.

Rarely used in the prehospital setting, care must be taken with their use. Dangerous in the setting of cell dehydration. Examples: D5% .45% NaCl, D5% LR, D5% NS, blood products, and albumin.

Flow Rates :
You will often need to calculate IV flow rates. The administration sets come in two basic sizes:
- Microdrip sets, Allow 60 drops (gtts) / mL through a small needle into the drip chamber (Good for medication administration or pediatric fluid delivery).
- Macrodrip sets, Allow 10 to 15 drops / mL into the drip chamber (Great for rapid fluid delivery. Also used for routine fluid delivery).
- Fluid may be ordered at a KVO rate. This means to Keep the Vein Open, or run in fluids very slowly, enough to keep the vein open, but not really deliver much volume.
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Tuesday, May 15, 2007

Nursing Care Plan (NCP)

Nursing Care Plan (NCP) is a plan that identifies the individual's needs which provides by a nurse with some guide to interventions necessary to meet those needs and which encompasses all phases of the nurse's process.

Care planning is an essential part of healthcare, The first step in care planning is accurate and comprehensive assessment. Once the initial assessment is completed, a problem list should be generated.
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Development of Preschoolers Children

Children aged 3 to 6 years can be claasified into 2 developmentally distinct group. 3 to 5 years-old children are considered preschoolers, where as children 5 years and older are part of the school-age. Preschoolers children are undergoing significant social development.

1. Physical and Motor Skills.
This is also time of advancement in motor skills. They have the coordination and balance of an adult. They also developing the muscular strength to perform difficult activities, including jumping rope, swimming, riding bicycles hop and climb.

2. Cognitive and Intellectual Development
Preschooler's vocabulary will expand to at least 2,500 word, and can understand as many as 30,000 words.They can tell elaborat stories with complex sentences of 5 to 8 words. They understand and respect roles. They show interest in reading, including independently looking through books, attempting to write letters and number, and listening attentivelly when others read to them.

3. Dietary Changes
Preschoolers generally have a healthy attitude about eating and will eat as a natural response to hunger. They may still have specific food preferences that can vary on a daily basis. They are receptive and vulnerable to media advertisements for popular foods and snacks that may be good-tasting but of poor nutritional quality, dietary habits that begin in these childhood years can impact health later in life.
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