OUR LADY OF FATIMA UNIVERSITY

QUEZON CITY

COVER PAGE

STRATEGIES IN HEALTH TEACHING

DEMONSTRATION TEACHING

LEADER: MARQUEZ, SANIEVYNE A. MEMBERS: Estipona, ailyn r. Lusica, angelica shane a. MARTINEZ, JANEL Y. NATANAUAN, ERICSSON C. OLASO, JHON KEVIN B. Olayta, noel sydfred p. Pepito, Eunice marie a. PICAZO, JANINE

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DETAILED LESSON PLAN IN STRATEGIES IN HEALTH TEACHING

I. OBJECTIVES: 1. Define what IV therapy is. 2. Demonstrate the proper insertion of IV.

3. ENUMERATE THE POSSIBLE COMPLICATIONS IN IV THERAPY

II. SUBJECT MATTER: TOPIC: Intravenous therapy REFERENCE BOOK: Fundamentals of Nursing; by POTTER & PERRY PAGE/S: MATERIALS: For Discussion: Powerpoint with LCD projector For Demonstration: Intravenous Set Intravenous Fluid Cotton balls (wet & dry) Avocath Micropore Tourniquet BANDAGE SCISSORS Splint RECEPTACLE III. PROCEDURE: teaChers aCtIvIty A. DRILL BY: JANEL Y. MARTINEZ FORMED 5 GROUPS EACH GROUP WILL BE ASKED TO HAVE A REPRESENTATIVE EACH PARTICIPANT WILL BE

STUDENTS ACTIVITY

THE STUDENT WILL LISTEN AND PARTICIPATE ACTIVELY 2

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ASKED QUESTIONS REGARDING THE SUBJECT MATTER THE PERSON ANSWERED MORE CORRECTLY WILL BE DECLARED AS WINNER

B. REVIEW BY: 1. WHAT IS THE IMPORTANCE OF IV THERAPY? ANSWER: CORRECT ELECTROLYTE IMBALANCES DELIVER MEDICATION BLOOD TRANSFUSION FLUID REPLACEMENT C. MOTIVATION BY: Who among you here already experienced Intravenous Insertion? THE STUDENT RAISE THEIR HANDS AND ACTIVELY LISTENING

THE STUDENT WILL PARTICIPATE ACTIVELY AND SHARE THEIR EXPIRIENCE

D. PRESENTATION/INTRODUCTION OF TOPIC BY: E. LESSON PROPER DISCUSSION 1: BY: JANEL MARTINEZ Intravenous therapy or IV therapy is the giving of substances directly into a vein. The word intravenous simply means "within a vein". Therapies administered intravenously are often called specialty pharmaceuticals. It is commonly referred to as a drip because many systems of administration employ a drip chamber, which prevents air entering the blood stream (air embolism) and allows an

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estimate of flow rate. Intravenous therapy may be used to correct electrolyte imbalances, to deliver medications, for blood transfusion or as fluid replacement to correct, for example, dehydration.

Compared with other routes of administration, the intravenous route is the fastest way to deliver fluids and medications throughout the body. Some medications, as well as blood transfusions and lethal injections, can only be given intravenously. ASK THE CLASS IF THEY UNDERSTOOD THE TOPIC DISCUSSION 2: PROPER INSERTION OF iv BY: SANIEVYNE MARQUEZ

THE STUDENTS WILL RESPOND ATTENTIVELY

Prepare the IV fluid administration set

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Inspect the fluid bag to be certain it contains the desired fluid, the fluid is clear, the bag is not leaking, and the bag is not expired. Select either a mini or macro drip administration set and uncoil the tubing. Do not let the ends of the tubing become contaminated. Close the flow regulator (roll the wheel away from the end you will attach to the fluid bag). Remove the protective covering from the port of the fluid bag and the protective covering from the spike of the administration set. Insert the spike of the administration set into the port of the fluid bag with a quick twist. Do this carefully. Be especially careful to not puncture yourself! GROUP 3 | STRATEGIES IN HEALTH TEACHING 4

Hold the fluid bag higher than the drip chamber of the administration set. Squeeze the drip chamber once or twice to start the flow. Fill the drip chamber to the marker line (approximately one-third full). If you overfill the chamber, lower the bag below the level of the drip chamber and squeeze some fluid back into the fluid bag. Open the flow regulator and allow the fluid to flush all the air from the tubing. Let it run into a trash can or even the (now empty) wrapper the fluid bag came in. You may need to loosen or remove the cap at the end of the tubing to get the fluid to flow although most sets now allow flow without removal. Take care not to let the tip of the administration set become contaminated. Turn off the flow and place the sterile cap back on the end of the administration set (if you've had to remove it). Place this end nearby so you can reach it when you are ready to connect it to the IV catheter in the patient's vein.

Perform the venipuncture

Be sure you have introduced yourself to your patient and explained the procedure. Apply a tourniquet high on the upper arm. It should be tight enough to visibly indent the skin, but not cause the patient discomfort. Have the patient make a fist several times in order to maximize venous engorgement. Lower the arm to increase vein engorgement. Select the appropriate vein. If you cannot easily see a suitable vein, you can sometimes feel them by palpating the arm using your fingers (not your thumb) The vein

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will feel like an elastic tube that "gives" under pressure. Tapping on the veins, by gently "slapping" them with the pads of two or three fingers may help dilate them.

If you still cannot find any veins, then it might be helpful to cover the arm in a warm, moist compress to help with peripheral vasodilatation. If after a meticulous search no veins are found, then release the tourniquet from above the elbow and place it around the forearm and search in the distal forearm, wrist and hand. If still no suitable veins are found, then you will have to move to the other arm. Be careful to stay away from arteries, which are pulsatile.

Don disposable gloves. Clean the entry site carefully with the alcohol prep pad. Allow it to dry. Then use a betadine swab. Allow it to dry. Use both in a circular motion starting with the entry site and extending outward about 2 inches. (Using alcohol after betadine will negate the effect of the betadine) Note that some facilities may require alcohol prep without betadine. To puncture the vein, hold the catheter in your dominant hand. With the bevel up, enter the skin at about a 30 to 45 degree angle and in the direction of the vein. Use a quick, short, jabbing motion. After entering the skin, reduce the angle of the catheter until it is nearly parallel to the skin. If the vein appears to "roll" (move around freely under the skin), begin your venipuncture by apply counter GROUP 3 | STRATEGIES IN HEALTH TEACHING 6

tension against the skin just below the entry site using your nondominant hand. Many people use their thumb for this. Pull the skin distally toward the wrist in the opposite direction the needle will be advancing.

Be carefully not to press too hard which will compress blood flow in the vein and cause the vein to collapse. Then pierce the skin and enter the vein as above. Advance the catheter to enter the vein until blood is seen in the "flash chamber" of the catheter. STUDENTS LISTEN ATTENTIVELY

If not successful If you are unsuccessful in entering the vein and there is no flashback, then slowly withdraw the catheter, without pulling all the way out, and carefully watch for the flashback to occur. If you are still not within the vein, then advance it again in a 2nd attempt to enter the vein. While withdrawing always stop before pulling all the way out to avoid repeating the painful initial skin puncture. If after several manipulations the vein is not entered, then release the tourniquet, place gauze over the skin puncture site, withdraw the catheter and tape down the gauze. Try again in the other arm. Otherwise, After entering the vein, advance the plastic catheter (which is over the needle) on into the vein while leaving the needle stationary. The hub of the catheter should be all the way to the skin puncture site. The plastic catheter should slide forward easily. Do not force it!!

Release the tourniquet. Apply gentle pressure over the vein just proximal to the entry site to prevent blood flow. Remove the GROUP 3 | STRATEGIES IN HEALTH TEACHING 7

needle from within the plastic catheter. Dispose of the needle in an appropriate sharps container. NEVER reinsert the needle into the plastic catheter while it is in the patient's arm!

Reinserting the needle can shear off the tip of the plastic catheter causing an embolus.

Remove the protective cap from the end of the administration set and connect it to the plastic catheter. Adjust the flow rate as desired. Tape the catheter in place using the strips of tape and/or a clear dressing. It is advisable not to use the "chevron" taping technique. Label the IV site with the date, time, and your initials. Monitor the infusion for proper flow into the vein (in other words, watch for infiltration).

Occasionally, you may inadvertently enter an artery. You'll recognize this because bright red blood is quickly seen in the IV tubing and the IV bag because of the high pressure that exists. If this occurs, stop the fluid flow, remove the catheter, and put pressure on the site for at least 5 minutes. It is sometimes helpful to draw blood after you have entered the vein and before you have connected the IV tubing and bag. You can easily withdraw blood into a 15 or 20 mL syringe and then inject it into blood vials. Be sure to fill the vials to at least three quarters full. To recall the order of the blood tubes, remember the pneumonic Red Blood Gives Life for red, blue, green, lavender top tubes. Gently rock the tubes back and forth a few times to mix the blood with GROUP 3 | STRATEGIES IN HEALTH TEACHING 8

the additives. There is no need to rock the red top tube, however, the blood in this tube will clot quickly because it contains no additives. It should not be shaken because this will destroy the sample.

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To discontinue an IV Remember to observe universal precautions. Start by clamping off the flow of fluids. Then gently peel the tape back toward the IV site. As you get closer to the site and the catheter, stabilize the catheter and remove the rest of the tape from the patient's skin. Then place a 4 x 4 gauze over the site and gently slide the plastic catheter out of the patient's arm. Use direct pressure for a few minutes to control any bleeding. Finally, place a band aide over the site. How to correctly apply a warm, moist compress Put a bath towel under hot water and wring it out. Then fold it in half (by width not length) and enclose the arm from fingertips to elbow in the towel. Now place the towel-wrapped arm into a plastic bag and seal the open end of the bag near the elbow. While the pack is working (using heat to cause venous dilation), you can be setting up your supplies and be ready to perform the venipuncture as soon as you remove the pack. It works wonders! Many professional, experienced IV Therapy nurses would not even consider performing a venipuncture on patient with limited venous access without using a pack first ASK THE CLASS IF THEY UNDERSTOOD THE TOPIC DEMONSTRATION THE STUDENTS WILL RESPOND ATTENTIVELY

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DISCUSSION 3: COMPLICATIONS OF IV THERAPY BY: KEVIN OLASO, JANINE PICAZO INFECTION - Any break in the skin carries a risk of infection. Infection of IV sites is usually local, causing easily visible swelling, redness, and fever. If bacteria do not remain in one area but spread through the bloodstream, the infection is called septicemia and can be rapid and life-threatening.

THE STUDENTS WILL OBSERVE CAREFULLY

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An infected central IV poses a higher risk of septicemia, as it can deliver bacteria directly into the central circulation. PHLEBITIS is inflammation of a vein that may be caused by infection, the mere presence of a foreign body (the IV catheter) or the fluids or medication being given. Symptoms are warmth, swelling, pain, and redness around the vein. The IV device must be removed and if necessary re-inserted into another extremity. INFILTRATION occurs when an IV fluid or medication accidentally enters the surrounding tissue rather than the vein. EXTRAVASATION (which refers to something escaping the vein). It may occur when the vein itself ruptures (the elderly are particularly prone to fragile veins due to a paucity of supporting tissues), where the vein is damaged during insertion of the intravascular access device or the device is not sited correctly or where the entry point of the device into the vein becomes the path of least resistance (e.g. if a cannula is in a vein for some time, the vein may scar and close and the only way for fluid to leave is along the outside of the cannula where it enters the vein).

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Fluid overload This occurs when fluids are given at a higher rate or in a larger volume than the system can absorb or excrete. Possible consequences include hypertension, heart failure, and pulmonary edema Hypothermia the human body is at risk of accidentally induced hypothermia when large amounts of cold fluids are infused. Rapid temperature changes in the heart may precipitate ventricular fibrillation. Electrolyte imbalance administering a too-dilute or tooconcentrated solution can disrupt the patient's balance of sodium, potassium, magnesium, and other electrolytes. Hospital patients usually receive blood tests to monitor these levels. Embolism a blood clot or other solid mass, as well as an air bubble, can be delivered into the circulation through an IV and end up blocking a vessel; this is called embolism. Peripheral IVs have a low risk of embolism, since large solid masses cannot travel through a narrow catheter, and it is nearly impossible to inject air through a peripheral IV at a dangerous rate. The risk is greater with a central IV.

ASK The CLASS IF THEY UNDERSTOOD THE TOPIC THE STUDENTS WILL RESPOND ATTENTIVELY

F. GENERALIZATION WHAT HAVE YOU LEARNED TODAY, CLASS? STUDENT WILL SUMMARIZED BRIEFLY ABOUT THE TOPICS LEARNED GROUP 3 | STRATEGIES IN HEALTH TEACHING 11

IV.

EVALUATION BY: QUIZ: 1. DEFINE IV THERAPY 2. 4. GIVE ATLEAST 3 INSTRUMENTS USED IN IV THERAPY 5. 7. IDENTIFY THE PARTS OF THE IV SET 8. - 10. GIVE ATLEAST 3 POSSIBLE COMPLICATIONS IN ADMINISTERING IV THERAPY

V.

ASSIGNMENT BY: WHAT ARE THE LATEST TRENDS IN INTRAVENOUS THERAPY WHAT ARE THE 5(FIVE RIGHTS) IN INTRAVENOUS THERAPY

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