Lab PacketNursing 241

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Lab ProjectNursing 241Fall Quarter

For your lab project, you will work together as a group of 3-4 individuals. Each group will select a topic from the list below. The purpose of this project is to identify the best practice by researching scholarly journals and determining, through the literature, evidence that supports best practice.

Your project will entail a written paper, between 7 to 10 pages, typed and double-spaced, in APA format. The paper will include a cover page and a reference page (not included in total pages). You must have a minimum of 5 references from books and scholarly journals. Tabers WILL NOT be accepted as a reference as well as references from web sites unless approved by the instructor. Your paper should be clearly written with correct spelling and grammar, and must identify the following areas:

Introduction The purpose/reason for the topic Current Practice What the literature states is best practice Comparing current practice with evidence of best practice Recommendations regarding changing current practice to best practice Conclusion

Additionally, each group will prepare a 10-15 minute presentation on their topic, identifying the best practice determined by the evidence in the literature. The presentation must be able to be turned in to the instructor at the end of the presentation. All individuals in the group must present a part of the project. How you present it is up to you, but please be creative! You must present on your lab day; no exceptions.

The list below is suggested topics: Intravenous Therapy Central Line Dressing Changes Chemotherapy Extravasation Pain Assessment Conscious Sedation Prevention of Nosocomial Infection Isolation Procedures Topic of Choice approved by instructor

When your group has selected a topic, please discuss your topic with the other groups to ensure 1 topic per group. Submit your topic choice and the names of the group members on the attached sheet to the instructor. Presentation and papers are due the last week of the quarter (September 27, 28, & October 1). A rubric is attached to help you out.

SPSCC

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NURSING 241GRADING RUBRIC FOR LAB PROJECT AND PRESENTATION

Behavior/Product 1 3 5

Content areas Introduction Purpose for Topic Current Practice Literature Review of Best

Practice Comparison of current

with EBP Recommendations for

changing current practice Conclusion

Less than four areas addressed

Score________

Four to Six areas addressed

Score_______

All areas addressed

Score_______

APA format Typing Title Page Spelling Grammar

Typed, but lacking double spacing, running

heads, or section headings. Pages not

numbered. More than two typos. More than five grammar errorsScore________

Typed, double spaced, with running heads; section heads

may be missing. Pages numbered. Up to two typos. Three to five grammar errors.

Score_______

Typed, double spaced, with running heads and

section headings. Pages numbered. NoTypos. No more than two grammar errors.

Score_______

References cited in text

References not entirely in proper format. Fewer

than four reference citations from two or fewer different books,

articles, or sourcesScore________

References in proper format. Four or five reference citations from at least three different books,

articles, or sourcesScore_______

References in proper format. Six or more reference citations from at least four different books,

articles, or sourcesScore_______

References page(Minimum of 5 references from

Scholarly Journals)

Incomplete in terms of style, typing, or

spacing;Not every reference

used in text was cited; less than 3 Scholarly

References usedScore________

Incomplete in terms of style, typing, or

spacing;All but one reference

used in text was cited; 3-4 Scholarly

References used.Score_______

Complete in terms of style, typing, and

spacing;Every reference used in text was cited; 5 or

more Scholarly References used.Score_______

Presentation 1 member provided presentation

Score__________

2 members provided presentation

Score__________

All members participated in presentation

Score__________

Note: This paper must contain references from at least three scholarly journals. You may use your text books, however 3 scholarly journals are required, and must not be older than 2003.

For APA style, use: APA publication manual (2010). (6th ed.). Washington: American Psychological Association.

Advanced IV Medication Lab

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Nursing 241Week 2

Objectives:

1. Describe the procedure for giving an IV push through an existing line and saline lock.2. Apply principles of medication administration IV push, titrated medications, and

electrolyte replacement.3. Discuss your responsibilities for administration of IV push, titrated medications, and

electrolyte replacement.4. Demonstrate math skills necessary to safely give these medications.5. Given a specific drug, can use IV medication book and other resources to safely

administer the medication.6. Demonstrate necessary skills to safely deliver both titrated, IV push medications, and

electrolyte replacement.

Prior to lab:

1. Read titrated drug hand-out.2. Read Phillips, Chapter 6: pp 345-354, 374; Chapter 9: pp. 546-592; Chapter 10: pp. 624-

6423. Review basic IV skills.4. Research the following and turn in for 10 points (you must include rate of administration,

mechanism of drug, and contraindications):* Solu-medrol 40 mg IV push* Reglan10 mg IV push* Heparin infusion (10,000 units/100ml of D5W at 1000 units/hr* Insulin infusion (100 units/100 ml D5W at 3 units/hour)* Replacement for potassium, 3% and 5% sodium, magnesium, calcium,

Phosphate.

Core Lab:Demonstration of IV techniques.IV irritated drugsIV push via saline SL, continuous IV compatible/incompatible.

Practice Lab: Practice each skill completing lab check-off sheet.Comp. lab: Math practiceEvaluation: IV math/med test. Skills validation.

You must pass the IV Math Exam with a 90% or better. You may retake this exam once.

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SOUTH PUGET SOUND COMMUNITY COLLEGENursing 241

Test Part 1: IV Therapy

Name:_________________________

Directions: Complete the following problems. Answer all question in the space provided. Show the formula used, how you set up the problem, and all calculations. To receive credit, answer must be correct and all work shown. You cannot use calculators.

1. A. 1000 ml of Lactated Ringers has been ordered to run over 10 hours. Assume the IV drip factor is 15 gtts/ml, calculate the IV rate.

B. Give the setting for IV pumps to deliver the above solution.

2. A buretrol contains 20ml of IV fluid. The tubing delivers 50 gtts/ml. Calculate the drip rate in order to give the fluid in 40 minutes.

3. An insulin drip has been ordered for a patient. The initial order is for 3 units of regular insulin per hour. The solution contains 100 units in 200 ml of D5W. This will be infused by an IV pump.

a. What is the concentration (units/ml) of the solution?

b. Using the concentration, calculate the rate in ml per hour deliver 3 units of insulin.

c. What will your pump settings be?

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d. The blood level is too high. You have an order to increase the dosage to 4 unit’s hour. You will increase the rate on the pump to ____________________

4. A heparin drip has been ordered on a patient. The patient has already received the loading dose, and will start at 1200 units/hr. The solution is 25,000 units in 500ml.

a. What is the concentration (units/ml) of the solution?

b. Using the above concentration, how many ml per hr must be given to deliver 1200 units?

c. What will your pump settings be?

d. Six hours later you need to reduce the dose to 1000 units. You will set the pump at ________________________.

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SOUTH PUGET SOUND COMMUNITY COLLEGENursing 241

Test Part II: IV Therapy

NAME:______________________________

Complete each question as completely as possible. Show your work.

Calculate infusion times for the following IVs.

1) An IV of 500 mL LR ordered to infuse at 25mL/hr.

2) A volume of 250 mL is to be infused at 50 mL/hr.

3) An infusion of 180 mL of NS to run at a rate of 30 mL/hr.

4) A volume of 1000 mL D5W ordered at a rate of 40 mL/hr.

5) An IV of 750 mL ordered to infuse at 25 mL/hr.

Calculate the heparin flow rates or hourly dosages as indicated in the following questions.

6) A patient is to receive heparin 1000 units/hr. The IV solution available has 25,000 units in 500mls of ½ NS. What is the flow rate?

7) A solution of 50,000 units of heparin in 1L of D51/2NS is to infuse via a pump at 25 ml/hr. Calculate the units per hour.

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8) A patient has orders for 20,000 units of heparin in 500 mL of D5W to infuse at 1600 units/ml. What is the pump setting per hour?

9) Calculate the hourly heparin dosage infusing at 50mL/hr from 25,000 units of heparin in 1 L D5W solution.

10) A liter of D5W with 2500 units of heparin is infusing at 25mL/hr. What is the dosage per hour?

Calculate infusion times for the following IVs.

11) An IV of 900 mL LR ordered to infuse at 80mL/hr.

12) A volume of 250 mL is to be infused at 30 mL/hr.

13) An infusion of 180 mL of NS to run at a rate of 25 mL/hr.

14) A volume of 1000 mL D5W ordered at a rate of 60 mL/hr.

15) An IV of 150 mL ordered to infuse at 80 mL/hr.

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Calculate the heparin flow rates or hourly dosages as indicated in the following questions.

16) A patient is to receive heparin 1000 units/hr. The IV solution available has 25,000 units in 1L of D5W. What is the flow rate?

17) A solution of 35,000 units of heparin in 1L of D51/2NS is to infuse via a pump at 1200units/hr. Calculate the flow rate.

18) A patient has orders for 20,000 units of heparin in 500 mL of D5W to infuse at 40 mL/hr. What is the dosage per hour?

19) Calculate the hourly heparin dosage infusing at 50mL/hr from 35,000 units of heparin in 1 L D5W solution.

20) A liter of D5W with 40,000 units of heparin is infusing at 25mL/hr. What is the dosage per hour?

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SOUTH PUGET SOUND COMMUNITY COLLEGENURSING 241

SKILLS VALIDATION

IV PUSH Acceptable Not Acceptable Comments

1. Determines IV site patent and free of

complications.

2. Demonstrates the 5 R's including math.

3. Researches med appropriately for rate of

infusion compatibility, precautions, side effects.

4. Prepares medication using aseptic technique.

5. Demonstrates universal precautions throughout

procedure.

6. Delivers medication at the appropriate rate.

7. Demonstrates one of the following: Continuous Infusion, compatible Continuous Infusion, incompatible IV heparin (saline) lock

TITRATED MEDICATIONS

1. Determines IV site is patent without

complications.

2. Demonstrates 5 R's including math.

3. Researches medication as above.

4. Demonstrates use of universal precautions.

5. Sets up IV equipment to give med at correct

rate.

6. Can adjust rate depending on lab/clinical

criteria.

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Blood Component TherapyNursing 241

Week 3

Objectives:

1. Describe the indications and type of blood component therapy.2. Describe the nursing responsibilities for administration of blood components.3. Demonstrate skills necessary to safely administer blood component therapy.4. Describe complications of blood component therapy including prevention and

treatment.

Prior to Lab:

1. Read Phillips Chapter 11: pp. 697-7882. Review basic IV skills3. Complete objectives 1,2, &4, and turn in for 10 points.

Core Lab:View video “Transfusion of Blood and Blood Products.”Discussion on blood component therapy and complications.Demonstration on blood administration.

Practice Lab:Practice steps in administration of a unit of packed cells..Given a complication, select appropriate nursing actions.

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Central Line Nursing Lab 1Nursing 241

Week 4

Objectives:1. Describe various types of central lines including long term access

devices commonly used in clinical settings.2. Discuss how central lines differ from peripheral lines in terms of indications

for use, insertion techniques, materials used, complications and nursing management.

3. Outline in detail complications associated with central lines including nursing management for prevention and treating each complication.

4. Describe nursing responsibilities during insertion, maintenance, and monitoring for central lines.

5. Demonstrate central line skills including administering fluids and medications, dressing and site care, flushing protocols, trouble shooting, and discontinuing line.

Prior to lab:Complete Objectives 1-4 and turn in for 10 pointsPhillips - Chapter 8: pp. 458-545, Chapter 9: pp. 593-623View video on Central Lines.

Core Lab:Be able to recognize and differentiate various central line devices.Recognize common complications of central lines and be able to trouble shoot.Demonstration of central line dressing change, blood draw, and access port.

Practice Lab:Work with identifying different types of central lines.Practice central line dressing change and blood draw.

Evaluation:Complete Central Line Dressing Change.Flush a Central Line.

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Central Line Nursing Lab 2Nursing 241

Week 5

Objectives:1. Continuation of objectives from Lab 1 on Central Lines.2. Discuss the nursing management of total parenteral nutrition

(TPN) including patient selection, nutritional assessment, protocols,Monitoring, administration, and patient teaching.

3. Compare TPN administration and management in acute care and home care settings.

4. Demonstrate the correct administration of TPN.5. Describe the manifestations and complications of Air Emboli.6. Describe the signs and symptoms associated with speed shock.

Prior to Lab:1. Phillips – Chapter 9: pp. 588-592 and Chapter 12: pp.789-8482. Complete Objectives 2, 3, 5, & 6 for 10 points.

Core Lab: Discussion of TPN including indications, required equipment, nutritional assessment, types, complications, and related nursing care.Demonstration of initiating TPN.

Practice Lab:Practice CL skills including administration of TPN.

Evaluation:Central Line Dressing ChangesCentral Line Flush

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NURSING 241Name: SKILLS PRACTICE CHECK LIST

CENTRAL LINE DRESSING CHANGE Acceptable Not Acceptable Comments

1. Organizes supplies in efficient manner.

2. Demonstrates central line precautions.

3 Inspects insertion site

4. Maintain sterile technique throughout the dressing change.

5. Demonstrates appropriate cleaning technique for skin and catheter.

6. Demonstrates universal precautions throughout procedure.

7. Documents dressing change.

AIR Emboli Precautions1. Discuss conditions in which an air emboli is most likely to occur.2. Discuss precautions to take to make an air emboli less likely.3. Recognize symptoms of air emboli and take appropriate actions.

TPN through a Central Line

1. Applies principle of CL management to TPN including nutritional assessment and relevant labs.

2. States the reason for a dedicated line.

3. Correctly verifies TPN and takes proper storage requirements.

4. Prepares TPN solution for administration per PSPH protocol.

5. Demonstrates universal precautions throughout procedure.

6. Delivers TPN at the rate prescribed using EID.

7. Discusses actions to take if TPN not available.

8.Discuss care of the patient for TPN for the next 24 hours.

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Chemotherapy LabNursing 241

Week 6

Objectives:1. State the purpose of chemotherapy.2. Describe classification of chemotherapy agents.3. Describe nursing assessment and management for patients receiving

chemotherapy.4. Discuss complications of chemotherapy, their prevention, and treatment.5. Describe safety measures to take when mixing and administering chemotherapy

agents.6. Define hazardous (vesicant) drugs including examples.7. Describe how to manage safely any accidental spills of chemotherapy agents.8. Describe actions to take if chemotherapy agents extravasations.9. Demonstrate skills necessary to safely administer and manage chemotherapy

agents.

Prior to lab:1. Read Phillips – Chapter 9: pp. 566-573 and Ignatavicius p. 421-4342. Complete all objectives and turn in for 25 points.

Core Lab:1. Discussion on principles and managements of chemotherapy.2. State the minimum requirements for certification as a chemotherapy nurse.3. Identify steps in managing extravasations.4. Identify steps to safely manage accidental spills.

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IV Conscious Sedation and Pain ManagementNursing 241

Week 7

Objectives:1. Define IV Conscious sedation.2. Discuss the legal aspects of IV conscious sedation in acute care and ambulatory

care settings.3. Discuss the nursing management of IV conscious sedation including preparation

of the patient, informed consent, management of the patient during the procedure, recovery, and patient teaching.

4. Describe nursing management in ambulatory setting when discharging patients who have received IV conscious sedation.

5. Describe common procedures requiring IV conscious sedation in acute care and ambulatory setting.

6. Describe equipment needed to safely manage a patient undergoing IV conscious sedation.

7. Discuss the advantages and disadvantages of Patient Controlled Analgesia.

Prior to Lab:1. Read Phillips – Chapter 10: pp. 642-651 and Ignatavicius Chapter 17: pp. 276-2792. Complete objectives 1, 5, 6, and 7 for 10 points.3. Describe the below common drugs used for IV conscious sedation including

classification, administration, contraindications, side and adverse effects, and related nursing areas for 10 points:Morphine sulfateNaloxoneFentanyl (Sublimaze)Diazepam (Valium)Midazolam (Versed)Lorazapam (Ativan)Flumazenil (Mazicon)Ketamine (Ketalar)Droperidol (Inapsine)

During Core Lab:Practice IV push skills and assessment of patient receiving conscious sedation.

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Advanced Fluid and Electrolyte SystemNursing 241

Week 8

Objectives:1. Describe assessment techniques to detect fluid volume excess.2. Describe assessment techniques to detect third spacing.3. Describe assessment techniques to detect volume deficits.4. Describe assessment techniques to detect sodium, potassium, calcium,

phosphorus, and magnesium imbalances.5. Describe the following nursing skills:

a. physical assessment techniques related to fluid and electrolyte imbalances.b. hypertonic, isotonic, hypotonic solutions.c. fluid challenge assessment parameters.d. managing fluid replacement for

GI lossGU- Renal insufficiency with failure to concentrate

Prior to lab:

1. Read Ignatavicius Chapter 13 & 142. Review physical assessment techniques from N142 or N200.3. Read Phillips Chapters 3: pp.105-186.4. Answer objectives 1-5 in paragraph form and turn in for 20 points.

Core Lab:Demonstration of Physical Assessment techniques specific to F/E

Practice Lab:Practice Physical Assessment techniques to Fluid/Electrolyte.

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12 lead EKGNursing 241

Week 9

Objectives:1. State the purpose of a 12 lead EKG.2. State the advantages and disadvantages of MCL 1 and Lead II for clinical

monitoring.3. Define the terms bipolar limb lead, augmented limb leads, and chest leads.4. Compare the vector of select leads with the electrical activity of the heart.5. Identify the proper placement of leads for a 12 lead EKG.6. Describe how to trouble shoot commonly known problems encountered in a 12

lead EKG.7. Demonstrate ability to correctly run a 12 lead EKG.

Prior to Lab:1. Review Chapter 7 & 19 in Chernecky (already assigned for cardiac arrhythmias)2. Read Ignatavicius pp. 730-7373. Complete objectives 1-3 and turn in for 10 points.

Core Lab:1. Identify land mark for 12 lead placements.2. Working in pairs, obtain a 12 lead EKG.3. Trouble shoot commonly encountered problems.

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Cardiac Arrhythmias HomeworkSaunders Nursing Survival Guide

ECGs & the heartNOTE: This if for review and not required as a homework assignment.

Chapters Do You Understand?

Session 1 2,3,4,5 pp.21-22 (1-13)pp. 35-41 (1-21)p. 48 (1-2)p.52 (1)p.56 (1-2)p. 58 (1-2)p.60 (1-4)p.62 (1-4)p. 66 (1-10)

Session II 8, 9 (127-136 pp. 119-122 (1-10)(148-155, 158-170) pp. 129-130 (1-2)

pp. 132-133 (1-5)p. 136 (1-6)pp. 154-55 (1-6)p. 161 (1-5)p. 162 (1-4)p. 164 (1-2)p. 169 (1-2)

Session III 11, 12, 13, 14 p. 180 (1-3)p. 184(1-6)p. 187 (1-4)p. 191 (1-3)p.200 p. 207 (1-16)p. 215 (1-8)p. 221 (1-7)p. 229 (1-12)

Session IV 16, 17, 23 p. 245 (1-8)p. 255 (1-6)p. 256 (1-5)p. 352 (1-5)

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p. 358 (1-10)

Cardiac ArrhythmiaNursing 241

Objectives:1. Describe the characteristics of select cardiac arrhythmias.2. Discuss a systematic approach to analyzing rhythm strips.3. Given a rhythm strip, can you correctly name the arrhythmia, state the

atrial and ventricular rate and rhythm, measure the intervals, and discuss nursing interventions.

4. See assigned chapter of Chernecky specific chapter objectives.

Complete the Cardiac Arrhythmias CD-ROM in the computer lab, room 222.

Computer Lab: Work with the CD-ROM on arrhythmias as assigned.

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CARDIAC MEDICATIONSNursing 241

Week 9

Define the list of drugs identifying dose, route, action, administration, and whether or not the drug can be given IV bolus or must be given by IV infusion. Turn in for 25 points.

ATROPINE*

ADENOSINE*

EPINEPHRINE*

DOPAMINE*

DOBUTAMINE

INAMRINONE/MILRINONE

NR-BICARB*

VERAPAMIL

LIDOCANE

VASOPRESSIN*

ESMOLOL

AMIODARONE*

*Drugs most commonly seen in cardiac arrest.

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Mock CodeNursing 241

Objectives:1. Discuss the need for code policies and procedures for cardiopulmonary resuscitation.2. Discuss the importance of advance directives and code status including legal,

ethical, and nursing responsibilities.3. Describe the various roles of health care providers in responding to code situations.4. State the route, action, and indication for use of common medications.5. List equipment and adjunct therapies needed for a code response.6. Demonstrate the ability to perform select procedures and roles in a mock situation.

Prior to Lab:1. Review skills covered in Health Care Provider CPR course.2. Research select code drugs and procedures as identified on work sheet.3. Read mock Code Handout.

Core Lab:1. Discussion on code management including common procedures, health care roles,

Legal-ethical issues and nursing management.2. Discussion on importance of documentation using a code sheet.3. Demonstration of select code procedures.

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Mock Code LabNursing 241

Every institution that provides patient care services must have a policy and procedure in place for handling emergency situations related to cardiovascular and/or respiratory arrest. This may be quite short or very complex depending upon the institution's mission and available resources. The policy sets the guidelines by which the procedure is developed. Areas that need to be addressed include roles, implementing the procedure, documentation, equipment, quality assurance, risk management, and education. Many institutions have a multi-disciplinary committee that is responsible for all these functions.

Roles of Health Care Workers in Code Situations:

RN TEAM LEADER

Administrative: Provides leadership to insure appropriate personnel are present, necessary equipment is available, insure other patients are being cared for, provide appropriate patient placement following the code, and oversees implementation of code procedures. Manages problems as they occur, insures appropriate follow up following the code.

Clinical: May perform all of the administrative plus provide management of specific care, see monitor nurse.

MONITOR NURSE

Has advanced education and experience in critical care including assessment, arrhythmia interpretation and treatment. ACLS may be a requirement for this position. In code, will assess and interpret patient's condition, and implement appropriate treatment based on standing orders in the absence of a physician. Will serve as a patient's advocate and monitor/manage patient's condition and response to treatment when physician is present. Must be an RN.

RECORDER

Provides accurate documentation of all events that occur during the code. Most institution's use a code sheet designed for this purpose. May be LPN or RN depending upon institution's policy.

12/04 ref [Mock Code Lab]

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MEDICATIONPrepares and administers all medications and treatments ordered during a code.

Will start IV if no IV team available in institution. Must be an RN.

CPR

Provides for cardiac compressions during an arrest. Responsible for counting the rate of compressions, and keeping track of time when CPR is interrupted for patient's assessment or treatment. Notifies team when CPR has been stopped for 5 seconds for assessment, 20 seconds for intubation. Checks for pulse during these times. May be RN, LPN, CNA as outlined in institution's policy.

AIRWAY

Provides for airway and ventilation management. Will mask/bag patient until intubated. Responsible for seeing intubation tray is ready, and oxygen and suction are set up prior to intubation. This requires two people. Respiratory therapist serves in the capacity in hospitals, assisted by the RN.

PRIMARY NURSE

Provides relevant patient history, current problems, and treatments. Responsible for seeing primary physician and family contacted. Assists code team as needed. RN in charge of the patient.

PHYSICIAN

Directs the medical care of the code patients, may be the ER physician in some hospitals. Manages code until primary physician arrives.

CLINICAL PHARMACIST

Prepares medications for administrations, serves as a consultant for pharmacological management of code.

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CHAPLAIN/SOCIAL WORKER

Liaison with code team and family, provides support and information to the family. Debriefs code team at conclusion of code.

OTHER

May include lab personnel, IV team, etc.

EQUIPMENT

Standardized Code Cart

Medications: Common medications used in code situations. Most are pre-filled and labeled syringes and IV bags.

Intubation (Adult/Child): Intubation tray with laryngoscopes, various blades, stylets, syringe for checking balloon on ET tube, various sizes of ET tubes, McGill forceps, airways, bite blocks, lubricant, tape/tube tamers. Will usually have drawer with adult intubation equipment, another drawer for children.

Defibrillator: Has monitor, print-out, adult and pediatric paddles, internal paddles, pre-jelled pads. Has capability of cardioversion/defibrillation. Some have external pacing capabilities.

IV Access Equipment: Includes angiocatheters, tubing, bags, labels, syringes, tape, pressure bags, tourniquets, swabs.

Other: Includes miscellaneous equipment such as NG Tube, Oxygen flow meters, suction head and canisters, ABG kits.

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