Introduction to Medical-Surgical Nursing, 6th ed.
18
Lesson Plans for
Intravenous Therapy
CHAPTER LESSON PLANS & OBJECTIVES
Lesson 18.1:
2. Describe the types of fluids used for intravenous fluid therapy.
4. Given the prescribed hourly flow rate, calculate the correct drop rate for an intravenous fluid.
6. Explain the nursing responsibilities when a patient is receiving intravenous therapy.
7. Identify intravenous medications that require dilution because they are vesicants or irritants.
CHAPTER TEACHING FOCUS
• In this chapter, students will have the opportunity to learn about the correct administration of
2 Chapter 18 Intravenous Therapy ____________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
CHAPTER PRETEST
Have the students answer these questions prior to covering this chapter to understand where they stand
in relation to the content.
1) Intravenous therapy is not used to administer __________.
a) fluids and nutrients
b) blood and blood products
c) medications
d) blood gases
2) Tonicity is an indicator of the __________.
a) number of red blood cells present in a fluid
b) concentration of electrolytes in a fluid
c) average volume of individual red blood cells in a fluid
d) ratio of oxygen to glucose in a fluid
3) In order to effectively deliver continuous intravenous fluids, an access device is used. These include
a(n) __________.
a) jugular central line
b) intraventricular shunt
c) intraaortic balloon pump
d) pulse oximeter
4) The procedural steps for venipuncture suggest that the nurse __________.
a) begin with the most proximal veins
b) use the arm with least lymphatic drainage, if possible
c) use veins that are hard and straight
d) avoid veins that are swollen or appear irritated
5) A tourniquet is used to perform venipuncture. A tourniquet should be __________.
a) vigorously cleansed with alcohol, then povidone-iodine solution
b) flat and at least one-half inch wide
c) applied directly below the venipuncture site
d) used on no more than a dozen patients before being discarded
6) A patient complains that every time a vein is accessed for intravenous catheter insertion, she
experiences pain that lasts for 30 minutes or more. An intervention that would help with this problem
is __________.
a) application of prilocaine (EMLA) cream to the site immediately after the catheter is inserted
b) application of prilocaine (EMLA) cream to the site 30 to 60 minutes before catheter insertion
c) intradermal injection of saline distal to the catheter insertion site
d) intradermal injection of lidocaine to the site 30 to 60 minutes after catheter insertion
7) The viscosity of the fluid affects the rate of intravenous infusion. This means that a __________.
a) thin fluid will flow faster if it is in a rigid, airtight container
b) thin fluid will flow more quickly than a thick fluid
c) thick fluid will flow more slowly if it is diluted with saline
d) thick fluid will flow faster if it is in an almost empty container
8) An advantage of using an infusion control device to deliver intravenous fluids is that __________.
a) aseptic technique is not necessary for catheter insertion
b) the patient does not need to be monitored
c) the patient can be ambulatory
d) the height of the fluid bag will not affect the infusion rate
Introduction to Medical-Surgical Nursing, 6th ed.
9) A special consideration for administering intravenous therapy to a confused 88-year-old patient is to
__________.
a) apply an immobilizer directly over the insertion site
b) apply an immobilizer above the insertion site
c) apply an immobilizer below the insertion site
d) never apply an immobilizer to the extremity with the intravenous catheter
10) Drugs that are vesicants can cause ___________.
a) hypovolemia and hypokalemia
b) hypervolemia and hyperkalemia
c) phlebitis and tissue necrosis
d) claudication and hypotension
4 Chapter 18 Intravenous Therapy ____________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
Chapter Pretest Answers
CHAPTER BACKGROUND ASSESSMENT
Discuss these questions with your students prior to covering this chapter to understand where they stand
in relation to the content.
Question: What are common indications for intravenous therapy?
Question: What are the key elements to include in your documentation for a patient receiving
intravenous fluid therapy?
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Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 18.1
Instructor Preparation
Textbook Objectives Covered
2. Describe the types of fluids used for intravenous fluid therapy.
4. Given the prescribed hourly flow rate, calculate the correct drop rate for an intravenous fluid.
6. Explain the nursing responsibilities when a patient is receiving intravenous therapy.
7. Identify intravenous medications that require dilution because they are vesicants or irritants.
Lesson Preparation Checklist
• Prepare lecture from TEACH lecture slides available on Evolve.
• Guest speaker: infusion therapist
• Student performance evaluation of all entry-level skills required for student comprehension of
principles underlying the administration of intravenous therapy, including:
• Indications for intravenous therapy
• Types of intravenous fluids
• Venous access devices
• Calculation of the correct drop rate
• Complications associated with intravenous therapy
• Assemble materials and supplies needed for each lesson as indicated below.
Materials and Supplies
• computer and PowerPoint
projector
Key Terms
• hypertonic (p. 287)
• cannula (p. 288)
• embolism (p. 298)
• solution (p. 287)
• thrombus (pl. thrombi)
6 Chapter 18 Intravenous Therapy ____________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 18.1
Student Preparation
Assignments 2 hours
1
READ – Textbook (p. 287)
ANSWER – Study Guide
• Part IIC: 2 (p. 106)
2
READ – Textbook (pp. 287-288)
ANSWER – Text
ANSWER – Study Guide
• Part IA: 1-6 (p. 105)
3
READ – Textbook (pp. 288-292)
REVIEW
• Figure 18-1: Venous access devices (p. 288)
• Figure 18-2: Common peripheral intravenous infusion sites (p. 289)
ANSWER – Text
• Review Questions for the NCLEX Examination: 1, 5, 9 (pp. 299-300)
4
READ – Textbook (pp. 292-294)
REVIEW
• Box 18-1: Sample Flow-Rate Calculation (p. 294)
ANSWER – Study Guide
5
READ – Textbook (pp. 294-299)
ANSWER – Text
• Review Questions for the NCLEX Examination: 7, 10 (p. 300)
ANSWER – Study Guide
• Part IA: 7-14 (p. 106)
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Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 18.1
6
READ – Textbook (pp. 288-297)
REVIEW
• Nursing Care Plan 18-1: Patient Receiving Intravenous Therapy (p. 296)
ANSWER – Text
• Review Questions for the NCLEX Examination: 8 (p. 300)
ANSWER – Study Guide
• Part IB: 1 (p. 106)
• Part IIID: 7, 8-14 (pp. 108-109)
7
READ – Textbook (pp. 288-297)
REVIEW
• Box 18-2: Partial List of Intravenous Drugs and Solutions that Require Proper Dilution to
Prevent Harm to Blood Vessels (p. 297)
50-Minute Lesson Plan
Lecture Outline 20 minutes
Slide 1
Chapter 18
Intravenous Therapy
1
Slide 2
Indications for Intravenous Fluid Therapy
• Administer medications
• Administer blood and blood components
• Fluid replacement
• Replacement of electrolytes
• Provide glucose
2
Types of Intravenous Fluids
• Tonicity
TALKING POINTS:
• Why is the tonicity of fluids important?
Slide 4
Types of Intravenous Fluids (cont.)
• Isotonic solutions
• The concentration is the same as body fluids (about 285 mEq/L)
• Hypertonic solutions
• The concentration is greater than 300 mEq/L
• Draws and retains water in the circulation, increasing the blood volume
• Hypotonic solutions
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Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 18.1
Slide 5
Types of Intravenous Fluids (cont.)
• Components
• Commonly used IV solutions: specific combinations of water, sugar (dextrose),
sodium chloride, and other electrolytes
• Sodium chloride solutions
• An isotonic solution is 0.9% sodium chloride
TALKING POINTS:
• What is the only source of calories in most intravenous solutions?
• Total parenteral nutrition provides dextrose, water, amino acids, electrolytes, vitamins,
3
Venous Access Devices
• Intravenous fluid is delivered by various types of venous access devices
Slide 7
Venous Access Devices (cont.)
• IV fluid administration requires placement of the venous access device into a peripheral or
central vein
• Peripheral veins
• Located in the extremities (and in the scalp of an infant)
TALKING POINTS:
• The central line may be placed in the subclavian vein through a surgical incision, inserted
into a peripheral vein and advanced to the desired location, or inserted through a skin
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Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 18.1
Slide 8
Port
• A device with a central catheter that is surgically implanted in the subcutaneous tissue
• A venous catheter and a port through which fluids can be injected, but it has no external
TALKING POINTS:
• A port requires less care and is less restrictive than other access devices, but it does
Slide 9
Needles
• Winged (“butterfly”) infusion needle
• A short needle with two plastic wings that are held during insertion
• Self-sheathing stylet
• Retracts into a rigid chamber at the catheter hub after insertion
TALKING POINTS:
• A winged infusion needle is useful in infants when a scalp vein is used for intravenous
Slide 10
Catheters
• A small plastic tube that fits over or inside a needle
• After insertion into vein, needle is withdrawn, leaving the catheter in the vein
• Peripherally inserted central catheter (PICC)
TALKING POINTS:
• Catheters are less likely than needles to puncture the vein once they are in place.
• What length catheters do nurses usually insert?
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Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 18.1
Slide 11
Implanted Devices
• Some devices can be implanted to allow immediate access to a vein without repeated,
painful venipunctures
• Include infusion ports, pumps that are implanted under the skin, and external infusion
pumps
Intermittent Infusion Devices
• Intravenous medications are given at specific intervals
• Drugs are often “piggybacked”
TALKING POINTS:
• The heparin lock was so named because it may be flushed with a dilute heparin solution
after each use to keep clots from forming and blocking the catheter.
6
Slide 13
Equipment
• Cannula (needle or catheter), tourniquet, alcohol swabs, skin cleansing solution, tape,
dressing supplies, gloves, tubing, solution container, a pole to suspend the container, and
infusion pump
• Prescribed solution or drug
TALKING POINTS:
• How do you determine what size cannula is needed?
Slide 14
Site Selection
• Should be the least restrictive
• A large vein that is in good condition
• A soft, straight vein is best
• Avoid veins that are hard and bumpy, bruised, swollen, near previously infected areas, or
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Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 18.1
Slide 15
Procedure
• Wash hands thoroughly; explain procedure to patient
• Apply tourniquet above venipuncture site to distend vein
• Locate appropriate vein; temporarily remove the tourniquet
TALKING POINTS:
• What cleansing solutions are recommended?
Slide 16
Procedure (cont.)
• Carefully insert cannula through the skin and guide it into the vein in the direction of blood
flow
TALKING POINTS:
• How often should IV site dressings be changed?
Slide 17
Procedure (cont.)
• Pain
• Venipuncture and cannula placement are painful
• Drugs to decrease venipuncture pain include intradermal lidocaine (Xylocaine),
TALKING POINTS:
• Intradermal lidocaine may cause vasospasm, allergic reactions, and anaphylaxis.
• Both lidocaine and EMLA cream must be applied and covered with an occlusive dressing
for 60 minutes to be effective.
• What is an iontophoresis of lidocaine?
12 Chapter 18 Intravenous Therapy ____________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 18.1
4
Slide 18
Factors Affecting Infusion Rate
• Height of fluid container over the patient’s heart
• When container is raised, the fluid flows faster
• Lowering container causes fluid to run more slowly
• Optimal height is 30-36 inches above the patient
Slide 19
Factors Affecting Infusion Rate (cont.)
• Cannula diameter
• Fluid flows more quickly through a large cannula than through a small cannula
• Venting of the fluid container
• Rigid containers must be vented to allow air to enter as fluid leaves
• Position of the extremity
• Certain movements or positions may interfere with the flow of fluid
Slide 20
Calculating the Infusion Rate
• Determine
• How much fluid to give each hour
• Physician’s order specifies the amount of fluid to be administered in a specific
period of time
TALKING POINTS:
• The physician’s order specifies the amount of fluid to be administered in a specific period
of time.
• The instructions on the delivery set package state how many drops equal 1 mL using that
set.
• How many drops per milliliter do microdrop sets deliver?
Calculating the Infusion Rate (cont.)
• When infusion rate is known, use the roller clamp or screw clamp on a gravity infusion to