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Complications of Peripheral I.V. Therapy: Part 2

clock February 9, 2015 03:46 by author Lisa Bonsall, MSN, RN, CRNP

If you are administering I.V. fluids or medications to a patient through a peripheral I.V. site, be alert for signs and symptoms of complications, institute preventive measures, and know how to intervene when complications do occur. Please review Complications of Peripheral I.V. Therapy: Part 1 for information on infiltration and extravasation.

Phlebitis

 

Phlebitis is inflammation of a vein. It is usually associated with acidic or alkaline solutions or solutions that have a high osmolarity. Phlebitis can also occur as a result of vein trauma during insertion, use of an inappropriate I.V. catheter size for the vein, or prolonged use of the same I.V. site.

 

 

Signs and symptoms

  • Redness or tenderness at the site of the tip of the catheter or along the path of the vein
  • Puffy area over the vein
  • Warmth around the insertion site

Prevention

  • Use proper venipuncture technique.
  • Use a trusted drug reference or consult with the pharmacist for instructions on drug dilution, when necessary.
  • Monitor administration rates and inspect the I.V. site frequently.
  • Change the infusion site according to your facility's policy.

Management

  • Stop the infusion at the first sign of redness or pain.
  • Apply warm, moist compresses to the area.
  • Document your patient's condition and interventions.
  • If indicated, insert a new catheter at a different site, preferably on the opposite arm, using a larger vein or a smaller device and restart the infusion.

Hypersensitivity

An immediate, severe hypersensitivity reaction can be life-threatening, so prompt recognition and treatment are imperative.

Signs and Symptoms

  • Sudden fever
  • Joint swelling
  • Rash and urticaria
  • Bronchospasm
  • Wheezing 

Prevention

  • Ask the patent about personal and family history of allergies.
  • For infants younger than 3 months, ask the mother about her allergy history because maternal antibodies may still be present.
  • Stay with the patient for five to 10 minutes to detect early signs and symptoms of hypersensitivity.
  • If the patient is receiving the drug for the first or second time, check him every five to 10 minutes or according to your facility's policy. 

Management

  • Discontinue the infusion and notify the prescriber immediately.
  • Administer medications as ordered.
  • Monitor the patient's vital signs and provide emotional support.

Infection

Local or systemic infection is another potential complication of I.V. therapy. 

Signs and symptoms

  • Redness and discharge at the I.V. site
  • Elevated temperature

Prevention

  • Perform hand hygiene, don gloves, and use aseptic technique during I.V. insertion. 
  • Clean the site with approved skin antiseptic before inserting I.V. catheter.
  • Ensure careful hand hygiene before any contact with the infusion system or the patient. 
  • Clean injection ports before each use.
  • Follow your institution’s policy for dressing changes and changing of the solution and administration set. 

Management

  • Stop the infusion and notify the prescriber.
  • Remove the device, and culture the site and catheter as ordered. 
  • Administer medications as prescribed.
  • Monitor the patient's vital signs.

With careful attention and skill, you’ll be able to recognize, prevent, and manage these complications of peripheral I.V. therapy.

References
(2008). I.V. Essentials: Complications of Peripheral I.V. Therapy. Nursing Made Incredibly Easy!, 6 (1). 
Smeltzer, S. (2010). Brunner and Suddarth's Textbook of Medical Surgical Nursing, 12e. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.
Spencer, S. & Gilliam, P. (2015). Teaching patients about their short peripheral I.V. catheters.  Nursing2015, 45 (2).



The Interspersing of Nursing: A Geographical Look at the Demand for Nurses

clock February 6, 2015 05:33 by author Lisa Bonsall, MSN, RN, CRNP

Use the infographic below to learn about the demand for nurses in the U.S. This was created by Adventist University of Health Sciences Online RN to BSN program.

Adventist University of Health Sciences



Complications of Peripheral I.V. Therapy: Part 1

clock February 4, 2015 05:24 by author Lisa Bonsall, MSN, RN, CRNP

If you are administering I.V. fluids or medications to a patient through a peripheral I.V. site, be alert for signs and symptoms of complications, institute preventive measures, and know how to intervene when complications do occur. 

Infiltration

 

Infiltration occurs when I.V. fluid or medications leak into the surrounding tissue. Infiltration can be caused by improper placement or dislodgment of the catheter. Patient movement can cause the catheter to slip out or through the blood vessel lumen. 

 

 

 

Signs and symptoms

  • Swelling, discomfort, burning, and/or tightness 
  • Cool skin and blanching
  • Decreased or stopped flow rate

Prevention

  • Select an appropriate I.V. site, avoiding areas of flexion. 
  • Use proper venipuncture technique.
  • Follow your facility policy for securing the I.V. catheter.
  • Observe the I.V. site frequently.
  • Advise the patient to report any swelling or tenderness at the I.V. site.

Management

  • Stop the infusion and remove the device.
  • Elevate the limb to increase patient comfort; a warm compress may be applied.
  • Check the patient's pulse and capillary refill time.
  • Perform venipuncture in a different location and restart the infusion, as ordered.
  • Check the site frequently.
  • Document your findings and interventions performed.

Extravasation

Extravasation is the leaking of vesicant drugs into surrounding tissue. Extravasation can cause severe local tissue damage, possibly leading to delayed healing, infection, tissue necrosis, disfigurement, loss of function, and even amputation.

Signs and symptoms

  • Blanching, burning, or discomfort at the I.V. site
  • Cool skin around the I.V. site
  • Swelling at or above the I.V. site
  • Blistering and/or skin sloughing

Prevention 

  • Avoid veins that are small and/or fragile, veins in areas of flexion, veins in extremities with preexisting edema, or veins in areas with known neurologic impairment.
  • Be aware of vesicant medications, such as certain antineoplastic drugs (doxorubicin, vinblastine, and vincristine), and hydroxyzine, promethazine, digoxin, and dopamine.
  • Follow your facility policy regarding vesicant administration via a peripheral I.V.; some institutions require that vesicants are administered via a central venous access device only. 
  • Give vesicants last when multiple drugs are ordered.
  • Strictly adhere to proper administration techniques.

Management

  • Stop the I.V. flow and remove the I.V. line, unless the catheter should remain in place to administer the antidote.
  • Estimate the amount of extravasated solution and notify the prescriber.
  • Administer the appropriate antidote according to your facility's protocol.
  • Elevate the extremity.
  • Perform frequent assessments of sensation, motor function, and circulation of the affected extremity. 
  • Record the extravasation site, your patient's symptoms, the estimated amount of extravasated solution, and the treatment.
  • Follow the manufacturer's recommendations to apply either cold or warm compresses to the affected area.

With careful attention and skill, you’ll be able to recognize, prevent, and manage these complications of peripheral I.V. therapy. In Complications of Peripheral I.V. Therapy: Part 2, we'll review the complications of hypersensitivity, phlebitis, and infection.

References
(2008). I.V. Essentials: Complications of Peripheral I.V. Therapy. Nursing Made Incredibly Easy!, 6 (1).
Smeltzer, S. (2010). Brunner and Suddarth's Textbook of Medical Surgical Nursing, 12e. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.
Spencer, S. & Gilliam, P. (2015). Teaching patients about their short peripheral I.V. catheters.  Nursing2015, 45 (2).
Vacca, V. (2013). TIME CRITICAL: Vesicant extravasation. Nursing2013, 43(9). 



Measles Update

clock February 2, 2015 16:34 by author Lisa Bonsall, MSN, RN, CRNP

The current outbreak of measles, which has been linked to a California amusement park, continues to make headlines in the United States. The Centers for Disease Control and Prevention (CDC) is tracking data on the states affected and the number of cases. I encourage you to stay informed so you’ll be able to best educate your patients and answer their questions.

Before I get to the purpose of this post – to review transmission, signs and symptoms, and treatment of measles – I’d like to briefly address why we are seeing this resurgence in cases. In 1998, a study was published in the Lancet which suggested a link between the measles, mumps, and rubella (MMR) vaccine and autism. As a result, increased numbers of parents opted to refuse the MMR vaccine for their children. The researchers later retracted their study, and current evidence concludes that there is no association between vaccines and autism.

As nurses, we have a responsibility to educate patients about the importance of vaccinations and the implications when vaccine-preventable diseases reemerge. Measles is extremely contagious and can have serious complications, especially for certain high risk groups. Please stay informed about the current outbreak and recommendations for vaccinations. 

What is measles?

Measles is an acute viral illness, transmitted by direct contact with infectious droplets or by airborne spread. After exposure (the incubation period can range from seven to 21 days), a prodromal syndrome of high fever, cough, runny nose, and conjunctivitis is characteristic. Koplik spots (white or bluish-white spots on the buccal mucosa) may occur and then the development of the characteristic maculopapular rash, which typically spreads from the head to the trunk to the lower extremities, follows. 


Complications of measles

Common:

  • Otitis media
  • Bronchopneumonia
  • Laryngotracheobronchitis
  • Diarrhea

Severe:

  • Encephalitis
  • Respiratory complications
  • Neurologic complications
  • Subacute sclerosing panencephalitis (SSPE)

Who’s at risk for severe complications?

  • Infants and children younger than five years; adults over 20
  • Pregnant women
  • Immunocompromised patients

Need-to-know information for nurses

  • After appearance of the rash, infected patients should be isolated for four days in a single-patient airborne infection isolation room (AIIR).
  • Measles is a reportable disease and local health departments should be notified within 24 hours of suspected measles cases. 
  • Routine childhood immunization for MMR vaccine starts with the first dose at 12-15 months of age, and the second dose at 4-6 years of age or at least 28 days after the first dose. (More vaccine schedules and information, including contraindications to vaccination, can be found here.)

References
Finerty, E. (2008). Did you say measles? American Journal of Nursing, 108(12). 
Skehan, J. & Muller, L. (2014). Vaccinations: Eliminating Preventable Illness. Professional Case Management, 19 (6).
Wade, G. (2014). Nurses as Primary Advocates for Immunization Adherence. The American Journal of Maternal/Child Nursing, 39 (6). 
Centers for Disease Control and Prevention. (2015, January 30). Measles (Rubeola): For Healthcare Professionals.



Celebrate Nursing 2015: Part 1

clock January 27, 2015 06:19 by author Lisa Bonsall, MSN, RN, CRNP

Here are the nursing recognition days, weeks, and months for the first half of 2015. Please leave a comment if you know of others so I can add them to our list! Thank you!

National IV Nurse Day January 25, 2015

National Nurse Anesthetists Week January 25-31, 2015

PeriAnesthesia Nurse Awareness Week February 2-8, 2015

Critical Care Transport Nurses Day February 18, 2015

Certified Nurses Day March 19, 2015

GI Nurses and Associates Week March 23-27, 2015

Transplant Nurses Day April 15, 2015

National Critical Care Awareness and Recognition Month May 2015

Oncology Nursing Month May 2015

National Nurses Week May 6-12, 2015 (National Nurses Day is May 6)

National School Nurse Day May 6, 2015

National Student Nurses Day May 8, 2015

International Nurses Day May 12, 2015

National Nursing Home Week May 10-17, 2015

Neuroscience Nurses Week May 17-23, 2015

Vascular Nursing Week June 7-13, 2015

38th Annual National Nursing Assistants Week June 11-18, 2015

Take some time to celebrate your hard work and be sure to recognize the work of your colleagues too! 



Ace your job interview!

clock January 21, 2015 01:15 by author Lisa Bonsall, MSN, RN, CRNP

You’ve landed an interview for your dream job – congratulations! As you embark on this journey, keep the following recommendations in mind. 

Be prepared

Become familiar with the organization and the position you are seeking. Use the facility’s website and other online resources, and talk to any employees you know. Think about how your skills and strengths will meet the needs of the employer and unit. 

Think about your strengths and weaknesses. Write down your skills and experiences, as well as examples of your commitment to team collaboration and quality nursing. 

Practice. If possible, ask someone to perform a mock interview with you. Be ready to answer questions, such as: 

  • Can you tell me a little about yourself?
  • How did you learn about us? Why do you want to work for us? 
  • Can you tell me about your current/last job? Why are you leaving? What did you like most about that job? What would you change about that job?
  • Did you ever have a disagreement with a manager?
  • Can you tell me about your education and training?
  • Can you give an example of a major problem you faced and how you solved it?
  • What's your greatest strength? What’s your greatest weakness?
  • Why did you choose to be a nurse?
  • How do you handle your on-the-job stress?
  • What do patients expect from nurses?
  • What's the difference between mediocre and excellent when it comes to nursing care?
  • How have you solved challenging nursing problems? Or, describe a challenging situation and how you managed it.
  • How have you demonstrated your ability to perform as a team member and team player?
  • What are your long-term goals in nursing?

As you prepare your answers for these questions, remember to focus on the positive, even when faced with a negative question. Be honest and keep your answers work- or project-related, rather than personal. For example, if asked about disagreements with leadership or a coworker, keep it positive by saying, "Sure, we disagreed at times, but we worked well together,” or make sure your example is a work-related one, such as a disagreement over a project due date, rather than a personal one.

Jot down your questions. Chances are, your interviewer will ask you if you have any questions and you probably will! Here are some things you may want to find out:

  • What are the nurse/patient ratios for each shift?
  • Can you please describe the orientation program?
  • What's the career ladder program and policy?
  • Are continuing-education (CE) programs available through the facility? 
  • What's the reimbursement policy for external CE programs, certification, or nursing classes?
  • Will I be tested?

Today's the day!

Think carefully about the first impression you’ll be making. Get enough rest so you’ll be energized and fresh. Dress professionally – conservative is best – and avoid distracting jewelry, make-up or perfume/cologne. Don't smoke, smell of smoke, or chew gum.

Plan to arrive about 15 minutes before your interview. Bring multiple copies of your resume in case more than one person is participating in the interview. Your resume should be printed on crisp white paper for a professional presentation. Also, bring names and contact information for references and employment and education institutions. Turn off or silence your cell phone. 

Greet the interviewer with a firm handshake while looking him or her in the eye, and continue to make eye contact with the interviewer during the interview. Throughout the interview, sit up straight, show interest, smile and speak clearly. Be yourself!

Listen carefully to questions asked and respond in an open, friendly manner. If a question is unclear, ask for clarification. Your answers should be complete, but concise.

As the interview process comes to a close, expect to learn the date when a decision is likely to be made and how you'll be notified. You can ask for this information if the interviewer doesn't mention it. In general, salary shouldn’t be discussed until a former offer has been made. Thank the interviewer and be sure to have his or her name and contact information. 

Follow-up

Within 24 hours, send a thank-you letter or e-mail. Be sure to express your continued interest in the position. Use this opportunity to reinforce how and why you're qualified for the position. 

Good luck!

 

References
Hathaway, L. (2005). Savvy answers to tough interview questions. Nursing2005, 35 (1). 
Rosati, L. (2014). Strike gold when interviewing for your first nursing job. Nursing2014, 44 (5).
Smith, L. (2010). PROFESSIONAL GROWTH: Are you ready for your job interview? Nursing2010, 40 (4). 



NursingCenter’s New Year’s Resolutions

clock January 8, 2015 06:36 by author Lisa Bonsall, MSN, RN, CRNP

As we get into 2015, here are some resolutions you can expect from Lippincott NursingCenter!

1. All of our enewsletters are getting a new look! We know that many of you check your email from your phone or tablet; we want to make sure that your are getting the best information in the best format for your device! Here is a peek at our newly launched NursingCenter enews

        

 

2. NursingCenter will also be getting a new look! Stay tuned for an update to our website. Make sure you are a registered member and that your profile is up-to-date. You will get content specific to your practice right on your NursingCenter home page!

3. Want to complete your CE activities while you are on-the-go? We have a new CE app in development, so you’ll be able to complete your CE activities right on your mobile device and then sync up with your computer to download and print your certificate! 

4. Look for more CE collections and Focus On collections so you can easily find topical information and specially-priced offers! 

5. We are also committed to keeping you updated on your license renewal requirements. Check back often for updates for your state CE requirements!

6. We’ve got a line-up of Nurses on the Move to keep you abreast of the great things nurses are achieving in our profession! Remember, you can nominate a colleague, friend, or even yourself by emailing ClinicalEditor@NursingCenter.com.

We are looking forward to a great 2015 and hope that you’ll continue to use Lippincott NursingCenter for all of your professional and clinical needs!



Who are “The Ebola Fighters?”

clock December 10, 2014 07:19 by author Lisa Bonsall, MSN, RN, CRNP

They are nurses. They are physicians. They are caregivers. They are scientists.

And as Time’s Person of the Year 2014, “The Ebola Fighters” are “The ones who answered the call.” These are the people who answer the call every day, putting themselves at risk without always knowing what those risks are. These are the people who feel it is an honor and a privilege to care for others during times of crisis and uncertainty. These are the people who thrive on answering tough questions and making tough decisions. 

It is wonderful to see this group recognized for their work. I am hopeful that this recognition will inspire The Ebola Fighters to continue this battle and will motivate others to join as well. We must all stay informed and follow recommendations to keep ourselves, our patients, and the public safe.

Congratulations to The Ebola Fighters – true heroes, deserving of our utmost respect and gratitude. 



World AIDS Day 2014

clock December 1, 2014 09:00 by author Lisa Bonsall, MSN, RN, CRNP

Over the past four decades, human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) have evolved from a global epidemic into a chronic disease. Screening methods, prevention recommendations, treatment options, and prognosis have evolved as well. As nurses, we care for patients with HIV and AIDS in every setting, are involved with public education, and participate in research. 

Today, December 1, 2014, is World AIDS Day – “an opportunity for people worldwide to unite in the fight against HIV, show their support for people living with HIV and to commemorate people who have died.” Many of us care for patients with HIV/AIDS in our practice, whether we work in a setting dedicated to treating this patient population or not. We must all remain vigilant in staying updated and making sure our patients and the public are informed.

Several articles have been published in our journals over the past year, which I think you will find informative and applicable to your practice. Take some time to review these articles and learn more about HIV and AIDS and improving care and outcomes for patients. 

 HIV Infection and its Implication For Nurse Leaders
Nursing Management, October 2014

The Synergistic Effects of HIV, Diabetes, and Aging on Cognition: Implications for Practice and Research 
Journal of Neuroscience Nursing, October 2014

Wounds in Patients with HIV
Advances in Skin & Wound Care: The Journal for Prevention and Healing, September 2014 

Nursing in the Fourth Decade of the HIV Epidemic  
American Journal of Nursing, March 2014

A Combination Drug for HIV Prevention in High-Risk Groups 
American Journal of Nursing, August 2014

For more reading on this subject, we also have a specially-priced CE collection on HIV and AIDS



Ebola: Keeping Perspective

clock October 17, 2014 08:21 by author Lisa Bonsall, MSN, RN, CRNP

Our NursingCenter team has been following the Ebola outbreak closely over the past months, but with recent developments of disease transmission here in the United States, media coverage has increased and protocols and recommendations are being closely examined. As nurses, we play an important role in patient and public education, and it is important that we continue to act with compassion and skill while gathering our knowledge from reputable sources and keeping recent developments in perspective.

Nina and Amber
My thanks and best wishes for a quick recovery go out to Nina Pham and Amber Vinson, two nurses who contracted the Ebola virus while caring for Thomas Eric Duncan, the infected patient who died on Oct. 8, 2014.  I commend your dedication and compassion. I am proud of you.

Nurses and other healthcare providers
To those of you caring for Nina and Amber, those already in or heading to West Africa to help with the outbreak there, and those studying current guidelines and possible systems issues, thank you. I am confident that your hard work will make a difference here and abroad, and that best practices for the safety of patients, healthcare providers, and the public is the priority. 

Stay informed
As a nurse, I will continue to look to professional organizations for the latest information and guidance. The Centers for Disease Control and Prevention has a long list of guidelines and checklists for U.S. health professionals. The Global Alert and Response of the World Health Organization includes up-to-date news and facts, frequently asked questions, and preparedness guidance. The National Institutes of Health also lists facts about the virus as well as the latest developments of research on prevention, treatment, and detection. 

I encourage you all to stay up-to-date and share your knowledge with your patients and the public. Refer to the sites above or to our Ebola page on NursingCenter (which we update daily with information from the above sites). Our colleagues at the American Journal of Nursing have also shared valuable insights from a nurse epidemiologist, who addresses the concerns surrounding personal protective equipment, and a nurse informaticist, who looks at the role of electronic health records in handling the Ebola outbreak.

Moving forward
I had the pleasure of spending the past week at Nursing Management Congress and was in the company of over 800 nurse leaders from around the country as the news of Ebola virus transmission in the U.S. unfolded. Themes from the general sessions included a focus on restoring pride in nursing, believing in team members, and dealing with root causes instead of putting out fires. I think these themes are appropriate as we face this new challenge in healthcare. 



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