Thursday, March 4, 2010

Required Areas of Care - Fluid Management

Fluid Management
  1. Assesses the hydration status of the patient by one of the following methods:
    • Checking skin turgor or
    • Inspecting the mucous membranes or
    • Palpating the anterior fontanel of a child less than 1 year of age
  2. For enteral fluids
    • Determines the kind(s) of fluid to be ingested
    • Administers or restricts fluids as designated
  3. For parenteral fluids:
    • Within 20 minutes after beginning the Implementation Phase:
      • Verifies the accuracy of flow rate by either
        • Counting the drops per minute currently flowing or
        • Documenting that the flow rate of the infusion control device is set at the exact number required to deliver the prescribed volume by writing the correct setting on the PCS Recording Form
      • Assesses the insertion site of peripheral, central, or implanted venous access devices for dislocation, infiltration, or other complications by using one of the following methods:
        • Feeling the surrounding skin for changes in temperature OR
        • Palpating the surrounding tissue for edema
      • Regulates the flow rate when required by either:
        • Adjusting flow to within +/- 5 drops per minute (regular or microdrops) of the calculated number of drops per minute OR
        • Adjusting the flow rate of the infusion control device to the exact number required to deliver the prescridbed volume
      • Records the prescribed fluid infusing on the PCS Recording Form
    • Throughout the Implementation Phase:
      • Administered the prescribed fluids
      • Administers the designated amount of fluid per hour within the following ranges (as long as this amount of error does not place the patient in physical jeopardy):
        • +/- 25 ml per hour for a patient over 2 years of age
        • +/- 10 ml per hour for a patient under 2 years of age
      • Recalculates the fow rate or adjusts the ICD settting if the physician's order changes
      • When the next prescribed primary IV fluid is required:
        • Selects the designated fluid
        • Calcuates the amont of fluid to infuse per specified period of time
        • Identifies the patient immediately before administering the IV solution by verifying two of the following peices of patient information
          • Patient name
          • Date of birth
          • Medical record number
        • Assesses the insertion site of peripheral, central, or implanted venous access devices for dislocation, infiltration, or other complications by using on of the following methods:
          • feeling the surrounding skin for changes in temperature OR
          • Palpating the surrounding tissue for edema
        • Clears IV tubing of air before initiating flow
        • Regulates the flow rate by either:
          • Adjusting the flow to within +/- 5 drops per minute (regular or microdrop) of the calculated number of drops per minute or
          • Adjusting the flow rate of the infusion control device to the exact number required to deliver the prescribed volume
        • Records on the PCS Recording Form the new fluid being administered
      • When maintenance of an intermittent venous access device is required:
        • Assesses the insertion site of peripheral, central or implanted venous access device for dislocation, infiltration, or other complications by:
          • Feeling the surrounding skin for changes in temperature OR
          • Palpating the surrounding tissue for edema
        • Aspirates for blood return unless cotraindicated
        • Flushes the intermittent access device with the designated flush solution
        • Records the flush solution on the PCS Recording Form
      • When a peripheral device is discontinued:
        • Assesses the condition of the IV site
        • Removes the cannula
        • Applies pressure to the venipuncture site
        • Applies a protective covering
  4. When enteral and/or parenteral intake is assigned:
    • Measures the amount of fluid ingested/infused
    • Records fluid intake within +/- 10% of the actual intake
    • Records kind(s) of fluid ingested/infused
    • Recouds hourly intake on PCS Recording Form within +/- 10 minutes of the designated time, when hourly intake is assigned
  5. When output is assigned:
    • Collects output
    • Measures output during the entire PCS
    • Records amount of output within +/- 10% of actual output for the PCS on the PCS Recording Foum (output from urinary retention catheters or other drainage apparatus is not measured during the PCS unless otherwise designated)
    • Records amount of hourly output on the PCS Recording form within +/- 10 minutes of the designated time, when hourly output is assigned
  6. Records data related to:
    • Hydration status
    • Condition of insertion site for peripheral, central, or implanted venous access devices

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