Intravenous fluids/non-pharmacologic pain interventions

Lesson 20

Objectives

• The student will be able to explain the purpose of IV/PICC lines and the role of the Nursing assistant in caring for the resident with them

• The student will be able to list complications that can occur when residents have IV/PICC lines and the role of the Nursing assistant in observing and reporting.

• The student will be able to describe the sign/symptoms of pain and explain various interventions used to relieve it.

Types of IV’s

Peripheral sites• Located from the

center of the body• Arms• Hands• Feet• Inner aspect of elbow• Forearm

Central venous sites• Subclavian/jugular veins• Close to heart• Long catheter inserted

into superior vena cava• Also use cephalic and

basilica veins in arm • Physicians or specially

trained nurses insert catheter into veins

IV/PICC lines uses

• Administer blood• Fluids• Nutritional substance• Medications such as antibiotics

Basic equipment used in IV therapy

• Solution container• IV needle/catheter• IV tubing• IV pole

Responsibility of Nursing Assistant Notify Nurse if

• No fluid is dripping • Blood is anywhere in the tubing• The tubing is disconnected • The dressing over the site is

wet• The alarm sounds or the fluid

container is empty• Resident complains of pain or

itching at the insertion site• Site appears swollen or

discolored• Any signs of infection

Special care• Take extra care when moving or

caring for a resident• Be careful not to move the

needle/catheter• Move IV pole to side of bed resident

is lying- allow some slack in tubing• Never disconnect the IV/PICC lines

from the pump• Never lower the bag below the site• DO NOT take blood pressure in the

arm with the IV/PICC line• Use good infection control

technique and proper hand hygiene

Complications• Bleeding, puffiness, or redness at the site• Hot/cold skin near IV site• Pain or itching at or near site• Fever• Drop in blood pressure• Increase in heart rate• Irregular pulse rate• Cyanosis• Mental status change• Difficulty breathing• Decreased urinary output• Chest pain• Nausea or vomiting

Pain recognition • Change in vital signs• Nausea or vomiting• Sweating• Facial grimacing of groaning• Crying or tears in eyes• Sighing, moaning, or groaning• Difficulty breathing• Increased Restlessness• Difficulty moving• Holding or rubbing a body part• Tightening the jaw or grinding

teeth• Increased anxiety

Information to gather before going to nurse

• Vital signs• Ask resident to rate pain• Determine location of pain• Ask resident to describe pain• Find out what the resident

was doing when pain started• Ask when pain started• Ask if they have had same

pain before

Other info on Pain

Reasons residents deny pain • Worry about becoming

addicted to pain medications

• Dislike side effects of pain medications

• Residents worried about staff being annoyed with them

Pain interventions• Proper positioning of resident or

repositioning• Back rub• Cool/warm wash cloth to place or

forehead• Assist resident to restroom or bedpan• Encourage resident to take slow deep

breaths• Calm environment• Be patient, caring, gentle and sympathetic• Observe residents response to

interventions • Follow up on request for pain medications