Author Question: A nurse is discontinuing a patient's peripheral IV access. Which actions should the nurse take? ... (Read 11 times)

Lobcity · **on:** Jul 22, 2018

A nurse is discontinuing a patient's peripheral IV access. Which actions should the nurse take? (Select all that apply.)

a. Wear sterile gloves and a mask.
b. Stop the infusion before removing the IV catheter.
c. Use scissors to remove the IV site dressing and tape.
d. Apply firm pressure with sterile gauze during removal.
e. Keep the catheter parallel to the skin while removing it.
f. Apply pressure to the site for 2 to 3 minutes after removal.

Question 2

A patient has 250 mL of a jejunostomy feeding with 30 mL of water before and after feeding and 200 mL of urine. Thirty minutes later the patient has 100 mL of diarrhea.

At 1300 the patient receives 150 mL of blood and voids another 200 mL. Calculate the patient's intake. Record your answer as a whole number. _____ mL

Fill in the blank with the appropriate word.

aadams68 · **Reply #1 on:** Jul 22, 2018

Answer to Question 1

ANS: B, E, F
The nurse should stop the infusion before removing the IV catheter, so the fluid does not drip on the patient's skin; keep the catheter parallel to the skin while removing it to reduce trauma to the vein; and apply pressure to the site for 2 to 3 minutes after removal to decrease bleeding from the site. Scissors should not be used because they may accidentally cut the catheter or tubing or may injure the patient. During removal of the IV catheter, light pressure, not firm pressure, is indicated to prevent trauma. Clean gloves are used for discontinuing a peripheral IV access because gloved hands will handle the external dressing, tubing, and tape, which are not sterile.

Answer to Question 2

ANS:
460

The patient's fluid intake is 250 mL of feeding, 60 mL of water (30 mL before and after), and 150 blood: . Fluid intake includes all liquids that a person eats (e.g., gelatin, ice cream, soup), drinks (e.g., water, coffee, juice), or receives through nasogastric or jejunostomy feeding tubes. IV fluids (continuous infusions and intermittent IV piggybacks) and blood components also are sources of intake. Fluid output includes urine, diarrhea, vomitus, gastric suction, and drainage from postsurgical wounds or other tubes.