[GingerSue]

this is hypothetical:

patient has IV started at 0600 (to run at 125 cc/hr)
(N/S alternating with D5W)

This is the material presented on the paperwork:
Clinical Record shows that the nurse has documented Intake/IV:
125 + 1000 + 1000 for total of 2125

but
the IV administration Record (this patient went to the OR at 0845 and returned between 1400 and 1530) with solutions/times/amounts documented as follows:
NS 1000 mLs @ 125/hr start at 0600, stop at 0745, Amt abs=200
NS 1000 mLs @ 125/hr start at 0745, stop at 0845, Amt abs=125
(these will be both from the first 1000 mLs of NS)
To OR at 0845

(I assume that the IV NS is running during the time in the OR)

From OR between 1400 - 1530
D5W 300 mLs @125/hr start at 1400, stop at 1530, Amt abs=175
D5W 300 mLs @125/hr start at 1530, stop at 1630, Amt abs=125
(the total D5W will be 300)
NS 1000 mLs @125/hr start at 1630, stop at 2330, Amt abs=1000
D5W 1000 mLs @ 125/hr start at 2330, stop at __, Amt abs=___

The total that I arrive at from this above record is 1000 NS (I'm assuming that the remaining 675 was absorbed in the OR) + 300 D5W + 1000 NS (+ maybe the amount between 2330 to midnight?) = 2300 or 2363? (the remaining 63 is NS between 2330 and 2400 - or maybe this 63 is omitted?)

Where does the clinical record get 125 + 1000 + 1000 = 2125?

Which should I use in my own answer for total Intake? The clinical record, or the IV administration record?
I will probably end up writing up a page of explanation for this inconsistency in the question, with my various answers.

[Daytonite]

How much did the patient get between 0845 and 1400? ORs often run bags of IV fluids at very fast rates to replace the insensible fluid loses sustained through their open incisions during surgery.

[GingerSue]

Originally Posted by Daytonite

How much did the patient get between 0845 and 1400? ORs often run bags of IV fluids at very fast rates to replace the insensible fluid loses sustained through their open incisions during surgery.

there is no information provided about the time between 0845 and 1400

the only information that is provided is the Clinical Record and the IV Admin record (with other history, assessment, teaching, notes - nothing else about the OR time)

So - Total intake will be calculated from either the Clinical Record or the IV admin record, and on the IV Admin record there is no documentation by OR staff (during the time 0845 to 1400 - maybe someone should have documented during this time?)

[Daytonite]

OK, I'm confused. So, this 2125cc is what is documented as being infused between 0745 hours and 2330 hours, is that what you're saying? That 2-8 hours shifts. 16 hours x 125cc/hr = 2,000cc

[GingerSue]

Originally Posted by Daytonite

OK, I'm confused. So, this 2125cc is what is documented as being infused between 0745 hours and 2330 hours, is that what you're saying? That 2-8 hours shifts. 16 hours x 125cc/hr = 2,000cc

The Clinical Record shows Intake: (3 columns) First column= 125
Second column=1000, Third column=1000
Then the total is written in: 2125

But that does not correspond to the IV Admin Sheet (as in my first post above) (which shows total of 200 + 125+ 175+ 125 + 1000 +(assuming there remaining 675 from the first NS) = 2300

(200 + 125 + in OR probably 675 = 1000 NS) + (175 + 125 of D5W) + 1000 NS

[Daytonite]

Well, the problem here is that I can't see what you are seeing. However, three columns to me sounds like 3 shifts of fluid intake. What times do these 8-hour shifts run from and to? If you are ending a shift at midnight, then a shift is starting at 4pm (1600 hours). That would make the shifts:

• 12am to 8am
• 8am to 4pm
• 4pm to 12am

Is that right? It doesn't sound like they're even following shift totals.

125/hr start at 0600 to 0745 = 218 mL
125/hr start at 0745 to at 0845 = 125 mL
??? from 0845 to 1400
125/hr start at 1400 to1530 = 188 mL
125/hr start at 1530 to 1630 = 125 mL
125/hr start at 1630 to 2330 = 875 mL (7 hours x 125 mL)
125/hr start at 2330 to midnight = 63 mL

That totals 1594 mL

[GingerSue]

I've added my explanations in Century Gothic beside your numbers, in order to explain what is presented in this printed case example:

Thanks for trying to understand this.

I will still write up the inconsistencies in the material so that the facilitator understands that certain areas of the material don't match other areas very well

Originally Posted by Daytonite

That would make the shifts:

• 12am to 8am
• 8am to 4pm
• 4pm to 12am

Is that right? It doesn't sound like they're even following shift totals

125/hr start at 0600 to 0745 = 218 mL (that would be accurate, but the IV Admin Record shows 200 mL documented between 0600 - 0745} so: 200
125/hr start at 0745 to at 0845 = 125 mL {0745 - 0845 is documented: 125} so: 125
??? from 0845 to 1400 {Nothing is documented so it's assuming that the remainder of the 1000 mL bag is absorbed - 675} so: 675
125/hr start at 1400 to1530 = 188 mL {documented is 175 of D5W) so: 175
125/hr start at 1530 to 1630 = 125 mL {documented is 125} so: 125
125/hr start at 1630 to 2330 = 875 mL (7 hours x 125 mL){ 875 would be accurate but documented is 1000 mL of NS} so: 1000

125/hr start at 2330 to midnight = 63 mL {63 is what I figure to complete the 24 hr day, although maybe the shift changes at 2330 - shift time isn't given, so it's guesswork} so: maybe 63 or maybe not 63

That totals 1594 mL { this would be accurate, but the numbers that are documented in this hypothetical client
record are 200 +125 +675 + 175 + 125 + 1000 = 2300 [perhaps with the 63]

But the documentation on the Clinical Record is those 3 columns (one for each shift?) of 125 + 1000 + 1000 = 2125 total

I'll probably select the 2300 (or 2363) with a page of explanation because on the IV Admin Record, each amount is documented (except for the OR intravenous amount)
Thanks again