DAR note???!!!
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This is a discussion on DAR note???!!! in Nursing Student Assistance, part of Nursing Student ... Hey, guys. How is everyone doing? Happy early Thanksgiving! So, I'm having a bit of a problem. ...
by miss anais Nov 26, '08Hey, guys. How is everyone doing? Happy early Thanksgiving!
So, I'm having a bit of a problem. I need help writing this DAR note. We were given a situation and asked to write a DAR note and what the patient has. I know some of it, but am confused on other parts.
Provider's Order IV RL @ 125CC/hr x 3 liters
Infusing now: RL @ 125cc/hr via 18 gauge intra-catheter in right wrist
IV started: 11/24/08 @ 0300
Time now: 11/24/08 @ 0930
IV site: without pain, pain level 0/10
* Cool to touch
* Edema around insertion site approx 10cm in diameter
No leakage from insertion site, insertion site blanched
Meds: Gentamycin 80mg IVPB due 11/24/08 @ 10:00
So, the data for this would be provider's order, what is infusing now, time started? would this also include the fact that there is an edema around the insertion site, or is this considered response (since it's a response to the medication the pt. is given)?
action is changing the IV RL (I haven't figured out what time you have to do this, yet), giving gentamycin at 10:00
response is pt denies pain, 0/10 on a pain scale
The patient has edema????
I'm really confused about this.
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Nov 26, '08 by Sue DamonesQuote from miss anaisOk... Data, Action, Response. Don't think too much into it or you'll get yourself all confused, lol. Think of the response being the response to the current situation or problem you're running into, which is an infiltrated IV.Hey, guys. How is everyone doing? Happy early Thanksgiving!
So, I'm having a bit of a problem. I need help writing this DAR note. We were given a situation and asked to write a DAR note and what the patient has. I know some of it, but am confused on other parts.
Provider's Order IV RL @ 125CC/hr x 3 liters
Infusing now: RL @ 125cc/hr via 18 gauge intra-catheter in right wrist
IV started: 11/24/08 @ 0300
Time now: 11/24/08 @ 0930
IV site: without pain, pain level 0/10
* Cool to touch
* Edema around insertion site approx 10cm in diameter
No leakage from insertion site, insertion site blanched
Meds: Gentamycin 80mg IVPB due 11/24/08 @ 10:00
So, the data for this would be provider's order, what is infusing now, time started? would this also include the fact that there is an edema around the insertion site, or is this considered response (since it's a response to the medication the pt. is given)?
action is changing the IV RL (I haven't figured out what time you have to do this, yet), giving gentamycin at 10:00
response is pt denies pain, 0/10 on a pain scale
The patient has edema????
I'm really confused about this.
D: (what are the facts? What do you see/assess): LR running at 125 ml/hr via R wrist PIV. Pt denies pain to IV site. Skin cool to touch, edema noted 10 cm surrounding site, skin blanched.
A: (what did you do about it/your intervention): LR infusion stopped. Physician notified. HOLD Gentamycin until patent IV can be started (what would happen if you ran gent into this IV?). Extremety elevated on pillow. (Consult with physician whether to use cold/warm compresses). D/C IV
R: (evaluate). Physician notified, orders received, new PIV started, good blood return, edema resolved, etc... pain scores, how the patient responded.
sorry I'm typing fast, in the middle of something...hope this helps!Last edit by Sue Damones on Nov 26, '08 : Reason: added more - Nov 26, '08 by miss anaisQuote from Sue Damonesi'm not sure... what WILL happen if you add gentamycin?Ok... Data, Action, Response. Don't think too much into it or you'll get yourself all confused, lol. Think of the response being the response to the current situation or problem you're running into, which is an infiltrated IV.
D: LR running at 125 ml/hr via R wrist PIV. Pt denies pain to IV site. Skin cool to touch, edema noted 10 cm surrounding site, skin blanched.
A: LR infusion stopped. Physician notified. HOLD Gentamycin until patent IV can be started (what would happen if you ran gent into this IV???!!). Extremety elevated on pillow. (Consult with physician whether to use cold/warm compresses). D/C IV
R: (like a reassessment). Physician notified, orders received, new PIV started, good blood return, edema resolved, etc... pain scores, how the patient responded.
sorry I'm typing fast, in the middle of something...hope this helps!
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- Nov 26, '08 by miss anaisyes, i'm a first year, first semester student.
sorry if i look like i don't know what i'm doing. i kind of don't when it comes to DAR notes. - Nov 26, '08 by Sue DamonesOk. Well, first thing you have to ask yourself is, is this IV good? No. Would you want to run anything into this IV? No. So... if you are trying to decide whether to run a strong antibiotic via this not-good IV, the answer would be heck no
You'll learn more when you get into pharmacology.
Did that help make the DAR note clearer though?miss anais likes this. - Nov 26, '08 by miss anaishey sue, thanks for all your help. so for action, i have to figure out what time I have to change the bag and put it in there, right?
also, any idea what the patient might have? a bruise or a broken leg, perhaps? not exactly sure. after I do the DAR note, i'll post it here and see if there's anything else i should add. i'll try my best to do it but i'm still confused!! - Dec 2, '08 by Sue DamonesNo. The action is to stop the infusion, notify the physician, and treat the infiltration. Where did the bruise/broken leg come from? I'm a little confused how that would come out of this. The edema is from the infiltrated IV. You would restart the infusion once a new patent IV was started.
Let me know how it turns out... -
Dec 2, '08 by Daytonitei've watch this thread with some interest and wasn't sure how to respond to it at first. there is a link to an example of dar charting posted on the sticky thread http://allnurses.com/forums/f205/nur...on-168921.html - nursing documentation but that doesn't seem to be the problem here. the problem is recognition of what is going on with this patient situation and how to resolve it. it requires knowledge of iv therapy of critical thinking. i was an iv therapist for many years. there is a common complication of iv therapy occurring here that you need to recognize and do something about. if you use the steps of the nursing process to problem solve it is much easier.
- assess - abnormal data is: cool to touch; there is edema around the insertion site approx 10cm in diameter (that is 4.5 inches); and the insertion site is blanched (white)
- problem - this is an infiltration and the iv fluids are infusing into the surrounding tissues rather than into the vein. the reason it is not a phlebitis is that the developing signs of phlebitis are redness, heat, swelling and pain, but redness, heat and pain are absent. this can only mean that the problem is an infiltration of the iv fluids.
- plan - stop this current infusion of rl @ 125cc/hr which was started at 0300 on 11/24/08, six and a half hours ago. remove the iv device from the right wrist. restart the iv in a new location, preferably the other arm and resume the infusion. the piggyback of gentamycin which is due at 1000 is a very irritating iv fluid and should not be given until a new and patent iv line is established.
- implementation - you stop the iv infusion, d/c the iv from the right wrist, start a new iv in the left forearm with a #20g iv catheter and restart the rl @ 125cc/hr.
- evaluation - at 1100 hours the gentamycin has been infused, the new iv site is without redness, swelling or tenderness and the iv continues to infuse at 125cc/hour.
you can read up on ivs and iv problems from the links on this post of this sticky thread: http://allnurses.com/forums/1458776-post6.html - Dec 3, '08 by Sue DamonesSo, how'd I do Daytonite? hehe. I wish I would have posted as good an answer that you did!
