DAR note???!!!

Sue Damones · Nov 26, 2008

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.

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: (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!

miss anais · Nov 26, 2008

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!

i'm not sure... what WILL happen if you add gentamycin?

Sue Damones · Nov 26, 2008

are you in nursing school?

miss anais · Nov 26, 2008

yes, 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.

Sue Damones · Nov 26, 2008

Ok. 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 · Nov 26, 2008

hey 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!!

Sue Damones · Dec 2, 2008

No. 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...

Daytonite, BSN, RN · Dec 3, 2008

i'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 https://allnurses.com/forums/f205/nursing-documentation-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.

now, all you need to do is put that in the form of a dar note.

you can read up on ivs and iv problems from the links on this post of this sticky thread: https://allnurses.com/forums/1458776-post6.html

Sue Damones · Dec 3, 2008

So, how'd I do Daytonite? hehe. I wish I would have posted as good an answer that you did! :)

mystic33 · Dec 4, 2008

wow daytonite!

you are simply amazing! you always always take the time to help students out, and your responses are always lengthy and filled with valuable information. i do not post much but wanted to encourage you by letting you know that i learn so much from you.

i'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 https://allnurses.com/forums/f205/nursing-documentation-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.
now, all you need to do is put that in the form of a dar note.
you can read up on ivs and iv problems from the links on this post of this sticky thread: https://allnurses.com/forums/1458776-post6.html

miss anais · Dec 6, 2008

hey, ladies!

thank you so much for all your help. the problem that i was looking for was INFILTRATION. i didn't know what it was, but i looked in the book under IV therapy and it listed infiltration with the common problems that the patient had. i figured out what time i had to cange the bag. i think i changed it at 10 or 11 not sure exactly. i wrote it all n a DAR note and i actually got 100% so i wanted to say thank you all for your help! :))