Care Plan for IV infiltration help please!!

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Here is the case. A 48 years old woman who just had abdominal surgery. And she is having an IV infusion of 5% dextrose running at 500mL in 6hours. The IV stopped running and her infusion site is swelling and pallor. She is also complaining about the IV is hurting her. She is feeling pain, discomfort and general malaise. She has hypertension and intermittent episodes of gout in her past health history. Here are her vital signs.

BP 148/62, Pulse:62, Temperature:36.5, Respiratory rate:26, SpO2 % in room air.

What are the significance and importance in this case? What should the care plan be? like an actual problem and potential problem? Impaired tissue integrity?

Online teaching has limited my study nowadays. May anyone please give me some help?

Specializes in Endoscopy/Gastroenterology, General Surgery.
On 3/17/2020 at 4:57 PM, NG KIU HO said:

There are other nursing diagnoses that might occur, should I also mention them, like the disturbed sleeping pattern because of pain, and disturbed body image? Since the case given doesn't give any evidence, I can't see them as an actual problem. And I have taken a look at the functional health pattern, they cannot put with "risk for".

I will say these are minors problems. Focus on the priority of the problems first.

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On 3/17/2020 at 4:45 PM, Wuzzie said:

I can’t properly quote on my old iPad (will answer some of your questions tomorrow) but just wanted to say you’re doing a great job. You’re really thinking more clearly and obviously working hard. I’m super proud that you took my tough love words and really applied yourself instead of just disappearing. Being able to take criticism and using it to steer your growth is a great attribute. Keep up the good work! ??

Awe! ?? Kind words from you! You remind me of my old nursing instructor with that tough love! I've enjoyed reading this thread and learning from y'all by helping OP. ?

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6 hours ago, Rosalie Blythe said:

What can risk of infection lead to? There could be serious complication to that; even though the given vital signs are not very suggesting it, but one of the vital signs did meet the criteria.

Sorry but I am not sure about this, is it pneumonia? s/s rapid breathing? Actually I still have some concerns about ineffective airway clearance, suppose that there should be a decline in SpO2 level but in this case, it is 100% which is normal.

If I am going to set 2 priority to 5 of them, should I prefer acute pain and ineffective airway clearance? Both of them can cause serious consequences or delay recovery. Also as you mentioned, poorly controlled acute pain might contribute to ineffective airway clearance because of inability to perform deep breathing and coughing

6 hours ago, Rosalie Blythe said:

On the other hand, I want you to know that; for any type of surgery, and especially for abdominal surgery, the patient is first placed on clear fluid diet, and then NPO before the surgery. So mentioning I & O is critical. In this case, the vital didn't show that the patient is dehydrated (VS will be hypotension and tachycardia) but I want to keep in mind that other patients can have fluid deficit; especially after surgery because we expect moderate amount of blood loss from any type of surgery.

Noted with thanks! I wish the case can give me more information too!

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Specializes in Endoscopy/Gastroenterology, General Surgery.
15 hours ago, NG KIU HO said:

If I am going to set 2 priority to 5 of them, should I prefer acute pain and ineffective airway clearance? Both of them can cause serious consequences or delay recovery. Also as you mentioned, poorly controlled acute pain might contribute to ineffective airway clearance because of inability to perform deep breathing and coughing

Yep, and also risk of infection. Those are the main one

15 hours ago, NG KIU HO said:

Sorry but I am not sure about this, is it pneumonia? s/s rapid breathing? Actually I still have some concerns about ineffective airway clearance, suppose that there should be a decline in SpO2 level but in this case, it is 100% which is normal.

Ummm, I want you to look up the signs of pneumonia and sepsis.

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Specializes in Home health.

Respiration high as well as pulse pressure post surgery risk for cardiovascular event. And obviously the I.v infiltration...

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8 hours ago, Rosalie Blythe said:

Yep, and also risk of infection. Those are the main one

I am going to do postoperative pain management, I am planning to prescribe IV Ibuprofen 400-800mg Q6H if necessary only.

Since the patient can't take medicine orally, IV of NSAID is necessary. And among NSAIDs that can be prescribed through IV, Ibuprofen should be the best choice. First, researches have mentioned that it has a better effect on pain relief than ketorolac. Second, Ibuprofen can also treat arthritis, which the patient has a hx of intermitted episode gout.

Am I doing it right for postoperative pain management? Or is there any better alternative like another multimodal analgesia? Like music therapy?

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12 hours ago, NG KIU HO said:

I am going to do postoperative pain management, I am planning to prescribe IV Ibuprofen 400-800mg Q6H if necessary only.

Since the patient can't take medicine orally, IV of NSAID is necessary. And among NSAIDs that can be prescribed through IV, Ibuprofen should be the best choice. First, researches have mentioned that it has a better effect on pain relief than ketorolac. Second, Ibuprofen can also treat arthritis, which the patient has a hx of intermitted episode gout.

Am I doing it right for postoperative pain management? Or is there any better alternative like another multimodal analgesia? Like music therapy?

Selecting and prescribing medication is not within an RN's scope.

What are **nursing** interventions you could do to help with post op abdominal pain and infiltration pain? (Requesting pain med orders may be among them, but there are other things you can do independently.)

Is there a reason that RR rate of 26 with an O2 sat of 100% on a patient who is able to communicate verbally leads you to believe there is an airway issue? Based on the RR, pain, positioning, limited mobility while in bed, known pulmonary risks related to being post op from major surgeries, I would be much more inclined to consider this a *breathing* problem than airway problem. (The terms can't be used synonymously.) What are two common bedside nursing interventions for post op patients associated with breathing/prevention of complications?

Also, if a patient just had a major abdominal surgery and has signs of uncontrolled pain, why would her options be limited to an NSAID? You'd let the doctor know pain control wasn't adequate and ask for something that works. (No, music therapy definitely does not have a place in this careplan.)

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On 3/21/2020 at 3:32 AM, FacultyRN said:

Selecting and prescribing medication is not within an RN's scope.

What are **nursing** interventions you could do to help with post op abdominal pain and infiltration pain? (Requesting pain med orders may be among them, but there are other things you can do independently.)

Is there a reason that RR rate of 26 with an O2 sat of 100% on a patient who is able to communicate verbally leads you to believe there is an airway issue? Based on the RR, pain, positioning, limited mobility while in bed, known pulmonary risks related to being post op from major surgeries, I would be much more inclined to consider this a *breathing* problem than airway problem. (The terms can't be used synonymously.) What are two common bedside nursing interventions for post op patients associated with breathing/prevention of complications?

Also, if a patient just had a major abdominal surgery and has signs of uncontrolled pain, why would her options be limited to an NSAID? You'd let the doctor know pain control wasn't adequate and ask for something that works. (No, music therapy definitely does not have a place in this Care Plan.)

Thx!

Besides, I am confused about the intervention to relieve pain for the IV infiltration of 5% dextrose.

I am wondering whether if a cold compress or warm compress would be appropriate for pain relief.

Since answers from the internet are different, and D5W is also tricky. It is isotonic in the bag but hypotonic when infused into the body.

And warm compress should be applied for isotonic and cold compress should be applied for the hypotonic.

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Specializes in Endoscopy/Gastroenterology, General Surgery.
On 3/22/2020 at 6:31 AM, NG KIU HO said:

Thx!

Besides, I am confused about the intervention to relieve pain for the IV infiltration of 5% dextrose.

I am wondering whether if a cold compress or warm compress would be appropriate for pain relief.

Since answers from the internet are different, and D5W is also tricky. It is isotonic in the bag but hypotonic when infused into the body.

And warm compress should be applied for isotonic and cold compress should be applied for the hypotonic.

ummmmm from what I remember, we usually use warm compress if we cannot locate a patient's vein; and we use cold compress for like bruises at the IV site (like for some people, when you removed the IV, they can get some bruises). I am not sure in this case but I would just put elevate the hand to relieve edema. I did some research and it said " Check your institution’s policy regarding which type of compress (warm or cold) should be applied. Generally speaking, if the infiltration solution was isotonic, a warm compress is used to alleviate discomfort and help absorb the infiltration by increasing circulation to the affected area. However, sloughing can occur from the application of a warm compress to an area infiltrated with certain medications such as potassium chloride. In certain situations, a cold compress is recommended."

https://www.RN.com/nursing-news/know-the-difference-infiltration-vs-extravasation/

Other websites that I have read also stated that the type of compress is depending on the type of fluid being infused, like you have stated. When I worked at general surgery, most patients are either on 0.9% NS or Lactated Ringer so we would usually applied warm, as NS and LR are both isotonic solution.

The other website has stated that use warm compress

"Warm compresses, NOT HOT, for normal or high Warm compresses, NOT HOT, for normal or high pH/alkaline solution (ex: D5W) pH/alkaline solution (ex: D5W)

 Cold compresses for low pH/acidic solutions ( ex: Cold compresses for low pH/acidic solutions ( ex: vanco )"

from https://www.mghpcs.org/EED_Portal/Documents/Central_Lines/CL_Module9.pdf

I am also curious of the answer, maybe you should ask your professor. But I think what you have said is also correct.

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Just wanted to say I loved reading all of this! Reminded me of when I first came here looking for help!! Although, I did give my thoughts to start with ? But it’s just so nice seeing someone come for help, and when they don’t provide their own thoughts and someone replies that we aren’t going to do their work for them, for the OP to not take offense and start being rude or just run off! To just provide the info n show they really want to LEARN! So good on you OP!

And to those of you that were so helpful to the OP ?? You’re amazing! Just makes me smile seeing people help other people! ????????

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