Riddle Me This

[blondy2061h, MSN, RN]

A few times in my nursing career I've seen this scenario play out. Nursing student/new staff member/under the weather staff member comes in and has busy day/doesn't eat/doesn't drink/participates in some disgusting procedure then proceeds to either outright pass out or just get dizzy and need to sit down. Vitals get done. Maybe some orthostics. I've even seen an EKG done. This person typically ends up getting a PIV and a liter or so of good ol' 0.9% NS. I've never seen any of these people lack ability to take PO fluids. Typically they're taking PO fluids in addition to whatever they got IV. I've also not consistently really seen any indication that they are in fact actually dehydrated.

Have you seen this done?

What's the point of lining them versus just having them take PO fluids? I get that NS has the advantage of having sodium chloride, but salt isn't exactly hard to find. I'm thinking it's just nurses either falling into the "hero" role, hospitals wanting to be viewed as caring, or just how we think/what we do. PO fluids would save the hospital money, nursing time, be less risky, and save the "patient" a likely-unnecessary needle stick.

Further, if there's really concern of dehydration or electrolyte disturbances the person should really be evaluated in an ER or minimally at their PCP's office.

Can anyone explain to me why this is?

[mamamerlee, LPN]

Every time I have been a witness to some similar scenario, if the person doesn't come around really quickly, it's off to employee health or the ER, whichever is the most appropriate. Who is deciding that an employee needs IV fluids while they are supposed to be working?!!!! I'm blown away!!

[ktwlpn, LPN]

I've never seen this happen-the employee goes straight to the ED, occupational health or 911 is activated (in the LTC) If you have seen employees treated on the unit who gave the orders? Scary...

[blondy2061h, MSN, RN]

Hospitalist gave the orders.

[tewdles, RN]

This is done as a measure of professional courtesy...saves the employee the need to go to the ER (big courtesy) and saves everyone time. Yes, the hospitalist or MD on the unit provides this service for the staff.

[blondy2061h, MSN, RN]

This is done as a measure of professional courtesy...saves the employee the need to go to the ER (big courtesy) and saves everyone time. Yes, the hospitalist or MD on the unit provides this service for the staff.

I know I would appreciate the professional courtesy if I were the one that had fallen ill, but does everyone who vasovagals out really need IV fluids?

[Vito Andolini]

I doubt it.

[netglow, ASN, RN]

Nope, but better chance you won't call off tomorrow. There's usually a motive.

[ChristyRN2009]

Well if it is truly vaguling down, then fluids won't really hurt. But if you assume that a person is vaguling down when they are really dehydrated, then you risk the dehydration going on unnoticed and the ensuing problems developing. As far as PO fluids vs IV. IV is just most easy to get the fluids into the vascular system quickly. If you drink water, it does take a little bit more time to get into your system. Plus, if you make someone drink a lot of fluid, you risk them getting sick and throwing it up, thus you are back at square one.

So, given all the risks of just pushing PO fluids, I think many caregivers just start the IVF thinking that 1. they need fluids and get it 2. they don't need fluids but they get it anyway to be on the safe side or 3. regardless of whether or not they need fluids, you err on the side of caution and IVF is often the most cautious and assured way to get fluids in a person.

HTH.

[CASTLEGATES]

I've seen it when a staff member had a severe hangover; had em back into staff in no time! A shot of an NSAID and IV liter and they were back.

Only once but it broke up the monotony!

(he later got into aa so that also was a good thing)