A nurse is planning to insert a peripheral iv. “just in case” they might be needed.

A nurse is planning to insert a peripheral iv 48. Insert the catheter at a 45° angle. What patient care order should the nurse anticipate? a. "The tourniquet should be released after Infusion Nursing PURPOSE To provide a safe, aseptic temporary peripheral short venous access for administration of short-term infusion therapies. Nursing Interventions. 4. Normal saline b. Options b, c and d are not effective techniques for dilating a vein for IV insertion. Which of the following veins is the best choice for a school-aged child?, A nurse is preparing to place a peripheral IV catheter (PIVC) in a patient who requires IV fluids for a diagnosis of dehydration. c. This guide provides a step-by-step guide to starting an IV, discusses the benefits of mastering this skill, and offers tips for improving technique. Fundus boggy at two fingerbreadths above the umbilicus. shave the excess hair from the insertion site d. A nurse prepares to insert a peripheral venous catheter in an older adult. Credit Hours: 3 Authors: Kevin Arnold, DNP, MSN, BBA, BS, BSN, RN This course covers the use of ultrasound equipment to aid in peripheral IV insertion and includes content on items such as technology, vessel and catheter selection, site preparation, techniques, complications, and potential pitfalls. We have to verify the need for it. Shave excess hair from the insertion site D. Open up the catheter package. -Ask the patient about allergies to latex or iodine. Nurses' Notes 1200: Large amount of lochia rubra noted on perineal pad. c) Insert IV access to the palmar side of the client's wrist Official Ninja Nerd Website: https://ninjanerd. Study with Quizlet and memorize flashcards containing terms like A nurse is administering an otic medication to an older adult client. Initiate IV therapy in the veins of the hand. See Table 1. Place the following steps in the order in which the nurse should perform them. Study with Quizlet and memorize flashcards containing terms like A nurse is caring for a client who is receiving a continuous IV through a peripheral intravenous device. 3 Elevate the client arm prior to insertion . Stop the infusion before removing the IV catheter. Hang the fluid and tubing Study with Quizlet and memorize flashcards containing terms like The nurse is preparing to insert a peripheral IV catheter into a patient who will require fluids and IV antibiotics. It is estimated that about 70% of people with PIVCs will develop associated complications, such as infections. B) Pack a small piece of cotton deep into the client's ear canal. c) Initiate IV access on the palmar side of the client's wrist Elevating the client's arm prior to insertion can cause veins to collapse, making it more challenging to insert the IV catheter. A nurse is planning to insert a peripheral iv catheter for an older adult client, the action in which the nurse should plan to take is to position the client's arm in the dependent position. Which of the following actions should the nurse plan to take? Position the client's arm in the dependent position A nurse is preparing to insert a peripheral intravenous access device into the arm of a client. A nurse is inserting a peripheral IV catheter and observes a blood return in the flashback chamber after puncturing the skin and selected vein. Intravenous (IV) therapy is an important part of clinical care. Learn more about procedures used to gain vascular access: https://www. 3a for potential local complications of peripheral IV therapy. Ensure your signature is included to authenticate the documentation and maintain accountability. Which of the following actions should the nurse plan to take? a-Insert the catheter at a 45 degree angle b-Place the client's arm in a dependent position c-Shave excess hair from the insertion site d-Initiate IV therapy in the veins of the hand The nurse is preparing to insert a peripheral intravenous (IV) line and administer prescribed 0. It is the responsibility of the nurse to monitor for signs and symptoms of complications and intervene appropriately. ***3. Place the following steps in the correct order. The nurse should recognize that which of the following findings indicates fluid volume excess? (select all that apply), While assessing a client who is receiving continuous IV therapy via his left forearm, a nurse notes that the site is red, swollen and A nurse is planning to insert a peripheral IV catheter in an older adult client. Which statement by the nurse indicates a need for further discussion? A. initiate IV therapy in the veins of the hand A nurse is preparing to start peripheral intravenous (IV) therapy. Apply warm compresses to the extremity. The catheter is then inserted into the vein at a 15- to 30-degree angle. 5% will require central venous line access due to the risk of vascular endothelial damage. An RN may insert a peripheral-short catheter in the alternative care setting with Study with Quizlet and memorize flashcards containing terms like 1. Study with Quizlet and memorize flashcards containing terms like A nurse is planning for the placement of a peripheral IV access. Which of the following actions should the nurse take?, a nurse rates a client's biceps reflex as 2+. Leave the roller clamp slightly open. higher than the primary solution container, A nurse is Study with Quizlet and memorize flashcards containing terms like A nurse is preparing to insert an IV catheter for a client and has selected the insertion site. The nurse should include that which of the following findings is an indication of early infiltration May 19, 2024 · Prescribed IV solution or medication with attached and primed administration set (Refer to the “Checklist for Primary IV Solution Administration” in Open RN Nursing Skills. b) Select a site proximal to previous venipuncture sites. , When caring for a client who requires intravenous (IV) therapy, which actions are within the nurse's scope of practice and can be performed independently? Select all that apply. Which action should the nurse plan to take? Place the client's arm in a dependent position (Because the veins will dilate due to gravity) Sep 9, 2024 · By following a systematic approach to IV insertion, from preparation and site selection to insertion and monitoring, nurses can improve their technique and provide high-quality care. The health care provider is planning to discontinue total parenteral nutrition for a patient who has been receiving it for 3 weeks after an episode of severe gastrointestinal (GI) bleeding. After the demonstration, they provide additional information about IV catheters and insertio Sep 28, 2023 · When planning to insert a **peripheral **IV catheter for an older adult client, the nurse should take the actions to ensure patient safety and effective therapy. How to Start an IV Step by Step. Place the following steps in the order in A nurse has just initiated a new peripheral IV infusion with 5% dextrose in water for continuous infusion. HESI LPN Medical Surgical Nursing . Although initiating IV Apr 6, 2022 · With the IV catheter connector, flush the extension tubing or cap. which of the following actions should the nurse plan to take? a. ) a. Which of the following actions should the nurse plan to take? Place the client's arm in a dependent position because the veins will dilate due to gravity. 1. "Selection of the catheter will depend on the age of the patient. merckmanuals. Placing the client's arm in a dependent position helps engorge the veins, making them easier to access. "The tourniquet should be applied distal to the site of venipuncture. Weston Hilland Inserting an IV Catheter 49. insert the catheter at a 45° angle b. Which of the following actions should the nurse plan to take? Position the client's arm in the dependent position A nurse is planning to insert a peripheral IV catheter for an older adult client. Specialty Exams . Which of the following veins should the nurse choose as the insertion site? a) superficial dorsal vein b) median vein in the forearm c) cephalic vein in the wrist d) great saphenous vein Nov 17, 2023 · Initiate IV therapy in the veins of the hand. How should the nurse always start the process of insertion? -Leave one hand ungloved to assess the site. The nurse is preparing to hang 1 liter of normal saline with 40 mEq (40 mmol) potassium chloride to infuse at 75 mL/hr beginning at 10:00 a. Which of the following actions should the nurse take?, A nurse is collecting data on a client who has diarrhea. Which of the following interventions should the nurse implement to prevent infection A) thread the IV catheter so that the hub rests at the insertion site B) shave the excess hair from around the insertion site C) cleanse the site with hydrogen perioxide prior to IV cath insertion D) palate A nurse is planning to insert a peripheral IV catheter for an older adult client. Continuous practice, feedback, and ongoing education are key to mastering this vital skill. Which of the following characteristics should the nurse document about the client's reflexes?, A nurse is caring for a client who is Oct 3, 2023 · The nurse should plan to shave excess hair from the insertion site when inserting a peripheral IV catheter for an older adult client. Place a warm, moist compress on the site. Full Transcript: Clinical Skills - Peripheral IV Insertion (Venipuncture) Study with Quizlet and memorize flashcards containing terms like A nurse in a clinic is caring for a middle adult client who states, "The doctor says that, since I am at an average risk for colon cancer, I should have a routine screening. Dec 12, 2023 · When planning to insert a peripheral IV catheter for an older adult, a nurse should take several key actions: Review the procedure aloud with the team, including the confirmation of the patient's identity, the procedure to be done, and that all necessary equipment is available and functioning. ) POLICY 1. A peripheral intravenous catheter (PIVC) is the most common type of IV. How often should the nurse plan to replace the primary infusion tubing? Every 96 hr. Which of the following actions should the nurse perform next? A) Secure the catheter to the skin with a transparent dressing. Apply tourniquet. Which infection control procedure will the nurse use to ensure safe client care? use of an indwelling urinary catheter Study with Quizlet and memorize flashcards containing terms like A nurse is caring for a client with scabies. Complications can be categorized as local or systemic. , The “just in case” they might be needed. Insert vascular access device. Insert the catheter at a 45° angle B. Which of the following actions should the nurse plan to take? A. Staff in NICU, Anesthesia, or vascular surgeons are sometimes needed for some patients. The nurse notes the catheter site is warm and painful to touch. Which of the following actions should the nurse take?Insert the IV catheter without using a tourniquet Here’s the best way to solve it. Study with Quizlet and memorize flashcards containing terms like a nurse prepares to replace the nearly empty container of total parenteral nutrition (TPN) for a client when she finds that there has been a delay in receiving the new container of solution from the pharmacy. The client has been prescribed a drug that has a topical route of administration. -Cleanse the skin with normal saline. A nurse is preparing to insert an IV catheter from a client . press gently on the tragus of the client's ear. How often should the nurse plan to replace the primary infusion tubing?, Which of the following actions should a nurse take when converting an IV infusion to a saline lock?, A client is to receive a 1,000 mL bag of 5% a nurse is planning to insert a peripheral IV catheter for an older adult pt. The insertion angle can vary from 10 to 30 degrees, depending on the depth and location of the vein. Place the patient on clear liquids for 1 week. d) It has to be inhaled. " C. 45% normal saline at 75 mL/hr. c) It has to be injected. C. Which of the following interventions should the nurse implement to prevent infection? Apply transparent dressing over the IV insertion site and securement device. Which of the following action should the nurse plan to take ? 1 Choose a vain that is palpable . Jun 19, 2024 · Nurse’s Signature. Select vein. The client’s belief that his needs will be met through education The nurse explaining the need for education to the client The client seeking family approval by agreeing to a teaching plan The nurse’s empathy about the client having to self-inject. e Background: The use of a peripheral intravenous catheters (PIVC) is a common invasive practice in healthcare settings. This is the act of starting an intravenous therapy such as medication administration, blood administration, etc. Place the client's arm in a dependent position. B. When inserting a peripheral IV, the nurse determines which vein is the most appropriate for the size and use of the catheter. A nurse is caring for a client who reports a pain level of 5 on a scale of 0-10. This is your ability to be a clinician. To avoid rolling the veins, a greater angle of 25 degrees between the skin and the catheter improves success with venipuncture. We want you to go out there and make sound decisions. Which of the following actions should the nurse take? a) Choose the client's dominant arm for IV access whenever possible. Mar 2, 2022 · Ellis demonstrates how to insert a peripheral IV (venipuncture). PIVC insertion can be painful, is often unnecessary, and may increase a patient's risk of developing a bloodstream infection. Study with Quizlet and memorize flashcards containing terms like PIV, vein entry: insert needle into skin at what angle?, Why is a tourniquet used when starting an IV? and more. Which of the following actions should the nurse take to ensure that the medication reaches the inner ear? A) Press gently on the tragus of the client's ear. The correct answer is choice D. What action will the nurse take to protect the client's skin during this procedure? a. Place the client's arm in a dependent position C. It can be used to restore fluids, administer blood products or medications, or serve as an alternate route for nutrition when the gastrointestinal tract is not functioning adequately. Study with Quizlet and memorize flashcards containing terms like A nurse is discontinuing a patient's peripheral IV access. Use all options. 4 Select a site on the client dominant arm May 19, 2024 · Several potential complications may arise from peripheral intravenous therapy. A nurse is planning to insert a peripheral IV catheter for an older adult client. 2 Apply a tourniquet below the venipunture site . The correct action for the nurse to plan to take when inserting a peripheral IV catheter for an older adult client is: B. Shave excess hair from the insertion site. Call on those who may have the best chance before all veins are used up. (Move the steps into the box on the right, placing them in the order of performance. IV Fluid Considerations via Peripheral IV line. which of the following actions should the nurse plan to take? Place the client's arm in a dependent position; the nurse should place the client's arm in a dependent position because the veins will dilate due to gravity. Which of the following actions should the nurse perform next? Secure the catheter to the skin with a transparent dressing. B) Advance the catheter into the vein with the finger hub. ), A nurse is teaching the mother of a 5-year-old The nurse has initiated a 20-gauge peripheral IV catheter in the client's left cephalic vein using aseptic technique. This article reviews the evidence for the appropriate use of short PIVCs in hospitalized patients, assesses the ongoing need for PIVCs, provides recommendations for alternative options, and argues for promptly removing a PIVC Study with Quizlet and memorize flashcards containing terms like A nurse is assessing an older adult client who is receiving IV therapy. Gravity can assist in distending the veins, so the arm should be positioned at or slightly below the level of the heart during IV insertion to maintain adequate blood flow. Which actions should the nurse take? (Select all that apply. 2. The new nurse gathers equipment, including an intravenous catheter and insertion kit, and a 4x4 gauze dressing to apply over the insertion site. Study with Quizlet and memorize flashcards containing terms like a nurse is administering an otic medication to an older adult client. -Remove excessive Study with Quizlet and memorize flashcards containing terms like A nurse is preparing to place a peripheral IV in an 8-year-old pediatric patient. A single-lumen catheter, usually between ¾ and 1 in (1. 2. - 2 The nurse should place the client's arm in a dependent position because the veins will dilate due to gravity. 5. 9 and 2. Lower the extremity below the level of the heart. It is the consensus Course Description. Hey, this patient does not need a peripheral IV. pack a small piece of cotton deep into the client's ear canal. First, initiate IV therapy in the veins of the hand because these veins are often the most accessible. Initiate IV therapy in the veins of the hand PIV Care and Maintenance Assess, at a minimum, every shift (adults) and every hour (pedi), and document assessment on flowsheet Flushing: • Minimum 2ml of 0. d. Which of the following actions should the nurse plan to take?Insert the catheter at a 45° angle. The nurse typically places this type of IV in either the arm or hand. In which order will the nurse perform the steps starting with the first one? 1. Which of the following actions should the nurse plan to take?, A nurse is caring for a client who has a prescription for wound irrigation. Practicing Needlestick Safety. Use scissors to remove the IV site dressing and tape. 6. The nurse has initiated a 20-gauge peripheral IV catheter in the client's left cephalic vein using aseptic technique. Study with Quizlet and memorize flashcards containing terms like A nurse is caring for a client who had IV fluids initiated at 0330. Intravenous (IV) therapy is essential for effective and efficient delivery of medications, fluids, and nutrients. Which is the order of priority that the nurse should take to prepare for the IV insertion? Arrange the actions in the order of priority that they should be performed. A nurse is caring for a client who is 1 hr postpartum. What does that involve?" Which of the following responses should the nurse make?, A nurse is caring for a client who is having difficulty breathing. IV therapy is a common intervention in nursing practice and useful for rapidly addressing symptoms and restoring hemostasis. The nurse is teaching a course about the special needs of older adults receiving IV therapy. b. com/professional/critical-care-medicine/approach-to-the-critically-ill-pat 1) insert the catheter at a 45 degree angle 2) place the clients arm in a dependent position 3) shave excess hair from the insertion site 4) initiate IV therapy in the veins of the hand CORRECT: 2) place the clients arm in a dependent position 1) generally the nurse should insert at a 10 to 30 degree angle but for older adults an angle of 10 to 15 degrees is preferable because veins are closer Aug 9, 2024 · After some reasonable unsuccessful attempts to insert the IV catheter, it would be best for the patient that the nurse calls for another healthcare provider to try inserting the IV. A nurse is caring for a client who is postoperative and refuses to use an incentive spirometer following major abdominal surgery. (A peripheral-short catheter is one that is less than or equal to 3 inches in length. Several potential complications may arise from peripheral intravenous therapy. First, the nurse should address the inflammation and pain with warm compresses. Tap the skin lightly and avoid slapping. Mar 2, 2022 · A demonstration on how to insert a peripheral IV (venipuncture). Monitoring for Potential Complications. What is a Peripheral iv catheter? Study with Quizlet and memorize flashcards containing terms like potential infusion sites for peripheral venous catheters, IV Flow Rate Formula, When hanging a new bag of IV fluid for a client, which action does the nurse perform first? Spike the new bag of fluid using aseptic technique. The steps for initiating peripheral IV access are described in the “Perform IV Insertion and IV Removal” checklist later in this chapter. Apply firm pressure with sterile gauze during removal. When inserting a peripheral IV catheter for the administration of IV fluid, the nurse should choose the client's dominant arm for IV access if that is possible. How to start a peripheral IV in the dorsum of the hand: clinical nursing skill technique. Povidone-iodine d. , The The charge nurse observes a new nurse preparing to insert an intravenous (IV) catheter. Which of the following findings is a manifestation A nurse is preparing to insert a peripheral IV catheter to initiate IV fluid therapy for an older adult client. What should the nurse tell the client regarding the administration of the drug? a) It has to be swallowed. The IV fluids are infusing at 120 mL/hr. Which of the following actions should the nurse plan to take? Insert the catheter at a 45° angle. Initiating Peripheral IV Access. Use all the steps. Which of the following actions should the nurse take? a) Select a site proximal to the previous venipuncture site. 5 cm) long, is inserted into the patient’s vein. At an equal height with the primary solution container D. b) Insert a larger gauge IV catheter to prevent phlebitis. If I have a patient that may need a central line over a peripheral IV, then I need to advocate for the patient. Once you have prepared for what you need to insert an IV successfully, you’ll need to figure out where you’d like to insert the IV. 1) Observation, patient teaching, and care in a diversity of health care settings (2) Contributions to the planning, implementation, and evaluation of nursing; (3) Administration of medications and treatments authorized by an individual who is authorized to practice in this state and is acting within the course of the individual's professional practice, except that administration of HESI LPN TestBanks. Place a washcloth between the skin and Jan 22, 2025 · Study with Quizlet and memorize flashcards containing terms like A nurse is discontinuing a peripheral IV catheter. Study with Quizlet and memorize flashcards containing terms like A nurse is planning to insert a peripheral IV catheter for an older adult client. A nurse is preparing to insert an IV catheter into a client's arm prior to initiating IV fluid therapy. After the demonstration, they provide additional information about IV catheters and insertio A nurse is inserting a peripheral IV catheter and observes a blood return in the flashback chamber after puncturing the skin and selected vein. Pull the catheter straight back from the insertion site. A nurse is planning to insert a peripheral iv catheter Get the answers you need, now!. Advance and secure. This technique uses gravity to increase blood flow to the arm and dilate the veins, making it easier to insert a peripheral IV catheter. HESI Test Bank Medical Surgical Nursing Jul 25, 2023 · Peripheral line placement, also referred to as peripheral intravenous (IV) cannulation, is the insertion of an indwelling single-lumen plastic conduit across the skin into a peripheral vein. Wear sterile gloves and a mask. A nurse is inserting a short peripheral IV catheter for a client who requires IV fluids. The nurse should include that which of the following findings is an indication of early infiltration?, A Study with Quizlet and memorize flashcards containing terms like A nurse us preparing to administer a medication by intravenous piggyback. Administering fluids containing glucose concentration greater than 12. The correct answer is that the nurse should dangle the client's arm over the edge of the bed to help dilate the vein. Such devices may be referred to as peripheral IV (or venous) lines, cannulas, or catheters depending on the country. This is important because hair can interfere with the proper adhesion of the dressing and increase the risk of infection. Where will the piggyback container be placed? A. D. Sep 9, 2024 · About 80% of hospital patients, according to the Journal of Infusion Nursing, receive peripheral IV fluid administration, and nurses are vital in preventing complications during this procedure. apply firm pressure over the vein. When preparing the skin for insertion, which of the following should the nurse use to prevent possible health-care associated bloodstream infections? a. Starting an IV (intravenous catheter) can be an intimidating experie Peripheral Intravenous Catheters. " B. Upon removalthe nurse should assess the catheter for which of the following?, A nurse has just initiated an W infusion and is teaching the client about possible complications. The A nurse is planning to insert a peripheral IV catheter for an older adult client. A nurse is planning to insert a peripheral IV catheter in an older adult client. below the level of the patient's heart B. Shave excess hair from the insertion site. What teaching will the nurse include? A. Also, identify the need. Question: A nurse is planning to insert a peripheral IV catheter for an older adult client. 7. Clean site. 3. Now you’re ready for proper IV insertion. place the pt's arm in a dependent position c. Which of the following actions should the nurse take to secure the a nurse is planning to insert a peripheral IV catheter in an older adult client. C) Move the client's auricle down and A nurse is planning to insert a peripheral IV catheter for an older adult client. Release tourniquet. They actually needed a central A nurse is preparing to remove an IV catheter from the arm of a client who has phlebitis at a peripheral IV site. 9% preservative-free saline using a pulsatile, push- The nurse should place the client’s arm in a dependent position because the veins will dilate due to gravity. Which Fluids and how much fluids to use Refer to the Intravenous Fluids RCH Clinical Practice Guideline: Intravenous Fluids. 3. org/lecture/peripheral-iv-insertion-nurs Inserting a new IV catheter distal to the discontinued IV site is not the immediate action to take for phlebitis. Initiate IV therapy in the veins of the hand. A catheter is a small hollow tube placed in the vein. Peripheral Intravenous Catheters. Alcohol c. b) It has to be applied on the skin. Which of the following actions should the nurse plan to take? There are 2 steps to solve this one. This will facilitate the insertion of the catheter and reduce the risk of complications such as infiltration, phlebitis, or hematoma. A nurse is inserting a short peripheral IV catheter for a client that requires IV fluid. The nurse should choose a vein that is palpable and straight for IV catheter insertion. Chlorhexidine In general, smaller gauge catheters (20 to 24) are preferred for peripheral IV therapy, and larger gauge catheters (14 to 18) are used for rapid fluid administration or blood transfusion. Reapply tourniquet. Place the client's arm in a dependent position. If a new IV site is needed, it can be considered after managing the client's symptoms. orgYou can find this lecture on our website at: https://www. m. move the clients' auricle down and Study with Quizlet and memorize flashcards containing terms like The nurse is preparing to insert an intravenous catheter into an adult client. The nurse is preparing to insert a peripheral intravenous catheter into a client. Upon removal, the nurse should assess the catheter for which of the following?, A nurse has just initiated an IV infusion and is teaching the client about possible complications. which of the following solutions should the nurse infuse until the next container of TPN solution becomes available, a Study with Quizlet and memorize flashcards containing terms like A nurse is discontinuing a peripheral IV catheter. Study with Quizlet and memorize flashcards containing terms like A nurse has just initiated a new peripheral IV infusion with 5% dextrose in water for continuous infusion. Study with Quizlet and memorize flashcards containing terms like A nurse is caring for a client who is in early stage renal failure and has a prescription for the infusion of IV fluids, Which of the following IV fluids does the nurse anticipate a prescription for and why?, A nurse has just inserted a peripheral IV catheter. ninjanerd. Study with Quizlet and memorize flashcards containing terms like A nurse is measuring a client's vital signs and notices an irregularity in the pulse. Plus, info about IV catheters and insertion tips. Changing IV every 72 hours or sooner dependent on facility policy, Practicing of surgical aseptic technique. All options must be used. Sep 28, 2023 · A nurse is planning to insert a peripheral IV catheter for an older adult client. Advance the catheter into the vein with the finger hub. Start tube feedings tid via A nurse is planning to initiate IV therapy for an older adult client who requires IV fluids. lower than the primary solution container C. The dominant arm is usually stronger and has larger veins, making it easier to insert the catheter and reducing the risk of complications. Squeeze the drip chamber to half fill it. which of the following action should the nurse take to ensure that the medication reaches the inner ear? 1. The nurse should record how many mL of IV fluids on the intake record at 0600?, A nurse is preparing to insert an IV catheter for a client and has selected the insertion site. The nurse should clip excess hair from the IV insertion site and avoid shaving the area because shaving can cause breaks and cuts in the skin that could place the client at risk for infection d. Close the roller clamp on the tubing. ) Sterile 10-mL prefilled syringe (or a syringe specifically designed to generate lower injection pressure) containing preservative-free normal saline solution; IV pole In general, smaller gauge catheters (20 to 24) are preferred for peripheral IV therapy, and larger gauge catheters (14 to 18) are used for rapid fluid administration or blood transfusion. *** With the catheter stabilized and using a slow, steady movement, the nurse should withdraw the catheter straight back and away from the insertion site, making sure to keep the hub parallel to the skin. Which of the following actions should the nurse plan to take? Insert a new IV catheter distal to the discontinued IV site. ucffq rfyzm inbcd vtdtl fahlb gth aude bedrdw ejpiuz josusjqg chvim blsb uyoplq ojam pqjal