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98 Cards in this Set
- Front
- Back
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Kg to LBS conversion factor and how to solve for
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2.2 lbs = 1 kg
1) divide pounds by 2 2) subtract 10% of above 80lbs / 2 = 40 lbs - 10% (4) = 36lbs |
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1 gram = how many mg?
1mg = how many mcg? 1 liter = how many mL? |
1 gram = 1000mg
1mg = 1000mcg 1liter = 1000mL |
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IV bag sizes and theory
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250/500ml = IV acces for pushing meds
1000ml = volume replacement (bleeding deydration etc) check bag for clarity, and expiration date, correct fluid type has drip port, and drug access port |
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Administration Set contains
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drip chamber - visual flow
volume control - controls flow Y port - medications put into the IV |
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Microdrip Administration set
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delivers 60drops/ml
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Macrodrip Administration set
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delivers 10gtts/ml or 15 gtts/ml
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Parts of the IV catheter
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catheter = plastic sheath that goes into the vein
hub = catheter base flash chamber = shows blood if you are in the vein stylet = needle |
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Vein selection criteria
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-Volume Replacement (shocky)
vs -IV access for drugs (potential problems) |
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Needle Sizing
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Four common sizes
20 18 16 14 14 & 16 = large bore volume 18 & 20 = drug access 22 & 24 = peds/elderly 12 & 10 = carried in the airway box used for cricothyrotomy |
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Vein location
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Hand - start here, for meds
Anterior Cubital - elbow good vein access for volume (trauma/MI/cardiac arrest) |
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Needle Packaging info
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gauge
needle length 1.25-2" |
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bifurcation
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Y in vein, helps to hold vein from moving around
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valves
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help to keep the blood moving in 1 direction
catheter tends to hang up in the valves |
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joints
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avoid the wrist
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TKO
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To Keep Open
-prevents the coagulation of blood in the catheter |
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3 basic metric units for measurement
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meter - linear measurement
liter - capacity or volume gram - unit of weight |
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common metric prefixes
kilo deci centi milli micro |
kilo - 1000 times greater
deci - 10 times less centi - 100 times less milli - 1000 times less micro - 1 million times less |
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primary unit of mass in the apothacary system
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grain (derived from the weight of a single grain of wheat)
1 grain = 60-65mg other units include -minim = volume of water (1 grain) -dram, OZ, pound 60 grains = 1 dram 8 drams (48 grains) = 1 oz |
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Household system units
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glass, cup, tablespoon, teaspoon, drop, quart, pint
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celcius/fahrenheit conversions
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Celsius to Fahrenheit = (C X 9/5) + 32
Fahrenheit to Celsius = F - 32 (5/9) |
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Basic Forumla (desire over have)
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Desire/Have X unit of measure or volume on hand = Answer
Ex. you need to administer 25 mg of drop, you have a 10 mL vial that contains 50mg of drop, how many mL will you give? 25mg/50mg X 10 mL = X 25/5 X 1 mL = X 5 X 1 mL = X X = 5 mL |
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Ratios and Proportions
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Dose on Hand:Volume on Hand :: Desired Dose : Desired Volume
EX: you are to administer 40mg XTC. you have 100 mg of the drug in 10mL of solution, how many mL will you give? 100mg : 10mL :: 40 mg : X mL multiply extremes and means 100x X 400 divide number in front of "x" x = 400/100 x = 4 |
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3 things you need to know for calculating IV flow rates
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1) volume to be infused
2) period of time in minutes over which the fluid is to be infused 3) number of drops (gtt) per mL the infusion set delivers gtt/min = (Volume to be infused X Drop Factor) / Duration of infusion EX. give 250ml of saline over 90 min, your infusion set delivers 10 gtt/mL 250ml/90min X 10gtt/ml = gtt/min gtt/min = (250mL x 10 gtt/mL)/90 minutes = 27.7gtt/min |
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3 things you need to know for calculating infusion rates
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1) prescribed dose
2) concentration of the drug in 1 mL of solution 3) drop factor of the IV infusion set gtt/min = (Prescribed dose X Drop factor) concentration of drug in 1 mL EX: admininister procainamide at 3mg/min. you have 1 g of the drug in 250 mL of D5W the infusion set delivers 60gtt/mL how many drops per minute convert all units to like measurements and calculate the concentration of the drug in 1 mL 1g x 1000 = 1000 ml 1000mg / 250 mL = 4 mg/ml calculate the gtt using the iv drip fomula gtt/min = (3mg/min X 60 gtt/mL)4mg in 1 mL = 180/4 = 45gtt |
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Special dopamine calculation formula
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(Dose X weight in kg X 60 gtts/mL)/1600
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Safety considerations and procedures
concerning medications |
-repeat all orders from medical direction
-written order for all administered meds -5 rights. (right patient, right dose, right drug, right route, right time) -verify medication 3 times before admin -label syringes immediately -check expiration dates -monitor the pt for 5 minutes after the med -document all meds given, 5 r's and the pt's reaction |
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medication errors common causes
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-prescriber ordered the wrong dose of medication
-drug calculations were incorrect -wrong route -wrong patient |
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medication error (how to fix)
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-accept responsibility
-advise medical direction or the prescriber immediately -assess and monitor the pt, monitor for effects of the drug -document the error -make changes in the personal practice technique -follow EMS agency procedures to document the incident & quality improvement |
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medical asepsis
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removal or destruction of disease causing organisms or infected material
perfomed by clean technique (requires hygenic measures, cleaning agents, antiseptics, disinfectants, and barrier fields) |
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antiseptics vs disinfectants
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both are not very effective against spores of bacteria, fungi, many viruses
disinfectants used on non living objects (toxic to tissue) antiseptics applied only to living tissue, they are more dilute |
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4 levels of cleaning
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sterilization (all forms of microbial life) = autoclave, dry heat, chemical sterliant.
-Scalples, needles etc High-Level disinfectant (all microbial life except high numbers of bacterial spores) = hot water pasteurization/epa registered chemical sterilient -reusable instruments or deveices that come into contact with mucous membranes (laryngoscope blades, ET tubes) intermediate level (vegetative bacteria, most viruses, most fungi) = hospital level disinfectant, free bleach 1 cup per 1 gallon of tap water -instruments ad equiupment that come in contact with intact skin but have been bloodied low level disinfectant (most bacteria, some viruses, some fungi) = epa registered hospital disinfectants -routine housekeeping or removal of soiling in the absence of visible blood contamination |
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administration of meds by gastric tube
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confirm correct tube location (30-50mL of air, and epigastric ascultation)
-drug inserted into tube, followed by 30 mL of water typically activated charcoal |
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rectal administration of drugs
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diazepam and lorazepam
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parenteral drugs
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administered outside the GI tract (usually injections)
-intradermal, subQ, intramuscular, IV and I/O routes hazards with administration include cellulitis, absess formation, necrosis, skin sloughing, nerve injury, prolonged pain, periostitis |
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factors affecting choice of needle
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1) route of administration
2) charateristics of the fluid (aqeuous or oil based) 3) volume of medication range from 1 mL (insulin, tuberculin) - 60 mL irrigation |
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Tuberculin syringes
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marked in 0.01 mL gradients
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Insulin syringes
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.5 and 1 mL volumes, marked in 1 unit increments
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Sub Q injections
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5/8" 23 or 25 gauge needle
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Intramuscular injections
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1-2" 19 or 21 gauge needle, occasionally 16-18 gauge needle
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2000 healthcare worker needle stick prevention act and OSHA bloodborne pathogens standards recommendations
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needle safe devices
self, sheathing hypodermic syringes, self blunting phlebotomy needles, retracting lancet, and disposable scapels |
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procedure for withdrawing medications
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1) assemble equipment (18-gauge for ampule) alcohol swab, syringe
2) compute the volume of medication to be given 3) vial -clean rubber stopper with alcohol -push a volume of air equal to the amt of med into the vial -gently push the plunger to expel the air 4) Ampule -lightly tap or shake the ampule to dislodge any solution from the neck of the container -wrap the neck of the glass ampule with an alcohol swab or gauze to protect the fingers -grasp the ampule, snap off the top, discard the top -insert an 18 gauge needle (do not touch the sides of the ampule -discard the 18 gauge needle attach the needle to be used for injection |
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Mixing Medications from 2 vials (5 steps)
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1) use only 1 syringe to mix the drugs
2) aspirate air in the dose of the first drug into the vial, making sure the needle does not touch the solution 3) aspirate a volume of air equivalent to dose inject into vial B, withdraw the med from vial B 4) put a new needle on the syringe and insert it into vial A, without pushing the plunger in, withdraw the desired amt of drug from vial A into the syringe 5) put a new sterile needle on the syringe and administer the injection |
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mixing medications from one vial and one ampule (3 steps)
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1) withdraw the desired drug dose from the vial first
2) use the same syringe and needle to withdraw medication from the ampule 3) put a new sterile needle on the syringe and administer the injection |
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prefilled syringes (4)
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1) calculate the volume of medication to be administered
2) remove the protective caps from the syringe barrel and medication cartridge 3) screw the cartridge into the syringe barrel 4) gently push in the plunger of the syringe to expel air |
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preparing the injection site
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aseptic technique
2% chlorhexidine preferred, tincutre of iodine, iodophor or 70% alcohol can be used 1) scrub the site with the cleanser to remove dirt, dead skin, other contaminates 2) clean the site using concentric circles 3) allow the site to dry |
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Intradermal Injections
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just below the dermis
uses a tuberculin syringe less then .5 mL allergy testing, and administration of local anesthetics medial surface of the forarm and back 1) choose the injection site and cleanse the skin surface 2) hold the skin taut with one hand 3) with the other hand, hold the syringe with the needle bevel up at a 10-15 degree angle to the injection site 4) gently puncture the skin, insert the needle until the bevel is completely under the skin surface, inject med 5) withdraw the needle and sipose of the equipment |
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Sub Q injections
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place medications below the skin into the Sub Q layer
less then .5 mL 1/2 or 5/8 inch 23 or 25 gauge needle 45 degree angle epinephrine most common 1) choose the injection site and cleanse the area 2) elevate the subq tissue by gently pinching the injection site 3) with the needle bevel up insert the needle at a 45 degree angle in one quick motion 4) pull back slightly on the plunger if no blood smoothly inject the med, if blood is present withdraw the needle and discard med and equip 5) after the injection, withdraw the needle at the same angle at which it was inserted, use an alcohol swab to massage the site, helping to distribute medication and promote absorption by dilating blood vessels in the area increasing blood flow |
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Intramuscular Injections
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-deeper injections made into muscle tissue
-drug too irritating or greater volume/faster absorption needed -MAX VOLUME 5 ML -hold skin taut, 90 degree angle |
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IM Injection needle criteria
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1) site of the injection
2) condition of the tissue 3) size of the pt 4) type of drug to be injected (oily suspensions require larger needles) longer needle length (1.5 inches and 19 or 21 gauge) |
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IM muscle injection site
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deltoid muscle - small volume (1 mL or less)
gluteal muscles (medius upper outer quadrant, 3 mL) vastus lateralis muscle, rectus femoris muscle, ventrogluteal muscle |
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medius gluteus muscle tips
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do not use on children under 3
-underdeveloped muscles & sciatic nerve issues -up to 5 mL, over 3 mL uncomfortable -have the pt lie prone, toes in |
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vastus lateralis & rectus femoris
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vastus lateralis - lateral to the rectus femoris
place two hands on the pt, middle third is injection site for both muscles vastus lateralis preferred, up to 5mL have the pt sit upright or lying supine |
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ventrogluteal muscle
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make a v with hand. palm on the greater trochanter, middle finger on illiac crest, index on anterior superior iliac spine
5 mL for adults useful for all pt's |
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IV therapy 3 indications
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1) administration of fluids
2) administration of drugs 3) obtain specimens for lab testing |
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Route of choice for IV & common fluids
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peripheral vein in an extremity, assuming no trauma to that arm or above on that side
common fluids - normal saline, lactated ringers, mixtures of glucose and water lactated ringers = fluid replacement and used for drug admin |
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types of IV cath (3 types)
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1) hollow needle (butterfly) - difficult to secure
2) indwelling plastic cath over hollow needle - most common 3) indwelling plastic cath trhoguh a hollow needle (usually in hospital) |
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common IV sites
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hands, arms (AC aka antecubital fossae), long saphenous veins and external jugular veins
embolism and infection may occur with external jugular or long saph |
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IV procedure
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1) explain procedure and need
2) assemble the equip -inspect fluid for contamination -appearance and expiration date -prepare micro or macro drip for infusion, attach to bag 3) clamp tubing and squeeze reservoir on the infusion set until it fills halfway, open the clamp and flush the air from the tubing, close the clamp 4) select the cath (large bore for fluids 14/16) or (small bore for meds TKO 18/20) 5) Prep other equipment -alcohol/iodine wipes -4x4 gauze -adhesive tape -syringes and vacutainers for blood samples -TQ 6) put gloves on 7) select puncture site, apply TQ, good distal and then work proximally 8) prepare the puncture site and cleanse the area 9) stabilize the vein by applying distal pressure and tension up to the point of entry, bevel up (bevel down in kids with constricted periph veins) -advance 2 mm after flash, and push cath -apply direct pressure to stop blood flow -blood samples 10) release the TQ attach the IV tubing, open the tubing clamp and allow fluid infusion to begin at the prescribed flow rate 11) cover the puncture site with a dressing to ensure asepsis and secure the line 12) document |
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complications of IV techniques
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Local
-hematoma formtion -thrombosis -cellulitis -phlebitis Systemic -sepsis -pulmonary embolism -catheter fragment embolism -arterial puncture -fiber embolism from cotton or paper figers in the cath irrigation solution |
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Infiltration
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needle or cath has been displaced
-blood leaks from around cath or vein punctured 2 times S&S -coolness of skin at the puncture site -swelling at the puncture site with or without pain -sluggish or absent flow rate check by lowering bag to see if there is back flow, if not, you are infiltrated, remove and restick DOCUMENT |
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Air Embolism
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air in the blood stream
10 mL for critically ill 100 mL for normal adults heart begins to foam blood, flow is impeded = shocky S&S -hypotension -cyanosis -weak rapid pulse -LOC FIX -close tubing -turn pt on L SIDE HEAD DOWN -check tubing for leaks -administer high concentration O2 -notify medical direction accidental disconnection of IV tubing, unchanged fluid containers |
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complications of femoral vein cannulation
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local
-hematoma -thrmbosis may extend to the deep veins leading to edema -phlebitis -use of the femoral vein frequently precludes subsequent use of the saph vein systemic complications -thrombosis or phlebitis may occur and extend to the iliac veins or even the IVC |
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IV meds
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injection
-bolus -less then 5 mL -slow push Infusion -mixed with saline IV bag and dripped in |
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adding medication to the fluid reservoir of an iv line steps
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1) compute the volume of the drug to be added
2) draw up the prescribed dose into a syringe, (if prefilled note volume of medication in syringe and dose to be used) 3) cleanse the rubber sleeve of the fluid reservoir with an alcohol swab 4) puncture the rubber sleeve and inject the prescribed med into the reservoir (iv bag) 5) withdraw needle and discard, gently mix meds 6) label the bag with -name of the med -amount of the med -resultant concentration -date and time of the infusion -name of the medic 7) calculate the rate of admin in gtt/min |
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inline volume control devices
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electronic devices allow more acurate delivery of medication diluted in precise amount s of fluids, then watching a drip rate
-used on meds that cause toxicity when given too quickly (antidysrhythmics, vasopressors |
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External Jugular
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-typically used on unconsc. pt's
-angle of the jaw ---> midclavicle -valve under clavicle if in cardiac arrest you will see flash if not, no flash complications -infiltration, fluid dumps into thoracic cavity -MUST prevent air from being drawn into the catheter (air embolus) |
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stylette preferred for external jugular
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1.25" Large Bore 14 or 16
so you dont hit valve (under the clavicle) C-collar prevents external jugular IV |
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infiltration
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displaced needle, check by wide open IV, (no flow/hematoma)
-lower bag, blood should flow up the line |
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bag changing
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if the bag runs out, the catheter coagulates and you need to reinsert IV
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piggy backing
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used to drip medication via IV
-allows the ability to stop drug flow if the pt has a bad reaction |
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Blood drawing
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-red tubes do not have a chemical
-utilize a vaccum to draw blood out -can draw through adapter or via iv catheter |
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saline lock
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used when you dont want to infuse volume, but need access for drugs
-allows for saline lock to IV -stops coagulation, flush cath every so often -herparin locks used to be used after pushing drug, you must flush the cath |
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arm boards
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used when pt moves arm and occludes the IV
"positional IV" - works if the arm is in a specific position, tempermental IV |
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catheter shear
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pull styette and then reinsert bc cath resistance is felt, cath can shear and become an embolus
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drug users
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terrible veins, but tend to kow where their best vein is
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fluid challenge
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we give 4 liters max to trauma/bleeding victims
Total Blood = 70 mL X Kg avg 5 liters Diagnostic check (don't know this will work) -take baseline vitals, push 500 mL take more vitals, see if situation improves |
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blood loss body effects
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10-15% Compensatory (high HR)
25-30% Decompensation (low BP, high HR) 40% or greater Non Compensatory, death |
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what do we check for b4 fluid challenging
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crackles
-lungs fill up first, you cant push saline b/c you will overflow them |
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cardiac fluid challenge
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(cardiogenic shock)
-check for clear lungs -give 200mL see if improvement occurs -TKO check vitals |
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Opsite
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not standardized so tape is used
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tape
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3 strips 1/2" X 8"
3 strips 1" X 8" |
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IV Bag check
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clarity, expiration date, correct fluid type
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Bag Prep
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-pull blue port off bag, pull sheath off stylet and gently insert into bag
-squeeze drip chamber so its halfway full -flow fluid to get rid of air bubbles -put cab back on and clip to volume control -Get IV access -screw in admin set -Steady stream (look for infiltration) |
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taping
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either
1) U shape under cath 2) second piece flat across 3) chevron OR 1) chevron 2) chevron 3) Flat peice |
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excess IV tube secureing
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tape arm with the least amount of cath.
2 loops distal tape elevated (in line with IV) |
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I/O
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direct access to long bones.
-may be used when peripheral veins have collapsed children - just below tibial tuberosity, or femur adults - sternum, just below the sternal notch (alternates include tibia, medial malleolus, head of the humerus) |
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blood sample procedure
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1) prepare all equipment in advance
2) hold pressure on the cath to prevent blood leaving cath 3) while stabiliizing the site, insert the vacutainer into the hub of the IV catheter 4) push blood collection tubes into the barrel of the vacutainer 5) after obtaining the required specimens, attach the IV tubing and begin infusion 6) label the sample with the pt's name and the time and date obtained |
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peacehealth dress code
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-photo badges Req'd
-small jewelry -no headbands, scarves hair ornaments -no stinky stuff -trim and clean nails -solid white pants, dresses, skirts or scrubs (small print) no royal blue -NON PC areas street clothes -conservative shoes, no open toes |
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peacehealth core values
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respecting individual human dignity and worth
stewardship collaboration social justice |
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peacehealth 5 strategic areas
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1) culture and people
2) safe and clinically effective care 3) clinician partnership and coordinated care 4) growth and innovation 5) high value |
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Peacehealth injury or exposure policy
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1) treat the injured area immediately
2) report the injury immediately to your direct supervisor and to your instructor whether or not medical attention is required 3) notify the dept of learning and development |
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PH hand washing policy
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hands visibly contaminated, blood body fluids etc
required after caring for pts wit diarrhea after restroom before eating -15 seconds, use paper towel to turn off faucet Alchohol based rubs -more effective in reducing number of bacteria and viruses -assessible at the point of care -less hand irritation and dryness |
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PH PPE
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1) gloves
2) masks, face, and eye protection 3) gowns and protective apparel |
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PH MSDS requirements
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required to read unit appropriate MSDS policies when neccessary
remember pertinent info to common materials know location of MSDS manuals |
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PH electrical safety
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remove faulty equipment from serve before it can cause injury
report injuries keep the device set up for review |
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PH FIRE
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Dr Red - code for fire, smoke, smell of burning
close doors until ALL CLEAR is sounded -no phones or elevators send a fire extinguisher to combat fire, unless you only have 1 |
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PH Fire RACE
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Rescue anyone in immediate danger
Alarm Contain close all doors and windows disconnect medical gas regulators if fire is in the pt room, turn off electrical equipment Extinguish small fires the size of the a wastebasket using the PASS method |
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PH abbreviations
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Do not use - Acceptable
U - UNIT IU - international Unit QD/QOD - daily, every other day Trailing/leading Zero = 2 mg or 0.2 MG MS, MGSO4 = morphine sulfate, mangesium sulfate ug = mcg TIW = 3 times weekly |
