Iv Medication Administration

Front 1

1. List four rationale for administering medications intravenously versus another route: (text, pp. 152-153)

Back 1

• Patient needs a rapid therapeutic effect
• Med can't be absorbed by GI tract
• Patient is NPO
• Irritating drug would cause pain or tissue damage if given IM or sub-q
• Controlled administration rate needed

Front 2

2. List and define four benefits of intravenous medication: (text, pp. 152-153)

Back 2

• Rapid response: goes directly to bloodstream, often need lower dose
• Effective absorption: by-pass first-pass metabolism in the liver; may be unstable in gastric juice/digestive enzymes, interact with food/other meds; muscle/skin can delay passage
• Accurate titration: adjust concentration of infusate and administration rate
• Less discomfort: prevent pain/irritation of sub-q/IM injection; can irritate veins

Front 3

Risks of IV therapy

Back 3

• solution/drug incompatibilities
• poor vascular access in some patients
• immediate adverse reactions
• more likely the more complex a solution is

Front 4

3. List three categories of incompatibility: (text, p. 154)

Back 4

• Physical
• Chemical
• Therapeutic

Front 5

4. Define physical incompatibility: (text, p. 154)

Back 5

• occurs with multiple additives
• signs: precipitation, haze, gas bubbles, cloudiness
• *calcium increases likelihood of precipitate forming*

Front 6

5. Define chemical incompatibility: (text, p. 154)

Back 6

• mixing 2 drugs cause one to lose more than 10% of its potency
• factors: concentration, pH, volume of solution, length of contact, temperature, light

Front 7

6. Define therapeutic incompatibility: (text, p. 156)

Back 7

• one drug negates the other

Front 8

7. List six factors which may affect drug compatibility: (text, p. 155)

Back 8

• order of mixing - with more than one drug
• drug concentration - make sure evenly disperses
• contact time - longer together, more likely incompatibility will occur
• temperature - higher temperature makes chemical reaction more likely
• light - prolonged exposure can affect the stability of certain drugs
• pH - similar pH to avoid incompatibility

Front 9

8. Why is it critical to observe for adverse reactions when administering IV medication? (text, p. 156)

Back 9

1. severe reactions will happen quickly

Front 10

9. Identify four safety precautions the nurse should take when preparing IV medication: (text, p. 161)

Back 10

1. Aseptic technique - wash hands before mixing
2. Use a syringe that is large enough to hold the entire dose when draying up a drug
3. Check the expiration date, filtration needs, special diluent requirements, look of solution
4. label solution: name, room number, date, time mixed, your initials

Front 11

10.List the six rights of medication administration: (text, p. 165)

Back 11

1. Right drug
2. Right patient
3. Right time
4. Right dosage
5. Right route
6. Right documentation/right to refuse

Front 12

11.Identify the three methods of administering IV medications and the advantages and disadvantages of each: (text, pp. 165-167

Back 12

1. Direct injection: single bolus or intermittent multiple does; IV push; creates immediate high blood levels; good if drugs are incompatible
2. Intermittent Infusion: piggyback (short time); saline lock (constant access, not constant infusion), volume control set (low-volume)
3. Continuous infusion: maintain continuous serum level,

Front 13

13.List ten steps involved in administering medication through a saline/heparin lock: (text, p. 172-173)

Back 13

1. Put on gloves.
2. Assess IV site
3. Wipe injection port of intermittent infusion device with alcohol pad; insert saline syringe
4. Aspirate for blood - stop if resistance is felt
5. Inject saline and look for infiltration, puffiness, pain -remove syringe
6. Insert syringe with medication into port; Inject med at required rate
*may also attach a minibag with meds; prime tubing first if using*
7. Flush with saline
8. Watch for adverse reaction
9. Document & clean up

Front 14

Into an existing line

Back 14

1. assess site
2. if new drug/existing a compatible, keep infusion running
3. if not compatibly stop infusion, flush line with saline syringe (remove air, clean port, inject)
4. Attach med syringe and inject at even rate
5. Observe for reaction

Front 15

15.List three special considerations when setting up infusions for pediatric patients: (text, pp. 184-186)

Back 15

1. Cannot tolerate as much fluid
2. Drugs dose based on weight = different normal dose for each person
3. Ensure no drugs remain in IV tubing after it is changed (due to small volume and slow delivery)

Front 16

Safety for children's IV meds

Back 16

• flow control clamps are out of childs reach
• tamper proof pumps
• infusion pump with anti-free-flow device

Front 17

Retrograde administration

Back 17

uses coiled low volume tubing
administer antibiotic over 30 minute period without increasing the volume of fluid
tubing must hold entire volume of medication

Front 18

Syringe pump

Back 18

useful for giving intermittent infusions to pediatric patients
needs to be: tamperproof, built in guard against uncontrolled flow, alarm sensitive to low pressure occlusion

Front 19

Intraosseous infusion

Back 19

used in emergency
quick and effective
use only until venous access established

Front 20

16.List three special considerations when setting up infusions for elderly patients: (text, pp. 186-187)

Back 20

1. Decreased functioning in biological systems - watch for renal toxicity and respiratory/CNS depression
2. Fragile veins = more likely to have infiltration/phlebitis
3. Need more fluid to dilute so veins are less irritated/prone to fluid overload

Front 21

17.Name five serious complications that can arise from IV medication administration: (text, p. 187-195)

Back 21

1. Hypersensitivity - check for allergies; stay with for first 5-10 minutes; check every 5-10 minutes if new drug
2. Infiltration - IV fluid leaks into surrounding tissues; more likely if tip of device points toward flexion area
3. Extravasation: irritating drugs leak into surrounding tissues
4. Phlebitis: inflammation of a vein
5. Infection

Front 22

20.List signs and symptoms of a local infection at the IV site: (text, p. 188)

Back 22

• Redness
• Discharge

Front 23

21.List signs and symptoms of a systemic infection related to IV therapy: (text, p. 188)

Back 23

• Elevated temperature
• Malaise

Front 24

23.Define extravasation: (text, p. 189)

Back 24

Leaking of vessicant drugs into the surrounding tissue
• discomfort
• delays healing
• create infection, necrosis, disfigurement
• Loss of function/amputation

Front 25

Extravasation Interventions:

Back 25

stop infusion
estimate amount of solution that leaked
antidote as ordered
elevate extremity
document site, symptoms, amount, treatment, practitioner
ice/warm compresses

Front 26

Extravasation prevention:

Back 26

ensure site patency
start infusion with D5W
check for infiltration before giving med (Watch for blood backflow)
Slow IV push
Give vessicants last
Use transparent dressing
flush with D5W/normal saline when catheter is removed

Front 27

18.List the signs and symptoms of fluid overload and the appropriate nursing interventions to deal with this: (text, p. 188)

Back 27

1. neck vein disgorgement
2. respiratory distress
3. increased BP
4. crackles
5. positive fluid balance

Hint 27

Interventions:
1. stop infusion; semi-fowlers
2. reduce anxiety
3. oxygen as needed
4. notify practitioner
5. diuretics as ordered

Front 28

19.List the signs and symptoms of phlebitis and appropriate nursing interventions to deal with this: (text, p. 188)

Back 28

1. redness, tenderness at tip of device
2. puffy area over vein
3. elevated temperature
4. may take 2-3 days to develop
5. more likely with antibiotics when piggybacked

Hint 28

Interventions:
1. Stop infusion, remove device
2. warm pack
3. document condition/interventions/notify practitioner if indicated
4. insert new IV catheter
5. prevent: dilute drug, secure device, use filter needle, change infusion site, monitor infusion, watch rate, use transparent semipermeable dressing