Medication Administration Review

What is IM?

Intramuscular

What is IV?

Intravenous

What is IV PB?

Intravenous piggyback

What is SQ/Subcut?

Subcutaneous

What is SL?

Sublingual

What is ID? What is it most commonly used for?

Intradermal and it's used for TB

What is GT?

Gastrostomy tube

What is NG?

Nasogastric tube

What is NJ?

Nasojejunal tube

What is p.o.?

By mouth, orally

What is p.r.?

Per rectum, rectally

What is a.c.?

Before meals

What is p.c.?

After meals

What is ad. Lib.?

As desired, freely

What is p.r.n.?

When necessary

What is stat?

Immediately, at once

What is asap?

As soon as possible

What is b.i.d.?

Twice a day

What is t.i.d.?

3 times a day

What is q.i.d.?

4 times a day

What is min?

Minute

What is h?

Hour

What is q.h?

Every hour

What is q.2h?

Every 2 hours

What is a with a line over it?

Before

What is p with a line over it?

After

What is c with a line over it?

With

What is s with a line over it?

Without

What is q?

Every

What is qs?

Quantity sufficient

What is aq?

Water

What is NPO?

Nothing by mouth

What is gtt?

Drop

What is tab?

Tablet

What is cap?

Capsule

What is et?

And

What is noct?

Night

When administrating medications a nurse stores meds how?

Separate storage area or "med room"

Locked movable carts

Special med room refrigerator

Computerized dispensing machine

Locked medication cabinet

When administrating medications a nurse must never do what?

NEVER relabels a medication, if a label is illegible, return the container to the the pharmacy for
proper identification and labeling

What goes on the Medication Administration Record (MAR)?

Clients name

Medication's generic name

Dosage

Administration route

Scheduled times

When setting up for administrating medications, what are some things to do to help you prevent
a medication error?

*Observe facility's routine for administrating medications

*Follow universal rules for safe administration

*Check the order with the MAR

*Check for client allergies

*Set up medications for one client at a time

*Compare each meditation label with the MAR

*Measure the dose with appropriate equipment

As a nurse what is a priority?

Safe administration of medication is an absolute priority.

What can you do to improve the accuracy of client identification?

Use at least two client identifiers

What are the "Five Rights" of medication administration? And the sixth and seventh?

Right client

Right medication

Right dose

Right time

Right route

Sixth "right"-right documentation

Seventh "right"-right programming, when using pump administration

To ensure that the correct medication is given to the correct client, what do you "Check TWO for
safety"?

The identification band

Asking the client's name

Asking the client's birth date

Corroboration by another responsible person

As a nurse you compare and confirm the medication's name and dosage with the client's MAR
by doing what?

The first check is on removing the medication from the storage area

The second check is when scanning it and placing it in the medication cup or envelope

The third check is on opening the medication unit-dose package at the client's bedside

Also note to self, that you do not administer a medication that someone else has prepared or to a
client assigned to another nurse

How do you know when to administer medications as ordered to maintain the medication's
therapeutic effects?

STAT dose

PRN dose

HS hour of sleep (bedtime) doses

Deviation from the "time window" is considered a medication error

Is the following statement true or false?

A medication that is ordered for 1000 hours, may be administered anytime between 0930 hours
and 1030 hours and still be considered "on time".

True

Most facilities allow 30 minuets on each side of the schedule time for administering medications.

Deviation from the "time window" is considered a medication error.

All actions not documented are considered what?

Not to have been done

If a client refuses a medication, what do you do?

Document client refusal or held medications

What are some client teachings about administering medications ?

*What medications they are given (generic and trade name), and why they are taking them

*Dosage and frequency, and how to administer or take them at home

*Expected effects and possible undesirable side effects

*How long they will need the medications and what to do if they miss a dose

*Signs and symptoms client's should report to healthcare provider

Is the following statement true or false?

Differences in color and shape of a medication mean that the medication is incorrect.

False

Differences in color and shape of a medication may be due to a change in the dosage, the
manufacturer, or because they are now receiving a generic form of the medication.

Differences do not necessarily mean that the medication is incorrect, although it is important to
verify that the correct medication is being administered.

Where is topical application applied?

Applied to the mucous membranes of the eye, mouth, nose, throat, vagina, or rectum by
instillation, irrigation, swabbing, or spraying.

What are systemic effects?

Medications are administered by transdermal application, mouth, or injection, although other

methods, such as nasal inhalation, can also produce systemic effects

What is enteral administration?

Administration by way of the digestive tract

Oral, buccal, and via gastrointestinal tubes

What is parenteral administration?

Administration into any part of the body other than by way of the gastrointestinal tract

What are some enteral administration methods?

Oral administration

Sublingual administration

Translingual administration

Orally disintegrating tablets

Buccal administration

Administration through a gastric tube

Rectal administration

What are some parenteral administration methods?

Injection

Vaginal administration

Eye (ophthalmic) administration

Ear (otic) administration

Nasal or respiratory administration

Inhalants and aerosol systems

Nasal sprays or drops

Transdermal administration

Is this statement true or false?

Enteric-coated or time-release medications may be crushed and given by nasogastric (NG) Tube.

False

Crushing an enteric-coated or time-release medication may interfere with its desired action.

Only medications specified as enteral may be given via G-tubes

What are the various injection methods?

SC injection

IM injection

Intradermal injection

SC injection is Subcutaneous, what are some medications given this way?

Insulin, heparin, and novalox

IM injection is intramuscular, where are these areas?

Deltoid- At the shoulder

Dorsogluteal- The back

Ventrogluteal- Outer upper thigh

Vastus Lateralis- Front thigh (done a lot on babies)

Is the following statement true or false?

A nurse must always dispose of all syringes and needles in the hazardous waste container.

False

Always dispose of all syringes and needles in the sharps container to prevent needlstick injuries
to nurse and environmental personnel. A needlstick injury can cause serious infections and/or
other disabilities.

Injection or intravenous (IV) infusion is what?

More invasive than administration by mouth, rectum, or through the skin

What are some reasons for administration of medication by injection?

*It is the most effective methods of administration.

*Any other form of administration is unavailable.

*The desired action is achieved quickly.

*Dosage accuracy is critical.

*The client can not retain oral medications.

*The client is unable or unwilling to swallow oral medications.

*The digestive system cannot absorb the drug.

What angles would you give a intramuscular injection?

72 to 90 degree angle

What angles would you give a Subcutaneous injection?

90 to 45 degree angle

What angles would you give a Intradermal injection?

15 degree angle

What are the different types of preparation of injectable medications?

*Powders that must be reconstituted with a diluent

*Premixed by the manufacturer

*Ampule- Filtered needles are what you use to draw up a medication and then switch the needle
with a new one

*Vial

*Prefilled syringe- Ex. Lovenox

What is intradermal injection?

Shallow injections given just beneath the epidermis, they are often used for diagnostic testing,
it's inner aspect of the forearm; the back may be used, tuberculin syringes, make sure you
instruct the client not to scratch or pinch the site

What are the rights of medication administration?

Right client

Right medication

Right dose

Right time

Right route

How many Medication checks are there?

Two

When do you complete all of your medication checks?

It's on opening the medication unit-dose package at the client's bedside

How, where, and when do you administer PO meds?

Capsule, pill, liquid

Oral, sublingual, translingual

As ordered and directed

How, where, and when do you administer SQ meds?

Injection

Into a fatty tissue area

As ordered and directed

How, where, and when do you administer IM meds?

Injection

Into a lager muscle area

As ordered and directed

How, where, and when do you administer Intradermal meds?

Injection

Directly under the skin, forms a little pocket

As ordered and directed

How, where, and when do you administer eye drops?

Hold drops over the eye

Instill drops in the lower conjunctival sac, then gently apply pressure on the inner canthius

As ordered and directed

How, where, and when do you administer ear drops?

Hold drops over the ear, for an adult pull up, back, and out, for a child older than 3 pull lobe
straight back, for younger then 3, pull the lobe down and back

As ordered and directed

How, where, and when do you administer rectal suppository?

Left Sims position

Lubricate the med and push 3" to 4"

Rectal

As ordered and directed

How, where, and when do you administer PEG meds?

Med mixed and then flushed before and after through the tube "be sure to clamp"

Wherever the tub is located (gastric)

How, where, and when do you administer medication patches?

Either med is put on/comes on already on patch

Can be applied in many areas "follow orders"

As ordered and directed

For safe medication administration, when administering meds and when receiving order you
must ?

Read back and you always read back when receiving telephone order

What do you do when a patient refuses a medication?

Document client refusal and inform the physician

When drawing up meds from vials you?

Apply clean gloves, vigorously shake the vial, wipe the rubber seal of the vial with an alcohol
swab, introduce air equal to the amount of medication needed, and then draw medication once
the rubber top has dried, to keep from contaminating the medication

When drawing up meds from ampules you?

Either an alcohol swab or 2x2 gauze to open it and then use a filter needle to draw up but then
switch the needle with a new one to administer

What's the difference between single dose vs. multidose vials?

Single dose vials are approved for use on a SINGLE patient for a SINGLE procedure or injection.

Multi dose vials can be used for more than one patient when aseptic technique is followed, after
24 hours the medication is no longer good

When do you document after passing meds?

Document all medications immediately on giving them

When you are given a STAT order, what do you do when you receive this type of medication
order?

Whatever was ordered STAT give immediately, at once

Where are IM injection sites?

Intramuscular which could be the Deltoid (at the shoulder) or the Dorsogluteal (the lower back
upper butt)

Where are SQ injection sites?

Subcutaneous which is done mostly with (Insulin, Heparin, Novenox)

How do you identify a client?

By using two client identification

What is the correct way of pouring liquid from a medication bottle?

Grab the bottle with the label in your palm so that the medication doesn't drain down the bottle
and make the label eligible, pour it out the side opposite of the label

How is Heparin administered?

SC injection

How do you determine how much air goes into a bottle?

Medication calculation; the amount of air should equal the volume of medication to be drawn into
the syringe

When looking at a patients information on a drug label, what should it include?

Drug form

Dosage strength

Supply dosage or concentration

Total volume of drug container

Administration route

Expiration date

What is the appropriate gauge and needle length for Subcutaneous in Adults?

20-30 Gauge

1-2 Inch needle

What is the appropriate gauge and needle length for Subcutaneous in Adults?

25-27 Gauge

3/8-5/8 inches

When mixing insulin's, if you draw too much of the second insulin (NPH), you must what?

Discard the entire medication and start over

With Insulin and Heparin, you must what what before administering?

They must be checked by two nurses

When mixing insulin, what must be done?

Two nurses must verify each step of the process

What is the most desirable site for administration of Heparin?

The abdomen

What is the two finger rule for Heparin?

Two fingers or two inches from the umbilicus, any scar tissue, and recent injection sites. Too
close to any of these may interfere with absorption

Why is it necessary to rotate insulin injection sites?

To promote absorption and prevent lipodystrophy

In what position should the bevel be when preparing to injection a SQ/IM injection?

In an upward position

What are some rapid acting medications and whats their duration?

Humalog, Novalog, Apidra (glulisine) and their duration is 5-15 minuets onset, peak in 45 to 75
minuets, and 2-4 hours duration

What's a short acting medication and their duration?

Novolin (insulin) and it's duration is onset 30 minuets, peak 2-4 hours, and 5-8 hour duration

What's intermediate -acting?

2 hours onset, peak in 6-10 hours, and 18-28 hours duration

What's long-acting meds and examples?

2 hours onset, no peak, 6-24 hours duration and Levemir(detemir) and Lantus(glargine)

What should you not do with long acting medication?

NEVER mix long acting insulin with another insulin

Would you administer a medication that someone else prepared?

Never

What is insulin given in?

Only given in an insulin syringe. Use the smallest available syringe

If you are unsure if the insulin's you are giving can be mixed what do you do?

Do not mix them, either give as two separate injections, or check with the pharmacist or drug
manual

What are the ten rights of medication administration?

Right patient, right medication, right time, right dose, right route, right assessment, right
evaluation, right documentation, right education, right to refuse

How many checks should be completed prior to administering medications to a client?

Three

On removing the medication from the storage area

When placing it in the medication cup or envelope

When opening/preparing the medication at the client's bedside

What is the proper way to pour a liquid medication into a cup?

Palm the label of the medication container; wipe the medication container spout, pour liquid into
medication cup at eye level and read the level at the bottom of the meniscus; set on flat surface
to verify

Can time-release capsules or enteric coated tablets be crushed?

No

What does it mean when a tablet is scored? Should you cut or break a tablet that is not scored?

Scored tablets are marked at equal dosages; you should not cut or break a tablet that is not
scored because the client may not receive an accurate dose

How many methods of identifying your client must you use when administering medications?
Name these methods

Two

Compare the MAR with name and account number on the armband it ID bracelet; ask the client
to state his/her name and date of birth

If a client states that he/she would like to finish breakfast prior to taking his/her medications and
request that you leave them at the bedside, what should your response be?

I will return after you finish your breakfast and administer your medications; take medications
with you and bring them with you after they have finished eating to administer

What is the meaning of PRN?

As needed

What is IM an abbreviation for?

Intramuscular

What is SQ an abbreviation for?

Subcutaneous

Can Heparin or enoxaparin (Lovenox) be given in SQ sites other than the abdomen?

Yes, under special circumstances, but a provider order must be obtained

Why is it necessary to rotate insulin injection sites?

To promote absorption and prevent lipodystrophy

Should Heparin injection sites be messaged after administration?

No

Should the nurse aspirate when administering a medication SQ?

No

Should the nurse aspirate when administering a medication IM?

Yes

Are medications absorbed more quickly PO or SQ/IM? Explain

SQ/IM injections are absorbed more quickly; because they absorb faster into systemic circulation

How does the nurse determine the volume of air to inject into the vial prior to drawing up the
medication for IM or SQ administration?

Medication calculation; the amount of air should equal the volume of medication to be drawn into
the syringe

Is it necessary to inject air into the ampule prior to drawing up the medication?

No

At what angle should the nurse administer a SQ injection?

45 to 90

At what angle should the nurse administer an IM injection?

90

In what position should the bevel be when preparing to inject a medication?

Facing upward

When breaking an ampule, the nurse must cover the neck of the ampule with what? Why? What
direction should the nurse break the ampule to?

Either an alcohol swab or 2x2 gauze; prevents cuts or injuries; break away from the body or face

The injection site must be cleaned prior to medication administration using what technique?

From inner to outer

Should z-track method injection sites be messaged?

No

Should IM injection sites be messaged? Why or why not?

Yes, to promote absorption and increase client's comfort

How should the nurse recap a contaminated needle?

Needles should never be recapped

Should regular insulin be clear or cloudy in the vial?

Cloudy

Should NPH insulin be clear or cloudy in the vial?

Clear

How should you draw up regular and NPH insulin to mix in a syringe?

Regular first the NPH; clear to cloudy; inject air into NPH(cloudy) first and then remove needle
without drawing up medication; then inject needed air into regular (clear) and withdraw needed
medication; the draw up NPH(cloudy)

Introduction to Intravenous Therapy Review

What is the purpose of administering fluids via an IV catheter?

To give medications

Supplement fluid intake

Fluid replacement

Electrolytes

Nurtients

Whats a Peripheral catheter?

Short term use for administration of fluids and nutrients

What is central lines?

Long term use, products that cannot be administered through a peripheral line (supplied in
plastic bags and rarely in glass bottles)

A advantage of having a IV Catheter is Rapid effects, what's a disadvantage of this?

Circulatory overload if too fast or to rapid

Physicians order, Infuse 0.9% NS @ 100 ml/hr, what does it mean?

Give 0.9% NS @ 100 ml over an hour

Physicians order, Infuse 1000 ml 0.9% NS over 3 hours, what does it mean?

Give 1000 ml of 0.9% NS over 3 hours

What happens when you use a IV Bolus?

Large amounts of IV fluid is given in a short period of time, usually less than 1 hr (it's wide open)

What would be the point of using a Bolus?

Replace fluid loss, dehydration,shock,hemorrhage,burns,or trauma

What gauge would you use for a IV catheter to maintain a rapid rate?

Use a large gauge (18 g or larger)

Physicians order, 1000 mL 0.9% NS with 20 mEq KCL @ 75 mL/hr, what does it mean?

1000 mL 0.9% NS mixed with 20 mEq KCL @ 75 mL over 1 hour continuously, it will either come
premixed or will be mixed by pharmacist

What's a intermittent IV Bolus?

Done with Antibiotics, given in small amounts of solution (25 mL to 250 mL), it's done through a
continuous IV system or Saline/Heparin lock

Physicians order, Levaquin 500 mg IVPB q 12 hr, what does it mean?

Levaquin 500 mg given IV piggyback ever 12 hours

How is a IV Bolus administered?

Small amounts of solution

Concentrated or diluted

Injected over a short time-emergent or non-emergent

IVP pain medication given directly into the IV or access port

(IVP or IV Push, achieve an immediate medication level in the bloodstream)

How should you administer potassium chloride (KCL)?

Should only be administered via IV pump for accurate dosage control (never done by Bolus)

What happens if (KCL) is not administered via IV Pump?

It can stop the pt. Heart (Death)

What's a safe medication administration technique?

Use a new fluid container every time

What should you not do if there is a IV line infusing blood, blood products, or parenteral nutrition
solutions (TPN)?

Do not infuse medication through the IV

When mixing medication through IV line, what should you look for?

When multiple medications are being infused through the same line, they must be compatible.
Never hang meds if you are not sure if they are compatible, NEVER

What's some needle stick preventions?

Be familiar with IV insertion equipment

Avoid using needles with needless systems are available

Use protective safety devices when available

Dispose of needles immediately in puncture-resistant receptacles

Do not break, bend, or recap needles

What should you avoid and what should you use when inserting a IV?

You need to avoid Touniquets and use a blood pressure cuff instead, do not slap to visualize
veins

What can you do to make the insertion of a IV easier for the nurse?

Hold the skin below the vein taut (stretched or pulled tight) to stabilize the vein, hold the client's
hand below the heart

What's the first choice of IV placement?

The back of the hand

How would you go about inserting a IV in a obese client?

They may require use of anatomical landmark to find veins

What's very important in preventing infection with IV?

Changing IV solution bag every 24 hours, never disconnect tubbing for convenience, and a IV
should be changed every 3 days

What are some other preventative ways for IV infections?

Standard precautions

Change site PRN and per facility policy

Discontinue asap

Use new catheter for each insertion attempt

Don't write on IV bags with marker. Ink may contaminate the solution

Wipe ports with alcohol before each use to prevent introduction of micro-organisms

Do not allow ports to remain exposed to air

Wash hands before and after handling IV systems

What's almost always used to start an IV?

Over-the-needle or inside-the-needle catheters are almost always use

What's the IV site of choice?

The back of the hand or wrist and inner aspect of forearm (but painful)

What's is used if a pump is not used?

A roller clamp on the IV tubing regulates the flow rate. If the clamp is completely closed, the flow
is occluded and stops completely

What's should always be carefully monitored?

Rate, flow, amount, and type

If a pump alarm goes off what action should occur?

They should be addressed immediately

What should the nurse do if a IV bag is almost empty?

Replace IV bag before, because air collecting in the tubing is dangerous to the client as a blood
clot may form

What are some benefits for the nurse when educating the client and family regarding IV therapy ?

If they are taught how the infusion should operate, they can recognize signs of infiltration, empty
bags, pump alarms, etc. and can notify the nurse immediately

What should you remember with IV fluids?

They flow by gravity

If a client has to leave the unit, what should the nurse do?

Make sure there is enough fluids in the bag until their return

What should you do with IV pumps in the room and why?

Make sure they are plugged at all times and it's because they have a back up battery

What should be done when assessing/touching an IV?

Gloves should be worn anytime IV is touched, an IV site presents direct exposure to the client's
bloodstream. Gloves also decreases the nurses risk of infection

A trauma client just came rushing in, as a nurse what IV therapy system will you use and gauge
to insert it?

Rapid fluid volume and a 16 gauge

What gauge should you use on adults for IV insertion?

20 Gauge

What gauge should you use on older adults and children for IV insertion?

22 to 24 gauge

What's the Post-procedure for IV?

Maintain patency of IV access

Do not stop continuous infusion or allow blood to back up into catheter

Clots form at the tip of the needle or catheter and can become lodged against the vein wall,
blocking the flow of fluid

Instruct the client not to manipulate flow rate, change settings on IV pump, or lie on the tubing

Make sure dressing is not too tight

Monitor site and infusion rate PRN and per policy

How should you flush a intermittent IV catheter?

It's flushed with the appropriate solution after every medication administration or every 8 to 12
hours when not in use

What should you document for Intra-procedure for IV?

Date and time of insertion

Insertion site and appearance

Catheter size

Type of dressing

IV fluid and rate (if applicable)

Number, locations, and conditions of site-attempted cannulations

Clients response

Correct way to document the Intra-procedure for IV?

05/31/18 0800 20 Gauge IV to right inner forearm X1 attempt. Applied tegraderm dressing. Site
without bruising or bleeding. Initiated 1/2 NS @ 100 mL/hr via infusion pump. Patient tolerated
well. Denies c/o pain to insertion site. C. Meche, RN

What are some findings of a Infiltration complication?

Pallor

Local swelling

Decreased skin temperature around site

Damp dressing

Slowed infusion

What's some treatments for a Infiltration complication?

Stop infusion and remove catheter

Elevate extremity

Encourage active range of motion

Apply warm or cold compress based on type of solution infiltrated the tissue

Check with provider to determine whether client still needs IV therapy. If so, restart infusion
"proximal to the Infiltration site or in another extremity"

What are some preventions for an Infiltration for IV?

Carefully select site and catheter

Secure the catheter

What are the findings to a Extravastion complication (Infiltration of a vesicant or tissue damaging
medication) with IV?

Pain

Burning

Redness

Swelling

What are the treatment to a Extravastion complication (Infiltration of a vesicant or tissue

damaging medication) with IV?

Stop the infusion and notify provider

Follow facility protocol, which may include infusing an antidote through the catheter before
removal

What are the prevention to a Extravastion complication (Infiltration of a vesicant or tissue

damaging medication) with IV?

Closely monitor the IV site and dressing

Always use an infusion pump

What will be a sign of Extravasation?

Large fluid filled mass with redness at IV site or large opening on the skin with redness around it
at the IV site

What are the findings of a Phlebitis/Thrombophlebitis ?

Edema

Throbbing

Burning

Pain at insertion site

Increased skin temperature

Erythema

Red line up the arm with palpable band at the vein

Slowed infusion

What are the treatments for Phlebitis/Thrombophlebitis with IV?

Immediately stop fluids and d/c catheter

Apply cold compress to minimize flow of blood, then apply warm compress to increase
circulation

If continued IV therapy needed, restart IV on opposite side

If drainage present, obtain specimen from the site and send culture to lab, if ordered

What's some preventions to a Phlebitis/Thrombophlebitis with IV?

Rotate IV sites PRN and per policy

Avoid the lower extremities

Use aseptic technique

What's a sign of Phlebitis/Thrombophlebitis?

Red line from IV site

What are some findings of a Hematoma?

Ecchymosis at insertion site

What are some treatments for a Hematoma?

Do not apply alcohol

Apply pressure after IV catheter removal

Use warm compress and elevation after bleeding stops

What are some preventions for a Hematoma?

Minimize tourniquet time

Remove the tourniquet before starting infusion

Maintain pressure after IV catheter removal

What are some findings from a Cellulitis?

Pain

Warmth

Edema

Induration

Red streaking

Fever, chills, and malaise

What are the treatments for Cellulitis?

Discontinue IV infusion and remove IV catheter immediately

Elevate extremity

Apply warm compress QID

If drainage present obtain specimen from site and send it and the catheter for culture, if ordered

Administer antibiotics, analgesics, antipyretics

What are some preventions for Cellulitis?

Rotate IV site PRN and per policy

Avoid the lower extremities

Use hand hygiene

Use aseptic technique

What's a sign of Cellulitis?

Long, large, redness near IV site

What kind of finding will you see with fluid overload?

Distended neck veins

Increased BP

Tachycardia

Shortness of breath

Crackles in lung

Edema

What are the treatments for fluid overload?

Slow the IV rate to KVO or per policy

Raise HOB

Check VS

Anticipate administration of diuretics

What are some preventions for fluid overload?

Use and infusion pump

Monitor I&O

What are some findings of Catheter Embolus?

Missing Catheter tip when discontinued

Severe pain at the site with migration, or no symptoms

What are some treatments for Catheter Embolus?

Place tourniquet high on extremity to prevent venous flow

Prepare for removal under x-ray or in surgery

Save the Catheter after removal to determine the cause

What's a prevention for catheter Embolus?

Do not reinsert the stylet into the catheter

What kind of pressure do you use to deliver a preset fluid volume?

Positive pressure

What are some IV medications that require two nurses to double-check pump programming?

Heparin and Insulin

What's PCA used for?

Used for chronic or intractable pain

What are commonly used medications for PCA?

Morphine, Fentanyl, and Hydromorphone

How are patient controlled analgesia medications given?

May be delivered by continuous infusion or in PCA mode (patient activates pump when needed),
limits are present, time intervals are present (lockout)

Who can't set up PCA?

LPN “Ask a RN to give pain medication”

Portable pumps that patients manage.

Insulin pump for diabetes, antiemetics for chemotherapy patients or for hyperemesis of
pregnancy

When inspecting the site you?

Cover with transparent dressing for easy viewing

Write date on dressing

Make sure slide clamp (white) is open when the IV is running

Wear gloves when discontinuing IV, or when changing tubing or dressing

Teach patient and/or family what to watch for, if they know how the infusion should operate, they
can report signs of Infiltration, an emptying bag, pump alarm, or other concerns so problems can
be dealt with immediately.

If signs of Infiltration exist, what do you do?

Stop the infusion and report the situation immediately. The provider will determine if the infusion
should be discontinued, tissue damage may occur if Infiltration is allowed to continue

What should you do with IV fluids before administering them?

Check IV fluid (IVF) to make sure there is no cloudiness or sediment, because cloudiness could
be life threatening to the client

As a nurse, the IV is not irrigated to determine patency why?

If clogged or stopped IV has caused a blood clot in the vein, the clot could be dislodged, which
would be life threatening

Why do you monitor IV site for redness or hardness that follows the vein?

This is a sign of phlebitis, which can be life threatening

It is important to ensure that all settings are correct and that the fluids is flowing properly, what
do you do to monitor for this?

The rate,of flow and amount and type of solution present are carefully monitored

As a nurse, investigating alarming pumps immediately is a correct assessment, why?

This is reassuring to the client and any difficulty can be quickly corrected

Why do you have to use preprinted stickers or a piece of tape and not write on IV bags with
markers or pen?

Ink may penetrate the plastic bag and contaminated the IV fluid. The tip of a pen could also
pierce the bag

Why do you have to make sure to replace IV bags before they are totally empty?

It is hazardous for the client if air has collected in the tubing, venous blood may clot if the bag
runs dry, this can be dangerous

As the nurse, why should you carefully protect the infusion site during transport, ambulate, and
transfers, also remember the IV controller works on principle of gravity?

Tubing may trip patient, tubing may be dislodged from the bag, blood may flow up the tubing and
cause complications

Why should you prevent the IV site from getting wet or soiled?

By doing so this will reduce the possibility of infection, moisture is route of transmission for
pathogens

When a patient is leaving the unit , why should you make sure there is adequate solution to be
infused while gone, and why make sure the battery is charged on the IV pump?

This allows the client to receive infusions without interruption and the backup battery is important
in the event of a power failure

Why should you change the IV dressing per facility protocol and why should you use clear
dressing over the IV site?

Each time dressing is changed there is a chance of contamination or dislodging the catheter,
however, dressing must be changed at appropriate intervals, to allow staff to inspect the site and
prevent infection. Clear dressing provides opportunity to observe the site without removal of the
dressing

As the nurse you must change IV tubing per facility protocol, when this is done what is attached
to the new set and why?

A preprinted sticker is attached, dated, and initialed when tubbing is changed, this is done
because the label allows staff to know when tubing was last changed

Why should gloves be worn at all times when starting or discontinuing an IV, and when adding
medications?

Gloves are worn because an IV site presents direct exposure to the client's body fluids,
particularly blood. Gloves help protect the client from infection

It is important that the nurse focuses on less handling with the dressing and connections to the
bag or IV catheter why?

This will lower the client's risk of infection

How is normal saline written?

0.9% NS or 0.9% NaCl

How is 5% Dextrose in Normal Saline written?

D5NS

How is 5% Dextrose in Sterile Water written?

D5W

How is 5% Dextrose in 0.45% (half-normal saline) Normal Saline written?

D51/2NS

What's administered through a different type of tubing for an IV?

Blood and TPN are administered through a different type of tubing

Which lines are not tunneled?

Central lines and Peripherally inserted central catheter (PICC) Lines

What's a central lines and some examples?

They are used to administer large amounts of fluids, including total parenteral nutrition (TPN) and
examples are, Central lines, Central Venous Access Devices (CVAD), Central Venous Catheters
(CVC)

The type of central line to be used is determined by what?

• Fluids to be administered

• Patient's condition

• Length of time will be in place

Central lines have lower risk of IV infiltration because of their deep placement

Which lines are tunneled?

Hickman and Broviac (smaller than Hickman)

What's a Hickman?

Refers to all standard tunneled central catheters, it May have 1, 2, or 3 lumens, Used for blood
draws and Used for administration of IV fluids

What's a broviac?

Refers to standard tunneled central catheters, it's Smaller than Hickman, Can't be used for blood
draws and is Used for administration of IV fluids

Why would someone get a tunneled catheter?

Because tunneled catheters can stay in for long periods of time and decrease the risk for
infection

Where will you see a non tunneled central venous catheter?

inserted into the subclavian vein and threaded up into the superior vena cava.

On the chest right above the breast or in the neck

Where will you see a non tunneled PICC line?

Inserted into the antecubital space and is sufficiently long enough to be threaded up into the
superior vena cava or right atrium of the heart.

• Single lumen On the arm, done with a butterfly

What's a central venous catheter (central line)?

• May have one, two, or three lumens (tubes)

• Incompatible fluids can be infused because they are being delivered to different areas.

• Sutured to the skin at insertion site

• Used for supplementary fluids or TPN

• Used for short length of time

• Short venous catheters can also be tunneled under the skin to allow for longer-term use

Who puts in a central line, where, and what kind of technique is used?

The Doctor puts in a central line, it can be done at the bedside, and it is a sterile procedure

What's a PICC line?

• Single lumen

• Not sutured to the skin

• Can be used to administer IVF and blood products

• Can be used to measure central venous pressure

• Can be left in place for long periods of time - weeks to months

• Used in home care

• Length is determined by measuring the client's arm to the central location (12-16 inches or
more)

• Disadvantage - restricts use of client's arm and excessive arm movement can cause the
catheter's outward migration or irritation at the insertion site.

What's a port catheter or a mediport?

• Subcutaneously implanted port allows long-term, intermittent access to the central vein,
without the need for a catheter protruding from the skin.

• Infuse-a-Port, Mediport, Port-a-cath

• Port is palpated under the skin, then a special angled needle - Huber 90 degree non-coring
needle is inserted into the port

• Kept patent with periodic flushing

• Used long term for frequent infusions, chemotherapy, blood products

• Placed in the superior vena cava via the subclavian vein.

What is a midline catheter?

• Not specifically a central venous catheter, because it does not extend into the great central
veins.

• Shorter then a central line - 4-8 inches

• Inserted into the antecubital area and extends only to the larger blood vessels in the proximal
area of the arm.

• Can remain in place 2 to 4 weeks

• Can deliver greater volume than a peripheral vessel, but not as great as the central veins.

If not clamped a clot will start to form

What's the difference and similarities of a. PICC line and a midline?

PICC line and midline look the same and are placed in the same area but the PICC line is much
longer, it goes from the middle of the arm to the heart, the midline just goes up to the shoulder

What's some nursing alerts for central lines?

• Scrupulous site care is REQUIRED for any central line to prevent infection

• Close the clamp on any CVC whenever the end will be opened for any reason

to prevent embolism.

What's TPN?

• Formerly known as hyperalimentation

• AKA central parenteral nutrition

• Volume is equal to routine maintenance IV, but additional components can be added making it
much thicker than IV solution.

• Contents:

• Amino acids

• Dextrose (10%-70%)

• Electrolytes

• Vitamins (sometimes)

• Trace elements (zinc, copper, manganese, chromium)

• Lipids (fats)- given separately

TOTAL PARENTAL NUTRITION

What's TPN used for and how is it given?

its used to maintain adequate levels of nourishment for clients who are unable to receive
adequate levels of nutrients by mouth

• Must be given in a large blood vessel - such as the subclavian vein, internal jugular vein in the
neck, or the superior vena cava

• Rationale: TPN is concentrated and could cause irritation, clots, or swelling if administered into
a smaller vessel. The larger vessel provides sufficient

blood flow to adequately dilute the TPN solution

When administering TPN you must do what before hanging it and you have to keep it at what
temp.

You have to get another nurse to check it before handing it and it must be kept at room
temperature for 30 to 60 min before hanging because it's kept in a fridge, you do this because
cold meds are uncomfortable through IV and can cause shock

What do you have to have with TPN?

You must have a 1.2 micron filter and (be sure to get all air out- (life threatening)

Macrodrip – large opening to permit larger quantities of solution to be

infused (10, 15 OR 20 gtts PER 1 mL)-

• Microdrip – small opening to permit smaller quantities of solution to be

infused (60 gtts PER 1 mL)- used when infusion must be carefully

controlled to prevent overload

Typical values of mL/h to expect in calculations are in the range of 50

mL to 200 mL/h. Use this guideline as part of checking for reasonable

answers.

• A SLOWER RATE IS USUALLY NECESSARY FOR OLDER ADULTS AND SMALL CHILDREN,

CLIENTS WITH KIDNEY OR HEART DISEASE, AND CLIENTS WITH HEAD INJURIES.

• A RAPID INFUSION RATE MAY CAUSE CIRCULATORY OVERLOAD OR INCREASED

INTRACRANIAL PRESSURE.

• SOMETIMES A FASTER INFUSION RATE IS OFTEN DESIRABLE FOR PERSONS WHO HAVE

LOST LARGE AMOUNTS OF BODY FLUIDS AND ARE SEVERELY DEHYDRATED.

To properly administer and IV infusion, you must know the flow rate

in millimeters per hours and/or drops per minute.

For a simple blood draw, a butterfly needle is often used.

Blood glucose levels are monitored several times daily. Higher

concentrations of dextrose are used when the client’s fluids must be

restricted; lower concentrations help prevent hyperglycemia. Monitor

daily weights and I&O.

• Rationale – Metabolic and fluid balance changes can occur quickly. It is important not to raise
blood sugar to a dangerous level, and to make sure the client is not retaining too much fluid, and
is voiding in appropriate amounts. MONITOR I&O

Monitor vital signs at least every 4 hours. • Rationale – early detection of infection

Medical Math Review

Give the following temperature equivalent as indicated: Round answer to nearest tenth

52. 99.5°F = ________°C °C to °F °F to °C

°F = °C × 1.8 + 32 °C = °F - 32 = / 1.8

53. 7°C = ________°F

Check you work:

54. 103.5°F = ________°C 52. 37.5

53. 44.6

55. 37°C = ________°F 54. 39.7

55. 98.6

Check your work:

56. 0.5 61. 2

57. 2 62. 0.5

58. 8 63. 10

59. 1 64. 0.5

60. 1 65. 0.3

Calculate one dose of the following drug orders.

56. Order: Codeine 50 mg po every 4 hr prn pain Supply: Codeine 100 mg tablets

Give: ______________ tablet(s)

57. Order: Synthroid 0.1 mg po daily Supply: Synthroid 50 mcg tablets

Give: ______________ tablet(s)

58. Order: Neomycin 2 g po every 6 hrs Supply: Neomycin 250 mg tablets

Give: ______________ tablet(s)

59. Order: Levothyroxine 500 mcg po bid Supply: Levothyroxine 0.5 mg tablets

Give: ______________ tablet(s)

60. Order: Diabinese 100 mg po daily Supply: Diabinese 0.1 g tablets

Give: ______________ tablet(s)

61. Order: Lopid 0.8 g po bid Supply: Lopid 400 mg tablets

Give: ______________ tablet(s)

62. Order: Robinal 250 mcg IM every 6 hrs Supply: Robinal 0.5 mg/1mL

Give: ______________ mL

63. Order: Penicillin VK 500 mg po bid Supply: Penicillin VK 250 mg per 5 mL

Give: ______________ mL

64. Order: Morphine Sulfate 12.5 mg IM every 4 hours as needed Supply: Morphine Sulfate 25
mg/mL Give: _________________mL

65. Order: Tobramycin 6 mg IV every 12 hours Supply: Tobramycin 20 mg/mL Give:

_________________mL