CH 14 Medication Administration

What is the purpose of vascular access in patients?

It may be needed for patients in hemodynamically unstable condition.

What should you do if you are not confident with medication administration?

Use protocols, a drug formulary, a flip guide, a smartphone app, or consider medical control.

What does online medical control provide?

Approval of medications and general consultation of treatment modalities.

What should be documented during medication administration?

Dose administered, name of medication, route, rate, time of administration, who administered the drug, who helped perform the medication check, and the patient's response.

What should be checked at the beginning of your shift regarding medications?

Ensure medications are not expired, not damaged, and readily available in the right quantity.

What is medical asepsis?

The practice of preventing contamination of the patient using aseptic technique.

What are the two techniques of asepsis?

Clean technique and sterile technique.

What is the difference between antiseptics and disinfectants?

Antiseptics are used before invasive procedures, while disinfectants are toxic to living tissue.

What should be done with contaminated sharps after use?

Immediately dispose of all sharps in a sharps container.

What is the primary composition of the human body?

The human body is composed mostly of water.

What are signs and symptoms of dehydration?

Decreased level of consciousness, postural hypotension, tachypnea, dry mucous membranes, decreased urine output, tachycardia, poor skin turgor, and flushed, dry skin.

What can cause dehydration?

Diarrhea, vomiting, gastrointestinal drainage, infections, metabolic disorders, hemorrhage, environmental emergencies, high-caffeine diet, and insufficient fluid intake.

What are signs and symptoms of overhydration?

Shortness of breath, puffy eyelids, edema, polyuria, moist crackles (rales), and acute weight gain.

What can cause overhydration?

Unmonitored IVs, kidney failure, water intoxication in endurance sports, and prolonged hypoventilation.

What is the importance of IV fluid composition?

Each bag of IV solution is individually sterilized and altering IV concentration can move water into or out of fluid compartments.

What are crystalloid solutions?

Solutions that contain dissolved crystals in water, can cross membranes, and alter fluid levels.

What are colloid solutions?

Solutions with molecules too large to pass out of capillary membranes, remaining in the vascular system and reducing edema.

How are IV solutions categorized?

By their tonicity: isotonic, hypertonic, and hypotonic.

What is the role of electrolytes in IV fluid composition?

Electrolytes can become altered from excessive vomiting, diarrhea, dietary issues, medications, blood loss, or other injuries.

What is the recommended action if you are unsure about medication administration?

Contact medical control for guidance.

What is the significance of maintaining a sterile field?

To prevent contamination and reduce the risk of infection during procedures.

What is the recommended practice for hand hygiene during medication administration?

Practice medical asepsis to reduce risk of contamination.

What should be done if a patient exhibits signs of dehydration?

Assess and manage fluid intake and consider medical intervention.

What is the effect of prolonged hypoventilation on fluid balance?

It can lead to overhydration due to increased fluid retention.

What should be done with expired medications?

They should be disposed of properly to ensure safety.

What is the importance of documenting medication administration?

It ensures accountability and provides a record for future medical care.

What are isotonic solutions?

Solutions with the same concentration of sodium as cells, causing no change in cell shape.

Give two examples of isotonic solutions.

Lactated Ringer's (LR) solution and D5W (5% dextrose in water).

What are hypotonic solutions?

Solutions with a lower concentration of sodium than cells, which hydrate cells while depleting the vascular compartment.

Provide an example of a hypotonic solution.

0.45% sodium chloride.

Define hypertonic solutions.

Solutions with a greater concentration of sodium than cells, pulling fluid from intracellular and intestinal compartments to the intravascular compartment.

What is an example of a hypertonic solution?

3% sodium chloride.

What is the purpose of hypertonic solutions?

To stabilize blood pressure, increase urine output, and reduce edema.

What are oxygen-carrying solutions?

Solutions that include whole blood or synthetic blood substitutes used for replacing lost blood.

What is involved in IV therapy?

Cannulation of a vein with a catheter.

What should be kept sterile during IV therapy?

IV equipment.

What equipment should be gathered for IV administration?

Latex-free tourniquet, cleaning wipe, gauze pads, tape, IV catheter, saline flush, and IV fluid.

What is the maximum time an opened IV solution bag can be used?

24 hours.

What are the two sizes of administration sets?

Microdrip set (60 gtt/mL) and Macrodrip set (10 or 15 gtt/mL).

What should be verified before preparing an administration set?

Expiration date and solution clarity.

What is the correct angle for inserting an IV catheter?

35 to 45 degrees initially, then drop to 15 degrees after piercing the vein.

What should be done to secure the IV line?

Tape the area to secure the catheter and tubing, and cover the site with sterile gauze.

What is the first step in changing an IV bag?

Stop the flow by closing the roller clamp.

What should be done when discontinuing an IV line?

Shut off the flow, peel back the tape, and stabilize the catheter.

What should be avoided when choosing an IV site?

Areas with valves, bifurcations, trauma, injury, or infection.

How should a bulging vein be handled during IV insertion?

Pull the skin over the vein taut to prevent rolling.

What type of catheter is most commonly used?

Over-the-needle catheter.

What is the relationship between gauge size and catheter diameter?

The smaller the gauge, the larger the diameter.

What is the purpose of using a vein identification assistive device?

To help visualize a patient's vasculature in challenging IV starts.

What should be done to the IV tubing before spiking the bag?

Ensure the tubing is not tangled and protective covers are present.

What is the purpose of the roller clamp during IV administration?

To control the flow of the IV solution.

What is a common mistake to avoid when inserting an IV catheter?

Failing to maintain adequate traction on the vein.

What should be done to remove air bubbles from the IV line?

Twist the protective cover and check the drip chamber fluid level.

What is the role of a sharps container in IV administration?

To safely dispose of used needles and sharp objects.

What is the first step in discontinuing an IV line?

Shut off the flow.

What should you do after shutting off the IV flow?

Peel tape back and stabilize the catheter.

What should you avoid doing when removing the IV tubing?

Do not remove IV tubing from the hub.

What is the purpose of applying pressure after removing an IV line?

To prevent bleeding.

What is a saline lock?

A method to maintain an active IV site without running fluids through the vein.

What is the EJ vein?

A large vein that runs behind the jaw, used for cannulation.

What position should a patient be placed in for EJ vein cannulation?

Supine, with the head down.

What is the best gauge for over-the-needle catheters in pediatric IV therapy?

20, 22, 24, 26.

What is the preferred location for starting a pediatric IV line?

Hand veins.

What should be considered when performing IV therapy on older adults?

Use smaller catheters and be cautious of vein elasticity.

What factors can affect IV flow rates?

Fluid type, administration set, height of the bag, catheter type, constricting band, and line positioning.

What is infiltration in IV therapy?

Localized area of edema caused by dislodgement of catheter or solution leakage.

What should you do if infiltration occurs?

Discontinue the IV line and reestablish it in another site.

What is catheter occlusion?

A physical blockage of the vein or catheter, indicated by a decreasing drip rate.

What should you do if catheter occlusion is suspected?

Remove the catheter and assess its integrity.

What are the signs of vein spasm during IV therapy?

Sluggish infusion rate and severe pain radiating up the extremity.

What should be done if a vein spasm occurs?

Slow the infusion rate and remove the catheter if the spasm persists.

What is phlebitis?

Inflammation of a vein, which can be chemical, mechanical, or bacterial.

What should you do if phlebitis develops?

Discontinue the IV line and save equipment for analysis.

What is thrombophlebitis?

Inflammation of a vein associated with blood clots, often occurring in patients with long-term IV therapy.

What should be done if thrombophlebitis is suspected?

Stop the infusion and discontinue the IV line.

What is a hematoma in relation to IV therapy?

Accumulation of blood surrounding tissue near an IV site, often caused by vein perforation.

What are the signs and symptoms of a hematoma?

Bruising, pain at the site, swelling, and inability to flush the IV line.

What can cause nerve, tendon, or ligament damage during IV therapy?

Improper venipuncture technique or identification of anatomic structures.

What should be done if nerve damage occurs during IV therapy?

Remove the catheter and select another IV site.

What indicates an arterial puncture during IV therapy?

Bright red blood spurting back through the catheter.

What should you do if an arterial puncture occurs?

Withdraw the catheter and apply direct pressure for at least 5 minutes.

What are allergic reactions in the context of IV therapy?

Responses to IV solution, preservatives, or medication, with a wide range of signs and symptoms.

What should be done if an allergic reaction occurs during IV therapy?

Stop the infusion, discontinue the IV, and select a new IV site.

What are pyrogenic reactions?

Reactions caused by foreign proteins capable of producing fever, beginning within 30 seconds.

What steps should be taken if a pyrogenic reaction occurs?

Stop the infusion, start a new IV line in the other arm with fresh solution, remove the first IV, and inspect IV bags before use.

What is circulatory overload in IV therapy?

A condition caused by excessive fluid administration, potentially leading to pulmonary edema.

What should be done if circulatory overload occurs?

Slow the IV rate to keep the vein open, place the patient in a semi-Fowler position, administer high-flow oxygen, and monitor vital signs.

What is speed shock?

A rapid introduction of medication or solution into the circulation.

What actions should be taken if speed shock occurs?

Halt the infusion or medication and ensure the IV line is patent while monitoring.

What is an air embolus?

A condition where air enters the bloodstream.

What should be done if an air embolus is suspected?

Place the patient on the left side with head down, administer 100% oxygen, transport to the closest facility, and assist ventilations if needed.

What are vasovagal reactions?

Reactions caused by anxiety concerning needles or the sight of blood, leading to a drop in blood pressure and collapse.

What should be done if a vasovagal reaction occurs?

Place the patient in a supine position, apply high-flow oxygen, monitor vital signs, and establish an IV line.

What is catheter shear?

A situation where a needle slices through a pinched catheter, creating a free-floating fragment.

What actions should be taken if catheter shear is suspected?

Put the patient in a left lateral recumbent position, obtain an IV site in the other extremity, and transport.

What is the recommended equipment for obtaining blood samples during IV therapy?

A 15- or 20-mL syringe, an 18- or 20-gauge needle, and self-sealing blood tubes.

What is the procedure for obtaining blood samples when IV therapy is indicated?

Occlude and remove the constricting band, attach a syringe to the IV hub, draw blood, and then attach IV tubing to begin infusion.

What should be done if blood samples are required but IV therapy is not indicated?

Use a Vacutainer, apply a constricting band, locate the vein, prep the vein, insert the needle, and label all tubes after removal.

What is the importance of mixing blood tubes?

Blood tubes must be turned back and forth to mix, but the red tube should not be shaken.

What is the verification process for blood transfusions?

Verify the name, medical record number, transfused product, product unit number, and ABO/Rh type of the product.