module 8: lesson 35-38 Med Administration and Dose Calculations

30 minutes of the prescribed time

medication should be administered within

antacids, iron and grapefruit juice

what can affect the absorption of medications

the medication dose, the date, and her initials; immediately after giving it

after administering the medication, the nurse should document what; when

adverse effects and side effects of the medication; including evaluating any therapeutic effects

the nurse has given a medication, what should be monitored after

patient should follow up with HCP, pt should wear a medic-alert bracelet whilst taking corticosteroids, anticonvulsants, anticoagulants and MAOI’s and antimyasthenic medications

the patient is being discharged, what should the nurse add in the client teaching regarding medication

second nurse to witness the disposal and the record is signed by both nurses

the nurse is discarding a controlled substance, due to agency policy and procedure there has to be a

enteric coated and sustained release capsules

what medications can’t be crushed

a calibrated dropper; add a small amount of liquid to water or juice

the nurse is about to give medication to a child, what should be used; it can also be used to

subQ, intramuscular, intravenous and or intradermal

what are the administration routes for parenteral medications

ampules, vials, cartridges, and premeasured syringes

how are parenteral medication packages

3 mL per intramuscular site or 1 mL per subcutaneous injection site

The nurse should not administer more than

a 5mL syringe can be used

when a volume greater than 3 mL is required

nearest 10th

Standard medication doses for adults are to be rounded to the

intradermally

tuberculin injections are to be given

total of 100 units, or 1 mL

how are insulin syringes calibrated; for a total of

insulin

The standard U-100 insulin syringe is used to measure

blink 1-2x and then shut eyes for several minutes

while administering eye drops the nurse should direct the client to

conjuctival sac

where should the nurse place the eye drops when administer them; in the

Squeeze a strip about a quarter-inch (0.5 cm) long into the lower conjunctival sac and instruct the client to gently close their eyes and keep them closed for 2 to 3 minutes

when administering ointment in the clients eye, the nurse should instruct the client to

up and back

In an adult client or older child, pull the

down and back

in an infant or child younger than 3 years, pull the pinna

2 minutes

after administering ear drops, the nurse should have the client keep their head tilted for how long

remove the old patch or ointment and cleanse the clients skin

the nurse is about to administer a transdermal patch or ointment, she should

the hair on the skin

when applying ointment or transdermal patch to client skin, the nurse should avoid applying it to

1-2 minutes

the patient is prescribed 2 inhales, after administer one. the nurse should wait how long before giving it

lithotomy or dorsal recumbent

before the nurse administers a vaginal suppository, the client should be placed in what position

2-3; 5-10 minutes

the nurse should insert the vaginal suppository how many inches in; have patient lay in suphone for how long

left recumbent; suphine, for 5-10 minutes

before giving a rectal suppository, what position should the client be placed in ; what position should they be placed in after and for how lng

Oral pediatric medications are presented in

liquid or suspension form

how many inches is the length of pediatric syringes; what is the gauge size

0.5 to 1 inch; 22 to 25

how can needle length be estimated

by grasping the muscle for injection between the thumb and forefinger

what is used to measure the child’s BSA

nomogram

what is administered primarily to treat hypovolemic shock resulting from hemorrhage

whole blood

what is used to replace erythrocytes lost as a result of trauma or surgical intervention or in clients with bone marrow suppression

red blood cells (RBC’s)

what is administered to clients with low platelet counts as a means of preventing hemorrhage and to thrombocytopenic clients who are actively bleeding or scheduled for invasive procedures

platelets

what is administered to augment clotting factors in clients who are deficient in cloting

Fresh-frozen plasma

what is used to treat hypovolemic shock or hypoalbuminemia

albumin

what is used for various blood components to remedy deficiencies of clotting factors in conditions such as hemophilia or von Willebrand disease

Cryoprecipitates

a donation reduces the risk of disease transmission and potential transfusion complications but is not an option for a client with leukemia or bacteremia is called

autologous

To test the donor's and recipient's blood for compatibility, the nurse would use

cross matching

the universal donor is

O-negative

what can be used to prevent hypothermia and adverse reactions when several units of blood are being administered

blood warmers

how soon should blood be administered after being reviewed from the blood bank

within 30 minutes

what is the rate of infusion for blood transfusion

as quickly as the clients condition allows

15-30 minutes; circulatory overload

the pt is receiving a blood bank that contains few platelets, how fast should it be infused ; what should be avoided

Y-set/syringe via an IV push method

Platelets are transfused using a

before transfusion of blood, what should the nurse assess

Vital signs and lung sounds

vital signs and lunges sounds should be assessed

before, during and after blood transfusion; after should be done every hour until 1 hour has passed since the transfusion has been done

To help prevent delivery to the wrong client, blood products need to be

transported from the blood bank to a single client at a time

before giving blood transfusion, the nurse notices that the client's temperature has been elevated. the nurse should ; why

notify the hcp; because a fever can mask a transfusion reaction

what vital signs should be checked for blood transfusion

renal, circulatory, and respiratory status and the client’s ability to tolerate intravenous (IV) fluids

An adverse and potentially life-threatening event that occurs when a client receives blood that is incompatible with his or her blood type or Rh type is called a

Transfusion reaction

To help prevent circulatory overload the nurse should

check the bag for its volume before starting the infusion

increased to the prescribed rate

during the blood transfusion, the nurse should administer the blood slowly and monitor the client closely; if no reaction is noted during the first 15 minutes, the flow can be

A major ABO incompatibility or severe allergic reaction is evident during

the first 50mL of the transfusion

the patient is experiencing mild jaundice, fever and their labs have shown a decrease in hematocrit. this means the patient is experiencing

delayed blood transfusion reaction

the patient is experiencing dyspnea, abdominal cramping, diarrhea, headache vomiting, chills and cyanosis. these are sx of

an adverse reaction to blood transfusion; immediate signs

During a blood transfusion, the nurse notices there is a reaction. The nurse should

stop the transfusion, change the IV tubing down to the IV site, and keep the IV line open with 0.9% normal saline solution

how often should vs be checked when patient had a transfusion reaction

every 5 minutes

blood-administration set should be changed every

4 to 6 hours

infusions should be completed in

4 hours

The breakdown of red blood cells (RBCs) is checked after a

transfusion reaction

Seepage of IV fluid from a vein into the surrounding interstitial space is called

infiltration

An inflammation of the vein that may occur as a result of mechanical or chemical (medication) trauma or a local infection is called

phlebitis

Remedies extracellular fluid deficits in the client with a low serum level of sodium or chloride and metabolic acid-base imbalances is called

0.9% saline (normal saline, NS): isotonic

Remedies extracellular fluid deficits (e.g., fluid loss from burns, bleeding, or dehydration resulting from loss of bile or diarrhea) would use

Lactated Ringer’s solution: isotonic 5% dextrose in lactated Ringer’s solution: hypertonic

what solution replaces deficits of total body water

5% dextrose in water (D₅W): isotonic

what technique is used to insert an IV

sterile

before inserting an IV the nurse must cleanse the pts skin with what; a

antimicrobial solution using inner to outer circular motion and prime the IV tubing system

the nurse has given the pt an IV and notices that here is infiltration on the antecubital, she should; why

use a different arm; the lower veins generally cannot be used for puncture sites

when the venipuncture site is located in an area of flexion the nurse should provide the pt with an

arm board

after inserting an IV catheter, the nurse should

label the tubing, dressing, and solution bags clearly. indicate the date and time of the infusion procedure

how often should an IV dressing be changed

every 72 hours

how often should the nurse check the IV flow rate of an adult;child

every 1-2 hours; every hour

IV bag or bottle should not be hung no more than (should be changed every)

24 hours

the IV tubing should be changed every

96 hours

after removing an IV catheter, the nurse should inspect the skin for

redness, swelling, drainage and check the catheter for intactness

what gauge size should be used for an older adult

21 or smaller

the nurse is about to insert an IV and notices that the pt has very small veins, what gauge size should she use

24-25

the patient will receive lipids (fat emulsion) what gauge size should the nurse use

20-21

for clear fluids or IV fluid, the nurse should use what gauge size

22-24

what drip chamber delivers 60 gtts/mL and is usually used for potent medications (used for pediatric or pts in critical care)

microdrip

which drip chamber is used for thick solutions or to infuse rapidly (>100 mL/Hr) - drop factor of 10, 15, 20 gtt/mL

macrodrip

for IV fluids, how often should the IV filter be changed

every 24-72 hours

before the nurse adds medication to the IV bag the nurse should

clean (swab) the access port with 70% alcohol or equally effective solution or any equally effective solution

what is used to control the amount of fluid infusing

pressure bags

pressure bags are used for

central venous lines, parenteral nutrition infusions and infusions containing medications

what is used when a small volume of medication is administered; a

syringe pump

the patient is about to receive an epidural catheter, the nurse reads the patients chart and sees there is a hx of sepsis and multiple abscesses. the nurse should

inform the provider of the contraindication

sepsis, skeletal/spinal abnormalities, blood disorders, multiple abscesses and the use of anticoagulants are contraindicators for what procedure

epidural catheter

the nurse has given the patient an epidural catheter, what should be assessed

vital signs, LOC, motor and sensory function

before giving the medication during an epidural catheter, the nurse should ; if more than 1mL of blood or clear fluid is returned the nurse should'; why

aspirate ; notify the HCP and or the anesthesiologist immediately; because the catheter might have migrated into the subarachnoid space/blood vessel

Edema, pain, and coolness at site, with or without blood return are sx of

filtration; signs of complications with IV

Increased blood pressure, distended jugular veins, tachycardia, dyspnea, moist cough, crackles are sx of

circulatory overload; IV complications

Ecchymosis; immediate swelling and leakage of blood at site after catheter insertion; hard, painful lumps at insertion site are sx of

Hematoma; complication with IV site

Heat, redness, tenderness at site, and sluggish infusion but usually no swelling or hardness at site are sx of

phlebitis; IV complication

Decreased blood pressure; pain along vein; weak, rapid pulse; cyanosis of nail beds; loss of consciousness are sx of

catheter embolism

Tachycardia, dyspnea, cyanosis, decreased level of consciousness are sx of an

air embolism ; IV complication

the dressing site and tubing should be changed every

72-96 hours

remove the IV, start an IV on the other arm and notify the hcp

if the patient is experiencing thrombophlebitis, the nurse should