NURS-341: Patho-Pharm 2 (Exam 1)

What are parenteral medications?

Medications administered by routes other than oral

What are examples of parenteral medication routes?

• Intravenous (IV)

• Intramuscular (IM)

• Subcutaneous (SubQ/SC)

• Intradermal (ID)

Which parenteral route produces the most rapid effect?

Intravenous (IV) route

What are the three major types of IV medication administration?

• IV push

• Continuous IV infusion

• IV piggyback (IVPB)

Which IV method is considered a quick administration?

IV push

Which IV method provides a steady infusion?

Continuous IV infusion

Which IV method uses a secondary bag?

IV piggyback (IVPB)

What is another name for IV push medication administration?

Bolus administration

What volume is typically used for IV push medications?

Usually less than 10 mL

How quickly are IV push medications administered?

Over seconds to minutes

Why do IV push medications require careful monitoring?

They require careful rate checks and compatibility verification

List the steps in order for IV push administration.

1. Perform appropriate safety checks while pulling/prepping the medication

2. Perform hand hygiene/don gloves

3. Perform 7 rights of medication administration

4. Assess IV site

5. Clean port with antiseptic per facility policy

6. Connect syringe; aspirate for blood return (if applicable)

7. Flush with saline (if indicated)

8. Administer medication at the correct rate

9. Flush with saline

10. Safely dispose of supplies and document required information

How are medications administered during continuous IV infusion?

Medications are mixed in IV fluids and infused at a controlled rate using a pump

What does “KVO” stand for?

Keep vein open

What is the purpose of a KVO rate?

To maintain IV patency with a minimal continuous infusion

What are common uses of continuous IV infusions?

• Maintaining steady medication levels

• Total parenteral nutrition (TPN)

• Fluid resuscitation or maintenance

Why are infusion pumps important in continuous IV therapy?

They ensure precise infusion rates

List the steps in order for continuous IV infusion.

1. Perform appropriate safety checks while pulling/prepping the medication

2. Perform hand hygiene/don gloves

3. Perform 7 rights of medication administration

4. Check/prime IV tubing

5. Prepare medication/label bag per facility policy (if applicable)

6. Assess IV site (verify patency if applicable)

7. Clean access point with antiseptic per facility policy

8. Connect/program smart pump to infuse at the correct rate

9. Monitor patient for adverse reactions/IV site concerns

10. Safely dispose of supplies and document required information

What is another name for IV piggyback medication administration?

Intermittent infusion

How is an IV piggyback connected?

Through a secondary medication bag attached above the primary line using a Y-site

Why must the IV piggyback bag hang higher than the primary bag?

So the secondary medication infuses before the primary solution

What are common examples of IV piggyback medications?

Vancomycin and ceftriaxone

List the steps in order for IV piggyback infusion.

1. Perform appropriate safety checks while pulling/prepping the medication

2. Perform hand hygiene/don gloves

3. Perform 7 rights of medication administration

4. Prepare/label medication

5. Prime piggyback tubing

6. Assess IV site

7. Connect secondary tubing to Y-site above pump

8. Hang piggyback bag higher than primary bag

9. Program infusion pump

10. Monitor patient for adverse reactions/IV site concerns

11. Safely dispose of supplies and document required information

What IV site complications should nurses assess for regularly?

Infiltration and phlebitis

Why must dilution, infusion rate, and flushing requirements be followed carefully?

To prevent medication errors and complications

What should occur with high-risk medications?

A second nurse should verify them

What is phlebitis?

Inflammation of the vein wall

What are causes of phlebitis?

• Mechanical irritation (e.g., catheter rubbing the vein)

• Chemical irritation (e.g., harsh medications)

• Bacterial contamination

What are signs of phlebitis?

• Warmth

• Redness (erythmea)

• Pain

• Red streak along the vein

What should the nurse do if phlebitis occurs?

• Stop the infusion

• Notify the healthcare team

• Prepare to remove the IV

What is infiltration?

Leakage of non-vesicant (non-irritating) IV fluid into surrounding tissue

What types of fluids commonly cause infiltration?

• Normal saline

• Dextrose solutions

• Most IV antibiotics

True or False: Infiltration causes tissue necrosis.

False

What are signs of infiltration?

• Coolness

• Pallor

• Swelling/edema

What actions should the nurse take for infiltration?

• Stop the infusion

• Notify the healthcare team

• Prepare to remove the IV

What is extravasation?

Leakage of vesicant (highly irritating) medications into surrounding tissue

What are examples of vesicant medications?

• Chemotherapy agents

• Vasopressors like (norepinephrine)

• Concentrated electrolytes (like calcium chloride)

Why is extravasation dangerous?

It can cause tissue injury, skin breakdown, and necrosis

What are signs of extravasation?

• Intense pain

• Redness

• Skin sloughing or breakdown

What should the nurse do if extravasation occurs?

• Stop the infusion

• Notify the healthcare team

• Prepare to remove the IV

What medication is commonly used as an antidote for extravasation?

Hyaluronidase

What was the old brand name for hyaluronidase?

Wydase

What specialty consults may be needed for severe extravasation?

Dermatology or plastic surgery consults

What is a Y-site?

A specialized IV injection port that allows multiple lines or syringes to connect into one main IV line

What is the upper Y-site port typically used for?

IV piggyback medications

What is the lower Y-site port closest to the patient used for?

IV push medications

Why are IV push medications given in the port that is closest to the patient?

So the medication reaches the patient quickly

Why is compatibility especially important at the Y-site?

Because medications mix there before entering the vein

What can happen is incompatible medications mix at the Y-site?

Precipitates or crystals may form

What are manifolds?

Multi-port access points commonly used in critical care

What does “scrub the hub” mean?

Cleaning the IV access point with antiseptic before use

How long should nurses scrub the hub?

About 15 seconds or according to facility policy

Why should IV lines be flushed with saline after scrubbing the hub?

To clear previous medications from the line

Why is IV medication compatibility considered a critical safety issue?

Incompatible medications can form precipitates that may cause embolism or medication failure

Why are ICU patients at increased risk for compatibility issues?

They often receive multiple IV drips and fluids simultaneously

Why is compatibility especially important with chemotherapy?

Chemotherapy agents are reactive vesicants that can cause severe injury if incompatible

Why is TPN considered high risk for incompatibility?

Its high lipid and mineral content interacts with many medications

Who performs the final compatibility check before IV medication administration?

The nurse

What electronic tools help verify IV compatibility?

• Lexicomp

• Micromedex

• UpToDate

What should nurses look for when inspecting IV lines and fluids?

• Cloudiness

• Color changes

• Flecks or precipitates

What should the nurse do if an IV solution appears abnormal?

Stop the infusion immediately

What were compatibility charts historically used for?

Determining whether IV medications and fluids were compatible

True or False: Compatibility charts are still used today.

True

Why are smart pumps especially important for pediatric patients?

Pediatric medications are weight-based and involve very small volumes

Why is IV site stabilization important in pediatric patients?

To protect the IV site and prevent dislodgement

What comfort measures are important for pediatric IV procedures?

• Pain management

• Explaining procedures

• Infant-specific considerations

Why are geriatric patients at higher risk for IV complications?

They have fragile skin and veins

How should tourniquets be applied in geriatric patients?

Lightly to prevent tissue injury

Why must medication administration be slower in geriatric patients?

Due to reduced metabolism and increased sensitivity to medications

Why are IV complications sometimes “invisible” in geriatric patients?

Age-related tissue changes can make complications harder to detect

Why is catheter choice important in geriatric patients?

To reduce trauma and complications

What is the formula for calculating cardiac output (CO)?

CO = (HR)(SV)

What internal systems govern the heart’s pumping function?

The electrical system and the Renin-Angiotensin-Aldosterone System (RAAS)

What are classic clinical symptoms of an acute cardiac event?

Crushing chest pain (often left-sided or radiating to the back), left arm numbness, nausea, severe fatigue, and shortness of breath

What are major historical risk factors for cardiovascular events?

Family history of heart disease, unmanaged hypertension, obesity, and a history of smoking

What are the basic measurable components of an ECG waveform?

P wave, PR segment/interval, QRS interval, ST segment/interval, T wave, U wave, QT interval, and RR interval

What does the P wave represent on an ECG tracing?

Atrial depolarization

What does the QRS interval represent on an ECG tracing?

Ventricular depolarization

What does the T wave represent on an ECG tracing?

Ventricular repolarization

What is the baseline, healthy rhythm of the heart called?

Normal sinus rhythm

What does NSTEMI stand for?

Non-ST elevation myocardial infarction

What does STEMI stand for?

ST elevation myocardial infarction

Which type of MI involves a complete artery blockage?

STEMI

Which type of MI is a “drop everything” emergency requiring immediate reperfusion/cath lab?

STEMI

True or False: Both STEMI and NSTEMI present with elevated troponin levels.

True

What clinical symptoms present in cases of NSTEMI?

Chest pain

What clinical symptoms present in cases of STEMI?

Sudden, severe chest pain, nausea, and shortness of breath

What visually indicates ischemia or infarction on a patient’s 12-lead EKG?

Deviations in the ST segment (elevations or depressions) across multiple leads

What does an NSTEMI look like on an EKG?

ST depression or T wave inversion

What does an STEMI look like on an EKG?

ST segment elevation in more than 2 leads

What is acute coronary syndrome (ACS)?

A sudden drop in blood flow to the heart muscle, usually caused by a blocked coronary artery

What three conditions fall under the ACS umbrella?

Unstable angina, NSTEMI, and STEMI

What physiological event usually triggers ACS?

Plaque rupture and blood clot formation

What is the ultimate goal of ACS treatment?

To rapidly restore blood flow to the heart to minimize heart muscle damage, relieve ischemic pain, and prevent complications like heart failure or fatal arrhythmias

What are the five standard first-line interventions for ACS?

Morphine, oxygen, nitroglycerin, aspirin (i.e., MONA), and tenecteplase (TNK)

How does nitroglycerin work?

It dilates vascular smooth muscle in both veins and arteries, relieving pain from low oxygen

What are the common side effects of nitroglycerin?

Headache, hypotension, tachycardia, and dizziness

What must a nurse do when handling oral nitroglycerin doses?

Wear gloves to prevent the medication from melting and absorbing into their own skin, which causes hypotension

What is the primary indication for tenecteplase (TNKase)?

To dissolve blood clots in coronary arteries during a STEMI acute myocardial infarction

What is the optimal administration window for tenecteplase?

Within 3 hours of symptom onset (but can be given up to 12 hours)