Advanced Patient Care Exam 1: Chapters 14 and 15

What is the most common drug interaction?

Drug receptor interactions

Where does most drug metabolism occur?

In the liver

Acronym for pharmacokinetics

ADME

Absorption

Distribution

Metabolism

Excretion

Efficacy

The degree to which a drug produces a desired effect

Potency

Relative concentration required to produce an effect

Half-life

The time required for drug concentration to reduce by 50%

Side effect

Mild and predictable

Adverse Effect

Unwanted effect, more serious

Toxicity

The degree to which something is poisonous; antidote treats this effect

Idiosyncratic Reaction

Occurs when a patient overreacts or under-reacts to a drug or has an unusual reaction

Allergic Reaction

Immune mediated response by the body to a drug

Drug-drug interactions

When two or more drugs act in unison to produce a response

Synergism

Two drugs act together to produce a positive (additive) response

Incompatibility

Drugs that should not be taken together

Why drug interactions can be dangerous

Many drugs alter the metabolism of other drugs

Pharmacogenetics

Study of how your genes (DNA) affect your response to medications

How are drug interactions impacted?

Method of consumption and where it acts in the body

What happens after you take a drug?

The body needs to break it down and get it to the intended area

How is the drug response influenced?

DNA can affect multiple steps in the drug breakdown process

Enteral

Through the GI tract

Parenteral

Injected directly into the body, bypassing the GI tract

Intradermal

Within the skin layers

Subcutaneous

Under the skin

Intramuscular

Into the muscle

Most common intravascular injection

IV

Intraarterial (IA)

Injected into an artery (angiography)

Intrathecal

Contrast injected into the spinal canal; myelograms and anesthesia

Intravenous

Route that offers the most immediate effects; common route for fluids

What are the 4 different structures of blood vessels?

Tunica intima, tunica media, tunica adventitia, and lumen

Tunica Intima

Innermost, connective tissue

Tunica Media

Thicker in arteries, smooth muscle

Tunica Adventitia

Stabilize and anchor vessel

Lumen

Center of vessel where the blood flows

What are the two types of blood circulation

Arterial and venous

Arterial

Takes blood away from the heart; thicker muscle wall; High pressure; High O₂ (Except pulmonary artery)

Venous

Take blood to heart; deoxygenated blood (except pulmonary vein); peripheral veins have valves

What does IV site selection depend on?

length of therapy, material to be infused, and patient age/overall condition

What should be avoided for IV selection sites?

Flex areas, bruises, sclerosed or thrombosed veins, areas of skin disease or breakdown, tattoos, and mastectomy

What are some common venipuncture sites in adults?

Digital–Metacarpal, Cephalic, basilic, and median cubital

What are common venipuncture sites in adolescents?

Metacarpal, median cubital

What are common venipuncture sites in infants and neonates?

Scalp veins, umbilical vein, hands and feet

When is IV therapy used?

Medication administration, fluid replacement, and parenteral nutrition

When is IV therapy used for medication administration?

When rapid response is necessary, chemotherapy

What is involved in IV therapy used for fluid replacement?

Dextrose in water (D₅W), normal saline (NS), and lacated ringers (electrolyte replacement)

Types of syringe tips

Luer lock, straight tip, catheter tip

Catheter tip

Connected to a catheter; usually used for contrast media

Straight tip

Can be used with or without a needle

Luer lock

Needle locks directly into the tip of the syringe

Steps to filling a syringe

Do not contaminate the plunger, fill the syringe with air to desired level, invert the bottle, inject air into the bottle, and withdraw solution

What are the different venipuncture devices?

Wing tip (butterfly), hypodermic, and IV catheter

Wing Tip Needle Facts

Short small gauge metal needle with one or two plastic side arms; 19 – 27 g, .5” - .75” length; Used for short term therapy

Advantages of wing tip needle

easy to use; less chance of phlebitis

Disadvantages of wing tip needle

rigid, less mobility, may infiltrate

Over the needle catheter facts

Plastic catheter mounted on metal needle; 10 – 27g, .75” - 3” length; used for more long term therapy

Advantages of over the needle catheter

Decreases chance of infiltration, allows for patient mobility

Disafvantages of over the needle catheters

Phlebitis, can kink, improper insertion can lead to catheter emboli

What is the use of existing lines sometimes called?

Piggyback

What is piggyback?

connecting an IV bag via its own tubing to an existing IV line

What does piggybacking do?

Before beginning, assure compatibility of meds, Piggyback line is filled and clamped before attached to the IV line, IV line is clamped, Piggyback line is opened

Important intermittent venous access things to know

Never flush with sterile water, wipe stopper, inject 1cc normal saline, observe the site, inject contrast, and flush with saline

Venipuncture procedure facts

Requires assembly supplies, do not draw up contrast in front of patient, do not inject anything drawn up by others, tear tape prior to putting on gloves, place tourniquet 6-8 inches above puncture site

What are the standard precautions for venipuncture?

Wash hands, don gloves, cleanse site

What is the procedure for venipuncture?

Acute angle to puncture skin, decrease angle advance cannula, release tourniquet, secure device

What does it mean to verify patency?

Making sure the vein is open and that we are in the right spot

How do you verify patency?

There is blood return on aspiration, palpate site, observe for swelling or redness, inject saline, question patient about pain, never force an injection

How many times should you verify your medication before injection?

3 times

When should you verify your medication?

When picking it out, when drawing it up, and right before injection

What should you do during injection?

Document any adverse effects and patient reaction

Charting of medication facts

Must comply with institution policies, all medications are recorded in the patients EMR, there are radiology specific forms and incident report forms

What medication information is included in the patient’s EMR?

Date, time of day, drug name, dosage, route of administration, person administering drug

What is included in the radiology-specific forms?

Radiologic requests, informed consent, contrast administration records

What is the process of discontinuing IV lines?

Prepare tape or bandaid, wash hands and don gloves, stabilize cannula and remove tape, inspect the site, place sterile gauze over the site, remove the needle and apply pressure, dispose of the needle, and apply dressing.

What should you do if the IV is running slowly or not running at all?

Check the obvious

What happened in IV therapy if there is infiltration (extravasation)?

Injection into tissues surrounding vein

What happened in IV therapy if there is hematoma?

bruising, bleeding into the tissues

What happened in IV therapy if there is phlebitis?

Inflammation of the vein

What happened in IV therapy if there is infection?

It is not immediately evident

What should you do in IV therapy if there is catheter embolism?

Check catheters at the end of procedure, if broken place tourniquet above site, call doctor

What should you do in IV therapy if there are allergic reactions?

Monitor patient for signs of itching, dyspnea, color changes, sweating