Shared Flashcard Set

Details

Pharm II unit 1
all of chapter 10
263
Nursing
Undergraduate 1
09/05/2011

Additional Nursing Flashcards

 


 

Cards

Term

To avoid medication errors, nurses should always follow which concept?



Definition
Six rights of medication administration.
Term
Name the six rights of medication administration?
Definition

 

Drug

 Dose

 Route

 Time

 Patient

 Documentation

 

Term
True or False. Computerized medication ordering and administration is safer than manual ordering.
Definition
True
Term
What is a volume control chamber?
Definition
A Delivery method used to administer meds and iv solution s for ped patients and/or small well controlled drugs.
Term
Generally, how long should it take to infuse a med via a volume control chamber?
Definition
15 mins to 1 hr
Term
To successfully use the vol controlled delivery system, the nurse should follow what four steps? 
Definition

Calculate the amount of med to be delivered

 

Use the correct type of diluent soln.

 

Use the correct rate.

 

With ped patients, always double check the drug and dosage with another RN.

 
Term
What are 4 advantages of IV med administration 
Definition

1-direct access 

2-instant drug action/termination

3-controlled rate

4-for delivering high drug concentrations

 

Term
Why would a pt. need IV Administration vs. oral? 
Definition

It would be for a pt. who cannot tolerate oral medication due to:

GI irritation

better control of rate of drug admin

use if the GI is limited

Term
Drugs can be give intravenously when these other 2 routes cause irritating properties that cause pain and trauma: 
Definition

intramuscular or subcutanious

 
Term
What are disadvantages of IV infusion?
Definition

Drug interaction/incompatibilities

Errors in mixing meds

Speed shock

Extravasation of a vesicant drug

Chemical phlebitis

Term
What is the standard for Nurses to be responsible for when giving an IV?
Definition

knowing the med use, dose, side effects, adverse reactions

assessing the apropriate reason for prescribed therapy, pt age, condition

 
Term
many factors affect drug interactions including : 
Definition

drug solubility

drug compatibility

 
Term
mixing of two drugs in a solution can cause an adverse interaction called? 
Definition
mixing of two drugs in a solution can cause an adverse interaction called? 
Term
factors affecting drug solubility and compatability include: 
Definition

- drug concentration

-I.V. fluid or drug

- type of administration set

- preparation technique, duration of drug-drug or drug-solution contact

- PH value

-Temperature of the room and light

Term
drugs can be ____________ when mixed in certain solutions but ___________ when mixed with others. 
Definition

compatible

incompatible

 
Term
What can mixing two incompatible drugs in solution in a particular order do?
Definition
It may be enough to avoid potentially adverse interaction 
Term
what must be considered when compounding medications? 
Definition
the PH of BOTH the solution and the drug 
Term
drugs that are widely dissimilar in PH values are:  
Definition
unlikely to be compatible in solution 
Term
dextrose solutions are slightly? 
Definition

acidic

with a PH of 4.5-5.5

 
Term
several antiboitics on the market have an ________ PH 
Definition

acidic

- which is stable in dextrose-

Term
Alkaline antiboitics are ___________ when mixed with dextrose: 
Definition

unstable.

 

ex. carbenicillin

 
Term
PH of dextrose: 
Definition
4.5-5.5 
Term
dextrose ( PH 4.5-5.5) should be used as a base for: 
Definition
acidic drugs 
Term
alkaline medication dilution should be used with: 
Definition
soduim chloride solution 
Term
to prevent I.V drug incompatibilities, the best practice is to flush the infusion device with ___________ _________ before and after medications are infused 
Definition
soduim chloride 
Term
the attachment of one substance to the surface of another:
Definition
Adsorption 
Term
many drugs adsorb to: 
Definition
glass or plastic 
Term
disadvantages associated with adsorption: 
Definition

pt recieves smaller amount of the drug than was intended

- amount of absorption is difficult to predict

Term
the amount of adsorption is difficult to predict and is affect by: 
Definition

- the drug concentration

-solution of the drug

-amount of surface contacted by the drug

- temperature changes

Term
an example of adsorption is the binding of insulin to : 
Definition
plastic and glass containers 
Term
during the initial part of the infusion how much of a druge is a patient getting and why? 
Definition

very little of the drug will reaches the patient

 

 

until it saturates all potential adsorption sites (IV containers and tubing)

 

then more of the drug is delivered to the patient

 
Term
What should a nurse doto prevent drug adsorption losses? 
Definition

inject the drug as close to the IV insertion site as possible

 

* will promote better theraputic drug effects*

 
Term
polyvinyl chloride (PVC) in plastic flexible IV bags that promotes: 
Definition
drug adsorption 
Term

what is Di(2- ethylhexyl) phthalate

[DEHP]:

Definition
is a plasticizer that is added to PVC that allows PVC to be flexible 
Term
some drug formulations leach the plasticizer [DEHP} out of the plastic matrix and into: 
Definition
the solution
Term
what is the solubility of DEHP? 
Definition
fat soluable 
Term
what products can extract the plasticizer from the pvc bags and tubing? 
Definition
IV fat emulsion products 
Term
DEHP is also leached from pvc bags by: 
Definition
organic solvents and 
surfactants contained in some drugs

> which may result in DEHP induced toxicity 
Term
when mixing medications into glass or plastic systems< refer to? 
Definition
the maufacturer"s guidelines to prevent adsorption
Term
If a patient complains of burning at the IV site from a presumably dilute drug is a warning that: 
Definition
the concentration of the drug is too high and needs to be diluted further 
Term
many hospitals allow only registered ___________ to prepare admixtures 
Definition
pharmacists 
Term
what can result from inadequate mixing of a drug into the infusion container? 
Definition

drug toxicity

subtheraputic infusion

erratic theraputic effects 

Term
inadequate mixing can contribute to a :
Definition

BOLUS of medication being delivered to the patient

 

(which may cause adverse effects)

Term

factors that contribute to inadequate mixing include:

(5)

Definition

- Length of time required to adequately mix drugs in flexible bags

- Addition of a drug to a hanging flexible bag

- Addititives injected at a slow rate into the primary bag  (the turbulence of fast flow promotes mixing, esp. in glass containers)

- Inadqeuate movement of the additive from the injection port (e.g., the long, narrow sleeve-type additive ports on some flexible bags, as opposed to the button type, hinder effective mixing)

- Tendency of very dense drugs to settle at the bottom of the infusion container

Term
to adequately mix the medication with the solution, taking care to avoid foaming the solution, you do what? 
Definition
gently invert the IV container 
Term

mixing:

 when inversion is impossible, what do you do to prevent the drug from settling to the bottom of the container?

 
Definition
gently swirl or rotate the container 
Term
when agitating an intermittent infusion set, clamp off the air vent; if the vent become wet: 
Definition
the solution will not infuse properly after mixing 
Term
vacuum devices can facilitate mixing in plastic flexible bags by creating a vacuum and drawing any drug left in the port into: 
Definition
the body of the bag 
Term
add ____ drug(s) at a time to the primary IV solution 
Definition
one 
Term
add which types of drugs to the solutions first because of incompatibilities, such as precipitiates, require a certain concentration or amount of time to develop: 
Definition

the most concentrated &

the most soluable drugs

 

*mix well and then add the diluted bags*

 
Term
add which additives last to avoid masking possible precipitate cloudiness? 
Definition
colored additives 
Term
always visually inspect containers after adding and mixing drugs; hold the container against a light of white surface and check for: 
Definition

particulate matter

obvious layering

foaming

Term
if you do not have a clear understanding of the compatibility or stability of the admixtures you are using, check : 
Definition
the manufacturer's recommendation or consult a pharmacist

Term

when mixing:

what are the signs of incompatibility?

Definition

cloudiness

foam

layering

precipitate

Term
What are the 3 types of drug incompatibility? 
Definition
Chemical, physical and  therapeutic compatibility 
Term
How menny types of compatibility must you check before administering an IV? 
Definition
you must check all 3 
Term
An incompatibility results when:
Definition
two or more substences react,  interact or change the normal activity of the substence. 
Term
When are incompatibilitys most likly to occur? 
Definition

when seveal drugs are added to make a mixture

 

if soultions are given one after another using qme IV tubing

 

a drug is mixed in wrong substence

 

reacts withanother drugs preservatives

Term
A physical incompatibility is also called- 
Definition
a pharmaceutical incompatibility 
Term
What are the two types of physical incompatibility? 
Definition
Insolubility and Absorption 
Term
When does insolubility occur? 
Definition
When a drug is added to an inappropriate fluid solution. 
Term
What are the signs of insolubility? 
Definition
Visible precipitation, haze, gas bubbles, and cloudiness.
Term
What prevents microscopic precipitates from entering the blood stream? 
Definition
The use of micropore filters.
Term
What electrolite increases the risk of forming a precipitate when mixed with other drugs? 
Definition
Calcium 
Term

True or False

 

If you see precipitates in an IV it is ok to administer it if you have a micropore filter.


Definition

False

 

If you see the precipitates, it is no longer microscopic.

 
Term
Do not mix drugs prepared in special ___________ with other drugs. 
Definition
Diluents 
Term
When administering a series of medications you must prepare each drug in __________? 
Definition

A Separate syringe

 

this will lessen the possibility of precipitation

Term
What does insolubility result from? 
Definition

They use incorrect solution to reconstitute a drug.

 

Follow all manufacturers instructions.

Term
What is therapeutic incompatibility? 
Definition
An undesirable effect occurring as a result from two or more drugs being given concurrently. 
Term
As a result of therapeutic incompatibility is a drugs therapeutic response increased or decreased? 
Definition
Either can occur. 
Term
What is a chemical incompatibility? 
Definition
A reaction between drugs with other drugs or solutions which result in alterations of the integrity and potency of the drug.

Term
What is the most common cause of chemical incompatibility? 
Definition
A reaction between acid and alkaline drugs or solutions resulting in a pH level that is unstable for one of the drugs.

Term
What methods are used to administer I.V medications?

Definition

-continous

 

-intermittent

 

-I.V push

Term
If a route has not been prescribed, what administration route should you use? 
Definition

None!!

 

Call the physican!!

Term

Using _________ technique and standard ___________

when preparing a admixture?

Definition
Aspetic, precaution 
Term
Is it necessary to identify the expiration date on solutions and medications T/F? 
Definition
True
Term
Who's guidlines should you follow for preparation and storage of the medications? 
Definition
Manufacture's
Term
Monitor the patient for _____ response to the medication? 
Definition
Therapeutic
Term
What three things di you need to check the label for to confurm appropriateness for I.V use? 
Definition
Drugs, Diluents, Solutions
Term
Why do you need to use a filtered needle when drawing I.V medications from ampoules? 
Definition

To eliminate possible pieces of glass

 
Term
 you need to adequatley mix all drugs added to a solution T/F? 
Definition
True
Term
Verify that all soultions containers are free from what three things? 
Definition
Cracks, leaks, punctures
Term
When monitoring temperature. Most medications tolerate variation in temperature from ____ to _____? 
Definition

15 to 30 C

Or

59 to 86 F

( room temp)
Term
you  shoulduse a single dose vial for parenteral additives or medications T/F? 
Definition
True
Term
After a soultion is mixed it needs to be clear or cloudy? 
Definition
Clear
Term
What are the 3 types of infusions? 
Definition

1. Continuous

2. Intermittent

3. Secondary

Term
What is continuous infusion? 
Definition
Used for large-volumes of parenteral solutions of 250-1000 mL of infusate to be administered over 2-24 hrs. 
Term
How are medications infused when added to a continuous infusion? 
Definition
When medications are added to large volume infusates, they are also administered at a coninuous rate. 
Term
When would you used continuous infusion for a medication? 
Definition

1. When a medication should be highly diluted.

2. When constant plasma concentrations of the drug needs to be maintained.

3. Or when large volumes of fluids and electrolytes are administered.


Term
How would a nurse ensure an accurate flow rate for continuous infusion? 
Definition
Electronic infusion device. 
Term
What are the 2 advantages of continuous infusion? 
Definition

1. Admixture and bag changes can be performed every 8-24 hrs.

 

2. Constant serum levels of the drug are maintained.


Term
What are 3 disadvantages to continuous infusions? 
Definition

1. Monitoring the drug rate can be erratic if not electronically controlled.

 

2. There is a higher risk of drug incompatibility problems.

 

3. Accidental bolus infusion can occur if the medication is not adequately mixed with the solution.


Term

Nursing Fast Fact

 

Safety in adding medications to an infusion container?

Definition
When adding medications to an infusion container, use single-dose vials instead of multiple-dose vials to decrease the potential for infections, complications and medication errors. 
Term

What is the INS standard for parenteral medications and solutions?

 

(life)

Definition
After being added to an administration set, the medication or solution should be infused or discarded within 24 hours. 
Term
What is intermittent infusion? 
Definition
Any administration of a medication or an infusion that is not continuous. 
Term
How is medication administer via intermittent infusion? 
Definition
A medication is added to a small volume of fluid and infused over 15-90 minutes. 
Term
What are types of intermittent infusions? 
Definition

1. Piggybacked through an established pathway of a primary solution.

2. Simultaneous infusion.

3. Use of volume controll set.

4. Intermittent infusion through a locking device.

Term
What is a piggyback? 
Definition
A secondary IV line, through a primary pathway, used intermittently to deliver medications. 
Term
Most common intermittent technique? 
Definition

Piggyback.

 

Secondary infusion through an established pathway of the primary solution is the most common method for drug delivery by the intermittent route.

 
Term
Equipment needed for a secondary infusion through a primary pathway (piggyback)? 
Definition

1. Small IV containter

2. Short administration set without ports.

3. A macrodrip system.

Term
What type of tubing is with the piggy back method of infusion? 
Definition
Y port tubing with the backcheck valve on the primary line. 
Term
Why is drug compatibility important with primary and secondary infusates? 
Definition
Although the primary infusion is interrupted during secondary infusion, the drug from the intermittent infusion container comes in contact with the primary solution below the injection port. 
Term
What are the 4 advantages of intermittent infusions? 
Definition

1. The risk of incompatibility is reduced.


2. A larger drug dose can be administered at a lower concentration per mL that with the IV push method.


3. Peak flow concentrations occur at periodic intervals.

 

4. The risk of fluid overload is decreased.

Term
What are the 5 disadvantages of intermittent infusions? 
Definition

1. Administration rate may not be accurate unless electronically monitored.

2. High concentrations of drugs in intermittent solution may cause venous irritation.

3. IV set changes can result in wasting a portion of the drug.

4. If the pt is not properly monitored, fluid overload or speed shock may result.

5. Drug incompatibility can occur if the administration set is not adequately flushed between medication administration.


Term
How can a seconday infusate be infused concurrently with the primary infusate? 
Definition
Instead of connecting the secondary infusion at the piggyback port, attach it at the lower Y site. 
Term
What is the 2 disadvantages of concurrently infusing a primary and secondary infusate? 
Definition

1. Tendancies for blood to back up into the tubing after the secondary infusion has been completed, causing occlusion of the venous access device.

2. Increased risk for incompatibility.

Term

Nursing Fast Fact!

 

Infusions in relationship to I/O's?

Definition
Fluid volume delivered via infusion should be added into the pt's intake. 
Term

Nursing Points of Care for intermittent drug delivery.

 

7 Points of care.

Definition

1. Drug compatibility: IV solutions and medications, both the primary system solution and diluent in the secondary system.

2. Assess IV site and patency of catheter.

3. Medication calculations to be added to solutions.

4. Correct amount and type of diluent.

5. Correct administration rate.

6. Correct primary line port for infusion.

7. Correct label on the secondary bag with: start date and hour, discard date and hour, and your initials.

Term
What is the method of administering high concentrations/ small volume of medication through an IV?
Definition

Intravenous push (IV Push)

 
Term
Direct injection or IV push requires that the drug to be drawn how? 
Definition
into a syringe before injection or available in a prefilled syringe 
Term
What are the advantages of an IV Push?
Definition

Barriers of drug absorption are bypassed

 

Drug response is rapid and usually predictable

 

the patient is closely monitored during the full admin of the med

Term
After verifying the order,  right pt/teaching, and washing hands for an IV push what would be the next 2 steps for IV Push? 
Definition

check compatability of drug with primary solution (if in continuous infusion)

 

Dilute if an opiod analgesic

Term
You must always do what to the port before administering an IV Push? 
Definition
cleanse with antiseptic solution 
Term
If the drug is incompatible with the primary solution what can you do to administer the medication? 
Definition
Flush the catheter with 0.9% sodium chloride before and after adminstration of the med and pinch tubing to primary line
Term
How much of the medication do you give the pt over a 15-20 second period for IV push if concerned with adverse effects? 
Definition
1/4 of the medication,  then deliver 1/4 of  it again  3 more times. 
Term
How long should an IV push take to give the full amount of medication? 
Definition

At least a Minute

 

But always follow manufactuer delivery

(ex phentoyin and diazepam more time)

 
Term

What are the disadvantages of an IV push?

 
Definition

Adverse effects occur at same time/rate as therapeutic effects

 

greatest risk of adverse effects/toxicity due to drug concentrations sharply elevated

 

Speed shock from too-rapid admin of med

Term
Signs and Symptoms of Speed Shock are: 
Definition
Some signs of speed shock are a flushed face, headache, a tight feeling in the chest, irregular pulse, loss of consciousness, and cardiac arrest.
Term
the concept of patient controlled analgesia (PCA) began in what year? 
Definition
1970 
Term
PCA is a pain management strategy that allows a patient to: 
Definition
self administer I.V. narcotic pain medication 
Term
how does the PCA medications get administered? 
Definition
by pressing a button that is attached to a computerized pump which delivers the dose 
Term
patients may receive intermittent doses of PCA narcotics when they state that their pain is: 
Definition
episodic 
Term
it is desireable to treat pain only: 
Definition
when experienced 
Term
we treat episodic pain with: 
Definition
fast acting narcotics that are effective for only short periods 
Term
the goal of PCA is to provide the patient with: 
Definition
serum analgesia level for comfort with minimal sedation
Term

TRUE OR FALSE:

 

it is more desireable to use small doses of narcotics freequently than large doses of narcotics infrequently

Definition
TRUE 
Term
PCA can be used for a ______ range of patients 
Definition
wide 
Term
Candidates for whom PCA should be considered include: 
Definition

1. patients who are anticipating pain that is very severe yet intermittent. (e.g. pt suffering from kidney stones)

2. patients who have constant pain that worsens with activity

3. pediatric patients who are older than age 7 years who are capable of being taught to manage the PCA machine

4. patients who are capable of pushing a button

5. patients who are motivated to use PCA

6. home care pt's with long-term pain control needs. portable PCA pumps are available

Term
a pump infuser can be used to administer I.V. bolus doses of analgesics for the relief of: 
Definition
Acute pain 
Term
when patient controlled analgesia is used, the nurse retains responsibility for assessing the patient's:
Definition
 level of comfort and for addressing the deficient knowledge related to this method of pain relief 
Term
after surgery when does the patient have the greatest need for pain control? 
Definition
the first 24 hours after surgery
Term
PCA has been shown to be both: 
Definition
safe and effective in relieving pain
Term
when patients are in control and know they can get more immediate pain relief by pushing a button : 
Definition
they are more relaxed 
Term
analgesia is most effective when:
Definition
a theraputic serum level is consistently maintained 
Term

true or false:

 

post operative patients can easily titrate doses according to the need and avoid peaks and troughs associated with conventional I.V. and intramuscular administration of an opioid

Definition
true 
Term

true or false:

 

without a PCA- after abdominal surgery, patients ambulate sooner after surgery

 
Definition
FALSE 
Term
patients are better able to cough and deep breathe if: 
Definition
their pain is controlled 
Term
monitor PCA patients carefully for the first 24 hours because: 
Definition
opiates, even at theraputic doses, can suppress respiration, heart rate, and blood pressure 
Term
what are three unsuitable candidates that cannot safely manage PCA: 
Definition
those whith ↓ level of consciousness, psychosocial reasons, or limited intellectual capacity 
Term
what are four main side effects of PCA: 
Definition
constipation, nausea, vomiting, and pruritus 
Term
risk factors for respiratory depression with IV PCA:
Definition

atient older than 70 years of age

- basal infusion with IV PCA

- Renal, hepatic, pulmonary, or cardiac impairment

- sleep apnea

- concurrent central nervous system depressants

- obesity

- upper abdominal or thoracic surgery

- IV PCA bolus greater than 1 mg morphine without basal (continuous) infusion

Term

true or false:

 

at no time should anyone but tha patient push the PCA button?

 
Definition
True
Term
intermittent infusion: 
Definition
a small amount of fluid infused over 15- 90 mins 
Term
intermittent infusions are able to run: 
Definition
alone, piggybacked or simultaneously
Term

intermittent infusion:

 if piggybacked, attached at:

Definition
Y port- stops primary line while a medication is administered 
Term
electronic infusion devices help: 
Definition
accuracy of fluid delivery
Term

intermittent infusion:

be careful of?

Definition
simultaneous infusion 
Term
if you are using and infusion pump to administer the piggyback you will need to calculate the rate based on:
Definition

ml/hour

NOT- gtts/min

Term
if you are not using and infusion pump you willl need what in order to infuse the solution at the proper rate? 
Definition
the drip factor for the tubing you are using 
Term
A patient older that _______ years is at a higher risk for respiratory depression with IV PCA. 
Definition
70 years old 
Term
The _______ infusion with IV PCA is a risk factor for respiratory  depression. 
Definition
Basal Infusion 
Term
What physical conditions put one at a higher risk for respiratory depression with IV PCA? 
Definition
Renal, Hepatic, Pulmonary, Cardiac, Impairments, Sleep Apnea, Obesity, Abdominal or Thoracic Surgeries 
Term
What medication complications put one at a higher risk for respiratory depression with IV PCA? 
Definition

CNS Depressants

IV PCA Bolus > 1 mg without basal (continuous) infusion

Term
Before placing a patient on a PCA what does the nurse assess? 
Definition

Vital Signs

Cognitive Status

Pain Level

 
Term
When setting up a PCA what three things must a nurse remember to do? 
Definition

Give initial loading dose

Lock out interval between each dose

Lockout the one hour or four hour lockout dose limit.

Term
Before administering initial dose, or when changing the rate, what must a nurse first do? 
Definition
Get varification from a second nurse  that the pump is set correctly.
Term
What is the recommended dose interval for a PCA? 
Definition
6 to 8 minutes and a 1 hour lockout 
Term
Where should the patient dosing control button be placed?
Definition
Within reach of the patient 
Term
What monitoring should a nurse do while a patient is on a PCA? 
Definition

Pulse Oximetry

Sedation Scale

Pain

Term
What is a continuous SQ infution typicly used for?
Definition
Pain controll for Pts that csn not sallow.
Term
What is the typical does with SQ infutions
Definition
< 1 ml / hr
Term
How offten should a nurse change the sight of a continuous SQ infution?
Definition
Every three days
Term
What is an intraperitoneal infusion? What is the main purpose of this administration. 
Definition

Administration of a drug directly into the peritoneal cavity.

The purpose is to administer chemo agents. And peritoneal dialysis

 
Term
What are the advantages of using IP infustion? 
Definition

a. Hidden microscopic cancer cells are exposed.

b. Dose intesification is reached at IP  sites.

c. IP chemo is diffused directly into the a cavity for prolonged exposure to the tumor.

d. Lower systemic chemo agents levels can be used for treatment. .

Term
Whats the appropriate site for IP Sites? 
Definition

Below the bra line.


lowwest intercostel space  

Term

 T/F Nurse should  only follow state guidelines

 

Definition

False

A nurse also needs to  follow facility policies

 
Term
How many pt adentifiers did you need? 
Definition
At least 2 
Term
To avoid accidental dosing? the nurse should always make sure that; name two thing 
Definition

Label contents

verify contents

 
Term
What two measures should the nurse take to avoid med errors? 
Definition

Check Expiration dates

Label containers

 
Term
What does the nurse need to document
Definition

Volume

Site

Dressing

infusate, dose and concentration

Rate

Assessment and response to therapy.

Term
T/F When dealing with IV repalacment bags sterile procedures need to be observed. 
Definition

False 


It is an aseptic technique

Term

T/F

before a IP infution the nurse doesn't need to premedicate for nausea. 

Definition
Term
How many liters of fluid of NS is given with IP chemo. 
Definition
2 liters at 37o
Term
What rate should be used when administering IP chemo? 
Definition
2 liters within 30 - 180 mins 
Term

T/F

You do not use an infusion pump for IP infusion 

Definition
True. 
Term
What extra supplies does the nurse need for IP infusion
Definition

20 gauge right angle Huber needle

Occlusive dressing

10 ml NS

Term
The nurse should use ...............mls of NS to flush the IP  tubing 
Definition
10 ml 
Term
T/F Can the nurse turns the patient during IP infusion? 
Definition
False 
Term
How often should the nurse turn the pt after infusion?
Definition
Every 15 mins per position 
Term
In what order should a pt be turned after IP? 
Definition

Every 15 mins per position

Left, right, supine and prone - 2 hours to distribute the solns evenly.

Term
What should the nurse monitor  during IP infusion? 
Definition
Leakage, Breathing difficulties and vital signs. 
Term

What route is Intraosseous med admin?

 

why is it used?

Definition

Intraosseous is admin of drugs or solutions through a needle inserted into the bone marrow

 

used when conventional routes cannot be used

Term
In what type conditions would a person need a intraosseous Infusion?
Definition

extensive burns or trauma in whom diffuse edemal causes difficult peripheral access

 

profound shock resulting in poor circulatory system

 

combative behavior

Term
What age group is intraosseuos infussion used most?
Definition
for children younger than age 6 years is common practice in ER settings
Term
the spinal anatomy consists of What two spaces: 
Definition

the epidural space and

the intrathecal space

Term
the term _______ is used to encompass both the epidural and intrathecal spaces surrounding the spinal cord 
Definition
intraspinal 
Term
the intrathecal space is surrounded by the epidural space and seperated from it by the_____ ____. 
Definition
dura mater 
Term
the intrathecal space contains ____ fluid that bathes the ________ cord.
Definition

cerebral spinal fluid (CSF),

which bathes the spinal cord

Term
this is a potential space because the ligamentum flavum and the dura mater are not seperated until? 
Definition
medication or air is injected between them 
Term
 
Definition
Term
this potential space contains a network of veins that are
Definition
large and thin walled 
Term
At the epidural site it has high activity of what blood cell to reduce the risk of infection? 
Definition
leukocyte 
Term
dividing the epidural and intrathecal spaces is a tough, fatty membrane called: 
Definition
the dura 
Term
the permiability of the dura is important in determining: 
Definition

how fast the epidural drugs cross into the intrathecal space and

*how long they remain there to be active

Term
opiate receptor sites are cells contained in: 
Definition

the dorsal horn of the spinal cord

 

--> at which point opioids combine with their respective receptor site to generate analgesia

Term
epidural percutaneous catheters were used initially for : 
Definition
surgical and obstetric anesthesia 
Term
epidural- used later for: 
Definition

opioid postoperative analgesia


especially in orthopedics 

Term
to initiate epidural anesthesia, the anesthesia provider administers one or more of these drugs: 
Definition

- a local anesthetic

- an opioid

- a combination of both

- or a steroidal compound

Term
they deliver the drugs into the epidural space via: 
Definition
a special needle or a microbore catheter 
Term
In epidural infusion  the medication diffuses through the: 
Definition

- dura mater

- arachnoid mater

- and the pia mater

--> to the spine

Term
the spinal cord and nerve roots are bathed in the medication, which: 
Definition
blocks pain impulses before they reach the brain 
Term
What are steroid used for in epidurals?
Definition
it reduces inflammation 
Term
epidural pain control is applicable to what age groups?
Definition
patients of all ages 
Term
What are various approaches to the administration of narcotics and anesthetics via the epidural route: 
Definition

 a single-bolus injection of opioid

-local anesthetic

- a continuous infusion of opioid with or without local anesthetics

- a continuous infusion of opioid with a patient- activated bolus

Term
What are two types of epidural catheters: 
Definition
temporary and permanent 
Term
the temporary epidural catheter is used in: 
Definition
periobstetric and perioperative period 
Term
the Temporary epidural catheter is designed for: 
Definition
short term use with materials that easily pass into the epidural and intrathecal spaces 
Term
Teflon catheters allow visualization of: 
Definition
aspirated fluid 
Term
Teflon catheters can become stiff and: 
Definition
migrate out of their original placement 
Term
teflon catheters are what type of catheter? 
Definition
external catheters 
Term
temporary catheters are intended to be used for what time period?
Definition
days to weeks 
Term
use of the permanent catheters for _________ to _______ via the epidural route is supported by many pain specialists
Definition
weeks to months 
Term
what are two advantages of the permanent catheters?
Definition

a dacron cuff to aide in the stabilization of the catheter to the tissues,

 and many have a second vitacuff inpregnated with silver to reduce antimicrobial activity

Term
permanent catheters are generally what type of catheter:
Definition
internal catheters 
Term
a single injection of epidural opioid may be used for: 
Definition

procedures that produce a short course of postoperative pain

 

** this method may be appropriate for a pateint having a cesarean section or vaginal hysterectomy, or after same- day surgical procedures

 
Term
continuous epidural infusion is administered for what time frame?
Definition
short and long peroids of time 
Term
patients with pain from surgery, trauma, and acute medical disorders creating severe pain may benefit from: 
Definition
short-term continuous infusions 
Term
epidural and intrathecal medications: 
Definition

baclofen

bupivacaine hydrochloride

clonidine

DepoDur

Fentanyl

hydromorphone hydrochloride

morphine sulfate

sufentanil

ziconotide

Term
what method of delivery can also be employed for the cancer patient with acute exacerbation of pain: 
Definition
short-term continuous infusions 
Term
the insertion of an epidural catheter is a ______________ procedure 
Definition
sterile 
Term
administration of medication by a nurse through and epidural catheter must be in accordance with: 
Definition
each state's nurse practice act 
Term
nursing responsibilities for med administration with epidural catheter include: 
Definition

1- patient and family education,

2- site and dressing management

3- medication administration(depending on state practice)

4- evaluation of pain relief

Term
the epidural medication catheter is managed by:
Definition
the staff nurse 
Term
epidural morphine as a single bolus dose has demonstrated analgesia that lasts up to ____________ with DepoDur. 
Definition
24-48 hours 
Term
Pt with epidurals in clinical trials, 90% of respiratory depression occured: 
Definition
within the first 24 hours after administration 
Term
patient monitoring requirments for epidural patients include: 
Definition

pain score

respiratory rate

sedation scale rate- every hour for 2 hours, then every two hours for the remainder of the 48 hours from the time of administration

 
Term
candidates for epidural anesthesia are patients with:
Definition

1- general surgeries of the thoracic or abdominal area

2- labor pains

3- acute and chronic pain (chronic lumbar pain)

4- cancer pain

5- phantom limb pain

6- pancreatic pain

7- incisional pain

Term
epidurals are contraindicated in the following situations: 
Definition

1- active infection near the epidural catheter insertion site

2- use of systemic anticoagulation and anti platelet therapy.

3- in patients on long term use of aspirin products or nonsteroidal anti-inflammatory drugs

4- hypovolemic shock

5- identified allergy to drugs being used for epidural or intrathecal anesthesia

6- heart failure or aortic stenosis

7- patients who cannot understand the procedure well enough to give informed consent

8- a scarred, distorted, or obliterated epidural space from previous thoracic or lumbar spinal surgery

9- a severe spinal curvature such as scoliosis

Term
epidural medication administration permits delivery of __________ doses of a narcotic to achieve the desired level of analgesia 
Definition
smaller 
Term

epidural medication administration prolongs the analgesia:

 

average ?

extended release epidural morphine

Definition

average- about 14 hours

extended release morphine- 24 to 48 hours

Term
epidural medication administration allows terminal cancer patients treated with epidural narcotics to be: 
Definition
more comfortable and more mobile 
Term
epidural medication administration does not produce: 
Definition
motor paralysis 
Term

epidural medication administration:

 

 

only ________________-______ opioids can be used

Definition
preservative-free 
Term
epidural medication administration complications may occur such as: 
Definition

paresthesia

urinary retention

respiratory depression ( greatest 6-10 hrs after injection)

Term
epidural medication administration catheter-related risks:
Definition
e.g. infection, dislodgement, and leaking 
Term

epidural medication administration

 

what can occur on the face, head, and neck or may be generalized?

 
Definition
pruritus 
Term
unless the epidural catheter and medication are clearly labeled, an accidental intravenous infusion could cause: 
Definition
serious complications or death 
Term

for intraspinal infusions,

 a 0.2 micron filter needle that is:

Definition
surfactant- free, particulate- retentive, and air- eliminating shall be used 
Term
sterile technique, including what equipment, should be used when accessing, caring for and maintaining and intraspinal access device? 
Definition

mask

sterile gloves

 
Term
in the hospital how long are external catheters are in place?
Definition
3 days - 1 week 
Term
external catheters are securred to: 
Definition
the patients back --> thenattached to an infusion into the patients epidural space 
Term
epidural access advantages: 
Definition

 

alleviates pain quickly

- prolongs analgesia

-does NOT produce moto paralysis or hypotension

 

 

Term
epidural access disadvantages: 
Definition

typically catheter related- usually accidental dislodgement and leaking

- catheter is placed in the OR

-medication is prepared by the pharmacy

Term
why does the pharmacy handle epidural medication preparation? 
Definition
so it is not confused with opioid preparations that are used with PCA's 
Term
every epidural patient should have which assessments per hospital policy, usu every 2 hours for status changes? 
Definition

neuro

pain

resp.

 
Term
Intrathecal medication may cause a spinal 
HA for up to___ days espically in young women
Definition
3 days
Term

When the opiod wears off an Interthecal infusion the patient will experience high levels of pain T/F?

Definition
TRUE
Term

Choose the correct side effects of intra spinal opiods?

-N/V -High BP -Increase urine output

-urinary retention -sommnolence -pruritus

-confusio

Definition

Right Answers

-N/V

-Sommnolence

-urinary retention

-confusion

-Pruritus

Term
What drug should be avaible to reverse the deppressants effects of a interthecal narcotic?
Definition

Naloxone

(narcan)

Term

Which conditions related to a epidural should you immediately notify your physician about choose all that apply?

 

-dizziness -drowsiness -infection -pain at insertion site -new onset of paresthesia -pt becomes thirsty and hungry -inadeqate pain relief

Definition

Right answers!!

 

-dizziness -drowsiness -infection -pain at insertion site -new onset of paresthesia -inadequate painrelief

Term

Different methods for delivery

parenterally at home include (3):

Definition

Gravity

 

IV Push

 

Ambulatory Pump

Term
Home drug therapy (Ex:Anti-infectives) will not be successful unless:
Definition
The Pt. understands the treatment, procedure,cost, and admin. regimen and accepts into lifestyle
Term
These IV routes for anti-infectives proved safe and effective in the home setting?
Definition
PICC, peripheral, or central
Term
3 routes parentally for pain managment at home include:
Definition
IV push as long as emergency drug is available for reactions
Term
When should a Pt call the Home care Nurse with IV Medication?
Definition

* Side effects from drug

* Particles in Meds or discolored

* Med bag is leaking

* Med schedule must be altered for any reason

* Pump malfunction

* Site pain, redness, swelling

*dressing loose

Term
What are the steps to educate Pt with a PCA?
Definition
How to use, when to push the bolus button, discussion of fears,  if pain is not controlled, and expected outcomes(pain 1-2 level)
Term
Pt education for admin of anti-infectives are important because?
Definition
pts need to take entire course and take on scheduled time
Term
Important factors as a nurse to educate to the Patient about IV at home:
Definition

instructions and outline of procedure done

Potential complications

Routine maintenance involved and how to do it

24-hour assistance phone #

Check list: to evaluate if steps were learned

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