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

Drug

 Dose

 Route

 Time

 Patient

 Documentation

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.

1-direct access 

2-instant drug action/termination

3-controlled rate

4-for delivering high drug concentrations

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

intramuscular or subcutanious

Drug interaction/incompatibilities

Errors in mixing meds

Speed shock

Extravasation of a vesicant drug

Chemical phlebitis

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

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

drug solubility

drug compatibility

- 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

compatible

incompatible

acidic

with a PH of 4.5-5.5

acidic

- which is stable in dextrose-

unstable.

ex. carbenicillin

pt recieves smaller amount of the drug than was intended

- amount of absorption is difficult to predict

- the drug concentration

-solution of the drug

-amount of surface contacted by the drug

- temperature changes

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

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

* will promote better theraputic drug effects*

what is Di(2- ethylhexyl) phthalate

[DEHP]:

drug toxicity

subtheraputic infusion

erratic theraputic effects 

BOLUS of medication being delivered to the patient

(which may cause adverse effects)

factors that contribute to inadequate mixing include:

(5)

- 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

mixing:

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

the most concentrated &

the most soluable drugs

*mix well and then add the diluted bags*

particulate matter

obvious layering

foaming

when mixing:

what are the signs of incompatibility?

cloudiness

foam

layering

precipitate

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

True or False

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

False

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

A Separate syringe

this will lessen the possibility of precipitation

They use incorrect solution to reconstitute a drug.

Follow all manufacturers instructions.

-continous

-intermittent

-I.V push

None!!

Call the physican!!

Using _________ technique and standard ___________

when preparing a admixture?

To eliminate possible pieces of glass

15 to 30 C

Or

59 to 86 F

1. Continuous

2. Intermittent

3. Secondary

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.

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

2. Constant serum levels of the drug are maintained.

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.

Nursing Fast Fact

Safety in adding medications to an infusion container?

What is the INS standard for parenteral medications and solutions?

(life)

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.

Piggyback.

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

1. Small IV containter

2. Short administration set without ports.

3. A macrodrip system.

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.

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.

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.

Nursing Fast Fact!

Infusions in relationship to I/O's?

Nursing Points of Care for intermittent drug delivery.

7 Points of care.

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.

Intravenous push (IV Push)

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

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

Dilute if an opiod analgesic

At least a Minute

But always follow manufactuer delivery

(ex phentoyin and diazepam more time)

What are the disadvantages of an IV push?

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

TRUE OR FALSE:

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

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

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

true or false:

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

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

true or false:

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

intermittent infusion:

 if piggybacked, attached at:

intermittent infusion:

be careful of?

ml/hour

NOT- gtts/min

CNS Depressants

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

Vital Signs

Cognitive Status

Pain Level

Give initial loading dose

Lock out interval between each dose

Lockout the one hour or four hour lockout dose limit.

Pulse Oximetry

Sedation Scale

Pain

Administration of a drug directly into the peritoneal cavity.

The purpose is to administer chemo agents. And peritoneal dialysis

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. .

Below the bra line.

lowwest intercostel space  

 T/F Nurse should  only follow state guidelines

False

A nurse also needs to  follow facility policies

Label contents

verify contents

Check Expiration dates

Label containers

Volume

Site

Dressing

infusate, dose and concentration

Rate

Assessment and response to therapy.

False 

It is an aseptic technique

T/F

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

T/F

You do not use an infusion pump for IP infusion 

20 gauge right angle Huber needle

Occlusive dressing

10 ml NS

Every 15 mins per position

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

the epidural space and

the intrathecal space

cerebral spinal fluid (CSF),

which bathes the spinal cord

how fast the epidural drugs cross into the intrathecal space and

*how long they remain there to be active

the dorsal horn of the spinal cord

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

opioid postoperative analgesia

especially in orthopedics 

- a local anesthetic

- an opioid

- a combination of both

- or a steroidal compound

- dura mater

- arachnoid mater

- and the pia mater

--> to the spine

 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

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

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

baclofen

bupivacaine hydrochloride

clonidine

DepoDur

Fentanyl

hydromorphone hydrochloride

morphine sulfate

sufentanil

ziconotide

1- patient and family education,

2- site and dressing management

3- medication administration(depending on state practice)

4- evaluation of pain relief

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

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

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

epidural medication administration prolongs the analgesia:

average ?

extended release epidural morphine

average- about 14 hours

extended release morphine- 24 to 48 hours

epidural medication administration:

only ________________-______ opioids can be used

paresthesia

urinary retention

respiratory depression ( greatest 6-10 hrs after injection)

epidural medication administration

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

for intraspinal infusions,

 a 0.2 micron filter needle that is:

mask

sterile gloves

typically catheter related- usually accidental dislodgement and leaking

- catheter is placed in the OR

-medication is prepared by the pharmacy

neuro

pain

resp.

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

Choose the correct side effects of intra spinal opiods?

-N/V -High BP -Increase urine output

-urinary retention -sommnolence -pruritus

-confusio

Right Answers

-N/V

-Sommnolence

-urinary retention

-confusion

-Pruritus

Naloxone

(narcan)

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

Right answers!!

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

Different methods for delivery

parenterally at home include (3):

Gravity

IV Push

Ambulatory Pump

* 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

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