BLOCK 5: MED ADMINISTRATION Flashcards
what is the insertion of a catheter in to a body cavity, duct, or vessel to allow for blood flow
cannulation
what is a bolus
single dose administered by IV
what are HRO’s and how are they relevant in medical field
high-reliability organization
focuses on double-checks like cross-checking a medication before administration, etc to ensure a single failure does not lead to patient harm
what is medical asepsis
preventing contamination from pathogens by using aseptic technique to prevent contamination of a site when performing invasive procedure
what are antiseptics and examples
used to cleanse an area before performing invasive procedure like IVs
examples: rubbing alcohol, iodine, chloraprep
difference between antiseptics and disinfectants
antiseptics are not toxic to living tissues, disinfectants are
leading cause of disease transmission in healthcare setting
needlesticks
how many liters of fluid does a healthy person lose a day
2-2.5L
definition of dehydration
inadequate total systemic fluid volume
what is the cardinal sign of overhydration
edema
what is the benchmark to calculate a solution’s tonicity
sodium
what is the concentration of sodium in the cells of the body
0.9%
IV solutions are categorized as either ___ or ____ based on their dissolved components
crystalloid or colloid
IV solutions are categorized as ___, ___, or ___ based on their tonicity
isotonic, hypotonic, hypertonic
what are crystalloid solutions
dissolved crystals in water with ability to cross membranes
fluid should be administered to restore ___ not ___
perfusion, normal BP level
BP during fluid bolus should be titrated to what
90mm Hg systolic
what are colloid solutions
contain molecules too large to pass through membranes, draw fluid from cellular compartments to reduce edema
isotonic solutions and their effect on the cell
have same sodium concentration of cell
water does not shift - no cell shape change
hypertonic solutions and their effect on the cell
greater sodium concentration than cell
water is drawn out of cell - cell may collapse
hypotonic solutions and their effect on the cell
lower sodium concentration than the cell
water flows into the cell - causes cell to swell or burst
what is osmolarity
concentration of sodium
what common solutions are isotonic
normal saline, lactated ringer, D5W
what is third spacing and who is at risk of it
abnormal fluid shift into body’s serous linings
patients with burns, trauma, malnutrition, or liver disease that receive a hypotonic solution
what is the best fluid to replace blood loss and why
whole blood because it contains hemoglobin to carry oxygen to cells
what is the cannulation of a vein with a catheter to access patient’s vascular system called
intravenous therapy
once the protective wrap around IV solutions is removed, it must be used ____
once the pigtail is removed from the port, the IV solution, it must be used ____
within 24hrs
immediately or discarded
two ports of an IV bag
injection port for meds and access port for connecting administration set
most common prehospital IV volumes
1,000 and 500mL
what is the drip size
how many drops it takes for 1mL to pass into the drip chamber
microdrop sets
60drops per mL
macrodrip sets
10-15 drops per mL
what is a volutrol
microdrip set that allows you to calibrate the drip chamber with a specific amount of fluid to avoid fluid overload
what is blood tubing
macrodrip set for rapid fluid replacement with dual piercing spikes
how to identify valves and bifurcations in veins
valves: bumps in vein
bifurcations: where one vein splits into two
why use caution if using IV in leg
can put patient at higher risk of venous thrombosis and pulmonary embolism
3 factor’s of catheter size selection
purpose of IV, patient’s age, location
what is an over-the-needle catheter
teflon catheter inserted over the hollow needle and uses automatic needle retraction after insertion
what is a butterfly catheter
hollow stainless steel needle with two plastic wings for handling
how far up from intended puncture site to place tourniquet
4-8 inches
what angle to establish and IV at and what angle to advance the catheter at
35-45 degrees
15 degrees
change the IV bag when there is approximately __mL of fluid left
25
cannulating the EJ vein comes with what high risks
puncture of carotid artery with rapidly expanding hematoma and air embolism
what is infiltration vs. extravasation
infiltration: escape of fluid into surrounding tissues
extravasation: escape of irritating agent from vessel which causes blistering
what is catheter occlusion
physical blockage of a vein or catheter
what are venous spasms caused by
severe reaction to administration of irritating meds or fluids
what is phlebitis
vein inflammation
what is thrombophlebitis
inflammation of a vein related to a blood clot
what is a hematoma
accumulation of blood in the tissues surrounding an IV site from advancement of needle entirely through vein
what increases risk for injury to nerves, tendons, and ligaments during IVs
IV site located near joints
how to minimize risk of inadvertent arterial puncture
check for a pulse in a vessel before you cannulate
what are pyrogenic reactions
foreign proteins in infusion solution or administration set that have abrupt temp elevation (as high as 106)
what is circulatory overload
occurs when excessive fluid volume is administered and can lead to pulmonary edema
what is speed shock
occurs when medication or solution is rapidly introduced to circulation
difference between circulatory overload and speed shock
circulatory overload is a volume problem
speed shock is a rate problem
air embolism
occurs when air enters the bloodstream
what is a vasovagal reaction
syncope due to sight of blood or needles
drop in BP, decreased blood flow to brain, and brief LOC
what is a catheter shear
needle slices through the catheter creating a free-floating fragment
blood-tube top colors
red
blue
green
lavender
red: clot activator in PLASTIC tube
blue: citrate (reversible anticoagulant)
green: heparin
lavender: anticoagulant for blood counts
which blood tube do you not shake
red topped
how many pounds of pressure is required for FAST IO insertion
32lbs
what is osteomyelitis
inflammation of the bone and muscle caused by an infection
three primary areas for IO needle insertion
proximal tibia, distal tibia, humeral head
what is osteogenesis imperfecta
congenital disease resulting in fragile bones
meter
basic unit of length in metric system
liter
basic unit of volume in metric system
gram
basic unit of mass in metric system
micro number placement
5 zeros before number 0.000001
milli number placement
2 zeros before number 0.001
centi number placement
1 zero before number 0.01
a
a
1 mcg = ___ mg
0.001
1mg = __mcg
1,000
1g = __ mg
1,000
1kg = __ g
1,000
1mL = ___ ccs
1
100mL = __dL
1
1,000mL = __L
1
one teaspoon is approximately how many mL
5
one tablespoon is approximately how many mL
15
one cup is approximately how many mL
240
on the celsius scale, water freezes at __ and boils at __
0, 100
on the farenheight scale, water freezes at ___ and boils at ___
32, 212
normal body temp in F and C
F: 98.6 and C: 37
conversion for farenheit to celsius
subtract 32 then multiply by 0.555
conversion for celsius to farenheit
multiply by 1.8 then add 32
what does a percentage mean in terms of drug concentration
number of grams present in 100mL
how far to insert suppository into the rectum
1-1.5 inches
what is a parenteral route
any route other than the GI tract
what syringe size is most commonly used for injections
3mL
what is the hub of a hypodermic needle
plastic piece that houses the needle to fit on syringe
what is the shaft or cannula of the needle
length of the needle
what is the bevel of a needle
slanted tip at the end of needle
what is the opening within the bevel called
lumen
what are ampules
breakable sterile glass containers for single doses of meds
what are vials
glass or plastic bottles with rubber-stopper top (single or multiple med doses)
what is drug reconstitution
removing the sterile water or provided diluent from the vial and injecting it into vial that contains the powder to make a solution for injection
what is intradermal injection and how to do it
administering small amount of med (less than 1mL) into the dermal layer just below epidermis at a 10-15 degree angle with the bevel up
what is subcutaneous injections and how to do it
given between loose connective tissue between dermis and muscle layer at a 45 degree angle for adult, 90 degree angle for child (2mL or less for adult, 0.5-1mL for kids)
what are intramuscular injections and how to do it
insert needle through the dermis and subcutaneous tissue into the muscle layer at 90 degrees (up to 5mL in adult, up to 2mL in kids)
most common IM injection sites (4)
vastus lateralis muscle
rectus femoris muscle
gluteal area
deltoid muscle
what is the IV administration set that is connected directly to the hub of the IV catheter and what is generally flowed through it
primary line
isotonic solution like saline
what is the line that is connected to the continuous infusion
“piggyback” or secondary line
what is a mechanical device that infuses a precise volume programmed by a clinician called
infusion pump
IV infusion pumps deliver fluids or meds via ___
positive pressure
3 alarms equipped on infusion pumps
change in flow pressure, presence of occlusions, depletion of medication supply
what are percutaneous routes of administration
meds applied to and absorbed through skin and mucous membrains
how are transdermal medications applied
topically
where to administer ocular medication
on the conjunctival sac
what are aural medications
meds administered via mucous membranes of aural (ear) canal
intranasal meds require ____ times the dose of IV meds
2-2.5
most common inhaled medication
oxygen
metered-dose inhalers are also called ___ after the propellant ____
HFAs
hydrofluoroalkane
which medications can be administered via ET tube
LEAN
lidocaine
epinephrine
atropine
naloxone
what are nontunneling vascular access devices
inserted direct venipuncture through the skin directly into a selected vein
insertion and distal end of peripheral inserted central catheters
insertion: antecubital vein
distal: superior vena cava
insertion and distal end of midline catheters
insertion: antecubital
distal: proximal end of extremity
insertion and distal end of central venous catheters
insertion: subclavian, femoral, or internal jugular vein
distal: vena cava
what are implanted vacsular access devices
implanted surgically and sutured under the skin
what is an arteriovenous fistula
connects a vein to an artery
when accessing multiple-lumen devices, which ones should be attempted to access first
largest in diameter, if same diameter then the most distal lumen
lumen that should be used is usually marked with a #1
