Chapter 14: Medication Administration Flashcards
What does the tool Medication Administration Cross-Check (MACC) do?
To catch and reduce the number of errors
Check medications and doses with another provider
Define medical asepsis
The practice of preventing contamination by using aseptic technique
Define aseptic technique
Method of cleaning to prevent contamination of a site when performing an invasive procedure (IV line)
Define sterile
Destruction of all living things; achieved by using heat, gas, or chemicals
Define dehydration
Inadequate total systemic fluid volume
Signs and symptoms of dehydration
Decreased LOC Orthostatic hypotension Tachypnea Dry mucous membranes Decreased urine output Tachycardia Poor skin turgor Flushed, dry skin
Causes of dehydration
Diarrhea Vomiting GI drainage Infections DKA Hemorrhage Environmental emergencies High-caffine diet Insufficient fluid intake
Signs and symptoms of overhydration
Shortness of breath Puffy eyelids Edema Polyuria Moist crackles (rales) Acute weight gain
Causes of overhydration
Unmonitored IV lines (in pediatric patients)
Kidney failure
Water intoxication in endurance sports
Prolonged hypoventilation
What are crystalloid solutions?
Dissolved crystals (eg, salts or sugars) in water
When using an isotonic crystalloid solution to support BP after blood loss, what’s important to remember?
3-to-1 replacement rule (3 mL to replace 1 mL of blood)
What is imperative to remember about crystalloid solutions?
Cannot carry oxygen
Should be administered to maintain perfusion, not to restore BP
What can happen when you increase BP too much using IV solutions?
Dilutes remaining blood volume
May increase internal bleeding by interfering with hemostasis (body’s internal blood-clotting mechanism)
What are colloid solutions?
Molecules (usually protiens) that are too large to pass through the capillary membranes
Remains in the vascular system
What do colloid solutions do?
Reduce edema by drawing fluid into the vasculature (high osmolarity)
What is an isotonic solution
Same sodium concentration as the cell
Water does not shift and no change in cell shape
What is a hypertonic solution
Greater concentration of sodium than the cell
Water is drawn out of the cell
What is a hypotonic solution
Lower concentration of sodium than the cell
Water flows into the cell
What are Lactated Ringer (LR) solutions generally used for
Patients who have significant blood loss
What do Lactated Ringer (LR) solutions do
Combats intracellular acidosis associated with severe blood loss
When are Lactated Ringer (LR) solutions contraindicated
Patients with liver problems
How is D5W a unique type of isotonic solution
Once administered the dextrose is quickly metabolized and becomes hypotonic
What is the best fluid to replace blood loss
Whole blood
Once an IV solution wrap is torn and removed, it must be used within _____
24 hours
What are the most common prehospital IV fluid bag volumes
1,000 mL and 500 mL
What is the difference between microdrip and macrodrip sets
Microdrip - 60 gtts/mL
Macrodrip - 10 or 15 gtts/mL
When choosing an IV site what should you avoid
Areas that contain valves or bifurcations
Veins that cross over a joint
Why should you use caution then cannulating leg veins
Greater risk of venous thrombosis and pulmonary embolism
What is an over-the-needle catheter
Teflon catheter inserted over a hollow needle
What is a butterfly catheter
Hollow, stainless steel needle with two plastic wings
What are butterfly catheters most commonly used for
Phlebotomy
How are gauges sized for catheters
The smaller the gauge the larger the diameter
What gauge is usually a good size for adults
18 or 20 gauge
What are two considerations used when inserting an IV catheter
Keep the beveled side of the catheter up when inserting
Maintain adequate traction of the vein during cannulation
What are the insertion angles for a catheter
45 degrees until vein is pierced
Drop down to 15 degrees
What is a flash chamber
An area of an IV catheter that fills with blood to help indicate when a vein is cannulated
What does ultrasonography do
Allows providers to see deeper veins, often in the upper arm, that are not visible to the naked eye
Why should you double back the tubing to create a loop at the IV line
To act as a shock absorber
How should you secure the line if the patient is attempting to pull it
Consider wrapping the extremity and tubing with roller gauze
When should you change the IV bag
When about 25 mL of fluid is left
What are saline locks good for
Maintaining an active IV site
What are saline locks primarily used for
Patients who don’t need additional fluids but who may need rapid medication delivery
What catheter gauge is best used for pediatric patients
20, 22, 24, or 26 gauge
Butterfly catheters
What is a good technique for starting a pediatric line
Use a penlight to illuminate the veins on the back of the hand by shining the light through the palm
Once found slightly graze the surface with your fingernail
How do you secure a scalp vein line
Tape a paper cup over the site to avoid any direct pressure
What is important to remember when starting IV therapy in older patients
Often simply puncturing the vein will cause a massive hematoma
Tape can lead to skin damage
What vein locations should you avoid in older patients
Small spidery veins (rupture easy) Varicose veins (almost completely closed off)
What is an infiltration
The escape of fluid into the surrounding tissue causing a localized area of edema
Signs and symptoms of an infiltration
Edema at the site
Continued IV flow after occlusion of the vein above the site
Patient reporting tightness, burning, and pain around the site
What should you do if an infiltration occurs
Discontinue the line and reestablish it in the opposite extremity or proximally
Apply direct pressure over the swollen area to reduce further swelling
What is an occlusion
Physical blockage of a vein or catheter
What is the first sign of an occlusion
Decreasing drip rate or presence of blood in the tubing
How do you determine whether an IV line should be reestablished after an occlusion
Use saline to add pressure to the line to disrupt the occlusion
If it does not dislodge, discontinue administration and reestablish
How is vein irritation usually caused
By a too rapid infusion rate
What is thrombophlebitis
Inflammation of the vein
How does a hematoma often occur during IV administration
Vein perforation
Improper catheter removal
What should you do if a hematoma develops during IV therapy
If it forms during or after insertion, stop and apply direct pressure
If it forms after insertion, evaluate the flow and hematoma. if both are controlled leave the site in place
How will you know if you hit a nerve, tendon, or ligament
The patient will experience sudden and severe shooting pain
What should you do if you pierce an artery during cannulation
Stop and apply direct pressure for at least 5 minutes or until the bleeding stops
What is a pyrogen
Foreign proteins capable of producing a fever
How is a pyrogenic reaction characterized
Abrupt temperature elevation Severe chills Backache Headache Weakness Nausea / vomiting Signs and symptoms of shock
When will a pyrogenic reaction manifest
Usually within 30 minutes after IV infusion
How should you treat a pyrogenic reaction
Stop the infusion immediately
Start a new IV line with a new solution
When does circulatory overload become a problem
In patients with cardiac, pulmonary, or renal dysfunction
Signs and symptoms of circulatory overload
Dyspnea JVD Hypertension Crackles (rales) Acute peripheral edema
How should you treat a suspected air embolus occurs during IV infusion
Place the patient on their left side with the head down
- Traps any air inside the right atrium and ventricle
Administer 100% O2
Rapid transport
Prepare to assist ventilations
What is a vasovagal reaction
A drop in BP due to anxiety
What is a catheter shear
Part of the catheter is pinched against the needle
Creates a free-flowing segment
What medication is appropriate to administer rectally
Diazepam (Valium)
1 cc is equal to ____ mL
1
The IO space collectively comprises the ________ bone of the ________ and the medullary cavity of the ________.
cancellous, epiphysis, diaphysis
When changing an IV bad, it is important to:
Ensure that fluid remains in the drip chamber
To make push-dose epinephrine, you should:
Take a 10 mL normal saline flush and waste 1 mL
Draw out 1 mL of epinephrine (1:10,000) into the syringe
The most important point to remember about IV therapy is to:
Prepare all supplies ahead of time
After inserting the needle during an intramuscular injection, but before delivering the medication, you should:
Pull back on the plunger to aspirate for blood
Volumes of a drugs given subcutaneously are typically:
1 mL or less
The purpose of a Volutrol (Buretrol) administration set is to:
Avoid inadvertent fluid overload
Neither subcutaneous nor intramuscular injections should be given to patients:
With inadequate peripheral perfusion
