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Paramedicine > Chapter 14: Medication Administration > Flashcards

Chapter 14: Medication Administration Flashcards

1
Q

What does the tool Medication Administration Cross-Check (MACC) do?

A

To catch and reduce the number of errors

Check medications and doses with another provider

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2
Q

Define medical asepsis

A

The practice of preventing contamination by using aseptic technique

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3
Q

Define aseptic technique

A

Method of cleaning to prevent contamination of a site when performing an invasive procedure (IV line)

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4
Q

Define sterile

A

Destruction of all living things; achieved by using heat, gas, or chemicals

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5
Q

Define dehydration

A

Inadequate total systemic fluid volume

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6
Q

Signs and symptoms of dehydration

A 
Decreased LOC
Orthostatic hypotension
Tachypnea
Dry mucous membranes
Decreased urine output
Tachycardia
Poor skin turgor
Flushed, dry skin
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7
Q

Causes of dehydration

A 
Diarrhea
Vomiting
GI drainage
Infections
DKA
Hemorrhage
Environmental emergencies
High-caffine diet
Insufficient fluid intake
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8
Q

Signs and symptoms of overhydration

A 
Shortness of breath
Puffy eyelids
Edema
Polyuria
Moist crackles (rales)
Acute weight gain
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9
Q

Causes of overhydration

A

Unmonitored IV lines (in pediatric patients)
Kidney failure
Water intoxication in endurance sports
Prolonged hypoventilation

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10
Q

What are crystalloid solutions?

A

Dissolved crystals (eg, salts or sugars) in water

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11
Q

When using an isotonic crystalloid solution to support BP after blood loss, what’s important to remember?

A

3-to-1 replacement rule (3 mL to replace 1 mL of blood)

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12
Q

What is imperative to remember about crystalloid solutions?

A

Cannot carry oxygen

Should be administered to maintain perfusion, not to restore BP

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13
Q

What can happen when you increase BP too much using IV solutions?

A

Dilutes remaining blood volume

May increase internal bleeding by interfering with hemostasis (body’s internal blood-clotting mechanism)

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14
Q

What are colloid solutions?

A

Molecules (usually protiens) that are too large to pass through the capillary membranes
Remains in the vascular system

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15
Q

What do colloid solutions do?

A

Reduce edema by drawing fluid into the vasculature (high osmolarity)

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16
Q

What is an isotonic solution

A

Same sodium concentration as the cell

Water does not shift and no change in cell shape

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17
Q

What is a hypertonic solution

A

Greater concentration of sodium than the cell

Water is drawn out of the cell

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18
Q

What is a hypotonic solution

A

Lower concentration of sodium than the cell

Water flows into the cell

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19
Q

What are Lactated Ringer (LR) solutions generally used for

A

Patients who have significant blood loss

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20
Q

What do Lactated Ringer (LR) solutions do

A

Combats intracellular acidosis associated with severe blood loss

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21
Q

When are Lactated Ringer (LR) solutions contraindicated

A

Patients with liver problems

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22
Q

How is D5W a unique type of isotonic solution

A

Once administered the dextrose is quickly metabolized and becomes hypotonic

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23
Q

What is the best fluid to replace blood loss

A

Whole blood

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24
Q

Once an IV solution wrap is torn and removed, it must be used within _____

A

24 hours

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25
Q

What are the most common prehospital IV fluid bag volumes

A

1,000 mL and 500 mL

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26
Q

What is the difference between microdrip and macrodrip sets

A

Microdrip - 60 gtts/mL

Macrodrip - 10 or 15 gtts/mL

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27
Q

When choosing an IV site what should you avoid

A

Areas that contain valves or bifurcations

Veins that cross over a joint

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28
Q

Why should you use caution then cannulating leg veins

A

Greater risk of venous thrombosis and pulmonary embolism

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29
Q

What is an over-the-needle catheter

A

Teflon catheter inserted over a hollow needle

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30
Q

What is a butterfly catheter

A

Hollow, stainless steel needle with two plastic wings

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31
Q

What are butterfly catheters most commonly used for

A

Phlebotomy

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32
Q

How are gauges sized for catheters

A

The smaller the gauge the larger the diameter

33
Q

What gauge is usually a good size for adults

A

18 or 20 gauge

34
Q

What are two considerations used when inserting an IV catheter

A

Keep the beveled side of the catheter up when inserting

Maintain adequate traction of the vein during cannulation

35
Q

What are the insertion angles for a catheter

A

45 degrees until vein is pierced

Drop down to 15 degrees

36
Q

What is a flash chamber

A

An area of an IV catheter that fills with blood to help indicate when a vein is cannulated

37
Q

What does ultrasonography do

A

Allows providers to see deeper veins, often in the upper arm, that are not visible to the naked eye

38
Q

Why should you double back the tubing to create a loop at the IV line

A

To act as a shock absorber

39
Q

How should you secure the line if the patient is attempting to pull it

A

Consider wrapping the extremity and tubing with roller gauze

40
Q

When should you change the IV bag

A

When about 25 mL of fluid is left

41
Q

What are saline locks good for

A

Maintaining an active IV site

42
Q

What are saline locks primarily used for

A

Patients who don’t need additional fluids but who may need rapid medication delivery

43
Q

What catheter gauge is best used for pediatric patients

A

20, 22, 24, or 26 gauge

Butterfly catheters

44
Q

What is a good technique for starting a pediatric line

A

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

45
Q

How do you secure a scalp vein line

A

Tape a paper cup over the site to avoid any direct pressure

46
Q

What is important to remember when starting IV therapy in older patients

A

Often simply puncturing the vein will cause a massive hematoma
Tape can lead to skin damage

47
Q

What vein locations should you avoid in older patients

A 
Small spidery veins (rupture easy)
Varicose veins (almost completely closed off)
48
Q

What is an infiltration

A

The escape of fluid into the surrounding tissue causing a localized area of edema

49
Q

Signs and symptoms of an infiltration

A

Edema at the site
Continued IV flow after occlusion of the vein above the site
Patient reporting tightness, burning, and pain around the site

50
Q

What should you do if an infiltration occurs

A

Discontinue the line and reestablish it in the opposite extremity or proximally
Apply direct pressure over the swollen area to reduce further swelling

51
Q

What is an occlusion

A

Physical blockage of a vein or catheter

52
Q

What is the first sign of an occlusion

A

Decreasing drip rate or presence of blood in the tubing

53
Q

How do you determine whether an IV line should be reestablished after an occlusion

A

Use saline to add pressure to the line to disrupt the occlusion
If it does not dislodge, discontinue administration and reestablish

54
Q

How is vein irritation usually caused

A

By a too rapid infusion rate

55
Q

What is thrombophlebitis

A

Inflammation of the vein

56
Q

How does a hematoma often occur during IV administration

A

Vein perforation

Improper catheter removal

57
Q

What should you do if a hematoma develops during IV therapy

A

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

58
Q

How will you know if you hit a nerve, tendon, or ligament

A

The patient will experience sudden and severe shooting pain

59
Q

What should you do if you pierce an artery during cannulation

A

Stop and apply direct pressure for at least 5 minutes or until the bleeding stops

60
Q

What is a pyrogen

A

Foreign proteins capable of producing a fever

61
Q

How is a pyrogenic reaction characterized

A 
Abrupt temperature elevation
Severe chills
Backache
Headache
Weakness
Nausea / vomiting
Signs and symptoms of shock
62
Q

When will a pyrogenic reaction manifest

A

Usually within 30 minutes after IV infusion

63
Q

How should you treat a pyrogenic reaction

A

Stop the infusion immediately

Start a new IV line with a new solution

64
Q

When does circulatory overload become a problem

A

In patients with cardiac, pulmonary, or renal dysfunction

65
Q

Signs and symptoms of circulatory overload

A 
Dyspnea
JVD
Hypertension
Crackles (rales)
Acute peripheral edema
66
Q

How should you treat a suspected air embolus occurs during IV infusion

A

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

67
Q

What is a vasovagal reaction

A

A drop in BP due to anxiety

68
Q

What is a catheter shear

A

Part of the catheter is pinched against the needle

Creates a free-flowing segment

69
Q

What medication is appropriate to administer rectally

A

Diazepam (Valium)

70
Q

1 cc is equal to ____ mL

A

1

71
Q

The IO space collectively comprises the ________ bone of the ________ and the medullary cavity of the ________.

A

cancellous, epiphysis, diaphysis

72
Q

When changing an IV bad, it is important to:

A

Ensure that fluid remains in the drip chamber

73
Q

To make push-dose epinephrine, you should:

A

Take a 10 mL normal saline flush and waste 1 mL

Draw out 1 mL of epinephrine (1:10,000) into the syringe

74
Q

The most important point to remember about IV therapy is to:

A

Prepare all supplies ahead of time

75
Q

After inserting the needle during an intramuscular injection, but before delivering the medication, you should:

A

Pull back on the plunger to aspirate for blood

76
Q

Volumes of a drugs given subcutaneously are typically:

A

1 mL or less

77
Q

The purpose of a Volutrol (Buretrol) administration set is to:

A

Avoid inadvertent fluid overload

78
Q

Neither subcutaneous nor intramuscular injections should be given to patients:

A

With inadequate peripheral perfusion

Paramedicine (2 decks)

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