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PCP > Chapter 8 Vascular Access and Medication Administration > Flashcards

Chapter 8 Vascular Access and Medication Administration Flashcards

1
Q

Medication administration is governed by?

A

local or regional protocols, the best evidence in the literature, and/or communication with the medical control physician

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2
Q

Standing orders

A

form of indirect medical control, in which the paramedic performs certain pre-defined procedures without any direct consultation

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3
Q

direct medical control

A

Some EMS system medical directors may not allow paramedics to perform certain procedures before making contact with the medical director

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4
Q

safe on-scene practices for drug orders

A
  1. confirm that the patient is not allergic
  2. read label carefully
  3. ensure the correct medication is being administered
    4, check for defects
  4. make sure the drugs are compatible
  5. monitor the patient for possible adverse side effects
  6. dispose of the syringe and needle safely
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5
Q

if online physician consultation is required

A
  1. make sure the physician understand the situation
  2. make sure you understand the physician’s orders clearly
  3. always repeat any orders
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6
Q

six rights of medication administration

A
  1. right patient
  2. right medication
  3. right route
  4. right dose
  5. right time
  6. right documentation
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7
Q

Always document the following information on the patient care report after administering a medication

A
  • name of drug
  • dose of drug
  • time you administered the drug
  • route of administration
  • your name or the name of the paramedic who administered the drug
  • patients response to the medication
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8
Q

Medical asepsis?

A

practice of preventing contamination of the patient by using aseptic technique
ex. hand washing, wearing gloves, and keeping equipment as clean as possible

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9
Q

Sterile technique?

A

refers to the destruction of all living organisms and is achieved by using heat, gas or chemicals

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10
Q

Antiseptics

A

used to cleanse an area before performing a procedure
Isopropyl alcohol and iodine are the two most common antiseptics
Not toxic to living tissues

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11
Q

Disinfectants

A

are toxic, do not use on patients, use only on nonliving objects
ex. Virex, Cidex, Microcide

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12
Q

Accidental needle sticks

A

most common route for disease transmission in the health care setting

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13
Q

Total body water (TBW) percentage in adult?

A

60%

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14
Q

Intracellular fluid (ICF)

A
  • water contained inside the cell

- 45% of body weight

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15
Q

Extracellular fluid (ECF)

A

-water outside the cell
-15% of body weight
Divided into two types
-Interstitial fluid, 10.5% of body weight, water bathing the cells
-Intravascular fluid (plasma) 4.5% of body weight, water within the blood vessels

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16
Q

Solvent

A

fluid that does the dissolving

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17
Q

Solute

A

dissolved particles contained in the solvent

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18
Q

Organic molecules vs inorganic molecules

A

organic contain carbon atoms, while inorganic do not

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19
Q

Cation vs Anion

A

Cation+

Anion-

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20
Q

Sodium (Na+)

A

principal extracellular cation needed to regulate the distribution of water

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21
Q

Potassium

A

-major role in neuromuscular function and in the conversion of glucose into glycogen

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22
Q

Hypokalemia

A
  • low potassium levels

- can lead to decreased skeletal muscle function, gastrointestinal disturbances, and alterations in cardiac function

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23
Q

Hyperkalemia

A
  • high potassium levels

- can lead to hyperstimulation of neural cell transmission, resulting in cardiac arrest

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24
Q

Calcium (Ca+2)

A
  • principal cation needed for bone growth
  • important part in the functioning of the muscles for contraction, heart muscle, nerves, and cell membrane stability and blood clotting
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25
Q

Hypocalcemia

A
  • low calcium levels

- can lead to overstimulation of nerve cells

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26
Q

Hypercalcemia

A
  • high calcium levels

- can lead to decreased stimulation of nerve cells

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27
Q

Magnesium (Mg+2)

A

important role as a coenzyme in the metabolism of proteins and carbohydrates

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28
Q

Bicarbonate

A

levels of this is the determining factor between acidosis and alkalosis

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29
Q

Chloride

A

concentration is a primary determinant of stomach pH, also regulates ECF levels

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30
Q

Phosphorus

A

important component in adenosine tri-phosphate (ATP), the body’s powerful energy source

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31
Q

Concentration gradient

A

natural tendency for materials to flow from an area of high concentration to low concentration

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32
Q

Diffusion

A

process of particles moving from an area of high to low concentration

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33
Q

Filtration

A 
type of diffusion, commonly used by kidneys to clean blood.
Antidiuretic hormone (ADH) prevents loss of water from kidneys
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34
Q

Active transport

A

uses energy in the form of ATP to transport compounds across its membrane

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35
Q

Osmosis

A

movement of a solvent from low to high concentration,

is a form of passive transport

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36
Q

Tonicity

A

concentration of sodium in a solution and the movement of water in relation to the sodium levels inside and outside the cell

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37
Q

3 basic types of iv solutions

A
  • crystalloids
  • colloids
  • blood products
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38
Q

further classifications of crystalloids

A
  • isotonic
  • hypotonic
  • hypertonic
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39
Q

types of isotonic solutions

A
  • normal saline
  • lactated ringer
  • D5W (5% dextrose in water)
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40
Q

hypotonic solutions

A
  • osmolarity less than a serum
  • dilutes serum
  • hydration
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41
Q

hypertonic solutions

A
  • osmolarity higher than serum
  • stabilize blood pressure
  • increased urine output
  • reduce edema
  • rarely used in prehospital setting
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42
Q

crystalloid solutions

A
  • dissolved crystals
  • best choice for body fluid replacement
  • 3-1 replacement rule
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43
Q

colloid solutions

A
  • very high osmolarity

- reduce edema

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44
Q

oxygen-carrying solutions

A
  • best fluid to replace lost blood is whole blood
  • o-negative blood
  • synthetic blood substitutes
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45
Q

peripheral vein cannulation

A

involves cannulating veins of the periphery

46
Q

2 ports of IV bag

A
  • injection port

- access port

47
Q

2 primary sizes of administration sets

A
  • microdrip (allow 60 gtt/mL)

- macrodrip (allow 10 or 15 gtt/mL)

48
Q

when preparing an administration set check for:

A
  • expiry date
  • solution clarity
  • solution colour
  • prepare to spike bag
49
Q

other administration sets

A
  • blood tubing (macrodrip) facilitates rapid fluid replacement
  • volutrol/beurtrol (microdrip) calibrated drip chamber with precise amount of fluid to avoid fluid overload
50
Q

when selecting appropriate veins avoid:

A
  • valves

- rolling veins

51
Q

where to start, and which way to work when administering an IV

A

start distally, work proximally

52
Q

criteria when choosing an IV catheter

A
  • purpose of the IV
  • age of the patient
  • location of the IV
  • available vessels for venipuncture
53
Q

needle types

A
  • over-the-needle catheters
  • butterfly catheters
  • through-the-needle catheter
54
Q

contaminated stick:

A

paramedic punctures skin with the same catheter used to cannulate the vein

55
Q

2 considerations when inserting the IV catheter

A
  1. keep the beveled side of the catheter up

2. maintain adequate distal traction on the vein

56
Q

insertion angle of catheter

A

45 degrees

57
Q

once flash of blood enters the flash chamber, drop down angle of catheter to:

A

15 degrees

58
Q

4 steps for changing an IV fluid bag

A
  1. stop the flow of fluid
  2. prepare the new IV bag
  3. remove the piercing spike
  4. ensure that the drip chamber is appropriately filled
59
Q

6 steps for discontinuing IV line

A
  1. shut off the flow
  2. peel back the tape toward the IV line
  3. stabilize the catheter while you loosen the tape
  4. do not remove the IV tubing
  5. place a 10x10 cm piece of gauze and place over site
  6. gently pull the catheter and IV line
60
Q

5 checks to preform after completing IV administration

A
  1. check the fluid
  2. check the administration set
  3. check the height of the bag
  4. check the catheter
  5. check the tourniquet
61
Q

infiltration:

A

the escape of fluid in surrounding tissue that causes edema

62
Q

infiltration causes

A
  • iv needles pass completely through the vein
  • patient moves excessively
  • the catheter enters the tissue surrounding the vein
63
Q

occlusion:

A

physical blockage of vein or catheter

64
Q

signs and symptoms of occlusion

A

decreased drip rate or blood in the tubing

65
Q

causes of occlusion

A
  • positional IV
  • near-empty IV bag
  • patient’s BP exceeds infusion pressure
66
Q

cause of vein irritation

A

too-rapid infusion rate

67
Q

hematoma:

A

accumulation of blood in the tissues surrounding an IV site

68
Q

Pryogens:

A

foreign proteins capable of producing a fever

69
Q

signs and symptoms of pryogenic reactions

A
  • fever/chills/achy
  • weakness
  • nausea/vomiting
  • total vascular collapse, with signs of shock
70
Q

causes of circulatory overload

A

failure to readjust the drip rate after flushing an IV line immediately after insertion

71
Q

signs and symptoms of circulatory overload

A
  • dyspnea
  • jugular vein distention
  • hypertension
72
Q

air embolus:

A

when air bubble is introduced into IV line

73
Q

catheter shear:

A

occurs when part of the catheter is pinched against the needle, needle slices through catheter, creating a free-floating segment

74
Q

IO space is commonly referred to as a:

A

noncollapsible vein

75
Q

when Iv access can’t be obtained within 3 attempts or 90 seconds, to establish vascular access use

A

IO infusion

76
Q

what degree is required for manually inserted IO needles

A

90 degrees

77
Q

FAST1:

A
  • first IO device approved for use in adults

- placement in the sternum

78
Q

EZ-IO

A
  • hand-held, lithium battery powered medical drill to which a needle is attached
  • used to insert IO needle into the proximal humerus, proximal tibia, or distal tibia
79
Q

Bone injection gun:

A
  • spring loaded device

- used to insert IO needle into the proximal tibia

80
Q

Extravasation:

A
  • needle rests outside the bone

- IV fluid will collect in the soft tissues

81
Q

Osteomyelitis:

A
  • inflammation of the bone and muscle
  • caused by an infection
  • fewer than 0.6% of IO insertions
82
Q

what you must know to calculate flow rate

A
  • the volume to be infused
  • the period over which it is to be infused
  • the properties of the administration set
83
Q

calculation of flow rate

A

gtt/min=(volume to be infused x gtt/mL of administration set) / total time of infusion in minutes

84
Q

first rule of medicine is

A

primum non nocere, “first, do no harm”

85
Q

desired dose:

A

amount of a medication that the physician orders or is indicated in your local standing order protocols for you to give to a patient

86
Q

concentration:

A

total weight of the drug contained in a specific amount of volume

87
Q

drug dose calculation

A

volume to be administered = (desired dose x volume on hand) / dose on hand

88
Q

parenteral medications

A

any route other than gastrointestinal tract

89
Q

syringes consist of:

A

plunger, body or barrel, flange and tip

90
Q

Gauge of needle refers to:

A
  • diameter (18-26)

- smaller the number, the larger the diameter

91
Q

ampules:

A

breakable sterile glass containers that are designed to carry a single dose of medication

92
Q

subcutaneous injections:

A
  • given into loose connective tissue between the dermis and muscle layer
  • usually 1 mL or less
  • uses 24-26 gauge
93
Q

common sites for IM administration

A
  • vastus lateralis
  • rectus femoris
  • gluteal area
  • deltoid muscle
94
Q

degree of IM injection

A

90 degree straight into the muscle

95
Q

IV bolus medication administration:

A
  • places the drug directly into the circulatory system
  • fastest route for medication
  • no room for error
96
Q

bolus:

A

single dose, usually given by IV route

97
Q

stopcocks:

A
  • allows multiple lines to be connected
  • can control from which direction the flow is coming from
  • off points to the direction that is being blocked
  • allows for precise dosage to be delivered
98
Q

saline locks:

A

-used for patients who are not in need of IV fluid but may need medication therapy

99
Q

IV infusion pumps:

A
  • medication maintenance infusion
  • allow you to set the parameters of medication administration
  • has safety features (alarms)
100
Q

Percutaneous medication administration:

A
  • applied and absorbed through the skin and mucous membranes

- absorption is predictable

101
Q

transdermal medication administration:

A
  • on the surface of the skin

- very slow and steady rate

102
Q

sublingual medication administration:

A
  • under the tongue

- rapidly absorbed

103
Q

buccal medication administration:

A

-between the cheek and the gums

104
Q

aural medication administration:

A

-administered via the mucous membranes of the ear canal

105
Q

mucosal atomizer device (MAD)

A

device used to administer emergency medications through the intranasal route

106
Q

most common inhaled medication

A

oxygen

107
Q

a patient with a history of respiratory problems will usually have a

A

metered-dose inhaler (MDI)

108
Q

4 medications given down the tracheal tube

A

LEAN

  • lidocaine
  • epinephrine
  • atropine
  • naloxone
109
Q

dose given by the tracheal route is 2 to 2.5 times the recommended amount of

A

IV dose

110
Q

medication routes and rates of absorption, shortest to longest onset of action

A
  • IO
  • IV
  • tracheal
  • inhalation
  • nasal
  • sublingual
  • IM
  • subcutaneous
  • rectal
  • oral
  • topical

PCP (12 decks)

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