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
2
Q
Standing orders
A
form of indirect medical control, in which the paramedic performs certain pre-defined procedures without any direct consultation
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
4
Q
safe on-scene practices for drug orders
A
- confirm that the patient is not allergic
- read label carefully
- ensure the correct medication is being administered
4, check for defects - make sure the drugs are compatible
- monitor the patient for possible adverse side effects
- dispose of the syringe and needle safely
5
Q
if online physician consultation is required
A
- make sure the physician understand the situation
- make sure you understand the physician’s orders clearly
- always repeat any orders
6
Q
six rights of medication administration
A
- right patient
- right medication
- right route
- right dose
- right time
- right documentation
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
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
9
Q
Sterile technique?
A
refers to the destruction of all living organisms and is achieved by using heat, gas or chemicals
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
11
Q
Disinfectants
A
are toxic, do not use on patients, use only on nonliving objects
ex. Virex, Cidex, Microcide
12
Q
Accidental needle sticks
A
most common route for disease transmission in the health care setting
13
Q
Total body water (TBW) percentage in adult?
A
60%
14
Q
Intracellular fluid (ICF)
A
- water contained inside the cell
- 45% of body weight
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
16
Q
Solvent
A
fluid that does the dissolving
17
Q
Solute
A
dissolved particles contained in the solvent
18
Q
Organic molecules vs inorganic molecules
A
organic contain carbon atoms, while inorganic do not
19
Q
Cation vs Anion
A
Cation+
Anion-
20
Q
Sodium (Na+)
A
principal extracellular cation needed to regulate the distribution of water
21
Q
Potassium
A
-major role in neuromuscular function and in the conversion of glucose into glycogen
22
Q
Hypokalemia
A
- low potassium levels
- can lead to decreased skeletal muscle function, gastrointestinal disturbances, and alterations in cardiac function
23
Q
Hyperkalemia
A
- high potassium levels
- can lead to hyperstimulation of neural cell transmission, resulting in cardiac arrest
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
25
Hypocalcemia
- low calcium levels
| - can lead to overstimulation of nerve cells
26
Hypercalcemia
- high calcium levels
| - can lead to decreased stimulation of nerve cells
27
Magnesium (Mg+2)
important role as a coenzyme in the metabolism of proteins and carbohydrates
28
Bicarbonate
levels of this is the determining factor between acidosis and alkalosis
29
Chloride
concentration is a primary determinant of stomach pH, also regulates ECF levels
30
Phosphorus
important component in adenosine tri-phosphate (ATP), the body's powerful energy source
31
Concentration gradient
natural tendency for materials to flow from an area of high concentration to low concentration
32
Diffusion
process of particles moving from an area of high to low concentration
33
Filtration
```
type of diffusion, commonly used by kidneys to clean blood.
Antidiuretic hormone (ADH) prevents loss of water from kidneys
```
34
Active transport
uses energy in the form of ATP to transport compounds across its membrane
35
Osmosis
movement of a solvent from low to high concentration,
| is a form of passive transport
36
Tonicity
concentration of sodium in a solution and the movement of water in relation to the sodium levels inside and outside the cell
37
3 basic types of iv solutions
- crystalloids
- colloids
- blood products
38
further classifications of crystalloids
- isotonic
- hypotonic
- hypertonic
39
types of isotonic solutions
- normal saline
- lactated ringer
- D5W (5% dextrose in water)
40
hypotonic solutions
- osmolarity less than a serum
- dilutes serum
- hydration
41
hypertonic solutions
- osmolarity higher than serum
- stabilize blood pressure
- increased urine output
- reduce edema
- rarely used in prehospital setting
42
crystalloid solutions
- dissolved crystals
- best choice for body fluid replacement
- 3-1 replacement rule
43
colloid solutions
- very high osmolarity
| - reduce edema
44
oxygen-carrying solutions
- best fluid to replace lost blood is whole blood
- o-negative blood
- synthetic blood substitutes
45
peripheral vein cannulation
involves cannulating veins of the periphery
46
2 ports of IV bag
- injection port
| - access port
47
2 primary sizes of administration sets
- microdrip (allow 60 gtt/mL)
| - macrodrip (allow 10 or 15 gtt/mL)
48
when preparing an administration set check for:
- expiry date
- solution clarity
- solution colour
- prepare to spike bag
49
other administration sets
- blood tubing (macrodrip) facilitates rapid fluid replacement
- volutrol/beurtrol (microdrip) calibrated drip chamber with precise amount of fluid to avoid fluid overload
50
when selecting appropriate veins avoid:
- valves
| - rolling veins
51
where to start, and which way to work when administering an IV
start distally, work proximally
52
criteria when choosing an IV catheter
- purpose of the IV
- age of the patient
- location of the IV
- available vessels for venipuncture
53
needle types
- over-the-needle catheters
- butterfly catheters
- through-the-needle catheter
54
contaminated stick:
paramedic punctures skin with the same catheter used to cannulate the vein
55
2 considerations when inserting the IV catheter
1. keep the beveled side of the catheter up
| 2. maintain adequate distal traction on the vein
56
insertion angle of catheter
45 degrees
57
once flash of blood enters the flash chamber, drop down angle of catheter to:
15 degrees
58
4 steps for changing an IV fluid bag
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
6 steps for discontinuing IV line
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
5 checks to preform after completing IV administration
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
infiltration:
the escape of fluid in surrounding tissue that causes edema
62
infiltration causes
- iv needles pass completely through the vein
- patient moves excessively
- the catheter enters the tissue surrounding the vein
63
occlusion:
physical blockage of vein or catheter
64
signs and symptoms of occlusion
decreased drip rate or blood in the tubing
65
causes of occlusion
- positional IV
- near-empty IV bag
- patient's BP exceeds infusion pressure
66
cause of vein irritation
too-rapid infusion rate
67
hematoma:
accumulation of blood in the tissues surrounding an IV site
68
Pryogens:
foreign proteins capable of producing a fever
69
signs and symptoms of pryogenic reactions
- fever/chills/achy
- weakness
- nausea/vomiting
- total vascular collapse, with signs of shock
70
causes of circulatory overload
failure to readjust the drip rate after flushing an IV line immediately after insertion
71
signs and symptoms of circulatory overload
- dyspnea
- jugular vein distention
- hypertension
72
air embolus:
when air bubble is introduced into IV line
73
catheter shear:
occurs when part of the catheter is pinched against the needle, needle slices through catheter, creating a free-floating segment
74
IO space is commonly referred to as a:
noncollapsible vein
75
when Iv access can't be obtained within 3 attempts or 90 seconds, to establish vascular access use
IO infusion
76
what degree is required for manually inserted IO needles
90 degrees
77
FAST1:
- first IO device approved for use in adults
| - placement in the sternum
78
EZ-IO
- 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
Bone injection gun:
- spring loaded device
| - used to insert IO needle into the proximal tibia
80
Extravasation:
- needle rests outside the bone
| - IV fluid will collect in the soft tissues
81
Osteomyelitis:
- inflammation of the bone and muscle
- caused by an infection
- fewer than 0.6% of IO insertions
82
what you must know to calculate flow rate
- the volume to be infused
- the period over which it is to be infused
- the properties of the administration set
83
calculation of flow rate
gtt/min=(volume to be infused x gtt/mL of administration set) / total time of infusion in minutes
84
first rule of medicine is
primum non nocere, "first, do no harm"
85
desired dose:
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
concentration:
total weight of the drug contained in a specific amount of volume
87
drug dose calculation
volume to be administered = (desired dose x volume on hand) / dose on hand
88
parenteral medications
any route other than gastrointestinal tract
89
syringes consist of:
plunger, body or barrel, flange and tip
90
Gauge of needle refers to:
- diameter (18-26)
| - smaller the number, the larger the diameter
91
ampules:
breakable sterile glass containers that are designed to carry a single dose of medication
92
subcutaneous injections:
- given into loose connective tissue between the dermis and muscle layer
- usually 1 mL or less
- uses 24-26 gauge
93
common sites for IM administration
- vastus lateralis
- rectus femoris
- gluteal area
- deltoid muscle
94
degree of IM injection
90 degree straight into the muscle
95
IV bolus medication administration:
- places the drug directly into the circulatory system
- fastest route for medication
- no room for error
96
bolus:
single dose, usually given by IV route
97
stopcocks:
- 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
saline locks:
-used for patients who are not in need of IV fluid but may need medication therapy
99
IV infusion pumps:
- medication maintenance infusion
- allow you to set the parameters of medication administration
- has safety features (alarms)
100
Percutaneous medication administration:
- applied and absorbed through the skin and mucous membranes
| - absorption is predictable
101
transdermal medication administration:
- on the surface of the skin
| - very slow and steady rate
102
sublingual medication administration:
- under the tongue
| - rapidly absorbed
103
buccal medication administration:
-between the cheek and the gums
104
aural medication administration:
-administered via the mucous membranes of the ear canal
105
mucosal atomizer device (MAD)
device used to administer emergency medications through the intranasal route
106
most common inhaled medication
oxygen
107
a patient with a history of respiratory problems will usually have a
metered-dose inhaler (MDI)
108
4 medications given down the tracheal tube
LEAN
- lidocaine
- epinephrine
- atropine
- naloxone
109
dose given by the tracheal route is 2 to 2.5 times the recommended amount of
IV dose
110
medication routes and rates of absorption, shortest to longest onset of action
- IO
- IV
- tracheal
- inhalation
- nasal
- sublingual
- IM
- subcutaneous
- rectal
- oral
- topical
