Foundations Exam 2 Flashcards
absorption
Drug dosage and local conditions at site of admin influence absorption
distribution
Distribution depends on physical/chemical properties of medication and the physiology of the person taking it
After hitting bloodstream, med will go to tissue, organs, or site of actions
metabolism
Biotransformation; lungs, kidneys, intestines (highly vascularized), blood
Medications made into less-potent or inactive form
excretion
Kidneys main organ
GI, liver, lungs, glands
what are drugs classified by
- Effect on body
- Chemical composition
- Therapeutic action
Idiosyncratic effect
different undesired reaction than normal
Iatrogenic effect
negative, toxic effect from prescribed drug (chemo)
what does safe therapeutic range fall between
toxic concentration and minimum effective concentration
sublingual vs buccal
sublingual - under tongue
buccal - against cheek
what are the parts of a medication order
Pts name
Date and time written
Name of drug
Dosage of drug
Route
Frequency
Signed off by physician
5 rights of medication administration
- patient
- route
- dosage
- frequency
- medication
important notes about eye and ear drops
ear:
- under 3: pull ear down
- over 3: pull ear up
eye:
- different eye drops give 5 mins apart
important note about inhaled medications
must rinse mouth after to avoid thrush
what are the parts of a syringe
hub - needle - (shaft, lumen, bevel)
pre-filled syringe
convenient for home
- 100 or 150mg/ml; less risk of med errors
cartridge syringe
needs to be put into device to give med
insulin syringe (orange)
100 units/ml
- 1 unit of insulin can drop blood sugar 30-100
insulin pen
keep in fridge
change spot on body
Tuberculin syringe
brown cap
regular needles
higher the gauge - smaller the diameter
- BEST place for IM injection is ventrogluteal
what bloodborne pathogen diseases can occur with needles
HIV
HBV
HCV
reconstitution
powder medications that need sterile water to reconstitute drug
Once mixed, then you can draw up into mL
ampules
single dose
- vial must be broken cleanly
- use filtered needle then change to injection needle to administer
vials
glass or vial that is self-sealing
Intradermal injections
angle: 5-15 degrees
gauge: 26-27
needle length: 1/4 - 1/2
sites: inner forearm, upper back
- hold skin taut, bevel up
subcutaneous injections
angle: 90 degrees
gauge: 25-30
needle length: 3/8 - I inch
sites: upper back, back upper arm, abdomen, thigh
- pinch skin
Intramuscular injections
angle: 90 degrees
gauge: 18-25
needle length: 5/8 - 11/2 inch
sites: deltoid, vastus lateralis, ventral gluteal
- z track method
peripheral IVs
< 3 inches
inserted in peripheral veins of hand/feet
rotate sites: 72-96hrs
Midline peripheral catheters
> 3 inches
Inserted peripherally into cephalic or brachial vein, stops at axilla*
Longer use
*Both used for IV fluids, medications, and blood products
steps of inserting IV
- should be 2in away from bending joint or non-dominant side
1. find vein
2. tourniquet
3. warm compress, dependent position
4. palpate vein for bouncy/spongey
neuropraxia
nerve structure remains intact but pt has temporary damage (zipper feeling)
Axonotmesis
severe nerve injury resulting in permanent paralysis of motor or sensory function
Neurotmesis
nerve is completely severed, leaving permanent damage
phlebitis
inflammation in the vein - pain, redness, warmth and swelling*
Remove IV, apply warm compress, and give anti-inflammatory
infiltration
IV medication leaks out of vein and into tissue - swelling, pain, coolness, blanching (pale)
— Stop IV, apply cool compress
Extravasation
fluid leaks out of vein and is vesicant which irritates the tissue
Infection: do not remove catheter, stop fluids, give reignite around IV site to stop destruction of the tissue
PICC line (central venous access device)
Long catheter 20-24in
Peripheral vein in arm into superior vena cava and RA
X Ray used for confirmation
central venous catheter non-tunneled
Short term fluid or blood admin
Between Superior vena cava and RA
Single or multi lumens
Can be placed in neck, chest or groin
Temporary *
central venous catheter tunneled
Surgical procedure - Under skin
Exits through abdomen or chest wall
Tip is where superior vena cava and ra meet
DACRON CUFF is in place to stabilize catheter and prevent infection*
Pt can go into ARRHYTHMIAS
serious complications of central line insertions
Arterial puncture
Lung puncture
Arrhythmias*
Hemorrhage*
Air embolism*
local IV infection
Redness, warmth
Tenderness
Edema
Purulent drainage
systemic IV infection
Fever, chills
Leukocytosis
N/V
Malaise
Can lead to sepsis
why is I & O important to monitor
not equal means fluid volume excess or deficit
what does a physician’s order of IV therapy include
1 - Amount of solution
2 - Type of solution
3 - Any additives
4 - Rate of administration
ex) 1 L D5W w/ 20mEq KCl @ 125mL/hr
Crystalloid vs Colloid solutions
Crystalloid - used to replace losses of water, CHO, and electrolytes
Colloid - function like plasma proteins, increasing intravascular volume
Hypotonic Solution
<240 mOsm/L - used for dehydration
1. Fluid moves from intravascular space into the cells (Swell)
- Increased intracellular fluid
- Increased Intracranial pressure b/c fluid passes blood brain barrier
Isotonic Solution
240-340 mOsm/L - used for volume replacement (same as body fluids)
- Increases ECF volume
- Assess for signs of fluid overload
Hypertonic Solution
> 340 mOsm/L - used to reduce fluid overload (shrink)
- Increases osmotic pressure in the blood, drawing fluid from the cells
- Cellular dehydration may occur
125mg gentamicin IV every 8hr, medication is in 100mL minibag to infuse over 90 minutes, what would be the correct rate that this is going to infuse at in mL/hr?
(100mL/1.5hr) = 66.7mL/hr
Volume imbalance
disturbance in extracellular compartment fluid balance
Osmolality imbalance
disturbance in concentration of body fluids
hypernatremia vs hyponatremic influence on fluid
hyper - cellular water deficit (shrink)
hypo - cellular water excess (swell)
different parts of the drip chamber
Macrodrip: 10-20gtts/ml
Microdrip: 60gtts/ml
types of drug incompatibility
chemical: change in potency of drug
physical: change in appearance (dissolution)
therapeutic: change in effect of drug
Methods of IV administration
- continuous infusion
- intermittent infusion
- IV push or bolus
what do you do if there is a medication error
assess vitals immediately
notify healthcare provider
document incident
IVPB - intravenous piggy back bag
secondary medication placed in bag above regular IV administration
mini bag
50-100ml bag used intermittently
Buretrol
volume controlled IV chamber
- used to prevent fluid overload
4 main components of blood
wbcs, rbcs, plasma, platelets
what is plasma
55% of blood volume (intravascular part of extracellular fluid)
Made of 90% water & 10% solutes
Solutes such as protein, lipids, electrolytes..
what are antigens
what provoke an immune response
what are antibodies
immunoglobins produced after antigen or foreign substance exposure
what is the antigen-antibody response
incompatible blood antigens trigger an immune response
A blood type
A antigens
Anti-B antibodies
B blood type
B antigens
Anti-A antibodies
O blood type
neither A or B antigens
both anti-A and anti-B antibodies
Rh negative and Rh positive
Rh (-) can only receive (-) blood
Rh (+) can receive (-) and (+) blood
universal donor and universal recipients
donor - O
recipient - AB
whole blood
must be ABO identical
- used for acute blood loss over 25%
Packed RBCS
increases O2 carrying capacity
Washed RBCS
washes out components of blood and only gives pt RBCS
- used for febrile, non-hemolytic reactions
Fresh frozen plasma
used to increase clotting factors and treat bleeding disorders
Colloid blood infusion
used for massive shock or hemorrhage
- increases volume
process of administering Infusion
- admin blood slowly 2-5ml/min
- Vital Signs every 5-15 mins
- After 15 mins, increase rate
- Vital signs every 15-30 mins until done
acute hemolytic reaction
ABO incompatibility
S/S: burning along vein, lumbar pain, flank pain, flushing of face, fever, chills, shock
STOP TRANSFUSION
febrile, non-hemolytic reaction
NOT an ABO incompatibility - Sensitization to some other element in the blood
S/S: fever, shaking, N/V, headache, chest pain, dyspnea, hypotension, cough, malaise
Allergic reaction
Sensitivity to plasma proteins
S/S: rash or hives
what will 1 unit of blood raise H&H by
hematocrit - 3%
hemoglobin - 1g/dl
how fast do you have to give blood once taking it out of fridge
4 hours
how fast do platelets and FFB have to be infused by
30 mins
