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N206 Final > IV meds > Flashcards

IV meds Flashcards

1
Q

Med calculation.

Formula for gtt factor

A

ml/hr x gtt/ml

/60

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2
Q

IV route is used to provide…

A

a rapid effect and more uniform blood levels of meds for PTs

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3
Q

IV med checklist

A
  1. order
  2. action
  3. adverse effects: most common and most detrimental.
    - -know location of emerg equip and antidote if any
  4. route
  5. dose
  6. compatibility
  7. Preparation
  8. Rate
  9. site
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4
Q

Adding liquid med to an IV bag

A
  1. prep label
  2. draw up med using filter needle
  3. switch needle
  4. cleanse mini-bag port
  5. lay bag flat and inject med
  6. label
  7. gently agitate bag
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5
Q

attaching a mini-bag and secondary line to a primary line

A

Prior to bedside:

  1. close roller clamp of secondary line
  2. spike mini-bag with secondary line
  3. attach the line date tag

At the bedside

  1. identify your PT with MAR info
  2. Ensure IV is patent
  3. Cleanse highest port of primary tubing
  4. Attach secondary line to cleanse port
  5. Lower mini-bag, unclamp secondary line roller clamp and slowly prime seconday tubing and drip chamber
  6. close secondary line roller clamp
  7. hang mini-bag above primary bag and open secondary clamp fully
  8. regulate flow by adjusting roller clamp of primary tubing
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6
Q

Continuous Infusion

A

instillation of a parenteral drug over several hours, (continuous drip)

adds medication to large volume of iv solution

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7
Q

iv administration is the route chosen when…

A
  • emergency
  • clients have disorders that affect absorption
  • blood levels of drugs need to be maintained at a consistent level
  • client decides to avoid repeated injections
  • a mechanism is needed to give drugs a long time (cancer)
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8
Q

Intermittent Infusion

A

short term administration of medication (from minutes up to an hour)

prn med

Given 3 ways:

  1. bolus
  2. secondary
  3. when volume control is set
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9
Q

Bolus administration

A

undiluted medication given quickly into a vein (iv push)

  • no info, give it 1ml per minute
  • given through a port in an existing iv port, or through a medication lock
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10
Q

Secondary Line

A

the administration of a parenteral drug that has been diluted in a small volume of iv solution (50 to 100 ml) over 30 to 60 minutes.

“piggyback infusion”

Tandem with primary IV solution

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11
Q

Reconstitution device

A

Systematically mixed

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12
Q

Incompatible

A

Two solutions cannot be mixed together

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13
Q

Volutrol

A

Control Volume

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14
Q

** Advantages if IV meds

A
  1. direct system access
  2. immediate discontinuation possible
  3. accurate titration d/t accurate absorption
  4. able to use meds not suitable or not possible via other routes
  5. less discomfort
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15
Q

Disadvantages of IV meds

A
  1. direct systemic action- immed action
  2. rapid side effects- accurate in dose calc and preparation
  3. potential incompatibilities
    - - know desired action
    - - know side effects
    - - antidote if there is one
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16
Q

7 rights of med delivery

A

Right:

dose, drug, PT, route, time, document, reason

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17
Q

If adverse rxn occurs:

A
  1. stop med immed
  2. assist/comfort PT
  3. notify doc
  4. admin emerg measures
  5. monitor PT
18
Q

Correct med route?

A

confirm safety via IV route and confirm hosp policy

19
Q

Understand meds theraputic action

resources**

A

why ordered of PT?
how is it metabolized? excreted?

Research for meds:
> FHA intranet parentral drug therapy manual (PDTM)
> CPS
>Drug guide 
>medication insert
20
Q

Be sure of dose

A

> critical
adjustments rqrd for children, obese and emaciated
refere to calc chart and conversion tables
calc twice
check with another RN

21
Q

IV meds compatibility

A
  1. Therapeutic
  2. physical
  3. chemical

> refer to PDTM and charts
check primary bag solution
check primary bag med and compatibility
check with PCA

22
Q

Rate is based on:

A
  1. therapeutic and adverse effects
  2. dosage
  3. concentration

Adverse rxns depend on rate

23
Q

Check the IV site

A

Primary bag
Secondary bag

Check status of IV solution, line, site
explain to PT
cleanse port

24
Q

reconstitute 80mg in 50ml over 30 min

A

50 + 50 = 100 ml/hr, 10 gtt/ml

divide by 60min

= 16.6 gtt/min —-> 17gtt/min

25
Q

UFV policy for IV meds:

A

Students may under direct supervision:

  1. Narcotics
  2. Theophyllines–> bronchodilators. Inhibit phosphodiesterase, producing increased tissue contractions of cAMP. Also increases diuresis.
  3. Hypoglycemics–> decrease hepatic glucose production. decrease intest glucose absorption and increase sensitivity to insulin
  4. Corticosteriods
  5. Anticoagulants–> heparin. fast acting
  6. Magnesium Sulphate–> mineral and electrolyte replacement. It is essential for activation of many enzymes tx: HTN, hypomagnesiumia, prevent seizures
  7. Direct supervision also includes med infusions: antibiotics in mini-bag, add-a -line infusion, TKVO ect.)
26
Q

Students can not*** admin IV route either direct or infusion:

A
  1. Sedatives: benzo, and barbituates
  2. antineoplastics
  3. antihypertensives: olol, pril, sartan, dipine
  4. antiplatelets: asa, clopridogrel
  5. thrombolytics- dissolve bld clots; alteplase, reteplate
27
Q

FHA CIVA program

A

centralized IV additive program

>all antibiotics 
> all orders written during pharmacy hours of operation
> D5W is atandard ad-mix
>24 hr supply delivered @ 1500 hrs
> individually labeled
> some are refrigerated
28
Q

Restricted meds:

A

> possible severe, immediate reaction (hypotension)
variable dose depends on PT response
narrow theraeputic to toxic ratio
possibility of extravasion, tissue sloughing necrosis
infrequent use

29
Q

Types of incompatibilities

A
  1. therapeutic - undesirable combination side effect of two or more similar drugs (increase or decrease response)
  2. Physical (visual) - precipitation, gas. coloration, turbidity
  3. Chemical rxn - degradation of drug resulting in inactivation/ slowing/ toxic effect ex. alkaline vs. acidic
    * dependent on chemical reactions and concentration of solutes
30
Q

Documenting additive compatibility:

A
  1. meds combined in IV bag for at least 24 hrs
  2. compatible if mixed in glass or polyolefin
  3. meds combined in same IV bag for hours specified
  4. compatibility at Y-sites
  5. Incompatible
  6. blank- no info
31
Q

Heparin

A

start second IV because you do not want to disturb hep.

32
Q

To avoid incompatibility issues:

A
  1. Always follow manufacturers instructions reg. Vol and type of dilutent
  2. always watch for changes appearance in solutions
    > color, gas, bubbles, precipitate
  3. always check incompatibilities on med profile
    > chart for clarification
  4. If info is inconclusive or absent, assume incompat exist.
33
Q

The largest number of incompat are likely produced by

A

changes in pH: these alter pH:

  1. adding defferent meds
  2. preservatives in meds or dilutants
  3. degree of dilution
  4. standing time
  5. order of mixing drugs
  6. room temp

pH changes will interfere with the action of the medication and may not always produce an observable change

34
Q

What do you do if the primary solution and the mini-bag med are not compat

A

Attach a new primary line to the lowest port of the existing line, flushing the line below the port to remove any incompat med in the line.

The min-bag med is then attached to the “new” primary line via a second line and administer at the appropriate rate.

The original primary line needs to be clamped during.

35
Q

Flushing IV lines so that incompat meds do not touch

A
  1. clamp the primary line and lower the empty mini-bag so that it flushes 20-30mls of solution. clamp seconday line and remove old mini-bag and reattach new one.
  2. or a normal saline mini-bag can be attached to secondary line btwn meds to flush the line
36
Q

Guidelines to reduce IV med errors:

A
  1. isolated clean area to work
  2. aseptic
  3. proper dilution with recommended dilutent
  4. admin meds separately whenever poss
  5. follow manufacturers instruct
  6. thorough mix reconstituted meds bfr adding
  7. only one drug can be added to a mini-bag
  8. visually check completed admixture for changes
  9. no info? call pharmacy
37
Q

info that is essential when admin IV meds:

A
  1. allergies of PT
  2. Doctors orders
  3. Compatibility
  4. assess PT
  5. Equipment needed
38
Q

what are 2 poss sources of info about IV meds incompatibilities?

A
  1. Drug insert
  2. Health regions PDTM (parenteral drug therapy manual)
  3. drug guide
39
Q

make sure the IV bag has a

A

label

40
Q

what is the importance of knowing the time within which the med should be infused?

A

helps predict therapeutic and adverse effects.

assists in calculation rate

ensures stability is maintained

N206 Final (4 decks)

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