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Module 2- Administering IV Medications Flashcards

1
Q

what is hypersensitivity?

A

reflection of excessive or aberrant immune response to any type of stimulus

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2
Q

how many reactions are there for H? and which ones are usually allergic rxns?

A

classified into 4 types of reactions (most allergic reactions are either T1 or 4)

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3
Q

what is the most severe H?

A

anaphylaxis (type 1)

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4
Q

what are the S+S of anaphylactic H?

A

edema in many tissues, hypotension, bronchospasm, and cardiovascular collapse (severe cases)

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5
Q

when does the immediate anaphylaxis rxn start?

A

in minutes of exposure to antigen

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6
Q

which ab is involved?

A

IgE

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7
Q

anaphylaxis can be what?

A

local or systemic

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8
Q

what are examples of T1 H?

A

allergic rhinitis, asthma, severe allergic response in people allergic to penicillin or latex

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9
Q

what is type 2 H and describe it with the type of Ab’s

A

Cytotoxic H. this is when the immune system mistakenly identifies a normal constituent of the body as foreign. IgG or IgM

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10
Q

what is/describe T3 H and the type of Ab’s

A

Immune Complex H where IC are formed when Ag’s bind to Ab’s. they deposit in tissues on endothelium and cause injury

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11
Q

what is the most common cause of anaphylaxis?

A

penicillin

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12
Q

what is a good indicator of the severity of allergic rxn?

A

time from exposure to the antigen to onset of symptoms: the faster the onset, the more serious the reaction

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13
Q

the severity of previous reactions does not what?

A

does not determine the severity of subsequent reactions, it could be the same, or more or less severe

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14
Q

what are the mild reaction symptoms and when does this begin

A

consist of peripheral tingling and sensation of warmth, possibly accompanied by sensation of fullness in mouth and throat
○ Begins in 2 hours of exposure

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15
Q

what are the moderate reaction symptoms and when does this begin

A

• Moderate reactions may include flushing, warmth, anxiety, itching in addition to any of the milder symptoms
○ More serious include bronchospasm and edema of airways or larynx with dyspnea, cough and wheezing
-Onset is 2 hours as well

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16
Q

what are the symptoms for a severe systemic reaction?

A

• Severe systemic reactions have an abrupt onset with same S+S described previously
-Symptoms progress rapidly to bronchospasm, laryngeal edema, severe dyspnea, cyanosis, and hypotension

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17
Q

what might an insulin allergic patient with diabetes and those allergic to penicillin need?

A

desensitization

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18
Q

what is desensitization

A

based on controlled anaphylaxis, with a gradual release of mediators

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19
Q

what should those who undergo desensitization be aware of?

A

are cautioned that there should be no lapses in therapy because this may lead to the reappearance of the allergic reaction when the medication is resumed

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20
Q

what is the medical management for anaphy.?

A

depends on severity of reaction.

  • epinephrine
  • antihistamines, corticosteroids
  • IV fluids, volume expanders, vasopressor agents are administered to maintain BP
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21
Q

how long are those who suffered severe reactions monitoring for?

A

12-14 hours

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22
Q

what is anaphylactic shock?

A

• Occurs rapidly and is life-threatening
-Because anaphylactic shock occurs in patients already exposed to an antigen and who have developed antibodies to it, it can often be prevented

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23
Q

how is anaphylactic shock caused?

A

• Caused by severe allergic reaction when patients who have already produced antibodies to a foreign substance (antigen) develop a systemic antigen-antibody reaction

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24
Q

S+S of anaphylactic shock

A

• Commonly show signs of respiratory distress (wheezing, stridor), hypotension d/t vasodilation, and cardiovascular changes and neurologic compromise in addition to a wide variety of other potential S+S
• Angioedema: lips/tongue swelling or eyes/trachea
-Normally you see a increase in HR with a decrease in BP, and then go bradycardic

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25
medical management for anaphylactic shock
- removing the causative antigen when possible, administering medications that restore vascular tone, and providing emergency support of basic life functions - Epinephrine - diphenhydramine (benadryl) is used to reverse effects of histamine (reducing cap perm) - Epinephrine, antihistamine, corticosteroid, broncho-dilator, vasopressors
26
what is nursing management for anaphylactic shock
• Nurse must assess all patients for allergies/previous reactions to antigens and communicate the existence of these allergies or reactions to others - assesses pt's understanding of previous rxns - advises pt to wear identification of specific allergen/antigen - must be aware of S+S of anaphylaxis
27
what do you need to do when more than one med is added to a solution?
you assess compatibility
28
what are the risks and benefits of IV's?
- invasive - risk for infection - can be difficult to put in - huge risk for anaphylaxis - good for fluids - immediate response - can titrate more or less as needed
29
what is an IV piggy back?
• Small (25-250mL) IV bag or bottle connected to a short tubing line that connects to the upper Y-port of a primary infusion line or to an intermittent venous access such as a saline lock
30
why is it called piggy back?
because the small bag or bottle is set higher than the primary infusion
31
how does the flow of the primary bag not infuse when the piggyback is set up? and how does it start up again
* The port of the primary IV line contains a back-check valve that automatically stops the flow of the primary infusion once the piggyback infusion flows * After the piggyback solution infuses and the solution within the tubing falls below the level of the primary infusion drip chamber, the back check valve opens and the primary infusion starts to flow again
32
what do you need to do if you give medication through existing IV line?
determine compatibility of medication with IV fluids and any additional additives within IV solution
33
what type of tubing do you never administer IV medications into?
into tubing that is infusing blood, blood products, or parenteral nutrition solutions
34
what is a solute can it be solid or liquid?
a substance to be dissolved or diluted. Can be solid or liquid form
35
what is a solvent?
a substance (liquid) that dissolves another substance to prepare a solution. Diluent is a synonymous term
36
what is a solution?
the resulting mixture of a solute plus a solvent
37
what is a reconstituted solution?
a solid substance or concentrate, the solute, is diluted with a solvent to obtain a reconstituted solution of a weaker strength
38
when is reconstitution necessary?
necessary to create a measurable and usable dosage form
39
what are the most commonly used diluents?
sterile water and NS
40
what are the two types of reconstituted parenteral solutions?
single strength and multiple strength
41
what type is the most simple to dilute?
single strength
42
how many ml's do you flush for a peripheral vs CVAD when determining the rate to flush at? and why ?check
1ml for a peripheral line and 3mls for CVAD. you want it at this slow introductory rate so speed shock doesn't occur
43
what is IV bolus
introduced a concentrated dose of a medication directly into a vein by way of an existing IV access
44
what is a benefit with IV bolus for someone on fluid restrictions
an IV bolus or "push" usually requires small volumes of fluid
45
when is IV bolus common
during emergencies when you need to deliver a fast acting medication quickly
46
why is IV bolus dangerous?
it allows no time to correct errors
47
administering an IV push medication too quickly can cause?
DEATH
48
what is important to know for calculations of a bolus
need to be sure on the correct amount of medication to give and rate of admin
49
when should you never give an IV bolus
if the insertion site appears edematous or reddened or if the IV fluids do not flow at the ordered rate
50
what is the mnemonic CATS PRRR about? and what does it stand for
to help remember safety checks for administering IV meds: Compatibilities, Allergies, Tubing correct, Release clamps, Return and Reassess patient
51
list 4 advantages of IV push method
- rapid onset - can be prepared quickly and given over shorter time than piggyback - doses of short acting meds can be titrated based on needs - method provides a more accurate dose of medication delivered because no med is left in intravenously
52
list 5 disadvantages of IV push method
- not all meds can be done through push - higher risk for infusion reactions (action peaks quickly) - less opportunity to stop injection if adverse rxn occurs - risk for infiltration and phlebitis is increased - H can cause immediate/delayed systemic rxn to a med, requiring supportive measures
53
how are IV push meds given?
either through an existing continuous IV infusion or an intermittent venous access (saline lock)
54
what is a saline lock
an IV catheter with a small "well" or chamber covered by a rubber cap
55
is the insulin bolus based on weight? is the heparin one?
the initial insulin bolus dose is NOT based on patient's weight, but the heparin bolus dose is
56
what is the insulin bolus dose based on? is a bolus dose always required?
a patient's glucose levels. no, a bolus dose is not always required
57
you dont start an insulin infusion until when?
until the glucose is under 6. goal is 6-10mmol/L
58
what BG do you call the doctor and initiate the protocol?
less than 2.8 (IH is 2.6)
59
what do you need to make sure of when you bolus dextrose?
use separate lumen**
60
T or F you can interrupt an insulin line
FALSE, you cannot. if you have one lumen, you need to start a new line, if you have more than one lumen, then you can use the same line
61
what are the primary methods for managing acute DVT and PE?
heparin and warfarin sodium
62
heparin is used to prevent what
used to prevent recurrence of emboli but has no effect on emboli that are already present
63
how long is heparin continued for ?
until INR is within therapeutic range (2-2.5 typically)
64
how long must patients continue to take an anticoagulant after an embolic event?
for atleast 3-6 months
65
if patient doesnt have diabetes, what level of insulin infusion do they start at
start at lowest level, level 1
66
for both heparin and insulin protocols, what is the 3 sequential actions?
1. bolus 2. continuous infusion 3. re-bolus and adjust infusion rate
67
for 1st action, bolus, describe it
determine need for a bolus dose according to pt condition specified in protocol. A bolus dose is a large dose of medication given to rapidly achieve the needed therapeutic concentration in bloodstream
68
describe the 2nd action of continuous infusion
acquire right concentration of the continuous solution from the pharmacy, calculate the amount required to provide ordered dosage and calculate and set the flow rate as determined by protocol
69
describe the 3rd action of rebolus/adjust infusion rate
based on patient monitoring, determine whether an additional bolus is needed or whether the continuous infusion rate needs to be increased, decreased or d/c
70
what is the antidote for heparin sodium OD?
protamine sulfate
71
what is a patient with insulin drip at risk for?
hypokalemia (watch K levels)
72
how long is a mixed bag good for?
24hrs
73
what is IV direct?
The administration of a medication via syringe over a specific period of time (greater than 1 minute).
74
for continuous infusion only, when adding medication to a bag, what do you need to consider?
if the added volume of medication is 10% or greater than the bag volume, withdraw the volume to be added before adding the medication to the IV bag. If the medication volume to be added is less than 10%, there is no need to withdraw any fluid from the bag.
75
what should you know regarding vesicant drugs and where to administer them?
never admin vesicant drugs in peripheral IV's if longer than 12 hours, use central access
76
prior to peripheral administration of vesicant drugs, what should you do?
initiate a new IV site to ensure correct catheter placement and vein patency. Vein wall integrity may be weakened in previously used IV sites.
77
define compatibility
The ability of a medication to retain its properties when combined with a diluent such as normal Saline
78
define stability
The ability of substances to remain unchanged in the presence of other substances
79
medical management for anaphylaxis
``` Remove the antigen/STOP INFUSION Stay with patient Call for help (CALL A CODE) Apply Oxygen Vitals, Spo2, assess ABC Keep the vein open/ start IV Emotional support ```
80
what's the purpose of adding medication to a primary bag?
1) Maintain a constant level of medication in the client's blood stream 2) Provide medication at a continuous slow rate
81
name 6 common antigens for anaphylaxis
Foods (peanuts, shrimp, fish. milk), diagnostic agents, vaccines, Latex, insect stings, medications – penicillin, sulfa, lidocaine, Latex, insect sting
82
name specific medications that can cause anaphylaxis
Antibiotics especially penicillins, NSAIDs, opioids, salicylates, anesthetic agents, drugs from animal sources: insulin, hormone and enzymes. Contrast agents used in radiology and antibiotics cause the most severe reaction
83
what is speed shock
A systemic effect that occurs when an IV medication is given too rapidly causing the plasma levels to rise too fast and be at toxic level
84
how do you flush a line if administering incompatible medications back to bad?
Run 30 mls solution from new mini bag (can back flush method if primary bag solution is compatible)
85
when is diluting a syringe allowed?
only when its less than 1ml!! label your syringe. not recommended to dilute, just done to make the post flushing calculation easier to calculate
86
describe the sandwich technique
- PINCH throughout entire process - Aspirate if CVAD - Flush 10 ml Normal Saline - Medication administration - Flush 10 ml Normal Saline at same rate initially as medication administration - Release pinch
87
what is your goal for giving heparin in terms of PTT
having a therapeutic PTT 1.5-2 times the normal level
88
When would anticoagulant therapy be contraindicated?
-Recent CVA, surgery or biopsy within 8hrs, puncture of vessels. Active bleeding Allergy Abnormal liver function History of HIT (can never receive heparin again in their life) but can receive different type of anticoagulation therapy
89
nursing care for heparin
``` -Monitor FOR BLEEDING: Incisions, IV & drain sites, mouth, gums, nares, GI, GU, brain, bruising and flank pain Always know the PTT No IM injections Use only electric razors Client teaching Alerts for other med orders e.g. ASA May need to D/C Heparin for procedures ( D.O or policy) ```

N243 (2 decks)

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