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Six rights to med admin

right client, drug, dose, time, route, documentation

Three med checks

when taking med from IV storage area the client's drawer or the fridge, before spiking IV bag with tubing either at client bedside or when preparing med at cart, when hanging med on IV pole in client's room

Two ID checks

compare MAR to ID bracelet, ask client to state his name

Gravity drip infusions

must calculate the flow rate, drops per minute, and manually count the drops using a watch

Continuous drip pump infusions

know how to operate the pumps

Intermittent infusions

recur on a regular basis such as every 6 hours, must be able to backflush the intermittent infusion tubing nad set the medication to run over the prescribed time

Direct IV push medications

must always look up the action, onset, peak, duration, and rate of admin in a drug book, check the dilution requirements and fluid incompatibilities of the medication, and monitor the client for incompatabilities or reactions during the med admin

Additional checks for IV fluids for administration

check the clarity of the soln, expiration date, compatabilities of additives and medications, and the correct volume to be administered over the correct time

Steril econnections

IV fluids and IV tubing have this. Must pay attention to sterility to avoid contaminating this when changing out the fluids

Instantaneous effects

IV solutions and fluids have this. Therefore, use meticulous care and med checks when administering them, including checking for allergies

Nursing responsibility

monitoring and maintenance of IV site and insertion site care

Provider with prescriptive authority

IVs are ordered by this person and the order must be legible, complete with a date and signature, and be written for the correct client

Complications of IV therapy

infection, phlebitis, infiltration, air embolism, thrombophlebitis, circulatory overload

Phlebitis

inflammation of the vein with tenderness, redness, and warmth possible

Infiltration

leakage of fluid from the vein causing a cool, hard, swollen, and painful area

Air embolism

20 mL/sec required in peripheral line

Thrombophlebitis

blood clot with inflammation

IV meds

may be mixed by pharmacy or you may prepare them, depending on agency policy

Blood products

must be stored only in refridgerators and freezers monitored by the transfusion service.

Plasma derivatives

such as albumin are routinely stored at room temp and are commonly dispensed through the pharmacy or central stores

Nursing unit fridge or other unmonitored fridge

don't sotre blood precuts here

30 minutes

do not keep blood out of a monitored fridge for more than __ before the transfusion

warm blood

do not ____ blood in an unmonitored water back or sink or in a microwave

blood filter

don't administer blood without this

4 hours

do not use the same blood filter for more than __ hours

4 hours

do not transfuse a unit of blood for more than __ hours

add medications

don't __, including those used for IV use, to blood or components or infuse meds through the same admin set as the blood component

0.9% normal saline

do not allow any solution other than this to come in contact with the blood component or the admin set

blood bank

donot pick up a blood product from here until you confirm the order is signed by a provider, there is signed consent in the chart, the patient understands the procedure, and any premeds have been administered

transfusion reaction

when this occurs, stop the transfusion immediately!

.9% normal saline

with a reaction, keep the IV open with new IV tubing primed with this so no more blood is transfused

report

the reaction to the transfusion service and provider immediately

clerical check

do another one of these at bedside identifying tags and numbers

treat symptoms

per the provider's order ro agencypolicy and monitor vital signs including O2 sats

blood bag

sned this with attached admin set and labels to the transfusion service

blood and urine samples

collect these and sent to lab. Check with trnasufusion service to determine the specific ___ and ___ samples needed to evaluate reactions

document

the symptoms and your actions thoroughly on the transfusion reaction form and in the client chart

general

fever (rise of 1 degree C or 2 degrees F), chills, muscle aches or pain, back and chest pain, headache, heat at site of infusion or along vein

nervous system

apprehension, impending sense of doom, tingling, numbness

respiratory system

resp rate (tachypnea, apnea), dyspnea, cough, wheezing, rales

GI system

nausea, vomiting, pain, ab cramping, diarrhea (may be bloody)

CV system

heart rate (tachy or bradycardia), BP (hypo or HTN), peripheral circulation (color cyanoiss, facial flushing temp: cool/clammy, hot/flushed, dry, edema), bleeding (generalized, oozing at surgical site)

Renal system

changes in urine volume (oliguria, anuria, renal failure), changes in color (dark, concentrated, shades of red, brown, amber)

Integumentary system

rashes, hives, swelling, itching, diaphoreses

PCA

patient controlled analgesia

PCAs

used to provide legally controlled opiates IV to a client frm an external infusion pump

PCA

developed to provide a more finely titrated control of client pain and opiate serim levels in post op clients, but are now routinely also used for chronic pain management and clients with burns or trauma

Criteria for selection of PCA

moderate to severe pain requiring repeated doses, client is able to understand and follow directions, willing to use PCA therapy

Commonly used opiates

morphine, hydromorphone, meperidine

Cannot

the infusion pump program can/not be overridden by the client

PCAs

often used for post surgical pain management and may be initiated in the PACI when the client is still sedated. Must continue to re educate your clinet on how to use the PCA the entire time they have it

Oversedate

discourage family members from administering doses while the client is asleep as this may ___ them

Narcan

be aware of meds used to reverse or correct oversedation such as __, and where to locate them quickly

3 methods for deliverating PCA opiates

on demand only when the client uses the PCA button, as a continuous infusion scheduled to admin a dose of med to the clinet at pre programmed intervals aka basal infusion, a combination of both on demand and basal infusion

home health setting

here, PCAs are used SQ

hospitals

here, the IV route is used for PCAs

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