Medication Administration Routes

Questions and Answers

What is the characteristic sputum production in Heart Failure?

Yellow/green

Frothy (pink) (correct)

Blood-tinged

Clear

Which of the following is a risk factor for both Heart Failure and Acute Myocardial Infarction?

COPD

Hypertension (correct)

CAD

Pneumonia

What is the typical chest pain duration in Acute Myocardial Infarction?

Usually more than 20 minutes (correct)

Constant

Less than 20 minutes

Gradually worsening

What is the characteristic air entry pattern in Pneumonia?

Patchy air entry Signup and view all the answers

What is the characteristic temperature pattern in Pneumonia?

Hot Signup and view all the answers

What is the characteristic crackle pattern in Heart Failure?

Present with HF, otherwise clear Signup and view all the answers

What is the typical blood pressure pattern in severe shortness of breath?

Decreased Signup and view all the answers

What is the characteristic wheezing pattern in COPD?

Must have air entry to wheeze Signup and view all the answers

Which of the following is NOT a primary function of non-invasive positive pressure ventilation (NIPPV) / CPAP?

Increases preload, transmural pressure, and afterload Signup and view all the answers

Which of the following clinical findings suggests the potential need for NIPPV/CPAP in a patient with respiratory distress?

Capnograph: “sharkfin” waveform Signup and view all the answers

How does NIPPV/CPAP help improve alveolar aeration?

By recruiting and stabilizing collapsed alveoli Signup and view all the answers

Which of the following is NOT a potential benefit of NIPPV/CPAP in patients with respiratory distress?

Decreased pulmonary compliance Signup and view all the answers

How does NIPPV/CPAP affect afterload?

Decreases afterload by reducing intrathoracic pressure Signup and view all the answers

Which of the following describes the mechanism by which NIPPV/CPAP improves pulmonary compliance?

By recruiting and stabilizing collapsed alveoli Signup and view all the answers

Which of the following is a key characteristic of NIPPV/CPAP that distinguishes it from other forms of ventilation?

It provides high flow oxygen and constant positive airway pressures throughout the respiratory cycle. Signup and view all the answers

Which of the following would be a contraindication to the use of NIPPV/CPAP?

Pulmonary edema with hemodynamic instability Signup and view all the answers

What is the significance of a concordant ST elevation ≥ 1 mm in terms of scoring?

It can result in 5 points. Signup and view all the answers

According to the updated Smith criteria, what happens if the ST-QRS ratio is greater than 0.25?

It is classified as STEMI. Signup and view all the answers

What does excessive discordant ST elevation ≥ 5 mm suggest in the context of the QRS complex?

It can imply a potential myocardial infarction. Signup and view all the answers

How does the Smith criteria differ from the Sgarbossa’s criteria regarding point allocation?

All three criteria carry equal weight in the Smith criteria. Signup and view all the answers

Which of the following is an indicator of Left Main Disease?

ST elevation in aVR. Signup and view all the answers

In the context of diagnosing myocardial infarction in patients with known LBBB, what is the sensitivity and specificity of having any single criterion present?

80% sensitive and 99% specific. Signup and view all the answers

Which dosage of Acetaminophen IV should be administered for a child weighing 15.4 lbs (7 kg)?

105 mg Signup and view all the answers

What is the maximum total dose of Acetaminophen IV that can be given in a single day?

3,750 mg Signup and view all the answers

For a child weighing 22 lbs (10 kg), how much Epinephrine IV should be administered?

0.4 mg Signup and view all the answers

What defines a posterior STEMI based on the content provided?

ST elevation of ≥0.5 mm in leads V7, V8, V9 Signup and view all the answers

What is the dose of Midazolam to be given to a child weighing 30 lbs (14 kg)?

0.6 mg Signup and view all the answers

How should Fentanyl be administered for a child weighing 9 kg?

1 mcg Signup and view all the answers

What is the minimum dose of Diphenhydramine that can be administered to a child?

0.1 mg Signup and view all the answers

In the context of cardiac conditions, which ST elevation criteria applies to women?

1.5 mm STE in V2 or V3, 1 mm in other lead Signup and view all the answers

What is the maximum single dose of Midazolam that can be given?

2.5 mg Signup and view all the answers

How much Naloxone should be administered for a child with a weight of 40 lbs (18 kg)?

0.72 mg Signup and view all the answers

A patient has a fractured proximal humerus. Which route of medication administration is contraindicated?

Intraosseous (IO) Signup and view all the answers

Which of the following is NOT a contraindication for IO access?

Previous mastectomy Signup and view all the answers

When administering a medication intranasally, what should be done if the total volume exceeds 0.4 mL?

Administer the medication in two separate doses Signup and view all the answers

Which of the following is a critical step to take before administering a medication intravenously?

All of the above Signup and view all the answers

In which situation would an intramuscular (IM) injection be preferred over an intranasal (IN) injection?

When the medication is for a systemic effect Signup and view all the answers

What is the purpose of the Medication Administration Cross-Check Procedure (MACC)?

To ensure the medication is administered safely and effectively Signup and view all the answers

What is the recommended site for an intramuscular injection in adults?

Vastus lateralis muscle Signup and view all the answers

Which of the following routes of medication administration is most likely to be associated with rapid onset of action?

Intravenous (IV) Signup and view all the answers

Study Notes

Drug Routes

IN route is generally preferred over IM unless contraindicated
IN or NAS routes: use nostrils for secretions/obstructions, suction, and remove NPA; max 1 mL/nostril
IM preferred site: Vastus Lateralus muscle in mid-anterolateral thigh
IO approved sites: Proximal humerus, proximal tibia, distal tibia, and distal femur (depending on age)
IV selection: based on vein condition, purpose (fluid/drugs to be infused), patient age/size, clinical status, and presence of special vein & skin problems

7 RIGHTS of Medication Administration

RIGHT Patient: Confirm absence of allergy
RIGHT Drug: Check package/drug container for name, concentration, integrity/sterility of parenteral medication, and expiration date
RIGHT Dose: Prepare dose in compliance with SOP/OLMC, with consideration for controlled substances, IV inopressors, and high-risk meds
RIGHT Route: Verify correct route of administration
RIGHT Time: Verify correct time of administration
RIGHT Response: Monitor for desired response and side effects
RIGHT Documentation: Accurately document medication administration

Medication Doses for Pediatrics

Acetaminophen IV: 15 mg/kg, max dose 750 mg, max daily dose 3750 mg
Adenosine: 0.1 mg/kg, max 6 mg
Amiodarone: 5 mg/kg
Atropine: 0.02 mg/kg
Diphhenhydramine: 1 mg/kg, max 50 mg
Epinephrine: 0.01 mg/kg IM/IN, max 0.3 mg

ECG Interpretation

STEMI:
- Men < 40: 2.5 mm STE in V2 or V3, 1 mm in any other lead
- Men ≥ 40: 2 mm STE in V2 or V3, 1 mm in any other lead
- Women: ≥ 1.5 mm STE in V2 or V3, 1 mm in any other lead
Posterior STEMI:
- ST depression in leads V1, V2, V3 (V4?)
- Tall, broad R waves (dominant in V2)
- Upright T waves
LBBB:
- Smith criteria:
  - Concordance: ST segment is in the same direction as the QRS
  - Discordance: ST segment is in the opposite direction to the QRS
- Appropriate discordance: ST segments in all leads should be discordant to the majority direction of the QRS

Differential Diagnosis for SOB

HF/PE:
- S&S: SOB, cough, sputum, fever, sweats, chest pain
- Sputum: Frothy (pink)
- Chest pain duration: Variable
- Hypertension: + Risk
AMI:
- S&S: SOB, cough, sputum, fever, sweats, chest pain
- Chest pain duration: Usually > 20 min
- Hypertension: + Risk
COPD:
- S&S: SOB, cough, sputum, wheezing, cyanosis
- Sputum: Clear
- Chest pain: -
- Hypertension: -
Pneumonia:
- S&S: SOB, cough, sputum, fever, sweats, chest pain
- Sputum: Yellow/green
- Chest pain duration: Gradually worsening
- Hypertension: -

Non-Invasive Positive-Pressure Ventilation (NIPPV) / CPAP

Primary functions:
- Provides high flow O2 and constant positive airway pressures throughout inspiration and expiration
- Improves pulmonary compliance and keeps distal airways open longer
- Recruits and stabilizes collapsed alveoli
- Reduces inspiratory work and relieves respiratory muscle fatigue

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Description

This quiz covers the different routes of medication administration, including intranasal, intramuscular, and intravenous routes, highlighting important considerations and contraindications.