Medication Administration Routes
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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?

    <p>Patchy air entry</p> Signup and view all the answers

    What is the characteristic temperature pattern in Pneumonia?

    <p>Hot</p> Signup and view all the answers

    What is the characteristic crackle pattern in Heart Failure?

    <p>Present with HF, otherwise clear</p> Signup and view all the answers

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

    <p>Decreased</p> Signup and view all the answers

    What is the characteristic wheezing pattern in COPD?

    <p>Must have air entry to wheeze</p> Signup and view all the answers

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

    <p>Increases preload, transmural pressure, and afterload</p> 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?

    <p>Capnograph: “sharkfin” waveform</p> Signup and view all the answers

    How does NIPPV/CPAP help improve alveolar aeration?

    <p>By recruiting and stabilizing collapsed alveoli</p> Signup and view all the answers

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

    <p>Decreased pulmonary compliance</p> Signup and view all the answers

    How does NIPPV/CPAP affect afterload?

    <p>Decreases afterload by reducing intrathoracic pressure</p> Signup and view all the answers

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

    <p>By recruiting and stabilizing collapsed alveoli</p> 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?

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

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

    <p>Pulmonary edema with hemodynamic instability</p> Signup and view all the answers

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

    <p>It can result in 5 points.</p> Signup and view all the answers

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

    <p>It is classified as STEMI.</p> Signup and view all the answers

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

    <p>It can imply a potential myocardial infarction.</p> Signup and view all the answers

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

    <p>All three criteria carry equal weight in the Smith criteria.</p> Signup and view all the answers

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

    <p>ST elevation in aVR.</p> 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?

    <p>80% sensitive and 99% specific.</p> Signup and view all the answers

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

    <p>105 mg</p> Signup and view all the answers

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

    <p>3,750 mg</p> Signup and view all the answers

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

    <p>0.4 mg</p> Signup and view all the answers

    What defines a posterior STEMI based on the content provided?

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

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

    <p>0.6 mg</p> Signup and view all the answers

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

    <p>1 mcg</p> Signup and view all the answers

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

    <p>0.1 mg</p> Signup and view all the answers

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

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

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

    <p>2.5 mg</p> Signup and view all the answers

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

    <p>0.72 mg</p> Signup and view all the answers

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

    <p>Intraosseous (IO)</p> Signup and view all the answers

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

    <p>Previous mastectomy</p> Signup and view all the answers

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

    <p>Administer the medication in two separate doses</p> Signup and view all the answers

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

    <p>All of the above</p> Signup and view all the answers

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

    <p>When the medication is for a systemic effect</p> Signup and view all the answers

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

    <p>To ensure the medication is administered safely and effectively</p> Signup and view all the answers

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

    <p>Vastus lateralis muscle</p> 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?

    <p>Intravenous (IV)</p> 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.

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