Exam 1 Medication Administration PDF

Exam 1 Contents: Medication Administration ❖ The Six Rights 1. RIGHT MEDICATION 2. RIGHT PATIENT 3. RIGHT TIME 4. RIGHT DOSE 5. RIGHT ROUTE 6. RIGHT DOCUMENTATION(2002) #7. The right form of med) ❖ Routes of Administration There are sever...

Exam 1 Contents: Medication Administration ❖ The Six Rights 1. RIGHT MEDICATION 2. RIGHT PATIENT 3. RIGHT TIME 4. RIGHT DOSE 5. RIGHT ROUTE 6. RIGHT DOCUMENTATION(2002) #7. The right form of med) ❖ Routes of Administration There are several routes of administrating medications: The Oral Route has a slower onset of action/more prolonged effect, including: Oral: swallowed with fluid Sublingual: under the tongue Buccal: against the mucous membrane of the cheek Topical includes: Inhalations: Nebulizer or positive pressure breathing apparatus Dermatological: Dermatologic preparations: Applied to the skin Installations & irrigations: Urinary bladder, eyes, ears, nose, rectum, vagina – Ear – otic instillations- Straighten the ear canal of an adult by pulling the pinna up and back. Irrigations: The washing out of a body cavity using a stream of water or other ma Installations: a method used to put a liquid into the body slowly or drop by drop.edicated/ non-medicated fluid, often using a syringe. Suppository: Should be passed about 4 inches deep (10 centimeters) for an adult. 2 inches or 5 centimeters in a children Parenteral includes: SQ, IM, Intradermal & IV Any medication given by injection Meds given by the parenteral route are more easily absorbed The four major sites are: – Intradermal- just below the epidermis – Subcutaneous- fatty tissue just below the dermis – Intramuscular – into muscle – Intravenous- into a vein IV sites: Central Venous Lines (CVL) Usually placed in the subclavian or internal jugular veins Always initiated by a physician How to flush lines: Peripheral Lines: 3-5 MLS Central lines, every port you must flush 10 ml of normal saline SAS method – S: saline to confirm patency & Placement – A: administration of medication – S: saline to flush medication AND to maintain patency of the device ***IV Complications*** Infection: occurs when microorganisms invade the IV line, port, or skin on the site of injection. can be prevented with proper sterilization and hygiene. Symptoms: Local: pain, warmth, edema, malodorous drainage, induration Systemic: fever, chills, malaise, elevated WBC *Phlebitis Occurs when the cannula is too large for the vein or if it's improperly secured Symptoms: Erytherna. edema. warmth. and pain The vein may be indurated Might observe a streak in the superficial vein *Infiltration Occurs When IV fluids or medications leak out of the vein and into the surrounding tissue. Symptoms: swelling, damp site, cold to touch, pain Slowed rate of IV infusion (fluid may leak from IV site) *Extravasation Another type of infiltration: occurs when a vesicant agent in the IV leaks into surrounding tissues and causes serious tissue damage. Symptoms: pain, edema, burning, erythema Formation of blisters, necrotic tissue, slough or eschar Hematoma: Occurs when the IV anagiocatheter passes through more than one wall of a vein or if pressure is not applied to the IV site when the catheter is removed Symptoms: Swelling, pain, ecchymosis Air embolism: Occurs when air enters the venous system from the IV catheter and circulates. Symptoms: Hypotension, tachycardia, difficulty breathing, cyanosis Managing Peripheral IVs & Central Lines Blood Transfusion Change the Y tubing set if used for more than 2 hours. Isotonic fluid 0.9% sodium chloride Normal saline is the only iv solution given with blood. Blood components: Plasma 55%, red blood cells 40-45%, white blood cells and platelets: 6 months: Limited, intermittent, or persistent Origin of pain: Cutaneous: superficial pains. Skin to subcutaneous Visceral: organ pains (kidney and stomach pains) Deep or Somatic pains: bones or muscle. Tendons ligaments, blood vessels nerves. Tends to be chronic. Referred – felt in part of the body removed from the actual origin Radiating – felt at the source and extends to nearby tissue Intractable – highly resistant to relief measures. Neuropathic – felt as a result of disturbance of the CNS Phantom – pain sensation perceived in missing body part Psychogenic – from a non-physical source The mechanism or process of pain is believed to involve four stages: Transduction: Defined as the activation of pain receptors. Involves the conversion of painful stimuli into electrical impulses that travel to the spinal cord Transmission: Pain sensations are conducted along pathways of nerve endings. Fast-conducting A-delta-fibers (acute, well-localized cutaneous pain).A-delta fibers respond to mechanical (pressure) stimulus and produce the sensation of sharp, localized, fast pain. Slow C-fibers (diffuse, visceral pain) Why would the doctor order different analgesics based on that? The fast pathway records sharp, localized pain (such as that caused by cutting your skin) and transmits this information to the cortex in less than a second. The slow pathway travels through the limbic system, a detour that delays arrival at the cortex by seconds. Perception Modulation Immobility ❖ Patient Assessment ◼ Range of motion (ROM) of joints. To prevent stiffness. ROM can be active or passive (if we stretch the limbs for them) ◼ Gait: ability and manner of walking ◼ Exercise: physical activity ◼ Activity Tolerance: type and amount. Let them do whatever they can to their tolerance. ◼ Body Alignment: normal and abnormal Nursing Diagnosis: Ex: Impaired physical mobility. Risk for disuse syndrome(irreversible) (bring very stiff or contracture)(Immobile Patients at risk for this) ❖ Complications of Immobility + Nursing Interventions The GI system goes slowly. Musculoskeletal: Muscle weakness and atrophy. Active ROM or Passive ROM 3-4 times daily.Positioning - Body Alignment. Utilize Assistive Devices: ❑ Foot Board ❑ Trochanter Roll ❑ Hand Rolls ❑ Foot Boots ❑ Pillows, wedges Respiratory: pneumonia, pulmonary embolism. Promote expansion of the chest and lungs. Prevent stasis of pulmonary secretions. Maintain patent airway. Promoting the adequate exchange of respiratory gases Skin: Skin ulcers Metabolic: Glucose intolarnce. High-protein, high-calorie diet with vitamin B & C supplements. Monitor dietary intake. Calorie Count when appropriate. Dietary Consults. Cardiovascular: Postural hypertension, DVT, cardiac muscle atrophy. Monitor BP/Pulse/Peripheral pulses. Monitor for edema. Monitor for DVT. ❖ Treatment of Pressure Ulcers PREVENTION ◼ Conservative ❑ Cleansing (irrigation w/ syringe or hydrotherapy) ❑ Dressing Changes ◼ Aggressive ❑ Debridement (Chemical and/or surgical) ❑ Surgical Repair (flap repair) *Moisture causes skin breakdown * Wounds All wound care treatments are doctors' orders. Neoplasms are the most common skin cancer. Wounds, any alteration in the integrity of skin. Acute and chronic pain. Different stages of pressure wounds 1-4 Stage 1 Pressure Injury: Intact skin with a localized area of nonblanchable erythema, which may appear differently in darkly pigmented skin. The presence of blanchable erythema or changes in sensation, temperature, or firmness may precede visual changes. Color changes do not include purple or maroon discoloration; these may indicate deep tissue pressure injury. Stage 2 Pressure Injury Partial-thickness skin loss with exposed dermis Partial-thickness loss of skin with exposed dermis. The wound bed is viable, pink or red, and moist and may also present as an intact or ruptured serum-filled blister. Adipose tissue (fat) is not visible, and deeper tissues are not visible. Stage 3 Pressure Injury: Full-thickness skin loss Full-thickness loss of skin, in which adipose tissue (fat) is visible in the ulcer and granulation tissue and epibole (rolled wound edges) are often present. Slough and/or eschar may be visible. Stage 4 Pressure Injury: Full-thickness skin and tissue loss with exposed or directly palpable fascia, muscle, tendon, ligament, cartilage, or bone in the ulcer (see Fig. 48.4D). Slough and/or eschar may be visible. A clean surgical incision is an example of a wound with little tissue loss. The surgical incision heals by primary intention. The skin edges are approximated or closed, and the risk of infection is low. Healing occurs quickly, with minimal scar formation, if infection and secondary breakdown are prevented. In contrast, a wound involving loss of tissue such as a burn, Stage 2 pressure injury, or severe laceration heals by secondary intention. The wound is left open until it becomes filled by scar tissue. It takes longer for a wound to heal by secondary intention. Stage 1: just erythema of the skin. Stage 2: erythema with the loss of partial thickness of the skin including epidermis and part of the superficial dermis. Stage 3: full-thickness ulcer that might involve the subcutaneous fat. Stage 4: full-thickness ulcer with the involvement of the muscle or bone. How to measure wounds? In centimeters. Length by width by depth. How to describe the wound bed? Use coca (color, odor, consistency, amount) How to know if wounds are well-approximated? Wounds that fit neatly together are referred to as “well approximated.” This is when the edges of a wound fit neatly together, such as a surgical incision, and can close easily. Wound care uses sterile techniques Steroids thin skin, and depress the immune system Types of Exudates/Drainage Sanguineous: Composed of RBCs. Serous-sanguineous: Composed of serous and sanguineous drainage appearance (RBCs). Serous: Composed of the clear portion of blood. Purulent: Composed of WBCs and bacteria Wound Complications Infection Begins in 3-5 days for a surgical wound Begins in 2-3 days for a traumatic wound Increased amount of tissue drainage Inhibits the healing process Hemorrhage Maybe internal or external Internal – detected by localized swelling, hematoma or s/s of hypovolemic shock External – greatest risk during the first 48 hours. Maybe due to a dislodged clot, slipped suture or erosion of a blood vessel Dehiscence Partial or total disruption of a wound Often associated with: Coughing Sneezing Vomiting Obesity Poor nutritional status The client may report a sudden gush or that “something gave way” Evisceration Wound separates and organs protrude through the wound opening A true emergency Never attempt to replace organs. Cover with saline-soaked sterile towels Fistula Abnormal passage between two organs Usually the result of poor wound healing is caused by radiation, illness, trauma etc. Increases the risk of infection and skin breakdown from chronic drainage Nursing Care for Skin Alterations Assessment  Data collection regarding skin disease, lesions, condition and usual healing time Inspect and palpate surgical wound to determine appearance, drainage and pain level. Appearance assessment includes: Wound edges for approximation Color of wound and surrounding skin Diagnosis Impaired skin integrity Impaired tissue integrity Risk for infection Pain Drugs: Fentanyl patch or Duragesic: opioid class of drugs Furosemide or Lasix: loop diuretics (also known as water pills). Furosemide is given to help treat fluid retention (edema) and swelling that is caused by congestive heart failure, liver disease, kidney disease, or other medical conditions. Nitroglycerin: Antianginals nitrates. Nitrates are a class of medications that cause vasodilation. Nitrates exert their effects by dilating venous vessels, coronary arteries, and small arterioles; their maximal vasodilation is in the venous vessels. Pantoprazole or Protonix: Antiulcer agents, & Proton pump inhibitors (PPIs) are a group of medicines that decrease stomach acid production. They can help relieve symptoms of chronic acid reflux Solumedrol or Medrol: a synthetic corticosteroid used for severe or incapacitating allergic conditions, dermatologic diseases, endocrine disorders, gastrointestinal diseases, rheumatic disorders, and several other conditions. IV and TPN: Change IV every 72 hrs, change piggyback every 24 hours. Total Parenteral Nutrition (TPN): Last resort when the GI tract system is not working or needs rest. Change every 24 hours (unless milky, every 6 hours) D10 is the replacement for TPN TPN has sodium, potassium, regular insulin, vitamins, and minerals. Check the patient's blood sugar regularly, and monitor intake and output I&O. In some instances, parenteral nutrition may be given through peripheral venous access. While it may be ordered on total parenteral nutrition orders, it is actually PPN – peripheral parenteral nutrition or partial parenteral nutrition because it has fewer nonprotein calories as a lower concentration of dextrose is used. PPN should only be administered as short-term therapy. PPN solutions should have only 5% to 10% dextrose and 2 to 4% amino acids. In general, the osmolarity of peripheral parenteral solutions should not exceed 800. labs: WBC- 5000-10000 RBC- 4.7-6.1 male. 4.2-5.4 female Hemaglobin- 14-18 male. 12-16 female Hematocrit- 42-52% male- 37-47% female Platelet count- 150,000-400,000 INR of 1.1 or below The international normalized ratio (INR) blood test tells you how long it takes for your blood to clot. International normalized ratio (INR) is the preferred test of choice for patients taking vitamin K antagonists (VKA). It can also be used to assess the risk of bleeding or the coagulation status of the patients.