ATI RN Pharmacology for Nursing (8th ed.) PDF

CHAPTER 4 UNIT 1 PHARMACOLOGICAL PRINCIPLES WAYS TO ADMINISTER IV MEDICATIONS CHAPTER 4 Intravenous Therapy Give the medication the pharmacist mixed in a large...

CHAPTER 4 UNIT 1 PHARMACOLOGICAL PRINCIPLES WAYS TO ADMINISTER IV MEDICATIONS CHAPTER 4 Intravenous Therapy Give the medication the pharmacist mixed in a large volume of fluid (500 to 1,000 mL) as a continuous IV infusion, such as potassium chloride and vitamins. Deliver the medication in premixed solution bags from Intravenous therapy involves administering fluids the medication’s manufacturer. via an IV catheter to administer medications, Administer volume-controlled infusions. Give an IV bolus dose. supplement fluid intake, or give fluid replacement, electrolytes, or nutrients. TYPES OF IV ACCESS Nurses administer large-volume IV infusions on a Peripheral or central venous access continuous basis. GUIDELINES FOR SAFE IV Nurses or pharmacists mix IV medication in a MEDICATION ADMINISTRATION large volume of fluid to give as a continuous Use an infusion pump to administer medications that can cause serious adverse reactions. Never administer IV infusion or intermittently in a small amount them by IV bolus. Double-check the dose prescribed, the of fluid. Nurses also administer medications as dilution or amount of fluid, and the rate at which to give the medication. an IV bolus, giving the medication in a small Add medications to a new IV fluid container, not to an IV amount of solution, concentrated or diluted, container that is already hanging. Never administer IV medications through tubing and injecting it over a short time (1 to 2 min or that is infusing blood, blood products, or parenteral longer, depending on the medication). nutrition solutions. Verify the compatibility of medications with IV solutions REFER TO FUNDAMENTALS FOR NURSING, CHAPTER 49: before infusing a medication through tubing that is INTRAVENOUS THERAPY FOR IV PROCEDURAL GUIDELINES. infusing an IV solution. Perform any assessments required prior to DESCRIPTION OF PROCEDURE administration, based on the medication, and determine if continuous monitoring is required during The provider prescribes the type of IV fluid, the volume administration (ECG). to infuse, and either the rate at which to infuse the IV Use the IV port closest to the client to administer fluid or the total amount of time it should take to infuse the medication. the fluid. The nurse regulates the IV infusion, either Ensure the IV is patent prior to administration. If the with an IV pump or manually, to be sure to deliver the client does not have IV fluids infusing or has fluids that right amount. are not compatible with the medication, flush the IV access before and following administration. ADVANTAGES Specific considerations Rapid effects Precise amounts Older adult clients, clients who are taking Less discomfort after initial insertion anticoagulants, and clients who have fragile veins Constant therapeutic blood levels ◯ Avoid tourniquets. Use a blood pressure cuff to help Less irritation to subcutaneous and muscle tissue visualize, but not overdistend, the veins to help Permits the use of large volumes of fluid for medications prevent hematoma formation. that are poorly soluble and need larger amounts of fluid ◯ Do not slap the extremity to visualize veins. to dissolve ◯ Instruct the client to hold their hand below the Permits the use of medications that contain irritant level of the heart to help distend and thus visualize properties, such as chemotherapy the veins. ◯ Avoid using the back of the client’s hand. ◯ Avoid rigorous friction while cleaning the site. DISADVANTAGES Edema in extremities Circulatory fluid overload is possible if the infusion is ◯ Apply digital pressure over the selected vein to large or too rapid. displace edema. Immediate absorption leaves little time to correct errors. ◯ Apply pressure with an alcohol pad. IV fluid administration can irritate the lining of the vein. ◯ Cannulate the vein quickly. Failure to maintain surgical asepsis can lead to local Clients who are obese: Use anatomical landmarks to and systemic infection. find veins. RN PHARMACOLOGY FOR NURSING CHAPTER 4 INTRAVENOUS THERAPY 35  COMPLICATIONS Application Exercises Complications require notification of the provider and complete documentation. Use new tubing and catheters for 1. A nurse is caring for a client experiencing IV restarting IV infusions after detecting complications. extravasation. The facility requires the administration of an antidote for the prescribed IV solution. Infiltration (infiltration of a nonvesicant solution) After stopping the IV infusion, which of the following actions should the nurse take first? FINDINGS: Pallor, local swelling at the site, decreased A. Remove the IV catheter. skin temperature around the site, damp dressing, B. Withdraw the solution from the IV access. slowed infusion C. Administer the antidote to the vesicant. TREATMENT D. Insert a new IV access in a different extremity. Stop the infusion and remove the catheter. Elevate the extremity. Encourage active range of motion. 2. A nurse is preparing to initiate IV therapy for Apply a cold or warm compress depending on the type an older adult client. Which of the following of solution that infiltrated the tissue. actions should the nurse plan to take? Check with the provider to determine whether the A. Use a disposable razor to remove client still needs IV therapy. If so, restart the infusion excess hair on the extremity. proximal to the site or in another extremity. B. Select the back of the client’s hand to insert the IV catheter. PREVENTION C. Distend the veins by using a blood pressure cuff. Carefully select the site and catheter. Secure the catheter. D. Direct the client to raise their arm above the heart. Inspect IV infusion site frequently for any findings of infiltration. 3. A nurse assessing the IV catheter insertion site for a client receiving a nonvesicant solution and Extravasation (infiltration of a vesicant notes swelling at the site with decreased skin or tissue-damaging medication) temperature. Which of the following actions should the nurse take? (Select all that apply.) FINDINGS: Pain, burning, redness, swelling A. Stop the infusion. TREATMENT B. Start a new IV access distal to this site. Stop the infusion and notify the provider. C. Apply warm compresses to the insertion site Follow the facility’s protocol, which can include withdrawing the vesicant solution from the IV D. Elevate the client’s arm. access and infusing an antidote through the catheter E. Obtain a specimen for culture at the insertion site. before removal. Further treatment is the same as for IV infiltration. PREVENTION Closely monitor the IV site and dressing. Active Learning Scenario Always use an infusion pump. A nurse on a medical-surgical unit is providing care for a Other complications group of clients who are receiving IV therapy. The nurse is assessing the clients for complications. Use the ATI Active Catheter embolus, phlebitis/thrombophlebitis, cellulitis, Learning Template: Nursing Skill to complete this item. fluid overload INDICATIONS: Identify three indications for IV therapy. NURSING ACTIONS: Provide treatment according to facility protocol. POTENTIAL COMPLICATIONS: Identify four potential complications of IV therapy. 36 CHAPTER 4 INTRAVENOUS THERAPY CONTENT MASTERY SERIES  Application Exercises Key Active Learning Scenario Key 1. A. Remove the IV catheter because the IV access Using the ATI Active Learning Template: Nursing Skill is no longer functional. However, the nurse INDICATIONS should take another action first. To administer medications B. CORRECT: According to evidence-based practice, To supplement fluid intake the nurse should first withdraw the solution from the IV access. This reduces the amount of vesicant in the To replace electrolytes and nutrients body, and lowers the risk of tissue damage. POTENTIAL COMPLICATIONS C. Administer the antidote to the vesicant to reduce the Infiltration risk of damage to the subcutaneous tissue. However, Extravasation the nurse should take another action first. Cellulitis D. Insert a new IV access in a different extremity to ensure the client receives the prescribed IV therapy. However, Fluid overload the nurse should take another action first. Catheter embolus Phlebitis, thrombophlebitis NCLEX Connection: Pharmacological and Parenteral Therapies, ® Parenteral/Intravenous Therapies NCLEX® Connection: Pharmacological and Parenteral Therapies, Parenteral/Intravenous Therapies 2. A. Remove excess hair by clipping it with scissors. Shaving with a disposable razor can cause skin damage that can lead to infection. B. In most instances, the IV catheter is inserted into a distal site, such as the back of the client’s hand. However, when inserting an IV catheter for an older adult, the nurse should select a site on the arm because older adults typically have fragile veins in the back of their hands. C. CORRECT: Distend the veins using a blood pressure cuff to reduce overfilling of the vein, which can result in a hematoma. D. Direct the client to hold their arm below the level of the heart to distend the vein. NCLEX® Connection: Pharmacological and Parenteral Therapies, Parenteral/Intravenous Therapies 3. A. CORRECT: Decreased temperature and swelling at the insertion site are manifestations of IV infiltration. Stop the infusion and start a new line in the other extremity. B. If the provider still requires the client to have an IV, insert a new one in a site more proximal to the body. C. CORRECT: Apply a warm or cold compress for a client who is experiencing manifestations of an IV infiltration, depending on the solution. D. CORRECT: Elevate the arm of a client who is experiencing edema with an infiltration. E. Obtain a specimen for culture and send the catheter to the laboratory for culture for the client experiencing phlebitis. NCLEX® Connection: Pharmacological and Parenteral Therapies, Parenteral/Intravenous Therapies RN PHARMACOLOGY FOR NURSING CHAPTER 4 INTRAVENOUS THERAPY 37 38 CHAPTER 4 INTRAVENOUS THERAPY CONTENT MASTERY SERIES