College of Nursing Adult Health Nursing II Block
College of Nursing Adult Health Nursing II Block 7. 0 Topic: IV Medication Administration Module: 1. 2
IV Medication Administration Block 7. 0 Adult Health II Block 7. 0 Module 1. 2
Learning Outcomes § Apply the principles of safe intravenous medication administration. § Apply knowledge of dosage calculations to determine correct medication dosages for patients. § Develop an individualized plan for each patient’s education about intravenous medication administration. § Identify nursing responsibilities for the patient experiencing an adverse drug reaction § Manage a patient on multiple IV drugs that are incompatible § Demonstrate appropriate documentation. § Be prepared to discuss key terms. Block 7. 0 Module 1. 2
Key Terms § § § § Extravasation Vesicant medications Infiltration Phlebitis Thrombosis Thrombophlebitis IV Drug Compatibility Block 7. 0 Module 1. 2
IV Drug Therapy § Most rapid therapeutic effect § Can lead to immediate serious reactions § Nurse must know: § Drug indications & proper dosage § Contraindications & precautions § Appropriate dilution, rate of infusion, p. H & osmolarity, compatibility with other IV meds § Never assume that IV administration is the same as giving the drug by other routes Block 7. 0 Module 1. 2
IV MED ADMINISTRATION § Six rights of med administration: § § § Right drug Right dose Right route Right time Right patient Right documentation § Document on the MAR immediately after giving § If you did not give the med, indicate on the MAR & document in the nurse’s notes why you did not give the med Block 7. 0 Module 1. 2
IV MED ADMINISTRATION § Do 3 checks on the first 5 rights: § Check #1: Compare the med label to the MAR as you remove the drug from the storage area § Check #2: Compare the med label to the MAR as you prepare each drug § Check #3: Compare the med label to the MAR at the patient’s bedside before you give each drug Block 7. 0 Module 1. 2
Premedication Assessment § Reduces risk of adverse advents § Provides baseline for evaluating IV med intervention § Review: § § Health history esp. drug allergies & current labs Medication data contraindications to IV med Vital signs Physical assessment check IV site for redness, swelling, drainage § Patient’s learning needs Block 7. 0 Module 1. 2
Preparing Drugs § Most IV drug solutions are prepared in the pharmacy § If nurse prepares, drug for IV administration, follow these safety rules: § Check expiration date § Maintain sterile technique § Inspect the drug, dilutent and solution for particles or cloudiness Block 7. 0 Module 1. 2
Reconstituting Powdered Drugs § Common diluents § Normal Saline (0. 9%) § Sterile Water for injection § Dextrose 5% in water § Some drugs come in double chambered vials, one with powder, one with diluent § Solution containers must be labeled § § Patient’s name Room number Date Name and amount of solution and drug Block 7. 0 Module 1. 2
Labeling Reconstituted Drugs § § § Name of the drug Concentration of the drug. Type of diluent used to reconstitute the drug. Expiration date and time of the drug. Any other important details - for example, if there are different reconstitution directions for IV and IM used, we should indicate whether the medication is for IM or IV use. § Initials or name of RN reconstituting drug (depending upon hospital policy). Block 7. 0 Module 1. 2
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Reconstitute Kefzol What is the diluent? ____________ What is diluent volume? ______ What is reconstituted volume? ____ What is solution concentration? _______ Block 7. 0 Module 1. 2
Adverse Reactions § Severe adverse reactions may occur quickly § Hypersensitivity to IV drugs can occur immediately § The most severe reaction is anaphylaxis § Dramatic, acute reaction § Marked by sudden onset of rapid, progressive urticaria and respiratory distress § The most common anaphylaxis-causing drug is Penicillin § It causes a reaction in 1 to 4 persons out of 10, 000 § Is most likely to occur after parenteral administration Block 7. 0 Module 1. 2
IV Meds Compatibility Refers to the chemical stability of 2 or more IV meds when administered together. IV drug compatibility is defined as: § No visible or electronically detection of particulate formation, haze, precipitation, color change, or gas evolution; and § Stable (<10% decomposition) for at least 24 hr in admixture When administering 2 or more IV meds in one IV line, determine the compatibility of each med with the other. Block 7. 0 Module 1. 2
Compatibility Chart Block 7. 0 Module 1. 2
Managing Drug Incompatibility Problems with giving multiple, incompatible IV drugs on time: § Too many IV drugs scheduled at same time or too close together § Patient has limited # of IV access ports Resolution: § Stagger IV drugs for time management discuss with pharmacy § Flush IV line with NS if multiple IV drugs scheduled close together § Suggest placement of 2 -3 lumen PICC or central line Block 7. 0 Module 1. 2
IV Push Meds Medications injected directly into IV port using syringe. § USN nursing students can only “push” NS to flush IV tubing § As an RN, when giving IV push meds, be sure to flush the IV line before & after each med with 10 m. L of NS or per facility protocol Block 7. 0 Module 1. 2
Med IV Push OR PICC Line Flush Block 7. 0 Module 1. 2
Patient Teaching Pre-administration, teach patient: § Name of drug § Desired action § Frequency of administration § Possible adverse effects § Report pain or swelling at or distal to IV insertion site Block 7. 0 Module 1. 2
Documentation of IV Med Administration § Drug, dose, route (bolus or “push” or piggyback), time, & signature § If you withhold a drug or if patient refuses it, indicate this on the MAR & document the reason in your nurses’ notes § Patient’s response to the medication § Appearance of IV site before, during, & after administration § Amount and type of fluid to which the medication is added § Whether it is being infused by an electronic pump or by gravity § Period of time during which the medication is infused § Flow rate § Amount and type of fluid for flushing the intravenous line before and after medication administration Block 7. 0 Module 1. 2
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