Administer and Monitor Intravenous Medications in the Nursing Environment Essay

When managing verbal orders, the overriding principle for every nurse is safety. This is because it has a higher potential for causing errors as the speaker may be misheard or misinterpreted due to the medium being used. This order may be accepted by a registered nurse when the authorized prescriber is absent. The procedure requires that the nurse first starts by identifying him or herself, then specifying the patient’s name before communicating the order. Thereafter, the receiver documents this order immediately through the prescriber order form. Administer and Monitor Intravenous Medications in the Nursing Environment Essay. The order information is then repeated back to the authorized prescriber including; the name of the patient, drug name and its spelling, dosage which is given in single digits, route of administration, and frequency (Gorbach et al., 2015). Thereafter, the receiver follows up on the medication indication to ensure an error was not made. Finally, he confirms with the prescriber if there are any uncertainties. After the order has been successfully communicated, the prescriber must countersign the order in not more than 24 hours.

A standing order, on the other hand, authorizes specific persons with no prescribing rights, to supply and administer given medicines and other controlled drugs to a given group of people without prescription. The procedure involves printing out the appropriate standing order administration document and completing it. Next, the authorized individual administers or dispenses the medication. Thereafter, the administration is also updated in the document. If the patient showcases any adverse reactions or complications, these should also be indicated in the documentation (Gorbach et al., 2015). Lastly, the document is scanned into record, and the original is placed in the Senior Nurse Practice’s in-tray for review and audit. Administer and Monitor Intravenous Medications in the Nursing Environment Essay.

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PRN is an abbreviation of a Latin term which usually means, “As is needed”. It is a medical order made by the health care professional. First, the order needs to be signed and dated. Second, the healthcare professional is expected to identify the name of the medication, its strength and the formulation. Third, the quantity and route of administration are also included. Next, the professional is supposed to calculate the required intervals between doses so as to understand the number of times a dose is to be taken. The result is also indicated in the document. Next another determination which is needed is the maximum dose for a 24 hour period. The reason for administration and the expected outcome must also be documented in the PRN order. The date the doctor started PRN is also indicated in the document.

Journal 1.2

The standard routes of medication administration are; oral, injection, rectal, vaginal, ocular, otic and nasal. The abbreviation S/C should never be used to refer to subcutaneous as it has been reported for causing confusion and medication errors. It is often assumed to mean sublingual. Therefore, the recommended term is “subcut”.  Also, the abbreviation µg should not be used in medical orders because of confusion as well. It intends to mean microgram, which is also mistaken for mg. Therefore, the best approach is to write “microg”.

Journal 2.1

From the case study, the patient is suffering from severe dehydration. When administering IV solutions, the patient should be given that which has a tonicity that is opposite their problem (Greenberg & Bowden, 2009). Therefore, the solution that should be given in this case is a hypotonic solution since the patient’s blood is hypertonic as a result of dehydration.Administer and Monitor Intravenous Medications in the Nursing Environment Essay.  The hypotonic solution will bring back the tonicity to the normal range.

Journal 2.2

When a patient is dehydrated, the blood vessels tend to position deeper into the skin. This is because the body tries to respond to the excessive loss of water through sweating too. Therefore, this will make it quite difficult to locate and access the vein for IV therapy. Using access devices are advantageous both for the patient and professional because the whole process becomes simple and effective. It allows for frequent access to the veins without the need for deep needle sticks. It has other advantages in the sense that it reduces risk of vein irritation, formation of blood clots and even inflammation and scarring. It is more comfortable for the patient, hence reducing anxiety that one would have experienced when using the usual IV.

Journal 3.1

To determine the total mls per hour of the IV normal saline solution, the following formula will be used since the infusion pumps do not feature a calibrated drop factor.

Volume (mL)  = Y (Flow Rate in ml/hr)

Time (min)

Therefore,

1000ml

1 hour

= 1000 ml/ h

In relation to Gentamycin the following calculation will be used to determine dosage.

Amount Desired x quantity

Amount on hand

=300 x 2ml

80

= 7.5 mls will be administered to Mr. Bourke

Lastly, to calculate the drip rate for administering the metronidazole using a macro infusion set, the following formula is employed. Administer and Monitor Intravenous Medications in the Nursing Environment Essay.

Volume x drop factor

Time

Since 100 mg of the metronidazole is added to 100 mls of saline solution, it is necessary to start by calculating the total volume first. In this case, there is 100 mg/100 mls, which is equal to 1mg/ml

=100mls x 20

20

= 100 drops per minute.

Journal 4.1

The purpose of medication alerts is to offer the various health care professionals with the necessary safety information relating to the different medicines prescribed (Phansalkar et al., 2014). These alerts are basically information from the local, national and even international sources. This alert specifies the actions which the health professionals should take, the time within which these steps must be taken, and the responsibility of such an action. Basically, it seeks to offer guidance on specific realizations to ensure patients receive the best medication and in the appropriate dosage. In case a medication is noted to trigger negative effects, the alerts will warn the health services and give them guidance on how to prevent the medication from being prescribed to individuals.

Journal 4.2

As an enrolled nurse, my administration of medication is defined by specific factors. First, I am allowed to prescribe medication because I have completed the EN medication administration education. Second, I rely on the rules presented on the legislation which is why I have had to conduct a thorough analysis of the state and territory drugs and poisons legislation.Administer and Monitor Intravenous Medications in the Nursing Environment Essay.  I have also had to gain sufficient knowledge of the policy requirements of my health department, the workplace policies, and even the procedures and protocols that must be followed during drug administration. Therefore, these are the rules which I must follow whenever I am administering drugs to patients.

Journal 4.3

            The therapeutic goods act is responsible for the regulation of therapeutic goods such as prescription medicines, vaccines, vitamins and minerals, blood and blood products, and even medical devices. It controls the supply of these products within Australia by requiring that they all pass through the Australian Register of Therapeutic Goods before any distributions are made. Administer and Monitor Intravenous Medications in the Nursing Environment Essay.

Journal 4.4

The national health act applies to the benefits relating to medications, sickness and hospital benefits, including the medical and dental services. It features several laws and regulations which try to ensure that patients will benefit from the healthcare services offered to them.

Journal 5.1

When educating a patient on taking a course of oral medications, the three important points are; first, always take the right dosage at all times. Do not increase or decrease unless advised otherwise by the healthcare professional. Second, always take the dose at the required time to ensure a balance in the time difference. Third, always complete the dose. Do not stop even if you start experiencing relief from the symptoms. Administer and Monitor Intravenous Medications in the Nursing Environment Essay.

Journal 5.2

When there is a delayed adverse drug reaction, the situation needs to be managed promptly. The first step to take is to administer antihistamine to the patient to relieve the discomfort (Brodowy & Nguyen, 2016). Second, since this is a delayed reaction, it is impossible to determine which drug caused it. Therefore, all the drugs prescribed recently will be identified and set aside for further research.  When an acute adverse drug reaction is experienced, the next step will be to provide antihistamine before considering which drug it was and stopping the dosage immediately (Brodowy & Nguyen, 2016).

Journal 5.3

The five assessments that I would conduct on a patient receiving peripheral therapy are as follows; First, assess whether the systolic blood pressure falls under 100 mmHg; second, Assess whether the heart rate is going much faster than 90 beats per minute; third, check for the capillary refill time. It should not be more than 3 seconds, and the peripherals should not be cold; fourth, check for the respiratory rate which should not be beyond 20 breathes per minute. Lastly, assess for peripheral oedema, the peripherals should appear normal and not swollen. Administer and Monitor Intravenous Medications in the Nursing Environment Essay.

References

Brodowy, B., & Nguyen, D. (2016). Optimization of clinical decision support through minimization of excessive drug allergy alerts. American Journal Of Health-System Pharmacy, 73(8), 526-528. doi:10.2146/ajhp150252

Gorbach, C., Blanton, L., Lukawski, B. A., Varkey, A. C., Pitman, E. P., & Garey, K. W. (2015). Frequency of and risk factors for medication errors by pharmacists during order verification in a tertiary care medical center. American Journal Of Health-System Pharmacy, 72(17), 1471-1474. doi:10.2146/ajhp140673

Greenberg, C. S., & Bowden, V. R. (2009). Administration of Hypotonic Solutions vs. Isotonic Solutions In Hospitalized Children. Pediatric Nursing, 35(1), 62-63.

Phansalkar, S., Zachariah, M., Seidling, H. M., Mendes, C., Volk, L., & Bates, D. W. (2014). Evaluation of medication alerts in electronic health records for compliance with human factors principles. Journal Of The American Medical Informatics Association, 21(e2), e332-e340. doi:10.1136/amiajnl-2013-002279

Question 1

a. Signs and symptoms of iron deficiency anaemia include fatigue, irritability, tachycardia, pale skin, difficulty concentrating, brittle nails and shortness of breath. (Williams & Hopper 2011 p. 562).

b. As the patient has iron deficiency anaemia a blood transfusion is necessary to increase haemoglobin levels within the blood as this helps to transport oxygen to cells and tissues. She also has a history of PR bleeding.Administer and Monitor Intravenous Medications in the Nursing Environment Essay.  Therefore this blood transfusion is helping to replace volume lost, to increase circulating blood volume and to improve the oxygen carrying capacity (Hamlin, Richardson-Tench, Davies 2009 pp 155,156)

c. It is important to follow the Pico prep instructions as faecal matter can obscure the viewing of the the colon. Pico prep aims to thoroughly cleanse the colon of any matter or gas to ensure that the visual field is clear ( Corbett & Banks 2011 pp. 675,676).

d. Pico prep is an osmotic laxative, its action decreases the fluid absorption within the bowel which then results in the onset of diarrhoea within 1-4 hours. Side effects can include abdominal bloating, abdominal pain, nausea, vomiting and flatulence. ( Tiziani 2013 pp. 876,879).

e. The action of this medication would have quite an impact on this elderly patient. Although she mobilises with a four wheel walker it would become increasingly difficult to mobilise to the toilet so frequently to empty her bowels in time. This may increase the chances of her having a fall ( Williams & Hoper 2011 p. 747). Lowering the bed, having her four wheel walker in reach and the application of hip protectors may aid in reducing the risk of her having a fall and in the chances of her having a fall the hip protectors may aid in protecting that area.( Crisp, Taylor, Douglas, Rebeiro 2013. p. 454).

Providing a bedside commode may also reduce the chances of falls as it is located closer to her than the toilet may be. As she is an older patient the skin around the area may become excoriated and skin breakdown may occur due to the acidity of the diarrhoea and the area frequently being wet. Barrier creams should be applied to at risk areas for protection. Diarrhoea can also quickly cause dehydration and electrolyte imbalances in the elderly, this may also have an impact on this patients fluid and electrolyte levels (Williams & Hopper 2011. pp. 275, 747).

Question 2.

a) This patient is displaying possible signs and symptoms of a suspected urinary tract infection such as incontinence, a burning sensation when she voids, fever, confusion and blood stains on her pad. Administer and Monitor Intravenous Medications in the Nursing Environment Essay.

A urinalysis should be performed to support a diagnosis of a urinary tract infection ( Williams & Hopper 2011 p. 838). As she is incontinent of both urine and faeces a thorough skin assessment should be performed to identify the areas at risk and to identify any change in skin integrity. Skin turgor should also be assessed as this can indicate a sign of dehydration (Crisp et. al. 2013 p. 592). A fluid balance chart should be maintained to assess if the patient is in a positive or negative fluid balance and the weight of the patient should also be assessed as noticeable weight changes can indicate hypovolaemia (Crisp et.al 2013 p.1214, Scott 2010 p. 62). Auscultation of the chest could prove useful in determining the reason of the increased respiratory rate and low oxygen saturation levels ( Lewis & Foley 2011 p. 356). A falls risk assessment should also be performed as the elderly patient has a few risk factors for falls such as confusion, reduced mobility and is incontinent of urine and faeces. This can help to implement interventions to reduce the risk of a fall ( Crisp et.al p. 454).

As this patient is at risk of both hypovolaemia and hypokalaemia the doctor should be notified to thoroughly assess the patient and implement therapy for a suspected urinary tract infection.

b) Cranberry juice can be effective in helping to reduce pain when urinating and also prevents the bacteria adhering to the wall of the bladder, this method can be helpful in reducing the pain of a urinary tract infection however the patient is undergoing a procedure the next day, therefore this intervention should be implemented with the approval of a medical officer. A heat pack could be placed on her abdomen to relive any pain and discomfort along with the administration of an antipyretic to reduce her fever and pain (Williams & Hopper 2011 p. 840). As the patient is having difficulty breathing she should be placed in a suitable position to help with proper lung expansion such as the high fowlers position along with the administration of oxygen to increase oxygen levels within the blood. (Williams & Hopper 2011 p. 604). The patient’s vital signs should be continuously assessed to monitor any improvements or deterioration especially her blood pressure and heart rate as any further abnormalities such as arrhythmias and a further decline in blood pressure could indicate hypovolaemia and hypokalaemia. Continuous assessment of her neurological state should also be implemented to monitor any changes (Scott 2010 p. 64).

c. Hypokalaemia occurs due to an excessive loss of potassium from the body or from an inadequate intake of potassium. The body is unable to conserve potassium and relies on an adequate intake of potassium to maintain a balance within the body. Administer and Monitor Intravenous Medications in the Nursing Environment Essay. An excessive loss of potassium can be due to diuretic therapy – especially potassium wasting diuretics, corticosteroids, vomiting and diarrhoea.

Signs and symptoms include an irregular weak pulse, hypotension, muscle cramps, muscle weakness and shallow respirations. (Williams & Hopper 2011 p. 79, Scott 2010 p. 98).

Medical management is aimed at restoring potassium levels either by increasing the intake of potassium in the diet or oral potassium supplements. Intravenous replacement therapy is also implemented in those with severe hypokalaemia to rapidly increase potassium levels. Diuretics may be changed to a potassium sparing diuretic to prevent the loss of potassium from the body. (Scott 2010 pp. 100,101).

Nursing management includes monitoring fluid input and output, monitoring the heart rate and rhythm of those receiving IV replacement therapy, maintaining and ensuring the correct administration of the therapy and continuous monitoring of the patient’s condition throughout. ( Scott 2010 p.102).

Hypovolaemia occurs due to the loss of fluid from the body and extracellular spaces; this can be due to excessive bleeding, excessive sweating, burns, diuretic therapy, diarrhoea, renal impairment and vomiting. The loss of fluid then results in a decreased blood volume. (Williams & Hopper 2011 p.71, Scott 2010 pp. 60, 61). Signs and symptoms include thirst, nausea, hypotension, restlessness, confusion, dizziness, cool pale skin, tachycardia, increased body temperature, weight loss and a decline in cognitive status. (Williams & Hopper 2011 p 72, Scott 2010 p. 62).

Medical management includes finding and stopping the source of the fluid loss, the replacement of lost fluid with an intravenous infusion with the same osmolality of blood to increase the body’s blood volume. ( Scott 2010 p.63).

Nursing management includes the administration and maintenance of intravenous fluid replacement, monitoring the daily weight of the patient, monitoring fluid input and fluid output, encouraging the intake of fluids to aid in restoring fluid balance and providing mouth care to maintain the integrity of the oral mucous membranes. (Crisp et.al. p. 73). Administer and Monitor Intravenous Medications in the Nursing Environment Essay.

Question 3

a) Midazolam is used in this procedure as it is a sedative, hypnotic agent and muscle relaxant. This aims to reduce the amount of movement throughout the procedure and assists in keeping the patient in a sedative state and impairs memory function ( Tiziani 2013 p. 967). Fentanyl would be used to reduce pain during the procedure and also aids in the maintenance of the anaesthesia ( Tiziani 2013 p 928) Diprivan is used to induce sedation and also increases the effects of the hypnotic agent and analgesia ( Tiziani 2013 p 793.)

b) Midazolam acts by binding with a benzodiazepine receptor in the central nervous system which inhibits neurotransmitters in the brain resulting in a calming sedative affect ( DrugBank, Midazolam DB00683 2013). Midazolam given intravenously takes affect within 1.5 – 2.5 minutes. Adverse effects include respiratory depression, memory impairment, anxiety, muscle weakness, drowsiness, hypotension, dizziness, fatigue and decreased alertness. (Tiziani 2013 pp 964, 967)

Fentanyl acts on receptors within the brain, spinal cord and muscles and bind with opioid receptors producing an analgesic affect. Administered intravenously fentanyl takes affect almost immediately.

Side effects include respiratory depression, apnoea, dyspnoea, vomiting, nausea, increased intra cranial pressure, bradycardia, sedation, confusion, constipation, hypotension and muscle rigidity. (Tiziani 2013 p. 923)

Diprivan suppresses the central nervous system and produces a loss of consciousness. Adminstered intravenously diprivan takes affect within 30 seconds of administration. Side effects include respiratory depression, tachycardia, hypotension, shivering and involuntary muscle movements (Tiziani 2013 p 793)

Nursing care includes continuous monitoring of respiratory rate, heart rate and vital signs during administration of these agents and throughout the procedure, ensuring that the dose is titrated to produce the right affect, a sedation scale should be performed when the patient is conscious, ensuring that the patient is aware that midazolam can cause muscle weakness so care should be taken when mobilising.  Administer and Monitor Intravenous Medications in the Nursing Environment Essay.Central Nervous System toxicity may occur when all three medications are given together therefore continuous monitoring is extremely important as the effects on the central nervous system are increased ( Tiziani 2013 p 964,968).

c) As this patient has renal failure the kidneys ability to filter and excrete waste is decreased, this may

result in an accumulation of the medications and could possibly result in drug toxicity – especially opiate medications (Tiziani 2013 p.925). This patient is elderly and may have increased sedation and confusion after the procedure due to her age and renal function and is at a high risk of falls especially as midazolam causes muscle weakness. Midazolam administered to an elderly patient can cause delirium, therefore this patient is at an increased risk of being affected by this ( Tiziani 2013 p.964).

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Constipation is also going to affect this patient as this is one of the major side effects of opiate medications.

Reference List

Corbett, J., Banks, A., (2013). Laboratory Tests and Procedures with Nursing Diagnoses ( 8^th Edition) New Jersey: USA. Pearson Education

Crisp, J., Taylor, C., Douglas, C., Rebeiro, G., (2013). Potter & Perry’s Fundamentals of Nursing (4^thEdition). Chatswood: NSW. Elsevier Australia.

DrugBank (September 2013) Midazolam (DB00683) Retrieved March 10, 2015, from http://www.drugbank.ca/drugs/DB00683

Hamlin, L., Richardson-Tench, M., Davies, M., (2009) Perioperative Nursing (1^st Edition). Chatswood: NSW. Elsevier Health.

Lewis, P., Foley, D., (2011) Health Assessment in Nursing (1^st Edition). Broadway: NSW. Lippincott & Wilkins

Scott, W., (2010) Fluid & Electrolytes Made Incredibly Easy (1^st Edition) London: England. Lippincott Williams & Wilkins

Tiziani, A., (2013). Harvard’s Nursing Guide to Drugs (9^th Edition). Chatswood: NSW. Elsevier Australia.

Williams, L.S., Hopper, P.D., (2011). Understanding Medical Surgical Nursing (4^th Edition). Philadelphia: USA. F.A Davis Company.  Administer and Monitor Intravenous Medications in the Nursing Environment Essay.