ATI Section 2: Medication therapies Flashcards
pharmacokinetics
- ADME
- describes the onset of action, peak level, duration of action, and bioavailability
Medication interaction
when a medication is given with another medication and alters the effect of either or both medications
Adverse reaction
negative effects experienced by a client as the result of a specific medication, may be hazardous, tolerated, or subside with continued use
Before giving a medication the RN must assess
- allergies to adverse effects
- current medication regimen for potential interactions
- physiologic status compared to baseline assessment data
6 rights of medication administration
- client
- drug
- dose
- route
- time
- documentation
Therapeutic drug monitoring
- measures blood drug levels to determine effective medication dosages and precent medication toxicity
- It can also be used to identify noncompliance issues
- blood testing is preferred because it provides info about current therapeutic levels , whereas urine levels reflect the presence of a drug over several days
peak levels
-reflect the highest concentration
Trough levels
reflect the lowest concentration or residual level and are usually obtained within 15 min prior to administration of the next scheduled dose.
average times for drawing peak levels
- oral intake: 1-2 hrs
- IM: 1 hr
- IV: 30 min
Culture and sensitivity
- obtained to detect the presence of pathogens within the specimen collected
- begin antibiotic therapy after obtaining the sample
What is the purpose of IV therapy
administration of fluids via an intravenous catheter (peripheral vein or central vein access) for the purpose of providing medication, fluid, electrolyte, or nutrient replacement
Infiltration
- Prevention: use the smallest catheter for prescribed therapy, stabilize the port-access, assess blood return
- Tx: stop infusion, remove peripheral catheters, apply cold compress, elevate extremity, insert new catheter in opposite extremity
Extravasation
- Prevention: know vesicant potential before giving medication
- Tx: stop infusion, discontinue administration set, aspirate drug if possible, apply cold compress, document condition of site, may photograph
Phlebitis/thrombophlebitis
- Prevention: rotate sites every 72-96 hr, secure catheter, use aseptic technique, for PICCs, avoid excessive activity with extremity
- Tx: stop infusion, remove peripheral IV catheter, apply heat compress, insert new catheter in opposite extremity
Hematoma
- Prevention: avoid veins not easily seen or palpated, obtain hemostasis after insertion
- Tx: remove IV device and apply light pressure if bleeding, monitor for signs of phlebitis and treat
Venous spasm
- Prevention: allow time for vein diameter to return after tourniquet removed, infuse fluids at room temp
- Tx: temporarily slow infusion rate, apply warm compress
Total parenteral nutrition (TPN)
Hypertonic solution containing dextrose, proteins, electrolytes, minerals, trace elements, and insulin prescribed according to the clients needs and administered via central venous device (PICC line, subclavian, or internal jugular vein)
care and maintenance of TPN
- before administration verify prescription
- administer via infusion pump
- monitor weight daily
- monitor I&O
- monitor serum glucose levels every 4-6 hrs
- monitor for signs of infection
- change dressing every 48-72 hrs
- change IV tubing and fluid every 24 hrs
- If TPN is temporarily unavailable, administer dextrose 10% in water to prevent hypoglycemia
Complications with a central venous catheter
Pneumothorax (during insertion)
- Prevention: use ultrasound to locate veins, avoid subclavian insertion when possible
- Tx: administer oxygen, assist provider with chest tube insertion
Complication with a central venous catheter
Air embolism
- Prevention: have client lie flat when changing administration set or needles connectors, ask client to perform valsalva maneuver if possible
- Tx: place client in left lateral Trendelenberg, administer oxygen
Complication with a central venous catheter
Lumen occlusion
- Prevention: flush promptly with NS between, before, and after each medication
- Tx: use 10 mL syringe with a pulsing motion
Complication with a central venous catheter
Bloodstream infection
- Prevention: maintain sterile technique
- Tx: change entire infusion system, notify provider, obtain cultures, and administer antibiotics
Antidote/reversal agent
acetaminophen
acetylcysteine (Mucomyst)
Antidote/reversal agent
Benzodiazapine
flumazenil (Romazicon)
Antidote/reversal agent
Curare
edrophonium (Tensilon)
Antidote/reversal agent
Cyanide poisoning
methylene blue
Antidote/reversal agent
Digitalis
digoxin immune FAB (Digibind)
Antidote/reversal agent
Ethylene poisoning
fomepizole (Antizol)
