Chapter 14: Medication Administration Flashcards by Jayden McKee

What does the tool Medication Administration Cross-Check (MACC) do?

To catch and reduce the number of errors

Check medications and doses with another provider

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Define medical asepsis

The practice of preventing contamination by using aseptic technique

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Define aseptic technique

Method of cleaning to prevent contamination of a site when performing an invasive procedure (IV line)

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Define sterile

Destruction of all living things; achieved by using heat, gas, or chemicals

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Define dehydration

Inadequate total systemic fluid volume

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Signs and symptoms of dehydration

Decreased LOC
Orthostatic hypotension
Tachypnea
Dry mucous membranes
Decreased urine output
Tachycardia
Poor skin turgor
Flushed, dry skin

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Causes of dehydration

Diarrhea
Vomiting
GI drainage
Infections
DKA
Hemorrhage
Environmental emergencies
High-caffine diet
Insufficient fluid intake

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Signs and symptoms of overhydration

Shortness of breath
Puffy eyelids
Edema
Polyuria
Moist crackles (rales)
Acute weight gain

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Causes of overhydration

Unmonitored IV lines (in pediatric patients)
Kidney failure
Water intoxication in endurance sports
Prolonged hypoventilation

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What are crystalloid solutions?

Dissolved crystals (eg, salts or sugars) in water

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When using an isotonic crystalloid solution to support BP after blood loss, what’s important to remember?

3-to-1 replacement rule (3 mL to replace 1 mL of blood)

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What is imperative to remember about crystalloid solutions?

Cannot carry oxygen

Should be administered to maintain perfusion, not to restore BP

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What can happen when you increase BP too much using IV solutions?

Dilutes remaining blood volume

May increase internal bleeding by interfering with hemostasis (body’s internal blood-clotting mechanism)

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What are colloid solutions?

Molecules (usually protiens) that are too large to pass through the capillary membranes
Remains in the vascular system

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What do colloid solutions do?

Reduce edema by drawing fluid into the vasculature (high osmolarity)

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What is an isotonic solution

Same sodium concentration as the cell

Water does not shift and no change in cell shape

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What is a hypertonic solution

Greater concentration of sodium than the cell

Water is drawn out of the cell

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What is a hypotonic solution

Lower concentration of sodium than the cell

Water flows into the cell

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What are Lactated Ringer (LR) solutions generally used for

Patients who have significant blood loss

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What do Lactated Ringer (LR) solutions do

Combats intracellular acidosis associated with severe blood loss

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When are Lactated Ringer (LR) solutions contraindicated

Patients with liver problems

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How is D5W a unique type of isotonic solution

Once administered the dextrose is quickly metabolized and becomes hypotonic

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What is the best fluid to replace blood loss

Whole blood

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Once an IV solution wrap is torn and removed, it must be used within _____

24 hours

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What are the most common prehospital IV fluid bag volumes

1,000 mL and 500 mL

What is the difference between microdrip and macrodrip sets

Microdrip - 60 gtts/mL | Macrodrip - 10 or 15 gtts/mL

When choosing an IV site what should you avoid

Areas that contain valves or bifurcations | Veins that cross over a joint

Why should you use caution then cannulating leg veins

Greater risk of venous thrombosis and pulmonary embolism

What is an over-the-needle catheter

Teflon catheter inserted over a hollow needle

What is a butterfly catheter

Hollow, stainless steel needle with two plastic wings

What are butterfly catheters most commonly used for

Phlebotomy

How are gauges sized for catheters

The smaller the gauge the larger the diameter

What gauge is usually a good size for adults

18 or 20 gauge

What are two considerations used when inserting an IV catheter

Keep the beveled side of the catheter up when inserting | Maintain adequate traction of the vein during cannulation

What are the insertion angles for a catheter

45 degrees until vein is pierced | Drop down to 15 degrees

What is a flash chamber

An area of an IV catheter that fills with blood to help indicate when a vein is cannulated

What does ultrasonography do

Allows providers to see deeper veins, often in the upper arm, that are not visible to the naked eye

Why should you double back the tubing to create a loop at the IV line

To act as a shock absorber

How should you secure the line if the patient is attempting to pull it

Consider wrapping the extremity and tubing with roller gauze

When should you change the IV bag

When about 25 mL of fluid is left

What are saline locks good for

Maintaining an active IV site

What are saline locks primarily used for

Patients who don't need additional fluids but who may need rapid medication delivery

What catheter gauge is best used for pediatric patients

20, 22, 24, or 26 gauge | Butterfly catheters

What is a good technique for starting a pediatric line

Use a penlight to illuminate the veins on the back of the hand by shining the light through the palm Once found slightly graze the surface with your fingernail

How do you secure a scalp vein line

Tape a paper cup over the site to avoid any direct pressure

What is important to remember when starting IV therapy in older patients

Often simply puncturing the vein will cause a massive hematoma Tape can lead to skin damage

What vein locations should you avoid in older patients

``` Small spidery veins (rupture easy) Varicose veins (almost completely closed off) ```

What is an infiltration

The escape of fluid into the surrounding tissue causing a localized area of edema

Signs and symptoms of an infiltration

Edema at the site Continued IV flow after occlusion of the vein above the site Patient reporting tightness, burning, and pain around the site

What should you do if an infiltration occurs

Discontinue the line and reestablish it in the opposite extremity or proximally Apply direct pressure over the swollen area to reduce further swelling

What is an occlusion

Physical blockage of a vein or catheter

What is the first sign of an occlusion

Decreasing drip rate or presence of blood in the tubing

How do you determine whether an IV line should be reestablished after an occlusion

Use saline to add pressure to the line to disrupt the occlusion If it does not dislodge, discontinue administration and reestablish

How is vein irritation usually caused

By a too rapid infusion rate

What is thrombophlebitis

Inflammation of the vein

How does a hematoma often occur during IV administration

Vein perforation | Improper catheter removal

What should you do if a hematoma develops during IV therapy

If it forms during or after insertion, stop and apply direct pressure If it forms after insertion, evaluate the flow and hematoma. if both are controlled leave the site in place

How will you know if you hit a nerve, tendon, or ligament

The patient will experience sudden and severe shooting pain

What should you do if you pierce an artery during cannulation

Stop and apply direct pressure for at least 5 minutes or until the bleeding stops

What is a pyrogen

Foreign proteins capable of producing a fever

How is a pyrogenic reaction characterized

``` Abrupt temperature elevation Severe chills Backache Headache Weakness Nausea / vomiting Signs and symptoms of shock ```

When will a pyrogenic reaction manifest

Usually within 30 minutes after IV infusion

How should you treat a pyrogenic reaction

Stop the infusion immediately | Start a new IV line with a new solution

When does circulatory overload become a problem

In patients with cardiac, pulmonary, or renal dysfunction

Signs and symptoms of circulatory overload

``` Dyspnea JVD Hypertension Crackles (rales) Acute peripheral edema ```

How should you treat a suspected air embolus occurs during IV infusion

Place the patient on their left side with the head down - Traps any air inside the right atrium and ventricle Administer 100% O2 Rapid transport Prepare to assist ventilations

What is a vasovagal reaction

A drop in BP due to anxiety

What is a catheter shear

Part of the catheter is pinched against the needle | Creates a free-flowing segment

What medication is appropriate to administer rectally

Diazepam (Valium)

1 cc is equal to ____ mL

The IO space collectively comprises the ________ bone of the ________ and the medullary cavity of the ________.

cancellous, epiphysis, diaphysis

When changing an IV bad, it is important to:

Ensure that fluid remains in the drip chamber

To make push-dose epinephrine, you should:

Take a 10 mL normal saline flush and waste 1 mL | Draw out 1 mL of epinephrine (1:10,000) into the syringe

The most important point to remember about IV therapy is to:

Prepare all supplies ahead of time

After inserting the needle during an intramuscular injection, but before delivering the medication, you should:

Pull back on the plunger to aspirate for blood

Volumes of a drugs given subcutaneously are typically:

1 mL or less

The purpose of a Volutrol (Buretrol) administration set is to:

Avoid inadvertent fluid overload

Neither subcutaneous nor intramuscular injections should be given to patients:

With inadequate peripheral perfusion

Chapter 14: Medication Administration Flashcards

(78 cards)