Precautions And Considerations For Administering Medications Via IV Therapy

Packed Red Blood Cells

Part a: The Packed Red Blood Cells has been ordered because before the surgery because considering the age of Mr. George Stanford (60 years) doctors took a precautionary measure. Just in case during surgery if blood administration is needed.

Part b: The potential side effects of blood administration are dark urine, Urticaria (hives), hypertension or hypotension, pain along the intravenous infusion line, bleeding and oozing, fever and chills.

Part c: The steps that a nurse must take before the administration of PRBCs are (Valentine et al., 2014)-

• Verification of the order of transfusion.
  
  
• A nurse must thoroughly assess a patient physically to identify changes later on.
  
  
• Check for a proper and appropriate vascular access.
  
  
• The nurse must ensure that all the equipment necessary before the PRBC administration are near her, like the hypersensitivity kit, suction, oxygen and saline solution.
  
  
• The nurse must infuse the blood along with the normal saline solution via a filtered tube.

Part a: the rate of intravenous fluid for Mr. Stanford is 125mls/hr. The drops/min rate of Mr. Stanford IV is 42 drops/min.

Part b: Isotonic fluids- refers to two fluids that have the exact osmotic pressure across a semi permeable membrane. Example- 0.9% saline.

Hypotonic fluids- refers to a solution that has low osmotic pressure than the other solution. Example- 0.45% saline (1/2 NS)

Hypertonic fluids- refers to a solution that has high osmotic pressure compared to other solution. Example- 3% saline (Utas.edu.au, 2017).

Part a: The nurse must immediately provide Mr. Stanford an oxygen therapy that will assist him to breath. After the incident the nurse must report to Mr. Stanford’s doctor that he has experienced SOB.

Part b: the typical signs of fluid overload are as follows (Kelm et al., 2015)

• The skin might become swollen, shiny and moist.
• The area around abdomen looks distended.
• The person may feel heaviness in the body.
• The patient may complain about difficulty in breathing.
• Increased heartbeat, confusion and fatigue.

Part a: The common circumstances under which Frusemide is prescribed are (Morgan et al., 2017)

• Shortness of breath
• Swelling of abdomen, legs and arms.
• Treatment of high blood pressure
• Treat edema, caused due to kidney and liver disease.

Part b: Furosemide belongs to the major medication group of Diuretics.

Part c: yes, as endorsed enrolled nurse I can give Frusemide to Mr. Stanford only if I have the “do not have a notation” on my registration.

Part d: the adverse side effects of Frusemide are dehydration, clay colored stools, fever, nausea, dark urine, increased urine, muscle cramps (Mims.com.au, 2017).

Part e: the specific nursing considerations of a patient care before administering Frusemide

• Assessment of the fluid status in the body, monitor the body weight.
• Before administering Frusemide, the nurse must monitor the blood pressure and the pulse of the patient.

Part f: the doctor is required to check the frusemide dosage during preparation and administering.

Part g: the documentation that needs to done after administering Frusemide are

• Assessing the patient, whether he is experiencing a hearing loss.
• Assess the patient, whether the patient has developed any skin rash.

Part a: the peripheral IV catheter is a peripheral venous line for the insertion and subsequent delivery of medication fluids.

Part b: Phlebitis is an inflammation of a vein. Mechanical phlebitis is the inflammation which is caused by the IV catheter. Chemical phlebitis is caused by the IV medications or by the fluids. Bacterial phlebitis is caused by the bacterial infection (Tett, 2008)

Frusemide Administration

Part c: the dressing must be intact, dry and clean to prevent any microbial contamination of the site. Changing PIVC dressing when it becomes loose and damped and to apply bandage or tape on the connection to avoid any injury. I would be assessing the site for any mechanical injury or bacterial infection, and if the site is affected by bacterial and mechanical injury then I will document it.

To assess the pain of Mr. Stanford (Tett, 2008).

• I will first take a visual overview of the right knee
• Then I will proceed to see whether the dose of morphine is correctly getting administered
• In the final step, if did not find any problem, I will inform Mr. Stanford’s doctor.

Part a: patient controlled analgesia machine works like computerized dispenser of drug that has a definite lock out time and dispenses the drug when a patient presses the dispensing switch. the patient controlled analgesia cannot be used subsequently within 5 minutes (Tett, 2008).

Part b: advantages- it empowers the patient to have control over the pain, the procedure is fast and effective.

Disadvantages: patients who are confused regarding the usage have difficulties using it, patient controlled analgesia is not appropriate for critically ill patients.

Part c: Mr. Stanford can be told that the usage of patient controlled analgesia is for his own good, it will help him to relieve his pain and there are no issues related to addiction. Whereas, the lockout period of 5 min is for his own safety, so that he does not use the patient controlled analgesia in quick succession.

Part a: the 10mls of 0.9% normal saline will help to dilute the intravenous injections of antibiotics.

Part b: yes, the medication does require checking with another nurse.

The 3 possible complications that may occur when a patient is receiving fluids/medications via IV therapy are as follows (Cdhb.health.nz, 2017):

Hypervolemia- the risk category includes pregnant women, children and infant, patients with cardiac diseases, elderly.

The clinical symptoms include hypertension, increase in weight, pulmonary edema, dyspnea.

Management- stopping the infusion, notifying the medical staffs.

Extravasation- the symptoms include swelling, blood return from cannula is lacking, sensation of burning at the insertion site.

Management- not to flush the line, try to aspirate the drug from the cannula, removal of the cannula once aspiration is complete.

Anaphylaxis- the symptoms include edema, low blood pressure, cramps and diarrhea.

Management- stopping the treatment, implementation of the resuscitation depending on the severity, notifying the doctor.

Part a: According to (Trove.nla.gov.au, 2017), the precaution that are must during administering the potassium chloride via the intravenous route are as follows:

• Extra care must be taken to ensure that the catheter is within the lumen of the targeted vein, so that extravasation do not occur.
  
  
• The potassium chloride solution must be delivered carefully to the patients having cardio-vascular diseases or renal diseases.
  
  
• Potassium having high concentration of plasma cannot be administered to patients, it may lead to cardiac arrest.
  
  
• Care must be taken for patients that are already been given corticosteroids or corticotrophin, to such patient intravenous potassium chloride administration must be done cautiously.

Part b: signs and symptoms of potassium chloride intoxication includes: flaccid paralysis, heaviness or weakness of the legs, paresthesias of extremities, heart block, hypotension, cardiac arrhythmias (Dailymed.nlm.nih.gov, 2017).

Potassium Chloride

As per the question, dose ordered is 5 mcg/kg/min and the weight of the patient 49 kg.

The dose available, ml of dopamine is not mentioned, while the calculation of the rate can be done using a formula (Sachlos et al., 2012).

Firstly, convert mcg/kg/min into mg/hr

(mcg x kg)	X 60
1000

Then, IV dosage formula can be used

dose ordered	X volume available
dose available

Part a: The bolus delivery in mLs is calculated by the following steps (Schmidt et al., 2012)

500unit bolus x 50 mLs volumes of heparin= 25,000 unit bolus

25,000 unit bolus/ 5000units heparin= 5mLs

Part b: to calculate the infusion rate in mls/hr, the following steps are done (Amin et al., 2015)

Heparin infusion rate:

X (ml/hr) = (500 units per hour X 50 ml) / 5000 units

Hence, the infusion rate is 5mls/hr.

Part a: the heparin precautions are as follows (Smythe et al., 2012):

• The patient must not take ibuprofen, aspirin or any anti-inflammatory medicines while taking heparin.
  
  
• Precaution must be taken as Heparin causes allergic reactions.
  
  
• It is better and advisable to inform the doctor that a patient is using heparin before the doctor proceeds for further treatment.

The side effects of usage of heparin are as follows (Smythe et al., 2012):

• Hemorrhage is the major complication which involves retroperitoneal hemorrhage, adrenal hemorrhage, ovarian hemorrhage.
  
  
• Generalized hypersensitivity has been reported among patients, fever, chills along with lacrimation, rhinitis, asthma.

Part b: the issues related to the Intravenous administration of heparin are as follows (Smythe et al., 2012):

• The major complications of heparin administration are death occurring due to hemorrhage, blood transfusion during the heparin administration.
  
  
• Other complications include hematuria if its magnitude increases after heparin administration.

The common electrolytes for IV administration are sodium, potassium (Utas.edu.au, 2017). The type of IV fluid into which I would dilute these electrolytes are crystalloids, colloids and blood and blood products (Utas.edu.au, 2017).

According to Nutt, King & Nichols (2013),

IV Gentamycin belongs to schedule 4 of drugs

IV Frusemide belongs to schedule 3 of drugs

IV Morphine belongs to schedule 2 of drugs

IV Gentamycin should be stored at -20 degree Celsius and IV Fentanyl should be stored at 20-25 degree Celsius and should be away from light (Baertschi, Alsante & Reed, 2016).

According to Frost et al. (2013),

Pharmacokinetics-  it is the study of the fate of the drug inside the body, the movement of the drug in and out of the body, its absorption, metabolism and excretion.

Pharmacodynamics- it is the study of the drug and what it does to the body, binding to the receptors and chemical interactions.

Toxicology- it is the study of adverse effects that occur inside the body due to certain chemicals.

Part a: Nurse initiated medication includes the administration of unscheduled, schedule 2 and schedule 3 drugs. Which means that an EN is authorized to administer these scheduled as per the case and situation demands (Safetyandquality.gov.au, 2017).

Part b: yes, an EN acting independently can carry out nurse initiated medication administration because, ENs who do not have a notation on their registration can administer medications and they can carry out other nursing practices with ease.

Heparin Administration

References

Amin, A., Perreiah, P., Providence, S., McCartney, L., Camhi, S., & Rao, R. (2015). 579: INTRAVENOUS HEPARIN CALCULATION ERRORS PRE-AND POST-IMPLEMENTATION OF THE HEPARIN NOCLOT WIZARD©. Critical care medicine, 43(12), 146.

Baertschi, S. W., Alsante, K. M., & Reed, R. A. (Eds.). (2016). Pharmaceutical stress testing: predicting drug degradation. CRC Press.

Cdhb.health.nz. (2017). Cdhb.health.nz. Retrieved 14 November 2017, from https://www.cdhb.health.nz/Hospitals-Services/Health-Professionals/CDHB-Policies/Fluid-Medication-Manual/Documents/Complications-Of-IV-Therapy.pdf

Dailymed.nlm.nih.gov. (2017). INTRAVENOUS SOLUTIONS with POTASSIUM CHLORIDEPotassium Chloridein 0.9% Sodium Chloride Injection, USP. Dailymed.nlm.nih.gov. Retrieved 14 November 2017, from https://dailymed.nlm.nih.gov/dailymed/archives/fdaDrugInfo.cfm?archiveid=1321

Frost, C., Wang, J., Nepal, S., Schuster, A., Barrett, Y. C., Mosqueda?Garcia, R., ... & LaCreta, F. (2013). Apixaban, an oral, direct factor Xa inhibitor: single dose safety, pharmacokinetics, pharmacodynamics and food effect in healthy subjects. British journal of clinical pharmacology, 75(2), 476-487.

Kelm, D. J., Perrin, J. T., Cartin-Ceba, R., Gajic, O., Schenck, L., & Kennedy, C. C. (2015). Fluid overload in patients with severe sepsis and septic shock treated with early-goal directed therapy is associated with increased acute need for fluid-related medical interventions and hospital death. Shock (Augusta, Ga.), 43(1), 68.

Mims.com.au. (2017). MIMS Australia. Mims.com.au. Retrieved 13 November 2017, from https://www.mims.com.au/

Morgan, T., Tadokoro, M., Martin, D., & Berliner, R. W. (2017). Effect of furosemide on Na+ and K+ transport studied by microperfusion of the rat nephron. American Journal of Physiology--Legacy Content, 218(1), 292-297.

Nutt, D. J., King, L. A., & Nichols, D. E. (2013). Effects of Schedule I drug laws on neuroscience research and treatment innovation. Nature Reviews Neuroscience, 14(8), 577-585.

Sachlos, E., Risueño, R. M., Laronde, S., Shapovalova, Z., Lee, J. H., Russell, J., ... & Levadoux-Martin, M. (2012). Identification of drugs including a dopamine receptor antagonist that selectively target cancer stem cells. Cell, 149(6), 1284-1297.

Safetyandquality.gov.au. (2017). Safetyandquality.gov.au. Retrieved 16 November 2017, from https://www.safetyandquality.gov.au/wp-content/uploads/2012/02/SAQ123_NursesUserGuide_V6.pdf

Schmidt, S., Meldgaard, M., Serifovski, N., Storm, C., Christensen, T. M., Gade-Rasmussen, B., & Nørgaard, K. (2012). Use of an automated bolus calculator in MDI-treated type 1 diabetes. Diabetes Care, 35(5), 984-990.

Smythe, M. A., Mehta, T. P., Koerber, J. M., Forsyth, L. L., Sykes, E., Corbets, L. R., ... & Parikh, R. (2012). Development and implementation of a comprehensive heparin-induced thrombocytopenia recognition and management protocol. American Journal of Health-System Pharmacy, 69(3).

Tett, S. E. (2008). AMH (Australian Medicines Handbook. Clinical Pharmacology & Therapeutics, 83(1), 12-13.

Trove.nla.gov.au. (2017). Australian injectable drugs handbook / edited by Nicolette Burridge and Keli Symons. - Version details. Trove. Retrieved 14 November 2017, from https://trove.nla.gov.au/version/243931268

Utas.edu.au. (2017). Utas.edu.au. Retrieved 16 November 2017, from https://www.utas.edu.au/__data/assets/pdf_file/0020/528041/Management-of-IV-Fluids-and-Electrolyte-Balance-slides.pdf

Valentine, S. L., Lightdale, J. R., Tran, C. M., Jiang, H., Sloan, S. R., Kleinman, M. E., & Randolph, A. G. (2014). Assessment of hemoglobin threshold for packed RBC transfusion in a medical-surgical PICU. Pediatric Critical Care Medicine, 15(2), e89-e94.