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College of Nursing Adult Health Nursing II Block 7.0

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. Learning Outcomes. Apply the principles of safe intravenous medication administration.

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College of Nursing Adult Health Nursing II Block 7.0

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  1. College of Nursing Adult Health Nursing II Block 7.0 Topic: IV Medication Administration Module: 1.2

  2. IV Medication Administration Block 7.0 Adult Health II Block 7.0 Module 1.2

  3. 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

  4. Key Terms • Extravasation • Vesicant medications • Infiltration • Phlebitis • Thrombosis • Thrombophlebitis • IV Drug Compatibility Block 7.0 Module 1.2

  5. 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, pH & 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

  6. 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

  7. 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

  8. 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

  9. 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

  10. 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

  11. 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

  12. Block 7.0 Module 1.2

  13. Reconstitute Kefzol What is the diluent? _______________________ What is diluent volume?___________ What is reconstituted volume?________ What is solution concentration?_______ Block 7.0 Module 1.2

  14. 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

  15. 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

  16. Compatibility Chart Block 7.0 Module 1.2

  17. 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

  18. 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 mL of NS or per facility protocol Block 7.0 Module 1.2

  19. Med IV Push OR PICC Line Flush Block 7.0 Module 1.2

  20. 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

  21. 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

  22. Block 7.0 Module 1.2

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