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Administration of Intravenous Medications

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Administration of Intravenous Medications Principles of IV Therapy BSN336 Spring QR 09 Principles of Intravenous Medication Adinistration ADVANTAGES: Direct access to ... – PowerPoint PPT presentation

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Title: Administration of Intravenous Medications


1
Administration ofIntravenous Medications
  • Principles of IV Therapy
  • BSN336
  • Spring QR 09

2
Principles of Intravenous Medication Adinistration
  • ADVANTAGES
  • Direct access to the circulatory system
  • A route for administration of fluids and drugs to
    patients who cannot tolerate oral medications
  • A method of instant drug action
  • A method of instant drug administration
    termination

3
Principles of Intravenous Medication
Administration
  • DISADVANTAGES
  • Drug interactions because of incompatibilities
  • Drug loss via adsorption of IV containers and
    administration sets
  • Errors in mixing techniques
  • Speed shock
  • Extravasation of vesicant drugs
  • Phlebitis

4
Intravenous Drug Safety
  1. Aseptic technique and standard precautions
  2. Hospital or institution formulary
  3. Orders reviewed for appropriateness of prescribed
    therapy.
  4. Knowledge of indications for therapy, side
    effects and potential adverse reactions and
    appropriate interventions

5
Intravenous Drug Safety (cont)
  1. Appropriately label all containers, vials, and
    syringes identify patient, verify contents,
    dose, rate, route, expiration date, integrity of
    the solution
  2. Evaluate, monitor effectiveness of therapy
    document response, adverse events, and
    interventions
  3. Medications discarded after 24 hr

6
Intravenous Drug Safety (cont)
  • Common Types of Drug errors
  • Incomplete patient information
  • Unavailable drug information
  • Miscommunication of drug orders poor hand
    writing, similar names, misuse of zero, decimal
    points, dosing units, abbreviations
  • Lack of appropriate labeling

7
Drug Compatibility
  • Physical Incompatibility
  • Insolubility and absorption
  • Never administer a drug that forms a precipitate
  • Do not mix drugs prepared in special diluents
    with other drugs
  • Prepare each drug in a separate syringe
  • Use the proper diluents to reconstitute a drug

8
Drug Compatibility
  • Chemical Incompatibility
  • Alterations of the integrity and the potency of
    the active ingredient
  • Therapeutic Incompatibility
  • Undesirable effect occurring in a patient as a
    result of two or more drugs being given
    concurrently
  • Pt may fail to show the expected clinical
    response

9
Intravenous Medication Administration
  • General Guidelines
  • Is the prescribed route appropirate
  • Use aseptic technique and Standard Precautions
    when preparing drug
  • Check for expiration date
  • Follow the manufactures guidelines
  • Monitor the patient response

10
Intravenous Medication Administration
  • Methods of Administration
  • Continuous Infusion
  • Intermittent Infusion
  • Direct Injection (IV push)
  • Continuous Subcutaneous Medication Administration
  • Intraperitoneal Medication Administration
  • Intraosseous Medication Administration
  • Intraventricular Medication Administration
  • Intra-arterial Medication Administration

11
Special Drug Administration Considerations
  • Anti-Infectives Administered to achieve
    therapeutic coverage based on culture and
    sensitivity reports
  • Antibiotics
  • Action bacteriostatic, inhibiting bacterial cell
    wall synthesis and producing a defective cell
    wall, or bactericidal, altering intracellular
    function of the bacteria
  • Antifungal
  • Action Injury to the cell wall of the fungi
    amphoB, caspoifungin, fluconozol

12
Special Drug Administration Considerations
  • Antivirals
  • Selectively toxic to viruses acyclovir,
    cidofovir, foscarnet, ganciclovir, zidovudine
  • Investigational Drugs
  • Phase I- Clinical pharmacology and therapeutics
  • Phase II- Initial clinical investigation for
    therapeutic effect
  • Phase III- Full scale evaluation of treatment
  • Phase IV- Post marketing surveillance

13
Pain Management
  • Pain management begins with complete assessment
    of the patients pain, including location,
    intensity, quality, frequency, onset, duration,
    aggravating and alleviating factors, associated
    symptoms, and coping mechanisms
  • Pain is the most common reason patients seek
    health care

14
Pain Management
  • Definition of Pain
  • What ever the experiencing person says it is,
    existing whenever he says it does
  • Margo McCaffery

15
Pain Management
  • Landmark study from 1973 showed that pain is
    generally undertreated
  • Authorized prescribers underperscribe
  • Nurses administer fewer analgesics than
    prescribed
  • Patients request fewer analgesic medications than
    they need
  • The as needed regimen of administering opioid
    agents ensures that the patient will experience
    pain.

16
Pain Management
  • Study from 1998 and 2003 shows that little has
    changed in
  • Attitudes
  • Knowledge
  • Behaviors in managing pain
  • Negative language is the most difficult barrier
  • Narcotic rather than Opioid
  • Complains of pain rather than patient reports
    pain

17
Pain Management
  • The concern for iatrogenic addiction (addiction
    inadvertently cause from valid medical use of
    opioids) from families and health care workers is
    over estimated
  • Actual incidence is less than 1

18
Pain Management
  • American Academy of Pain Management, American
    Pain Society, and the American Society of
    Addiction state the following definitions
  • Addiction a primary, chronic, neurobiological
    disease with genetic, psychosocial, and
    environmental factors influencing its development
    and manifestation.

19
Pain Management
  • Behaviors include
  • Impaired control over drug use,
  • Compulsive use
  • Continued use despite harm, and craving
  • Physical Dependence state of adaptation that is
    manifested by a drug class-specific withdrawal
    syndrome following
  • abrupt cessation
  • rapid dose reduction
  • decreasing blood levels
  • And/or administration of an antagonist

20
Pain Management
  • Tolerance state of adaptation in which exposure
    to a drug induces changes that result in
    diminution of one or more of the drugs effects
    over time
  • Use of words
  • Drug seeker
  • Clock watcher
  • Addicted to their pain medication

21
Pain Management
  • Patient not behaving inappropriately
  • The treatment for pain is
  • Not the right medication
  • Not the right dose
  • Not the right dosing interval

22
Pain Management
  • McCaffery and Pasero(1999) described the four
    basic ways how pain becomes conscious or the
    noception of pain
  • Transduction
  • Transmission
  • Perception
  • Modulation

23
Pain Management
24
Categories of Pain
  • Acute Pain
  • Chronic Pain
  • Nociceptive Pain
  • Somatic
  • Visceral
  • Neuropathic Pain

25
Types of Pain Medication
  • Non-opioid, adjuvant, or co-analgesic agents
  • Nsaids and cox-2s
  • Tricyclic antidepressants
  • Anticonvulsants
  • Alpha2-adrenergic agonists

26
Types of Pain Medication (cont)
  • Opioids
  • Endogenous opioids
  • Opioid receptors
  • Agonist-antagonist
  • Antagonist
  • Parenteral Opioids
  • Continuous infusion
  • Intermittent doses
  • Combination

27
Types of Pain Medication (cont)
  • Patient-controlled analgesia (PCA)
  • Anticipating pain that is sever but intermittent
  • Constant pain that gets worse with activity
  • Old and young who can use
  • Ability to manipulate the dose button
  • Motivated
  • Not already sedated from other medications
  • Subcutaneous administration

28
Pain ManagementEpidural and Intrathecal
Medication
  • Two spaces in the spinal anatomy
  • Epidual and intrathecal intraspinal is used to
    encompass both
  • Epidural and intrathecal space share a common
    center the spinal cord
  • Intrathecal space is surrounded by the epicural
    space and separated from it by the dura mater,
    the intrathecal space contains CSF which bathes
    the spinal cord

29
Pain ManagementEpidural and Intrathecal
Medication
  • When a patient experiences acute pain, the
    sympathetic system is activated, increasing the
    work load of the heart.
  • Increasing blood pressure, pulse and respitations
  • Decreasing the workload on the heart by using a
    local anesthetic with the opioid helps to
    decrease thrombophlebitis and paralytic ileus.

30
Pain ManagementEpidural and Intrathecal
Medication
  • Epidural Medication Administration
  • External Catheters
  • Internal Catheters
  • Common Epidural Medications
  • Preservative free morphine
  • Sublimaze (fentanyl)
  • Sufentanil (sufenta)
  • Bupivacaine (Marcaine)
  • Lidocaine
  • Tetracaine

31
Epidural Catheter
32
Pain ManagementEpidural and Intrathecal
Medication
33
Pain Management
  • JCAHO guidelines for pain assessment
  • Recognize the right of patients to appropriate
    assessment and management of their pain
  • Assess pain in all patients
  • Record the results of the assessment in a way
    that facilitates regular reassessment and
    follow-up
  • Educate relevant providers in pain assessment and
    management

34
Pain Management
  • Guidelines cont
  • Determine competency in pain management and
    management
  • Establish policies and procedures that support
    appropriate prescribing
  • Educate patients and families about elective pain
    management
  • Include pain management needs in care planning

35
Pain ManagementNursing Care
  • Knowledge of the pharmacological implications of
    the medications along with baseline information
  • Pulse rate
  • Respirations
  • Blood pressure
  • Known drug allergies
  • History of opioid use
  • Pain level before opioid use

36
Pain ManagementComplications
  • Inadequate pain relief
  • Respiratory depression
  • Side effects
  • Dose related
  • Continuity of care

37
Pain Management
  • Moderate Sedation/Analgesia
  • Conscious sedation

38
Questions?
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