Rationale: Intravenous infusion, sometimes referred to as intravenous therapy or a drip, is a common technique to deliver medications and fluid directly into the blood stream under a controlled flow rate over long periods of time. The flow rate is set by timing the drips seen inside of the drip chamber that connects the liquid being infused to the line running into the patient’s vein. This drip chamber also acts as a barrier to air entering the venous system which could cause an air embolism. Intravenous infusions are typically used for dehydrated patients requiring fluid replacement and/or electrolyte balancing, medication delivery, and blood transfusions. Intravenous delivery is the fastest route of dispersal because of the direct route to the heart. From there, the arteries rapidly distribute the liquid infusion throughout the body.
Rationale: Standing orders are a way for the physician to have certain actions carried out under certain conditions as a matter of policy or procedure. This isn’t something that necessarily needs to be written into a chart, sometimes it can be found as part of a policy and procedure handbook. For example, it is typical for there to be a standing order of NPO after midnight for patient’s having an elective surgery. This tells the healthcare workers to communicate to the patient that nothing may be eaten or drank after midnight on the night before this type of surgery. This isn’t something that the physician needs to tell anyone, but it must be understood that this is what the physician needs in this case, every time. This gives the healthcare workers parameters to work under without direct orders from the physician, and this gives the physician more time to work with other aspects of patient care without having to micro-manage every circumstance.
Rationale: The terms medication and drugs can be used interchangeably, however, the term drugs has taken on a negative connotation in modern society. Medications are simply a substance (typically chemical) that is used to cure, prevent, treat, diminish or slowdown the effects of an illness or disease. Some medications come from plant life while others are taken from animal sources. Synthetic manufacturing of certain drugs is becoming a viable option and could possibly replace the source for some of the most widely used medications. Medications can be named in a few different ways. A generic name is given to describe the chemical family the medication comes from, such as aspirin. A chemical name is given to describe what chemicals were chosen to create the medication. Acetylsalicylic acid is the chemical name for aspirin. The companies that create these medications then brand their product with a proprietary name. This is the name that shows up on the store shelves.
Rationale: Pharmacokinetics is the study of how the human body processes medications. This study involves medication absorption, the metabolism (physical and chemical change) of the medication in the body, the distribution of medications throughout the body, and the ways in which the drugs are excreted. It is important to understand how these qualities change from person to person because it can drastically change the amount and type of the drug prescribed. Many patient factors affect the type of medication chosen. These factors can include age, gender, weight, and any disease the patient may be diagnosed with. For example, if the patient has impaired kidney function, medication may not be excreted as efficiently. The medication could then become toxic if allowed to stay in the body for longer periods of time.
Rationale: Pharmacodynamics is the study of the mechanism of drugs on the functions of the human body. The function of a drug that is most commonly demonstrated is the binding of a medication to a cell’s receptor sites. This binding can create what is known as a therapeutic effect. The therapeutic effect is an outcome from the use of the drug that demonstrates a desired effect. This effect can only occur when the receptor sites lock together with the medication. A drug that locks together with a receptor site and stimulates a specific result is referred to as an agonist. For example, morphine simulates the production of endorphins in the body and aids in replicating those actions throughout the central nervous system . A drug that locks together with a receptor site and denies a function of the body is referred to as an antagonist. A common antagonist is called insulin. Insulin is used to lower a patient’s blood sugar.
Rationale: Extravasations can be painful events. Drugs can cause blistering and necrosis if infiltrated into the tissue. Steps should be taken while setting up an IV to minimize the risk of extravasation. When placing a needle into a vein check for backflow to confirm placement. If there is no blood return you must resituate the needle, or remove the needle and try again. Once in place, always secure the IV using the proper tape. Once the injection begins, pay close attention to the patient. If the patient begins to react negatively, question them about discomfort at the injection site. If extravasation has occurred, the needle must be removed immediately followed by constant pressure at the site. Once the bleeding is controlled, place a cold compress on the site. This both reduces the pain and constricts the blood vessels to reduce the tissue affected by the infiltration. Cold therapy should continue for one hour, and must be repeated 3 times a day until the swelling is relieved.
Rationale: The intradermal injection is generally used as a skin test for certain diseases. The most common is the tuberculin skin test, also known as the TB test. To perform an intradermal injection, you must first use a small needle at about a 26 gauge that is around ½ inch long. The needle’s approach is almost parallel to the anterior surface of the forearm using a 10-15 degree angle of insertion. It is absolutely critical that the bevel (opening) of the needle tip is facing up. The bevel should be inserted just under the surface of the skin, and the plunger on the syringe should be depressed slowly. The skin around the injection site will begin to rise up from the fluid being forced between the skin layers. This lump is referred to as “the wheal”.
The Six Rights of Medication Administration
Rationale: The Six Rights to Medication Administration is a mnemonic device used to avoid grievous errors while preparing drugs for patients. The device goes like this: The Right dose, of the Right medication, to the Right patient, at the Right time, by the Right route, with the Right documentation. The dose is how much of the Right medication you prepare for delivery to the patient. The Right patient is critical. Have the patient give you the two patient identifiers, their full name and date of birth. Medications are timed out to avoid rising toxicity levels in the body, so you must confirm the Right time for the next dose of medication. Some medications can only be given into the body through certain routes. These routes can be oral, rectal, topical, sublingual, intravenous, inhaled, etc. If the medication is delivered incorrectly, it could have dangerous side effects. And always document the medication you used, the patient you used it on, and the date and time you used it.
Rationale: Antihistamines are medications used to relieve a body’s allergic responses. Some examples of antihistamines are Diphenhydramine (Benadryl) and Phenagren. A common side effect of the antihistamine is drowsiness. Antihistamines are a type of antagonist drug that attaches itself to the receptor sites the body’s histamines and inhibit them from carrying out their tasks. Histamines are released into the body when something needs re-supplied. In the case of allergic reactions, histamines try violently to replenish the body’s fluid levels and can overcompensate, which is why the body can react by having a runny nose, watery eyes and sneezing.
Rationale: Analgesics are a common type of pain relief that can be given to a patient with negligible side effects. Some standard types of analgesics are acetaminophen (Tylenol), aspirin, and ibuprofen. These types of over-the-counter analgesics are classified as NSAIDs, which stands for non-steroidal anti-inflammatory drugs. Some people do not respond to OTC counter versions of analgesics appropriately. Physicians can then prescribe stronger variations of analgesics. Because they are in the same family as opioids, which means they have actions that are similar to that of morphine, certain analgesics can have a much higher potency. Opioids act by relieving pain through the depression of the central nervous system and creating a state of drowsiness. If a patient is prescribed excessive doses of stronger analgesics, the patient must be monitored closely to avoid depressed respirations and possible coma.