 BASIC PHARMACOLOGY

Therapeutic effect – the primary effect intended that is the reason the drug is priscribed and also
known as Desired effect
Drug allergy - the immunologic reaction to the drug
Anaphylactic shock- a severe allergic reaction which usually occurs immediately following
administration of the drug
Drug tolerance- a decreased physiologic response to the repeated administration for a drug or
chemically related substance.
- Excessive increase in the dosage is required in order to maintain the desired
therapeutic effect
Cumulative Effect- it is increasing response to the repeated doses of a drug that occurs when the rate
of administration exceeds the rate of metabolism or excretion
Idiosyncratic Effect - it is the unexpected peculiar response to the drug; either overresponse,
underresponse, different response than expected, unpredictable or unexplained
response
Drug Abuse - inappropriate intake of a substance, either continually or periodically
Drug dependence - it is a person’s reliance to take a drug or substance.
- Intense physical or emotional disturbance is produced if the drug is withdrawn

Addiction – it due to biomedical changes in body tissues, especially the nervous system. These tissues
come to require the substance for functioning and also called physical dependence
Habituation – it is the emotional reliance on a drug to maintain a sense of well-being accompanied by
feelings of need or cravings for the drug and also known as psychological dependence

Drug interaction - effects of ne drug are modified by the prior or concurrent administration of another
drug, thereby increasing or decreasing the pharmacological action

Drug antagonist - conjoint effect of two drugs is less than the drugs is less than the drugs acting
separately

Summation - the combined effect of two drugs produces a result that equals the sum of the individual
effect of each agent

Synergism - the combined effects of drugs are greater than the sum of each individual agent acting
independently

Potentiation - the concurrent administration of two drugs in which one drug increases the effect of the
other drug

Therapeutic Actions of Drugs

Palliative
-relieves the symptoms of a disease but does not affect the disease itself
- example: paracetamol for headache
Curative
- treats the disease condition
- example: antibiotic for infection
Supportive
- sustains body functions until other treatment of the body’s response can take over
- example: mannitol to ICP in a client for surgery due to brain tumor
Substitute
- replaces body fluid or substances
- example: insulin injection for DM
Chemotherapeutic
- destroys malignant cells
-example: Cyclophosphamide for of the prostate gland
Restorative
- returns the body to health
- example: multivitamins for elderly clients
 General Properties of Drugs

1. Drugs do not confer any new function on a tissue or organ in the body. They only modify
existing functions
2. Drugs in general exert multiple actions rather than single effect, therefore, no drug is free from
side effect
3. Drug interaction results from physiochemical interaction between the drug and a functionally
important molecule in the body.
PHARMACOKINETIC FACTORS IN DRUG THERAPY
1. Absorption – is the process from its site of administration into the bloodstream
Factors That Affect Drug Absorption
a. Blood Flow
 Rich blood supply enhances absorption
 IM injection promotes faster absorption than subcutaneous injection because there is
more blood supply in the muscles than in the subcutaneous area
b. Pain
 Slows gastric emptying rate, so the drug taken orally will be absorbed slowly
c. Stress
 Causes vasoconstriction, so the drug taken orally will be absorbed slowly
d. Foods
 Interfere with drug absorption
e. Exercise
 #It can decrease blood circulation to the GI tract by causing more blood flow to the
muscle
 Oral drugs will be absorbed more slowly
f. Nature of the absorbing surface
 Transport of drug molecules is faster through a single layer of cells.
 Drugs applied to the mucous membranes will be absorbed faster than those applied on
the skin
g. Solubility of the drug
 The drug must in solution
 Liquid drugs are absorbed faster than solid drugs
h. pH
 acidic drugs are best absorbed in the acidic environment and alkaline drugs best
absorbed in the alkaline environment
i. Drug Concentration
 Drug administered in high concentration tend to be more rapidly absorbed than the
drugs administered in low concentrations.
 Bolus dose is given to obtain rapid effect of the drug
j. Dosage Form
 An active drug may be combined with another substance from which lit is slowly
released, or may be prepared in a vehicle that offers relative resistance to the digestive
action of the stomach contents
 Example: enteric coated drugs like erythromycin
2. Distribution – the transport of a drug from its side of absorption to its site of action
Factors that affect drug distribution:
a. Plasma-Protein Binding
 Medications connect with plasma protein (albumin) in vascular system
 Strong attachments have a longer period of drug action
 Clients with reduced plasma proteins could receive a heightened drug effect. Example:
clients with kidney or liver disease
b. Volume Distribution
 Client with edema has enlarged area in which a drug can be distributed, and may need an
increased dose
 Smaller dose may be needed for client with dehydration

c. Barriers to Drug Distribution

  Prevent some medications from entering certain body organs
 Blood Brain Barrier – to pass through this barrier, drug must be lipid soluble and loosely
attached to plasma proteins
 Placental Barrier – shields from the possibility of adverse drug effects. Many substances like
drugs, nicotine, and alcohol may not cross the placental barrier
d. Obesity
 Body weight plays a role in drug distribution because blood flows through fat slowly, thus
increasing time before drug is released
e. Receptor Combination
 A receptor is usually protein or nucleic acid.
 Other receptor are enzymes, lipids, and carbohydrate residues
 Drug can have agonist or antagonist effect
 Agonist will connect itself to the receptor site and cause pharmacological response
 Antagonist will attempt to attach but because attachment is uneven, there is no drug response
 There can be competition at receptor site when more one drug tries to occupy it
3. Metabolism or Biotransformation
 A sequence of chemical events that change a drug to a less active form after it enters the body.
Also called detoxification
 The liver is the principal site of drug metabolism
 Oral medications – go directly to the liver via the portal circulation before entering the systemic
circulation
 Many medications become entirely inactivated by the liver the first time they go through it
Factors That Affect Drug Metabolism
a. Age – infant and elderly have reduced ability to metabolize some drugs
b. Nutrition – liver enzymes involved in metabolism rely on adequate amounts of amino acids,
lipids, vitamins and carbohydrates
c. Insufficient amounts of major body hormones – like insufficient insulin/adrenal corticosteroids
can reduce metabolism of drugs in the liver

4. Excretion
 Is the process by which drugs are eliminated from the body
 Most important route of excretion for most drugs is the kidney

Factors That Affect Drug Excretion

a. Renal Excretion – carried out by glomerular filtration and tubular secretion which increases
quantity of drug excreted
b. Drugs can affect elimination of other drugs
Examples:
 Probenecid prevents excretion of penicillin
 Antacid increases elimination of ASA
c. Blood concentration levels – when peak level of drug is reached, excretion levels become
greater than absorption and blood levels of drugs begin to drop
d. Half-live – it is the time required for the total amount of drug to decrease by 50%

Physiologic Changes Associated with Aging that Influence Medications

Administration and Effectiveness
1. Altered memory – the elderly client usually forgets whether he/she had taken the drug or not.
2. Less acute vision – the client has difficulty reading labels of drugs
3. Decrease in renal function resulting in slower elimination of drugs
4. Less complete and slower absorption from gastrointestinal tract
5. Increased proportion of fat to lean body mass which facilitates retention of fat-soluble drugs
and increases potential for toxicity
6. Decreased liver function which hinders biotransformation of drug
7. Decreased organ sensitivity – this may lead to underresponse to drug
8. Altered quality of organ responsiveness, resulting in adverse effects becoming pronounced
before therapeutic effects are achieved

Principles in Administering Medication

 1. Observe the “7 Rights” of Drug Administration
a. Right drug – read the label three times
b. Right dose – know the usual dose of the dose of the drug. Calculate the correct amount
c. Right time – standard time may followed in the institution
d. Right route – check the route of administration
e. Right patient – identify patient by: checking the ID band (most accurate patient identifier)
or asking him to state his/her name (not accurate for confused clients)
f. Right recording – sign medication sheet immediately after administration of the drug
g. Right approach

Best Practice: “Perfect Med Pass”

2. Practice asepsis – wash hands before and after preparing medications

3. Nurses who administer medications are responsible for their own actions. Question any order
that you consider incorrect (may be unclear or inappropriate)
4. Be knowledgeable about the medications that you administer. Know the action, indication,
nursing responsibilities, side effects, and adverse effect of the drugs

A Fundamental rule of safe administration is:

“Never administer an unfamiliar medication”

5. Keep narcotics in locked place

6. Use only medications that are in clearly labelled containers. Relabelling of drugs is the
responsibility of the pharmacist not of the nurse.
7. Return liquid that are cloudy in color to the pharmacy (for clear liquid meds)
8. Do not leave the medications at the bedside. Stay with the client until he actually takes the
medications
9. The nurse who prepares the drug administers it. Only the nurse who prepared the drugs knows
what that drug is. Do not accept endorsement of medications
10. If the client vomits after taking medication, report this to the nurse in charge or physician
11. Preoperative medications are usually discontinued during the postoperative period unless
ordered to be continued. The preoperative discontinuing of meds is usually SOP
12. When a medication is omitted for any reason, record that fact together with the reason
13. When a medication error is made, report it immediately to the nurse in charge or physician, to
implement necessary measures immediately. This may prevent any adverse effects of the drugs

Routes of Drug Administration

1. Oral
 Advantages
a. Most convenient
b. Usually less expensive
c. Safe, does not break skin barrier
 Disadvantages
a. Inappropriate for client with nausea and vomiting
b. Drugs may have unpleasant taste or odor
c. Inappropriate if client cannot swallow and if GIT has reduced motility
d. Drugs may discolour the teeth
e. Drugs may irritate gastric mucosa
f. Drugs may be aspirated by seriously ill patient
 Drug Forms for Oral Administration
a. Solid: tablet, capsule, pill, powder
b. Liquid: syrup, suspension, emulsion, elixir, milk, or other alkaline substances
- Syrup: sugar-based liquid
- Suspension: water-based liquid, shake the bottle before use of medication to
properly mix it.
c. Emulsion: oil-based liquid medication
d. Elixir: alcohol-based liquid. After administration of elixir, allow 30 minutes to
elapse before giving water, to allow maximum absorption of the medication

Reminder:
  Never crush enteric-coated or sustained-release tablets.
 Crushing enteric-coated tablets allows the irritating medication to come in contact with the
oral or gastric mucosa, resulting in mucositis or gastric irritation
 Crushing sustained-release medication allows all the medication to be absorbed at the time,
resulting in a higher than expected initial level of the medication and a shorter than
expected duration of drug

2. Sublingual – a drug that is placed under the tongue, where it dissolves. When medication is in
capsule and ordered sublingually, the fluid must be aspirated from the capsule and placed under
the tongue.
 Advantages
a. Most convenient
b. Usually less expensive
c. Safe, does not break skin barrier
d. Drugs can be administered for local effect
e. Drugs are rapid absorbed in the bloodstream
 Disadvantages
a. If swallowed, drugs may be inactivated by gastric juices
b. Drugs must remain under the tongue until dissolved land absorbed
3. Buccal – a medication is held in the mouth against the mucous membranes of the cheek until
the drug is dissolved. The medication should not be chewed, swallowed, or placed under the
tongue. Example: sustained release nitroglycerine, opiates, antiemetics, tranquilizers,
sedatives.
 Advantages
a. Same as oral plus +
b. Drugs can be administered for local effect. Ensures greater potency because drugs
directly enter the blood and bypass the liver.
 Disadvantages
a. If swallowed, drugs may be inactivated by gastric juice
4. Topical/Percutaneous – application of medications to a circumscribed area of the body
a. Dermatologic – includes lotions, liniments and ointments
- Wash and pat dry area before application to facilitate absorption
- Use surgical asepsis when open wound is present
- Remove previous application before the next application
- Apply only thin layer of medications, to prevent systemic absorption
- Use gloves when applying the medication over a large surface, like large
area of burns
b. Ophthalmic – includes instillations and irrigations
1. Instillations – to provide an eye medication that the client requires
2. Irrigation – to clear the eye of noxious of other foreign material
- Position client either sitting or lying
- Use sterile technique
- Clean the eyelid and eyelashes with sterile cotton balls moistened with
sterile normal saline from the inner to the outer canthus
- Instill eye drops into lower conjunctival sac
- Instill a maximum of two drops at a time. Wait for 5 minutes if additional
drops need to be administered. This is for proper absorption of the
medication
- Avoid dropping a solution onto the cornea directly, because it causes
discomfort
- Instruct the patient to close eyes gently, because shutting the eyes tightly
cause the spillage of the medication
- For liquid eye medication, press firmly on the nasolacrimal duct (inner
canthus) for at least 30 seconds to prevent systemic absorption of the
medication
c. Ear/Otic Administration – includes instillations and irrigations
 Instillations
1. To soften earwax
2. To reduce inflammation
3. To relieve pain
 Irrigations
 1. To remove cerumen or pus
2. To apply heat
3. To remove foreign body

To instill ear medication

 Warm solution at room or body temperature. Using hot or cold solution into the ear
can cause nausea, vertigo, and pain
 Side lying position with the ear being treated uppermost
 Clean the pinna and the meatus of the ear canal with cotton-tipped applicator
 Straighten the ear canal
- 0-3 years old: pull the pinna downward and backward
- Older than 3 years old: pull the pinna upward and backward
 Instill eardrops on the side of the auditory canal to allow the drops to flow in and to
continue to adjust to body temperature.
 Press gently but firmly a few times on the tragus of the ear to assist the flow of
medication into the ear canal
 Ask the client to remain in side lying position for about 5 minutes
 Insert a small piece of cotton fluff loosely at the meatus of the auditory cannal for 15 to
20 minutes to prevent spillage of medication out of the ear
d. Nasal – nasal instillations usually are instilled for their astringent effect (to shrink swollen
mucous membrane), to loosen secretions and facilitate drainage or treat infections of the
nasal cavity or sinuses.
Example: decongestants, steroids, calcitonin
 Have the client blow the nose prior to nasal instillation
 Assume back lying position, or sit up and lean head back
 Elevate the nares slightly by pressing the thumb against the client’s tip of the nose, and
while the client inhales, squeeze the bottle
 Keep the head tilted backward for 5 minutes after instillation of nasal drops
 When the medication is used on a daily basis, alternate nares to prevent irritation
 For sinus instillation:
 Parkinson’s position for frontal and maxillary sinuses
 Proetz position for ethmoid and sphenoid sinuses

e. Inhalation – use of nebulizers, metered-dose inhalers (MDI)

 Semi or high Fowler’s position or standing position. To enhance full chest expansion
allowing deeper inhalation of the medication
 Shake the canister several times. To mix the medication and ensure uniform dosage
delivery
 Position the mouthpiece 1 to 2 inches from the client’s open mouth. As the client
starts inhaling, press the canister down to release one dose of the medication. This
allows delivery of the medication more accurately into the bronchial tree rather than
being trapped in the oropharynx than swallowed
 Instruct client to hold breath for 10 seconds. To enhance absorption of the medication
 Is a spacer is attached to the inhaler, seal the mouthpiece with the lips. A spacer is
used to trap most ofs the medication and maximum amount will be inhaled
 If bronchodilator, administer a maximum of 2 puffs, for at least 30 seconds interval.
Administer bronchodilator before other inhaled medication. This opens airway and
promotes greater absorption of the medication
 Wait at least 1 minute before administration of the second or inhalation of a different
medication by MDI
 Instruct client to rinse mouth, if steroid had been administered. This is lto prevent oral
fungal infection

f. Vaginal
  Advantage
1. Provides local therapeutic effect
 Disadvantages
1. Hsd limiyrf udr
 Drug forms: tablet, liquid (douches), cream, jelly, foam, and suppository
 Use applicator or sterile gloves for vaginal administration of medications

Vaginal Irrigation – is the washing of the vagina by a liquid at low pressure. It is also called douche

 Empty the bladder before the procedure

 Position and drape the client
1. Instillation: back-lying position with knees flexed and hips rotated laterally
2. Irrigation: back-lying position with the hips higher than the shoulders (use
bedpan)
 Irrigating container should be 30 cm. (12 inches ) above.
 Ask the client to remain bed for 5-10 minutes following administration of vaginal
suppository, cream, foam, jelly or irrigation
g. Rectal
 Advantage
1. Can be used when the drug has objectionable taste or odor
 Disadvantage
1. Dose absorbed is unpredictable
 Suppository needs to be refrigerated so as not to soften
 Use glove for insertion of suppositories
 Have client lie on left side and breath through the mouth to relax the
anal sphincter
 Insert suppository until a sensation of “as if something has grabbed it
away” occurs. This indicates that suppository hav been inserted past
the internal anal sphincter.
 Ensure that the suppository comes in contact with the rectal wall. This
ensures accurate absorption of the medication
 Client must remain on side for 20 minutes after insertion. To promote
adequate absorption of the medication

4. Parenteral. The administration of medication by needle

a. Intradermal – under the epidermis
b. Subcutaneous – into the subcutaneous tissue
c. Intramuscular – into the nuscle
d. Intravenous – into the vein
e. Intraarterial – into the artery
f. Intraosseous – into the bone

Intradermal injection: the administration of a drug into the dermal layer of the skin beneath the
epidermis.
 The sites are the inner lower arm, upper chest and back, and beneath the scapulae
 Indicated for allergy and tuberculin testing and for vaccinations
 Use left arm for tuberculin tests; use right arm for all other tests.
 Use the needle gauge 25, 26, 27; needle length 3/8”, 5/8”, or ½”
 Needle at 10 to 15 degree angle; bevel up
 Inject a small amount of drug slowly over 3 to 5 seconds to form a wheal or bleb
 Do not massage the site of injection, to prevent irritation of the site, and to prevent
absorption of the drug into the subcutaneous

Subcutaneous: drugs administered subcutaneously are as follows:

- Vaccines, preoperative medications, narcotics, insulin, and heparin
  The sites are the outer aspects of the upper arms, anterior aspect of the thighs,
abdomen, scapular of the upper back, and ventrogluteal and dorsogluteal areas but
not into the muscles
 Only small doses of medication should be injuected via subcutaneous route (0.5 to
10 ml)
 Rotate site of injection minimize tissue damage
 Needle length and gauge are the same as for intradermal injections
 Use5/8” needle for adults when the injection is administered at 45 degree angle; ½
needle is used at a 90 degree angle
 For heparin injection: do not aspirate; do not massage the injection site to prevent
hematoma formation
 For insulin injection: do not massage site. To prevent rapid absorption thereby,
preventing hypoglycemic reaction. Always inject insulin at 90 degree angle to
administer the medication in the packet between the subcutaneous and muscle
layer. Adjust the length of the needle, depending on the size of the client
 For other medications, aspirate before injection of the medication check if blood
vessel had been hit. If blood appears on back of the plunger of the syring, remove
the needle and discard the medication and equipment
Intramuscular injections:
 Needle length is 1”,1 ½”, 2”; to reach the muscle.
 Use needle gauge 20, 21, 22, 23 depending on the viscosity of medication
 Clean the injection site with alcoholised cotton ball. To reduce microorganisms in
the area
 Inject the medication slowly to allow the tissues to accommodate vlume

Sites of Intramuscular Injections

1. Ventrogluteal site (von HOchsteter’s site)

 Uses gluteus medius which lies over the gluteus minimus muscle
 The area contains no large nerves, or blood vessels and less fat. It is farther from
the rectal area, so it less contaminated
 Position the client in prone or side-lying. When in prone position, curl the toes
inward. When in side-lying position, flex the knee and hip. These ensure relaxation
of gluteus muscles and minimize discomfort during injection
 To locate the site, place the heel of the hand over the greater trochanter, point the
index finger towards anterior superior iliac spine, and then abduct the middle (third)
finger. The tingle formed by the index finger, the third finger and the crest of the
ilium is the site.
2. Dorsogluteal site
 Uses gluteus medius
 Position of the client is similar to ventrogluteal site
 The site should not be used for infants under 3 years, because the gluteal muscles
are well-developed yet
 To locate the site, the nurse draws in imaginary line from the greater trochanter to
the posterior superior iliac spine. The injection site is lateral and superior to this line
 Another method of locating this site is to imaginary divide the buttocks into four
quadrants. The upper outer quadrant is the site of injection. Palpate the crest of
ilium to endure that the site is high enough

Avoid hitting the sciatic nerve, major blood vessel or bone by locating
the site properly
3. Vastus lateralis
 Recommended site of injection for infants
 Located at the middle third of the lateral aspect of the thigh
 Assume back-lying or sitting position
4. Rectus femoris site
 Located at the middle third, anterior aspect of the thigh

5. Deltoid site
  Not used often for IM injection because it is relatively small muscle and is very close
to the radial nerve and radial artery
 To locate the site, palpate the lower edge of the acromion process and the midpoint
on the lateral aspect of the arm that is in line with the axilla. This is approximately 5
cm (2 inches) or 2 to 3 fingerbreaths below the acromion process.
 Variation of the IM injection: Z-tract technique
 Used for parenteral iron preparation. To seal the drug deep into the
muscles and prevent permanent staining of the skin
 Retract the skin laterally, inject the medication slowly. Hold retraction skin
until the needle is withdrawn
 Do not massage the site of injection. To prevent leakage of medication into
subcutaneous
 Prone position: Curl toes inward to relax gluteus muscles
 Side-lying position. Flex the upper leg to relax gluteus muscles

General Principles in Parenteral Administration of Medications

1. Check the doctor’ order
2. Identify the client properly. This ensures that the medication is administered to the right client
3. Practice ASEPSIS. To prevent infection
4. Use appropriate needle size. To minimize tissue injury
5. Plot the site of injection properly. To prevent hitting nerves, blood vessels, bones
6. Use separate needles for aspiration and injection of medications. To prevent irritation of tissues
7. Introduce air into the vial. To allow easy withdrawal of the medication
8. Allow a small air bubble (0.2 ml) in the syringe to push the medication that may remain in the
hub and lumen of the needle
9. Introduce the needle in a quick thrust. To lessen discomfort
10. Either spread or pinch muscle when introducing the medication. Depending on the size of the
client.
11. Minimize discomfort by applying cold compress over the injection site before introduction of
medication to numb nerve endings; apply warm compress to improve circulation in the area.
12. Aspirate before introduction of medication. To check if blood vessel had been hit.
13. Support the tissues with cotton swabs before withdrawal of needle. To prevent discomfort of
pulling tissues as needle is withdrawn
14. Massage the site of injection to hasten absorption
15. Apply pressure at the site for few minutes. To prevent bleeding
16. Evaluate effectiveness of the procedure and make relevant documentation

a. Intravenous
 Direct IV, IV push, IV infusion
 Most rapid route of absorption of medications
 Predictable therapeutic blood levels of medications can be obtained
 The route can be used for client with compromised gastrointestinal function or
peripheral circulation
 Larger doses of medications can be administered by this route
 For “piggy back” administration, the secondary line should be higher than the primary
line. This is to allow the primary line to run when the secondary line is over and to
prevent air from entering IV tubing.

Types of IV Fluids
1. Isotonic solution. Has the same concentration as the body fluids. E.g. D₅W, NaCl 0.9%, plain
Ringer’s lactate, plane Normosol M, D₅ ½ NS
2. Hypotonic. Has lower concentration than the body fluids. E.g. ½ NS (NaCl 0.45%)
3. Hypertonic. Has higher concentration than the body fluids. Elg. D₁₀W, D₅₀W, D₅LR, D₅NM, D₅NS

Nursing Interventions in IV Infusion

1. Verify the doctor’s order.
2. Know the type, amount, and indication of IV therapy
3. Practice strict asepsis
4. Inform client and explain purpose of IV therapy
5. PRIME IV tubing to expel air. This will prevent air embolism
6. Clean the insertion site of IV needle from center to the periphery with alcoholised cotton swab
7. Shave area of needle insertion if hairy
8. Change/alter tubing every 72 hours. To prevent contamination
9. Change/alter IV needle insertion site every 72 hours. To prevent thrombophlebitis
 10. Regulate IV every 15-20 minutes. To ensure administration of proper volume of IV fluid as
ordered
11. Observed for potential complications

Complications of IV Infusion
1. Infiltration. The needle is out of vein, and fluids accumulate in the subcutaneous tissues.
 Assessment
 Pain
 Swelling
 Skin is cold at needle site
 Pallor of the site
 Flow of IV rate decreases or stops
 Absence of backflow of blood into the tubing as the IV fluid is put down, or the IV
tubing is kinked
 Nursing Interventions
 Change the site of the needle
 Apply cold compress. This will relieve pain, promote vasoconstriction and reduce
swelling
“Cold to Cold” (cold skin, cold application)
2. Circulatory Overload
 Assessment
 Headache
 Flushed skin
 Rapid pulse
 Increased BP
 Weight gain
 Syncope or faintness
 Pulmonary edema
 Increase venous pressure
 Coughing
 SOB (short of breathness)
 Tachypnea
 Shock
 Nursing interventions
 Slow infusion to KVO (keep vein open: 10 gtts/min)
 Place patient in high-Fowler’s position. To ease breathing
 Administer diuretic and bronchodilator as ordered. Diuretic enhances excretion of
sodium and water and relieves congestion. Bronchodilator relieves dyspnea
3. Drug Overload. The patient receives an excessive amount of fluid containing drugs
 Assessment
 Dizziness
 Shock
 Fainting
 Nursing Interventions
 Slow infusion to KVO. Notify the physician
4. Superficial Thrombophlebitis. Is the inflammation of the vein. It is due to overuse of a vein,
irritating solutions or drugs, clot formation, large bore catheters.
 Assessment
 Pain along the course of vein
 Vein may feel hard and cordlike
 Edema and redness at needle insertion site
 Arm feels warmer that the other arm
 Nursing Interventions
 Change IV site every 72 hours
 Use large veins for irritating fluids
 Stabilize venepuncture at area of flexion
 Apply warm compress immediately to relieve pain and inflammation
“Warm to Warm” (warm skin, warm application)
Do not irrigate IV because this could push clot into the systemic circulation

5. Air embolism. Air manages to get into the circulatory system; 5ml of air or more causes air
embolism.
 Assessment
  Chest, shoulder, or back pain
 Hypotension
 Dyspnea
 Cyanosis
 Tachycardia
 Increased venous pressure
 Loss of consciousness
 Nursing Interventions
 Do not allow IV bottle to “run dry”
 “Prime” IV tubing before starting infusion to expel air from the IV tubing
 Turn client to left side, in the Trendelenburg position (head lower than the body).
To allow air to rise in the right side of the heart. This prevents pulmonary embolism
6. Nerve Damage. May result from tying the arm too tightly to the splint.
 Assessment
 Numbness of fingers and hands

 Nursing Interventions
 Massage area and move arm through it ROM
 Instruct the patient to open and close hand several times each hour
 Physical therapy may be required

Note: apply splint with the fingers free to move

7. Speed Shock. May result from administration IV push medications rapidly.

 Nursing Interventions
 To avoid speed shock, and possible cardiac arrest, give most IV push medication
over 3 to 5 minutes.

BLOOD TRANSFUSION THERAPY

Purposes
1. Administer required blood components
2. Restore blood volume
3. Improve oxygen-carrying capacity of the blood
Blood Types
A AB
B O
The blood type indicates the type of antigen present in the surface of the haemoglobin
Nursing Interventions in Blood Transfusion
1. Verify doctor’s order
2. Inform client and explain purpose of the procedure
3. Check written consent for blood transfusion
4. Check for cross-matching and blood typing; to ensure compatibility
5. Obtain and record baseline VS
6. Practice strict ASEPSIS
7. At least 2 nurses check the label of the blood transfusion
 Check the following:
 Serial number
 Blood component
 Blood type
 Rh factor
 Expiration date
 Screening tests (VDR for sexually transmitted diseases; HBsAg for hepatitis B; ELISA
test for HIV}
 This is to ensure that the blood is free from blood-carried diseases and
therefore, safe for transfusion
 Expired blood may cause hyperkalemia, and septic shock
8. Warm blood at room temperature before transfusion. To prevent chills
9. Administer blood within 30 minutes from the time it was taken from the blood bank
10. Identify client properly. Two nurses check the client’s identification
11. Use needle gauge 18 or 19. This allows easy flow of blood.
12. Use BT set with filter. To prevent administration of blood clots and other particulates
 13. Start transfusion slowly at 10 gtts/min. remain at bedside for 15 to 30 mins. Adverse reaction
usually occurs during the first 15 to 20 minutes
14. Monitor VS. altered VS indicates adverse reaction
15. Do not mix medications with blood transfusion. To prevent adverse effects. Do not incorporate
medication into the blood transfusion. Do not use the blood transfusion line for IV push of
medications
16. Administer 0.9 % NaCl before: during or after BT. Never administer IV fluids with dextrose.
Dextrose causes hemolysis
17. Administer BT for 4 hours (whole blood, packed RBC) to prevent hemolysis. For plasma,
platelets, cryoprecipitate, transfuse quickly (20 minutes). Clotting factors can easily be
destroyed.
18. Observe for potential complications. Notify physician
a. Allergic Reaction
b. Febrile, non-hemolytic
c. Septic reaction
d. Circulatory overload
e. Hemolytic reaction
19. Make relevant documentation

Complications of Blood Transfusion

1. Allergic Reaction. It is caused by sensitivity to plasma protein or donor antibody, which reacts
with recipient antigen
 Assessment
 Flushing
 Rash, hives
 Pruritus
 Laryngeal edema, difficulty of breathing

2. Febrile, Non-hemolytic Reaction. It is caused by hypersensitivity to donor white cells, platelets

or plasma proteins. This is the most symptomatic complication of blood transfusion.
 Assessment
 Sudden chills and fever
 Flushing
 Headache
 Anxiety

3. Septic Reaction. It is caused by the transfusion of blood or components contaminated by

bacteria
 Assessment
 Rapid onset of chills
 Vomiting
 Marked hypotension
 High fever

4. Circulatory Overload. It is caused by administration of blood volume at a rate greater than the
circulatory system can accommodate.
 Assessment
 Rise in venous pressure
 Dyspnea
 Crackles or rales
 Distended neck vein
 Cough
 Elevated BP
(TRALI – transfusion reaction acute lung injury results to pulmonary edema}

5. Haemolytic Reaction. It is caused by infusion of incompatible blood products.

 Assessment
 Low back pain (first sign). This is due to inflammatory response of the kidneys to
incompatible blood products.
 Chills
 Feeling of fullness
 Tachycardia
 Flushing
  Tachypnea
 Hypotension
 Bleeding
 Vascular collapse
 Acute renal failure

Nursing Interventions when Complication Occurs in Blood Transfusion

1. Stop blood transfusion immediately. Notify physician

2. Start an IV line (0.9 % NaCl).
3. Collect urine specimen. To detect presence of bacteria, which may be causing the adverse
reaction to blood transfusion
4. Monitor VS
5. Send unused blood and BT set to the blood bank, for laboratory examination
6. Administer antihistamine, diuretics and bronchodilators as ordered.
7. Make relevant documentation

Computation of Dosage of Medications

1. Oral Medication: Solids
Desired dose = Quantity of drug
Stock dose
(D/S=Q)

2. Oral/Parenteral Medications: Liquids

Desired dose x dilution = Quantity of drug
Stock dose
(D/S x dilution = Q)

3. IV Fluids Rate
a. gtts/min = Volume in cc x factor
No. of hours x 60 min.
b. cc/hr = Volume in cc or gtts/min x 4
No. of hours

c. Duration in hours = Volume in cc

cc/hr

4. Conversion of Temperature
a. ⁰C to ⁰F = (⁰C x 1.8) + 32 (Note: 1.8 is 9/5)
b. ⁰F to ⁰C = (⁰F – 32)(0.55) (Note: 0.55 is 5/9)

5. Pediatric doses
a. Clark’s Rule

Wt. in lbs x Usual adult dose = Safe Child’s Dose

150

b. Freid’s Rule

Age in mos. X Usual adult dose = Safe Child’s Dose

c. Young’s Rule

Age in years___ x Usual adult dose = Safe Child’s Dose

Age in years + 12

Equivalents

 Common Household Measurements

 1 quart 4 cups
1 pint 2 cups
1 cup 8 ounces
1 teacup 6 ounces
1 tablespoon 3 tsp.; 15-16 mls
1 teaspoon 60 gtts; 4-5 mls
(Note: 1 ounce = 30 mls}

 Apothecary Measurements
60 minims 1 fluidram
8 fluidrams or 480 minims 1 fluidounce
16 fluidounces 1 pint
2 pints 1 quart (qt)
4 quarts 1 gallon (C)

Other Important Unit Equivalents

 1 G (gram) 15 gr.
 1 gr (grain) 60 mg
 1 mg (milligram) 1,000 mcg.
 1 ml (milliliter) 1 cc.; 15 gtts; 60 mcgtts,; 1G
 1 gal. (gallon) 4 L,; 4 qt.; 4,000 mls
 1 oz. (ounce) 30 G.; 30 mls.; 30 cc
 1 kg. (kilogram) 2.2 lbs
 1 lb (pound) 16 oz