Bie. cuarren 22 Parenterat Mecicatons Recording and Reporting * Afr inating CSQL immediatly chart medication, dose route, site time, dare, and type of medication pump in patient’s medial record, Use initials or signatures If medication is an opioid, follow agency policy to document Record parents response to medication and appearance of site every 4 hours or according to agency policy in nurses notes and electronic health record (EHR). . ‘+ Report any adverse effects ftom medication or infection at inser- ion site to patient's health care provider and document accon- ing to agency policy. Patient’s condition often indicates need for additional medical therapy. Special Considerations Teaching * Instruct patient to wear medical alert bracelet along with ‘medical information, including disease (e.g, diabetes), allergies, and a contact phone number for the pump manufacturer for technical suppor. ‘+ Instruct patients to carry back-up batteries and extra medica- tion if they are going to be away from home. * Patients receiving insulin require intensive diabetes manage: ‘ment education (Box 22-8). ‘+ Never immerse pumps in water or expose them to x-ray flms or magnetic resonance imaging. Pediatric * CSQI improves glycemic control in children and adolescents. There is a decreased rate of severe hypogtycemia, cathetersite infection, and weight gain (Cope et al., 2008; Hockenberry and Wilson, 2011), + Insulin pumps offer more flexibility for adolescents, placing the responsibility of diabetes management on the child. Extensive child and family education is needed in using CSQI (Hocken- berry and Wilson, 2011), + Clean and change CSQI sites in children every 48 to 72 hours cr at the first signs of inflammation (Hlockenberry and Wilson, 2011). Gerontologic # CSI delivers isotonic IV solutions w dehydrated older adult, known as hypodermocysis therapy. This method of providing 2 critical thinking Exercises SN Tre nurs is proparng to car for a patent newly dlagroned wh vom Trt aes secede eva hepa 500 units subcuare eoeyn a ovr 8 her. he hapa comes fom ts pramacy fa rum ove val. *° ch comet does he nurse need to know abou tho medca- ton and wa ee enitoa? 2 Which ntometon oes the nee need Know abut to patnt before acrnstering the hops? The sant welge 100 Ky 20 pounds). The drag caution has see eof hepa needs 0 bo adits. What spermine ti) noe wi be ised fo admit te nection? (iach sas res appropato to aamntr ro madeaton? + neser ihe sere eon, te tibet trots tora) push vey Shes ares {orbit ptt heen‘ and th rr has ovawod (rorntsconon rtwencas andthe oar provide’ ord menacatorl factors dove the nue od 10 esse bore mining te mornin? ey f Eyer Eres : Pern amrststisa acs Blood glucose monitoring * Meal planning and food choices Incorporating exercise into daily routine How to program and use the insulin PUP ness guidelines and management Management of hypoglycemia Prevention and management of hyperglycemia Prevention of infection, especially at CSQ1 infusion site Problem-solving and decision-making skils ‘Special considerations and precautions (eg. what to do with Pump when showering and sleeping) “Modified fom Daton Mt a: Salely Saves" ue of contrwous subovianeoxs insuln rus puns (Si) n Rosptaied pats, Hosp Pharm 1(10) 956, 2006, CSGr, Continuous subewtansous inion Ihydration avoids the need to transfer a patient from home fr long-term care facility to an acute care hospital. Infuse fluids slowly (est, 30 mlhr) during the first hour of therapy. If the patient remains comfortable, you can increase the rate of infusion. Usually infusion rates do not exceed 60 mL/hr. Hypodermoclysis isan easy-to-use, safe, and cost-effective alter- native to IV hydration for older adults (Gorski, 2009; Scales, 2011), Home Care * Patients in the home using CSQI need a responsible family caregiver if available, Educate the patient, family, andor signif cant others about the desired effect of the medication, side effects and adverse effects of the medication, operation of the pump, how to evaluate the effectiveness of the medication, when and how to assess and rotate injection sites, and when to call a health care provider for problems. Patients need to know where and how to obtain and dispose of all required supplies * Patients managing CSQI at home may use an antibacterial soap (cg. Hibiclens, pHisotex) instead of alcohol and chlothexi- dine to clean insertion sie. buiz (M REVIEW QUESTIONS 41 The nurse needs to reconstitute a medication for an intramuscular Injection. Which action would indicate thatthe procedure was com- pleted correctly? ‘The nurso shakes tho vial after the Mud is injected into I to imix it completa. 2 The nurse determines the amount of prepared mecication and concentration needed before adding the appropriate clluent 38 The powder is injected slowly into the vil of clivent. 4 The nurse evaluates tho concentration after the diluent and ‘powder aro mixed. 2 The nurse is mixing two medications in one syringe. One medica tion is in avi, and the other is in an ampule. Which sequence of Preparation is corect? 1 The nurso witidraws the modication from tho via fst. 2 Tho nurse propares the mecicaton from the ampule fist. 3 The nurse draws all the medication out of both the ampule ‘and tho vial 4 The nurse insets air into the ampule frstfn arge Sze 90-yard woman isto have an amor injection inthe ventrglitea site. Which needle is pproprat fr ‘administering the aqueous-based medication? 4 28 gauge, % inch 2 20-9auge, 1) inch 3 25 gauge, 1 inch 4 22 gauge. 1% inch 4 Boore administration of an intravenous (¥) push medication, the ‘nurse notes that the patient's ste col, pale, and swolen, The nuree should take whic action? 1 Stop the curent IV infusion and changeit to another sito 2 Slow the rate of the IV infusion 3 Flush tho IV ine with anormal saline fush 4 Take off he IV dressing and place a new one on thats not as tignt 3 Which action is the most important for the nurse to implement before giving an intravenous (W) push medication? 1 iluing the medication fo minimize vin tation 2 Stopping the primary (maintenance uid infusion 3 Assessing the IV insertion st 4 Ensuring that the correct fier needle i use to withdraw the medication trom the vi 5 Which of the falling assessment fags indicates a postive tuberculin reaction n'a patient wrth no known sk factors for ‘bereuosi? 1 large are of redness and sweling atthe injection ste 2 An induration of 18 mm 3 Frequent, productive cough accompanied by a fever 4 Sudden onset of shortness of breath and wheezing 7 Which of the folowing symptoms may indicate that a patent has sustained an injury tO 8 nerve ar an intramuscular (M) inection? 1" Pain, numbness, and tingling atthe injection site 2 hour ater the injecton 2 Pain exparanced during the injection 3. Unicana, eczema, wheezing, and dyspnea 44 Nausea, voting, and chara {© Match the need aze to Use when administering an injection in each stuation ited 1 25-gauge, 5 to tinch 2 2e-gauge, Vesnen 8. 2r-gauge, Hench 8. nvadermal Mantoux test Charen oler than 1 year ©. Average-size female receung intramuscular injecton 9. A patent wih dabetes fs experiencing tow blood glucose levels. ‘The nurse teaches the patient to use which o the folowing when aor she experiences low blood glucose. 1 Dank 4 ounces of sugar-te0 juice 2. Eat several saline crackers wih peanut butter 2. Eat one or two hard candies 4 Drink at least 4 ounces of fut juice 10 and a= are symptoms (of an anaphylactic reaction REFERENCES _ Alms nin ig on ens aah ‘Anetta DisktesAsecaion (ADA) Staal of medial creates, 201, “hm Diets Cae M151 2011 ‘mercan NaresAasation (ANA) Prenng neck tris ear Miles Gale 2010, avalbe, tg hmwurangecn Doce ValoOxctrarafEnvvonmeniclledChediiecps, acescd Joh oir Anthony K, at No ineryption lee: snpsct of 9 nointemition soe eran fry ene catenin, Cre Cane Nine 300.) 210 ‘AshenbennerD, YeubleS: Drag sey in maing 3, Pilakghis, 2009, Lippnc, Wills 6 Wilane Se Louis, 200, CHAPTER 22 Parenteral Medications: Billys D, Kowal K: Do your CATS PRRR? A mnemonic device o teach safety ‘heck for admunernyitavenons tmsictons J Conn Educ Nurs 36(3) 104, dees, ‘Cache: Clinical effcivenss and cos ffecivens of continues subs anew inulin snfusn for dabees systematic review and cconumi evalu tion iJ Matern Cid Nay 36(1) 32,2011 ‘Center f Diese Cont and Prevention (CDC) Epemilgy ar prevenson ‘wore preventable dace, of 12, Washinton, DC, 2011s, Public Healt Foundation. Centers for Duesse Control and Prevention (CTIC) Taran in test fat es “DOLD, | hupfawovckpovtpublictionsoetheetstetingshinesting has, ‘ete Jy 11, 201 (Chery © Stu |: Poke guide to ull este hath ae, Philadephia, 2011, TA Davie. CCocoman’s: Moray} Ieramsculr incon: view of bes prctics for mental ath nen] Pechae Meal Heath Nes 15424, 2008. Cosma A. Mera een be ev ence and changing pace on nection Ste: Br} Nace 1918) 1170, 2010 Cope Jet al Adolescent we of melin and patentceotlled analgesia pump Technoloy-# 10 en food ad deg admuniseation erspecive sty of adverse ‘vers, Peis 121(51133, 2008, Canin Ee Clinical effeivenes 20d eos ffecvenes of continues ake Tancos sin infin for dbetesemuie evi and eanoeme eal ton Healh Teel Ass L411), 2010 DDegarment of Health and Human Services, Cancers fr Madicare & Medica "Serces Uatelaknce on medion adrian, Hospal Append A of the Sete Oporaons Maral Blimore, MD, 2011, Department of Health and Homan Services Envonmental Pxeetion Agency (EPA): New information about dapesing of ‘elial shams, Octber 2004, hrpJiewwepagevfeswinoahhindstal) tmodicallmod gue pt Secced July 5,21 Gitoey M, eral: Skin nd mbestancour adipose ayer tenes in als woth da eres es wed fr imum injections kapiiios for needle length eco mention, Cur Med es Opa 26(6) 1520, 2010 Giger IN Teruel nian asesmene end never, ed 6, St Lous, 2013, "Meaty, Gar Speaking of wandarde: continous svbetancous access devices] Infasin "Nis 324): 185, 2009. Groves A: Calta competency athe bee, Med Soy Mates 19(4)4, 2010, Hodkenbery M), Wison D: Wg musing cre of fons and chide, ed 8, St Louis 2011, Mey Hane C Which sie Bato an TM injection Narsng200838(11)'62, 2008 ante K:Inrarsca anjeton techni, Net Send 22(2935, 20080, Hunter K-Schewaneou jet technique, Nis Sand 22(21) 41, 2008, Inde Nurses Society (INS): Infusion uring sandals facie, Invaven Nas Salts), 2017 Insite for Safe Mediation Practices (ISMP): Cuil for sadder ss, 210, sealable at pew sp ontolsunelineStandadOwlerSet pl accesed ly 201 Insets for Sate Mediction Practices (1SMP): Pcl of dene 2 medaton Lis for nnotenas pik meses for peseespee maton et, 2011 sealable ar hep ee amp oy Tol sidelinesfabelFemaeyPipyback sep, ‘cowed jy 5, 2012 Insite for Soe Madiaion Practices (ISMP): Acute cre ale fry ain ‘Seana schol melons. 2011, here rp on Tolzielines acurccactasm pl cessed July 11 2012 Jakisch Bea Comparison fcontnucussukewtaneus sli (CS) nd maltile dhl inectone (MDD in pela eype I eres a multicenter atcha pat akon anal over 3 yer, Dabs Med 25(1) 80,2008 Jones Teer L- When'S rghts go wrong: meta enos fom dhe ming Pespestve, J Nas Cane Ql 25(3) 240, 2010. Jus M- Continues sabostancous ison an efcacios cont-effecive malgsa leer the end fie, Home Heal Mare 213) 140, 2909, Lele Re Pharmacy for mesg ea, el 7, St Loi, 2010, Sacer [efor L, et a Efe of distraction fee envionment on redation ero, Am J Fal Sysem Pharnay 659795, 2009 Malik M, ct a Culturally adapeed pharmacotherapy and integrative formulation, (Child Ales Paychurt Cin Noh An 19(4) 791, 2010, Meduonic MiniMel: MiuMed Param REAL Time Irby Pan Conimens ‘Glue Montonng Sytem, 2011, avaiable a hp /ivww mined ened) index a, eee a 2011 Middleman A, et al fee of rece length when immunisingsbese adolecents ith hepatitis B vaccine, Parcs 123(3).508, 2010. Nicholl L, Hey A: Intrnsculr injection a inegratve reserch review and ruikline for evidence hed practice. Api Nurs fas 16(2)199, 202 Nine Ee all Medication safety tsi in edacng micton rors, J Nie ‘Care Qual 25(35:124, 2010 (Occupational Safety and Health Adminstration (OSHA): Blame aan ad veelsick oes, T7 FR 19934, 2012, walale a¢ bup/fewesohasp oshawehlowaiyp sho doeuanent.table=STANDARDSGp. i-10051 acces Jy 2012‘Maria atthe correct time, and uses two patient identifiers to ensure that she the right patient. Which step does Kyle need to take next {in administering the medication? © Answers to Clinical tion Questions can be found on = Application Quest found on the B REVIEW questions Are You Ready to Test Your Nursing Knowledge? 1. You are a new graduate nurse completing your orientation on a very busy intensive care unit You cannot read a health care pro vider's order for one of your patient's medications. You have heard from more experienced nurses that this health care provider does ‘ot like tobe called, and you know that another ofthe healthcare provider’ paticntsis very unstable. What isthe most appropriate next step for you to take? 1. Call the health care provider to clarify the order 2 Talk with your preceptor to help you interpret the order 3. Refer toa mediation manual before giving the mediation 44 Use your best judgment and critical thinking and administer the dose you think the healthcare provider ordered 2 A toddler isto receive 25 ml of an antipyretic by mouth. Which «squipment isthe most appropriate for medication administration for this chil? ‘medication cup 2 Ateapoon 3. A Sem syringe 44. An oral-dosng syringe 3. What statement made by a2-yea-old patient's mother indicates that she understands how to administer her son's eardrops? “To straighten his ear canal, | need to pull the outside part of his ear down and bac” 2. “I nced to straighten his ear canal before administering the ‘medication by pulling his ear upward and outwat.” 3. “Ped wo put my son in a chair and make sure that he's 16 up with his head tited back before I give him the eardeops” 4. “Aficr Im done giving him his ardrops, I need to make sure that my son remains sting straight up frat east 10 minutes” ‘healthcare provider ordered enalapril (Vasote) 2 mg IV push for a patient with hypertension. The pharmacy sent vials marked 1.25 mg enalapeil/ml. How many ml. does the nurse administer? i 5K nurse admits «72-year-old patient with « medical history of hypertension, heart failure, renal failure, and depression to a general medical patient care nit The nurse reviews the patient's medication orders and notes that the patient has three health cae providers who have ordered otal of 13 medications. What isthe ‘most appropriate action forthe nurse to take next 1. Give the medications flr identifying the patient using wo patient identifiers 2. Provide medication education to the patient wo help with ‘adherence o the medical plan 34 Review the lst of medications with the healthcare providers to ensuce that the patient needs all 13 medications 4 Set up 4 medication schedale forthe patient that slat die tuptive to the expected treatment schedule in the hospital “The nurse i administering a intravenous (LV) push medication Ke pun who ast eomptie 1 fs unig huh intravenous tubing, Place the folowing steps in the appropriate order. in amount of time pharmacist, of medication ) tubing cloves 19 rt should accept jedication refer- 1 Ree abn an inject eatin with recommended by agency policy tlre manu Une wt ine a 2 Select injection port of intravenous (IV! tien, Whenever possible, injection pot neces syringe. Use 1 filer if required by ™ 3. Ate jeg ition clase eubing, witha #8 and recheck fluid infusion rate. 4: Connect syringe to port of intravenous (1) line Insert needle: les tip or small-gauge needle of syringe containing P drug through center of injection port. 5. Clean injection port with antiseptic swab. Allow to dry 6 Occlude intravenous (1V) lin by pinching tubing just above injection port. Pull back gently on syringe plunge to aspira! blood return. 7. A nursing student is administering ampicillin PO. The expiration date on the medication wrapper was yesterday. What i the appro™ priate action forthe nursing student to take next? 1. Ask the nursing professor for advice 2 Return the medication to pharmacy and get another tablet 3 Call the health cae provider afer dscusing this situation with the charge nurse 44 Administer the medication since medications are good for 30 days after thee expiration date 8. A nursing student is administering medications to a patient through a gastric tube (G-tube). Which ofthe following actions taken by the nursing student requires the nursing instructor 10 intervene? 1. The nursing student placesall he patients medications in dif- ferent medicine cups. 2 The mursng student evaluates each medication and holds the tube feeding before administering a medication that needs to be administered on an empty stomach, 3. The nursing student flushes the tube with 30 mL. of water between each medication. 4. The nursing student crushes a nifedipine extended-release tablet and mixes it with water before administering it 9. A pediatric nurse takes a medication to a 12-year-old female Patient. The patient ells the nurse to take i away becase she is ‘ot going to take it, What i the nurse's next action? 1. Ask the patient’ reason for refusal 2. Consult with the patient's 3. Take the medication away and chat the patient’ refusal 44 “ellthe patent tha her healthcare provider for her 10XA nurse ca ig fora patient on a general surgical unit notes the following medication order in the patient's mesical recon 3 March 2016 1415 Administer 25 mg, hydrochlorothiazide PO ID D. Anderson, M What should the nurse do next? 1, After receiving an intramuscular (IM) injection in the deltoid, a Patient states, “My arm really hurts. I's burning and tingling where I got my injection, What should the nurse do next? (Select all that apply) 1. Assess the injection site 2. Administer an oral medication for pain Notify the patient's health care provider of assessment findings 4. Document assessment fielings and related interventions inthe patients medical record 5. This isa normal finding 40 nothing needs to be done 6 Apply ie to the site for relief of burning pain1B. CHAPTER 32 Medication Administration es #. You are working in a health clinie on a college campus, You need to administer medroxyprogesterone acctae intramuscularly (IM) to. female patient for birth control. You look up this medication ina reference manual and determine that it is viscous and injec. tions can be painful. On the basis of this information, you plan Which of the following when administering this medication? (Select all that apply.) 4, Inject the medication over 3 minutes to reduce pain associated ‘with the injection ‘Administer the medication in the vental gluteal site Use the Z-track method when administering the medication Use the deltoid site for medication administration ‘Ask the patient questions about her major and which clases she is taking during the injection to provide distraction After seeing a patient, the health care provider starts to give a ‘nursing student a verbal order for a new medication. The nursing student first needs to: 1. Follow ISMP guidelines for safe medication abbreviations. 14. A nurse accidently gives a patient the medication and read it 3 Write down the order on the patient's order sheet and read it ‘back to the health care provider. . 4. Ensure that the six rights of medication administ followed when giving the medication. mas that were ‘ordered for the patient's roommate, What is the nurses Grst priority? 1. Complete an occurrence report 2. Notify the healthcare provider. 3, Inform the charge nurse ofthe error 4 Assess the patent for adverse effets. A child i taking albuterol through a pressurized metered-dose inhaler (pMDI) that contains a total of 64 puffs. The dose is 2 Puls every 6 hours. How many days wil the pMDI last? days. © Rationales for Review Questions can be found on the Evolve website. 2. Explain to the health care provider thatthe order needs to be given to a registered nurs. 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Insite for Sf Metiction Pace (SMP) IMP at cae iden or tiny adnan of ‘chee edo 201, wp Tolsuveinesncelecaftmpdl. Accel ne 6, Tnstute fo Safe Medication Prats (SMP: SMP lex of ererproneabireviatons ys and dase ssa, 20134 pena Tok crrorproneabreiionspat Aces oe 62015, Insta for Safe Mecaton Pacts (SMP) At U:500 nan safe comer mun te ehnk ‘afew of eng ave 10,2013 ps eismpor/nenstelactcrlbowarle ‘spud, Aree Jane 8215 nut for Saf Metaton Traci (SMP): Oming mca aout isu po es sw hpi ed ‘mir ranstoning amy fro thn, 20.3 ‘enone! Shower anpieA, Ace Fanuary 11,2015, Insitute fr Ste Medeton races (SMP) Ol ae fos that shold ot cath, 214, hates oroldnotrah p, Ace oven 28,2014 Into Safe Medication Practices (1SMP}: Metiaton satya: Ace Cae 19062, 20,