Math Test 2

What medication can be given in an insulin syringe

** Only insulin is measured and given in insulin syringe**

Subcutaneous maximum volume =

1 mL

· Normally wouldn't give more than

2-3 tablets, or 1L of medication at a time

Intramuscular maximum volume =

3 mL

· What is a unit?

A unit is the amount of a drug needed to produce a particular result

What does parenteral refer to?

Absorbed outside of the GI system, anything other than PO

Rule for insulin syringe

Always choose the smallest-capacity insulin syringe for accurate dosages

Packaging of Parenteral Medications

Ampules (single use) Break glass Vials (single or multi use) Mix-O-Vials Break to mix powder and solution Syringes

3 CNO Standards

Authority Competence Safety

The CNO Medication Practice Standard includes three principles that outline expectations related to medication practices for nurses that promote public protection.

Authority--Nurses must have the necessary authority to perform medication practices Competence--Nurses ensure that they have the knowledge, skill and judgment needed to perform medication practices safely Safety--Nurses promote safe care and contribute to a culture of safety within their practice environments, when involved in medication practices.

What type of patients would be ordered parenteral medications?

Critical care pt Med/Surg pt Unable to swallow meds Dysphagia, unconsciousness, uncooperative anaphylaxis In a lot of pain

Milliequivalents Example

Electrolytes

Tuberculin Syringes

Hold 1 ml max, small doses of medication, calibrated to .01 ml, 2 decimal places in calculations

Syringes

Hypodermic syringes are identified by the amount of fluid they contain Measure at widest angle at the side

Mixing Medications: Two meds may be mixed if

IF they are compatible with each other - Make sure compatible before putting anything in IV line make sure medication is compatible with anything they may have had in that line within the last 4 hours AND the total amount does not exceed the amount that can be safely administered in a site - Know what is too much to give in as ingle IM ex. 5 ml so don't mix if it will be too much Calculate the dosage to be administered to the nearest tenth for each med Add the results to find the total volume

What are the routes for parenteral medications?

IM, SUBCUT, ID, IV

Syringe sizes

If we need 2.5 ml do in 3 ml syringe, select smallest syringe size for the amount of fluid you are pulling up 3, 5, 10, 20 ml syringes Use 3 ml syringe when above 1 ml and under 3 ml

Insulin Syringes

Insulin syringes were developed for the administration of insulin They are calibrated in units and available in 30 units, 50 units and 100 units Insulin is also available in prefilled insulin pens

Insulin

Insulin, a hormone made in pancreas necessary for metabolism of glucose Patients who are diabetics are deficient in insulin Type 1- Required to take insulin daily Insulin ready-to-use solution measured in units

Parenteral Dosages Types

Intramuscular Subcutaneous Intradermal Intravenous

Heparin

Medication to thin blood- may be in intravenous or subcutaneous form Doses that are too large might cause hemorrhage Doses that are too small might not produce the desired result Only syringes marked in mL can be used to administer heparin parenterally

Penicillin

Medication to treat an infective process. May be in oral, intravenous, liquid or cream Ask patients whether they have had previous allergic reactions to penicillin. Observe patients for signs of allergic reactions

Why Parenteral?

NPO Testing, can't keep down, won't take Rapid action is required Absorbed directly into bloodstream- more accurate dosing Not available by any other method Uncooperative patient Unconscious patient Less discomfort from multiple injections

Medicine Cup and Dropper

Need to be cleaned thoroughly, try not to put in mouth when using dropper Always measure with lowest curvature when in medicine cup

Oral Dosages (By Mouth)

Oral drugs preferred route- Easy to take and convenient Production costs lower Absorption- Primarily small intestine Some oral medications are irritating to the gastrointestinal system and MUST be given with food Most common form is a tablet NOT all tablets can be crushed-Check Drug guide Person needs to be able to swallow

Mixing Insulin

Patients may require two types of insulin at the same time To avoid injecting the patient twice, it is common practice to draw up both insulins in the same syringe (if compatible) To accurately draw up both insulins in the same syringe you need to know the total units of both insulins

· Common drugs measured in units:

Penicillin Heparin Insulin Epogen

Needleless Systems

Protects the patient and the nurse from needle stick injuries! Lorelock syringes and putting them into the port of a IV

What are the advantages of administering medications via parenteral route?

Rapid onset Don't have to worry about going through GI system Accurate dosing Give when NPO

Scored Pills

Score line use pill cutter with score line up

Only what type of tablets may be broken?

Scored tablets can be broken and usually only in half

If a calculation indicates a scored tablet must be broken into pieces other than ½ what do you do?

See if drug is available in different concentration or strength, talk to pharmacist, if need 4g and only have 16g ask if available in 4g or if there is 8g that you can break in half

Three Step Approach to Dosage Calculations:

Step 1- CONVERT: Ensure all measurements are in the same size unit of measurement. If not, convert before proceeding. Step 2- THINK: Estimate what is a reasonable o amount of the drug to administer Step 3- CALCULATE: Apply the formula o D (Desired)/ A (available) × Q (quantity) = X (amount)

Parenteral Dosages

The term parenteral is used to designate routes of administration other than gastrointestinal

What is the biggest risks to the patient when administering parenteral medications?

What you put in you can't take out, what you put in will be utilized by the body

Syringes for medication orally

Will be provided with syringe either nurse or patient Tip is off center so it wont fit in IV and only fits into feeding tube Often med bottles have adapter for syringe, but if open lid pour into med cup and draw into syringe Give this way if have tube or difficulty swallowing Tip on side so can get all medication and for ng tubes

Use 3ml syringe when

above 1 ml and under 3ml

Injectables over 1 ml-

carry dosage to 1 decimal space (tenths) syringe is calibrated in 0.1 mL

Injectables under 1 ml-

carry dosage to 2 decimal places (hundredths) syringe is calibrated in 0.01 mL

Most common insulin supply dosage

is 100 units per mL

Breaking an unscored tablet

is dangerous and can result in an unintended dose Unscored may crumble and not split properly in half

Formula Method

o D/A × Q = X (tablet(s) required) o Quantity always 1 when medication is a solid such as capsule or tablet o Quantity varies with liquid forms and injectables.

Intradermal

pertaining to within the skin

Subcutaneous

under the skin

Intravenous

within a vein

Intramuscular

within the muscle

Forms of Oral Dosages (3)

§ Tablets § Capsules § Liquids

Insulin importance

· Accuracy in insulin preparation and administration is critical. Inaccuracy is potentially life-threatening. · Nurses must understand: Information on drug label, Interpret the insulin order, Select the correct syringe

Remember

· Convert o All units of measurement to the same system · Think o Estimate the logical amount · Calculate o D/A X Q = X

Insulin Sliding Scale Practice Problem

· Insulin Lispro Sliding Scale subcutaneous TID 4.1- 7 mmol/L- No Insulin 7.1- 10 mmol/L- 2 units of Regular Insulin 10.1- 13 mmol/L- 4 units of Regular Insulin 13.1- 16 mmol/L- 6 units of Regular Insulin 16.1- 20 mmol/L- 8 units of Regular Insulin Call MD if blood glucose > 20 mmol/L Insulin may be ordered based on the patient's blood glucose reading

How parenteral medications are prepared

· Most parenteral medications are prepared in liquid or solution form, and packaged in dosage vials, ampules, or prefilled syringes. o Can also be in a state where they need to be reconstituted

Never use U for units because

· SAFETY ALERT! o Never use "U" for units, write out the whole word. "U" has been mistaken for a Zero resulting in a 10-fold overdose (e.g., 5 U read as 50)