Chapter 14 medication administration

sublingual

under the tongue

vials

Vials are small glass or plastic bottles with a rubber stopper top; they may contain single or multiple doses of a medication

catheter shear

Catheter shear occurs when part of the catheter is pinched against the needle, and the needle slices through the catheter, creating a free-floating segment. The catheter segment can then travel through the circulatory system and possibly end up in the pulmonary circulation, causing a pulmonary embolus.

aural

Certain medications—mainly antibiotics, analgesics, and earwax removal preparations—are administered via the mucous membranes of the aural (ear) canal

normal saline

A general phrase referring to a sterile solution of sodium chloride (NaCl, more commonly known as table salt) in water, but is only sterile when it is to be placed parenterally (such as intravenously); otherwise, a saline solution is a salt water solution.

hematoma

A hematoma is an accumulation of blood in the tissues surrounding an IV site, often resulting from vein perforation or improper catheter removal

Bolus medication

A single dose

Ampules

Ampules are breakable sterile glass containers that are designed to carry a single dose of medication Figure 14-47. They may contain as little as 1 mL or as much as 10 mL, depending on the medication

administration set

An administration set moves fluid from the IV bag into the patient's vascular system. IV administration sets are sterile as long as they remain in their protective packaging.

Detrose

An isotonic solution,

thrombophlebitis

Infection and thrombophlebitis (inflammation of the vein) may occur in association with venous cannulation; both conditions are most frequently caused by lapses in aseptic technique. Thrombophlebitis is commonly encountered in patients who abuse drugs as well as in patients who are receiving long-term IV therapy in a hospital or hospice setting or with vein-irritating solutions (eg, dextrose solutions, which have a low pH, or hypertonic solutions of any sort). It can also be produced by mechanical factors, such as excessive motion of the IV needle or catheter after it has been placed.

blood tubing

Blood tubing is a macrodrip administration set that is designed to facilitate rapid fluid replacement by manual infusion of multiple IV bags or IV and blood replacement combinations. Most blood tubing administration sets have dual piercing spikes that allow two bags of fluid to be used simultaneously for the same patient Figure 14-10 . The central drip chamber has a special filter designed to filter the blood during transfusions.

LR contraindications

During blood transfusion,the calcium binds with the anticoagulant creating a possible blood clot, also for mannitol,methylprednisolone,nitro,nitropussidr,norepinephrine,procainamide,and propranolol infusions

enteral medications

Enteral medications are those that are given through some portion of the digestive or intestinal tract. These are also referred to as alimentary medications. This includes medications that are administered orally, through a feeding tube, or rectally

isotonic solution

Expand the contents of the intravascular compartments without shifting fluid to or from other compartments or changing cell shape hypotension/hypovelmic patients

Isotonic Crystalloid Solutions

Fluid replacement for blood pressure,3ml needed to replace 1ml of the patients blood

hypotonic solution

Hydrate the cells wile depleting the vascular compartment,they may be nedded for a patient who is receiving dialysis when diuretic therapy dehydrates the cells solutions such as hyponic may be used for hyperglycemia,with high sugar it draws fluids out of the cella into vasclae intersutsal compartments

Dehydration

Inadequate total systemic fluid volume

Infiltration

Infiltration is the escape of fluid into the surrounding tissue, which causes a localized area of edema. Causes of infiltration include the following problemThe IV catheter passes completely through the vein and out the other side. ■ The patient moves excessively. ■ The tape used to secure the IV line becomes loose or dislodged. ■ The catheter is inserted at too shallow an angle and enters only the fascia surrounding the vein (this problem is more common with IV lines in larger veins, such as those in the upper arm and neck)

intradermal injection

Intradermal injections involve administering a small amount of medication—typically less than 1 mL—into the dermal layer, just beneath the epidermis.

Itramuscular (IM)

Intramuscular (IM) injections are given by penetrating a needle through the dermis and subcutaneous tissue and into the muscle layerThis technique allows administration of a larger volume of medication (up to 5 mL) than the subcutaneous route

Tonicity

Is the concentration of sodium in a solution and the movement of water in relation to the sodium levels inside and outside the cell

occlusion

Occlusion is the physical blockage of a vein or catheter. If the flow rate is not sufficient to keep fluid moving out of the catheter tip such that blood enters the catheter,then a clot may form and occlude the flow. The first sign of an occlusion is a decreasing drip rate or the presence of blood in the IV tubing

ocular

Ocular medications are typically administered for pain relief, allergies, drying of the eyes, or infections.

Osteomyelitis

Osteomyelitis is inflammation of the bone and muscle caused by an infection. Osteomyelitis can occur from IO insertion but is rare.

Colloid solutions

Proteins thar are to large to pass through the cellular membrane, they draw fluid from the interstitial and intercellular compartments into vascular compartment ls reducing edema

hypertonic solution

Pulls fluids and electrolytes from the intracellular and interstitial compartments into the intravascular systemThe danger is that the cells may collapse from the incr eased extracellular osmotic pressure. Hypertonic solutions shift body fluids into the vascular spaces and help stabilize blood pressure, increase urine output, and reduce edema

Pyrogens

Pyrogens are foreign proteins capable of producing fever. The presence of pyrogens in the infusion solution or administration set may induce a pyrogenic reaction, which is characterized by an abrupt temperature elevation (as high as 106°F [41.1°C]) with severe chills, backache, headache, weakness, nausea, and vomiting

Overhydration Signs and Symptoms and causes

Shortness of breath Edema Crackles Kidney failure Prolonged hypoventilation

Crystalloid solutions

The ability of these fluids to cross membranes and alter fluid levels make them the best choice for injures patients who need fluid replacement

buccal region

The buccal region, which is also highly vascular, lies in between the cheek and gums. Most medications administered via the buccal route are in the form of tablets or gels. Glucose is one of the few medications that may be administered buccally in the prehospital setting

cannulation

The insertion of a catheter, such as into a vein to allow for fluid flow.

intraosseous space

The intraosseous (IO) space collectively comprises the spongy cancellous bone of the epiphyses and the medullary cavity of the diaphysis. Its vasculature drains into the central circulation by a network of venous sinuses and canals

parenteral route

The parenteral route refers to any route other than the gastrointestinal tract. Parenteral routes for medication administration include the intradermal, subcutaneous, IM, IV, IO, and percutaneous routes.

drug concentration

The volume

transdermal

Transdermal medications are applied topically—that is, on the surface of the body.

disinfectants

Use on non living things

Lactated Ringer's Solution

Used in the field for blood loss,lactate that metabolized in the liver to form bicarbonate the key buffer that combats intracellular acidosis associated with serve blood loss

Vasovagal reaction

Vasovagal Reactions Some patients have anxiety concerning needles or the sight of blood. Such anxiety may cause vasculature dilation, leading to a drop in blood pressure and patient collapsing

Volutrol

Volutrol (also called Buretrol or burette) allows you to fill a 100- or 200-mL calibrated drip chamber with a specific amount of fluid and administer only that amount to avoid inadvertent fluid overload. This type of set is commonly used in pediatric patients.

percutaneous

With percutaneous routes of administration, medications are applied to and absorbed through the skin and mucous membranes. Because percutaneously administered medications bypass the gastrointestinal tract, their absorption is more predictable. Percutaneous routes of medication administration include the transdermal, sublingual, buccal, ocular, aural, and nasal routes.

air embolism

a bubble of air in the bloodstream,If your patient begins developing respiratory distress with unequal breath sounds, then consider the possibility of an air embolus. Other associated signs and symptoms include cyanosis (even in the presence of high-flow oxygen), signs and symptoms of shock, loss of consciousness, and respiratory arrest. Treat a patient with a suspected air embolus by placing the patient on his or her left side with the head down to trap any air inside the right atrium or right ventricle, administering 100% oxygen, and rapidly transporting to the closest appropriate facility. Be prepared to assist ventilations if the patient experiences inadequate breathing.

Circulatory Overload

an excess in intravascular fluid volume,Signs and symptoms of circulatory overload include dyspnea, jugular vein distention, and hypertension. Crackles are often heard when you are evaluating breath sounds. Acute peripheral edema can also be an indication of circulatory overload. To treat a patient with circulatory overload, slow the IV rate to keep the vein open and raise the patient's head to ease respiratory distress. Administer high-flow oxygen,Consider the use of continuous positive airway pressure (CPAP) to push fluid out of the lungs (alveoli).

Causes of dehydration

dihhra Vomiting

third space fluid shift

distributional shift of body fluids into potential body spaces

infusion

infusion is a technique of administering fluids, blood and blood products, and medications into the intraosseous space of the proximal tibia, humeral head, or sternum.Long bones, such as the tibia, consist of a shaft (diaphysis), the ends (epiphyses), and the growth plate (epiphyseal plate)

Medical asepsis (clean technique)

practice used to remove or destroy germs and to prevent their spread from one person or place to another person or place

antiseptic

substance that prevents infection, for iv theropy

Oxygen carting solution

whole blood is the best replacement for lost blood