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What are the elements of pharmacokinetics?
- route - how meds enter the body
- absorption - how it moves from site into blood
- distribution - moving from blood into cells, tissues, organs
- action - how a drug alters physiological functions
- metabolism - how it is changed to prepare for excretion
- excretion - how a drug exits the body
- action - how medications act
What are factors that influence absorption?
- route of administration
- ability to dissolve
- blood supply to the site of administration
- body surface area (small intestine has more absorption because it has a greater area)
- lipid solubility of medication
What does drug distribution depend on?
- membrane permeability
- protein binding
What are the main organs of metabolism and excretion?
- metabolism - liver
- excretion - kidneys
how should the ear be moved for administration of medications?
- For children - down and back
- For adults - up and out
How do you administer meds through an NG tube?
- need to be in liquid form (can't be enteric or time release)
- must be dissolved in 15-30ml of warm water
- flush tube with 15-30ml of warm water between medications
- flush after with 30-60ml
What are the 7 rights?
patient, med, route, dose, time, documentation, refuse
What are special concerns with pregnant, pediatric and geriatric patients?
- pregnant - medication crossing the placenta and affecting the fetus
- pediatric - dosing
- geriatric - polypharmacy
How much fluid should oral meds be taken with?
What parts of the syringe are considered sterile?
tip, inside of barrel, inside of the hub, shaft of hte plunger, needle
What gauge of syringe is recommended for blood products, IM, subQ, intradermal?
- 18-20 for blood
- 19-23 for IM
- 25-27 for sub Q
- 26-27 for ID
How should insulins be mixed?
clear then cloudy!
What is the length, gauge, dose size and angle for subQ injections?
- 3/8 - 5/8
- 1/2 to 1
- 90 or 45
What is the length, gauge, dose size and angle for IM injections?
- 1-11/2 inches (child 5/8 to 1 1/4)
- 19-23 (child 25-27)
- 3ml (2ml if given in deltoid), child 1ml, infant 1/2
- angle 90 degrees with z track used
What are the anatomical landmarks for the ventrogluteal site?
heel on greater trochanter, thumb towards groin, index finger on anterior iliac spine, middle finger towards buttock
What are the anatomical landmarks for the deltoid site?
1-2 inches below acromion process or 3 fingerwidths
What is the length, gauge and dose size for ID injections?
- length 1/4 to 1/2
- gauge 25-27
- dose size .1-.2 cc
What are influencing factors for pain?
age, fatigue, genetic, neurologic, social, spiritual, psychological, cultural
What is the goal of IV therapy?
To correct or prevent fluid or electrolyte imbalances
What is an isotonic solution?
- same concentration as body fluids - used for volume replacement.
- examples - NaCl 0.9% (normal saline), D5W 5%
What is a hypotonic solution?
- a concentration lower than body fluids, used to rehydrate the cells
- examples - 0.45% NaCl (1/2 normal saline) D5 0.45% NS
What is a hypertonic solution?
- higher than body fluids - used to increase vascular volume
- examples - D10W, D5LR
What are lactated ringers?
IV fluids with electrolytes and additives
What is important to know about giving KCL?
- it is commonly added to IV solutions when patients are NPO because the body can't conserve K
- it must be administered slowly over several hours and diluted - if given as IV push it may be fatal!!!
What should orders for IV therapy contain?
- the specific solution, any additives, time schedule.
- IV solution is a med
What are butterflys and angiocaths used for?
Butterflys are used for drawing blood and angiocaths are used to start IVs.
What is a heparin lock/saline lock?
It is an IV that is in place but not hooked up to a running solution, has a port to give other meds. It needs to be flushed with normal saline and must be replaced every 72 hours
What is a central line?
A catheter that is placed into a larger vein (subclavian, jugular) by a physician. Can be used for months. Before it can be used an xray must be done.
What is a PICC line?
it is placed in the upper arm and threaded into a larger vein by a physician. When it is removed pressure must be applied for at least 5 minutes.
What are the steps for starting an IV?
- review the order
- gather supplies
- explain the procedure to the client
- find the best vein
- start distally
- perform venipuncture, secure, start fluids, transparent dressing
What are ways to assess client's fluid status?
- daily weight (best way)
- labs (Na+, K+, Cl, glucose, BUN)
- skin turgor
- breath sounds
What are phlebitis and infiltration?
- Phlebitis - inflammation/infection of the vein. Pain erythmea, heat and redness
- Infiltration - fluid entering the subcutanious tissue. Swelling, pallor and coolness, pain possible
With either one you have to discontinue IV and go to another site.
What does a blood transfusion include?
- whole blood
- packed RBCs
What are the purposes of blood transfusions?
- increase blood volume
- treat anemia
- replace blood componants
What are the time frames that are needed when transfusing blood products?
- transfuse within 30 minuted of receiving from pharmacy
- administer slowly for first 15 minutes to monitor for reaction
- don't give longer than 4 hours
What is an acute hemolytic reaction?
- incompatibility to antibodies causing RBC breakdown
- chills, fever, pain, tachycardia, tachypenia, flushing
What is a febrile nonhemolytic reaction?
- sensitization to specific components
- chills, fever, headache, flushing
What is a mild allergic reaction
- sensitivity to plasma proteins
- flushing, itching, hives
What is an anaphylactic reaction to blood products?
anxiety, itching, wheezing, cyanosis
What is circulatory overload?
- fluid given faster than circulation can accommodate
- cough, dyspnea, pulmonary congestion, headache, hypertension, tachycardia, distended neck veins