Intravenous Medications in the Nursing Environment

Intravenous Medications in the Nursing Environment Phoebe Roberts Administer and Monitor Intravenous Medications in the Nursing Environment Question 1 a. Signs and symptoms of iron deficiency anaemia include fatigue, irritability, tachycardia, pale skin,  difficulty concentrating, brittle nails and shortness of breath. (Williams Hopper 2011 p. 562). b. As the patient has iron deficiency anaemia a blood transfusion is necessary to increase  haemoglobin levels within the blood as this helps to transport oxygen to cells and tissues. She also  has a history of PR bleeding. Therefore this blood transfusion is helping to replace volume lost, to  increase circulating blood volume and to improve the oxygen carrying capacity (Hamlin, Richardson-Tench, Davies 2009 pp 155,156) c. It is important to follow the Pico prep instructions as faecal matter can obscure the viewing of the  the colon. Pico prep aims to thoroughly cleanse the colon of any matter or gas to ensure that the  visual field is clear ( Corbett Banks 2011 pp. 675,676). d. Pico prep is an osmotic laxative, its action decreases the fluid absorption within the bowel which  then results in the onset of diarrhoea within 1-4 hours. Side effects can include abdominal bloating,  abdominal pain, nausea, vomiting and flatulence. ( Tiziani 2013 pp. 876,879). e. The action of this medication would have quite an impact on this elderly patient. Although she  mobilises with a four wheel walker it would become increasingly difficult to mobilise to the toilet so  frequently to empty her bowels in time. This may increase the chances of her having a fall ( Williams   Hoper 2011 p. 747). Lowering the bed, having her four wheel walker in reach and the application of  hip protectors may aid in reducing the risk of her having a fall and in the chances of her having a fall  the hip protectors may aid in protecting that area.( Crisp, Taylor, Douglas, Rebeiro 2013. p. 454). Providing a bedside commode may also reduce the chances of falls as it is located closer to her than  the toilet may be. As she is an older patient the skin around the area may become excoriated and skin  breakdown may occur due to the acidity of the diarrhoea and the area frequently being wet. Barrier  creams should be applied to at risk areas for protection. Diarrhoea can also quickly cause dehydration  and electrolyte imbalances in the elderly, this may also have an impact on this patients fluid and  electrolyte levels (Williams Hopper 2011. pp. 275, 747). Question 2. a) This patient is displaying possible signs and symptoms of a suspected urinary tract infection such  as incontinence, a burning sensation when she voids, fever, confusion and blood stains on her pad. A urinalysis should be performed to support a diagnosis of a urinary tract infection ( Williams   Hopper 2011 p. 838). As she is incontinent of both urine and faeces a thorough skin assessment  should be performed to identify the areas at risk and to identify any change in skin integrity. Skin  turgor should also be assessed as this can indicate a sign of dehydration (Crisp et. al. 2013 p. 592). A  fluid balance chart should be maintained to assess if the patient is in a positive or negative fluid  balance and the weight of the patient should also be assessed as noticeable weight changes can  indicate hypovolaemia (Crisp et.al 2013 p.1214, Scott 2010 p. 62). Auscultation of the chest could  prove useful in determining the reason of the increased respiratory rate and low oxygen saturation  levels ( Lewis Foley 2011 p. 356). A falls risk assessment should also be performed as the elderly  patient has a few risk factors for falls such as confusion, reduced mobility an d is incontinent of urine  and faeces. This can help to implement interventions to reduce the risk of a fall ( Crisp et.al p. 454). As this patient is at risk of both hypovolaemia and hypokalaemia the doctor should be notified to  thoroughly assess the patient and implement therapy for a suspected urinary tract infection. b) Cranberry juice can be effective in helping to reduce pain when urinating and also prevents the  bacteria adhering to the wall of the bladder, this method can be helpful in reducing the pain of a  urinary tract infection however the patient is undergoing a procedure the next day, therefore this  intervention should be implemented with the approval of a medical officer. A heat pack could be  placed on her abdomen to relive any pain and discomfort along with the administration of an  antipyretic to reduce her fever and pain (Williams Hopper 2011 p. 840). As the patient is having  difficulty breathing she should be placed in a suitable position to help with proper lung expansion such  as the high fowlers position along with the administration of oxygen to increase oxygen levels within  the blood. (Williams Hopper 2011 p. 604). The patient’s vital signs should be continuously  assessed to monitor any improvements or deterioration especially her blood pressur e and heart rate  as any further abnormalities such as arrhythmias and a further decline in blood pressure could  indicate hypovolaemia and hypokalaemia. Continuous assessment of her neurological state should  also be implemented to monitor any changes (Scott 2010 p. 64). c. Hypokalaemia occurs due to an excessive loss of potassium from the body or from an inadequate  intake of potassium. The body is unable to conserve potassium and relies on an adequate intake of  potassium to maintain a balance within the body. An excessive loss of potassium can be due to  diuretic therapy – especially potassium wasting diuretics, corticosteroids, vomiting and diarrhoea. Signs and symptoms include an irregular weak pulse, hypotension, muscle cramps, muscle weakness  and shallow respirations. (Williams Hopper 2011 p. 79, Scott 2010 p. 98). Medical management is aimed at restoring potassium levels either by increasing the intake of  potassium in the diet or oral potassium supplements. Intravenous replacement therapy is also  implemented in those with severe hypokalaemia to rapidly increase potassium levels. Diuretics may  be changed to a potassium sparing diuretic to prevent the loss of potassium from the body. (Scott  2010 pp. 100,101). Nursing management includes monitoring fluid input and output, monitoring the heart rate and rhythm  of those receiving IV replacement therapy, maintaining and ensuring the correct administration of the  therapy and continuous monitoring of the patient’s condition throughout. ( Scott 2010 p.102). Hypovolaemia occurs due to the loss of fluid from the body and extracellular spaces; this can be due  to excessive bleeding, excessive sweating, burns, diuretic therapy, diarrhoea, renal impairment and  vomiting. The loss of fluid then results in a decreased blood volume. (Williams Hopper 2011 p.71,  Scott 2010 pp. 60, 61). Signs and symptoms include thirst, nausea, hypotension, restlessness,  confusion, dizziness, cool pale skin, tachycardia, increased body temperature, weight loss and a  decline in cognitive status. (Williams Hopper 2011 p 72, Scott 2010 p. 62). Medical management includes finding and stopping the source of the fluid loss, the replacement of  lost fluid with an intravenous infusion with the same osmolality of blood to increase the body’s blood  volume. ( Scott 2010 p.63). Nursing management includes the administration and maintenance of intravenous fluid replacement,  monitoring the daily weight of the patient, monitoring fluid input and fluid output, encouraging the  intake of fluids to aid in restoring fluid balance and providing mouth care to maintain the integrity of  the oral mucous membranes. (Crisp et.al. p. 73). Question 3 a) Midazolam is used in this procedure as it is a sedative, hypnotic agent and muscle relaxant. This  aims to reduce the amount of movement throughout the procedure and assists in keeping the patient  in a sedative state and impairs memory function ( Tiziani 2013 p. 967). Fentanyl would be used to  reduce pain during the procedure and also aids in the maintenance of the anaesthesia ( Tiziani 2013  p 928) Diprivan is used to induce sedation and also increases the effects of the hypnotic agent and  analgesia ( Tiziani 2013 p 793.) b) Midazolam acts by binding with a benzodiazepine receptor in the central nervous system which  inhibits neurotransmitters in the brain resulting in a calming sedative affect ( DrugBank, Midazolam  DB00683 2013). Midazolam given intravenously takes affect within 1.5 2.5 minutes. Adverse effects  include respiratory depression, memory impairment, anxiety, muscle weakness, drowsiness,  hypotension, dizziness, fatigue and decreased alertness. (Tiziani 2013 pp 964, 967) Fentanyl acts on receptors within the brain, spinal cord and muscles and bind with opioid receptors  producing an analgesic affect. Administered intravenously fentanyl takes affect almost immediately.   Side effects include respiratory depression, apnoea, dyspnoea, vomiting, nausea, increased intra  cranial pressure, bradycardia, sedation, confusion, constipation, hypotension and muscle rigidity.  (Tiziani 2013 p. 923) Diprivan suppresses the central nervous system and produces a loss of consciousness. Adminstered  intravenously diprivan takes affect within 30 seconds of administration. Side effects include  respiratory depression, tachycardia, hypotension, shivering and involuntary muscle movements (Tiziani 2013 p 793) Nursing care includes continuous monitoring of respiratory rate, heart rate and vital signs during  administration of these agents and throughout the procedure, ensuring that the dose is titrated to  produce the right affect, a sedation scale should be performed when the patient is conscious,  ensuring that the patient is aware that midazolam can cause muscle weakness so care should be  taken when mobilising. Central Nervous System toxicity may occur when all three medications are  given together therefore continuous monitoring is extremely important as the effects on the central  nervous system are increased ( Tiziani 2013 p 964,968). c) As this patient has renal failure the kidneys ability to filter and excrete waste is decreased, this may result in an accumulation of the medications and could possibly result in drug toxicity – especially  opiate medications (Tiziani 2013 p.925). This patient is elderly and may have increased sedation and  confusion after the procedure due to her age and renal function and is at a high risk of falls especially  as midazolam causes muscle weakness. Midazolam administered to an elderly patient can cause  delirium, therefore this patient is at an increased risk of being affected by this ( Tiziani 2013 p.964). Constipation is also going to affect this patient as this is one of the major side effects of opiate  medications. 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