4 Pharma IVT Basic

8/4/2019 4 Pharma IVT Basic

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ASSOCIATION OF NURSING SERVICEASSOCIATION OF NURSING SERVICE

ADMINISTRATORS OF THEADMINISTRATORS OF THE

PHILIPPINES, INC. (ANSAP)PHILIPPINES, INC. (ANSAP)


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R.A. # 9502 - An act providing forcheaper and quality medicines,amending for the purposeRepublic Act No. 8293 or the

Intellectual Property Code,Republic Act No. 6675 or theGenerics Acts of 1988, and

Republic Act No. 5921 or thePharmacy Law, and for other

purposes


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R.A. # 9165 DangerousDrug Act of 2002 - An ActInstituting the Comprehensive

Dangerous Drugs Act of 2002,repealing republic act no.6425, otherwise known as the

Dangerous Drugs Act of 1972,as amended, providing fundstherefor and for other

purposes


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RA 9173 PhilippineNursing Law of 2002 have

stated that parenteralinjection is in the scope ofnursing practice.


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Board of Nursing Resolution

No.8 Sec.30 (c) Art.VII oradministratively under Sec.21Art.III states that any

registered nurse withouttraining and who administersIV injections to patients shall

be held liable, eithercriminally whether causing ornot an injury or death to the

patient.


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PharmacokineticsPharmacokinetics

- The process by which a drug isabsorbed, distributed, metabolized,and eliminated by the body.

PHARMACOKINETICSPHARMACOKINETICS - what theBODY does to the DRUG

(PROCESSES)


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PharmacokineticPROCESSES

Absorption

Distribution

Metabolism

Excretion


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PharmacodynamicsPharmacodynamics

The study of the action oreffects of drugs on livingorganisms.

PHARMACODYNAMICSPHARMACODYNAMICS - what the

DRUG does to the BODY(EFFECTS)


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PharmacodynamicsPharmacodynamics

Symptomatic

Curative

Restorative

Preventive

Diagnostic


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An I.V. Medications mayAn I.V. Medications may

be ordered when:be ordered when:

rapid therapeutic effect.rapid therapeutic effect.

cant be absorbed by the GIcant be absorbed by the GI

tracttract..


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An I.V. Medications mayAn I.V. Medications may

be ordered when:be ordered when:

The client may receiveThe client may receive

nothing by mouth.nothing by mouth.

controlled administration ratecontrolled administration rate


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I.V. Medication may beI.V. Medication may be

given by:given by:Drug injectionDrug injection

Intermittent infusionIntermittent infusion

Continuous infusionContinuous infusion
http://www.featurepics.com/online/Pump-848919.aspxhttp://www.featurepics.com/online/SyringeAmpulaPictures69647.aspx


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BenefitsBenefits

Rapid ResponseRapid Response

Effective AbsorptionEffective Absorption

Accurate TitrationAccurate Titration

Less DiscomfortLess Discomfort


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RisksRisks

Solution and drugincompatibilities.

Poor vascular access in someclients.

Immediate adversereactions.


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IncompatibilityIncompatibility

Drug + DiluentDrug + Diluent == must bemust becompatiblecompatible

--The more complex the solution,The more complex the solution,the greater the risk ofthe greater the risk of

incompatibilityincompatibility


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An incompatibility results whenAn incompatibility results when

two or more substances react ortwo or more substances react or

interact so as to change theinteract so as to change the

normal activity of one or morenormal activity of one or more

components.components.


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Incompatibility may resultIncompatibility may result

in the loss of therapeuticin the loss of therapeutic

effects and may occureffects and may occurwhen:when:

Several drugs are added to largevolume of fluid to produce anadmixture.

Drugs in separate solutions areadministered concurrently or in closesuccession via the same IV line


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Incompatibility may resultIncompatibility may result

in the loss of therapeuticin the loss of therapeutic

effects and may occureffects and may occurwhen:when:

A single drug is reconstituted orA single drug is reconstituted or

diluted with the wrong solutiondiluted with the wrong solution

One drug reacts with anotherOne drug reacts with another

drugs preservativedrugs preservative


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Hazards of intravenousHazards of intravenous

medicationsmedications

Mixing of two incompatibleMixing of two incompatible

drugs in a solution can causedrugs in a solution can cause

an adverse interactionan adverse interaction


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Poor Vascular AccessPoor Vascular Access

Clients who require frequentor prolonged I.V. therapy may

developed small, scarred,inaccessible veins fromrepeated venipunctures or

infusion of irritating drugs.


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If peripheral venous access isntIf peripheral venous access isnt

possible, the doctor may use apossible, the doctor may use a

central vein, commonly by thecentral vein, commonly by thesubclavian route.subclavian route.


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Adverse Drug ReactionAdverse Drug Reaction

A response to a drug that isA response to a drug that isnoxiousnoxious andand unintendedunintendedand occurs atand occurs at dosesdoses

normallynormallyused in man for theused in man for the

prophylaxis, diagnosisprophylaxis, diagnosis oror

therapytherapyof disease, or forof disease, or formodification of physiologicalmodification of physiological

function (WHO).function (WHO).


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The following are someThe following are some

adverse drug reactionsadverse drug reactions

that you might notice:that you might notice:

Skin rashSkin rash

Easy bruisingEasy bruising

BleedingBleeding


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Severe nausea and vomitingSevere nausea and vomiting

DiarrheaDiarrhea

ConstipationConstipation

ConfusionConfusion

Breathing difficultiesBreathing difficulties


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What should you do if youWhat should you do if you

suspect an ADR?suspect an ADR?

Stop the medication immediately.Stop the medication immediately.

Report the incident to theReport the incident to the

physician.physician.

Monitor the client.Monitor the client.


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10 GOLDEN RULES FOR10 GOLDEN RULES FOR

ADMINISTERING DRUGSADMINISTERING DRUGS

SAFELYSAFELY

Administer the right drug.

Administer the right drug to the

right patient.

Administer the right dose.


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Administer the drug by the rightroute.

Administer the drug at the righttime.

Document each drug youadminister.

Teach your patient about the drughe is receiving.


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Take a complete patient drughistory.

Find out if the patient has any

drug allergies.

Be aware of patient drug drug

or drug-food interactions.


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Common Medication Errors

Wrong dose (overdose, underdose,

missed dose)Wrong medication to wrong patient

Wrong medication to right patient

Wrong medication due to wrongdispensing

Wrong interpretation of doctors

prescriptions for drugsWrong infusion rate ( over infusion,

under infusion, missed order )


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Transcription ofTranscription of

medication and treatmentmedication and treatment

ordersorders


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Interpretation of DoctorsInterpretation of Doctors

Order for DrugsOrder for Drugs The nurse must understand the order

perfectly before acting on it

> The Drug

> The Dose

> The Route

> The Frequency


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If any of the above are unclear oropen for interpretations, it is theResponsibility of the nurse to clarify

the order with the physician.


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Definition of Terms:Definition of Terms:

Transcription of medicalTranscription of medical

orders-orders- is the act of writing outmedical orders.

Kardex-Kardex- is the summarize

written presentation of all thecare and treatment of the patient.


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Medication/TreatmentMedication/Treatment

sheet-sheet- is the legal

documents in the patientschart were medicines and

treatments administered tothe patient are written,acknowledged and

administered by nurses.


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Physicians Order Sheet-Physicians Order Sheet-is a legal document wherein

medical orders are writtenand use as reference of

nurses in the transcriptionand executing nursing care.


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All medication and treatment orders mustbe written legibly and must contain thefollowing:

a. generic name and brand name ofmedicines

b. Dosage of the medicines

c. Frequency of administrationd. Route of administration

e. Signature over printed name of

attending physician or authorizedrepresentative

f. Date and time order was written


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The registered nurseindicates that he/she has

checked and completelytranscribe the medical order

by signing his/her name withthe date and time directlyright after the doctors order.


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As a general rule, telephoneorders are received and carried

out only in emergency cases bynurses. Nurses receive telephoneorders only from consultants.

RNs will review all ordersimmediately after the physicianwrites.


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Patient / Family TeachingPatient / Family Teaching

Inform the client about the medicationInform the client about the medication

you are about to administer.you are about to administer.

Reason why the medication is to beReason why the medication is to be

give.give. Adverse effect he may experienceAdverse effect he may experience

PainPain

RednessRednessswellingswelling


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DocumentationDocumentation

Type and amount of drug givenType and amount of drug given Date and time givenDate and time given

Confirmation that the I.V. line wasConfirmation that the I.V. line was

patentpatent Patients response to the medicationPatients response to the medication

Condition of the insertion siteCondition of the insertion site

Ongoing monitoring that youOngoing monitoring that you

providedprovided


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Where to DocumentWhere to Document

Nurses Progress NotesNurses Progress Notes Medication SheetMedication Sheet

Infusion SheetInfusion Sheet Vital Signs Monitoring SheetVital Signs Monitoring Sheet

Input and Output MonitoringInput and Output MonitoringSheetSheet


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Weighing InWeighing In

Remember!!!Remember!!!

2.2 lb. = 1 kg2.2 lb. = 1 kg


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Coming to the SurfaceComing to the Surface

Remember!!!

Body Surface Area useBody Surface Area use

NOMOGRAMNOMOGRAM


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NomogramNomogram

Find your weight in the rightFind your weight in the rightcolumn and your height in the leftcolumn and your height in the left

column. Place a straightedge oncolumn. Place a straightedge on

the nomogram so the weight andthe nomogram so the weight andheight are connected. The pointheight are connected. The point

where the straightedge crosseswhere the straightedge crosses

the center column denotes yourthe center column denotes yourbody's surface area in squarebody's surface area in square

meters.meters.


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Coming to the SurfaceComing to the Surface

Basal Surface AreaBasal Surface Area

Childs Dose =Childs Dose =

Childs BSAChilds BSA XX averageaverage

173 m2173 m2 adult doseadult dose

(average adult BSA)(average adult BSA)


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GENERAL FORMULA FOR DRUGGENERAL FORMULA FOR DRUG

CALCULATIONCALCULATION

1.1. desired strength x total ml ofsolution

strength on hand

22 C l l ti b R ti P tiCalculation by Ratio Proportion


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2.2. Calculation by Ratio : ProportionCalculation by Ratio : Proportion

8 mg : x = 16 mg : 1 tab8 mg : x = 16 mg : 1 tab

(works for any computation of Dosage if(works for any computation of Dosage ifyou have a given and a need to determineyou have a given and a need to determine

the unknown).the unknown).

Rule :Rule :

1. Units for each ratio must be the same.1. Units for each ratio must be the same.

2. Units for each ratio must be placed in the2. Units for each ratio must be placed in thesame order.same order.


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C l l i Ad i i i RC l l ti Ad i i t ti R t


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Calculating Administration RatesCalculating Administration Rates

One must know two key componentsOne must know two key componentsbefore using the formula:before using the formula:

Drop factor of the IV administrationDrop factor of the IV administration

setsetAmount of solution to be infused overAmount of solution to be infused over

one hourone hour

l l iR t C l l ti


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Rate CalculationsRate Calculations

Macrodrip SetMacrodrip Set10 drops = 1 ml10 drops = 1 ml

15 drops = 1 ml15 drops = 1 ml

20 drops = 1 ml20 drops = 1 mlMicrodrip SetMicrodrip Set

60 drops = 1 ml60 drops = 1 ml

Blood SetBlood Set10 drops = 1 ml10 drops = 1 ml

OFORMULA


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FORMULAFORMULA

Drip RateDrip Rate (gtts or mgtts/min)(gtts or mgtts/min) ==

Total no. of ml x Dripx Drip

Factor Total no. of min.Factor Total no. of min.

FORMULAFORMULA


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FORMULAFORMULA

ml per hour =ml per hour =

Total no. of mlTotal no. of ml

Total no of hoursTotal no of hours


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