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 Course Description

◦ This course focuses on safe and


effective administration of
medication in intravenous therapy.
Objectives
1. To discuss nurses responsibilities
and accountabilities on intravenous
drug administration.
2. To discuss the 12 Rights of
Medication Administration.
3. To calculate flow rate and IV drug
dosages in children and adults.
 Course Content
- Drugs commonly used in IV Therapy
- Dosage and solution, computation
and flow rate calculation.
- Principles and 12 Rights of
medication administration
- Procedure on Drug IV Push,
incorporation to solu-set and IV bottle.
Desired (D) X Unit of measure or volume on hand (Q)

Known dose on hand (H)

= volume or unit of measure to be administered (X)

D X Q = X
H
 You are ordered to give 5 mg Valium IV. The
label states there is 10 mg in 2cc(10mg/2cc).
How many cc’s will you give?
 The equation will look like this:
5mg X 2cc = X cc
10 mg
1 X 2 = X cc
X = 1 cc
you will give 1cc!
Desired dose (D) x Weight in Kg (W)
Known dose on hand
X Unit of measure or volume on hand (Q)
= Volume or unit measure to be administered (X)

D X W X Q = X
H
 You are to give 0.5 mg/kg IV push. Your patient
weighs 80 kg. The drug comes packaged:
100mg/10cc. How many mg will you give? How
many cc’s will you deliver.
 Your equation to determine mg will look like
this:
0.5mg/kg x 80 kg = 40mg to be given
 Your equation to determine cc will look like this
40 mg x 10 cc = 4cc
100 mg
“Clock” method (used only for 4:1)
60
4

45 3 1 15
2

30
If your dose is 1 mg/min, your drip rate is 15 gtt/min.
If the order is greater than 4 mg/min, add them
together. A dose of 6 mg/min is 90 gtt/min (4+2= 6
so 60+ 30 = 90)
Desired dose x Size of bag x gtt set = gtt/min
Amount of drug on hand
The order is for 5 mg/min. You have a 500cc bag of NS,
a 60 gtt/cc administration set, and 2g of drug on hand.
How many gtt/min will you administer ?
5 mg/min x 500 cc x 60 gtt/cc = 75 gtt/min
2000 mg
Note: If the dose is weight based, determine the total
dose prior to beginning the equation or multiply
everything by the number of kg.
 Enteral (via digestive tract)
 Oral (by mouth, PO)
 10-90 minutes to begin working
 Affected by digestion and absorption

Sublingual (under the tounge, SL)


 3-5 min
 Rectal (via the rectum, RE)
 5-30 minutes
 Parenteral
 Inhalation (IH)
 Endotracheal (ET)
 Transdermal (TD)
 Time for effects variable based on medication
 Subcutaneous (SQ)
 Intramuscular (IM)
 Intravenous/ Intraosseous (IV/IO)
 Inhalation
 Takes effect in 2-3 min
 Delivery
 90 degree angle, 1 ½ inch minimum needle
 Subcutaneous
 Takes effect in 15-30 min
 Delivery
 45 degree angle, ½-1 inch needle
 Standing Order
 able to give med or start procedure if patient meets
certain preset criteria
 Physician Order
 Must request med or procedure from on line
doctor
 when giving report, ask for doctor before beginning
 Give report and paint clear picture of patient status
 Specifically request the medication and dose you want to
give.
Things to look for ...
 Onset of Action- time between administration
and first effects seen
 Duration of Action- time after administration
until effects are last seen
 Side effect- undesirable and often unavoidable
effect that occurs. Effects are not the original
reason for administering the drug
 Interaction- good or bad effects that occur with
administration of multiple drugs. Can increase or
decrease effects of one or both meds.
 Synergism- action of a combination of
drugs that is greater than one drug
alone
 Allergy- systemic reaction to a drug
involving the immune response.
 Untoward effect- side effect that
becomes harmful to the patient
Documentation
 Medication
 Dose
 Time
 Route
 Person who administered
 Effects
 List good, bad, expected, and unexpected
effects
 Absorption- process of drug moving from site of
introduction into circulation
 Contraindication- factor that does not allow
administration of drug
 Dependence- state where absence or less of drug
causes physical or emotional effects
 Excretion- elimination of drugs or toxins
 Half life-time it takes for a drug level to reduce by
half
 Loading dose- large amount of drug given to
temporarily increase blood levels.
 Maintenance dose- amount of drug needed to
maintain steady blood levels.
 Peak- level- highest blood level from any given
dose
 Therapeutic action- wanted and intended effects
of a drug
 Tolerance- decreased response to drug after
repeated administration. May require increased
dose.
 Toxic level- blood levels are such that they may
produce adverse effects.
Prehospital Medication

 The following is a list of drugs given in the


TEMS region. Limited information is
included for a number of the drugs but due
to space constraints, everything could not be
listed. Please review all medications you are
responsible for administering.
Oxygen
 Dose: 2-15 LPM via nasal cannula, non-
rebreather, bag-balve-mask
 Indications: Any patient with reduced
oxygen levels or increased need for
oxygen.
Activated Charcoal (Actidose)
 Dose: Adult (50g), Pediatrics (25-30g) given
by mouth
 Action: Binds and absorbs ingested toxin
and then is excreted
 Indication: Overdose or poisoning when
induction of vomiting is not indicated
 Contraindications: Unable to swallow or
maintain airway. Not useful in cyanide,
methanol, caustic acid or alkalis, heavy
metals, or lithuim poisonings.
 Side Effects: None
Oral Glucose
 Dose: One tube
 Action: Increases blood glucose
 Indication: Consider if patient has an altered
level of consciousness and/or known
hypoglycemia
 Contraindications: Difficulty swallowing or
unable to protect own airway.
 Side Effects: None
Epinephrine- SQ (Adrenalin)
 Dose: 0.01mg/kg( up to .3mg) SQ 1:1000
 Action: Improves force of ventricular contractions and heart,
bronchodilation, peripheral vasoconstrictions, and histamine
antagonist.
 Indication: Anaphylaxis, severe asthma
 Contraindications: Hypovolemic shock, hypertensions,
cardiac insufficency
 Side Effects: Anxiety, restlessness, hypertension,
dysrhythmias
 Note- Physician order for any patient over 40 years of age
and or cardiac history.
Albuterol ( Proventil, Ventolin)
 Dose: PAM (1-2 puffs from MDI only), 2.5 mg
HHN repeated once.
 Action: Relaxes smooth muscle of bronchial tree
and peripheral vasculature
 Indications: Relief of bronchospasm, wheezing
 Contraindications: Tachycardia dysryhtmias
 Side Effects: Anxiety, restlessness, palpitations,
increased blood pressure.
Nitroglycerin (NTG)
 Dose: 0.4 mg SL every 3-5 min up total of 3
 Action: Dilation of arterioles and peripheral veins causing
decreased workload of the heart and decreased oxygen
demand by decreasing preload and afterload.
 Indications: Chest pain, CHF
 Cotraindications: Viagra use in past 24 hours, systolic
BP<100, head injury, cerebral hemorrhage
 Side Effects; Headache, hypotension, nausea and
vomitting, dizziness, burning sensation under the tongue
 Note- Monitor blood pressure closely in-between tablets.
Aspirin (ASA)
 Dose: 324 mg (four 81mg chewable)\
 Action: Antiplatelet and vasodilatory actions
allowed to occur through alterations in
enzyme production.
 Indication: Chest Pain
 Contraindications: ASA intake in past 24
hours
 Side Effects: Bleeding, GI upset
Diphenhydramine HCl (Benadryl)
 Dose: 50mg IV or IM (adult) 1-2mg/kg (peds)
 Action: Bind to histamine receptor sites
blocking the histamine response
 Indications: Allergic and EPS/dystonic reactions
 Contraindications: Acute asthma attack, taking
MAO inhibitors, narrow angle glaucoma
 Side Effects: Drowsiness, hypotension, drying
of secretions, sedation
Naloxe (Narcan)
 Dose: 2-4 mg IV titrated to effect
 Action: Reverses effects of narcotics by competing for
receptor sites
 Indications: Narcotic overdose, altered level of
consciousness or unconsciousness with unknown origin
 Contraindications: Use cautiously in drug dependent
patients as administration can cause withdrawals
 Side Effects: projectile vomiting and/or cardiac
dysrythmias with rapid admin, withdrawals, diaphoresis
 Note: Narcan’s effect are shorter acting than the narcotic’s
so monitor patient closely.
Thiamine (Betaxin, Vitamin B1)
 Dose: 100mg IV or IM
 Action: Combines with ATP to form a coenzyme
necessary in the metabolism of carbohydrates
 Indications: Prior to the administration of D50
as part of the unconscious protocol, Wernick’s
encephalopathy
 Contraindications: None
 Side effects: Hypotension from rapid admin,
anxiety, nausea and vomiting, diaphoresis, red
following up the vein.
Dextrose 50% (D50)
 Dose: 25g in 50 cc for adult 0.25g?kg of 25%
solution for peds
 Action: Increases blood glucose.
 Indication: Blood glucose level <60 mg/dl,
altered level of consciousness and/or
seizure of unknown origin
 Contraindications: Intercranial hemorrhage
 Side Effects: No systemic effects but may
develop necrosis from infiltration locally.
Adenosine: (Adenocard)- narrow complex tachycardias, svt
 Dose: 6mg, 12mg rapid IV push

 Atropine-asystole (SO:CT,PM)- 1mg every 3-5 min up to 3mg

 Bradycardia (PO:CT and SO:PM)

 0.5mg-1mg every 3-5min up to a total of 0.04mg/kg 3mg

 Bretylium (Bretylol)- Pulseless Vtach/ Vfib or Vtach


 PO: CT, PM

 5mg/kg rapid IV push repaeted in 5 min at 10mg/kg to a max of


30mg/kg over 24hours
 Calciun Choride- Ca channel blocker overdose, crush syndrome,
hyperkalemia, hypocalcemia
 PO: CT, PM
 8-16 mg/kg slow IV push
Cardizem (Diltiazem)- Afib or Aflutter
 PO: CT, SO: PM

 Dose: 0.25mg/kg IV over 2 min

 Diazepam (Valium)- sedation or seizure control


 PO: CT, SO: PM
 2-5mg IV for adults, 0.2-0.3mg/kg for peds
 Dopamine (Intropin)- hypotension without hypovolemia
 PO: CT, PM
 5-20 mcg/kg/min IV drip (400 mg/250cc)
 Epinephrine (Adrenalin)- cardiac arrest (IV, ET)
 SO: CT, PM
 1 mg IV every 3-5 min in cardiac arrest, doubled for ET
Epinephrine drip- profound symptomatic bradycardia
 PO: CT, PM

 2-10 mcg/ min IV drip (1mg/250cc)

 Epinephrine nebulized- pediatric upper airway obstuction


 PO: CT, PM

 2-3 mg of 1:1000 in nebulizer

 Furosemide (Lasix)- rales, CHF

 PO: CT, PM

 40 mg IV or 0.5-1.0 mg/kg for adult and 1 mg/kg for peds

 Lidocaine (Xylocaine)- Vtach,Vfib, wide complex tachycardias


 SO: CT (cardiac, arrest only), PM

 1.5 mg/kg initial dose and repeat for cardiac arrest up to 3mg/kg
total
 0.5-0.75 mg/kg repeat dose with pulse up to 3mg/kg total
Magnesium Sulfate- Torsades de pointes, refractory Vfib, pre
eclampsia
 PO: CT, PM
 1-2 g in 10cc IV over 1-2 min for arrest and 2-4g in 50cc NS slow IV
push
 Midazolam (Versed)- sedation, seizures
 PO: CT, SO: PM
2mg slow IV push titrated to effect
 Morphine Sulfate- pain, CHF
 PO: CT and PM
 1-3mg slow IV for CHF and chest pain and 2-4 mg IV for burns
 Sodium Bicarbonate (Bicarb)- tricyclic antidepressant overdose,
return of circulation after long arrest, known severe acidosis
 PO: CT and PM
 1 mEq/kg IV push
 Solmedrol (Methylprednisone)- anaphylaxis,
severe asthma
 PO: CT and PM
 125 mg IV
Rate Calculations
Macrodrip Set
 10 drops = 1 ml
 15 drops = 1 ml
 20 drops = 1 ml
Microdrip Set
 60 drops = 1 ml
Blood Set
 10 drops = 1 ml
Formula
Desired x size of bag x gtt set = gtt/min
Amount of drug on hand
 The order is for 5 mg/min. You have 500cc bag of NS,
a 60 gtt/cc administartion set, and 2g of drug on hand.
How many gtt/min will you administer?
5 mg/min x 500cc x 60gtt/cc = 75gtt/min
2000 mg
Note: If the dose is weight based, determine the total
dose prior to beginning the equation or multiply
everything by the number of kg.
27
Formula

Ml per hour = Total no. of ml


Total no. of hours
Exercise # 1: Rate Calculation

1. The physician orders 1000ml of 5%


dextrose and water at 100ml/ hour.
You have available 20 drop- factor
tubing. Calculate the drops per
minute.
Answer
Formula: cc/ hr= volume of IVF in ml
Number of hours
Drop factor x cc = drops per minute
1 hour x 60 minutes
Drop factor x cc = drops per minute
60 minutes
• 1.20 x 100 ml = drops per minute
60 minutes
2000 ml = 33 drops per minute
60 minutes
Exercise #2
• 2. The physician orders 1000 ml of
5% dextrose and 0.45% sodium
chloride at 150 ml/hour. You have
available 15 drop- factor tubing.
Calculate the drops per minute.
Answer
Formula: cc/hr = volume of IVF in ml
Number of hours
Drop factor x cc = drops per minute
1 hour x 60 minutes
Drop factor x cc = drops per minute
60 minutes
2250 ml = 38 drops per minute
60 minutes
Exercise # 3
3. The physician orders 45 ml/hour of
0.45% sodium chloride fluid on an 8-
month-old baby. Calculate the drops
per minute using 60-drop factor
administration set.
Answer
3. 60 x 45 ml = drops per minute
60 minutes
2700 ml = 45 drops per minute
60 minutes

Note: when using microdrip or pediatric


administration sets, the ml per hour are the same
as the drops per minute.
Exercise # 4
4. The physician orders 3000 ml of a
multiple electrolyte fluid over 24
hours. Calculate the drops per
minute using 20 drop- factor tubing.
Answer
4. In this problem the hourly volume must be
determined by dividing the total ml in 24 hours by
24.
• 3000 ml / 24 hours = 125 ml/ h
20 x 125 ml = drops per minute
60 minutes
2500 ml = 42 drops per minute
60 minutes
Exercise # 5
5. The physician orders 500 ml of
5% dextrose 0.25% sodium
chloride to be administered at 75
ml/hour. You have available 15
drop- factor tubing.
Answer
5. 15 x 75 ml = drops per minute
60 minutes
1125 ml = 19 drops per minute
60 minutes
I hated every minute of training,
but I said, “Don’t quit. Suffer now
and live the rest of your life as a
champion.”
- Muhammad Ali
Thank you…

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