Intravenous Medications in the Nursing Environment

Intravenous Medications in the Nursing EnvironmentPhoebe Roberts plow and Monitor Intravenous Medications in the Nursing EnvironmentQuestion 1a. Signs and symptoms of iron need genus Anemia include fatigue, irritability, tachycardia, pale clamber,difficulty concentrating, brittle nails and shortness of breath. (Williams grasshopper 2011 p. 562).b. As the tolerant has iron deficiency anaemia a line of work transfusion is necessary to increasehaemoglobin levels in spite of appearance the broth as this helps to transport oxygen to cells and tissues. She in either casehas a history of PR bleeding. Therefore this blood transfusion is circumstances to replace volume lost, toincrease circulating blood volume and to improve the oxygen carrying capacity (Hamlin, Richardson-Tench, Davies 2009 pp 155,156)c. It is valuable to follow the Pico preparation instructions as faecal matter abide obscure the viewing of thethe colon. Pico prep aims to thoroughly cleanse the colon of all matter or gas to ensure that thevisual scope is clear ( Corbett Banks 2011 pp. 675,676).d. Pico prep is an osmotic laxative, its action decreases the silver-tongued absorption within the bowel whichthen results in the onset of diarrhoea within 1-4 hours. place do 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 shemobilises with a four wrap walker it would become increasingly difficult to mobilise to the toilet sofrequently 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 flip and the application ofhip protectors may aid in reducing the risk of her having a fall and in the chances of her having a fallthe hip protectors may aid in protecting that area.( Crisp, Taylor, Douglas, Rebeiro 2013. p. 454).Providing a beds ide commode may also reduce the chances of falls as it is located closer to her thanthe toilet may be. As she is an elder patient the scrape around the area may become excoriated and skinbreakdown may pass on due to the acidity of the diarrhoea and the area frequently being wet. Barriercreams should be applied to at risk areas for protection. Diarrhoea can also quickly cause dehydrationand electrolyte im correspondences in the elderly, this may also have an impact on this patients fluid andelectrolyte levels (Williams Hopper 2011. pp. 275, 747).Question 2.a) This patient is displaying possible signs and symptoms of a venture urinary bundle transmittal much(prenominal)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 legal opinionshould be performed to identify the areas at risk and to identify any change in skin integrity. Skinturgor should also be assessed as this can repoint a sign of dehydration (Crisp et. al. 2013 p. 592). Afluid balance chart should be maintained to assess if the patient is in a verificatory or negative fluidbalance and the freight of the patient should also be assessed as observable weight changes canindicate hypovolaemia (Crisp et.al 2013 p.1214, Scott 2010 p. 62). Auscultation of the chest couldprove useful in determining the crusade of the change magnitude respiratory value and low oxygen saturationlevels ( Lewis Foley 2011 p. 356). A falls risk assessment should also be performed as the elderlypatient has a few risk factors for falls such as confusion, reduced mobility and is incontinent of urineand 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 t othoroughly 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 thebacteria adhering to the wall of the bladder, this method acting can be helpful in reducing the pain of aurinary tract infection however the patient is undergoing a procedure the next day, therefore thisintervention should be implemented with the approval of a medical officer. A heat pack could beplaced on her abdomen to live any pain and discomfort along with the administration of anantipyretic to reduce her fever and pain (Williams Hopper 2011 p. 840). As the patient is havingdifficulty breathing she should be placed in a suitable coiffure to help with proper lung expansion suchas the high fowlers position along with the administration of oxygen to increase oxygen levels withinthe blood. (Williams Hopper 2011 p. 604). The patients vital signs should be continuouslyassessed to varan any im provements or deterioration especially her blood pressure and heart rateas any further abnormalities such as ar one shotias and a further correct in blood pressure couldindicate hypovolaemia and hypokalaemia. Continuous assessment of her neurological state shouldalso be implemented to monitor any changes (Scott 2010 p. 64).c. Hypokalaemia occurs due to an inordinate release of potassium from the body or from an inadequateintake of potassium. The body is unable(p) to conserve potassium and relies on an adequate intake ofpotassium to maintain a balance within the body. An excessive loss of potassium can be due todiuretic therapy especially potassium waste diuretics, corticosteroids, vomiting and diarrhoea.Signs and symptoms include an irregular weak pulse, hypotension, muscle cramps, muscle weaknessand shallow respirations. (Williams Hopper 2011 p. 79, Scott 2010 p. 98). medical examination management is aimed at restoring potassium levels either by increasing the intake ofpota ssium in the sustenance or oral potassium supplements. Intravenous replacement therapy is alsoimplemented in those with severe hypokalaemia to promptly increase potassium levels. Diuretics maybe changed to a potassium sparing diuretic to prevent the loss of potassium from the body. (Scott2010 pp. 100,101).Nursing management includes monitoring fluid input and output, monitoring the heart rate and rhythmof those receiving IV replacement therapy, maintaining and ensuring the correct administration of thetherapy and continuous monitoring of the patients condition throughout. ( Scott 2010 p.102).hypovolaemia occurs due to the loss of fluid from the body and extracellular spaces this can be dueto excessive bleeding, excessive sweating, burns, diuretic therapy, diarrhoea, renal impairment andvomiting. The loss of fluid then results in a lessen 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 adecline 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 oflost fluid with an intravenous infusion with the same osmolality of blood to increase the bodys bloodvolume. ( Scott 2010 p.63).Nursing management includes the administration and alimentation of intravenous fluid replacement,monitoring the daily weight of the patient, monitoring fluid input and fluid output, encouraging theintake of fluids to aid in restoring fluid balance and providing mouth vexation to maintain the integrity ofthe oral mucous membranes. (Crisp et.al. p. 73).Question 3a) Midazolam is employ in this procedure as it is a sedative, hypnotic agent and muscle relaxant. Thisaims to reduce the amount of endeavour throughout the procedure and assists in keeping the patientin a sedative state and impairs computer storage function ( Tiziani 2013 p. 967). Fentanyl would be used toreduce pain during the procedure and also aids in the maintenance of the anaesthesia ( Tiziani 2013p 928) Diprivan is used to induce sedation and also increases the effects of the hypnotic agent andanalgesia ( Tiziani 2013 p 793.)b) Midazolam acts by binding with a benzodiazepine receptor in the central nervous system whichinhibits neurotransmitters in the brain resulting in a calming sedative affect ( DrugBank, MidazolamDB00683 2013). Midazolam given intravenously takes affect within 1.5 2.5 minutes. Adverse effectsinclude 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 receptorsproducing an analgesic affect. Administered intravenously fentanyl takes affect almost immediately.Side effects include respiratory depre ssion, apnoea, dyspnoea, vomiting, nausea, increased intracranial 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. Adminsteredintravenously diprivan takes affect within 30 seconds of administration. Side effects includerespiratory depression, tachycardia, hypotension, pall and involuntary muscle movements (Tiziani 2013 p 793)Nursing care includes continuous monitoring of respiratory rate, heart rate and vital signs duringadministration of these agents and throughout the procedure, ensuring that the dose is titrated toproduce 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 betaken when mobilising. Central Nervous System toxicity may occur when all trey medications aregiven together therefore continuous monitorin g is extremely important as the effects on the centralnervous 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 mayresult in an accumulation of the medications and could maybe result in drug toxicity especiallyopiate medications (Tiziani 2013 p.925). This patient is elderly and may have increased sedation andconfusion after the procedure due to her age and renal function and is at a high risk of falls especiallyas midazolam causes muscle weakness. Midazolam administered to an elderly patient can causedelirium, 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 opiatemedications.Reference ListCorbett, J., Banks, A., (2013). Laboratory Tests and Procedures with Nursing Diagnoses ( 8th Edition) New Jersey USA. Pearson EducationCrisp, J., Taylor, C., Douglas, C., Rebeiro, G., (2013). Potter Perrys Fundamentals of Nursing (4th Edition). Chatswood NSW. Elsevier Australia.DrugBank (September 2013) Midazolam (DB00683) Retrieved March 10, 2015, from http//www.drugbank.ca/drugs/DB00683Hamlin, L., Richardson-Tench, M., Davies, M., (2009) Perioperative Nursing (1st Edition). Chatswood NSW. Elsevier Health.Lewis, P., Foley, D., (2011) Health Assessment in Nursing (1st Edition). Broadway NSW. Lippincott WilkinsScott, W., (2010) nomadic Electrolytes Made Incredibly Easy (1st Edition) London England. Lippincott Williams WilkinsTiziani, A., (2013). Harvards Nursing Guide to Drugs (9th Edition). Chatswood NSW. Elsevier Australia.Williams, L.S., Hopper, P.D., (2011). Understanding Medical surgical Nursing (4th Edition). Philadelphia USA. F.A Davis Company.