HLTEN519C Administer and Monitor Intravenous Medication

ADMINISTER AND MONITOR INTRAVENEOUS MEDICATION NURSING
ENVIRONMENT 1
Administer and monitor intravenous medication in the nursing environment
Name
Institution

ADMINISTER AND MONITOR INTRAVENEOUS MEDICATION NURSING
ENVIRONMENT 2
IV case study (relates to Questions 1-8)
Mr George Stanford is a 60yr old gentleman who was admitted to the surgical ward you are
working on, Mr Stanford has just returned from theatre at 12pm following a right anterior
cruciate ligament (ACL) reconstruction. Post operatively - Mr Stanford's doctor has ordered
intravenous fluids of Hartman's solution 1000mls over 8 hrs with a drop factor of 20, Mr
Stanford also has a patient controlled analgesia (PCA) pump of 100mgs of morphine in
100mls of normal saline (concentration of 1mg/ml) set to deliver 1mg / dose when Mr Stanford
presses the patient controller, there is a lockout interval of 5minutes.
(Mr Stanford is a keen motorcycle enthusiast and while working on his motorbike recently
experienced a ACL tear to his right knee when attempting to rescue the motorbike from falling
over.)
Please answer the following questions 1-8 in relation to the above scenario
Q1
a. In an anterior cruciate ligament injury, Mr. Stanford could have lost a lot of blood causing
the reduction of the hemoglobin cells (Zink, 2009). To reduce the impact of the tear, then
a unit of PRBC would be necessary to increase the volume of his blood.
b. Blood transfusion has a lot of side effects to the patient including fever, allergic reactions,
breath shortness, dark urine, back pain and many more.
c. Before transfusion, the nurse must conduct a physical assessment of the patient to predict
future reactions and record the findings. She also needs to gather all the necessary
equipment like oxygen, hypersensitive kit and saline solution (Zink, 2009). It is also

ADMINISTER AND MONITOR INTRAVENEOUS MEDICATION NURSING
ENVIRONMENT 2
necessary to crosscheck the identification details of the patient to ensure that they get the
appropriate product.
Q2.
a) 100/8 = 12.5mls/hr
The drops/min rate of Mr Stanford’s IV?
20drops/5mins = 4drops/min rate
b) Isotonic: Isotonic are the kinds of solutions that contain similar osmotic pressure and
equal water and solutes concentration (Hoste, 2014). An example is saline solution.
Hypertonic: A solution with greater concentration or higher osmotic pressure on the
outside membrane than on the inside is called hypertonic solution (Hoste, 2014). An
example is sodium dextrose.
Hypotonic: Hypotonic solution is one whose concentration on the inside cells is higher
than the outside membranes. Example of hypotonic solution is Sodium Chloride (Hoste,
2014).
Q3.
a) The best immediate action for a patient with dyspnoea is to provide them with
supplementary oxygen as the main agenda is to help them breath. The follow up
reports should be to examine the extents of the condition and the frequency of its
occurrence (Lohmander, 2007).
b) Fluid overload, also known as Hypervolemia can be characterised by evident signs
like swelling of the face, wrists, feet and ankles. Stomach bloating, headaches and
breath shortness are also other signs and symptoms.

ADMINISTER AND MONITOR INTRAVENEOUS MEDICATION NURSING
ENVIRONMENT 2
Q4
a) Frusemide IV is a medication administ6ered to paediatrics and adult patients in
treatment of liver disease, heart failure and many others (Marais, 2009). However in
this case it was for the treatment of edema/ fluid overload diagnosed in Mr. Stanford.
b) Frusemide IV falls under the Antihypertensive medication group
c) Yes. As an endorsed nurse, I would give the medication because it is in my expertise
to do so as long as it is done under the instruction of a doctor or registered nurse.
d) Some of the side effects of Frusemide IV include appetite loss, itching, nausea, dark
urine, hearing loss and many others (Marais, 2009).
e) A nurse in this case should advice the patients on the dos and don’ts after the use of
the medication to reduce the impact of side effects that might come with the use of
Frusemide IV.
f) The laboratory expertise and doctor in charge are responsible for the whole procedure
involving the medication (Marais, 2009).
g) Administration document including the dosage, timing and the things to avoid during
the medication is important.

ADMINISTER AND MONITOR INTRAVENEOUS MEDICATION NURSING
ENVIRONMENT 2
Q5
a) It is a flexible tiny tube that is used to administer body fluids by placing it in the
peripheral vein (Aziz, 2009).
b) Phlebitis is the inflammation of veins and can be caused by the use of inappropriate
size of a catheter tube size. Phlebitis can be caused by either chemical, mechanical
and bacteria sources. Bacterial agents can cause vein inflammation, it can also be
caused by mechanical forces like the inappropriate placing of the catheter and can
also be brought about by the chemical content of the fluids used (Aziz, 2009).
c) The process should include the use of the appropriate tools and fluids for the
procedure putting into consideration the impacts of the procedure to the patient
(Aziz, 2009). It would therefore be necessary to record the signs and symptoms of
Mr. Stanford’s situation.
Q6: A pain in the knee considering the patient’s condition might be due to fluid overload and as
the nurse in charge the best strategy would be to offer medication for the issue and encourage the
intake of low salt intake.
Q7
a. A PCA machine is connected directly to the patient’s intravenous line so as to transfer
pain medication through a syringe from the pulp.
b. The main merit of a PCA is that the patient’s pain can be regulated by a self delivery
and fast method. Its disadvantages is that it cannot be used for a certain group of

ADMINISTER AND MONITOR INTRAVENEOUS MEDICATION NURSING
ENVIRONMENT 2
people like children under 5 years, the confused and patients in critical conditions,
meaning that it is not so effective for all (Woodhouse, 2007).
c. Using a PCA does is not influenced by narcotic addition and cannot have any
negative impacts on his health or results of the procedure (Woodhouse, 2007). A
lockout period is therefore necessary to give the body a chance to get rid of any
narcotic products before the administering of any fluids.
Q8
a. The doctor’s order is meant to treat the fluid overdose that causes pain on his
injured knee.
b. The prescription is final and does not require checking with another medical
professional.
Q9: IV therapy might lead to negative impacts like air embolism, intra-arterial injection and
phlebitis. In air embolism, the patient suffers from blood vessel blockage brought about by gas
bubbles. Intra-arterial injection might cause the injury of the arteries which is dangerous as it
might lead to loss of blood (Galanter, 2007). Finally IV can lead to the inflammation, also
known as phlebitis, which is painful and might lead to complications in the future.
Q10
a. -Potassium substitute therapy should be directed principally by sequential
electrocardiograms
-The catheter should be carefully inserted within the lumen
-One should be careful while using solutions that contain potassium

ADMINISTER AND MONITOR INTRAVENEOUS MEDICATION NURSING
ENVIRONMENT 2
-Should be administered only when the container is undamaged and the solution is clear.
b. Some of these include, flaccid paralysis, paresthesias of the extremities, mental
confusion, listlessness, and heart block
Q11
1kg=5micrograms/kg/min
49kg=?
49*5= 245micrograms/kg/min
Q12
a. 500*50= 25000
5000
25000/5000= 5mls
b. 5mls= 5mls/hr
Q13
a. Heparin can be dangerous an should therefore not be used in excess or frequently for
the same patient. Some of the side effects are blood blister, itching of the feet, chest
pains, nausea, irritation and redness of the skin and many more (Fahimi, 2008).
b. Some of the issues with compatibility of the IV is the drug concentration, order of
mixing, contact time, temperature and ph of the patient.

ADMINISTER AND MONITOR INTRAVENEOUS MEDICATION NURSING
ENVIRONMENT 2
Q14
Some examples of additional electrolytes include magnesium and phosphorous and they can
be used in the dilution of isotonic, hypertonic and hypotonic solutions.
Q15
 IV Gentamycin-S4
 IV Frusemide-S3
 IV Morphine- S2
Q16
 IV Gentamycin
Do not store above 25°C.
 IV Fentanyl
Stored away from direct light
Q17
 Pharmacokinetics
It is the division concerned with the movement of solutions and fluids in the body when they are
directed to an individual’s body.
 Pharmacodynamics
It is a branch that examines the effect of the drugs, fluids or solutions that enters the patient’s
body through IV therapy.
 Toxicology

ADMINISTER AND MONITOR INTRAVENEOUS MEDICATION NURSING
ENVIRONMENT 2
It is concerned with the detection, nature and effects of any poisons from the IV medication
(Fahimi, 2008).
Q18
a) Nurse initiated medication administration is the type of medication that can only be
administered by the professionals approved by the ministry of health. These include
registered nurses, endorsed enrolled type of nurse or a midwife.
b) The administration of medication however varies depending on the type of medical
procedure involved. When it comes to the administration of IV medication, not all
personnel’s are allowed to conduct the activity (Biron, 2009). An EN can only administer
IV only with the instruction or supervision of the registered nurse or doctor in charge.

ADMINISTER AND MONITOR INTRAVENEOUS MEDICATION NURSING
ENVIRONMENT 2
References
Aziz, A. M. (2009). Improving peripheral IV cannula care: implementing high-impact
interventions. British journal of nursing, 18(20).
Biron, A. D., Loiselle, C. G., & Lavoie‐Tremblay, M. (2009). Work interruptions and
their contribution to medication administration errors: an evidence review. Worldviews on
Evidence
‐Based Nursing, 6(2), 70-86.
Fahimi, F., Ariapanah, P., Faizi, M., Shafaghi, B., Namdar, R., & Ardakani, M. T.
(2008). Errors in preparation and administration of intravenous medications in the intensive care
unit of a teaching hospital: an observational study. Australian critical care, 21(2), 110-116.
Hoste, E. A., Maitland, K., Brudney, C. S., Mehta, R., Vincent, J. L., Yates, D., ... &
Shaw, A. D. (2014). Four phases of intravenous fluid therapy: a conceptual model.
British journal of anaesthesia, 113(5), 740-747.
Lohmander, L. S., Englund, P. M., Dahl, L. L., &Roos, E. M. (2007).The long-term
consequence of anterior cruciate ligament and meniscus injuries.The American journal of sports
medicine, 35(10), 1756-1769.
Marais, A. F., Song, M., & de Villiers, M. M. (2009). Effect of compression force,
humidity and disintegrant concentration on the disintegration and dissolution of directly
compressed furosemide tablets using croscarmellose sodium as disintegrant. Tropical Journal of
Pharmaceutical Research, 2(1), 125-135.
Woodhouse, A., & Mather, L. E. (2007). The influence of age upon opioid analgesic use
in the patient‐controlled analgesia (PCA) environment. Anaesthesia, 52(10), 949-955.
Zink, K. A., Sambasivan, C. N., Holcomb, J. B., Chisholm, G., & Schreiber, M. A.
(2009). A high ratio of plasma and platelets to packed red blood cells in the first 6 hours of

ADMINISTER AND MONITOR INTRAVENEOUS MEDICATION NURSING
ENVIRONMENT 2
massive transfusion improves outcomes in a large multicenter study. The American Journal of
Surgery, 197(5), 565-570.