Assessment Tasks

This document provides information on assessment tasks, including the Controlled Substances Act, intravenous medication administration, blood and blood products, IV medication storage, electrolyte imbalance, acid-base imbalance, and more.

Running head: ASESSMENT TASKS
ASESSMENT TASKS
Name of the Student
Name of the University
Author’s Note

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Assessment task 1:
1. The Federal U.S. Title II of the Controlled Substances Act (CSA) of 1970 is the law
under which states the guidelines for the manufacture, possession, importation, distribution
and uses of narcotics, hallucinogens, stimulants, anabolic steroids, depressants, and other
drug (Nova Center, 2019). Antibiotic intravenous drugs are not directly registered under the
list, however morphine, hydrocodone and other pain relief drugs are placed under Schedule II
which has a high potential for drug abuse and might lead to relentless physical and
psychological dependence and can only be obtained with a valid prescription. Anabolic
steroids like ketamine, codeine are listed under the drug schedule III as its dependence factor
is low to moderate. The schedule IV of drugs contain prescribed medicines like xanax,
valium, tramadol which has fewer refill regulations and are of low dependence potential.
Medications listed under schedule V are of least abuse and dependence potential and has the
fewest numberof refill rules and include drugs like pareceptolin, lomotil and so on (Dea.gov,
2019).
2. The rationale for the doctor to prescribe medicine intravenously is to deliver
instantaneous, quick therapeutic relief, which is vital during developing emergency
circumstances. The intravenously delivered drugs are completely absorbed and are more
consistently compared to medications administered via other routes such as oral, epidermal,
so on. The bioavailability of intravenous drugs is much higher and it provides a substitute for
the oral route of drug administration which might not get fully absorbed and might get
metabolized in the gastrointestinal tract, leading to alteration in the dosage. Medication
administered intravenously has 100% bioavailability whereas medication administered by the
use of other routes (such as orally) has much reduced bioavailability generally and absorption
might vary between different patients.

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3. The administration of blood and blood products to a patient is a daily clinical
procedure which provides life saving and unique therapeutic assistance to the patient. On the
other hand due to the constraints of the available resources and its viability, the blood
products are not always accessible to the concerned patient at the correct time. The foremost
concern for the blood product recipient and the physician is safe quality blood and effective
blood products to be obtainable when required. Customary practices must include proper
testing, cautious selection of the donors, appropriate screening of the donated products,
compatibility analytical testing, proper storage of the donated products for future clinical
usage, controlled documented issue of donated units for routine use or use during emergency
situations, suitable utilization of the blood supplied along with return of the unused sealed
units not required after issue, and documented reports of the transfusion reactions.
Fluids that are not compatible with blood are glucose solutions as the glucose present
in the fluid causes clumping with the red blood corpuscles. Colloidal or crystalloid solutions
containing calcium must never be administered concomitantly with any blood product as the
calcium will promote blood clotting.
4. Proper information must be given to patients before IV administration and the patient
should be asked to position appropriately. The patient must always be questioned about the
allergies, the kind of reactions, and the severity of possible reactions. Possible side effects
must be thoroughly discussed.
5. Common sites for jelco/cannula inertion are dorsal arch veins of the hand, volar
aspect of the hand, dorsal arch of the foot, cubital fossa, cephalic vein, saphenous vein at the
knee, median antecubital and the basilic veins.

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To secure cannula in place, application of transparent dressing and sterile adhesive
tape can be used or cannula specific specialized dressing can be utilized to safely secure the
venous access by the cannula device. Attachment of the cannula to the skin is of high priority
to make it comfortable for the patient along with safely keeping it in place inside the vein.
Skin tested adhesive tape must be used to keep the device attached to the skin and also
securing tubes leading to an additional attachment point.
6. Before administration of the intravenous medication, it is imperative to verify proper
placement of the intravenous cannula or catheter, because the intravenous push might injure
the blood vessel lining, cause irritation or damage the surrounding tissues. Since intravenous
medications act rapidly, close monitoring of the patients are required once the drug has been
intravenously administered. If the medication has not been administered to the patient before,
the medicine should first be checked for allergic reactions for the patient by doing a under the
skin epidermal allergic test. Appropriate dose of the medication must be achieved based
instructions and medication concentration available on the container prior to administration
of the intravenous medication and the rate of flow of the intravenous medicine must also be
scrutinized accurately to reduce chances of overdose. The compatibility of the intravenous
medication must be checked if the patient is receiving other drugs intravenously and also with
the other fluids present in the IV line to minimize complications and rise of any adverse
situations.
7. The 8 R’s for IV medication administration are:
i. Right PATIENT evaluation and examination
ii. Right MEDICATION that is required by the patient to treat his diseased condition

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iii. Right REASON for choosing the medicine keeping in mind allergies, compatibility
with other health conditions or medicines and the minimal side effects.
iv. Right DOSE complementary with the patient's weight
v. Right ROUTE of medicine administration
vi. Right FREQUENCY of administration of the medicine
vii. Right TIME of the day in giving the patient the medicine
viii. Right SITE of application or administration of the medicine
8. The procedure for checking the accurate IV medication administration includes
i. Establishment of a good IV line.
ii. The safe and secured placement of the IV line must be checked, prior to drug
administration.
iii. A comprehensible drug prescription must be available for the IV medication and with
proper charting and documentation completed by the physician.
iv. The one administering the intravenous drug must be aware of the basic nature of the
drug.
9. Risk assessment before IV medication administration includes checking of the IV
line, time of administration is very critical, correct clear prescription, patients condition along
with allergies assessment and monitoring of the possible side effects. The drug must be
included in the Drug Administration Protocol and must be appor else it must be avoided.
Various risks are related to intravenous administration of drugs such as the injecting drug
caused infiltration of the IV line, necrosis of tissue caused by IV bolus, thrombophlebitis of
the vein, air embolism, severe adverse reaction to the drug like cardiac arrest, venous

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thrombosis, hypotension, cardiac arrhythmias, allergic reaction, and persistent pain at the site
of IV administration.
10. Storage of IV medication must include proper security and regular quantity checking
along with maintenance of proper temperature. IV medicine storage should be done at 15°C
to 25°C but it must be warmed to 36.5°C before administering to the patient concerned. The
setting of the temperature of the air warming devices must be maintained at the patient
temperature of approximately 36.5°C. The irrigation fluids that are used intra-operatively
must be warmed to a temperature of 38–40°C in a sterile thermostatically monitored cabinet.
The Schedule 8 drugs, also known as the controlled drugs, are medical substances with high
potential for addiction, abuse and physical and psychological dependence whose possession
without permission is an offence. Maintaining and possession of the schedule 8 drugs require
legal authority and must be kept secured and locked.
11. Regular monitoring of the peak and the trough levels for particular IV medications is
advised for patients. The monitoring of the therapeutic drug is carried out when the patient is
administered an intravenous medications by measuring the level of the drug in the
bloodstream just prior to administration (trough) and after an interval post administration and
metabolism (peak), thus aiding the physician in determining the accurate dose, the required
frequency of the medication, and the patient’s tolerance to the advised treatment.
Peak and trough levels are usually monitored in patients with vancomycin and
gentamycin treatments as dosage of these antibiotics differ patient to patient. Therefore, the
peak levels of these antibiotics are generally evaluated post thirty minutes of completion of
the administered infusion whereas the trough levels are calculated just before administration
of the antibiotic.

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12. Necessary action needs to be taken when the patient complains of pain at the site of
jelco/cannula insertion. Firstly it has to be determined if the pain at the site of cannulation
and phlebitis is of chemical, mechanical or infectious cause. If it is chemical, then the drug
administered must be checked along with the dosage. If the site has gotten bruised or torn due
to mechanical reason then the site of cannulation must be changed immediately and the
bruised site must be carefully sterilized and taken care of. Secondly, proper documentation of
the site of jelco/cannula insertion must be made along with scoring the pain, and
documentation must be maintained to monitor the changes and the healing process. Analgesic
which are anti-inflammatory in nature might be prescribed to soothe the pain which is
associated with phlebitis, along with treatment of the inflammation.
13. The isotonic solution is defined when two solution has the same osmolar
concentration and the molecules can move freely without changing the concentration of the
either of the two solutions. In an isotonic solution, the cell neither swells up nor shrinks down
as there is a lack of concentration gradient that is required for the water to across the
membrane separating the two solutions. The water molecules disperse via the membrane in
both the directions and this water diffusion rate is similar thereby maintaining status quo.
The hypotonic solution refers to reduced concentration of the solution outside the cell
in comparison to the concentration inside of the cell. Therefore to resume balance, the water
has to move inside the cell via the membrane so that the concentration inside the reduces and
becomes similar to the outside solution, however if the difference in the concentrations is
high, the cell might burst as a lot of water might enter the cell to decrease the high
concentration and balance it with the outside low concentration.
In reverse, the hypertonic solution indicates greater concentration of the outside
solution in comparison to the concentration inside the cell. In this case, the solution from the

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inside of the cell has a tendency of crossing the membrane and going outside to resolve the
concentration imbalance, thereby shrinking the cell.
During blood loss or loss of fluid isotonic solutions are used to increase the
extracellular fluid volume and supply the extracellular fluid loss. Hypotonic solutions such as
hypotonic saline solutions are given to replenish electrolyte imbalance and to treat patients
suffering from dehydration.
14. Electrolytes are chemical materials that become ionic in solutions, thereby acquiring
the power of electricity conductance. The presence of electrolytes is of utmost importance in
the human body along with the maintenance of proper electrolytic balance as it helps in
functioning of the cells and maintaining the fluid balance of the cell. The blood electrolytes
including potassium, bicarbonates, chloride and sodium regulates muscular and nervous
functions along with regulation of the acid base balance.
15. Electrolyte imbalance is the disproportionate level of electrolyte in the blood due to
fluid loss or dehydration thereby leading to the imbalance. Loss of electrolytes occurs during
excessive sweating, dehydration along with a bout of diarrhea or vomiting which affects the
electrolyte concentration.
Measure of the sodium, potassium, chloride and bicarbonate levels can give
information regarding electrolyte imbalance. Intravenous administration of hypotonic saline
solutions or oral administration of oral rehydration solution may be used to replenish
electrolyte imbalance and to treat patients suffering from dehydration
16. The electrolyte replacement solution is given to patients which contains fluid along
with sodium, potassium, chloride and bicarbonate electrolytes to treat dehydration and loss of
fluid.

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Fluid replacement rehabilitation therapy can be performed using oral rehydration
solution which is a specialized solution and utilized to avert lack of fluids and also to treat
dehydration. Drinking water containing specific amount of sugar along with sodium,
potassium, chloride and bicarbonates is used in oral rehydration therapy, which can also be
administered via a naso-gastric tube.
17. The acid–base imbalance is the irregularity of the body's standard equilibrium of the
acids and the bases which makes the pH of the plasma to diverge out the normal pH range of
pH 7.35 to pH 7.45. The fetal normal pH range is different than the normal adult pH range as
it maintains the pH range of the umbilical vessel which is normally pH 7.25 to pH 7.45
whereas the pH of the umbilical artery ranges from pH 7.18 to 7.38.
An abnormal rise in the acidic pH is referred to as acidosis or acidemia whereas an
irregular increase in the basic pH is known as alkalemia or alkalosis. The rationale behind the
loss of acid base balance can be categorized on the basis of change in pH either acidosis or
alkalosis or caused by metabolic or respiratory disturbance. The diagnostic result identifying
respiratory acidosis or respiratory alkalosis along with metabolic acidosis or metabolic
alkalosis indicates presence of respiratory acidosis in conjunction with metabolic acidosis and
vice versa. Pulmonary issues are highlighted in cases of respiratory acidosis or alkalosis
whereas renal problems manifests as metabolic acidosis or alkalosis.
18. The documentation before IV administration must include the following items during
proper charting:
i. The time and date of insertion of IV
ii. The anatomic nomenclature of the vein accessed

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iii. The name of the gauge brand and the type the gauge used along with the catheter
length.
iv. Number of required attempts for proper channelization.
v. The drug and the dosage administered
vi. The flow rate of the IV.
vii. Response of the patient to theIV
viii. Name and signature of the one who has administered the IV
19. Example and name of one drug from each group:
 Beta-blockers: Acebutolol, such as Sectral
 Calcium channel blockers: Amlodipine, such as Norvasc
 Anti-hypertensive: thiazide diuretics such as Chlorothiazide (Diuril)
 Diuretics: Furosemide such as Lasix
 Statins: Atorvastatin such as Lipitor
 Anticoagulants: Warfarin such as Coumadin
 Sedatives: Benzodiazepines such as diazepam
 Antidepressants: Sertraline such as Zoloft
 Antipsychotics: Chlorpromazine such as thorazine
 Antimicrobials: Antibiotics such as amoxicillin (Amoxil)
 Vitamins/minerals: Calcium and Vitamin D such as Caltrate 600+D
 H2-inhibitors: Cimetidine such as Tagamet.
 Proton pump inhibitors: omeprazole such as Prilosec

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 Antiemetics: aprepitant such as Emend
 Hypoglycaemic agents: Biguanides such as metformin
 Respiratory medications: aclidinium such as Tudorza
 Analgesics: hydrocodone such as Zohydro ER
 Narcotics: Morphine such as MS Contin
 Steroids: bethamethasone such as Celestone
 Anaesthetics: Amobarbital such as Amytal
 Anticonvulsants: Clobazam such as Frisium
20. Definitions:
 Drug toxicology: The drug toxicology refers to the examination determining the kind
of drug taken (legal or illegal) along with its estimated amount. It is generally utilized
for drug abuse screen, to scrutinize the drug abuse crisis and to analyze the drug
overdose or intoxication if applicable.
 Anaphylactic reaction: An acute allergic reaction to an antigen to which the body has
become hypersensitive therefore causing a response involving more than one system
of the body.
 Contraindications: A contraindication refers to a specific reason or motive to hold
back or stop a particular medical treatment because of the predicted harm it might
cause for the patient, giving rise to adverse detrimental effect.
 Precautions: Precautions involve set protocols and practices aimed at controlling
infection and prevent plausible disease transmission via contact with body fluids,
blood and mucous membranes.
The difference between a side effect and an adverse reaction is that side effect
encompasses unwanted secondary effect that has occurred due to the prescribed drug therapy

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whereas adverse reaction involves development of pharmacologic reactions that were
unintended even after correct administration of the prescribed medication.
21. IV tubing must be changed every 72 hours: True
22. Not necessary to wear gloves when discontinuing an IV since there was no risk of
exposure to blood or body fluids: False
23. True
24. (A) 0.9% Normal Saline solution is isotonic in nture
25. (B) Hypotonic
26. (B) 5% dextrose
27. False

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Assessment task 2:
Scenario 1
Legal implications:
Theo is an enrolled nurse who facilitates and contributes to the healthcare plan of the
patient whereas May is the registered nurse assigned to the patient. May has prepared the IV
amoxicillin medication for Theo to administer who is an enrolled nurse, but leaves for her
morning break. Thus, Theo is supposed to administer the IV amoxicillin on his own without
any supervision and this medication he did not prepare. In this scenario, Theo himself must
have prepared the medication and administered the same with May’s guidance. If May
documents the medication as given, then it is falsifying data entry in the patient’s medical
record. Falsification of any record is a serious allegation that can result in an employee being
terminated or reported to the state board of nursing.
Twenty five percent of the patients are accidentally injured post hospitalization, and
unintentional error in medication cause majority of these adverse events. The article by
Lowe, 2017 includes a opioid-naive healthy twenty two year old man who was admitted with
severe upper back ache. Initially, 1–5 mg of morphine was administered intravenously every
two hours and increased to 5–10 mg of dose due to lack of improvement. Due to ill
management of the pain by morphine, intravenous administration of hydromorphone at 5–10
mg dose was started in the evening, with 4 hours interval. The following next morning, the
patient showed no vital signs, even after resuscitation efforts. The article illustrating this case
study is attached as appendix 1 with this assignment. The significance of proper treatment
and crucial analysis of suspected errors in medication is vital to distinguish the vulnerabilities
in medical practices, and accordingly design the required preventive strategies including
interventions to avert such fatalities.

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Scenario 2
No Emilia’s vital signs are not within limits for her age. Respiratory rate, along with
oxygen saturation and blood pressure has fallen markedly.
The antibiotic Flucloxacillin has to administered intravenously. Following has to be noted
as it is IV administration in a pediatric case. Intravenous fluids frequently have packaging
which is alike; hence it is crucial to take extra precautionary steps while selecting the
accurate intravenous solution. Meticulous care is mandatory if more than one intravenous
lines or pumps are present on the patient, to ensure that the lines do not get mixed up. When
the intravenous bag is being altered or additional medications are being included to one of the
present lines, the line must be tracked carefully to validate that the chosen line with the
additional input is the correct line. (Mantadakis, 2016).
Proper administration and maintenance of IV is the nurse’s responsibility. The IV
bags and syringes must be replaced daily and the IV tubing must be altered every 72-96 hours
whereas IV tubing containing lipids and intermittent must be changed every 24 hours to
reduced chances of blocked tubing. Proper labeling with name of the medication, date and
time must always be maintained along with mentioning the time of change.
When child is seriously ill, parents would not leave the child alone. This usually
means sleeping with them in hospital. The parents will be asked to keep an eye at the vitals
of the child and call the nurse in case of any significant changes.

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Scenario 3
Patient controlled analgesia or PCA is a technique by which the patient can control
the amount of analgesia or pain medicine they can receive.
The advantages of the patient-controlled analgesia consist of self-delivery of pain
medication which increasing the speed of pain relief because the patient can regulate the
medication and address medication as required which is better than medical staff monitoring
the dosage. With patient-controlled analgesia, the pain is reduced a lot faster and studies
prove that the patient utilizes medication in contrast to medicine administered by the medical
staff (Assouline et al., 2016).
The disadvantages of patient-controlled analgesia consist of the odds that the patient
might use the pain medication for its euphoric properties, despite the fact that the patient's
pain has already been sufficiently controlled. If patient-controlled analgesia device is not
programmed properly for the patient, it might result in either overdose or under-dose of the
medicine. The patient-controlled analgesia might be inappropriate for patients with
psychological issues, learning difficulties or confusion along with patients with reduced
manual dexterity leading to inability to properly press the required buttons for patient-
controlled analgesia. The patient-controlled analgesia may not be suitable for younger
patients.
The patients are prone to hypoventilation and hypoxia during the first twenty four
hours and during nighttime, therefore careful observation of patients with PCA needs to be
undertaken during those specific times.
Mr Howard is still experiencing pain, even after administration of morphine. This
might be due to post operative swelling, bruising or even infection.

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The device for patient-controlled analgesia contains computerized pump which is
called patient controlled analgesia pump. This pump contains a syringe of pain medication as
prescribed by a doctor, is connected directly to a patient's intravenous (IV) line. The pump is
set to deliver a small, constant flow of pain medication. Additional doses of medication can
be self-administered as needed by having the patient press a button. Other times, a patient can
control when he or she receives pain medication and does not receive a constant flow
(Gadsden and Warlick, 2015).
Patients should be taught about the proper use of PCA during the preoperative testing
visit so that they are not too groggy to understand. Family members and visitors should be
warned about the dangers of proxy control of PCA.
As Mr. Hudson is complaining of nausea, he might be prescribed antiemetic and H2
blockers for relief.
Effectiveness of morphine analgesic might be reduced due to excess body fat and
obesity (Mekhail et al.,2019).
As an enrolled nurse, scope of managing PCA is vital to ensure safety of the patient.
Patient-controlled analgesia can be a wonderful tool for managing pain while consuming less
analgesic, but this mode of pain control involves careful patient selection, appropriate dosing
and patient education to ensure patient safety (Wells & Caffery, 2018).

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Reference
Assouline, B., Tramèr, M. R., Kreienbühl, L., & Elia, N. (2016). Benefit and harm of adding
ketamine to an opioid in a patient-controlled analgesia device for the control of
postoperative pain: systematic review and meta-analyses of randomized controlled
trials with trial sequential analyses. Pain, 157(12), 2854-2864.
Dea.gov. (2019). Drug Scheduling. Retrieved from https://www.dea.gov/drug-scheduling
Gadsden, J., & Warlick, A. (2015). Regional anesthesia for the trauma patient: improving
patient outcomes. Local and regional anesthesia, 8, 45.
Lowe, A., Hamilton, M., Ma, J., Dhalla, I., & Persaud, N. (2017). Fatal overdoses involving
hydromorphone and morphine among inpatients: a case series. CMAJ open, 5(1),
E184. DOI:10.9778/cmajo.20160013
Mantadakis, E. (2016). Advances in pediatric intravenous iron therapy. Pediatric blood &
cancer, 63(1), 11-16.
Mekhail, N., Mehanny, D., Armanyous, S., Saweris, Y., & Costandi, S. (2019). The impact of
obesity on the effectiveness of spinal cord stimulation in chronic spine-related pain
patients. The Spine Journal, 19(3), 476-486.
Nova Center, N. (2019). Scheduling and Drug Classification Charts: Making Sense of Drugs.
Retrieved from https://novarecoverycenter.com/drug-use/scheduling-and-drug-
classification-charts

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Wells, N., Pasero, C., & McCaffery, M. (2018). Improving the quality of care through pain
assessment and management. In Patient safety and quality: An evidence-based
handbook for nurses. Agency for Healthcare Research and Quality (US).

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Appendix 1

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