Australian Injectable Drugs Handbook Analysis

This assignment requires students to critically analyze various resources pertaining to Australian injectable drugs. The analysis encompasses evaluating drug information provided in the 'Australian Injectable Drugs Handbook', assessing safety protocols outlined in documents from Safetyandquality.gov.au and Utas.edu.au, and examining legal aspects related to drug use as discussed in articles like the one on Schedule I drug laws by Nutt et al. (2013).

Running head: NURSING ASSIGNMENT
Nursing Assignment
Name of the Student:
Name of the University:
Author Note:

1NURSING ASSIGNMENT
Table of contents
Question 1:.....................................................................................................................................................2
Question 2:.....................................................................................................................................................2
Question 3:.....................................................................................................................................................3
Question 4:.....................................................................................................................................................3
Question 5......................................................................................................................................................4
Question 6......................................................................................................................................................5
Question 7......................................................................................................................................................5
Question 8......................................................................................................................................................5
Question 9......................................................................................................................................................6
Question 10....................................................................................................................................................6
Question 11....................................................................................................................................................7
Question 12....................................................................................................................................................7
Question 13....................................................................................................................................................8
Question 14....................................................................................................................................................9
Question 15....................................................................................................................................................9
Question 16....................................................................................................................................................9
Question 17....................................................................................................................................................9
Question 18..................................................................................................................................................10
References....................................................................................................................................................11

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Question 1:
Part a: The Packed Red Blood Cells has been ordered because before the surgery because
considering the age of Mr. George Stanford (60 years) doctors took a precautionary measure.
Just in case during surgery if blood administration is needed.
Part b: The potential side effects of blood administration are dark urine, Urticaria (hives),
hypertension or hypotension, pain along the intravenous infusion line, bleeding and oozing, fever
and chills.
Part c: The steps that a nurse must take before the administration of PRBCs are (Valentine et al.,
2014)-
 Verification of the order of transfusion.
 A nurse must thoroughly assess a patient physically to identify changes later on.
 Check for a proper and appropriate vascular access.
 The nurse must ensure that all the equipment necessary before the PRBC administration
are near her, like the hypersensitivity kit, suction, oxygen and saline solution.
 The nurse must infuse the blood along with the normal saline solution via a filtered tube.
Question 2:
Part a: the rate of intravenous fluid for Mr. Stanford is 125mls/hr. The drops/min rate of Mr.
Stanford IV is 42 drops/min.
Part b: Isotonic fluids- refers to two fluids that have the exact osmotic pressure across a semi
permeable membrane. Example- 0.9% saline.
Hypotonic fluids- refers to a solution that has low osmotic pressure than the other solution.
Example- 0.45% saline (1/2 NS)

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Hypertonic fluids- refers to a solution that has high osmotic pressure compared to other solution.
Example- 3% saline (Utas.edu.au, 2017).
Question 3:
Part a: The nurse must immediately provide Mr. Stanford an oxygen therapy that will assist him
to breath. After the incident the nurse must report to Mr. Stanford’s doctor that he has
experienced SOB.
Part b: the typical signs of fluid overload are as follows (Kelm et al., 2015)
 The skin might become swollen, shiny and moist.
 The area around abdomen looks distended.
 The person may feel heaviness in the body.
 The patient may complain about difficulty in breathing.
 Increased heartbeat, confusion and fatigue.
Question 4:
Part a: The common circumstances under which Frusemide is prescribed are (Morgan et al.,
2017)
 Shortness of breath
 Swelling of abdomen, legs and arms.
 Treatment of high blood pressure
 Treat edema, caused due to kidney and liver disease.
Part b: Furosemide belongs to the major medication group of Diuretics.

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Part c: yes, as endorsed enrolled nurse I can give Frusemide to Mr. Stanford only if I have the
“do not have a notation” on my registration.
Part d: the adverse side effects of Frusemide are dehydration, clay colored stools, fever, nausea,
dark urine, increased urine, muscle cramps (Mims.com.au, 2017).
Part e: the specific nursing considerations of a patient care before administering Frusemide
 Assessment of the fluid status in the body, monitor the body weight.
 Before administering Frusemide, the nurse must monitor the blood pressure and the pulse
of the patient.
Part f: the doctor is required to check the frusemide dosage during preparation and administering.
Part g: the documentation that needs to done after administering Frusemide are
 Assessing the patient, whether he is experiencing a hearing loss.
 Assess the patient, whether the patient has developed any skin rash.
Question 5
Part a: the peripheral IV catheter is a peripheral venous line for the insertion and subsequent
delivery of medication fluids.
Part b: Phlebitis is an inflammation of a vein. Mechanical phlebitis is the inflammation which is
caused by the IV catheter. Chemical phlebitis is caused by the IV medications or by the fluids.
Bacterial phlebitis is caused by the bacterial infection (Tett, 2008)
Part c: the dressing must be intact, dry and clean to prevent any microbial contamination of the
site. Changing PIVC dressing when it becomes loose and damped and to apply bandage or tape
on the connection to avoid any injury. I would be assessing the site for any mechanical injury or

5NURSING ASSIGNMENT
bacterial infection, and if the site is affected by bacterial and mechanical injury then I will
document it.
Question 6
To assess the pain of Mr. Stanford (Tett, 2008).
 I will first take a visual overview of the right knee
 Then I will proceed to see whether the dose of morphine is correctly getting administered
 In the final step, if did not find any problem, I will inform Mr. Stanford’s doctor.
Question 7
Part a: patient controlled analgesia machine works like computerized dispenser of drug that has a
definite lock out time and dispenses the drug when a patient presses the dispensing switch. the
patient controlled analgesia cannot be used subsequently within 5 minutes (Tett, 2008).
Part b: advantages- it empowers the patient to have control over the pain, the procedure is fast
and effective.
Disadvantages: patients who are confused regarding the usage have difficulties using it, patient
controlled analgesia is not appropriate for critically ill patients.
Part c: Mr. Stanford can be told that the usage of patient controlled analgesia is for his own good,
it will help him to relieve his pain and there are no issues related to addiction. Whereas, the
lockout period of 5 min is for his own safety, so that he does not use the patient controlled
analgesia in quick succession.

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Question 8
Part a: the 10mls of 0.9% normal saline will help to dilute the intravenous injections of
antibiotics.
Part b: yes, the medication does require checking with another nurse.
Question 9
The 3 possible complications that may occur when a patient is receiving
fluids/medications via IV therapy are as follows (Cdhb.health.nz, 2017):
Hypervolemia- the risk category includes pregnant women, children and infant, patients with
cardiac diseases, elderly.
The clinical symptoms include hypertension, increase in weight, pulmonary edema, dyspnea.
Management- stopping the infusion, notifying the medical staffs.
Extravasation- the symptoms include swelling, blood return from cannula is lacking, sensation of
burning at the insertion site.
Management- not to flush the line, try to aspirate the drug from the cannula, removal of the
cannula once aspiration is complete.
Anaphylaxis- the symptoms include edema, low blood pressure, cramps and diarrhea.
Management- stopping the treatment, implementation of the resuscitation depending on the
severity, notifying the doctor.

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Question 10
Part a: According to (Trove.nla.gov.au, 2017), the precaution that are must during administering
the potassium chloride via the intravenous route are as follows:
 Extra care must be taken to ensure that the catheter is within the lumen of the targeted
vein, so that extravasation do not occur.
 The potassium chloride solution must be delivered carefully to the patients having cardio-
vascular diseases or renal diseases.
 Potassium having high concentration of plasma cannot be administered to patients, it may
lead to cardiac arrest.
 Care must be taken for patients that are already been given corticosteroids or
corticotrophin, to such patient intravenous potassium chloride administration must be
done cautiously.
Part b: signs and symptoms of potassium chloride intoxication includes: flaccid paralysis,
heaviness or weakness of the legs, paresthesias of extremities, heart block, hypotension, cardiac
arrhythmias (Dailymed.nlm.nih.gov, 2017).
Question 11
As per the question, dose ordered is 5 mcg/kg/min and the weight of the patient 49 kg.
The dose available, ml of dopamine is not mentioned, while the calculation of the rate can be
done using a formula (Sachlos et al., 2012).
Firstly, convert mcg/kg/min into mg/hr
(mcg x
kg)
X 60

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1000
Then, IV dosage formula can be used
dose ordered X volume available
dose available
Question 12
Part a: The bolus delivery in mLs is calculated by the following steps (Schmidt et al., 2012)
500unit bolus x 50 mLs volumes of heparin= 25,000 unit bolus
25,000 unit bolus/ 5000units heparin= 5mLs
Part b: to calculate the infusion rate in mls/hr, the following steps are done (Amin et al., 2015)
Heparin infusion rate:
X (ml/hr) = (500 units per hour X 50 ml) / 5000 units
Hence, the infusion rate is 5mls/hr.
Question 13
Part a: the heparin precautions are as follows (Smythe et al., 2012):
 The patient must not take ibuprofen, aspirin or any anti-inflammatory medicines while
taking heparin.
 Precaution must be taken as Heparin causes allergic reactions.
 It is better and advisable to inform the doctor that a patient is using heparin before the
doctor proceeds for further treatment.
The side effects of usage of heparin are as follows (Smythe et al., 2012):

9NURSING ASSIGNMENT
 Hemorrhage is the major complication which involves retroperitoneal hemorrhage,
adrenal hemorrhage, ovarian hemorrhage.
 Generalized hypersensitivity has been reported among patients, fever, chills along with
lacrimation, rhinitis, asthma.
Part b: the issues related to the Intravenous administration of heparin are as follows (Smythe et
al., 2012):
 The major complications of heparin administration are death occurring due to
hemorrhage, blood transfusion during the heparin administration.
 Other complications include hematuria if its magnitude increases after heparin
administration.
Question 14
The common electrolytes for IV administration are sodium, potassium (Utas.edu.au,
2017). The type of IV fluid into which I would dilute these electrolytes are crystalloids, colloids
and blood and blood products (Utas.edu.au, 2017).
Question 15
According to Nutt, King & Nichols (2013),
IV Gentamycin belongs to schedule 4 of drugs
IV Frusemide belongs to schedule 3 of drugs
IV Morphine belongs to schedule 2 of drugs

10NURSING ASSIGNMENT
Question 16
IV Gentamycin should be stored at -20 degree Celsius and IV Fentanyl should be stored
at 20-25 degree Celsius and should be away from light (Baertschi, Alsante & Reed, 2016).
Question 17
According to Frost et al. (2013),
Pharmacokinetics- it is the study of the fate of the drug inside the body, the movement of
the drug in and out of the body, its absorption, metabolism and excretion.
Pharmacodynamics- it is the study of the drug and what it does to the body, binding to the
receptors and chemical interactions.
Toxicology- it is the study of adverse effects that occur inside the body due to certain chemicals.
Question 18
Part a: Nurse initiated medication includes the administration of unscheduled, schedule 2 and
schedule 3 drugs. Which means that an EN is authorized to administer these scheduled as per the
case and situation demands (Safetyandquality.gov.au, 2017).
Part b: yes, an EN acting independently can carry out nurse initiated medication administration
because, ENs who do not have a notation on their registration can administer medications and
they can carry out other nursing practices with ease.

11NURSING ASSIGNMENT
References
Amin, A., Perreiah, P., Providence, S., McCartney, L., Camhi, S., & Rao, R. (2015). 579:
INTRAVENOUS HEPARIN CALCULATION ERRORS PRE-AND POST-
IMPLEMENTATION OF THE HEPARIN NOCLOT WIZARD©. Critical care
medicine, 43(12), 146.
Baertschi, S. W., Alsante, K. M., & Reed, R. A. (Eds.). (2016). Pharmaceutical stress testing:
predicting drug degradation. CRC Press.
Cdhb.health.nz. (2017). Cdhb.health.nz. Retrieved 14 November 2017, from
https://www.cdhb.health.nz/Hospitals-Services/Health-Professionals/CDHB-Policies/
Fluid-Medication-Manual/Documents/Complications-Of-IV-Therapy.pdf
Dailymed.nlm.nih.gov. (2017). INTRAVENOUS SOLUTIONS with POTASSIUM
CHLORIDEPotassium Chloridein 0.9% Sodium Chloride Injection,
USP. Dailymed.nlm.nih.gov. Retrieved 14 November 2017, from
https://dailymed.nlm.nih.gov/dailymed/archives/fdaDrugInfo.cfm?archiveid=1321
Frost, C., Wang, J., Nepal, S., Schuster, A., Barrett, Y. C., Mosqueda‐Garcia, R., ... & LaCreta,
F. (2013). Apixaban, an oral, direct factor Xa inhibitor: single dose safety,
pharmacokinetics, pharmacodynamics and food effect in healthy subjects. British journal
of clinical pharmacology, 75(2), 476-487.
Kelm, D. J., Perrin, J. T., Cartin-Ceba, R., Gajic, O., Schenck, L., & Kennedy, C. C. (2015).
Fluid overload in patients with severe sepsis and septic shock treated with early-goal
directed therapy is associated with increased acute need for fluid-related medical
interventions and hospital death. Shock (Augusta, Ga.), 43(1), 68.

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Mims.com.au. (2017). MIMS Australia. Mims.com.au. Retrieved 13 November 2017, from
http://www.mims.com.au/
Morgan, T., Tadokoro, M., Martin, D., & Berliner, R. W. (2017). Effect of furosemide on Na+
and K+ transport studied by microperfusion of the rat nephron. American Journal of
Physiology--Legacy Content, 218(1), 292-297.
Nutt, D. J., King, L. A., & Nichols, D. E. (2013). Effects of Schedule I drug laws on
neuroscience research and treatment innovation. Nature Reviews Neuroscience, 14(8),
577-585.
Sachlos, E., Risueño, R. M., Laronde, S., Shapovalova, Z., Lee, J. H., Russell, J., ... &
Levadoux-Martin, M. (2012). Identification of drugs including a dopamine receptor
antagonist that selectively target cancer stem cells. Cell, 149(6), 1284-1297.
Safetyandquality.gov.au. (2017). Safetyandquality.gov.au. Retrieved 16 November 2017, from
https://www.safetyandquality.gov.au/wp-content/uploads/2012/02/SAQ123_NursesUser
Guide_V6.pdf
Schmidt, S., Meldgaard, M., Serifovski, N., Storm, C., Christensen, T. M., Gade-Rasmussen, B.,
& Nørgaard, K. (2012). Use of an automated bolus calculator in MDI-treated type 1
diabetes. Diabetes Care, 35(5), 984-990.
Smythe, M. A., Mehta, T. P., Koerber, J. M., Forsyth, L. L., Sykes, E., Corbets, L. R., ... &
Parikh, R. (2012). Development and implementation of a comprehensive heparin-induced
thrombocytopenia recognition and management protocol. American Journal of Health-
System Pharmacy, 69(3).

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Tett, S. E. (2008). AMH (Australian Medicines Handbook. Clinical Pharmacology &
Therapeutics, 83(1), 12-13.
Trove.nla.gov.au. (2017). Australian injectable drugs handbook / edited by Nicolette Burridge
and Keli Symons. - Version details. Trove. Retrieved 14 November 2017, from
http://trove.nla.gov.au/version/243931268
Utas.edu.au. (2017). Utas.edu.au. Retrieved 16 November 2017, from
http://www.utas.edu.au/__data/assets/pdf_file/0020/528041/Management-of-IV-Fluids-
and-Electrolyte-Balance-slides.pdf
Valentine, S. L., Lightdale, J. R., Tran, C. M., Jiang, H., Sloan, S. R., Kleinman, M. E., &
Randolph, A. G. (2014). Assessment of hemoglobin threshold for packed RBC
transfusion in a medical-surgical PICU. Pediatric Critical Care Medicine, 15(2), e89-
e94.