Intravenous Medications in the Nursing Environment

intravenous Medications in the care for Env press outmentPhoebe RobertsAdminister and Monitor Intravenous Medications in the Nursing EnvironmentQuestion 1a. Signs and symptoms of iron deficiency anaemia include fatigue, irritability, tachycardia, blench skin,difficulty concentrating, brittle nails and shortness of breath. (Williams hop-picker 2011 p. 562).b. As the forbearing has iron deficiency anaemia a blood transfusion is necessary to increasehaemoglobin levels deep down the blood as this helps to transport oxygen to cells and tissues. She alsohas a history of PR bleeding. Therefore this blood transfusion is helping to replace volume lost, toincrease circulating blood volume and to improve the oxygen carrying faculty (Hamlin, Richardson-Tench, Davies 2009 pp 155,156)c. It is important to fol execrable the Pico prep instructions as faecal matter asshole obscure the viewing of thethe colon. Pico prep aims to thoroughly cleanse the colon of each matter or gas to ensure th at thevisual field is clear ( Corbett Banks 2011 pp. 675,676).d. Pico prep is an osmotic laxative, its action decreases the wandering absorption within the bowel which then results in the onset of diarrhoea within 1-4 hours. Side effectuate 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 an impact on this time-honored patient. Although shemobilises with a four wheel walker it would become increasingly difficult to mobilise to the toilet sofrequently to vacate 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 reach and the application ofhip protectors may embolden 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 orbital cavity.( Crisp, Taylor, Douglas, Rebeiro 2013. p. 454).Providing a be dside flock may also reduce the chances of falls as it is located closer to her thanthe toilet may be. As she is an older patient the skin around the area may become excoriated and skinbreakdown may occur due to the acidity of the diarrhoea and the area frequently being wet. Barriercreams should be utilize to at risk areas for protection. Diarrhoea can also quickly cause dehydrationand electrolyte imbalances in the elderly, this may also have an impact on this patients changeable andelectrolyte levels (Williams hopper 2011. pp. 275, 747).Question 2.a) This patient is displaying possible signs and symptoms of a suspected urinary tract infection suchas incontinence, a burning sensation when she voids, fever, wonder 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 assessmentshould be performed to identify the areas at risk and to identify any change in skin integrity. Skinturgor should also be assessed as this can indicate a sign of dehydration (Crisp et. al. 2013 p. 592). Afluid balance chart should be maintained to assess if the patient is in a positive or negative fluidbalance and the weight of the patient should also be assessed as noticeable weight changes canindicate hypovolaemia (Crisp et.al 2013 p.1214, Scott 2010 p. 62). Auscultation of the chest couldprove useful in determining the reason of the increased respiratory rate 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 tothoroughly assess the patient and implement ther apy for a suspected urinary tract infection.b) Cranberry succus can be effective in helping to reduce pain when urinating and also embarrasss thebacteria adhering to the wall of the bladder, this method can be helpful in reducing the pain of aurinary tract infection however the patient is undergoing a function the next day, therefore thisintervention should be implemented with the approval of a medical officer. A heat pack could beplaced on her abdomen to relive any pain and discomfort on with the judicatory 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 desirable position to help with proper lung expansion suchas the high fowlers position along with the regime of oxygen to increase oxygen levels withinthe blood. (Williams Hopper 2011 p. 604). The patients vital signs should be continuouslyassessed to monitor any improvements or deterioration especially her blood pressure and totality rateas any further abnormalities such as arrhythmias and a further decline in blood pressure couldindicate hypovolaemia and hypokalaemia. Continuous assessment of her neurological reconcile shouldalso be implemented to monitor any changes (Scott 2010 p. 64).c. Hypokalaemia occurs due to an lush loss of potassium from the bole or from an inadequateintake of potassium. The body is unable 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 wasting 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 management is aimed at restoring potassium levels either by increasing the intake ofpotassium in the diet or oral potassium supplements. Intravenous replacement therapy is alsoimplemented in those with severe hypokalaemia to rapidly 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 decreased 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 ad ecline in cognitive status. (Williams Hopper 2011 p 72, Scott 2010 p. 62).Medical management includes finding and stopping the descent 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 maintenance 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 care to maintain the integrity ofthe oral mucous membranes. (Crisp et.al. p. 73).Question 3a) Midazolam is used in this procedure as it is a sedative, hypnotic agent and muscle relaxant. Thisaims to reduce the amount of movement throughout the procedure and assists in keeping the patientin a sedative state and impairs memory function ( Tiziani 2013 p. 967). Fentanyl would be used toreduce pain during the procedure and also a ids in the maintenance of the anaesthesia ( Tiziani 2013p 928) Diprivan is used to crap 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 dodge 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 about immediately.Side effects include respiratory depression, apnoea, dyspnoea, vomiting, nausea, increased intracranial pressure, bradycardia, sedation, confusion, constipation, hypotension and muscle rigidity.(Tiziani 2013 p. 923)Diprivan suppresses the central nervous dodge and produces a loss of consciousness. Adminsteredintravenously diprivan takes affect within 30 seconds of administration. Side effects includerespiratory depression, tachycardia, hypotension, shivering 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 three medications aregiven together therefore continuous monitoring is extremely important as the effects on the centralnervous system are increased ( Tiziani 2013 p 964,96 8).c) As this patient has renal failure the kidneys ability to filter and excrete waste is decreased, this mayresult in an solicitation of the medications and could possibly 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). putter around Perrys Fundamentals of Nursing (4th Edition). Chatsw ood 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) Fluid Electrolytes Made Incredibly Easy (1st Edition) capital of the United Kingdom 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.