1.ONE Unit of Packed Red Blood Cells (PRBC) has been ordered for Mr Stanford post-operative following a right anterior cruciate ligament.
a.Discuss why PRBC’s would be ordered
b.Discuss the potential side effects of blood administration
c.Discuss the steps that the nurse needs to take prior to administration ofPRBCs.
2.Please assess Mr Stanford’s intravenous fluid orders and determine:-
a)The mls/hr rate of Mr Stanford’s IV?
The drops/min rate of Mr Stanford’s IV?
b)Define and provide examples of the following types of fluids –
Isotonic
Hyperoni
Hypotonic
3.At 1430 hrs Mr Stanford starts complaining about feeling shortness of breath (SOB).
a)What would be your immediate nursing action for Mr Stanford and what is the follow-up reporting that you would carry out
b)The DR reviewed Mr Stanford and diagnosed fluid overload, what are typical signs of this condition?
4.The doctor orders Frusemide IV 20mgs to be given at 1500hrs hours
a)Discuss the common indications for use of this particular medicine, highlighting the specific use for this case study
b)Identify the major medication group the medicine belongs to
c)Can you give this drug in this circumstance as an Endorsed EN outline the reasons for your answer?
d)Using a Mims list the adverse side effects and contraindications for this medication.
e)What are some of the specific nursing considerations of patient care post administration of this medication?
f)Who is required to check this medication during preparation and when administering
g)What documentation is required once this drug has been administered
5.Mr Stanford starts to complain that his peripheral IV cannula site is painful.
a)What is a peripheral IV catheter
b)What is Phlebitis in relation to IV therapy – also please briefly discuss Bacterial, Mechanical and Chemical Phlebitis
c)Outline your care for a peripheral IVC in general. Discuss what you would be assessing the site for and what, if anything, you would be documenting.
6Mr Stanford is complaining of severe pain around his right knee
Explain the procedure you would go through to assess Mr Stanford’s pain?
7Mr Stanford states that his pain is around 8 out of 10, after reviewing the patient controlled analgesia (PCA) you notice that he has only administered one dose in the last hour. ( Mr Stanford’s current PCA regime is 1mg of morphine, lock out of 5 minutes with an hourly limit of 10mg of morphine)
a.Explain how a PCA machine works and indications for use?
bwhat are the advantages and disadvantages of using a PCA for pain management?
cMr Stanford states that he has not used the PCA as he fears narcotic addiction, what information would you provide to Mr Stanford in regards to the use of a PCA and addition - include the rationale for a lockout period?
8.Over the next few days Mr Stanford is stable, tolerating a diet and has had his IV therapy ceased, his IV cannula is still in place as he still requires antibiotics daily. The doctor has written an order on the medication chart for 10mls of 0.9% normal saline 6hrly
a.What is the purpose of this order?
b.Does this medication require checking with another nurse?
General Questions (these are not related to the scenario)
9.What are the possible complications that may occur when a patient is receiving fluids/medications via IV therapy (this is not related to the IV insertion site) List at least three and discuss in moderate detail to show understanding.
10.A medical officer has ordered a patient 40mmol of Potassium Chloride in 1000mls Normal Saline (premix bags) to run at 80mls/hr
a.Please state 4 main special precautions you need to be aware of when administering Potassium Chloride via the Intravenous route to ensure patient safety(Please use the Australian Injectable Handbook in the Tafe library for accurate information)
b.Please state 6 signs and symptoms of potassium intoxication
11.A 75-year-old female patient who weights 49kgs is 1 day post coronary arterial bypass surgery and has been commenced on Dopamine to assist in the increase of her renal perfusion
As per catalyst for IV Infusion: This drug infusion rate is titrated individually to each patient. However it is recommended that to begin the administration a diluted solution at doses of 5 micrograms/kg/min be administered
(As ENs you may never draw up this type of medication; however this question just wants you as students to show an understanding of basic math’s using weight for an elderly patient)
How many micrograms per min would this patient be started on (please show your working out)
12.Heparin 5000units in 50mLs has been prescribed for your patient to run at 500units/hr with a 500unit bolus. (please show working out)
a.Calculate how much the bolus delivery will be in mLs?
b.Calculate how much the infusion will run at in mls/hr
Please look at the article in additional resources titled “calculating infusion rates in units/hr” to assist with question a & b
13.a.What are some precautions and possible side effects of Heparin?
b.What compatibility issues, if any, are there in IV administration of heparin?
14.Administration of additional IV electrolytes (not the ones already in IV fluids) occurs commonly in acute care hospitals. What are some examples of electrolytes (provide at least 2) for IV administration and what type of IV fluid would you dilute these electrolytes in (please use the Australian Injectable Handbook for diluting information)
(Electrolytes are discussed in your Crisp and Taylor textbook - the chapter that discussed “Fluid, electrolyte and acid – base balance, also the PowerPoint in additional resources titled “TAFE Fluid Shift”
15.Please identify which drug schedule the following IV medications come under
IV Gentamycin
IV Frusemide
IV Morphine
16. Please state the storage requirements (including storage in a health care facility) for the following IV medications
IV Gentamyci
IV Fentanyl
17.Define each of the following in relation to IV medications and major drug group
Pharmacokinetics
Pharmacodynamics
Toxicology
18.
aPlease discuss your understanding of what constitutes a nurse initiated medication administration (this applies to all types of medications administered over a variety of routes including IV)
b Can an EN acting independently carry out a nurse initiated medication administration – Please provide a rationale for your answer