Fundamental Nursing Skills and Concepts

1
Fundamental Nursing Skills and Concepts

• Chapter 35

2
INTRAVENOUS ROUTE

• The administration of a drug via peripheral and
  central veins which provides an immediate effect.
• This route is the most dangerous
• Drugs given in this manner cannot be retrieved
  once they have been delivered
• Only qualified nurses are permitted to administer
  IV medications

3
INTRAVENOUS MEDICATION ADMINISTRATION continuous
or intermittent

• A quick response is needed during an emergency
• Clients have disorders (e.g. serious burns) that
  affect the absorption or metabolism of drugs
• Blood levels of drugs need to be maintained at a
  consistent therapeutic level, such as when
  treating infections caused by drug-resistant
  pathogens or providing postoperative pain relief
• It is the clients interest to avoid the
  discomfort of repeated intramuscular injections
• A mechanism is needed to administer drug therapy
  over a prolonged period, as with cancer

4
ADMINISTRATION TYPES

• CONTINUOUS-Instillation of a parenteral drug over
  several hours also called a continuous drip.
• INTERMITTENT-Is a short term parenteral
  administration ranging from a few minutes to one
  hour.
• BOLUS-The term bolus refers to a substance given
  all at one time. A bolus administration is
  undiluted medication given directly into a vein,
  could be given IV push.
• SECONDARY INFUSION-The administration of a
  parenteral drug that has been diluted in a small
  volume of IV solution, usually 50-100mL, over
  30-60 minutes

5
CENTRAL VENOUS CATHETER

• A central venous catheter is venous access that
  extends to the vena cava or right atrium. It
  provides a means for administering parenteral
  medication in a large volume of blood.
• CVC is used when
• Clients require long-term IV fluid or medication
  administration
• IV medications are irritating to peripheral veins
• It is difficult to insert or maintain a
  peripherally inserted catheter

6
PERCUTANEOUS CATHETERS

• A percutaneous catheter is inserted through the
  skin in a peripheral vein (jugular or subclavian)
• This type of catheter is used when clients
  require short-term fluid or medication therapy,
  lasting a few days or weeks
• Most are inserted by a physician and sutured in
  place

7
IMPLANTED CATHETERS

• An implanted catheter is sealed beneath the skin
• It provides the greatest protection against
  infection
• Possesses a self sealing port
• Implanted port can sustain 2,000 puncture sites

8
MEDICATIONS ADMINISTERED USING A CVC

• Antineoplastic agents-Medications used to destroy
  or slow the growth of malignant cells also
  commonly referred to as chemotherapy

9
NURSING IMPLICATIONS NURSING DIAGNOSES

• Anxiety
• Fear
• Risk for Injury
• Risk for Infection
• Excess Fluid Volume
• Ineffective Protection

10
GERONTOLOGICAL CONSIDERATIONS

• Older adults commonly receive IV medications
• Increasing emphasis on early discharges may
  require teaching older adults to flush venous
  access equipment
• Older adults require frequent and comprehensive
  assessment before and after IV medication
  administration because they are more likely to
  manifest adverse reactions
• Explain the purpose for each medication
  administered, especially by the IV route, is
  important because older adults often are
  reluctant to ask questions