1. CHAPTER 17: ADMINISTRATION OF MEDICATION AND INTRAVENOUS SOLUTIONS
PYRAMID POINTS
CHAPTER 17:
ADMINISTRATION OF MEDICATION AND INTRAVENOUS SOLUTIONS

2. PYRAMID POINTS I. Medication Administration Assess medication order
Ask client about medication allergies
Assess client’s understanding of medications, intravenous (IV) solutions ordered
Assess client concerns about medications
Assess five rights prior to and during administration process
Assess vital signs prior to, during, and after administration, depending on medication
Document administration of medication and client’s response to medication
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3. PYRAMID POINTS II. Drug Measurement Systems Metric system
Basic units are meter, liter, gram
Apothecary and household systems
Common apothecary units include grain, dram, ounce
Common household units include tablespoon, teaspoon, minim, drop
Additional common drug measures
Milliequivalent (mEq) expresses the number of grams of a medication contained in 1 milliliter (mL) of a normal solution
Unit measures medication in terms of action, not physical state
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4. PYRAMID POINTS III. Conversions Between metric units
Convert larger to smaller, multiply by 1000, or move decimal point three places to right
Convert smaller to larger, divide by 1000, or move decimal point three places to left
Between household and metric systems
First step in calculation of dosages can use method of ratio and proportion
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5. PYRAMID POINTS IV. Celsius and Fahrenheit Temperature
To convert Fahrenheit to Celsius: Subtract 32 from temperature in °F; divide result by 1.8
To convert Celsius to Fahrenheit: Multiply temperature in °C by 1.8; then add 32
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6. PYRAMID POINTS V. Medication Labels Always check expiration dates
Contains generic and trade name
Check medication label against physician’s orders, medication administration record
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7. PYRAMID POINTS VI. Medication Orders
Need to be written using accepted abbreviations, acronyms, symbols as well as per agency guidelines
If nurse has any questions or sees inconsistencies, contact person who wrote order immediately
Components of complete medication order
Name of client
Date, time when order written
Name of medication
Dosage of medication
Medication route
Time, frequency of administration
Signature of person writing order
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8. PYRAMID POINTS VII. Oral Medications
Scored tablets: Contain indented mark for breakage into partial doses if needed
Enteric-coated tablets: Covering on medication that delays absorption until medication reaches small intestine
Capsules: Contain powdered or oily medication in gelatin cover
Liquids: Contain specific amount of medication in a given amount of solution
Medicine cup: Capacity of 30 mL or 1 ounce; calibrated to measure teaspoons, tablespoons, fluid drams; pour medication while cup is at eye level
Syringes: Used for volumes less than 5 mL
Calibrated droppers: Used for infants, children; calibrations in mL, drops, or minims
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9. PYRAMID POINTS VIII. Parenteral Medications
Injection route, including IV, intramuscular (IM), subcutaneous, or intradermal
Single-use ampules, single- and multiple-dose vials, premeasured syringes and cartridges
No more than 3 mL IM or 1 mL subcutaneous should be administered in one site
Always question, verify excessively large or small volumes of medication
Standard 3-mL syringe used to measure most medications; calibrated in tenths of a milliliter
Calibrations on syringe read from top black ring on syringe, not middle or bottom ring
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10. PYRAMID POINTS VIII. Parenteral Medications (continued)
Prefilled medication cartridge
Standard medication doses rounded to nearest tenth
Volumes larger than 3 mL, use 5-mL syringe calibrated in fifths
Syringes available in 10-, 20-, and 50-mL sizes
Tuberculin syringe holds 1 mL and is calibrated in hundredths of a mL; each one tenth marked on the metric scale
Insulin syringe
When combining regular and NPH insulin, draw regular insulin first, then NPH
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11. PYRAMID POINTS IX. Injectable Medications in Powder Form
Used if medication is unstable when stored in solution form
Powders must be dissolved with sterile diluent, usually sterile water or normal saline; follow directions that accompany the vial
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12. PYRAMID POINTS X. Calculating the Correct Dosage
Double-check dosage and question an order that calls for more than three tablets
Double-check parenteral dosages and question an order that has amount that is too large a dose
Nurse is legally responsible for medications administered, even if incorrect dose was prescribed
All dose measures must be in same medication system
Round standard injection doses to tenths; measure in 3-mL syringe
Round small critical amounts or children’s dosages to hundredths; measure in 1-mL tuberculin syringe
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13. PYRAMID POINTS XI. Percentage and Ratio Solutions Percentage solutions
Express number of grams of medication per 100 mL of solution
Ratio solutions
Express number of grams of medication per total milliliters of solution
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14. PYRAMID POINTS XII. Calculating Medications Commonly used formula
Desired/available  quantity = amount per dose
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15. PYRAMID POINTS XIII. Intravenous Flow Rates
Monitor IV flow rate every 30 minutes for adult, every 15 minutes for child
If IV is running slow, collaborate with physician to increase flow rate appropriately
Don’t speed up IV rate to catch up if infusion is behind schedule
When increasing IV rate, assess cardiac and respiratory systems for signs of cardiac overload
Rate flow of IV generally measured as mL/hr
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16. PYRAMID POINTS continued …
Volume per hour calculated in drops per minute
IV tubing size directly correlated with drops/mL, which affects flow rate
IV flow rate formula
Total volume  drop factor divided by time in minutes = drops per minute
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17. PYRAMID POINTS XIV. Electronic Flow Rate Regulators Controller Pump
Works on same principle of gravity as regular IV drip; flow rate maintained by rapid compression and decompression of IV tubing by machine
Height of solution bag is critical; thus, solution bag must be maintained at height of 36 inches above controller
Flow rate set on controller as mL/hr
Pump
Physically pumps fluids against resistance; gravity not a factor
Height of solution bag is not a factor
Flow rate set as mL/hr
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18. PYRAMID POINTS XV. Calculation of Infusions Ordered by Unit Dose
Most common medications measured by units are heparin sodium and regular insulin
Calculate by determining amount of medication per 1 mL; then determine infusion rate (mL/hr)
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19. The client is to receive 1000 mL of D5W at a rate of 100 mL/hr
The client is to receive 1000 mL of D5W at a rate of 100 mL/hr. The drop factor is 10 drops/mL. The nurse adjusts the flow rate to deliver how many drops per minute?
1. 10 drops
2. 13 drops
3. 17 drops
4. 20 drops
Answer: 3
Rationale: The first step is to determine how many hours the IV will last. This requires simple division of the total volume of mL to be infused (1000 mL) by the total mL per hour (100 mL), which is 10 hours. Then, convert hours to minutes, which is 600 minutes. Next, use the formula to calculate the flow rate:
Total volume in mL  drop factor = flow rate in drops per minute
Time in minutes
1000 mL  10 drops = 10,000 = 16.6, or 17 drops per minute
600 minutes
Test-Taking Strategy: Use the formula for IV drip rates when calculating these IV problems. Remember that you need to determine the time factor for the infusion and convert hours to minutes. Be careful with the multiplication and division and verify the answer with a calculator. Review IV flow rate formulas if you had difficulty with this question.
Level of Cognitive Ability: Application
Client Needs: Safe and Effective Care Environment
Integrated Process: Nursing Process—implementation
Content Area: Fundamental Skills
Reference: Harkreader, H., & Hogan, M. (2004). Fundamentals of nursing (2nd ed., p. 598). St. Louis: W.B. Saunders.
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20. The physician orders an intramuscular dose of 250,000 units of penicillin G benzathine (Bicillin). The label on the 10-mL ampule sent from the pharmacy reads penicillin G benzathine (Bicillin), 300,000 units/mL. How much medication will the nurse prepare to administer the correct dose? mL mL mL
4. 8 mL
Answer: 2
Rationale: Use the formula for calculating the appropriate medication dosage. In this question, performing a conversion is not necessary. The information needed to perform this calculation is the physician’s order (250,000 units of penicillin G benzathine [Bicillin]) and the available amount of 300,000 units/mL. Next, use the formula to calculate the dosage:
Desired  mL = mL per dose
Available
250,000 units__ = mL per dose
300,000 units/mL
250,000 = 0.83 mL
300,000
Test-Taking Strategy: Follow the formula for the calculation of the correct dose. Recheck your work with a calculator and make sure that the answer makes sense. If you had difficulty with this question, review medication calculation problems.
Level of Cognitive Ability: Application
Client Needs: Physiological Integrity
Integrated Process: Nursing Process—implementation
Content Area: Fundamental Skills
Reference: Harkreader, H., & Hogan, M. (2004). Fundamentals of nursing (2nd ed., p. 598). St. Louis: W.B. Saunders.
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.