monitor medicines and intravenous therapy

Instructions to Student

General Instructions:
This assessments aim is to demonstrate some of the knowledge required to administer and monitor medications and intravenous (IV) therapy. Read the questions below and use information obtained in the content from this unit, resources suggested by your teacher and your own research, answer each question. APA 6^th/ 7^th edition style in-text referencing must be used for ALL answers and a reference list submitted with the assessment. Students must use their own words to answer the questions. Assessments that use, reproduce or adapt the work or ideas of another person without due acknowledgment will be graded as unsatisfactory. Please refer to the TAFE Queensland student rules regarding academic misconduct.
Information / Materials provided: Use information on your chosen topic taken from the unit information on Connect, supported with your own research.
Assessment Criteria: To achieve a satisfactory result, A satisfactory response must be provided for every question, your assessor will be looking for your ability to demonstrate the following key skills/tasks/knowledge to an acceptable industry standard: Detailed information is included in the marking criteria. Ensure that you review the marking criteria carefully prior to submitting your assessment to ensure that all the criteria are met.
Number of Attempts: You are required to satisfactorily complete all assessments listed in the table below to be receive a ‘Competency Achieved’ result for the Unit(s) of Competency. You are responsible for complying with TAFE Queensland’s assessment rules and complete assessment tasks honestly. You need to follow all assessment instructions, including submission details and retain a copy of all assessment items. You must submit assessment on or by the due date, unless an extension has been granted. Failure to submit or complete assessment on or by the due date will result in a “did not submit/sit” (DNS) being recorded (unless there are exceptional circumstances) and you will have five (5) days to submit your second and final attempt.
For more information, refer to the TAFE Queensland Student Rules and Policies: https://tafeqld.edu.au/about-us/policy-and-governance/policies-and-procedures/student-rules-and-policies/index.html

Submission details	Insert your details on page 1 and sign the Student Declaration. This will confirm you are submitting your own work. Include this template with your submission. Students are advised to follow teacher direction on submission processes. If online submission: Assessment to be submitted via TAFE Queensland Learning Management System: Connect url: https://connect.tafeqld.edu.au/d2l/loginUsername; 9 digit student numberFor Password: Reset password go to https://passwordreset.tafeqld.edu.au/default.aspx>
Instructions for the Assessor	Students are to attempt all assessment questions / tasks and submit for review and resulting by the due date. Please refer to QLD TAFE Student Rules and Policies for assessment and appeals processes: https://tafeqld.edu.au/about-us/policy-and-governance/policies-and-procedures/student-rules-and-policies/index.html Students are expected to complete unit content and personal study to assist in completing the assessment successfully. Assessors are to refer to the Benchmark Answers to ensure objectivity and consistency. All aspects of the marking criteria must be met in order to achieve a satisfactory result for this assessment. Assessors must satisfy the Standards for Registered Training Organisations (RTOs) 2015/AQTF mandatory competency requirements for assessors. In addition, assessors must hold current registration as a registered nurse with Nursing and Midwifery Board of Australia.
Note to Student	An overview of all Assessment Tasks relevant to this unit is located in the Unit Study Guide.

APA 6th / 7th edition style in-text referencing must be used for ALL answers and a reference list submitted with the assessment.

Define the following terms:
Pharmacokinetics

This is a branch of pharmacology which determines the fate if a substanceor substances that are administered to a living organism (Lavery, 2018)……………………………………………………………………………….

…………………………………………………………………………………………………………………………………………………….

Pharmacodynamics

This is the study if the biochemicak,physiologic and molecular impacts of drugs on the body and it incorporates the receptor binding,postreceptor impacts and chemical interactions (Scales, 2018)

…………………………………………………………………………………………………………………………………………………….

Bioavailability

This is the measure of the proportion of the intitial dose of a drug that reaches the site of action of the bodily fluid domain from which the targets have an unimpesed access (Ingram & Lavery, 2018)

…………………………………………………………………………………………………………………………………………………….

First pass effect

This refers to the phenomenon in which a drug gets metabolized in a particular location in the body that leads to a reduction in the concentration of the active drug when it reachs the targeted body part (Kayley, 2019).

…………………………………………………………………………………………………………………………………………………….

Drug indication

Drug indication is the utilization a drug for treating a patricular disease (Brooks, 2018)………………………….

…………………………………………………………………………………………………………………………………………………….

Drug contraindication

This refers to a particular situation in which a drugor a surgeryshould not be utilized because it may cause an harm to a person using it (Finlay, 2018)…………………………………………………………………………………………….

…………………………………………………………………………………………………………………………………………………….

Adverse drug reaction

This refers to an harmful or unpleasant reaction that results from the intervention which is related to the use of a medicinal product,unpleasant reactionthat results from an intervention related to the utilization of medicinal product,adversative impacts mostly predict harm from the future administration. (Tissot, Cornette, & Demoly, 2016)…………………………………………………………………………………………………………………………….

…………………………………………………………………………………………………………………………………………………….

Therapeutic range

This refers to the dosage rage of blod plasma concentration that is basically expected to achieve a desired therapeutic impact (Brooks, 2018)……………………………………………………………………………………………………

…………………………………………………………………………………………………………………………………………………….

Toxicology

This was traditionally known as the science of poisons.Nowadays, it is defined as the study of the impacts of chemical,physical and biological agents on living organisms and the ecosystem (Lavery, 2018)……………..

…………………………………………………………………………………………………………………………………………………….

a. List 3 forms of parenteral administration, and place an * next to the form that provides 100% bioavailability of a drug.

subcutaneous (SC/SQ), intraperitoneal (IP), intravenous (IV)the parenteral administration which provides 100% bioavailability is the subcutaneous and intravenous (Kayley, 2019)……………………………………………

…………………………………………………………………………………………………………………………………………………….

b. Identify and discuss 4 factors that affect absorption of a drug. (min 40 words)

Physiochemical properties- this can be in terms of solubility

Drug formulation- this can be in form of tablets,solutions or capsules

Route of administration- this includes buccal, sublingual, rectal or inhaled

The rate of gastric emptying (Kayley, 2019)……………………………………………………………………………………….

…………………………………………………………………………………………………………………………………………………….

c. List two (2) internal factors and two (2) external factors that affect metabolism of a drug.

Internal factors-hormones, pregrancy

External factors-Diet, Environment

…………………………………………………………………………………………………………………………………………………….

…………………………………………………………………………………………………………………………………………………….

d. What factors can affect drug metabolism in an ELDERLY client and why? (min 40 words)

Aging results in several changes in the human liver including rductions in the liver blood flow, drug metabloizing enzyme content and pseudocapillarization.Metabolism in the aged can also be caused by comorbid diseases,frailty and concomitant medicines (Lavery, 2018)…………………………………………………..

…………………………………………………………………………………………………………………………………………………….

e. List 4 routes by which drugs are excreted. Provide examples of 4 chronic diseases that may affect elimination of drugs.

Routes by which drugs are erected

Milk

Faeces

Saliva

Urine (Ingram & Lavery, 2018)

Chronic Diseases that may affect elimination of drugs

Liver cirrhosis
Diabetes Mellitus
High boold pressure
Lymphatic Leukemia (Tissot, Cornette, & Demoly, 2016)………………………………………………………….

…………………………………………………………………………………………………………………………………………………….

f. Define polypharmacy and describe what impacts this can have on a client. (min 40 words)

…………………………………………………………………………………………………………………………………………………….

polypharmacy……………………………………………………………………………………………………………………………….. This is the prescription of multiple medications inapproporiately or where the required benefit of the prescribed medicatrion is not realized.

The polypharmacy

Can have adverse impacts on a patient includingfunctional impairment,malnutrition falls,dizziness,depression and anxiety,hallucination,skin rashes and confusion aong others (Kayley, 2019)…………………………………..

…………………………………………………………………………………………………………………………………………………….

A. Match the formulation with the description.

Formulation:

Cream	Drops	Capsule	Tablet
Gel	Patch	Lotion	Wafer
Suspension	Emulsion	Syrup	Injection
Inhalant	Suppository

Formulation	Description
Cream	orally disintegrating tablet containing medication
Patch	medication dissolved in a water or alcohol base for topical application – lower viscosity than creams
Syrup	medication dissolved in sterile liquid for topical application
Suppository	a drug mixed with a base compound and compressed into a variety of shapes
Drops	emulsion of oil and water for topical application
Patch	mixture of oil and water containing a drug
Lotion	delivers drug through the skin at a steady concentration
Injection	sterile aqueous or oily suspensions containing a drug delivered parenterally
Gel	concentrated sugar solution containing a drug
Tablet	solid preparation containing a drug which dissolves when administered rectally
Wafer	liquid in which insoluble particles of the drug are dispersed
Emulsion	semi-solid emulsion in an alcohol base for topical application.
Syrup	gelatine container enclosing a drug in liquid
Inhalant	finely powdered or liquid drugs administered into respiratory system

What is meant by sustained or slow release? (min 30 words)

This is the whereby the there is a delivery of a particular drug at a programmed rate that leads to drug delivery for a longer period (Kayley, 2019)…………………………………………………………………………………………

…………………………………………………………………………………………………………………………………………………….

Complete the gaps in the following table with the * in them

Medication Group/Classification	Common medication use	Generic medication example
Anaesthetics	Sedation	Propofol
Analgesia	Neuralgia	*Ibuprofen
Antacids	*	Aluminium hydroxide
Antianginals	Angina	*Diltiazem
Antianxiety	Anxiety	* Benzodiazepines
Antiarrhythmics	* arrhythmias	Digoxin
Antibiotics	Bacterial infection	Cephalexin
* phenothiazines	Allergies	Promethazine
Anticoagulants	History of DVT	Heparin
* anticonvulsants	Epilepsy	Phenytoin
* antidepressants	Depression	Citalopram
Antidiarrhoeals	Diarrhoea	* Loperamide
Antiemetics	Nausea	* dimenhydrinate
* imidazoles	Thrush	Clotrimazole
* antihistamines	Hay fever	Cetirizine
Antihypertensives	Hypertension	* losartan
Anti-inflammatory	Osteoarthritis	Diclofenac
Antineoplastics	* melphalan	Vincristine
Antiparkinsonian	Tremor	* levodopa
Antipyretic	* ibuprofen	Paracetamol
Antipsychotics	Schizophrenia	* Chlorpromazine
*Iodine	Wound care	Betadine
Antiulcer	GORD	* Omeprazole
*antivirals	Herpes simplex	Acyclovir
* benzodiazepines	Generalised anxiety disorder	Clonazepam
* hormones	Menopause	Oestrogen and Progesterone
Hypnotics, sedatives	Sedative	barbiturates
Hyperglycaemic agent	* cardiovascular emergencies	Glucagon
Insulin	* diabetes treatment	Novorapid
* beta blockers	Hypertension	Propranolol
* bronchodilators	Asthma	Salbutamol
Electrolyte solutions	Rehydration	* convulsions
Laxatives/aperients	Constipation	*Constipation
Ophthalmic, otic	* treat outer ear infections	Acetozolamide
Nasal medications	* Nasal Congestion	Phenylephedrine
* estradiol	Pregnancy prevention	Oestrogen and Progesterone
Corticosteroids	Inflammation	* prednisone
* diuretics	Pulmonary oedema	Frusemide
Narcotic analgesia	Severe pain	* Dilaudid
Neuroleptics	Mood stabilizer	* risperidone
* vitamins	Bleeding disorders	Phytonadione

Below is a list of commonly used drugs. Discuss the following five (5) points for EACH of the drugs listed:
The major drug group/class
Common route/s of administration (there may be more than one)
Mode of action
Common adverse reactions
Nursing implications (Lavery, 2018)

Drug	Major drug group/class	Common routes for administration	Mode of action	Adverse Reactions	Describe at least 3 Nursing Considerations for each of the below medications (what you need to know as a nurse administering this drug, both for you and the client)
Glyceryl Trinitrate	Vasodilators	Spray Sublingual tablets Patches	Relaxation of vascular smooth muscle	Causes headache Dizziness Fainting Rapid heartbeat Nausea and vomiting	I should remember to tell the patient to do regular excercises,cease smoking and take diet low in sodium
Warfarin	anticoagulants	oral, intravenous, or subcutaneous	Warfarin blocks the function of the vitamin K epoxide reductase complex in the liver	Adverse bleeding Red or Brown Urine Severe headache	I need to remember to caution patients to avoid IM injections.I also need to caution patients to avoid activities that lead to injury. I should also remember to advisepatients to use soft toothbrush and not to shave using electric razors
Actrapid Insulin	insulins and analogues.	Injection	It lowers the effect of insulin due to the uptake of glucose	Pain Redness Hives Inflammation Bruising Swelling itching	As a nurse, I need to know that insulin has life threatening allergic reactions, it stimulates movement of potassium in blood cells and also causes hypoglycemia

Identify 6 actions that you may be required to do if you make a medication error

Report the error to the nurse leader

Assess the patient for any change of status

Disclose during thr shift report that the error was made

Ensure the error is documented as per the organizations policy

Report the matter to the patients family

Let the patient know that an error occured (Brooks, 2018).

…………………………………………………………………………………………………………………………………………………….

Case Study 1: Anaphylaxis

You answer Mr Brown’s buzzer and when you enter his room he is obviously distressed and is thrashing around on his bed. He complains of difficulty breathing and has an audible stridor (high pitched wheezing sound). You know that he commenced his first dose of intravenous penicillin 10 minutes ago via an infusion pump. You suspect that Mr Brown is having an anaphylactic reaction.

What is anaphylaxis? In your answer, please outline the pathophysiology of anaphylaxis and list five (5) common agents that may trigger anaphylaxis (min 100 words).

………………………………………………………………………………………………………………………………………… Anaphylaxis refers to a severe,life threatening and allergic reactionto venon ,food or medication.most of these cases are caused by a bee sting.it is caused by the release of inflamatory mediators and cytokinrs from mast cells and basophils,particularly due to an immunologic reactions.

The agents that may trigger anaphylaxis

Insect venom.

Medicines

Food

Insect stings

General aesthetics (Finlay, 2018)

…………………………………………………………………………………………………………………………………………………….

…………………………………………………………………………………………………………………………………………………….

Adrenaline 1:1000 via intramuscular injection is the drug of choice for treating anaphylaxis. What is this drug’s mechanism of action and how does it treat the signs and symptoms of anaphylaxis? Why is it preferably given by intramuscular injection? (min 100 words)

…………………………………………………………………………………………………………………………………………………….

Through its action on apha-1 receptors, epinephrine bringscauses an increased mascular smooth mucscle,sphincter muscle and pupillary muscle contraction.

How it treats the signs and symptoms of anaphylaxisAdrenaline which is injected in the outer muscles of the thigh functions rapidly to reduce throat swelling opens up airways and maintain heart functionality and blood pressure (Lavery, 2018)…………………………………………………………………………………………………………………..

…………………………………………………………………………………………………………………………………………………….

Describe your role as an EN responding to Mr B’s nurse call bell. Include in your answer,
Your immediate priorities, (remember he has an IV)
Follow-up assessments you as the EN may do over the next 15mins (name at least 4),
Who would you consult with throughout this event
What would you need to document?

…………………………………………………………………………………………………………………………………………………….

Immediate priorities:

stop the infusion and remove cannula

Follow urgency policy which is related to infiltration

Avoid the areas of flexion and assess IV site before giving ant fluids

Secure peripheral catheter with tape

As an EN, I will consult with a physician so that there is a perect inclusion of solution or medication, the rate of diffusion,date and time.

The documentation should include;

The date and time the VAD was inserted

Anatomic name of the vein accessed

The brand name or type and length of catheter

Number of attempts needed to insert the VAD

The typr of drug the patient is receiving (Ingram & Lavery, 2018).

…………………………………………………………………………………………………………………………………………………….

…………………………………………………………………………………………………………………………………………………….

Case Study 2: Blood Transfusion

Mrs Jones is a 78-year-old lady, who has arrived via the emergency department on Sunday 0800 after falling at home and fracturing her femur, on admission IV therapy was commenced at 1000mls over 12hrs. She is scheduled for surgery on Monday morning. Pathology indicated that her haemoglobin level was 9.7g/dL, and she has been prescribed a transfusion of 1 unit of packed red blood cells (PRBC). You assist the RN in preparing for Mrs Jones’ transfusion.

Explain the rationale for administering a blood transfusion to this patient. (min 50 words)

Putting into consideration that the most common symptoms are chills,fever, dizziness,hives and lfank pain, it is important to stop the blood transfusionand keep the IV open. Antihistamine will be adminsitered to control the itching then transfusion can be carried upon. Moderate altergic reactions also need hydrocortisone and mild anaphylactic requires additional treatment with adrenaline which has a 1: 1,000 solution and of 0.5 ml (Ingram & Lavery, 2018)………………………………………………………………………………………………………………….

…………………………………………………………………………………………………………………………………………………….

Describe the potential complications of blood transfusion including what you would do if the patient experienced a potential delayed reaction (min 50 words)

The possible complications can include

Chill reactions

Acute haemolytic reaction due to AB0circulation overload associated with blood transfusion

Non-hemolytic reactions

Acute transfusion affiliated with injury if the lungs (Lavery, 2018)…………………………………………………………

…………………………………………………………………………………………………………………………………………………….

What education would you provide to Mrs Jones to increase her awareness of the symptoms of a transfusion reaction? (min 50 words)

I would matriculate Mrs. Jones on the sings and symptoms of a transfusion reaction so that she can refer any adjustments during the progression such as headache,itching,vomiting and dyspnea, low back pain ans chest pain and for their treatment and how she can be able to act in haste. ………………………………………………….

…………………………………………………………………………………………………………………………………………………….

Describe how to transport, store, handle, check and dispose of blood and blood products safely. (min 50 words)

Minimal physical handling blood,ensure that there is no red blood cells exposed to tempreatures outside refrigeration,the blood clot bag should be inspected before sending it to another health provide.

Blood and products need to be packed and transported according to the validated specifications agrred between the health providers (Finlay, 2018)

…………………………………………………………………………………………………………………………………………………….

Case Study 3: IV Fluids

Jack King is a client who is on your ward with cholecystitis and is due to go to theatre in the morning. He has been prescribed intravenous (IV) fluids overnight as he is nil by mouth (NBM)

Discuss why Jack has been prescribed IV fluids and provide one (1) example of a type of IV fluid that he may be prescribed. (min 50 words)

Jack has been on nil by mouth ans therefore, he needs help to restore the tissue fluis while avoiding excessive intake of salt and water which would trigger normal tissue delivery without causing harm.

Normal saline will be a good prescription………………………………………………………………………………………….

…………………………………………………………………………………………………………………………………………………….

Identify what you would need to record when administering IV fluids.

Identify the follwing

Site of cannulation

Time of insusion

IV fluid that will be administered

…………………………………………………………………………………………………………………………………………………….

Discuss at least four (4) possible complications of IV therapy. (min 100 words)

Phlebitis-this can happen ti the vein where there was cannula insertion

Air embolism- this would happen when bubbles of air enter the vein and form emboli.

Hypervolaemia- this is the abnormal increase in the volume of blood and can occur if IV fluids were given in excess

Extravasation-this occurs due to leakage of the IV fluids in the tissue sorrounding the vein (Lavery, 2018)……………………………………………………………………………………………………………………………………………………..

…………………………………………………………………………………………………………………………………………………….

The RN tells you that Jack’s blood results show an electrolyte imbalance. Identify one common electrolyte imbalance and explain what would be given to treat this and how this would be administered. (min 50 words)

…………………………………………………………………………………………………………………………………………………….

This occurs when the conentration of sodium in the blood is very low.sodium assists in water regulation around the body cells.

Treatment……………………………………………………………………………………………………………………………………..

Treatment of the symptoms such ad nausea and headache

Treatment of the underlying condition presented by the client

Prescription of an IV sodium solution (Kayley, 2019).

…………………………………………………………………………………………………………………………………………………….

Jack tells you that he does not want the IV fluids and that he was not going to let you give them to him. Explain your actions relating to Jack’s refusal of the IV fluids. In your answer identify who you would report this to. (min 50 words)

…………………………………………………………………………………………………………………………………………………….

Jack has the right to refuse treatment. I am supposed to respect his decision but I will have to advice him on the impportance of IV fluids. I can easily be charged with battery with harm in a case whereby I started treating the patient without his consent.If he goes on to reduce the medication even after I advise him accordingly, I would document what I discussed with him and the feedback that he gaveand then give a ntofication to the covering practitioner……………………………………………………………………………………………….

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Have you completed all in-text references and a reference list?

APA 6th edition style in-text referencing must be used for ALL answers and a reference list submitted with the ass

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