Physiological Integrity: Pharmacological and Parenteral Therapies
Pharmacological and Parenteral Therapies tests safe medication administration, dosage calculation, IV and blood therapy, and monitoring for effects.
Rules
- Verify the rights: right client, drug, dose, route, time, reason, and documentation. Use two identifiers, check allergies, and read back verbal orders.
- High-alert medications need an independent double-check per policy: insulin, heparin, opioids, chemotherapy, and potassium.
- Do not leave medications at the bedside; do not crush extended-release or enteric-coated drugs without guidance; never prepare a drug from an unlabeled container.
Worked example
A child weighs 22 lb and is ordered 15 mg/kg/day of a medication divided every 8 hours. Available: 125 mg/5 mL. Convert weight: 22 lb divided by 2.2 equals 10 kg. Daily dose: 10 times 15 equals 150 mg. Each dose: 150 divided by 3 equals 50 mg. Volume: 50 mg divided by 125 mg, times 5 mL, equals 2 mL. Reasoning: convert pounds to kilograms first, divide the daily dose by the number of doses, then use the concentration to find the volume. The PN verifies the dose is safe with the provider or pharmacist if it exceeds the reference range.
Parenteral therapy
For IV therapy, assess the site for redness, swelling, pain, and patency; know compatible fluids; monitor for overload. For blood transfusion, use 0.9% sodium chloride, stay with the client for the first 15 minutes, and stop the infusion for fever, chills, back pain, or dyspnea.
Traps
Mixing NPH insulin before regular insulin; using a teaspoon for liquid medication; infusing blood with dextrose; ignoring a new IV site complaint; giving a crushed enteric-coated tablet; failing to check a digoxin level or potassium before administration.