NCLEX PN Physiological Integrity Pharmacological and Parenteral Therapies FAQs
- What is the nurse’s role in administering medications safely?
The nurse plays a critical role in ensuring that medications are administered safely, which involves several key steps:
- Medication verification: Nurses must verify the five rights of medication administration: right patient, right drug, right dose, right route, and right time. This helps prevent errors in medication administration.
- Patient education: Nurses provide education on the purpose, potential side effects, and instructions for taking medications. They should also inform patients of any special precautions related to the medication (e.g., taking with food, avoiding alcohol).
- Proper technique: Nurses ensure that medications are administered using the correct technique for the route (oral, intravenous, intramuscular, subcutaneous, etc.) and follow protocols for infection control, such as using sterile equipment when necessary.
- Monitoring for adverse effects: Nurses monitor patients for any adverse effects or allergic reactions to medications. They must know how to recognize and respond to side effects, such as nausea, dizziness, or severe reactions like anaphylaxis.
- Documentation: Accurate documentation is crucial for tracking medication administration. Nurses document the medication given, the time, dose, and any patient reactions or interventions that occurred.
- Medication verification: Nurses must verify the five rights of medication administration: right patient, right drug, right dose, right route, and right time. This helps prevent errors in medication administration.
- What are the common routes of medication administration, and how do nurses ensure their proper use?
There are several routes for administering medications, each requiring different techniques and considerations:
- Oral route: Medications are taken by mouth and absorbed through the gastrointestinal system. Nurses ensure that the patient is able to swallow, check for contraindications (e.g., nausea or vomiting), and provide appropriate fluids to aid in swallowing. Nurses should also check for drug interactions that may affect absorption.
- Intravenous (IV) route: Medications are delivered directly into the bloodstream through an IV catheter. Nurses must ensure that the correct type of IV catheter is used, verify proper placement, and monitor the IV site for signs of infiltration or phlebitis. They should also monitor for IV compatibility with other fluids.
- Intramuscular (IM) route: Medications are injected into the muscle tissue. Nurses select an appropriate muscle (e.g., deltoid, vastus lateralis), verify correct needle size, and administer the medication at the correct angle. They should ensure that the patient is relaxed to reduce discomfort.
- Subcutaneous (SQ) route: Medications are injected just beneath the skin. Nurses ensure that the needle is at the correct angle (usually 45 or 90 degrees depending on the patient’s body composition), and they rotate injection sites to prevent irritation and tissue damage.
- Topical and transdermal routes: Medications applied to the skin (creams, ointments, or patches). Nurses ensure that the skin is clean and dry before application, and for patches, they must monitor for proper adhesion and site rotation.
- Oral route: Medications are taken by mouth and absorbed through the gastrointestinal system. Nurses ensure that the patient is able to swallow, check for contraindications (e.g., nausea or vomiting), and provide appropriate fluids to aid in swallowing. Nurses should also check for drug interactions that may affect absorption.
- How do nurses manage patients receiving parenteral nutrition (PN)?
Parenteral nutrition is a form of nutrition that is delivered intravenously, bypassing the gastrointestinal system. Nurses manage parenteral nutrition with the following interventions:
- Assessment: Nurses assess the patient’s nutritional needs and verify that the parenteral nutrition formula is appropriate for the patient’s condition (e.g., weight loss, malnutrition, or inability to absorb nutrients through the GI tract).
- IV site care: Nurses ensure that the IV line or central venous catheter used for parenteral nutrition is properly placed and functioning. They monitor the site for signs of infection, infiltration, or clotting and maintain sterile technique when handling the catheter.
- Monitoring vital signs and laboratory results: Nurses frequently monitor vital signs (especially temperature and blood pressure) and laboratory tests such as electrolyte levels, glucose, and liver function to identify potential complications, such as hyperglycemia or electrolyte imbalances.
- Infusion rate and formula adjustments: Nurses monitor the rate of parenteral nutrition infusion, ensuring it is consistent with the prescribed rate. They adjust the infusion rate as needed based on the patient’s tolerance and lab results.
- Patient education: Nurses educate patients and their families about the importance of parenteral nutrition, potential complications (e.g., infection, liver dysfunction), and the need for ongoing monitoring.
- Assessment: Nurses assess the patient’s nutritional needs and verify that the parenteral nutrition formula is appropriate for the patient’s condition (e.g., weight loss, malnutrition, or inability to absorb nutrients through the GI tract).
- What are the key nursing interventions for patients receiving medication via an IV line?
Nurses need to be vigilant when administering medications via an IV line to prevent complications and ensure effective therapy. Key interventions include:
- IV insertion and site assessment: Nurses must ensure the IV line is inserted into an appropriate vein and is functioning correctly. They assess the IV site regularly for signs of infiltration, phlebitis, or infection and ensure proper dressing to keep the site sterile.
- Administering the correct medication and dose: Nurses verify the medication order, including drug name, dose, and route, and ensure that the medication is compatible with the IV solution to avoid chemical reactions or precipitation. They double-check the calculation for infusion rates and ensure medications are delivered in the correct sequence.
- Monitoring the patient during infusion: Nurses continuously observe the patient during the IV infusion, checking for adverse reactions or signs of discomfort. They monitor vital signs, especially during the first dose of a new medication, to detect any immediate adverse effects.
- Maintaining IV patency: Nurses maintain the patency of the IV line by flushing it with saline before and after medication administration to ensure that the line remains clear. This also prevents the formation of clots or blockages within the catheter.
- Emergency preparedness: Nurses are prepared for potential complications like anaphylactic reactions, extravasation, or air embolism by having emergency equipment readily available, including oxygen, epinephrine, and resuscitation equipment.
- IV insertion and site assessment: Nurses must ensure the IV line is inserted into an appropriate vein and is functioning correctly. They assess the IV site regularly for signs of infiltration, phlebitis, or infection and ensure proper dressing to keep the site sterile.
- How do nurses manage patients receiving opioid analgesics to prevent complications like respiratory depression?
Opioids are potent analgesics but can cause serious complications like respiratory depression and sedation. Nurses have a critical role in managing these medications to ensure patient safety:
- Assessment of pain: Nurses assess the patient’s pain level before administering opioids, using appropriate pain scales. They ensure that the opioid medication is prescribed based on the severity of the pain, and the patient’s history is reviewed for any risk factors (e.g., history of substance abuse, respiratory conditions).
- Monitoring for respiratory depression: Nurses closely monitor the patient for signs of respiratory depression, especially within the first hour after administration. This includes assessing respiratory rate, depth, and oxygen saturation. If respiratory depression occurs, the nurse must take immediate action, such as administering naloxone (Narcan) if prescribed.
- Encouraging non-opioid pain management strategies: Nurses implement non-pharmacologic pain relief strategies, such as positioning, relaxation techniques, or cold/heat therapy, to reduce the need for opioids and minimize risks.
- Patient education: Nurses educate patients about the potential side effects of opioids, including sedation, constipation, and nausea. They also inform patients about how to safely take the medication, the importance of adhering to the prescribed schedule, and the risks of overdose.
- Monitoring for side effects: Nurses routinely monitor for common side effects of opioids, such as constipation and nausea, and intervene by offering appropriate remedies (e.g., stool softeners, antiemetics) to improve patient comfort and prevent complications.
- Assessment of pain: Nurses assess the patient’s pain level before administering opioids, using appropriate pain scales. They ensure that the opioid medication is prescribed based on the severity of the pain, and the patient’s history is reviewed for any risk factors (e.g., history of substance abuse, respiratory conditions).
