NCLEX RN Physiological Integrity: Pharmacological and Parenteral Therapies FAQs

1. What are the key considerations for administering medications via the parenteral route?

Administering medications through the parenteral route involves delivering drugs by injection or infusion directly into the body, bypassing the gastrointestinal system. Key considerations include:

• Sterility: Always ensure that the equipment (syringe, needle, etc.) and the environment are sterile to prevent infection. Follow the proper protocols for cleaning and disinfecting the injection site.
  
• Correct Injection Site: Choose the correct site for the injection based on the type of medication and the preferred method of administration (e.g., intramuscular, subcutaneous, intravenous). The site should be free from infection or irritation.
  
• Needle Size: The needle size should match the medication and injection site. For example, larger gauges are needed for thick solutions, while smaller gauges are appropriate for less viscous medications.
  
• Injection Technique: For intramuscular injections, ensure the needle is inserted at a 90-degree angle, while for subcutaneous injections, use a 45-degree angle. Inject slowly and steadily to reduce tissue irritation.
  
• Patient Education: Educate patients about the purpose of parenteral medication, potential side effects, and the importance of not touching or contaminating the injection site. If self-administering injections (e.g., insulin), ensure they are properly trained.

2. What steps should a nurse follow when administering intravenous (IV) medications?

Administering medications via IV requires careful attention to technique and patient monitoring. The steps involved include:

• Verify the Order and Medication: Double-check the physician’s order, the medication label, and the patient’s identification. Ensure that the medication is compatible with the IV solution and the patient’s current condition.
  
• Prepare the Medication: Draw the medication into a sterile syringe or prepare it as per the manufacturer’s instructions (e.g., dilution or reconstitution). Avoid touching the tip of the syringe or needle to maintain sterility.
  
• Check the IV Site: Assess the IV site for signs of infection, infiltration, or phlebitis. Ensure that the site is patent (open and clear of blockages) and that there is no pain or redness.
  
• Administer the Medication: Follow the recommended rate of infusion to prevent adverse reactions such as fluid overload or rapid infusion. For bolus injections, push the medication slowly and monitor for any immediate reactions.
  
• Monitor the Patient: After administration, monitor the patient for any immediate reactions such as an allergic response or adverse side effects. Ensure proper documentation of the procedure, including the time, dose, and patient response.

3. How do nurses manage the administration of high-alert medications?

High-alert medications are drugs that have a higher risk of causing patient harm if used incorrectly. Nurses must take extra precautions when administering these drugs. Key management strategies include:

• Double-checking and Independent Verification: Always double-check the medication order, dose, route, and patient identity. It is ideal to have another nurse verify the medication and dose as a safeguard.
  
• Clear Communication: Ensure clear communication with the healthcare team about the medication, especially if adjustments or special considerations (e.g., renal function) are needed. This includes communicating any patient allergies, intolerances, or previous reactions.
  
• Use of Standardized Protocols: Follow established protocols for administering high-alert medications. For example, for insulin or anticoagulants, use standardized order sets and guidelines to ensure accurate dosing and administration.
  
• Patient Monitoring: Monitor patients closely for adverse effects. For example, after administering anticoagulants, monitor for signs of bleeding, and after administering opioids, monitor for signs of respiratory depression.
  
• Patient Education: Inform the patient about the medication, potential side effects, and what to expect. For example, when administering medications like insulin, educate the patient on signs of hypo- or hyperglycemia and the importance of adherence.

4. What is the importance of drug compatibility when administering parenteral medications?

Drug compatibility is critical when administering parenteral medications because administering incompatible drugs can cause dangerous reactions, including precipitate formation, loss of efficacy, or toxic effects. To manage drug compatibility:

• Review Drug Information: Always check the medication’s drug information (package insert, hospital formulary, etc.) for compatibility with other medications, especially when mixing or infusing them through the same IV line.
  
• Use Separate Lines if Necessary: If drugs are not compatible, they should be administered through separate IV lines or at different times. Some medications require flushing the line with saline or dextrose before administering a second drug.
  
• Be Aware of pH Levels and Dilution: Certain drugs are sensitive to pH levels, and others may require dilution before administration. For example, drugs like potassium chloride should be diluted before administration to avoid irritation or burning at the injection site.
  
• Monitor for Adverse Effects: After administering parenteral medications, monitor the patient closely for signs of incompatibility, such as changes at the IV site, sudden hypotension, or abnormal reactions.
  
• Consult Pharmacist: If unsure about the compatibility of drugs, consult the pharmacist for guidance on proper administration techniques and alternative methods.

5. What is the nurse’s role in monitoring the effects of parenteral medications on the patient?

Monitoring the effects of parenteral medications is crucial for ensuring patient safety and evaluating therapeutic effectiveness. The nurse’s role includes:

• Continuous Assessment: Continuously assess the patient’s vital signs, level of consciousness, and overall response to the medication. For example, after administering opioids, monitor for respiratory depression, and after administering antihypertensives, monitor blood pressure.
  
• Observe for Adverse Effects: Be vigilant for any side effects or adverse reactions, including allergic reactions (e.g., rash, swelling), local reactions (e.g., pain or swelling at the injection site), and systemic reactions (e.g., hypotension, dizziness).
  
• Patient-Specific Factors: Take into account patient-specific factors, such as age, weight, renal or liver function, and comorbid conditions, which may impact how the body responds to the medication. Adjustments in dosing may be necessary.
  
• Educate the Patient: Inform the patient of potential side effects and what to expect from the medication. Encourage patients to report any unusual symptoms, including dizziness, chest pain, or difficulty breathing, immediately.
  
• Document and Report: Document the medication administered, the time, dosage, route, and any reactions or interventions. Report any adverse reactions to the healthcare provider and follow up on changes in the patient’s condition.