Med surg exam 2
Med Administration
• Rights
o Patients have the right to refuse the medication, not receive unnecessary meds,
or receive appropriate therapy
o Nurses who administer the med are responsible for their own actions
• 3 checks: before pulling the med, while pulling the bed, before administering the med
• 10 rights
• Consent: taking the med once does not mean they consent to taking all of the meds
• Educating a pt
o The nurse must educate on purpose, dose, and education
• Oral meds
o Advantages: non-invasive, easy to prepare
o Disadvantages: pt can’t swallow, nausea/vomiting, bad taste, irritates gastric
mucosa, risk for aspiration.
• Intradermal injections
o Administered into dermis- used for sensitivity tests (TB, Allergies)
o Advantages: reactions are easily visible
o 0.25-0.5 (25 or 27 gauge)
o 5-15 degrees
• Subcutaneous injections
o Administered into adipose tissue
o Insulin and Heparin
o 25-30 gauge
o 45-90 deg depending on the size of the pt
• Intramuscular injections
o Administered into the muscle
o Needle length is based on the pt (the larger the pt, the larger the needle)
o 90 deg
o Deltoid, vastus lateralis, ventrogluteal
• Intravenous infusions
o The fastest and efficient method to administer fluids and medication
o Infusion of sterile fluids (Sterile solutions, medication, blood/blood products
o IV lines
§ Primary
§ Secondary
o Isotonic: a solution that has the same effective osmolarity as bodily fluids.
§ Infused to replace fluid loss and to expand the IV volume
o Hypotonic: solution has an effective osmolarity less than that of bodily fluids
o
• Infiltration
o Leaking of fluid from the vein into the subQ space.
, • Phlebitis: inflammation of the vein, which can be caused by the leakage of IV fluids.
• Embolism: a blood clot or foreign object, such as a catheter tip, that lodges in a blood
vessel.
Elimination
Bowel elimination
o Can be affected by surgery, immobility, medication, and diets.
o Stool specimen
§ Screening and dx tests
§ Send to the lab asap
o Bowel pattern alterations
§ Constipation, diarrhea
• Factors
o Age
o Diet
§ fiber requirement: 25-38 g/day
§ Food that increases gas/laxative effects/or increases risk for
constipation.
o Fluid intake
§ 2.7 L/day- females
§ 3.7 L/day-males
o Physical activity
o Psychological factors
o Personal habits
o Positioning, pain, surgery, and anesthesia
• Medications:
o Laxatives
o Cathartics
o Laxative overuse
• Incontinence
o Inability to control defecation
• Flatulence
o When gas builds up inside the intestines, it causes the abdomen to stretch
and feel bloated
• Hemorrhoids
o Enlarged, dilated blood vessels in the rectal wall from pregnancy, liver
disease, HF, and difficult defecation
Urinary elimination
• System of filtration, reabsorption, and excretion
o Most adults produce 1k-2k mL/day of urine
• After filtration, the urine passes through the ureters into the bladder and is stored.
o 250-450 mL in adults
o Kidneys produce 1-2 quarts of urine a day
Med Administration
• Rights
o Patients have the right to refuse the medication, not receive unnecessary meds,
or receive appropriate therapy
o Nurses who administer the med are responsible for their own actions
• 3 checks: before pulling the med, while pulling the bed, before administering the med
• 10 rights
• Consent: taking the med once does not mean they consent to taking all of the meds
• Educating a pt
o The nurse must educate on purpose, dose, and education
• Oral meds
o Advantages: non-invasive, easy to prepare
o Disadvantages: pt can’t swallow, nausea/vomiting, bad taste, irritates gastric
mucosa, risk for aspiration.
• Intradermal injections
o Administered into dermis- used for sensitivity tests (TB, Allergies)
o Advantages: reactions are easily visible
o 0.25-0.5 (25 or 27 gauge)
o 5-15 degrees
• Subcutaneous injections
o Administered into adipose tissue
o Insulin and Heparin
o 25-30 gauge
o 45-90 deg depending on the size of the pt
• Intramuscular injections
o Administered into the muscle
o Needle length is based on the pt (the larger the pt, the larger the needle)
o 90 deg
o Deltoid, vastus lateralis, ventrogluteal
• Intravenous infusions
o The fastest and efficient method to administer fluids and medication
o Infusion of sterile fluids (Sterile solutions, medication, blood/blood products
o IV lines
§ Primary
§ Secondary
o Isotonic: a solution that has the same effective osmolarity as bodily fluids.
§ Infused to replace fluid loss and to expand the IV volume
o Hypotonic: solution has an effective osmolarity less than that of bodily fluids
o
• Infiltration
o Leaking of fluid from the vein into the subQ space.
, • Phlebitis: inflammation of the vein, which can be caused by the leakage of IV fluids.
• Embolism: a blood clot or foreign object, such as a catheter tip, that lodges in a blood
vessel.
Elimination
Bowel elimination
o Can be affected by surgery, immobility, medication, and diets.
o Stool specimen
§ Screening and dx tests
§ Send to the lab asap
o Bowel pattern alterations
§ Constipation, diarrhea
• Factors
o Age
o Diet
§ fiber requirement: 25-38 g/day
§ Food that increases gas/laxative effects/or increases risk for
constipation.
o Fluid intake
§ 2.7 L/day- females
§ 3.7 L/day-males
o Physical activity
o Psychological factors
o Personal habits
o Positioning, pain, surgery, and anesthesia
• Medications:
o Laxatives
o Cathartics
o Laxative overuse
• Incontinence
o Inability to control defecation
• Flatulence
o When gas builds up inside the intestines, it causes the abdomen to stretch
and feel bloated
• Hemorrhoids
o Enlarged, dilated blood vessels in the rectal wall from pregnancy, liver
disease, HF, and difficult defecation
Urinary elimination
• System of filtration, reabsorption, and excretion
o Most adults produce 1k-2k mL/day of urine
• After filtration, the urine passes through the ureters into the bladder and is stored.
o 250-450 mL in adults
o Kidneys produce 1-2 quarts of urine a day
