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Preparing and Administering Intermittent Intravenous Medications with an Infusion Pump

JoVE 10277

Source: Madeline Lassche, MSNEd, RN and Katie Baraki, MSN, RN, College of Nursing, University of Utah, UT

Primary intermittent intravenous (IV) infusions are delivered alone as volume-controlled infusions, while secondary infusions are delivered with another IV fluid, usually maintenance fluids. Intermittent infusions are delivered over a specific amount of time, which is dictated by the type of medication, such as IV antibiotics. High-volume IV medications, anywhere from 50- to 500-mL infusions, are typically delivered using an infusion pump as either primary or secondary infusions. Infusion pumps deliver IV fluids in a volume-controlled manner, keeping medication side effects to a minimum and helping to prevent nurse medication errors. Careful review of the medication compatibility with maintenance fluids using an approved medication drug guide, pharmacy recommendations in the Medication Administration Record (MAR), and physician orders must be assessed prior to delivering an IV medication. This review will determine if primary or secondary delivery is appropriate based on the risk for patient harm, such as for concentrated electrolyte preparations like potassium. Certain medical conditions that preclude oral fluid intake, specific medication preparations, or situations that require an inc


 Nursing Skills

Preparing and Administering Secondary Intermittent Intravenous Medications

JoVE 10288

Source: Madeline Lassche, MSNEd, RN and Katie Baraki, MSN, RN, College of Nursing, University of Utah, UT

Secondary intravenous (IV) infusions are a way to administer smaller volume-controlled amounts of IV solution (25-250 mL). Secondary IV infusions are delivered over longer periods of time than IV push medications, which reduces the risks associated with rapid infusions, such as phlebitis and infiltration. In addition, some antibiotic medications are only stable for a limited time in solution. The secondary IV medication tubing is connected to the primary macrobore (large internal diameter) IV tubing and is therefore "secondary" to the primary infusion. The secondary solution bag is typically hung higher than the primary infusion bag and is subsequently "piggybacked" on top of the primary IV infusion. This higher position places greater gravitational pressure on the secondary IV solution. As a result, the primary infusion is temporarily paused until the secondary infusion volume has been delivered. This approach ensures that the medication is completely infused due to an immediate return of maintenance IV infusion in the IV line. The secondary IV infusion can be safely delivered when the patient's fluid volume status permits temporarily pausing the delivery of maintenance fluid and in hype


 Nursing Skills

Preparing and Administering Intramuscular Injections

JoVE 10261

Source: Madeline Lassche, MSNEd, RN and Katie Baraki, MSN, RN, College of Nursing, University of Utah, UT

Intramuscular (IM) injections deposit medications deep into the muscle tissue. Since muscle fibers are well perfused, this route of administration provides quick uptake of the medication and allows for the administration of relatively large volumes. Skeletal muscles have fewer pain-sensing nerves than subcutaneous tissue, which allows for the less painful administration of irritating drugs (e.g., chlorpromazine, an anti-psychotic). IM injections are recommended for patients unable to take oral medications and for uncooperative patients. Some examples of medications that are commonly delivered by IM injections include antibiotics, hormones, and vaccinations. As in any other route of administration, the nurse must consider if the medication is appropriate, given the patient's medical conditions, allergies, and current clinical status. In addition, specifically for IM injections, it is important to assess the patient's muscle mass to determine the appropriate needle size. Also, if the patient has already received this injection, it is necessary to verify the injection site that was previously used and to ensure that the previous dose did not result in any adverse


 Nursing Skills

Discontinuing Intravenous Fluids and a Peripheral Intravenous Line

JoVE 10278

Source: Madeline Lassche, MSNEd, RN and Katie Baraki, MSN, RN, College of Nursing, University of Utah, UT

Intravenous (IV) fluid administration and peripheral IV catheters (PIVs) may be discontinued for a number of reasons. The most common reason for discontinuing IV fluids is that the patient has returned to normal body fluid volume (euvolemia) and is able to maintain adequate oral fluid intake or is being discharged from the hospital. In addition, the Centers for Disease Control Guidelines for the Prevention of Intravascular Catheter-Related Infections (2011) recommends replacing PIVs every 72-96 h in adults to prevent the risk of infection or phlebitis. If the PIV becomes dislodged or if the insertion site demonstrates the signs and symptoms of infection, infiltration, extravasation, or phlebitis, the PIV should be discontinued and replaced. For pediatric patients, the Infusion Nurses Society recommends replacing the PIV only when the IV infusion site is no longer patent or when it demonstrates the signs and symptoms of complications. This video describes the approach to discontinue IV fluid administration and PIVs.


 Nursing Skills

Central Venous Access Device Dressing Change

JoVE 10311

Source: Madeline Lassche, MSNEd, RN and Katie Baraki, MSN, RN, College of Nursing, University of Utah, UT

Central venous access devices (CVAD), commonly known as central lines or central catheters, are large-bore intravenous (IV) catheters that are introduced into the central circulation. Typically, CVADs terminate in the superior vena cava, just outside of the right atrium of the heart, but they may also terminate in any one of the great veins (i.e., aorta, inferior vena cava, brachiocephalic vein, pulmonary artery, internal iliac vein, or common femoral vein). Patients may need a CVAD for any number of reasons. CVADs allow for the rapid infusion of fluids to treat significant hypovolemia or shock. They are also beneficial when administering vasoactive medications, highly concentrated medications, total parenteral nutrition (TPN), or chemotherapy, because the increased blood volume in these areas allows for the hemodilution of these potentially caustic or reactive agents. Patients who must receive multiple non-compatible IV medications, those that require long-term IV medications, or those with limited vascular access may also require the placement of a CVAD. These devices may be tunneled (i.e., inserted into a vein at one location and tunneled under the skin to emerge through the skin at another site)


 Nursing Skills

Friction

JoVE 10324

Source: Nicholas Timmons, Asantha Cooray, PhD, Department of Physics & Astronomy, School of Physical Sciences, University of California, Irvine, CA

The goal of this experiment is to examine the physical nature of the two types of friction (i.e., static and kinetic). The procedure will include measuring the coefficients of friction for objects sliding horizontally as well as down an inclined plane. Friction is not completely understood, but it is experimentally determined to be proportional to the normal force exerted on an object. If a microscope zooms in on two surfaces that are in contact, it would reveal that their surfaces are very rough on a small scale. This prevents the surfaces from easily sliding past one another. Combining the effect of rough surfaces with the electric forces between the atoms in the materials may account for the frictional force. There are two types of friction. Static friction is present when an object is not moving and some force is required to get that object in motion. Kinetic friction is present when an object is already moving but slows down due to the friction between the sliding surfaces.


 Physics I

Cleaning Glassware

JoVE 10342

Source: Vy M. Dong and Daniel Kim, Department of Chemistry, University of California, Irvine, CA

Organic synthesis is about transforming a readily available reagent into a more valuable product. Having clean glassware is crucial for the efficiency of this process. Dirty glassware can potentially affect the reaction and make isolation of the final product more challenging. Thus, a synthetic chemist must keep the glassware spotless. The methods described here will detail different glass cleaning techniques that are regularly used to remove organics, metals, grease, and salts.


 Organic Chemistry II

Preparing and Administering Subcutaneous Medications

JoVE 10234

Source: Madeline Lassche, MSNEd, RN and Katie Baraki, MSN, RN, College of Nursing, University of Utah, UT

Subcutaneous medication administration is a parenteral approach to administer small amounts of medication (less than 2 mL) into the layer of tissue just below the skin. Common medications administered via the subcutaneous route include anticoagulant medications, such as heparin or enoxaparin; epinephrine administered for allergic reactions; insulin; and some immunizations. Subcutaneous injection preparations are commonly provided in vials or ampules for withdrawal into a subcutaneous syringe. Subcutaneous needles have a shorter length and smaller diameter than syringes used for intramuscular injections, are typically less than 5/8th of an inch, and are 26 gauge or smaller. Medication absorption and onset is slower than for intravenous routes, with some absorption rates lasting 24 h or longer. This approach is selected for many medications that may be denatured or deactivated if given via the oral route, given the acidity of the gastrointestinal tract. Subcutaneous injection preparations are commonly provided in vials or ampules for withdrawal into a subcutaneous syringe. The nurse should determine the appropriate medication dose according to


 Nursing Skills

Torque

JoVE 10345

Source: Nicholas Timmons, Asantha Cooray, PhD, Department of Physics & Astronomy, School of Physical Sciences, University of California, Irvine, CA

The goal of this experiment is to understand the components of torque and to balance multiple torques in a system to achieve equilibrium. Much like how a force causes linear acceleration, torque is a force that causes a rotational acceleration. It is defined as the product of a force and the distance of the force from the axis of rotation. If the sum of the torques on a system is equal to zero, the system will not have any angular acceleration.


 Physics I

Newton's Law of Universal Gravitation

JoVE 10325

Source: Ketron Mitchell-Wynne, PhD, Asantha Cooray, PhD, Department of Physics & Astronomy, School of Physical Sciences, University of California, Irvine, CA

Legend states that Isaac Newton saw an apple fall from a tree. He noticed the acceleration of the apple and deduced that there must have been a force acting upon the apple. He then surmised that if gravity can act at the top of the tree, it can also act at even larger distances. He observed the motion of the moon and the orbits of the planets and eventually formulated the universal law of gravitation. The law states that every particle in the universe attracts every other particle with a force that is proportional to the product of their masses and inversely proportional to the square of the distance between them. This force acts along the line joining the two particles. Gravitational acceleration g, which is the acceleration an object on the surface of the Earth experiences due to the Earth's gravitational force, will be measured in this lab. Accurately knowing this value is extremely important, as it describes the magnitude of the gravitational force on an object at the surface of the Earth.


 Physics I

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