REIMBURSEMENT ISSUES

1

Chapter 23 Mathematics Review and Medication
Administration
2
Fractions

• Definitions
• Numerator top number of a fraction
• Denominator bottom number of a fraction
• Types of Fractions
• Proper fractions numerator is less than the
  denominator
• Improper fractions numerator is larger than the
  denominator
• Mixed fractions consist of a whole number plus a
  fraction

3
Fractions

• Changing an Improper Fraction to a Whole or Mixed
  Number
• Divide the denominator into the numerator.
• Changing a Mixed Number to an Improper Fraction
• Multiply the denominator into the whole number.
• Add the numerator to the product the sum is now
  the new number.
• Reducing Fractions to the Lowest Term
• Find a number that will evenly divide into the
  numerator and the denominator.

4
Fractions

• Determining Which Fraction Is Larger
• If the denominators are the same, the fraction
  with the larger numerator is the larger fraction.
• If the denominators are different, you must find
  a common denominator.
• Finding a common denominator means to find a
  number into which both denominators can be
  divided.
• After the common denominator is found, an
  equivalent numerator for each fraction must be
  found. (Divide the first denominator into the
  equivalent denominator multiply the answer by
  the first numerator.)

5
Fractions

• Adding Fractions that Have the Same Denominator
• Add the numerators and place the sum of the
  numerators over the denominator.
• Adding Fractions that Have Different Denominators
• Find common denominators for all fractions in the
  problem.
• Find the equivalent numerators.

6
Fractions

• Adding Mixed Numbers
• Add the fractions of the mixed number. Then add
  the sum of the fractions to the whole number.
• Subtracting Fractions with the Same Denominator
• Subtract the numerator and place it over the
  denominator.
• Subtracting Fractions with Different Denominators
• Find a common denominator, and then subtract.

7
Fractions

• Subtracting Mixed Numbers
• When the numerator of the top fraction is smaller
  than that of the bottom fraction, borrow one
  whole number from the whole number of the mixed
  fraction and express it as a fraction.
• Multiplying Fractions
• Multiply the numerators multiply the
  denominators.
• Multiplying Fractions and Mixed Numbers
• Change the mixed number to an improper fraction.
• Multiply.

8
Fractions

• Dividing Fractions
• Write the problem down correctly invert the
  second fraction.
• Multiply.
• Dividing Fractions and Whole Numbers
• Change the whole number to a fraction
• Divide.

9
Decimal Fractions

• The decimal fraction is a type of fraction that
  uses a decimal to indicate the denominator of the
  fraction.
• The placement or position of the decimal point
  determines whether the denominator is 10, a
  multiple of 10, or a division of 10.

10
Decimal Fractions

• Names of Decimal Places
• .00001 One hundred thousandths
• .0001 Ten thousandths
• .001 Thousandths
• .01 Hundredths
• .1 Tenths
• 1. Unit (whole number)
• 10 Tens
• 100 Hundreds
• 1000 Thousands
• 10,000 Ten thousands
• 100,000 One hundred thousands

11
Decimal Fractions

• Names of Decimal Places (continued)
• A decimal point found left of a whole number
  means that the number is a fraction of a whole
  number.
• A decimal point found after a number means that
  it is a whole number.
• A number without a decimal point is understood to
  have an invisible decimal point behind it.

12
Decimal Fractions

• Adding Decimals
• Align the decimal point of each decimal fraction
  in a column.
• Add.
• Subtracting Decimals
• Align the decimal point of each decimal fraction
  in a column.
• Subtract.
• Rounding a Number
• Numbers found after the decimal point that are 5
  or larger can increase the number before it by
  one whole number.

13
Decimal Fractions

• Multiplying Decimals
• Multiply. Decimal points in the problem do not
  have to be aligned.
• The decimal place in the answer is determined by
  how many numbers are found to the right of the
  decimal points in the numbers multiplied.
• Dividing Decimals
• Change a decimal fraction in the divisor to a
  whole number by moving the decimal point all the
  way to the right.
• Move the decimal point in the dividend the same
  number of places moved in the divisor.

14
Decimal Fractions

• Dividing Decimals (continued)
• Place the decimal point in the answer directly
  over the decimal point in the dividend after
  moving the decimal point in the dividend.
• If a decimal point is in the divisor, but not in
  the dividend, move it the same number of places
  as the divisor. Remember, there is an unexpressed
  decimal point at the end of all whole numbers.
  Add zeros after the decimal point in the dividend
  as needed.
• If the dividend contains a decimal fraction and
  the divisor does not, leave the divisor as it is.

15
Decimal Fractions

• Changing Fractions to Decimals
• Divide the numerator by the denominator.
• Changing a Decimal Fraction to a Common Fraction
• To change a decimal fraction to a common
  fraction, give the decimal fraction a denominator
  according to the position of the decimal point in
  the decimal fraction.

16
Percents

• The word percent and its symbol, , mean
  hundredths.
• A hundredth is a fraction of a whole number
  therefore, a number followed by percent sign ()
  is a fraction.
• The denominator of the fraction is understood to
  be 100.

17
Percents

• Changing a Percent to a Decimal Fraction
• Remove move the decimal point two places to
  the left to indicate hundredths.
• Changing a Fraction to a Percent
• Change a fraction to a percent by dividing the
  numerator by the denominator.
• Multiply the answer by 100.
• Label the answer with the percent symbol, .
• Multiplying by Percent
• Change the percent to a decimal.
• Multiply.

18
Ratios

• Ratios show the relationship of one number or
  quantity to another number or quantity.
• Numbers of a ratio are separated by a colon.
• A ratio is also a fraction.
• The value of a ratio is not changed if both terms
  are multiplied or divided by the same number.
• When numbers are written in ratio, they must all
  be expressed in the same units.
• A fraction may be written as a ratio.

19
Proportions

• Proportion shows that the relationship between
  two ratios has equal value.
• Definitions
• Means inner terms of the proportion
• Extremes outer terms of the proportion
• Set up the left side of the proportion as the
  known side using information that is known or
  given.

20
Proportions

• Set up the known side.
• Set up the unknown side. Use x for what you are
  trying to find.
• Set up the units in the same position on each
  side of the problem.
• Multiply the means.
• Multiply the extremes
• Solve for x (divide the number with the x into
  the number on the opposite side of the problem).
• Label the answer with the unit of measurement
  that accompanies the x in the problem.

21
Proportions

• Review of Proportion Method
• Set up problems in the same order on both sides.
• Multiply the means multiply the extremes.
• The number multiplied with the x is always that
  number with the x to the right of it.
• Divide the number with the x into the number on
  the other side of the problem.
• Label the problem by looking to see what unit of
  measurement the x is with the proportion.

22
The Metric System

• The metric system is based on the decimal system.
  
• The decimal system uses the divisions and
  multiples of a unit, which is always in ratios of
  tens.
• The metric system uses the following units
• liter (L) volume (amount) of fluids
• gram (g) weight of solids
• meter (m) measure of length

23
The Metric System

• Smaller units of the system are designated by the
  following prefixes
• deci 0.1 of the unit (liter, gram, meter)
  tenths
• centi 0.01 of the unit hundredths
• milli 0.001 of the unit thousandths
• Larger units of the system are designated by the
  following prefixes
• deka 10 times the unit (liter, gram, meter)
• hecto 100 times the unit
• kilo 1000 times the unit

24
The Metric System

• Units of Weight
• 1 gram (g) 1000 milligrams (mg)
• 0.001 gram (g) 1 milligram (mg)
• 1 kilogram (kg) 1000 grams (g)
• 0.001 kilogram (kg) 1 gram (g)
• Units of Volume
• 1 liter (L) 1000 milliliters (ml)
• 0.001 liter (L) 1 milliliter (ml)
• 1 milliliter (ml) 1 cubic centimeter (cc)

25
The Metric System

• Approximate Equivalents of the Metric System and
  the Apothecary System
• Volume
• 1 milliliter (ml) 15 or 16 minims
• 4 or 5 milliliters (ml) 1 fluid dram
• 30 milliliters (ml) 1 fluid ounce
• 500 milliliters (ml) 1 pint
• 1000 milliliters (ml) 1 quart

26
The Metric System

• Approximate Equivalents of the Metric System and
  the Apothecary System (continued)
• Weight
• 60 milligrams (mg) 1 grain (gr)
• 1000 milligrams (mg) 15 grains
• 4 grams (g or gm) 1 dram
• 30 grams (g) 1 ounce
• 0.45 kilogram (kg) 1 pound (lb.)
• 1 kilogram (kg) 2.2 pounds (lbs.)

27
The Metric System

• Metric Measurements of Length
• The basic unit of length is the meter.
• The meter is equal to 39.37 inches.
• 0.001 meter 1 millimeter (mm)
• 0.01 meter 1 centimeter (cm)
• 0.1 meter 1 decimeter (dm)
• 10 meters 1 decameter (dam)
• 100 meters 1 hectometer (hm)
• 1000 meters 1 kilometer (km)

28
The Metric System

• Metric Measurements of Length
• Most Frequently Used Equivalents
• 1 meter (m) 1000 millimeters (mm)
• 0.001 meter (m) 1 millimeter (mm)
• 1 meter (m) 100 centimeters (cm)
• 1 centimeter (cm) 10 millimeters (mm)
• 1 millimeter (mm) 0.1 centimeter (cm)

29
Pediatric Considerations

• Youngs Rule
• A method for the calculation of the appropriate
  dose of a drug for a child 2 years of age or
  older applies to children up to the age of 12
• Age of child__
• (Age of child 12)

X Average adult dose Childs dose
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Pediatric Considerations

• Clarks Rule
• A method of calculating the approximate pediatric
  dosage of a drug for a child
• Weight of child (lbs.)
• 150

X Average adult dose
Childs dose
31
Pediatric Considerations

• Frieds Rule
• This rule is used for infants younger than 2
  years of age.
• Age in months
• 150

X Average adult dose Childs dose
32
Pediatric Considerations

• Estimating Body Surface Area in Children
• Body surface area is defined as the total area
  exposed to the outside environment.
• Use body surface area scale to find the correct
  surface area (SA).
• SA (m2)
• 1.73 m2

X Adult dose Childs dose
33
Pharmacology

• This is the study of drugs and their action on
  the living body.
• Substances derived from plants and animals, from
  vitamins and minerals, and from synthetic sources
  can be used as drugs in the treatment and
  prevention of disease.
• The action of any drug on the body is a
  complicated process.

34
Pharmacology

• Pharmaceutical Phase
• The making of the drug until absorption of the
  drug takes place in the patients body
• Pharmacokinetic Phase
• The movement of the drugs active ingredients
  from the body fluids into the entire system and
  to the site where the intended action of the drug
  takes place
• Pharmacodynamic Phase
• Interaction of the drugs active ingredient with
  the intended body tissues the bodys cells
  respond to the action of the drug and change as
  the drug is metabolized

35
Pharmacology

• Drug Dosage
• The dosage is the amount of a drug prescribed for
  the patient by the physician.
• A dose of medicine refers to a single prescribed
  amount of drug given at one time.
• Nurses must become familiar with therapeutic
  dosages of frequently used drugs to confidently
  administer dosages of medication to each patient.

36
Pharmacology

• Drug Actions and Interactions
• Two general types
• Local affect only the area where the drug is
  placed
• Systemic affect the entire body
• Drug interaction one drug alters another drug
• Potentiation one drug increases the action or
  effect of another drug
• Incompatibilitydrugs that do not combine
  chemically with other drugs
• Antagonist drug that will block the action of
  another drug

37
Pharmacology

• An idiosyncratic response to a drug is an
  individuals unique hypersensitivity to a
  particular drug.
• A reduced response to a drug is called tolerance.
• An adverse drug reaction is a harmful, unintended
  reaction to a drug administered at a normal
  dosage.
• Contraindications are conditions under which the
  drug should not be given.
• Interactions are modifications of the effect of a
  drug when administered with another drug.

38
Pharmacology

• Factors that may affect how patients respond to
  medication
• Age
• Weight
• Physical health
• Psychological status
• Environmental temperature
• Gender
• Amount of food in the stomach
• Dosage forms

39
Medication Orders

• The nurse is ethically and legally responsible
  for ensuring that the patient receives the
  correct medication ordered by the physician.
• Medication orders should include the following
• Patient's name
• Date and time of the order
• Name of the drug
• Dosage of the drug
• Route of administration
• Time or frequency drug is given
• Signature of the physician
• Any special instructions

40
Medication Orders

• Controlled Substances
• Opioids, barbiturates, and other controlled drugs
  that have a high possibility for abuse or
  addiction are double-locked.
• Narcotic keys are kept by designated nurses per
  shift.
• Each controlled drug used is logged into the
  narcotic log book.
• At the end of each shift, controlled drugs are
  carefully counted by a nurse from the outgoing
  shift and a nurse from the incoming shift.
• Always have a witness to the wasting of a
  controlled substance.

41
Medication Orders

• Types of Orders
• Standing Orders
• Already written by a physician for all patients
  on a particular unit or area
• Carried out without having to call the physician
• Verbal Orders
• May be given in the presence of an LPN/LVN or an
  RN directly or over the telephone
• Should be written on the chart and signed by the
  physician as soon as possible

42
Medication Administration

• Six Rights
• Right medication
• Right dose
• Right time
• Right route
• Right patient
• Right documentation

43
Medication Orders

• Important Considerations of Medication
  Administration
• If you did not pour it, do not give it.
• If you gave it, chart it.
• Do not chart for someone else or have someone
  else chart for you.
• Do not transport or accept a container that is
  not labeled.
• Do not put down an unlabeled syringe.
• If given a verbal order, repeat it to the
  physician.
• If you make an error, report it immediately.

44
Medication Orders

• Important Considerations of Medication
  Administration (continued)
• Never leave a medication with a patient or family
  member. Watch the patient take it and swallow it.
• Always return to assess the patients response.
• Chart as soon as possible after giving
  medication.
• If a patient refuses medication, do not force it
  chart Refused medication because of .
• If you elect to omit a dose based on your nursing
  judgment, let another nurse help make the
  decision. If medication is not given, document
  Dose omitted because . Report to the physician.

45
Routes of Administration

• Enteral
• Via the GI Tract
• Powders
• Pills
• Tablets
• Liquids or suspensions
• Suppositories

46
Routes of Administration

• Percutaneous
• Through the Skin or Mucous Membranes
• Topical
• Instillation
• Inhalation

47
Routes of Administration

• Parenteral
• Methods Other than the GI Tract Needle Route
• Ampules
• Vials
• Intramuscular
• Subcutaneous
• Intradermal
• Intravenous

48
Enteral Administration

• Preparation of Tablets, Pills, and Capsules
• These preparations enter the GI tract and are
  absorbed more slowly into the bloodstream than
  via any other route.
• The slow absorption rate makes the PO (by mouth)
  route relatively safe.
• Some PO medications are irritating to the
  patients GI tract, and larger tablets may be
  difficult for some patients to swallow.

49
Skill 23-1 Step 5
(From Potter, P.A., Perry, A.G. 2005.
Fundamentals of nursing. 6th ed.. St. Louis
Mosby.)
Administering tablets, pills, and capsules.
50
Enteral Administration

• Preparation of Liquid Medications
• Liquid medications are often given to children
  to patients who cannot swallow tablets, pills, or
  capsules and to geriatric patients.
• Medications may be given PO or via a nasogastric,
  gastrostomy, or jejunostomy tube.
• Liquids must not be given to unconscious patients
  because of the possibility of aspirating.
• Some liquid medications are not to be followed by
  water, and some may stain the teeth.

51
Skill 23-2 Step 13
(From Potter, P.A., Perry, A.G. 2005.
Fundamentals of nursing. 6th ed.. St. Louis
Mosby.)
Administering liquid medications.
52
Enteral Administration

• Tubal Medications
• Nasogastric (NG) tubes are used to administer
  liquid medications to unconscious patients,
  dysphagic patients, and those who are too ill to
  eat.
• Many medications come in liquid form if they do
  not, solid tablets may be pulverized in a mortar
  and pestle, and capsules can be opened.
• Not all tablets are safe to use when crushed, and
  not all capsules are safe to use when opened.

53
Skill 23-3 Step 13
Administering tubal medications.
54
Skill 23-3 Step 16
Administering tubal medications.
55
Enteral Administration

• Suppositories
• Cone-shaped, egg-shaped, or spindle-shaped
  medication made for insertion into the rectum or
  vagina
• Dissolves at body temperature and absorbed
  directly into the bloodstream
• Useful for infants, patients who cannot take oral
  preparations, and patients with nausea and
  vomiting
• Stored in cool place so they do not melt

56
Percutaneous Administration

• With these routes, medications are absorbed
  through the skin or the mucous membranes.
• Most produce a local action, but some produce a
  systemic action.
• Drugs include topical applications,
  instillations, and inhalations and ointments,
  creams, powders, lotions, and transdermal
  patches.
• Absorption is rapid but of short duration.

57
Percutaneous Administration

• Ointments
• An oil-based semisolid medication may be applied
  to the skin or a mucous membrane
• Creams
• Semisolid, nongreasy emulsions that contain
  medication for external application
• Lotions
• Aqueous preparations that are used as soothing
  agents that relieve pruritus, protect the skin,
  cleanse the skin, or act as astringents

58
Percutaneous Administration

• Transdermal Patches (Topical Disk)
• Adhesive-backed medicated patches applied to the
  skin provide sustained, continuous release of
  medication over several hours or days.
• Eyedrops and Eye Ointments
• Care should be taken to keep all ophthalmic
  preparations sterile by not touching the dropper
  or the tube to the eye.
• Eardrops
• Containers of solutions to be used as eardrops
  will be labeled otic. They must be at room
  temperature when applied.

59
Figure 23-3
(From Elkin, M.K., Perry, A.G., Potter, P.A.
2004. Nursing interventions and clinical
skills. 3rd ed.. St. Louis Mosby.)
A variety of medications are available as
transdermal patches.
60
Percutaneous Administration

• Nosedrops
• Nosedrops are for individual use only.
• Nasal Sprays
• Sprays absorbed quickly less medication is used
  and wasted when administered in this manner.
• Inhalation
• Drugs may be absorbed through the mucous
  membranes of the respiratory tract.
• Inhalation produces a relatively limited effect
  or a systemic effect.
• This method is actively used by respiratory
  therapy and anesthesiologists.

61
Percutaneous Administration

• Sublingual Administration
• Drug is administered by placing it beneath the
  tongue until it dissolves.
• Drug may be a tablet or liquid squeezed out of a
  capsule.
• It is rapidly absorbed into the bloodstream.
• Buccal Administration
• A tablet is placed between the cheek and teeth,
  or between the cheek and the gums.
• Absorption into the capillaries of the mucous
  membranes of the cheek gives rapid onset of the
  drugs active ingredient.

62
Parenteral Administration

• Equipment
• Syringes
• Syringe consists of a barrel, a plunger, and a
  tip.
• Outside of the barrel is calibrated in
  milliliters, minims, insulin units, and heparin
  units.
• Types
• Tuberculin syringe
• Insulin syringe
• Three-milliliter syringe
• Safety-Lok syringes
• Disposable injection units

63
Figure 23-4
(From Elkin, M.K., Perry, A.G., Potter, P.A.
2004. Nursing interventions and clinical
skills. 3rd ed.. St. Louis Mosby.)
Parts of a syringe.
64
Figure 23-5
(From Clayton, B.D., Stock, Y.N. 2004. Basic
pharmacology for nurses. 13th ed.. St. Louis
Mosby.)
Tuberculin syringe calibration.
65
Figure 23-6
(From Clayton, B.D., Stock, Y.N. 2004. Basic
pharmacology for nurses. 13th ed.. St. Louis
Mosby.)
Calibration of U100 insulin syringe.
66
Figure 23-7
Reading the calibrations of a 3-mL syringe.
67
Figure 23-9
Safety-Glide syringe.
68
Figure 23-11
(From Clayton, B.D., Stock, Y.N. 2004. Basic
pharmacology for nurses. 13th ed.. St. Louis
Mosby.)
Parts of a needle.
69
Percutaneous Administration

• Equipment (continued)
• Needles
• Parts are the hub, shaft, and beveled tip.
• Opening at the needles beveled tip is the lumen.
• Size of the diameter of the inside of the
  needles shaft determines the gauge of the
  needle the smaller the gauge, the larger is the
  diameter.
• Needle gauge selection is based on the viscosity
  of the medication.

70
Percutaneous Administration

• Equipment (continued)
• Needle Length
• Selected based on the depth of the tissue into
  which the medication is to be injected
• Intradermal 3/8 to 5/8 inch
• Subcutaneous 5/8 to 1/2 inch
• Intramuscular 1 to 1 1/2 inch
• Intravenous Needles
• Butterfly (scalp needle)
• Over-the-needle catheter (Angiocath, Jelco)

71
Figure 23-12
(From Clayton, B.D., Stock, Y.N. 2004. Basic
pharmacology for nurses. 13th ed.. St. Louis
Mosby.)
Needle length and gauge.
72
Percutaneous Administration

• Equipment
• Needleless Devices
• Devices are designed with a sheath or guard that
  covers the needle after it is withdrawn from the
  skin.
• Intravenous catheters have been designed with
  blunt-edged cannulas, valves, or needle guards to
  minimize injuries.
• IV tubing with recessed and shielded needle
  connectors have been designed, further reducing
  needlesticks.

73
Percutaneous Administration

• Intramuscular Injections
• Involves inserting a needle into the muscle
  tissue to administer medication
• Site Selection
• Gluteal sites
• Vastus lateralis muscle
• Rectus femoris muscle
• Deltoid muscle
• Z-track Method
• Used to inject medications that are irritating to
  the tissues

74
Figure 23-15, C
(C, from Elkin, M.K., Perry, A.G., Potter, P.A.
2004. Nursing interventions and clinical
skills. 3rd ed.. St. Louis Mosby.)
Locating IM injection for ventrogluteal site.
75
Figure 23-16, C D
(C, D, from Elkin, M.K., Perry, A.G., Potter,
P.A. 2004. Nursing interventions and clinical
skills. 3rd ed.. St. Louis Mosby.)
Locating right dorsogluteal site. Giving IM
injection in left dorsogluteal site.
76
Figure 23-17, C
(C, from Elkin, M.K., Perry, A.G., Potter, P.A.
2004. Nursing interventions and clinical
skills. 3rd ed.. St. Louis Mosby.)
Giving IM injection in vastus lateralis site on
adult.
77
Figure 23-18
(From Clayton, B.D., Stock, Y.N. 2004. Basic
pharmacology for nurses. 13th ed.. St. Louis
Mosby.)
Rectus femoris muscle. A, Child/infant. B, Adult.
78
Figure 23-19, C
(C, from Elkin, M.K., Perry, A.G., Potter, P.A.
2004. Nursing interventions and clinical
skills. 3rd ed.. St. Louis Mosby.)
Giving IM injection in deltoid site.
79
Figure 23-20
(From Potter, P.A., Perry, A.G. 2005.
Fundamentals of nursing. 6th ed.. St. Louis
Mosby.)
A, Z-track method. B, Using an air lock. C,
Administering IM injection by airlock technique.
80
Percutaneous Administration

• Intradermal Injections
• Introduction of a hypodermic needle into the
  dermis for the purpose of instilling a substance
  such as a serum, vaccine, or skin test agent
• Not aspirated
• Small volumes (0.1 ml) injected to form a small
  bubblelike wheal just under the skin
• Used for allergy sensitivity tests, TB screening,
  and local anesthetics
• A tuberculin syringe used with a 25-gauge, 3/8-
  to 5/8-inch needle

81
Figure 23-21
(From Potter, P.A., Perry, A.G. 2005.
Fundamentals of nursing. 6th ed.. St. Louis
Mosby.)
Angles of insertion for intramuscular (90),
subcutaneous (45), and intradermal (15).
82
Percutaneous Administration

• Subcutaneous Injections
• Injections made into the loose connective tissue
  between the dermis and the muscle layer
• Drug absorption slower than with IM injections
• Given at a 45-degree angle if the patient is thin
  or at a 90-degree angle if the patient has ample
  subcutaneous tissue
• Usual needle length is 1/2 to 5/8 inch and 25
  gauge
• Used to administer insulin and heparin

83
Figure 23-22
(From Elkin, M.K., Perry, A.G., Potter, P.A.
2004. Nursing interventions and clinical
skills. 3rd ed.. St. Louis Mosby.)
Subcutaneous injection. Angle and needle length
depend on the thickness of skinfold.
84
Percutaneous Administration

• Intravenous Therapy
• Provide fluid and electrolyte maintenance,
  restoration, and replacement
• Administer medication and nutritional feedings
• Administer blood and blood products
• Administer chemotherapy to cancer patients
• Administer patient-controlled analgesics
• Keep a vein open for quick access

85
Percutaneous Administration

• Methods of Intravenous Administration
• IV push
• Intermittent venous access device
• Intermittent infusion (or piggyback)
• Continuous infusion
• Electronic pumps and controllers
• Patient-controlled analgesia
• Volumetric chambers

86
Figure 23-24
(From Potter, P.A., Perry, A.G. 2005.
Fundamentals of nursing. 6th ed.. St. Louis
Mosby.)
PCA infusion pump.
87
Figure 23-25
Volumetric chamber.
88
Percutaneous Administration

• Nursing Responsibility
• The nurse must ensure that fluid of the ordered
  type and amount is started and that the fluid is
  regulated to infuse over the period ordered.
• To find the drops per minute (the drip rate), you
  must know which type of IV tubing will be used
  with the infusion and obtain the drip factor for
  the tubing to be used.

89
Percutaneous Administration

• Nursing Responsibility (continued)
• Monitor Intravenous Therapy
• Check the infusion and the IV needle site at
  least every hour.
• Flow of fluid
• IV site erythema, wetness, and edema
• Phlebitis inflamed vein
• Infiltration fluid passes into the tissues
• Assess for chills, fever, headache, nausea,
  vomiting, anxiousness, and dyspnea.

90
Percutaneous Administration

• Nursing Responsibility (continued)
• Assess for Anaphylactic Shock
• Respiratory distress
• Skin reactions
• Signs of circulatory collapse
• GI signs and symptoms
• Change in mental status
• Requires immediate intervention.

91
Nursing Process

• Nursing Diagnoses
• Anxiety
• Health-seeking behaviors
• Injury, risk for
• Knowledge deficient
• Mobility, impaired
• Noncompliance drug regimen
• Sensory/perception, disturbed