Question

Discussion

1- Describe the fastest rout of medication administration and their expected onset. Give examples!

2- When given an IM injection what method is used and in which patients is contraindicated to give them IM injections?

3- Give examples of hypotonic and hypertonic solutions and how they work?

4- What solutions are considered identical to plasma volume and what is their effect on the human cell?

5- Describe fluid overload and dehydration, provide signs and symptoms; and nursing interventions for each scenario.

Answer 1

1. Intravenous route (IV)

In which the drug is injected directly into a vein and entered the blood stream quickly than other route of administration.

Onset it has a fastest onset of stimulation with peak in 10-15 minutes after injection and last for less than 30 minutes.

Eg:chemotherapic drugs (doxorubicin), Antibiotics (vancomycin)

2.

Step 1: Find the knobbly top of the arm (acromian process)

Step2: The top border of an inverted triangle is two finger widths down from the acromion process .

Step 3: stretch the skin and then bunch up the muscle

Step4: insert the needle at a right-angle (90 degree) to the skin in the centre of the inverted triangle.

Contraindications :

* Acute myocardial infarction, Intramuscular injection leads to the relase of muscle specific enzymes which complicate the laboratory diagnosis of myocardial infarction.

*Shock, Bloodsupply in the periphery is reduced which means in secure absorption of the active substances.

*coagulation disorders, It may cause risk for hematoma formation in the injection site

Eg: hemophilia

3.* Hypertonic solution: A solution that contain more desolved particles such as salt and other electrolytes.

Eg: saline solution (5%dextrose and 0.45%Nacl)

Mechanism: Hypertonic fluids contains a higher concentration of solute compared to plasma and interstetial fluids.This creates an osmotic gradient and drives fluid from the interstitial space into the intravascular space.

*Hypotonic solution: A solution that contain fewer desolved particles such as salt and other electrolytes that is found in normal cell and blood.

Eg: 0.45% Normal Saline

Mechanism : A hypotonic solution has a low solute concentration than the inside of the cell( solute concentration in the cell is high) .Osmotic force of then cause water from a solution to enter the cells. The cell eventually stretches and bursts in the process becoming lysis.

4. CRYSTALLOIDS

The most commonly used crystalloid fluid is normal saline ,a solution of sodium chloride at 0.9%concentration ,which is close to the concentration in the blood (isotonic).Saline solution administered intravenously and increses both intravascular and interstitial volume .

5. FLUID OVERLOAD

Fluid overload is a condition in which there is too much fluid in the blood which is also known as hypervolemia.

signs and symptoms : *Edema (especially lower extremities )

* Tiredness

*High blood pressure

*Bounding pulse ,tachycardia

*Cardiac problems eg: palpitation

*Abdominal distention

*Pitting edema

*Shortness of breath

INTERVENTION :

*Monitor the patient response to diuresis

- monitoring of weight, and intake output chart.

*Advocate patients of avoiding food with high sodium content.

*Review the doctor whenever necessary

DEHYDRATION

Excessive loss of fluid from the body-occurs when the loss of fluid exceed the fluid intake.

signs and symptoms:

*feeling excessive thirst

* Dark yellow and strong smelling pee

*Dizziness

*Tiredness.

*Dry mouth,lips and eye

*Poor skin turgor.

INTERVENTIONS:

* Obtain patient history to determine the cause of fluid imbalance

*Insert a urinary catheter ,as ordered for accurate monitoring of fluid output .

* Encourage the patient to increase oral intake of fluid

*Provide oral fluids of patient's preference and place within easy reach.

*avoid acidic juices,if the patient has impaired oral membrane integrity.

*provide intravenous fluid replacement of the patient can't orally consume adequate amounts of fluids.

*Continuous monitoring.