Chapter 2

Case Study #1

1) When initiating an IV for Gary, consider the following:

• Age
• Health history (including hypertension, diabetes, and colon cancer)
• Current symptoms and the need for PIV access to administer and deliver the medication
• Location of a vein for IV access
• Infection control measures and sterile technique for IV insertion

2) Based on the supplied metoprolol of 10 mg/10 mL, each dose of metoprolol for Gary will be 5 mg. To administer this dose, you would need to draw 5 mL of the medication into the syringe.

The rate of administration will depend on the administration method. If it is given as a rapid IV push, you would administer the 5 mL dose over 1-2 minutes and then wait 2 minutes and repeat up to three doses as ordered by the MD.

3) Medication Information

Indication and action of medication:

• Metoprolol is indicated for the treatment of hypertension, angina, and heart failure. It works by blocking the effect of certain hormones (epinephrine and norepinephrine) on the heart and blood vessels, which reduces the heart rate, blood pressure, and workload on the heart.

Onset, peak, and duration of the medication:

• Intravenous (IV) metoprolol has an onset time of approximately 5 minutes, a peak effect within 15 to 30 minutes, and a duration of 3 to 6 hours.

Nursing considerations or special instructions for use:

• Monitoring vital signs: Metoprolol can cause bradycardia and hypotension, so the client’s heart rate, blood pressure, and electrocardiogram should be monitored closely.

Assessments pre-, post-, and during administration:

• Pre-administration: Assess blood pressure and heart rate. Also, assess for any known allergies or adverse reactions to beta-blockers.
• During administration: Monitor blood pressure, heart rate, and respiratory rate. Assess for any signs of adverse reactions, such as chest pain, shortness of breath, or swelling of the legs or ankles.
• Post-administration: Monitor blood pressure and heart rate and assess for any changes in symptoms.

Patient education:

• Explain the purpose and action of metoprolol.
• Inform Gary that the medication will be given as a rapid injection into a vein. He may experience the following common side effects:
  • Decreased heart rate
  • Low blood pressure
  • Dizziness
  • Fatigue

• It is important that Gary communicates immediately to the health care provider if he notes any worsening of symptoms or side effects.

Case Study #2

1) When initiating an IV for Karen, consider the following:

• Assess Karen’s veins for IV placement, ensuring that the veins are large enough to accommodate the IV catheter. Note the presence of a client’s IV fistula, or location of hemodialysis access site, and take care to restrict IV placement to a non-fistula arm.
• Consider the type and amount of fluids Karen requires, taking into account her chronic kidney disease and biweekly dialysis.

2) Based upon the supply of medication 16mg/8mL, you will administer 4mL of medication IV push.

The IV push should be administered slowly between 2-5 minutes.

3) Medication Information

Indication and action of medication:

• Ondansetron is indicated for the treatment of nausea and vomiting. It acts by blocking the action of serotonin in the brain and gut, which reduces the stimulation of the vomiting center.

Onset, peak, and duration:

The onset of ondansetron is within 15 minutes, with a peak effect within 30 minutes, and a duration of 4 to 8 hours.

Nursing considerations or special instructions for use:

• Assess for potential allergies or adverse reactions to ondansetron before administering.
• Monitor Karen’s vital signs and level of consciousness during and after administration.
• Administer the medication slowly to avoid extravasation, which can cause tissue damage.

Assessments pre-, post-, and during administration:

• Pre-administration: Assess Karen’s level of nausea, vomiting, and hydration status.
• During administration: Monitor Karen’s vital signs and level of consciousness and check for any adverse reactions or extravasation.
• Post-administration: Assess Karen’s level of nausea and vomiting and document any adverse reactions or improvement.

Patient education:

• Explain to Karen the purpose and action of the medication and how it may help with her nausea and vomiting.
• Advise Karen to inform the health care provider if she experiences any adverse reactions, such as difficulty breathing, chest pain, or severe headache.
• Explain the importance of proper hydration and encourage Karen to drink clear fluids to prevent dehydration.

All of the answers to the interactive element are found within the element.