This document provides an overview of pharmacology basics including definitions of key terms, drug categories, pharmacodynamics, pharmacokinetics, drug computations, and examples of nursing teachings related to over-the-counter medications and sample patient cases. Key concepts covered include drug absorption, distribution, metabolism, excretion, factors influencing drug effects, allergic reactions, and conversions between units of measurement for drug dosages.

1. Must- Knows About Pharmacology Basics By: Dave Manriquez RN.

2. Basic concepts and Drug Categories

23. Pharmacodynamics

29. Pharmacokinetics

52. Drug effects and Misuse

63. Higher blood dose of Penicillin for a longer time Probenecid blocks excretion of Penicillin Probenecid is added Penicillin for bacterial infection Potentiating effect: An example

64. Lesser dose of Codeine needed More pain relief Aspirin is added Codeine for pain relief Additive effect: An example

69. Drug Computations

97. Principles in Drug Administration

98. Medication Orders / Forms of Meds

108. Basic Principles

173. The type of physician’s order that is carried out upon the judgment of the nurse, as required by the patient is: a. Standing order b. Single order c. STAT order d. PRN order PRACTICE QUESTIONS 

174. The most accurate method of identifying a client before drug administration is by: a. Asking the client to state his name b. Calling the client by his name c. Asking a relative to identify the client d. Checking the identification band/ bracelet of the client PRACTICE QUESTIONS 

176. During application of medication into the ear, which of the following is an inappropriate nursing action? a. Warm the medication at room or body temperature b. In an adult, pull the pinna upward c. Instill the medication directly into the tympanic membrane d. Press the tragus of the ear a few times to assist the flow of medication into the ear canal PRACTICE QUESTIONS 

178. Extracellular fluids Intracellular fluids Division of Body fluids 40% of body weight 20% of body weight PARENTERAL MEDICATION/ IV FLUIDS

179. Diffusion Movement of Fluids PARENTERAL MEDICATION/ IV FLUIDS

180. Osmosis Movement of Fluids PARENTERAL MEDICATION/ IV FLUIDS

181. Filtration Movement of Fluids PARENTERAL MEDICATION/ IV FLUIDS

182. Exercise Question: What is the mechanism by which Mannitol decreases IOP in patients with Glaucoma? a. Diffusion b. Osmosis c. Filtration d. Diuresis PARENTERAL MEDICATION/ IV FLUIDS

183. Exercise Question: The movement of air from the environment into the lungs follows what principle of gas movement? a. Diffusion b. Osmosis c. Respiration d. Filtration PARENTERAL MEDICATION/ IV FLUIDS

184. Exercise Question: Who among the following are at highest risk for dehydration? a. A breastfeeding 8-month old infant b. A 17 year-old with fever c. A 61 year-old man jogging d. A pregnant woman PARENTERAL MEDICATION/ IV FLUIDS

185. Above 40 y.o.: 40-50% Fast fact: Body fat is inversely proportional to body fluids. Adult: 50-60% Infant: 60-70% Neonate: 70-80 % Fluids as Percentage of Body weight PARENTERAL MEDICATION/ IV FLUIDS

186. Urine Lungs (Insensible) Average daily adult output: 1400-1500 mL 350-400 mL 350-400 mL 100 mL Skin (Insensible) Sweat Feces Total 100-200mL 2,300-2,600 mL PARENTERAL MEDICATION/ IV FLUIDS

187. Osmotic/ Oncotic pressure Hydrostatic pressure Pressures within the Blood vessel Pushing force of a fluid against the walls that contain it Pulling power of a solution for water PARENTERAL MEDICATION/ IV FLUIDS

188. ? Trivia Time What happens when hydrostatic pressure exceeds osmotic/oncotic pressure? PARENTERAL MEDICATION/ IV FLUIDS

189. ? Trivia Time: ANSWER 3 rd space fluid shift: manifested by decreased urine output. Occurs in burns, peritonitis, massive bleeding into a joint/cavity. PARENTERAL MEDICATION/ IV FLUIDS

190. Trivia Question: Are osmolality and Osmolarity the same? PARENTERAL MEDICATION/ IV FLUIDS

191. Osmolarity: Osmolality: Osmolality vs Osmolarity Solute / Kg of Water Solute/ Kg of a solution PARENTERAL MEDICATION/ IV FLUIDS

192. Osmolality vs Osmolarity Can we use the terms interchangeably? Yes If osmolality is high, what is the osmotic pressure of that solution? High PARENTERAL MEDICATION/ IV FLUIDS

193. Osmolality And Sodium Major plasma solute that determines Osmolality: Na Formula for estimated Osmolality: 2 x Serum Na Na: 135-145 mEq/L Serum Osmolality: 270-290 mOsm/L PARENTERAL MEDICATION/ IV FLUIDS

194. Isotonic solution Types of solutions: PARENTERAL MEDICATION/ IV FLUIDS

195. Indications: Dehydration or any ECF volume deficit Types of solutions: ISOTONIC Same osmolality as plasma Osmolality: PARENTERAL MEDICATION/ IV FLUIDS

196. Normal Saline(PNSS; 0.9% NaCl): NaCl ISOTONIC Solutions: Ringer’s Sol’n.: Na,K,Ca Lactated Ringer’s: Ringer’s + Lactate & Chloride PARENTERAL MEDICATION/ IV FLUIDS

197. Trivia Question: Do most isotonic fluids contain dextrose, magnesium or bicarbonate? NO PARENTERAL MEDICATION/ IV FLUIDS

198. 5% Dextrose in water (D5W) Lactated Ringer’s Solution 0.9% Saline (NS) Memory tip: commonly used solutions Isotonic Solutions 5% Dextrose in .225% Saline (5% D/ 1.4 NS) Exceptions to the memory tip on hypertonic solutions PARENTERAL MEDICATION/ IV FLUIDS

199. Hypertonic solution Types of solutions: PARENTERAL MEDICATION/ IV FLUIDS

200. Indications: Hyponatremia Types of solutions: HYPERTONIC Used in limited doses in carefully controlled settings via an infusion pump Precaution: Hypernatermia & FVO Risks: Close monitoring (V/S; Lungs; Neuro; Na) Nursing action: PARENTERAL MEDICATION/ IV FLUIDS

201. Sample Question: This hypertonic solution may be given via IV push for hypoglycemia in a code situation: a. 50% Dextrose b. 10% Dextrose c. PNSS d. 5% Saline PARENTERAL MEDICATION/ IV FLUIDS

202. Sample Question: This hypertonic solution is used to treat newborns with hypoglycemia as part of the treatment protocol: a. 5% Dextrose b. 10% Dextrose c. Plain LR d. 5% Saline PARENTERAL MEDICATION/ IV FLUIDS

203. TYPES OF INTRAVENOUS SOLUTIONS 10 % Dextrose in water (D10W) 5% Saline (5% NS) 3% Saline (3% NS) Memory tip: anything that’s above 0.9% or any combinations Hypertonic Solutions 5% Dextrose in 0.9% Saline (5% D/NS) 5% Dextrose in 0.45% Saline (5% D/ 1/2NS) 5% Dextrose in lactated ringer’s solution

204. Trivia Question: Do most hypertonic solutions provide calories to cells? Yes PARENTERAL MEDICATION/ IV FLUIDS

205. Hypotonic solution Types of solutions: PARENTERAL MEDICATION/ IV FLUIDS

206. Indications: Cellular dehydration Types of solutions: HYPOTONIC Acute brain injury Major contraindication: PARENTERAL MEDICATION/ IV FLUIDS

207. TYPES OF INTRAVENOUS SOLUTIONS 0.33% Saline (1/3 NS) 0.225% Saline (1/4 NS) 0.45% Saline (1/2 NS) Memory tip: anything that’s below 0.9% Hypotonic Solutions

208. Sample Question: If 1 liter of 0.45 saline/ 0.225 saline is given to patient, how much of it actually enters the cells a. 1 Liter b. 800 mL c. 500 mL d. 200 mL PARENTERAL MEDICATION/ IV FLUIDS

209. Sample Question: Does D5W provide adequate nutritional calories? No, but it does prevent ketosis PARENTERAL MEDICATION/ IV FLUIDS

210. Colloid volume expanders Types of solutions: PARENTERAL MEDICATION/ IV FLUIDS

211. Indications: Acute volume loss Types of solutions: Colloid volume expanders Albumin, Dextran, Hetastarch Examples: PARENTERAL MEDICATION/ IV FLUIDS

212. Air embolism prevention by: Priming IV tubing Change IV tubing every: 72 hours Change IV needle insertion site every: 15-20 minutes PARENTERAL MEDICATION/ IV FLUIDS IV Fluid therapy guidelines: Regulate IV every: 72 hours

224. Insulin Therapy and Oral Hypoglycemics

225. INSULIN Types of Insulin: Combination Insulin (Regular / Intermediate) Long-acting Intermediate- Acting Short-acting Rapid/ultra-short

226. INSULIN Types of Insulin: Ultra- Lente Lente Semi- Lente Humulin U Humulin N Humulin R Humulin 70/30, Humulin 50/50 Combination Insulin (Regular / Intermediate) Insulin Glargine (Lantus) Long-acting NPH/Isophane Insulin Intermediate- Acting Regular Insulin Short-acting Insulin Aspart, Insulin Lispro Rapid/ultra-short

227. INSULIN IN ACTION Long-acting Intermediate acting Short acting Rapid Duration Peak Onset Insulin type

228. INSULIN IN ACTION x2 x3 +10 / 3 Long-acting x3 x3 + 10 / 2 Intermediate acting x3 2-4 hours KEY VALUE / 2 Short acting x3 .5-1.5 hours / 2 Rapid Duration Peak Onset Insulin type

229. MIXING INSULIN ( R . N . Mnemonic) R = N = Note: never shake the vial ‘cos it creates bubbles leading to inaccurate dosing. Roll it between your palms instead. Draw R egular Insulin First (Clear) Draw N PH Insulin Next (Cloudy)

230. INSULIN Dawn phenomenon vs. Somogyi Effect

231. INSULIN & DAWN PHENOMENON Too little Insulin or Too early administration of Insulin before bedtime Normal Glucose until about 3 am when Glucose rises Morning Hyperglycemia

232. INSULIN & SOMOGYI EFFECT Too much Insulin or too little bedtime snack before bedtime Normal Glucose until about 3 am when Glucose lowers to HYPOGLYCEMIC levels Morning Hyperglycemia Counterregulatory hormones SNS Rebound effect

233. Decrease Insulin before bedtime or increase bedtime snack. Too much Insulin or too little bedtime snack before bedtime SOMOGYI EFFECT Increase Insulin or give Insulin when one is not in use. Too little Insulin or No Insulin at all before bedtime INSULIN WANING Increase Insulin before bedtime or administer Insulin close to bedtime. Too little Insulin or too early administration of Insulin before bedtime DAWN PHENOMENON Treatment Cause Causes of Morning Hyperglycemia

234. INSULIN & LIPODYSTROPHY: TYPES Treatment Significance Appearance HYPERTROPHY ATROPHY FEATURES

235. INSULIN & LIPODYSTROPHY: TYPES Rotate injection sites Inject pure human insulin into atrophic area Treatment Impaired insulin absorption Cosmetic only, physiologically harmless Significance Scar tissue at the injection site Dimpling/ pitting at injection site Appearance HYPERTROPHY ATROPHY FEATURES

236. INSULIN & LIPODYSTROPHY Non-rotation of Insulin SQ injection sites Constant trauma to fatty tissues results in Lipodystrophy Continued use of THICKENED site Decreased Insulin effects Hyperglycemia Use of another site Body got used to low Insulin levels Increased Insulin effects= hypoglycemia Etiology:

237. Abdomen Anterior thighs Hips Posterior arms INSULIN SQ INJECTION SITES (note: size of circle= speed of insulin absorption)

238. ? Trivia Time How frequent should injection sites be rotated? INSULIN SQ INJECTION SITES

239. INSULIN SQ INJECTION SITES ? Trivia Time: ANSWER Every 2-3 weeks

240. INSULIN USE in the PREGNANT WOMAN 1 ST TRIMESTER Baby uses up mommy’s glucose for its rapid development Mommy’s serum glucose decreases Insulin requirements: Most common time for HYPOGLYCEMIC REACTIONS Decrease 2nd-3rd month

241. INSULIN USE in the PREGNANT WOMAN 2 nd TRIMESTER Mommy’s placenta begins to produce Human Placental Lactogen HPL has an anti-insulin effect. It doesn’t want mommy to use up her glucose because it wants the baby to use it instead. Insulin requirements: Begin to increase

242. INSULIN USE in the PREGNANT WOMAN 3 rd TRIMESTER Mommy’s Placenta continues to produce HPL High HPL levels significantly decrease Insulin’s effectivity Insulin requirements: Most common time for INSULIN RESISTANCE Rise significantly 6th month

243. INSULIN USE in the PREGNANT WOMAN IMMEDIATE POST-PARTUM HPL is gone. Insulin resistance: Insulin Requirements: Disappears 1 st 24 hours: NO INSULIN NEEDED Thereafter: PRE-PREGNANT INSULIN REQUIREMENTS

244. ORAL HYPOGLYCEMICS

245. Why? S/e to look out for: Major suffix: -mide, -ride, -zide Anorexia It may potentiate hypoglycemia Pregnancy alert: Oral hypoglycemics are teratogenic! SULFONYLUREAS Vital facts:

247. 2 nd : 1 st : Urine Urine & bile SULFONYLUREAS 1 st generation versus 2 nd generation: Mode of Excretion Implications: 2 nd is safer for patients with renal dysfunction

248. 2 nd : 1 st : Shorter Longer (1-2x/day dosing) SULFONYLUREAS 1 st generation versus 2 nd generation: Duration of Action Implications: The more frequent a patient has to take the drug, the lesser the compliance

249. 2 nd : 1 st : High Low SULFONYLUREAS 1 st generation versus 2 nd generation: Cardiovascular disease risk

250. Stimulate beta cells to produce Insulin Increase the number of insulin receptors Improve Insulin binding to insulin receptors Insulin levels rise Glucose deposited into the cells SULFONYLUREAS Hypoglycemic effect Action:

251. Hypovolemia Extreme dehydration HHNK Prevent hypovolemia Fluid conservation SULFONYLUREAS Action: HHNK Palliative treatment Sulfonylureas increase ADH effectiveness

252. So what if it’s short? Half-life: Major suffix: -glinide Very short Lesser hypoglycemic effect Indication: Adjuncts to sulfonylureas MEGLITINIDES Vital facts:

254. Time taken (meals): Duration of effect: Main action: Similar to Sulfonylureas Short-lived 30 minutes a.c. Main goal of drug: Lower post-prandial blood glucose MEGLITINIDES Action and other facts:

255. Common s/e: S/e to look out for: Major suffix: None  Liver toxicity GIT disturbances Indication: Adjuncts to sulfonylureas ALPHA- GLUCOSIDASE INHIBITORS Vital facts:

257. ALPHA- GLUCOSIDASE INHIBITORS Alpha- glucosidase inhibition Delayed glucose absorption from GIT into blood Mild hypoglycemic effects Adjunct to Sulfonylureas Temporary prevention of complex Carbohydrates breakdown Decreased hyperglycemia after eating Action:

258. Common s/e: S/e to look out for: Major suffix: None  Liver toxicity GIT disturbances Indication: Adjuncts to sulfonylureas BIGUANIDES Vital facts:

260. BIGUANIDES Increases ability of Insulin to bind to peripheral tissues Increased glucose uptake by cells Mild hypoglycemic effect: Adjunct to Sulfonylureas Action:

261. ? Trivia Time What acid-base imbalance could occur with the intake of Biguanides? BIGUANIDES

262. ? Trivia Time: ANSWER Lactic acidosis BIGUANIDES

263. S/e #2: S/e #1: Major suffix: -glitazone Fluid retention  edema Hepatotoxicity  Jaundice Indication: Adjuncts to sulfonylureas THIAZOLIDINEDIONES Vital facts:

265. THIAZOLIDINEDIONES Decreases peripheral resistance to Insulin Increased glucose uptake by cells Mild hypoglycemic effects Action:

271. Sample Question: The nurse teaches a type 2 DM client how to recognize and report adverse drug reactions. Which of the following is a common adverse reaction to Glipizide? a. Headache b. Constipation c. Hypotension d. Photosensitivity ORAL HYPOGLYCEMICS

272. HYPOGLYCEMIA

273. Tachycardia, sweating, tremors, nervousness, hunger Think of Sx when you feel extremely hungry SNS stimulation Hypoglycemic reaction: High insulin but low glucose intake HYPOGLYCEMIA: SIMPLE PATHOPHYSIOLOGY Blood glucose < 60 mg/dl

274. HYPOGLYCEMIA ? Trivia Time What may be the only sign of hypoglycemia in an unconscious person?

275. ? Trivia Time: ANSWER Diaphoresis HYPOGLYCEMIA

276. Brain is depleted of glucose Hypoglycemic coma HYPOGLYCEMIA: SIMPLE PATHOPHYSIOLOGY Brain damage: paralysis, cognitive impairment Dangers of Hypoglycemia: Inadequate glucose to support brain activity

277. ? Trivia Time Between a DKA coma and Hypoglycemic coma, which one is more serious and why? HYPOGLYCEMIA

278. ? Trivia Time: ANSWER Hypoglycemic coma HYPOGLYCEMIA

279. Sx resolved: If regular meal is within 60 minutes: Sx unresolved: Retest blood glucose in 15 minutes 10-15g of fast-acting CHO Blood glucose 41-60 mg/dL MILD HYPOGLYCEMIA: TREATMENT Repeat tx Snacks containing CHO & CHONs (milk/cheese) Omit the snack

280. Same with Mild Hypoglycemia Blood glucose 21-40 mg/dL MODERATE HYPOGLYCEMIA: TREATMENT

281. Upon arrival @ hospital: Once conscious: Still unconscious after ten minutes: Unconscious: Blood glucose 20 mg/dL below SEVERE HYPOGLYCEMIA: TREATMENT SQ/ IM Glucagon 2 nd dose of Glucagon Give small meal Give IV 25-50 mL of Dextrose 50% in water

282. A client is taking NPH insulin every morning. The nurse instructs the client that the most likely time for a hypoglycemic reaction to occur is: a. 2-4 hours after administration b. 6-14 hours after administration c. 16-18 hours after administration d. 18-24 hours after administration PRACTICE QUESTIONS 

283. A client is brought to the ER in an unresponsive state, and a diagnosis of HHNK is made. The nurse would prepare immediately to initiate which of the following anticipated physician orders? a. 100 units of NPH insulin b. Endotracheal intubation c. IV replacement of Sodium Bicarbonate d. IV infusion of Normal Saline PRACTICE QUESTIONS 

284. A client is admitted with a diagnosis of DKA. The initial blood glucose level was 950 mg/dL. A continuous IV infusion of regular insulin is initiated along with intravenous rehydration with normal saline. The serum glucose level is now 240 mg/ dL. The nurse would next prepare to administer which of the following? a. IV fluids containing 5% dextrose b. NPH insulin SQ c. An ampule of 50% dextrose d. Phenytoin for seizure prevention PRACTICE QUESTIONS 

285. A client with DM visits a health care clinic. The client’s DM previously had been well controlled with glyburide (Diabeta), 5mg PO daily, but recently the fasting blood glucose has been running to 180-200 mg/dl. Which medication ,if added to the client’s regimen, may have contributed to the hyperglycemia? a. Prednisone (Deltasone) b. Atenolol (Tenormin) c. Phenelzine (Nardil) d. Allopurinol (Zyloprim) PRACTICE QUESTIONS 

286. If NPH insulin has been injected SQ at 6:00 am, the client would be assessed for any hypoglycemic reaction at: a. 12NN to 2:00 pm b. 6:00am the following day c. 8:00am -10:00 am d. 1:00 pm – 7:00pm PRACTICE QUESTIONS 

287. Oxygen Therapy

289. OXYGEN THERAPY Low Flow Systems High Flow Systems 25-50 90 above 60-90 40-60 20-40 O2 % (FiO2) Oxygen Tent 5-10 Venturi Mask 6-15 Non- Rebreather 6-15 Partial Rebreather 6-8 Face Mask 2-6 Nasal Cannula LPM DELIVERY SYSTEM

290. Non-constant O 2 % delivered Contributes partially to the gas the patient breathes Oxygen is delivered independent of the pt’s. breathing Constant O 2 % FiO 2 varies with pt’s breathing Constant FiO 2 e.g. :Face mask T-piece, Tracheostomy collars Low-Flow vs. High Flow Systems OXYGEN THERAPY

294. Build-up of oxygen free radicals Cells metabolize oxygen O 2 > 50% for more than 48 hours Oxygen toxicity: Free radicals can damage/ kill cells OXYGEN THERAPY

295. Signs and Symptoms: Why? Ideal diet: Rich in Vitamin E, C & Beta-Carotene It’s rich on anti-oxidants Oxygen toxicity: OXYGEN THERAPY Substernal discomfort Dyspnea & Fatigue X-ray: Alveolar infiltrates Progressive Resp. Difficulty

296. OXYGEN THERAPY Nasal cannula

297. OXYGEN THERAPY Skin integrity alert: Duration of use: Recommended LPM: Nasal cannula Water-soluble jelly to nares as needed Long-term use Flow rates higher than 6 LPM are useless.

298. OXYGEN THERAPY Consequence of flow rates>6-8lpm: Nasal cannula Air swallowing, mucosa drying

299. OXYGEN THERAPY Face mask

300. OXYGEN THERAPY Recommended LPM: Safety alert: Limitations: Face mask Minimum of 5 LPM to prevent rebreathing of exhaled air Watch for aspiration Limited ability to clear mouth

301. Partial Rebreather mask OXYGEN THERAPY

302. Why rebreathe? Mechanism: Partial Rebreather mask OXYGEN THERAPY 1/3 of exhaled tidal volume is rebreathed. Such air is O2 rich. The initial 1/3 exhaled air was mainly the dead space

303. Deflation means : Safety alert! Partial Rebreather mask OXYGEN THERAPY R.B. must be 2/3 full with inhalation Deflation means decreased O2 delivered. Reservoir bag must not deflate completely!

304. OXYGEN THERAPY Non- Rebreather mask

305. OXYGEN THERAPY Guidelines: Air inhaled: O 2 delivered: Non- Rebreather mask Bag deflation consequence: Same guidelines with partial rebreather masks Only Pure O 2 is inhaled Highest amount of O 2 delivered Suffocation can result with bag deflation

306. OXYGEN THERAPY Venturi mask

307. OXYGEN THERAPY Mechanism: Oxygen delivery: Venturi mask Exact proportion of room air + o2 is inhaled Most accurate oxygen delivery system

308. The oxygen administration device preferred for patients with COPD is: a. Nasal cannula b. Oxygen tent c. Venturi mask d. Oxygen hood PRACTICE QUESTIONS 

309. Which of the following is not to be included in the nursing interventions for a client receiving oxygen therapy? a. Place a “No Smoking” sign at the bedside b. Place the client in semi-fowler’s position c. Place sterile water into the oxygen humidifier d. Lubricate the nares with oil to prevent dryness of the mucous membrane PRACTICE QUESTIONS 

310. Which of the following is the most accurate oxygen delivery system? a. Nasal cannula b. Oxygen tent c. Venturi mask d. Oxygen hood PRACTICE QUESTIONS 

311. Which of the following oxygen delivery system would be ideal to use in someone who has just been diagnosed with CO poisoning? a. Nasal cannula b. Oxygen tent c. Venturi mask d. Non-rebreather face mask PRACTICE QUESTIONS 

312. After exposure in the clinical area, you know that the color of the oxygen tank is: a. Gray b. Blue c. Green d. Light pink PRACTICE QUESTIONS 

313. Blood Transfusion

314. TYPES OF BLOOD DONATION Homologous Blood salvage Autologous Homologous: Other person’s blood Blood salvage: Autologous donation Autologous: Patient’s own blood

315. TYPES OF APHERESIS Plasmapheresis Stem Cell harvest Erythrocyta-pheresis Leukapheresis Platelet pheresis PURPOSE: to remove… TYPE

316. TYPES OF APHERESIS Plasma proteins Plasmapheresis Circulating stem cells Stem Cell harvest RBCs Erythrocyta-pheresis WBCs Leukapheresis Platelets Platelet pheresis PURPOSE: to remove… TYPE

317. BLOOD/ BLOOD COMPONENTS Single donor platelets Fresh Frozen Plasma Random platelets Packed RBCs Whole blood INDICATION/S COMPOSITION TYPE

318. BLOOD/ BLOOD COMPONENTS Decreased alloimmunization risk Platelets from a single donor Single donor platelets Bleeding d/o All coagulation factors Fresh Frozen Plasma Increased alloimmunization risk Platelets from multiple donors Random platelets Symptomatic anemia 75% Hct (only RBCs are functional) Packed RBCs Significant bleeding Cells and plasma Whole blood INDICATION/S COMPOSITION TYPE

319. BLOOD/ BLOOD COMPONENTS Albumin Cryoprecipitate INDICATION/S COMPOSITION TYPE

320. BLOOD/ BLOOD COMPONENTS Burns Albumin Albumin Hemophilia A&B, VWD Von Will. Fx, Fx VIII, Fibrinogen Cryoprecipitate INDICATION/S COMPOSITION TYPE

321. Blood Components

327. 3. Baseline data: 2. Lab results: 1. Doc’s Order Cross-matching and Blood typing Vital signs 4. At least 2 nurses should check: Serial number, BT, Rh factor, Expiry date, Screening tests (VDRL & HBsAg) The Procedure: BLOOD TRANSFUSION

328. 7. Initial BT rate: 6. Needle gauge & filter: 5. Warm blood to room temp: Gauge 18 10 gtts/ min for 15-20 mins 8. Duration (Whole blood, Packed RBC): 4 hours 20 mins. The Procedure: BLOOD TRANSFUSION Rewarmer/ towel 8. Duration (platelets, cryoprecipitates):

329. Can I stop the BT in the presence of an adverse reaction? Can I give dextrose with the BT? Can I mix medications with the BT? No No -- hemolysis Yes Drill Questions: BLOOD TRANSFUSION

330. 3. Collect! 2. Start! 1. Stop! Stop the BT Start an IV line (0.9% NaCl) Collect urine specimen 4. Monitor! Monitor V/S 5. Send! Send unused blood and set to blood bank Transfusion reaction guidelines: BLOOD TRANSFUSION

331. 7. Document! 6. Administer! Antihistamines, diuretics, bronchodilators Transfusion reaction guidelines: BLOOD TRANSFUSION

332. TRANSFUSION COMPLICATIONS Sx Allergic Acute Hemolytic Febrile, Non-Hemolytic Tx ETIOLOGY TYPE

333. TRANSFUSION COMPLICATIONS Generalized Itching/ Urticaria Fever,chills, low back pain , chest tightness, dyspnea Fever w/in 2 hours of BT. Sx Antihistamines Sensitivity to plasma proteins Allergic Urine/blood specimens. Prevent shock & DIC ABO incompatibility (most dangerous) Acute Hemolytic Antipyretics. Non-life-threatening Antibodies to donor RBCs (90% of cases) Febrile, Non-Hemolytic Tx ETIOLOGY TYPE

334. TRANSFUSION COMPLICATIONS Sx Circulatory Overload Bacterial Contamination Tx ETIOLOGY TYPE

335. TRANSFUSION COMPLICATIONS Fever chills and hypotension, esp. psot BT Neck vein distention. Dyspnea. Sx Upright position with feet dependent. O2. Diuretics. KVO. Fast BT rate + pt. With heart failure Circulatory Overload IVF and antibiotics. Or else, septic shock may occur. Bacteria Bacterial Contamination Tx ETIOLOGY TYPE

338. After obtaining a unit of blood from the blood bank, the nurse next looks for which of the following members of the health care team to assist in checking the unit of the blood? a. Blood bank technician b. Registered nurse c. Medical Student d. Phlebotomis PRACTICE QUESTIONS 

339. After checking the unit of blood with another nurse, the nurse would assess for which of the following items just before beginning the transfusion? a. Vital signs b. Latest hematocrit level c. Skin color d. Urine output PRACTICE QUESTIONS 

340. A nurse has just received an order to transfuse a unit of packed RBCs for an assigned client. In planning coverage for the client assignment, the nurse asks if another nurse will be available to check on the other assigned clients for how long when the unit of blood is hung? a. 5 minutes b. 15 minutes c. 30 minutes d. 45 minutes PRACTICE QUESTIONS 

341. A client has an order to receive a unit of packed RBCs. A nurse would obtain which of the following IV solutions from the IV storage area to hang with the blood product at the client’s bedside? a. 0.9% Sodium Chloride b. Lactated Ringer’s c. 5% dextrose in 0.9% Sodium Chloride d. 5% dextrose in 0.45% Sodium Chloride PRACTICE QUESTIONS 

342. A nurse who is about to begin a blood transfusion knows that blood cells start to deteriorate after a certain period of time. The nurse checks which of the following items carefully before beginning the transfusion to ensure that this has not happend? a. Blood identification number b. Expiration date c. Blood group and type d. Presence of clots PRACTICE QUESTIONS 

343. DAVE MANRIQUEZ, RN End of Lecture Thank you so much for your attention!!!