Nursing Practice: Focus on Integrated Care 

Introduction to Intravenous Medicines

Intravenous medicines comes under the process of administering both diluted or undiluted (as per the patient’s need) medicines to the veins of the patient by a syringe (Sivertsen et al., 2018). The syringe can be used to administer the medicine by an existing IV line, saline lock or needleless port. Aim of the assignment is to demonstrate understanding about the theoretical administration of IV medicine. It will firstly provide a clear and concise discussion about validation of the medicine followed by a discussion about therapeutic interactions and indications of the medicine. It will then provide a discussion about the process of administering the medicine followed by proper documentation.

Validation of A Medical Order

A medical order is often made as per the patient’s needs and diagnostics. The patient in the case study is admitted to the ward with a possibility of pneumonia. Pneumonia is a serious lung infection that not only have a negative impact over the lungs and air sacs but it also impact the cardiovascular system of a person. According to Waterer et al., (2018), the community acquired pneumonia is highly responsible for deaths by contributing to the development of cardiovascular complications. A research conducted by Restrepo and Reyes (2018), have stated that streptococcus pneumonia (a bacterium that is highly responsible for pneumonia) can invade the muscles of heart and makes them dead which ultimately develop cardiovascular diseases.

Medicines such as Warfarin can be used to cure conditions of community acquired pneumonia. However, it cannot be administered intravenously to the patients. So, IV medicines such as Levofloxacin will be recommended for the patient. The patient in the case study require VTE prophylaxis in order to prevent the condition of pneumonia. VTE prophylaxis is administration of IV medicines in order to prevent any disease from occurring or spreading (Hamadi et al., 2019). Use of interventions such as intermittent pneumatic compression devices can prevent conditions of venous thromboembolism.

Therapeutic Interaction and Indication

Warfarin is an oral drug and it can exhibit some serious drug interactions with NSAIDS. Administration of NSAIDS together with warfarin can lead to some serious bleeding complications (Gelosa et al., 2018). Since, the NSAIDs are expected to cause gastrointestinal bleeding so they are fatal if administered with warfarin. Moreover, drugs like Levofloxacin are expected to cause some side effects of the central nervous system such as confusion, hallucinations and depression (Husain et al., 2016). And, administering NSAIDs with Levofloxacin can complicate the side effects. The Levofloxacin must be given intravenously to the patients in the form of injections as it is an intravenous medicine (Husain et al., 2016). The injection must be infused slowly for a time period of 60-90 minutes on the basis of the dosage. According to Husain et al., (2016), Levofloxacin is an intravenous medicine which can be used for the treatment of conditions such as community acquired pneumonia. A high dosage (750 mg) infusion is effective for a short course of 5 days for patients suffering from pneumonia. Infusion of levofloxacin to the patient can prevent him from developing pneumonia. I learnt that warfarin is an oral drug and patients on VTE prophylaxis require intravenous medication. Infusion of Levofloxacin would thus be effective for the patient.

Administering Intravenous Medicines

The IV push medicine is a medicine that is administered intravenously as it is pushed into the blood stream of the patients with a syringe. Further the IV line is expected to be flushed with normal saline. According to Alsaeed et al., (2018), flushing is filling the IV tubing with a solution so that the tube does not get blocked. Further, a set dose is administered for optimum results.

First step of the IV medicine administration is medication checks. It allows the nurse to check he medication label (Schutijser et al., 2019). This is because every patient in the healthcare have different diagnosis and require a different treatment. Any mixture of the medicine can lead to serious complications. Patient centered care require the nurse to check the medication label every time before infusing the medicine. Further suitability of medicine for IV push is checked. For example: metformin is an oral drug so it cannot be injected intravenously and Levofloxacin is an intravenous medicine which is infused intravenously. Supplies such as medication syringe, 2 saline syringes, heparin syringe (if required), disinfectant cap and sterile wipes are collected and duration of the push is calculated (Schutijser et al., 2019). The push is further set up for desired amount of time. For example: the Levofloxacin is infused slowly for a time period of 60-90 minutes. It is important to have a desired set of time for administering medicine as it dissolve the medicine effectively in the bloodstream and give maximum results (Peloquin, 2017)).

Documentation of Intravenous Medicines

It is required by every nurse to document the medication of the patients as a subject of effective and patient centered care. According to standard 1 of registered nurse standard for practice NMBA (2017), a nurse must always maintain timely documentation of actions or evaluations for greater patient safety and health. Documentation of the IV medicine administration is done in the patient report. The documentation include the date and time of the IV insertion, the time, gauge and length of the catheter that is used for the patient (Shokoohi et al., 2019). Followed by, the name of the vein that has been cannulated with a proper information about the number of times and locations the attempts of cannulation were made. The report also include information about the type of dressing applied, reactions of the patient (if the patient easily tolerated the procedure) followed by the names and credentials of the nurse. The documentation is done at the time of patient monitoring and any fluctuations or changes in patient’s condition are observed with time.

Conclusion on Intravenous Medicines

In conclusion, IV infusions are very effective form of administering medicines. Patients having conditions of pneumonia require medical treatment with best possible measures. Findings of the assignment concluded that metformin is an oral drug and it cannot be used IV. Use of Levofloxacin will be effective in this condition as it is administered intravenously. Before injecting a medicine its possible interactions are checked and it is administered with proper flush and with considerate time. A documentation for the process is done for further handover and analysis.

Reference for Intravenous Medicines

Alsaeed, D., Furniss, D., Blandford, A., Smith, F., & Orlu, M. (2018). Carers’ experiences of home enteral feeding: A survey exploring medicines administration challenges and strategies. Journal of clinical pharmacy and therapeutics, 43(3), 359-365.

Gelosa, P., Castiglioni, L., Tenconi, M., Baldessin, L., Racagni, G., Corsini, A., & Bellosta, S. (2018). Pharmacokinetic drug interactions of the non-vitamin K antagonist oral anticoagulants (NOACs). Pharmacological research, 135, 60-79.

Hamadi, R., Marlow, C. F., Nassereddine, S., Taher, A., & Finianos, A. (2019). Bariatric venous thromboembolism prophylaxis: an update on the literature. Expert Review of Hematology, 12(9), 763-771.

Husain, N. S., Goldman, P., Goldrath, K., & Malas, N. (2016). Levofloxacin-associated neuroexcitation. Journal of clinical psychopharmacology, 36(6), 737-739.

NMBA. (2017). Registered nurse standards for practice. Retrieved from https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards/registered-nurse-standards-for-practice.aspx

Peloquin, C. (2017). The role of therapeutic drug monitoring in mycobacterial infections. Tuberculosis and Nontuberculous Mycobacterial Infections, 119-127.

Restrepo, M. I., & Reyes, L. F. (2018). Pneumonia as a cardiovascular disease. Respirology, 23(3), 250-259.

Schutijser, B. C. F. M., Jongerden, I. P., Klopotowska, J. E., Portegijs, S., de Bruijne, M. C., & Wagner, C. (2019). Double checking injectable medication administration: Does the protocol fit clinical practice?. Safety Science, 118, 853-860.

Shokoohi, H., Boniface, K. S., Kulie, P., Long, A., & McCarthy, M. (2019). The utility and survivorship of peripheral intravenous catheters inserted in the emergency department. Annals of emergency medicine, 74(3), 381-390.

Sivertsen, M. S., Jørstad, Ø. K., Grevys, A., Foss, S., Moe, M. C., & Andersen, J. T. (2018). Pharmaceutical compounding of aflibercept in prefilled syringes does not affect structural integrity, stability or VEGF and Fc binding properties. Scientific reports, 8(1), 1-9.

Waterer, G. W., Self, W. H., Courtney, D. M., Grijalva, C. G., Balk, R. A., Girard, T. D., ... & Williams, D. J. (2018). In-hospital deaths among adults with community-acquired pneumonia. Chest, 154(3), 628-635.

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