Question

The 70-year-old female who was admitted to the hospital to rule out bowel obstruction continues to have nausea and vomiting. The client remains slightly confused and weak. Bowel sounds are absent in the right and left lower quadrants. Abdomen remains hard and distended. Mucous membranes dry; skin turgor poor. IV of Lactated Ringers is infusing at 100 mL/h in the client’s left hand. A Foley catheter is in place and is draining 20-30 mL/h. NG tube is in place, connected to intermittent suction, and is draining coffee-ground material.

The client’s daughter informs the health care provider (HCP) that her mother has hypertension and takes atenolol every morning. The client has no known drug allergies.

The health care provider (HCP) orders the following:

1. Metoclopramide 10 mg IVPB in 50 mL of D5W q.i.d.
2. Atenolol 50 mg po daily. Hold for systolic BP < 100 and P < 50. May take with sip of water.
3. Cefazolin 500 mg IVPB every 6 hours
4. Meperidine 25 mg IM every 4 hours PRN pain
5. Diet: NPO
6. Vitals signs every 4 hours
7. Monitor I & O every shift

Questions:

1. List the six (6) rights of medication administration.

2. What assessments should be made prior to administration of the following medications: Metoclopramide, Atenolol, Cefazolin, and Meperidine?

3. What is the action of each of the medications prescribed?

4. What are adverse effects of these medications that the nurse should monitor?

5. The HCP has ordered Cefazolin 500 mg IVPB every 6 hours. The pharmacy sends Cefazolin 500 mg in 50 mL of D5/W and it is to run over 1 hour via an infusion pump. The drop factor of the IVPB set is 60 gtt per mL.
   1. What is the hourly rate? __________mL/hr
   2. What would the hourly rate be if the HCP ordered the Cefazolin to run over 30 minutes?_____________ mL/hr

Answer 1

1. Six rights of medication Administration --

• Right Patient
• Right Drug
• Right Route
• Right time
• Right to know
• Right to refuse

2. Assessment, Action & Adverse effects Of Metoclopramide, Atenolol, Cefazolin, and Meperidine----

Metoclopramide--

Assessment -- Vital signs ( specially change in blood pressure, pulse & tachycardia )

Mental status ( Any kind of anxiety, depression )

Any kind of GI problems ( like- nausea,vomiting, constipation) etc..

Action-- Drug enters into the body

In upper GI tract Enhances the response to acetylcholine..

Contraction of muscles of GI tract

Increases peristalsis

Produce therapeutic effect

Adverse effect --

CNS- Headache,Restlessness

CV- Hypotension

GI- Dry mouth, constipation

GU- Decreased libido,amenorrhea

INTEG- rash

Atenolol----

Assessment -

Intake output ratio

Weight change

Jugular vein distension

Hypertension, hypotension

Hypoglycemia

Hepatic studies ( Like- Billirubin )

Action--

After entering the body the drug competitively blocks Beta adrenergic receptors in the vessele.

Decrease heart rate, Oxygen consumption in myocardium..also decrease the renin-aldosteron-angiotensin mechanism

Produce therapeutic effect

Adverse effect --

CNS- Insomnia,dizziness

CV- Profound hypotension

GI -- nausea,vomiting,

GU- impotence,decreased libido

RESP- Bronchospasm

Cefazolin --

Assessment -

Drug sensitivity

Blood studies ( like- AST,ALT,CBC etc)
Electrolyte ( like- sodium,potassium)
Nephrotoxicity
Any kind of skin rash

Action--
Inhibits bacterial cell wall synthesis
Renders the cell wall
Leads to cell death
Produce therapeutic effect

Side effects --

CNS- headache,dizziness
GI- Nausea,diarrhea
GU- pruritis,vaginitis
INTEG - rash
RESP- dyspnea

Meperidine--

Assessment -
Pain ( type,location,characteristics)
Vitals signs
Renal function
Blood urea nitrate (BUN)
Serum creatinine etc

Action--
Drug enters into the body
Decreases the transmission of pain impulses by interacting with opioid receptors..
Produce therapeutic effect..

Adverse effect --

CNS- dizziness,confusion
CV- Heart failure, hypertension
GI - vomiting, nausea
MISC- back pain
RESP- coughing..

3. Cefazocin --

Volume- 50 mL, Time - 1 hour=60 min, Drop factor= 60 gtt / mL.

Rate = ( volume* drop factor) / time

= ( 50*60) / 60 = 50 mL / hr..

4. If it has to run over 30 minutes then the rate will be- ( 50* 60) / 30 = 100 mL / hr..