Medication tidbits an ER nurse should always know

Specialties Emergency

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Hi all...I am currently doing an externship in the ER and even though I can't administer medications, I've picked up on a lot of important facts you have to remember about certain medications from watching my preceptor. Things like potassium and any other electrolytes always go on a pump with the pt on the monitor, bentyl is never given IVP, always put older people on a spo2 with narcs, IV antibiotics can make people hypotensive. I was just reading another thread about inapsine sending people into prolonged QT and arrhythimas which is something I've never heard even though we've given our pts inapsine. So I want to know...what are those things I should ALWAYS think about when giving certian meds? I'm sure theres a ton more out there!

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

The biggest thing is to follow your hospitals policy and procedure manual for administering IV drugs.....call your pharmacy.....look up everything before giving it, especially if you have never given it before. The are no short cuts to memorization and repetition. Every unit has their IV med books...here are some examples of those.......these meds so common ot the critical care areas are one of the reasons it is difficult for new grads to start in these fast paced areas.

How frequently you monitor a patient depends on the patient and the patients condition....but remember you are giving the med for a reason....monitor the patient for changes/relief.

Good Luck on your nursing journey!

IV meds.....

http://www.mc.vanderbilt.edu/pharmacy/ivroom/IVMedAdm061003.pdf

http://www.sjhlex.org/documents/Nursing/critical_care_intravenous_letter_052909.pdf

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Specializes in STICU, MICU.

Unless it is a code situation, question any order for Calcium Chloride. Routine/Non-Emergent replacements should be Calcium Gluconate. Ca Chloride is several times more concentrated, and not a ideal choice for simple replacement.

Be careful giving Calcium Chloride through peripheral IVs. If it infiltrates, it is VERY vesicant. NO ONE in my unit knew this, until we saw the aftermath of a Ca Chloride infiltrate. You think of pressors and chemo as being vesicant, but not Calcium.

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Specializes in Peds/Neo CCT,Flight, ER, Hem/Onc.

IV push Decaron too fast and the patient's genital were burn like they are on fire. They don't usually appreciate it. Also the IV form of Decadron CAN be given PO to pediatric patients. Just mix in small amount of juice. The alternative is Orapred which they WILL puke up about 30 seconds after you get it in them.

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I always laugh at the shocked look I get when I tell people this about Hydralazine: give it rapid push and don't dilute it. Also, don't give it to someone who's tachycardic. It causes reflex tachycardia. I actually had a PA question why I was questioning her when she wanted me to give hydralazine to a pt with a BP of 230/130 and HR of 135. If you have a hypertensive pt who's rate is 70 or below, always, IMO, ask the MD to give hydralazine rather than the commonly ordered Lopressor.

First, I'm not a Lopressor fan. Secondly, you won't risk dropping their HR with their BP. I love me some hydralazine.

Source: http://reference.medscape.com/drug/apresoline-hydralazine-342400#11

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As far as that hydralazine goes with the tachycardia...Wont it only cause tachycardia if it causes the bp to drop a bit too much? If im not mistaken, its a direct vasodilator with no chronotropic effect. I just cant see why hydralazine will cause a 230/130 to drop enough to actually stimulate the baroreceptors..... Just a thought.....

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Dilaudid is about 5-10x stronger than morphine, depending on the source of that infoDilute your dilaudid with the frequent flier patients so they still get the analgesic effect without that instant high when pushed in rapidlyPotassium iv burns like hell. Put ice in a specimen bag and place on the iv site to numb it someNitroglycerin is notorious for headaches. Be careful about giving a beta blocker iv and calcium channel blocker iv. Can cause a rapid decrease in bp.I know a bunch more tips but im tired haha

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These are great, keep 'em comming!

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Specializes in Peds/Neo CCT,Flight, ER, Hem/Onc.
Potassium iv burns like hell. Put ice in a specimen bag and place on the iv site to numb it

Sometimes pharmacy will add lidocaine to the bag to help it burn less.

Always, always check to make sure your patient hasn't taken Viagra before you administer Nitro.

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Specializes in Emergency Dept. Trauma. Pediatrics.
IV push Decaron too fast and the patient's genital were burn like they are on fire. They don't usually appreciate it. Also the IV form of Decadron CAN be given PO to pediatric patients. Just mix in small amount of juice. The alternative is Orapred which they WILL puke up about 30 seconds after you get it in them.

I found this out the hard way, I knew about the PO use, but I was a new nurse and new in the ER and I had to give this med. This patient was already very anxious and dramatic and here I give this med and she starts going crazy saying her "hoohah" is on fire. I sat there shocked thinking What the??? Then it passed. So I went to tell my co-workers about this and everyone thought it was crazy until one nurse said that she too had seen this happen. Crazy!

You can get a "rush" or "high" from IV Benadryl, we have patients that come to get it for that reason and the docs have finally started saying for us to inject it into the bolus.

Norflex and Toradol burn really bad IM. I always give my patients a heads up on this and it's less painful in the hip/butt instead of the arm.

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Specializes in ER.

With few exceptions, i.e. adenosine, and apparently hydralazine (which I didn't know about), if you are unsure, dilute and give slowly.

Always read the side of the vial if you have it available. It will give you valuable information such as what diluent to use, if you can give IV push, etc.

NEVER give procaine penicillin IV.

In general, if you have to open more than one vial of something, you are giving too much. Of course there are exceptions, but it should at least make you pause and think carefully about the dose.

Also, with rare exception, if you are giving a med IV and the patient says, "I'm feeling funny", then STOP giving the med! It may be an adverse reaction or you may be giving it too fast. Dilaudid does that to a lot of people. Adenosine is also the exception....you can tell the patient, "you will feel like you are going to die", because their heart stops and resets, so they feel awful before they feel better.

Even if you have checked and double checked the chart, always tell a patient (alert ones) what you are giving, ask if they are allergic or intolerant to it, and why you are giving it. That little rule will save you and the patient a world of problems!

If you have the slightest doubt about what you are giving, or how to give it, don't hesitate to ask. You will not be thought stupid for not knowing! If you don't ask and you do something that is against protocol, THEN you and your patient will pay dearly for it.

If a patient tells you, that pill doesn't look like my regular med....pay attention, and double check the 5 rights. Most times, it will be just a manufactures variation, but it may mean you have the wrong med, or it was ordered incorrectly.

Common med usage can vary from hospital to hospital and state to state. You mentioned Inapsine....we don't give it at all, and I haven't in years, but when I worked PACU in the 90's, we gave it like candy to everyone! Some hospitals still use Demerol, but it is not even on our hospital formulary.

If you are reconstituting a powdered med, and you cannot see thru it when you are finished, WARNING...you probably used an incompatible diluent. Generally speaking, if it looks milky in the syringe, don't give it. (Obvious exceptions, propafol, lipids).

Most hospitals now have internet or hospital intranet access that allows you to check for med information and compatabilities. Use it. If you are new to nursing, keep a little notebook in your pocket, and as new meds, procedures, diagnosis comes up, write it down to more throughly research it later.

Be careful with sound alike, look alike meds, i.e., hydralazine, hydroxyzine..looks similar but very different meds.

Many vials of IV meds look alike and have small print. Double check med name and concentration.

As far as pharmacy prepared med boxes, Pyxis etc. Trust but verify! Just because that little pocket opens when you click the patient name or name of the med, double check the label yourself. These are stocked and prepared by humans, and humans make mistakes.

Heparin dosing has caused many errors over the years. If your pharmacy does not label such meds with red warning stickers that say double check your dosage, then you may want to try to get that implemented. I think with publicity surrounding this particular med, people are more careful, but it can happen with any med. You may have a syringe that says heparin, but it could be 100U/cc, 1,000U/cc or 10,000 units per cc.

Epinepherine can be 1:1000 concentration or 1:10,000 concentration. So just pay attention. It is really amazing that there are not more drug errors!

I know I didn't give many specific meds, but just be careful and don't hesitate to check with another source if you are unsure at all. Lives depend on this.

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Specializes in Peds/Neo CCT,Flight, ER, Hem/Onc.

Activated Charcoal doesn't come out of scrubs. Wear a gown and gloves when mixing and administering.

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