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Giving Meds Safely in Urgent Situations

nursing pharmacology tips

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When a situation becomes urgent you won’t have a lot of time to try to think through and process things.  We will help you know how to get through those urgent situations and give medications safely even when rushed.  

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Podcast Transcription

What’s up guys. My name is Jon Haws, RN CCRN within our sng.com where our goal is to give you the tools and the confidence that you need to succeed in nursing school on the in clicks and in your life as a nurse to help you succeed on this journey. We’ve created weekly cheat sheets that we send to you every single Friday to sign up at over to nrsng.com/freebies. That’s interesting. [inaudible] dot com slash freebies and every single Friday we’ll send you a cheat sheet on pediatrics, OB, med surge, mental health, ICU, critical care, every single aspect of nursing care to help you succeed. That’s nrsng.com/freebies all right, now let’s roll into the show. 

Hey guys, what’s up? It’s season with NRSNG and I’m going to be talking about giving medications safely in urgent situations. Uh, which is a topic that I really enjoy because, um, I mean it’s part of the reason I became an ER nurse. I enjoy urgent situations. Um, but I to kind of talk about how the process goes for, um, eventually learning how to give meds in urgent situations. And then how to prepare yourself for those situations and prepare yourself for those medications. So, um, it all kind of starts off with the books and I know that’s not something you want to hear, but it does start by reading in a book, um, and kind of getting bits and pieces, learning the names and I know it’s going to be super difficult. I found reading from a book horrendously difficult, um, in the regards of remembering it, especially in an urgent situation. 

So yes, I have read about epinephrin but this patient who is coding and everything is really intense right now. Do I remember like all the details and the numbers that are floating around because I also have the numbers in my head for a dentist scene and Amniodarone and I have all of these numbers in my head right now and do what, what all makes sense. So, um, there’s the book reading and then there’s the experience that you get with it and how you start to really form your ideas and your, it’s, it’s almost like the file that you open up in your brain when it comes to that medication or even that situation and the certain medications that go along with it. Um, so if you can memorize drugs, that’s great. And even the, what you can memorize if you aren’t able to memorize all of it like I was, it’s a great start and it’s, most of the time it’s sufficient for administering, like most of the drugs that you’re going to be administering. 

But, um, in urgent situations it is the first thing I want to explain to you is that you, um, should always get a double check. Never do that situation alone. Never just go head on, especially if you’ve never done it. Um, just start administering a drug that you have no idea how to administer that you’ve never personally seen administered that you haven’t administered yourself, but you’ve read about it in a book or maybe you’ve seen a YouTube video about it. Um, so ask for help. But if there really truly is an urgent situation, you’re going to have more than one person around you. So, um, a group of people really come to help you out and support you. And there are multiple RO roles that need to happen in order for a patient to be safe in urgent situations. Um, because it’s, it’s not quick enough for the nurse to go to the Pyxis or, or whatever. 

Um, medication administration machine you guys have. So go to your, um, area, get the medication, bring it over, draw it up, have all the pieces for drawing it up, including the blunt, a needle and the syringe and the flush and the alcohol wipe. Um, and then also to administer it and then to also write down everything that’s happening and note the vitals and know it’s just impossible. So you have to have a team of people to do it because all of the things that I just described to you has to happen. But it has to happen now. And so you have a bunch of people and they all have their own roles. And it, it’s almost so depending on the situation in the ER, there are actually assigned roles for that. Like if you’re running a code or if you’re doing whatever. Um, but it’s really funny how I’ve noticed that when you are in an urgent situation, people gravitate towards certain rules. 

Nurses will notice, Hey, we need to have a, a nurse who’s getting, um, syringes and drawing up the medications. I’m going to take that role. Or Hey, we really need someone who’s going to to chart, I’ll be that nurse. So you’re going to have all these different nurses that come in and they kind of sell it, settle into their roles or they already have preassigned rules. If the situation is something that, you know, in the ER we have certain things set up for it. So, um, if you’ve never given a medication, if you’ve never been in that situation, it’s unlikely that you are going to be participating in that right away. There’s probably going to be other nurses that come in and kind of run that for you, um, or help you along the way. If for whatever reason, giving this, you are put into that situation where you’ve never given that medication and you don’t know about it and you are one of the few nurses that are there and you have to do it. 

I highly recommend that you verbalize any concerns you have to the doctor, to the other nurses that are in the room. Um, you question, Hey, how fast should I be giving this med? Um, can I just double check my dosage and that you will hear people shout out, um, Hey, by the way, um, I’ve got this medication going in at this time and it’s another double check. So you have all these ears listening and they’re hearing you say that out loud and they’re like, yep, that is the correct dosage and that this is the time it’s going in and everybody will be a part of that. Um, so you’re going to probably observe for the first time, maybe even the first couple of times depending. Um, but then you will start to participate in the administration process. And again, like I said, you’re not going to be alone, so you’ll have multiple people to, so man, and eventually you just kind of, uh, become more comfortable with it and you start to learn these medications and the process and see these patients like, um, you’re like, Holy smokes, this patient is crashing. 

I know I’m going to need the crash cart and I’m going to need to call the charge nurse and the doctor into the room and we’re going to have to set up a team. Um, and people come very quickly. So, um, you’ll start to recognize and be able to see the urgent situations. Um, and then having all of those people also there just really helps you catch any sort of med air, gives you that checks and balances system. So how do you prepare to be in that situation in the first, I mean, I know that we go through the stages where we kind of observe and then we participate and then we become comfortable with it. But, um, I actually have a cheat book and it’s just, it’s a little notebook that it’s, so there are little note cards. Um, that I can pull in and out of a ringed binder. 

Um, and you can, I highly recommend you make this for yourself, um, for your drugs, for your hospitals, protocols, anything that you need to know that’s specific to you. Um, and also can be a generalized information as well. Um, that really is a quick reference for you that you can carry around, put it at your desk, wherever you’re charting or um, put it in your pocket if you need to have it on the run. So you just kind of start off with a few drugs and I have a list of drugs. I’m going to name them off to you, um, that I think over you should start, start your book with, um, but then add drugs to it as you go. Um, if you find yourself in a situation and it was a drug that I didn’t put on this list and you need to know about it, write that drug down, create a new page in your book and just keep going with it and organize it in a way that makes sense to you. 

Um, maybe you learn something new and you don’t have space on that card to write, start over, rewrite your card out. Always going over your medications is a good thing. So, um, the list that I have, I’m just going to go through the baseless that I think that everybody should have in their book. Um, and there I may be missing some, but I’m pretty sure this is kind of the base. So epinephrin, Amniodarone, Cardizem heparin, nitroglycerin, a dentist seen Livo fed propafol, dobutamine, dopamine fentanyl, verse seven, rock eronium. And um, I never can pronounce this one right, succinylcholine or succinylcholine, but we call it Sachsen. It’s, you know, it’s a paralytic. And then lastly, um, TPA. So w what you would give it’s is clot-buster you would give for someone having a stroke. Um, and I, I’m gonna kind of, those are the, that’s the kind of the list that I really believe that you guys should start with. 

Um, read through pages or information about it. Maybe watch a couple of YouTube videos about it and write down the things that you think are important and you may, uh, end up getting experienced with that drug and be like, why would I write it a downer that’s not pertinent to what I need to know. And you cross that out and start your card over again. Um, but giving yourself a little bit of a base reference is something that I highly recommend. And if you don’t give these drugs, let’s say you work, um, you know, on a med surge floor and you’re not allowed to give the, some of the drugs that I gave, I know a lot of nurses are like, Oh, we can’t push leave off that on this floor. Or, um, if there’s a code that’s happening, they have to call a code team and the team comes and runs the code and they don’t actually do that. 

Um, so what do I have to say about the drugs that I just gave you a list for? I say start with those drugs anyway. And the reason why is because you may be caring for that patient. Um, post them having any of these drugs while they’re having any of these drugs. And it is very important for you to know what it is that, um, can happen Nishan to your patient. What do you need to monitor for what is, you know, is there a cardiac rhythm that you need to be looking at? Um, vital sign that could, you know, potentially be an alarming thing while they’ve had this medication. Um, when do you need to notify the doctor? Things like that. Um, and of course, you know, for your own sake, like you can write, um, when you’re adding your own drugs, if they are drugs that you’re giving or even if they’re not, um, you want to write indications contra-indications if that’s pertinent to you. 

Um, how to administer it. You know, do I give this med fast? Do I give it slow? Is it mixed with something? What can I mix it with? Things like that. Any interactions you need to be worried about allergies to medications, um, labs that you need to watch. Uh, and then of course, side effects. So those kinds of things are really important. And I’m just going to read off. Um, a few things that I wrote down for some of the drugs that we went, that I listed off there. Um, for the first couple I wrote, um, some of the stuff, I pulled it right out of my very own book. So, um, epinephrin you want to remember, there’s two ways to give it. Um, Ivy is for cardiac arrest. You do not give up an Afrin or epi pen or like people think about epi. 

They think EpiPen. Um, for an allergic reaction, you do not give that Ivy, you give it Ivy for cardiac arrest. And when you are giving a patient epinephrin Ivy, it will be one in 10,000. That’s the concentration. Now you should in your, um, I call it a Pyxis. Uh, I’ve worked at places, it’s called the Omnicell, but there’s like different ways that you can go get your meds. So wherever it is that you’re getting your meds, both concentrations, both one in 1001 in 10,000, is that those are both going to be in your Pyxis and you need to know the difference and you need to know why you would give one versus the other. So if you’re giving it a for an allergic reaction, you’re going to be giving it intramuscularly, um, like an EpiPen and that is one in 1000. Now, how do I remember that? 

I wrote a little note on my note card because I had someone mention it to me. If somebody is having a cardiac arrest, you are going to have lots of people running. So 10,000 people running into that cardiac arrest. Um, but if somebody is having an allergic reaction, and I know that if you’re having Anna Filactic reaction, more people are going to be coming to it. But, um, a cardiac arrest is a cardiac arrest, is a cardiac arrest and allergic reaction can vary. So if someone comes in and they were like, yeah, um, I had some tape on my hand and I’m having a little bit of a rash, now I’m having an allergic reaction to that tape. Um, nobody is really gonna come running. You’re going to have fewer people caring for that patient than you would have for a cardiac arrest. Um, so that’s the one in 1000 concentration and that goes intramuscularly. 

Um, and I also consider, I also remember that cardiac arrest has to do with your veins and your heart. So in order to get inside of the veins and inside of your heart, you have to go intravenously. So that helps. So these are the kinds of things that I write in my book. Little tips and tricks for like, what do I need to know about up enough run in a pinch? What do I need to know immediately? Um, for Amniodarone. Um, I mean there’s a lot of things that you can write, but one of the things that I had a patient who got Amniodarone and they were allergic to iodine. It’s contraindicated in patients that are getting iodine. And I learned that. So now that’s one thing that I know very well, but I also wrote it down under my Amniodarone card. Um, you know, it do not give it to patients that have an allergy to iodine or it’s contraindicated. 

Um, for Cardizem I wrote it’s a calcium channel blocker. Um, and these, so Stanton’s calcium channel blockers, ACE inhibitors, all of those medications I found super confusing because they kind of sorta did the same thing but in different ways. And um, so I in medications like that, I tend to write out what did, how, how has the mechanism working, um, or the pharmaco or pharmacokinetics or pharmacokinetics or however it’s pronounced. Um, so I did write calcium channel blocker and then in parentheses inhibits cardiacs muscle and smooth vascular muscle contraction. Um, but this means that it’s going to slow your heart rate and lower your blood pressure. So Cardizem lowering BP, uh, lowering your heart rate or slowing your heart rate. Um, for Halperin, I wrote to make sure you get your coagulation studies drawn before you start that because you need to have a baseline. 

Um, the heparin is going to be constantly monitoring your PT, your PT Ts, your INR, ours. Um, so you need to know what the baseline is and then in six hours you’ll get it drawn again and adjust that heparin drip appropriately. And if it’s not a heparin drip, um, I wrote, you know, to make sure to alternate spots. Um, that was, I don’t use that in the ER, but um, it was something that somebody said to me and I wrote it down once and I don’t have a lot on my Hepburn card. So, um, to alternate, you know, left abdomen to right abdomen to left arm to right arm kind of a thing. Um, nitroglycerin drip, I wrote that I need to know the max dose that I should give a patient is 200 micrograms per minute. Um, and I mean it’s rare that you’re going to max out on a nitroglycerin drip, but it’s good to know that that’s the point where you’re like, Whoa, I’ve titrated too much. 

I need to not go this high or we need to look into something different. I need to talk to the doctor because every time you a drug, um, which I took glycerin is Ty tradable. You’re not gonna alarm the physician by the way. I titrated this drug up or down. Um, it’s a set reason why you would titrate it up or titrate it down. So that just kind of gives you a parameter. Like even if you’re getting close, like if I’m getting super close to the 200, I might mention it before I hit that 200 micrograms permanent. And then the last one I I’m going to talk about, I have written down a dentist scene and this is one of my favorite ones because, um, there’s, there’s a couple parts to it, but it hits on one thing that I found interesting. Um, I know that a lot of people focus on counter indications and dosages and things that you need to monitor for. 

But this one, um, I really, I hit on the bags that you need to know the indication for this medication. Um, it is something that you’re going to be giving in an urgent situation and the person’s going to be coming in, in, um, super ventricular tachycardia or SVT. And so their heart rate is going to be super fast. Um, and it’s going to be one of those situations where you’re going to give that med, you’re going to push it super fast because it has a half life of 10 seconds of, or less than 10 seconds. So it’s like a bang, bang, bang. You give it, you draw it, you gave it six milligrams, 12 milligrams, 12 log milligrams, six milligrams of it doesn’t work. You move to 12, and then if that doesn’t work, you move to 12 again. And there is research out there that um, can state, you know, if you are giving six milligrams and it doesn’t work, 12 milligrams isn’t going work. 

Um, I’ve actually seen it convert after giving 12 milligrams. Um, so it just depends on the doctor and what they’re going to call out. But the reason why I pointed out the indication is because, um, if you have a patient that is in let’s say a fib, which is another heart arrhythmia identity scene isn’t going to help it. That is not something that you give adenosine for. So it’s, it’s only for SVT. And so I wrote that down only for SVT. Um, and now like when a patient comes in with SVT, is that what I’m thinking? Do I need to stop and look at my book? No, but the fact that I wrote it down, the fact that I have that written on there, it really helped me to remember. Um, and then, um, in regards to the, uh, 10 seconds of half-life, I mean the reason why that’s super important is because you are pushing that medication and you are pushing it super fast with a flush behind it. 

That is extremely fast because if it doesn’t reach your heart, it’s not going to do anything for your heart. It’ll convert before it reaches your heart. And then that’s the end of it. So these are just some ideas on how to write out different things for your drugs. And then of course the list that I provided are as kind of where I would start and then add things as you go. Um, not even just new drugs, but new information. If you find yourself in a situation with heparin, let’s say a patient gets um, their, their INR comes back too high and you’re like, Whoa, the doctor was concerned about this and they said that, you know, according to our heparin nomogram, we aren’t supposed to um, be giving the heparin anymore. We titrate it down or however it is. Maybe you want to write that note, whatever that hospital protocol is, um, INR greater than two or whatever it happens to be. So, um, again, I hope this really helps you guys give your medications safely in urgent situations knowing that you are going to be, um, surrounded by a team of people. You aren’t going to be thrown into that situation by yourself and you will have gone through a process of watching it than doing it with the team. And then you eventually become comfortable with it. Um, and then 

also with the list that I gave you a place to start and if you have any more to add it on. So good luck you guys. 

All right? All right. All right. I hope that was helpful today. Guys. I hope that gave you some motivation, some inspiration to go out and to be your best self, to go out and to become the nurse that you want to be, to make a difference and to do the best work that you can. Listen, we’re here to help you along your [email protected] our goal is to give you tools in competence to help you in nursing school on the in clicks and in life. One of those tools we created is our Friday freebies, these weekly PDF cheat sheets that you can refer to on the clinical floor in the classroom and just throughout your entire career as a nurse. To get these cheat sheets head over to nrsng.com/freebies that’s nrsng.com/freebies you guys, if you need anything, we’re here for you. You can reach out to us on social media or via [email protected] we want you to succeed. We want to help you along the way. We’re here to hold your hand. We’re here to give you the tools, the confidence that you need to achieve success in this journey to nurse or as you guys know what time it is now, it’s time to go out and be your best self today. Happy nursing.

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