Reference no: EM133097310

HLTENN007 Administer and monitor medicines and intravenous therapy

Assessment task 1 - Knowledge questions

Knowledge questions

1. Refer to the enrolled nurses and medicine administration fact sheet. Summarise the legal requirements for practice parameters of enrolled nurse outlined in the fact sheet in relation to the administration of medications including intravenous route of medication administration.

2. Identify and briefly describe the key objectives of the Health (Drugs and Poisons) Regulations applicable to your State/Territory.

3. Identify and briefly describe the key objectives of the Drugs and Poisons Acts applicable to your State/Territory.

4. Identify and briefly describe three (3) NMBA or ICN codes and guidelines that provide a framework for enrolled nurse practice.

5. Briefly describe the key intention of Standard 3 ‘Preventing and Controlling Health Care Associated Infections' of National Safety and Quality Health Standard (NSQHS).

6. What is meant by Visual Infusion Phlebitis Score (VIPS)? Briefly explain its significance in your nursing practice.

7. Interpret the following schedules of medications and provide two (2) examples of each of these schedules:
a. Schedule 2:
b. Schedule 3:
c. Schedule 4:
d. Schedule 8:

8. Complete the following table outlining how you will handle, calculate, administer and store the following forms of medications:

9. Briefly describe the following terms relevant to the pharmacology of medications using an example:
• Pharmacodynamics
• Pharmacokinetics
• Pharmacotherapeutics

10. Discuss the term ‘toxicology'.

11. Differentiate between adverse reactions and anaphylactic reactions.

12. Discuss the term ‘contraindications' of a medication using an example.

13. Precautions and side effects are common expressions in medicine administration. Explain both the terms with an example for each.

14. What causes the following potential complications of a blood transfusion? Identify a reason for each of these complications.

• Pain at IV site and arm:

• Acute immune haemolytic reaction with signs and symptoms such as loin pain, nausea, vomiting, haematuria and headache:

• Urticaria (hives):

• Flushing, chills or fever:

• Anxiety:

• Wheezing, progressing to cyanosis:

• Anaphylactic reaction including tachycardia, cardiac arrest or shock that may lead to death:

15. How should an enrolled nurse apply the following rights of medication administration?

• Right medication:

• Right dose:

• Right prescription (documentation):

• Right route:

• Right time:

• Right person:

• Right expiration date:

• Right to refuse:

16. Briefly describe the steps involved in administering medications via the buccal route.

17. Briefly describe the steps involved in administering medications using metered dose inhaler and spacer inhaler.

Metered dose inhaler:

Spacer inhaler:

18. Briefly describe the steps involved in administering medications via PEG tube.

19. Briefly describe the steps involved in administering medications via intranasal route (e.g. administering a nasal spray via a pressurised canister).

20. Briefly describe the steps involved in administering medications via vaginal route.

21. Identify and briefly describe an indication to use each of the following IV medication administration methods.

• IV bolus:

• Gravity or drip infusion:

• Electronic pump infusion:

• Via burette:

• IV piggyback and tandem:

• Syringe driver through sub-cut lines:

22. Discuss three (3) factors to be considered while calculating medication dosages.

23. A child with presenting complaints of fever is prescribed 240 mg of Paracetamol. The suspension of Paracetamol is available as 120 mg/5 ml solution. How much ml of the Paracetamol is to be administered? Identify the calculation formula you would use in this situation (10ml)

24. Tab Amitriptiline 30mg is prescribed for a client. It is available as 10 mg tablets. How many tablets need to be administered to get the prescribed dose? Identify the calculation formula you would use in this situation.

25. A client is to be given 960 ml over 24 hours. The drop factor is 15. Calculate how many drops per minute will be delivered. Identify the calculation formula you would use in this situation.

26. A child with a case of burns is prescribed 1200ml over 8 hours. Taking drop factor as 60, calculate the drops/ minute that must be given to the child. Identify the calculation formula you would use in this situation.

27. A client is given IV fluid NYS 500ml at a rate of 42 drops per minute. If the drop factor is 15, how many millilitres per hour is the client receiving? Identify the calculation formula you would use in this situation.

28. Inj. Ceftriaxone comes as 40mg/ml. A 5-year-old weighing 18kg is prescribed 100mg/kg/day. Calculate the dose of Ceftriaxone in ml to be administered for the child a day applying the calculation formula you would use in this situation.

29. A child is diagnosed with a case of leukaemia. He weighs 16.8 kg and is 97 cm tall. The required dose of Vincristine is 2mg/m2 and the drug comes as 1mg/ml concentration. Calculate the dose to be delivered in ml applying the calculation formula you would use in this situation.

30. The recommended dose of gentamycin is 1 to 5 mg/kg IV. Calculate the safe range to administer to an elderly man weighing 86kg? Identify the calculation formula you would use in this situation (86mg-430mg)

31. Cyclophosphamide is prescribed for an elderly client. Prescription: Cyclophosphamide (Cytoxan) 150mg/m2/day, IV, available dosage is 200mg, client's height is 170 cms, weight is 70 kg. Calculate the dose of medication to be administered per day as per the client's body surface area.

32. Dose administration aids (DAA) help clients in the community to better manage their medicines. Briefly describe four (4) factors to be considered while using DAA.

33. Briefly describe the action of acidifiers in controlling pH in our bodies. Provide two (2) examples of acidifiers used for fluid and electrolyte imbalance.

34. Briefly describe the action of alkalisers in treating fluid and electrolyte imbalance. Provide two (2) examples of alkalisers used for fluid and electrolyte imbalance.

35. Briefly describe the action of diuretics in managing fluid and electrolyte imbalance. Provide two (2) examples of diuretics.

36. Provide two (2) examples of electrolytes used for fluid and electrolyte imbalance. Briefly describe the action of one electrolyte you identified in managing fluid and electrolyte imbalance in the body.

37. Briefly describe the action of intravenous replacement solutions. Provide two (2) examples of replacement solutions used for fluid and electrolyte imbalance.

38. Briefly describe the use and actions of nitrous oxide and desflurane as anesthetic agents.

39. Briefly describe the use and actions of ibuprofen as an analgesic agent.

40. Briefly describe the use and actions of omeprazole as an antacid.

41. Briefly describe the use and actions of nitroglycerine as an antianginal.

42. Briefly describe the use and actions of lorazepam as an anti-anxiety medication.

43. Briefly describe the use and actions of metoprolol as an anti-arrhythmic medication.

44. Briefly describe the use and actions of amoxicillin as an antibiotic.

45. Briefly describe the use and actions of atropine as an anticholinergic.

46. Briefly describe the use and actions of warfarin as an anticoagulant.

47. Briefly describe the use and actions of clonazepam as an anticonvulsant.

48. Briefly describe the use and actions of amitriptyline as an antidepressant.

49. Briefly describe the use and actions of loperamide as an antidiarrheal agent.

50. Briefly describe the use and actions of ondansetron as an antiemetic agent.

51. Briefly describe the use and actions of clotrimazole as an antifungal agent.

52. Briefly describe the use and actions of cetirizine as an antihistamine.

53. Briefly describe the use and actions of captopril as an antihypertensive.

54. Briefly describe the use and actions of indomethacin as an anti-inflammatory drug.

55. Briefly describe the use and actions of vincristine as an antineoplastic drug.

56. Briefly describe the use and actions of L-dopa as an antiparkinsonion drug.

57. Briefly describe the use and actions of diphenhydramine as an antipruritic drug.

58. Briefly describe the use and actions of haloperidol as an antipsychotic agent.

59. Briefly describe the use and actions of iodine as an antiseptic agent.

60. Briefly describe the use and actions of pantoprazole as an antiulcer drug.

61. Briefly describe the use and actions of acyclovir as an antiviral drug.

62. Briefly describe the use and actions of alprazolam as an anxiolytic drug.

63. Briefly describe y the use and actions of propranolol as a beta-blocker.

64. Briefly describe the use and actions of salbutamol as a bronchodilator.

65. Briefly describe the use and actions of docusate as a laxative/aperient.

66. Briefly describe the use and actions of ormeloxifene as a contraceptive.

67. Briefly describe the use and actions of beclomethasone as a corticosteroid.

68. Briefly describe the use and actions of fentanyl as a narcotic analgesic agent.

69. Briefly describe the use and actions of risperidone as a neuroleptic agent.

70. Briefly describe the use and actions of levothyroxine as a hormone medication.

71. Briefly describe the use and actions of diazepam as a hypnotic or sedative medication.

72. Briefly describe the use and actions of metformin as a hypoglycemic agent.

73. Briefly describe the use and actions of novorapid.

74. Briefly describe the use and actions of ringer lactate as an electrolyte solution.

75. Briefly describe the use and actions of timolol as an ophthalmic medicine.

76. Briefly describe the use and actions of ciprodex as an otic medicine.

77. Briefly describe the use and actions of xylometazoline as a nasal medication.

78. Briefly describe the use and actions of Lasix as a diuretic.

79. Briefly describe the use and actions of ascorbic acid as a vitamin supplement.

80. Briefly describe how you should transport, store, handle and dispose of blood and blood products safely.

Transportation:

Storage:

Safe handling and checking of blood and blood products:

Disposing off blood and blood products:

81. Furosemide and low pH solutions such as glucose 5% solutions shouldn't be mixed together. Why?

82. Blood transfusion was completed for a patient in your clinical setting. Three hours post transfusion the person complained of severe headache and palpitations. You observed a dark discolouration of his urine. The patient had a blood pressure of 90/70mm of Hg. Identify a possible reason for these symptoms and discuss the most appropriate steps to be taken to address the situation.

Assessment task 3 - Simulation Based Assessments

Assessment Task 1: Oral medication administration (powder), per rectal suppository administration

Mr Henk Ventor, 66 years old, presented in your clinical setting with abdominal pain this morning. During a physical health assessment, Mr Ventor tells you that he has not opened his bowels for the past four days. Mr Ventor has a history of frequent constipation that has been managed by a high fibre diet at home.

You are required to undertake the following activities:
• Refer to Mr Ventor's medication chart (available in the patient folder in the simulation nursing laboratory)
• Calculate the correct dose of medication to be administered with 100% accuracy
• Apply rights of medication administration
• Safely administer the prescribed stat aperients
• Complete the medication chart (available in the patient folder in the simulation nursing laboratory).

You may demonstrate this procedure using the manikin in the simulated nursing laboratory. Your assessor will provide voice over for the manikin and respond to your questions to the patient.
Your assessor will play the role of the registered nurse, where appropriate. The time allocated for this assessment is ten minutes.

You are answering the nurses' call bell for Mrs. Richards, 66 years old. Time is 1345 hours. Mrs. Richards states that she has severe pain in her right shoulder and requests urgent pain relief. Mrs. Richards has a history of Osteoarthritis.
You are required to undertake the following activities:
• Perform pain assessment using appropriate tools (PQRST/ DOLOR/ Numerical scale etcetera)
• Refer to the medication chart of Mrs. Richards (available in the patient folder in the simulation nursing laboratory)
• Calculate the correct dose of medication to be administered with 100% accuracy
• Apply rights of medication administration
• Safely administer the prescribed analgesic
• Demonstrate the use of the pill cutter
• Apply complementary therapy suitable in this situation
• Complete the medication chart and progress notes (available in the patient folder in the simulation nursing laboratory).

You may demonstrate this procedure using the manikin in the simulated nursing laboratory. Your assessor will provide voice over for the manikin and respond to your questions to the patient.
The time allocated for this assessment is ten minutes.
Your assessor will play the role of the registered nurse, where appropriate.

Ms Simon, 44 years old, is admitted with abdominal pain for investigation. Ms Simon has a history of type 2 diabetes mellitus, is a chronic smoker and is currently on nicotine replacement therapy because the hospital is a no-smoking area. Ms Simon has dry eye syndrome in both eyes. Time is 1700 hours. Ms Simon is having her dinner. Your time planner shows that Ms Simon is due for some medications between 1700 and 1800 hours.

You are required to undertake the following activities:
• Refer to the medication chart and Diabetes Management Plan (Insulin chart) of Ms Simon (available in the patient folder in the simulation nursing laboratory)
• Calculate the correct dose of medication to be administered with 100% accuracy
• Apply rights of medication administration
• Safely administer the prescribed medications/patches
• Complete the medication chart and Diabetes Management Plan (Insulin chart) (available in the patient folder in the simulation nursing laboratory).

You may demonstrate this procedure using the manikin in the simulated nursing laboratory. Your assessor will provide voice over for the manikin and respond to your questions to the patient.
The time allocated for this assessment is ten minutes.
Your assessor will play the role of the registered nurse, where appropriate.

Mrs. Adrian, 84 years old, is admitted with infective exacerbation of COPD. Mrs. Adrian is on regular inhalers at home and does not use home oxygen. Mrs. Adrian's sputum culture came positive for Gram positive bacteria and she was on IV antibiotics. IV cannula observation shows that the IVC was inserted 3 days ago. The previous shift nurse handed over that the antibiotics has been changed to oral. Time is 0745 hours. Your time planner shows that Mrs. Adrian has medications due at 0800 hours.

You are required to undertake the following activities:
• Refer to the medication chart of Mrs. Adrian (available in the patient folder in the simulation nursing laboratory)
• Calculate the correct dose of medication to be administered with 100% accuracy
• Apply rights of medication administration
• Safely administer the prescribed medications
• Manage IVC, as required
• Complete the medication chart (available in the patient folder in the simulation nursing laboratory).

Simulation Based Assessment Task 5: Administration of IM injection (ventrogluteal site / deep IM)

Mr Smith, 68 years old, is admitted for monitoring after an unwitnessed fall at home. Mr Smith has a history of dementia and has been confused since the fall. Occasional aggression has also been seen since admission into the hospital. A staff assist call bell rings and you are attending to the bell. You find Mr Smith trying to get out of his bed and punch the care staff companioning him. Companion staff member states that he can manage the client at the moment and asks you to get some medication to calm the client.

You are required to undertake the following activities:
• Refer to the medication chart of Mr Smith (available in the patient folder in the simulation nursing laboratory)
• Calculate the correct dose of medication to be administered with 100% accuracy
• Apply rights of medication administration
• Check the prescription for medication to manage aggression and administer medication, as prescribed
• Complete the medication chart and progress notes after monitoring the client's response to the medication administered (available in the patient folder in the simulation nursing laboratory).

You may demonstrate this procedure using the manikin in the simulated nursing laboratory. Your assessor will provide voice over for the manikin and respond to your questions to the patient.
The time allocated for this assessment is five minutes.

Simulation Based Assessment Task 6: Administration of IM injection and IV hydration

Mr Maloney, 56 years, is hospitalised for management of symptomatic pernicious anaemia. Mr Maloney has shortness of breath and numbness and tingling sensation in the palms of hands and soles of feet. Mr Maloney looks pale and is lethargic throughout the day. His oral intake has been poor in the last week due to nausea. Blood tests reveal haemoglobin levels of 74g/L, and deranged electrolytes. The doctor has ordered some medications and IV hydration to manage the situation.

You are required to undertake the following activities:
• Refer to the medication chart and IV fluids orders of Mr Maloney (available in the patient folder in the simulation nursing laboratory)
• Calculate the correct dose of medications and IV fluids to be administered with 100% accuracy
• Apply rights of medication administration
• Administer medications and IV fluids, as prescribed
• Complete the medication chart and IV fluids chart (available in the patient folder in the simulation nursing laboratory).

You may demonstrate this procedure using the manikin in the simulated nursing laboratory. Your assessor will provide voice over for the manikin and respond to your questions to the patient.
The time allocated for this assessment is ten minutes.

Simulation Based Assessment Task 7: Administration of IV injection (bolus), IV medication administration (piggy back), IV hydration and oxygen therapy.

Ms Carfi is admitted for the management of septicaemia. Ms Carfi is nauseous, dehydrated, feels short of breath and complains of extreme lethargy. Her blood cultures reveal several Gram positive bacteria. Doctor has prescribed oxygen, IV fluids and medications for Ms Carfi.

You are required to undertake the following activities:
• Refer to the medication chart and IV fluids orders of Ms Carfi (available in the patient folder in the simulation nursing laboratory)
• Calculate the correct dose of medications and IV fluids to be administered with 100% accuracy
• Apply rights of medication administration
• Check the prescription for medications, oxygen and IV fluids, as prescribed
• Complete the medication chart and IV fluids chart after monitoring the client's response to the medication administered (available in the patient folder in the simulation nursing laboratory).
• Prescribed oxygen therapy: 1-4L/minute via Nasal Prongs, Target O2 Saturation = >92%

You may demonstrate this procedure using the manikin in the simulated nursing laboratory. Your assessor will provide voice over for the manikin and respond to your questions to the patient.
The time allocated for this assessment is ten minutes.

Simulation Based Assessment Task 8: Administration of IV bolus injection and blood transfusion

Mr Farrell is hospitalised for the management of symptomatic anaemia from chronic gastric ulcers. Mr Farrell is short of breath on exertion, lethargic, feels dizzy at times and cannot do activities of daily living due to these issues. Vital signs show tachycardia and tachypnoea. Recent blood test shows that Mr Farrell's haemoglobin level is 68g/L and the doctor has ordered 1 unit of packed red cells. Mr Farrell has a history of congestive heart failure and hypertension.

You are required to undertake the following activities:
• Refer to the medication chart and blood products order form of Mr Farrell (available in the patient folder in the simulation nursing laboratory)
• Calculate the correct dose of medication to be administered with 100% accuracy
• Apply rights of medication administration
• Administer medications and blood products, as prescribed
• Complete the medication chart, blood product order form, observation chart related to blood transfusion and progress notes after monitoring the client's response to the medication administered or blood transfusion (available in the patient folder in the simulation nursing laboratory).

You may demonstrate this procedure using the manikin in the simulated nursing laboratory. Your assessor will provide voice over for the manikin and respond to your questions to the patient.
The time allocated for this assessment is ten minutes.
Seek assistance from the assessor to act as the second nurse checker for the blood product.

Simulation Based Assessment Task 9: Medication administration via NGT + nebulisation

Mr. John Moore, 64 years old, has a nasogastric tube inserted for enteral feeding after multiple surgeries in the oral cavity. John is on regular medications for anxiety since a diagnosis of squamous cell cancer. After the surgery, John needs nebulisation to ease oropharyngeal secretions. Time is 1145 hours.

You are required to undertake the following activities:
• Refer to the medication chart of Mr Moore (available in the patient folder in the simulation nursing laboratory)
• Calculate the correct dose of medication to be administered with 100% accuracy
• Apply rights of medication administration
• Administer medications, as prescribed
• Complete the medication chart (available in the patient folder in the simulation nursing laboratory).

You may demonstrate this procedure using the manikin in the simulated nursing laboratory. Your assessor will provide voice over for the manikin and respond to your questions to the patient.
The time allocated for this assessment is ten minutes.

Intravenous fluids are prescribed for 58 year old Mrs Maria Dimitris post appendectomy. Maria is having shortness of breath and breathing difficulty and is on oxygen therapy. Doctors found that this was due to fluid shift in her lungs. The last bag of 0.9% Sodium Chloride (Isotonic saline) is on flow and will finish soon. IV cannula is placed on the right median cubital vein (in right ante-cubital fossa).

You are required to undertake the following activities:
• Refer to the IV fluids form and blood products form of Maria (available in the patient folder in the simulation nursing laboratory)
• Calculate the correct dose of IV fluids and blood products to be administered with 100% accuracy
• Apply rights of medication administration
• Monitor IV therapy
• Administer IV fluids and blood products, as prescribed
• Remove IV cannula after Albumin administration
• Complete IV fluids form and blood products form and progress notes (available in the patient folder in the simulation nursing laboratory).

You may demonstrate this procedure using the manikin in the simulated nursing laboratory. Your assessor will provide voice over for the manikin and respond to your questions to the patient.
The time allocated for this assessment is ten minutes.
Seek assistance from the assessor to act as the second nurse checker for the blood product.

Simulation Based Assessment Task 11: Administering enema
Demonstrate the appropriate steps in administering Microlax enema (5ml).
You may demonstrate this procedure using the manikin in the simulated nursing laboratory. Your assessor will provide voice over for the manikin and respond to your questions to the patient.
The time allocated for this assessment is five minutes.

Simulation Based Assessment Task 12: Administering lotion or cream

Demonstrate the appropriate steps in administering lotions or creams for a person. You may demonstrate this procedure using the manikin in the simulated nursing laboratory. Your assessor will provide voice over for the manikin and respond to your questions to the patient.
The time allocated for this assessment is five minutes.

Simulation Based Assessment Task 13: Administering eye ointment

Demonstrate the appropriate steps in administering eye ointment to a person. You may demonstrate this procedure using the manikin in the simulated nursing laboratory. Your assessor will provide voice over for the manikin and respond to your questions to the patient.
The time allocated for this assessment is five minutes.

Simulation Based Assessment Task 14: Using syringe drivers/pump

Discuss with your assessor what you will monitor when a medication is being administered via a syringe driver/pump. You must access the syringe driver/pump when you explain key aspects to be monitored. The time allocated for this assessment is five minutes.

Assessment task 4 - Professional Practice Assessment

Professional Practice Assessment Task 1

You are required to administer medication to at least three (3) people in your workplace under the supervision of a registered nurse.

The medication administration must include the following routes:
• Oral
• Sub-cutaneous injection

You must:
• Check the medications prescribed for the client in the medication chart, anticoagulant chart, fluid order forms and blood product order forms.
• Check client history, blood results, other investigations and progress notes for indication for these medications.
• Check eMIMs / pharmacy guidelines to learn about common side effects and adverse reactions.
• Discuss the pharmacokinetics of each medication with the registered nurse prior to its administration.
• Calculate medications with 100% accuracy
• Use the ‘Rights of Medication' to administer medication
• Complete relevant workplace documentation such as NIMC, progress notes etcetera following medication administration.
• Enter details of all medications you administered for each client during your demonstration in the table provided below.
• Ensure you administer medications through oral and sub-cutaneous routes at least once whilst administering medications to people in your workplace.

The Host Facilitator or EQUALS' Clinical Facilitator will observe your skills in administering medications and complete the observation checklist (provided in the logbook) and assessment outcome sections based on the skills you demonstrated and the documentation completed.

Professional Practice Assessment Task 2

Explore your workplace policy and procedure for addressing medication errors. What should an enrolled nurse do if they make/notice a medication error? Summarise your findings in the space provided below.
The Host Facilitator or EQUALS' Clinical Facilitator will cross verify your answer, ask you questions on your role in avoiding and/or managing medication errors and complete the observation checklist (provided in the logbook) and assessment outcome sections.

You should familiarise yourself with the observation checklist prior to undertaking the assessment.

Professional Practice Assessment Task 3:

In your workplace, you should:
• Identify a person presenting with complaints of pain
• Perform a pain assessment using appropriate pain assessment scale
• Administer prescribed medications to manage pain
• Apply complementary strategies (heat or cold application, diversion etcetera)
• Monitor and evaluate effectiveness of pain-relieving medication and non-medication therapies
• Complete the following progress notes summarising pain assessment, your nursing actions and outcomes.

The Host Facilitator or EQUALS' Clinical Facilitator will observe your skills in pain management and complete the observation checklist (provided in the logbook) and assessment outcome sections based on the skills you demonstrated and the documentation completed.
You should familiarise yourself with the observation checklist prior to undertaking the assessment.

Attachment:- Intravenous therapy.rar