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Glossary
This chapter contains some difficult terminology. Rather than disrupt the text with explanations, we have added a short glossary.
Angiotensin-converting enzyme (ACE) inhibitors ACEs, e.g. enalapril and lisinopril, are prescribed for hypertension or heart failure (see Jordan 2008)
Adverse drug reactions (ADRs) ADRs are any untoward and unintended responses in patients or investigational subjects to a medicinal product that is related to any dose administered. Serious ADRs are those that result in death, are life-threatening, necessitate hospitalisation or prolong hospitalisation, result in persistent or significant disability or incapacity, or are congenital anomalies (International Conference on Harmonisation 1996). The term
‘side effects’ is reserved for dose-related and therapeutically unrelated adverse effects (Edwards & Aronson 2000)
Anaphylaxis A serious life-threatening hypersensitivity
reaction, characterised by low blood pressure, shock and difficulty breathing
Antagonists or blockers These bind to receptors and block them,
preventing the agonist reaching the receptor and activating it. For example, the beta-blockers (propranolol or atenolol, for example) block the actions of the sympathetic nervous system, slow and stabilise the heart rate and induce
bronchoconstriction
Bioavailability A measure of absorption, or the fractional extent to which the drug dose reaches its site of action
Excipient A vehicle added to a prescription to confer a
suitable consistency or form to a pharmaceutical product
Enteral By way of the gastrointestinal tract
Enteric-coated preparations A term designating a special coating applied to tablets or capsules that prevents the release and absorption of their contents until they reach the intestine
25
Glomerular filtration rate (GFR) GFR is the volume of fluid filtered into the nephrons every minute, i.e. the sum of the volume of filtrate formed each minute in all functioning nephrons. The normal GFR for a standard male (body surface area 1.73 m2) is 100 mL per minute; the value for a female is 90%
of this. A GFR below 60 mL per minute per 1.73 m2 surface area indicates renal disorder and is associated with an increased risk of
cardiovascular disease. GFR is usually calculated from the serum creatinine concentration, and reported as eGFR (estimated eGFR). Where drug doses are finely balanced, at the extremes of body weight or if there are risks of toxicity, other methods of calculating the GFR are used, such as the Cockroft and Gault formula (BNF 2011). These calculations require the patient’s weight, which should be written on the drug chart
Hypersensitivity/hypersusceptibility response A response quantitatively greater than is usual for a given dose
Loading dose A large initial dose of drug given to reach a rapid therapeutic level of the drug
Non-steroidal anti-inflammatory drugs (NSAIDs) NSAIDs, or ‘aspirin-like drugs’, share certain therapeutic actions and ADRs. They modify the inflammatory reaction and the associated pain, and reduce fever. NSAIDs include ibuprofen and diclofenac
Selective serotonin reuptake inhibitors (SSRIs) SSRIs, e.g. fluoxetine and sertraline, are prescribed for the management of depressive illness or obsessive-compulsive disorders Therapeutic failure The situation in which treatment does not have
the required effect
Therapeutic range Drug plasma concentrations that will provide therapy but avoid toxicity to the patient. Above the therapeutic range, toxic effects may appear.
Below the therapeutic range, the drug does not have the desired effect
Toxicity The quality of being poisonous
Principles of
intravenous therapy
Lisa Dougherty
Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
3
Contents
Introduction 27
Anatomy and physiology of the veins 27 Overview of vascular access devices 29 Administration of intravenous therapy 30 Principles of infection prevention 35 Maintaining a closed intravenous system 36
Maintaining patency 36
Managing complications 36
Blood transfusion therapy 39
Conclusion 40
References 40
Further reading 43
Having read this chapter, you will be able to:
•
Understand the anatomy and physiology of the veins•
Describe the types of vascular access device•
Describe the methods for administering intravenous medications•
Understand how to choose the appropriate infusion device•
Describe how to prevent infection in intravenous therapy•
Recognise the signs and symptoms of the related complicationsLearning outcomes
Fundamentals of Medical-Surgical Nursing: A Systems Approach, First Edition. Edited by Anne-Marie Brady, Catherine McCabe, and Margaret McCann.
© 2014 John Wiley & Sons, Ltd. Published 2014 by John Wiley & Sons, Ltd.
27
Introduction
Parenteral therapy is the administration of drugs or fluids by any route other than by mouth or rectum and includes the intravenous and subcutaneous routes (Royal College of Nursing [RCN]
2010). For the purposes of this chapter, it refers to intravenous therapy. Intravenous therapy is now an integral part of the majority of nurses’ professional practice and requires both knowledge and skills (RCN 2010).