So you have a new order for a medication and you need to give it subcutaneous -
what do you do? What resources do you use? Well in this video we're going to talk
about the parental manual to show you how it will help you cover your
medication rights for best patient care, right after this. Welcome back my name is
Tammy and this isNnurseMinder and on this channel we do everything nursing so
if you're new here consider subscribing below so that you get the next video
when it's released. Today we are talking about the parental manual or parental
monograph as they are called. This is a tool we use when we give medications by
intravenous, intramuscular, subcutaneous roots and it helps us make sure we're
following our medication rights so our patient gets the safest care. So why
don't we start with a medication order for ondansetron 4 milligrams
subcutaneous every six hours PRN for nausea. This is one example of a
parenteral monogram. The first thing I need to check is that I have the right
medication and in fact I do have the ondansetron monograph here. Working down
the order of information on this monograph, we're next going to look at
the right route. I see here that I do have an option of giving an intravenous
subcutaneous or IM and my order is for subcutaneous and it says it is an
available route. The required equipment and education - that is an important
section to read in case you need to have an antidote available or you need to
have monitoring tools available. Next we want to look at the right reason. On this
document is known as the indications. If you recall our order was for nausea, and
under the indications I see that this can be used for a variety of situations
where my patient is nauseated. Following along the monograph, we next have the
right assessments. So we're looking at what would be a reason this patient
could not take this medication such as allergies, health history, drug to drug
contraindications. Other assessment data will come down
further in the document and we'll return to this. The next thing in this document
is age-appropriate dosing, so we're going to go past the neonates and the infants
and go straight to the adults. Now we have several categories of dosing in
here depending on whether it's chemo induced or radiation therapy, post-op
nausea, vomiting, prevention and treatment. What we're looking here is for do I
have the right dose? So we see there's a range between four milligrams up to 16
milligrams per dose and it's mostly IV in this in this section or IM but I
don't see a subcutaneous so I may actually need to go to another document to find my
subcutaneous parameters such as your drug guide or maybe a patient specific protocol. If I
look at the geriatric population, I do see that there are some times and
frequencies located on here and it says at the subsequent dose box that it doses
can be give given at 8 milligrams and may be given 4 to 8 hours after the first
dose, so I do I do have some information that helps me but I don't have my
subcutaneous information, so I'm going to keep looking. As I continue down to the
dilution and administration text I do see that there's a subcutaneous
injection box. This lets me know that it is used for palliative patients who are,
or those who are unable to take it by other routes, and it will be injected
undiluted. So I don't need to mix this in a saline or a sterile water, I'm going to
simply draw it up and administer it. It also tells me if I give more than 4 mls
I need to use 2 sites. As we continue to move down this document the next section
is the adverse events. This section helps to inform our patient
education and our evaluation. We can see that the most frequent complaints
include headache, constipation, and flushing or warmth. We want to make sure
our patient knows this so that they don't get too anxious if it does happen.
Similarly we would ask about these things when we assess them at the half
hour, at the hour, at the two hour mark, whatever it is your time frame is for
evaluation. Now don't jump over this clinical implications. This is another
box that helps inform our assessment phase. One of the first things we want to
make sure is that the IV site or subcutaneous site is in fact healthy. It
also indicates we should be looking at their electrolytes, their liver function,
anything to do with intestinal obstruction, and ECG monitoring maybe
needed if they take other medications that can prolong that QT interval. This
will inform your assessments to make sure your patient gets the safest care.
The product description, reconstitution, and stability box gives me information
as to how my medication is packaged ,how it needs to be stored, when it expires,
and what solutions it would be stable to dilute in. So as you can see there's a
lot of information but we're not done yet.
At the very end of this document we have our compatibility and incompatibility
charts. If your patient has an IV infusing and you are administering this
medication through the same line or would like to administer it through the
same line, you need to look to see if it is compatible. So for the purpose of this
demonstration let's imagine our order was for IV ondansetron and your patient
has an infusion of furosemide already running. We would look first through our
compatibility looking for a furosemide, I do not see it there. I'm gonna go
to my incompatible section and there I see furosemide, which means these two
drugs could not be in the same line because they will cause a reaction. They
might cause some precipitate. So that means I need to then infuse my
ondansetron after the furosemide and after the flush of that line or in
a separate line by itself. So you can see how well our parenteral monograms help
keep us on track to using our medication rights for best patient care and safe
outcomes. There are two rights on here we didn't talk about: the right to refuse, a
patient can always say no, and the right documentation. You want to make sure
you're documenting your assessment, your intervention, and your evaluation. That's
our lesson for today. Thanks for sticking around. Take a look at some of the other
videos I have and make sure you subscribe so that you get the next video
when it's released. Until next time have a great day :)