Parenteral Medication Student Practice: Sue Jones
Student Prep Required:
Med Cards for the following drugs:
 Heparin
 Hydromorphone (Dilaudid)
ANY DILUENT USED TO PRACTICE ADMINISTERING SUBQ OR IM IN THIS SCENARIO, PLEASE REPLACE
WITH YOUR OWN BEFORE RETURNING MEDICATION VIAL OR CARPUJECT TO DRAWER
DO NOT LOOK AT LAST PAGE (PRACTICE KEY) UNTIL YOU HAVE COMPLETED THE ENTIRE MED
SCENARIO-your partner will read this content to you
Scenario:
Today is October 4th
You are the student nurse caring for Mrs. S. Jones, an 80 year old female who was admitted to Normandale
Community Hospital the early morning of 10/4 for increasing SOB the last 2 days with productive cough of
yellow/green sputum with suspected pneumonia.
Past Medical History includes: Hypertension (HTN), Atrial Fibrillation, Myocardial Infarction (MI), Chronic
Obstructive Pulmonary Disease (COPD), and arthritis in both hands.
Last recorded VS 10/4 at 0200: T-101.5 P-94 R-24 BP-112/88 sats 90% on room air.
Allergies: Penicillin
Patient Data
Because of concerns of immobility, the physician has ordered Heparin to be given subcutaneous bid
Student Instructions: Today is November 6th and the time is 1000
Give the Heparin subcutaneous that the physician ordered
Give Hydromorphone (Dilaudid) 9/10 chest pain associated with pneumonia.
State out loud all checks you are making and any patient assessments to make before giving med.
©2011 Keith Rischer/www.KeithRN.com
Jones, Sue
Page
of 2_
MR # 9355644
DOB: 04/24/1933
Room 618-2
Dr. Thompson
1
N: 2300 - 0659
D: 0700 - 1459
E: 1500 - 2259
Allergies: Penicillin
STAT AND ONE TIME DOSES
Date
RN
Init
Medication/Dose/Route/Time
Date/
Time
Given
Init
Time
D
Time
E
2000
Date: 11/6
Start
Init
Medication Strength
Frequency route
11/6
GG
Lisinopril (Zestril) 20 mg po bid
0800
11/6
GG
Diltiazem (Cardizem) CD 180 mg
po daily
0800
11/6
GG
Warfarin (Coumadin) 50 mg po
daily
11/6
GG
Heparin 8000 units subcut. bid
20,000 unit/cc vial
SIGNATURE
INIT
Gloria Gale, RN
GG
Date
RN
Init
Time
N
SIGNATURE
©2011 Keith Rischer/www.KeithRN.com
N
D
0830
GG
Medication/Dose/Route/Time
Date: 11/7
E
Date/
Time
Given
N
D
Init
Date: 11/8
E
N
D
E
0830
GG
1600
1000
2200
INIT
SIGNATURE
INIT
SIGNATURE
INIT
PRNs
Jones, Sue
Page
2 of 2_
MR # 9355644
DOB: 04/24/1933
Room 618-2
Dr. Thompson
N: 2300 - 0659
D: 0700 - 1459
E: 1500 - 2259
Allergies: Penicillin
STAT AND ONE TIME DOSES
Date
RN
Init
Medication/Dose/Route/Time
Medication Strength
Frequency route
11/6
GG
Ibuprofen (Motrin) 600 mg po
every 6 hours prn for pain
11/6
GG
Hydromorphone (Dilaudid) 1 mg
IM every 4 hours prn severe pain
INIT
Gloria Gale, RN
GG
Init
Time
D
Time
E
RN
Init
Date
Time
N
SIGNATURE
©2011 Keith Rischer/www.KeithRN.com
N
Date: 11/7
D
Date/
Time
Given
Medication/Dose/Route/Time
Date: 11/6
Start
Init
SIGNATURE
Date/
Time
Given
E
N
Init
Date: 11/8
D
E
N
D
E
0200
GG
INIT
SIGNATURE
INIT
SIGNATURE
INIT
Parenteral Medication Practice Key for: Sue Jones
1. Did you calculate the correct dose of Heparin to be given?
 0.4mL
2. What is the mechanism of action of Heparin and why is it given for those who are at risk for immobility?
 Mechanism-refer to Davis Drug-familiarize with clotting cascade-most important aspect: prevents
conversion of fibrinogen to fibrin
 Prolongs clotting cascade making it more difficult for venous clots to form that could cause deep vein
thrombosis (DVT) that could cause pulmonary embolus
3. What nursing assessments are required before giving Heparin?

Assess for signs of bleeding: unusual bruising, black-tarry stools, hematuria
4. What is unique with administration of subcutaneous Heparin?
 Do not massage site afterwards
 Alternate injection sites from right to left side
5. Where is the correct location for subcutaneous administration of Heparin?
 Abdomen-lateral aspect above iliac crests-NOT central or close proximity to umbilicus
6. What assessments need to be made by the nurse before giving Dilaudid?
 Level of consciousness
 Orientation
 BP-hold if <90
 Severity of pain
7. When would you reassess this patient for pain based on your knowledge of the time action profile and when
this medication peaks?
 Peak 30-60”
8. How does Dilaudid work and what are the most common side effects?
 Binds to opiate receptors in CNS. Alters perception and response to painful stimuli…GENERALIZED
CNS DEPRESSION
 Because of CNS depression>most common side effects are confusion, sedation, respiratory
depression, hypotension and constipation
9. Where did you choose to administer the insulin? Why did you choose this site? What is the most you can
administer in this site?
10. Where did you choose to administer the Morphine? Why did you choose this site? What is the most you
can administer in this site?
11. Did you sign the MAR with your full name, SN NCC and your initials?
12. You’re all done! Good job. Good luck on the med test!
©2011 Keith Rischer/www.KeithRN.com