Infusion Confusion

The nurse checks the IV infusion rate and the infusion site frequently during administration of the drug. This is especially important if the patient is restless or confused. 

During the ongoing assessment, the nurse checks the needle site every 15 to 30 minutes or more frequently if the patient is restless or confused. When one of these preparations is given with a regular IV infusion set, the nurse checks the infusion rate every 15 minutes. The needle site is inspected for signs of extravasation (escape of fluid from a blood vessel into surrounding tissues) orinfiltration (the collection of fluid into tissues). 

SODIUM When NaCl is administered by IV infusion, the nurse observes the patient during and after administration for signs of hypernatremia (see Display 58-2). The nurse checks the rate of IV infusion as ordered by the primary health care provider, usually every 15 to 30 minutes. More frequent monitoring of the infusion rate may be necessary when the patient is restless or confused. To minimize venous irritation during administration of sodium or any electrolyte solution, the nurse uses a small bore needle placed well within the lumen of a large vein. 

Tea , in this work, refers only to the plant Camellia sinensis, its leaves, and the extracts and infusions thereof. Leaf, bark, stem, root, or flower extracts of scores of other plants are also sold as teas , creating confusion. An important reason for the consumption of these other teas , a.k.a. herbal teas or tisanes , is their lack of methylxanthines, unlike beverages prepared from Camellia sinensis which are naturally rich in these substances, especially caffeine. 

Amiodarone is the preferred antiarrhythmic during cardiac arrest according to the 2005 guidelines. Hypotension occurs frequently but can generally be reversed by decreasing the infusion rate. Other acute effects include fever, elevated liver function tests, confusion, nausea, and thrombocytopenia. 

They have a low incidence of adverse reactions and the reactions that occur are generally mild. Rapid intravenous infusion of H2 antagonists may cause bradycardia. Cimetidine is more inclined to cross the blood-brain barrier and CNS effects such as somnolence and confusion have been described, especially in the elderly and in patients with impaired renal function. Cimetidine in high doses, as the only one of its class, has antiandrogenic effects which could be explained by an increase of prolactin secretion, binding to androgen receptors and inhibition the cytochrome P450 mediated hydroxylation of estradiol. 

Herbs from these traditions often are administered in a confusing array of preparations (Table 69.2). In the U. S. market, tablet and capsule formulations are the most popular, while overseas, teas or infusions of herbs are the most widely used. Tinctures consist of an herb steeped in a mix of alcohol and water, and extracts consist of one part herb to one part ethyl alcohol. The alcohol content can be a concern, particularly with children. Some of these products have been withdrawn by the U. S. Food and Drug Administration (FDA) for this reason but may still be available outside the United States. 

An intravenous infusion involves a continuous flow of drug into a patient at a rate defined by the infusion rate constant, Rini, with units of mass/time. Discussions of infusion normally present the infusion rate constant as inf, which may be confused with a true reaction rate constant. Therefore, this presentation of infusion uses a less ambiguous variable, Rmi, for the infusion rate constant. 

Standardization of medications can be an effective method to reduce errors. High-risk medications can often be standardized to minimize confusion, streamline ordering, and allow preprinted rate charts to be available to staff. Insulin, heparin, cardiovascular agent infusions, and other high-risk medications lend themselves to this safety step. 

Adverse reactions are uncommon imless infusion is rapid or there is significant cardiac failure they include hypotension, dizziness, blurred sight, sleepiness, slurred speech, numbness, sweating, confusion and convulsions. 

Making an infusion is essentially synonymous with making a tea. Infusions can be hot or cold and are particularly favored for chemical compounds that are thought to be heat-labile. Leaves, flowers, or tender stalks are often prepared for consumption using this process. The solution is typically strained free of debris before consumption. This type of infusion is not be confused with a sterile intravenous infusion administered in contemporary medicine. 

There have been three reports of chloroquine overdose, two from Oman (40) and one from the Netherlands (41). The two reports from Oman were similar to previously published reports of chloroquine overdose associated with cardiac dysfunction, confusion, and coma both patients had standard treatment with activated charcoal, diazepam infusions, and positive inotropic drugs, and both survived. The single case report from the Netherlands gave pharmacokinetic measurements performed before, during, and after hemoperfusion. This showed that hemoperfusion extracted very little chloroquine and was unlikely to be of any use in chloroquine overdose, as would be expected from the high protein binding and large volume of distribution of chloroquine. 

A 68-year-old man developed diarrhea, dehydration, and atrial fibrillation 4 months after liver transplantation. He was taking tacrolimus (blood concentration 13 ng/ml) and was given a continuous infusion of diltiazem for 1 day followed by oral therapy. Three days later he became delirious, confused, and agitated, and the blood concentration of tacrolimus was 55 ng/ml. His mental statns gradnally improved after withdrawal of both dmgs. 

Of 20 patients, mean age 72, treated with low doses of doxapram by infusion, four developed violent restlessness, confusion, and hallucinations (SED-9, 5). Of these, three were known to drink excessive alcohol and two had abnormal Uver function. The reactions were relatively brief and occurred at the beginning and end of doxapram administration. 

Nervous system toxicity is most often seen with rapid intravenous infusion (3,25,26). The effects include headache, dizziness, tremor, confusion, tinnitus, dysarthria, paresthesia, respiratory depression, altered level of consciousness (from drowsiness to coma), and convulsions. 

IL-2 has been used in the treatment of sohd tumors such as metastatic melanoma, metastatic renal cell carcinoma, and colorectal carcinoma. Interleukin-2 infusions are associated with significant dose-dependent toxicity characterized by fevers, malaise, nausea, vomiting, diarrhea, hepatic dysfunction, pulmonary edema, somnolence, confusion, dysrhythmias, myocardial infarction, hematopoietic suppression, and renal insufficiency [10]. IL-2 has a short serum half-life of 6-10 min and a clearance of 30-60 min after bolus intravenously infusion [11]. Resultant toxicity is generally transient and reversible. It is possible that IL-2 induced renal failure only occurs in the setting of profound hypotension, prior volume depletion, concurrent administration of potentially nephrotoxic drugs, or the presence of underlying renal disease. 

Another possibility is that some other clotting factor is increased or activated in such a way that the assay system responds fortuitously to it in a way indistinguishable from the usual response to factor VIII, e.g., factors XI and XII factor XII is known to rise on exercise (II). That this might occur over a limited range of the dose-response curve in the thromboplastin generation test system was shown by experiments in which the addition of activation product (Wl) simulated an increased factor VIII concentration (author s unpublished observations, 1960 FI), although statistical invalidity would probably be detectable over a series of experiments if this were the explanation. This also was looked for, but was not found (14). It is interesting that, in a patient with severe factor VIII deficiency and partial factor XI deficiency (SI), adrenaline infusion was followed by a marked rise in factor XI concentration and the appearance of a trace of factor VIII (K. Schulz, personal communication, 1964). Furthermore, the confusion that arose some years ago over factor IX assay now seems to have been due to activation of the contact factors (P4), hence... 

The dose of ammonium chloride can be calculated on the basis of the chloride deficit using the same method as for HCl, using the conversion of 20 g ammonium chloride providing 374 mEq of H . However, only half of the calculated dose of ammonium chloride should be administered so as to avoid ammonia toxicity. Ammonium chloride is available as a 26.75% solution containing 100 mEq in 20 mL, which should be further diluted prior to administration. A dilute solution may be prepared by adding 100 mEq of ammonium chloride to 500 mL of normal saline and infusing the solution at a rate of no more than 1 mEq/min. Improvement in metabolic stams is usually seen within 24 hours. CNS toxicity, marked by confusion, irritability, seizures, and coma, has been associated with more rapid rates of administration. Ammonium chloride must be administered cautiously to patients with renal or hepatic impairment. In patients with hepatic dysfunction, impaired conversion of ammonia to urea may result in increased ammonia levels and worsened encephalopathy. In patients with renal failure, the increased urea synthesis may exacerbate uremic symptoms. ... 

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