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4. How is "free water" different from water that comes from a faucet or tap? 5. How should "free water" have been administered to the patient? 6. What is hemolysis, or a hemolytic reaction? (You may need to look this up.)

4. How is "free water" different from water that comes from a faucet or tap? 5. How should "free water" have been administered to the patient? 6. What is hemolysis, or a hemolytic reaction? (You may need to look this up.)

Curren'S Math For Meds: Dosages & Sol
Curren'S Math For Meds: Dosages & Sol
11th Edition
ISBN:9781305143531
Author:CURREN
Publisher:CURREN
Chapter7: Safe Medication Administration
Section: Chapter Questions
Problem 6SST
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Water, Water, Everywhere, But Please Don't Give IV Problem: The treatment of severe hypernatremia can be challenging, especially in patients with preexisting conditions that may seem to limit therapeutic options. Such a situation recently resulted in an ill-conceived decision to give sterile water for injection IV to an elderly patient who had been admitted to an ICU with pneumonia and severe hypernatremia. The physician did not want the patient to receive any further infusions containing sodium. But the patient also was severely hyperglycemic. The physician's concern with giving sodium or dextrose to a patient with high blood sugar led to an order to change the patient's IV to "free water" at 100 mL/hr. "Free water" refers to water not associated with organic or inorganic ions. Because hypernatremia usually results from a deficit of "free water," it's likely that the physician intended to replace this loss when he wrote the order. Water can be replaced orally, however, it should never be given IV without additives to normalize tonicity, or hemolysis may occur. Name ALERT DE Just before writing the order, the physician had contacted a pharmacist to ask if "large bags of sterile water for injection" were available. A pharmacy intern retrieved a bag from the sterile compounding area, placed the label on the back of the bag, and dispensed it to the ICU. The nurse began the infusion without question because she was aware of the patient's hypernatremia and overheard the physician ask the pharmacist if bags of sterile water were available. She failed to see a red statement on the bag stating "Pharmacy Bulk Package, Not For Direct Infusion" because the pharmacy label was on the opposite side of the bag. Another nurse noticed the statement later and the infusion was stopped, but not before 550 mL had infused. The patient experienced a hemolytic reaction, acute renal failure, and died.
Transcribed Image Text:Water, Water, Everywhere, But Please Don't Give IV Problem: The treatment of severe hypernatremia can be challenging, especially in patients with preexisting conditions that may seem to limit therapeutic options. Such a situation recently resulted in an ill-conceived decision to give sterile water for injection IV to an elderly patient who had been admitted to an ICU with pneumonia and severe hypernatremia. The physician did not want the patient to receive any further infusions containing sodium. But the patient also was severely hyperglycemic. The physician's concern with giving sodium or dextrose to a patient with high blood sugar led to an order to change the patient's IV to "free water" at 100 mL/hr. "Free water" refers to water not associated with organic or inorganic ions. Because hypernatremia usually results from a deficit of "free water," it's likely that the physician intended to replace this loss when he wrote the order. Water can be replaced orally, however, it should never be given IV without additives to normalize tonicity, or hemolysis may occur. Name ALERT DE Just before writing the order, the physician had contacted a pharmacist to ask if "large bags of sterile water for injection" were available. A pharmacy intern retrieved a bag from the sterile compounding area, placed the label on the back of the bag, and dispensed it to the ICU. The nurse began the infusion without question because she was aware of the patient's hypernatremia and overheard the physician ask the pharmacist if bags of sterile water were available. She failed to see a red statement on the bag stating "Pharmacy Bulk Package, Not For Direct Infusion" because the pharmacy label was on the opposite side of the bag. Another nurse noticed the statement later and the infusion was stopped, but not before 550 mL had infused. The patient experienced a hemolytic reaction, acute renal failure, and died.
4. How is "free water" different from water that comes from a faucet or tap? 5. How should "free water" have been administered to the patient? 6. What is hemolysis, or a hemolytic reaction? (You may need to look this up.)
Transcribed Image Text:4. How is "free water" different from water that comes from a faucet or tap? 5. How should "free water" have been administered to the patient? 6. What is hemolysis, or a hemolytic reaction? (You may need to look this up.)
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