Medication Administration (Exam 1) – Flashcards

the prescriber the pharmacist the nurse

are a permanent legal record

It is a shared legal responsibility. Nurses still need to check before administering medications.

order medications

written verbal standing MD protocols

repeated back to the physician

are standing orders that are given if a certain thing takes place. i.e. If K+ drops, do ___________. If K+ rises, do _____________.

must be clarified

Must be a part of every medication order patient name date and time order is written name of drug dosage of drug route of administration frequency of administration signature of person writing the order Please Do Not Drown Really Fresh Shrimp

drug should not be administered

standing order PRN order single order stat order

Everyday Give within 2 hours i.e. Lasix 40 mg every day

as needed i.e. Demerol 50 mg IM q 4 hr PRN for pain

given one time at a specific time i.e. Atropine 1 mg IVP stat

Medication needs to be given within 5 minutes

Medication needs to be given within 30 minutes

Maintain medication supply (pyxis & unit dose) Act as resource

24 hour supply for each patient

computer system that dispenses, tracks, bills, etc.

can ask about interactions or reactions

*correct transcription and communication of orders *accurate calculation, measurement, and administration techniques *recording drug administration *patient and family teaching

*clarify *withold harmful medication *notify the physician (if you withheld drug) *refuse to administer harmful drugs (some drugs require vital signs and certain ranges)

dose, route, frequency, why the medication is ordered

say to patient "I'm here to give you your 44 units of insulin" and they may be like "NO I take 4 units of insulin"

medical history (drug data and diet history) allergies (food and drug) perceptual or coordination problems patient's attitude level of knowledge learning needs

read medication label compare med label to MAR (in electronic record) reread label during med preparation do this before, during, and after administration

any preventable event that may lead to patient harm or incorrect administration

Right Drug - ambiguous drug names Right Dose - dosage calculation Right Patient - identification bands Right Route Right Time - 30 min hedge factor allowed Right Documentation Do Dragons Play Ring Toss Diligently?

a challenge when there are ambiguous drug names. In order to administer the right drug the nurse must use the 3 check system, closely examine spelling, be knowledgeable about drugs administered, and examine the relationship between the drug ordered and the patient's condition. When in doubt, the nurse must consult drug resources such as textbooks, pharmacist, and the physician.

Check product literature to make sure the drug dosage is ordered as indicated by the manufacturer. Evaluate serum drug levels and notify the physician when these may affect the patient's current condition. Drug calculations must be correct and when in doubt have another nurse recheck calculations.

always check identification bands

Check product literature to make sure the drug may be given by the ordered route. If the route is ordered incorrectly hold the medication and notify the physician. Nurses must be knowledgeable of each medication they administer.

give medications on time and assess that the schedule for the drug is consistent with maintaining therapeutic levels for the drug. There is a 30-minute hedge factor that is allowed before or after the time frame ordered.

chart each medication thoroughly and correctly

SAFETY

hospitals have set time frames for these medications

concentrate use appropriate measuring devices maintain asepsis avoid waste NEVER administer medication prepared by another NEVER leave medications unattended NEVER chart a med as given until given check for allergies on bracelet be aware of situations that contraindicate admin of meds listen to the patient

do not repeat medication as some begin absorption in the mouth. Notify the MD.

condition change, allergy, diagnostic tests

distractions

free from contaminates/bacteria enteral medications = clean/medical asepsis parenteral medications = surgical asepsis

wrong patient wrong dose poor penmanship wrong route record keeping errors

assess the patient notify the MD incident report

mandatory used for risk management helps identify the reason for mistake

*be informed of the purpose, action, and side effects of the drug *refuse a medication (document why done so) *have health hx and allergies assessed *be advised of experimentation *receive medication correctly and safely *not receive unnecessary meds

partnership in health improved health decreased healthcare costs (meds prevent future visits)

this is achieved when the patient understands the need for their medication therapy and accepts responsibility for learning and correctly managing their medication regimen

*medication action - why they are on the drug *side effects *how to administer *when to notify the MD *take as prescribed *keep current list of medications *OTC interactions

be as specific and simple as possible ask patient to review the steps in their words do verbal teaching and provide reading sheets have family present

assess learning need be brief sensory perceptual problems include family and significant others be creative

lack of knowledge sensory-perceptual problems cost basic needs come first (food/shelter) side-effects poor organization denial about condition can't go get meds

*safest route *absorbed in stomach or small intestine *slowest onset/prolonged effect *safety concerns (swallowing difficulties/aspiration) *available - tablets, capsule, liquids, powders, enteric-coated tip: let them see you wash your hands. no gloves needed. patient needs to be upright to prevent aspiration

buccal - inside of cheek sublingual - under tongue allow for rapid absorption due to thin membranes and plentiful blood vessels i.e. nitroglycerin

elixirs, spirits, suspensions, syrups measured at the base of the meniscus tip: patient can suck on ice cube first to help with the taste. Frequent oral hygiene is also important.

particles mixed with liquid base

prepared with distillation

follow package directions i.e. potassium chloride (KCl), metamucil, miralax

*Assess tube placement to prevent aspiration. PEG (J) Tubes do not need to be checked because surgically inserted *Ascultate 15cc air and listen for sounds in abdomen or pull back on syringe to check for stomach contents *Dissolve crushed medications in warm water *PEG stands for Percutaneous Endoscopic Gastrostomy. *Irrigate tube before and after with 50-150cc room temperature water (30 for someone on fluid restrictions or with renal failure or congestive heart failure) *Count flush water and dissolve water as intake *Patient is in semi-fowler's position unless contraindicated by condition

When medications are administered enterally and are incompatible with the prescribed tube feeding, it is best to stop the tube feeding for at least 30 minutes prior to and after the administration of the medication. A time period of thirty minutes allows for the tube feeding to clear the GI tract and therefore not mix with the medication. Don't forget to turn the feeding back on!

Site: skin Formulation:creams, liquid suspensions, ointments, pastes, sprays, patches Skin needs to be clean and dry; no previous applications Start in center and come outwards can have local or systemic effects

Site: eyes, ears, nose, bladder, vagina, rectum Formulation: drop, ointment, spray, suppository, jelly, cream, foam, enema

Drops or sprays Works locally on nasal tissues Patient should blow nose first Tip of applicator is inserted 1/4 inch Avoid nasal septum (causes sneezing) Clean applicator tip with warm water before each use Patient should have head tilted back and remain that way

*Do not share!! *Treat eye diseases *drops or creams *can have systemic effects *Pt. head back *pull down conjunctiva *applicator 1/2-3/4 in away *eye is considered sterile

always drops children 3 years and younger: pull pinna back and down adults over 3: pull pinna down and back

Yeast infections Supine postion or dorsal recumbent for at least 15 mins Given with applicator

Suppositories Patient positioned on side with leg up (15 mins after) Insert 3"-4" into rectum for adult Insert 1"-2" into rectum for child May produce local or systemic effects

Site: eyes, ears, nose, bladder, vagina, rectum Formulation: drop, ointment, spray, suppository, jelly, cream, foam Cleansing of body cavity by flushing with medication. Is used after surgery or on pressure wounds. Maintain surgical asepsis for wounds and body cavities Maintain medical asepsis for vaginal, rectal, and gastric. body cavity, wounds, vaginal, rectal, GI

an instillation is not removed whereas an irrigation is removed after a designated amount of time enema is an instillation because it is meant to remain in the body to either provide relief (ex: laxative) or kill bacteria (ex: medicated)

Site: respiratory tract Inhalers for respiratory illness Mainly education and teaching MDI=metered dose inhaler Spacers make it easier to reach lungs Rinse mouth after inhaler Big breath in, out, then depress on next in breath Hold 10 seconds Wait 2 minutes before next inhaled medication

Injections Outside GI system Do not originate in mouth or stomach Don't have to take 1st pass effect

rapid absorption rapid treatment route of choice for patients that can't swallow

Short duration Invasive = potential trauma Expensive Discomfort Irretrievable

Needle (.5-3 inches) Gauge (27g-14g) Bevel Hub

1/2" - 3" average for IM = 1" Depends on size of patient and size of muscle

27g-14g Greater the number = smaller the opening Depends on medication thickness

hole where the medication comes out

place where the needle attaches to the syringe

Insulin Tuberculin Luer-Lok

low dose syringe always use for insulin measured in units fused needle .5 in needle 26-29 gauge U100, U50, U30

0.5-1 mL total Minimims or 1/10 mL 5/8" needle

has the threads for needle to be screwed on

Plunger Barrel Tip Hub Shaft Bevel

Sheath or guard with retractable needle Reduce needle stick injuries

Hepatitis B Hepatitis C HIV

NEVER RECAP with two hands Can use one handed scoop method if necessary

Route of Administration Viscosity of Solution Quantity Body Size Medication Type Dose

Ampules Vials Prefilled Cartridges

1x use that must be broken use filter needle to remove any glass do not push air in

airtight container must inject air into container before withdrawing medication

Powder preparations Dilutent=liquid Recommended fluid and amount take cap off; push down prepared by nurses because of time sensitivity often corticosteroids

1-5mL syringe 20-23 gauge (ventrogluteal) 1-1.5 in needle 90 degree angle 1-3mL dorso(ventral) gluteal, vastus lateralis, deltoid Advantages: administration of irritating drugs, rapid absorption (bc of rich blood supply) is faster than subQ and ID , volume Always aspirate!! 3mL is max in a large, well developed, adult muscle

Avoid tender/damaged tissue Avoid large nerves, bones, vessels Rotate injection site (abdomen is less painful and absorbed more quickly)

anterior superior Iliac spine greater trochanter of femur

Intramuscular = 90 Subcutaneous = 45 Intradermal = 15

NEVER USE

greater trochanter and anterosuperior iliac spine 19-22 gauge 1.5- 2" needle Large volume (2-3 mL) ASPIRATE Preferred site for anyone over 7 months

3 mL

Just below greater trochanter and hand above patella 19-22 gauge (usually 20) 1-1.5" needle length 2mL or less ASPIRATE

1"-2" under acromion process 19-22 gauge about 1" needle 1mL ASPIRATE Potential danger to radial and ulnar nerves and brachial artery

is used for administering drugs that are irritating to subcutaneous tissue. After the medication is prepared 0.2 mL of air is added to the syringe. When the medication is injected the air follows and traps the medication, preventing it from tracking back into subcutaneous tissue.

used on the ventrogluteal muscle to administer irritating substances. Traction is held to displace the subcutaneous tissue while administering an IM injection. Once injected hold the needle in place for 10 seconds before removing, remove the needle, and release traction. The drug is trapped in the muscle by the Z that is formed. The injection is prepared and a new sterile needle is applied prior to injection. Medications that recommend Z track - Ferrous sulfate (iron) and vistaril.

*Wash hands and prepare medication *Identify patient and inform *Prepare syringe and apply gloves *Locate muscle *Clean the site *Warn the patient *Inject @ 90* *Aspirate prior to administration *Support tissue prior to removal *Apply pressure to site

1-3mL syringe 23-26 gauge (23-25 for non heparin meds, 24-26 for hep) 3/8 in needle 45/90 degree needle (45 if normal weight, 90 if obese) 0.5-1mL arm, leg, abdomen, subscapular insulin, heparin, vitamins

Inject air into NPH (cloudy) Change needles Inject air into regular (clear) Withdraw regular Withdraw NPH must be done right before administration Regular is fast acting Regular insulin is the only insulin that may be given intravenously or intramuscularly and is given via these routes in emergency situations only

Dependent on patients patterned BS Fasting and 4 o'clock blood sugar Determines how much insulin to give based on blood sugar

Preventative or Post surgery TB Syringe 5/8" 25-27 gauge Belly injection (1" or more away from navel) No aspiration or massage Heparin, Fragmen, Lovenox

TB/1mL Syringe 26-27 gauge 2/8-5/8 needle 10-15 degree angle 0.1-0.2 mL back, scapula, chest, forearm used for TB Pull skin tight prior to injection to prevent painful insertion Few blood vessels so slow absorption Bevel up and just under skin Creates a wheal

*Administration details: time, drug, dose, route, site (IV administration - diluted, rate, IV port/site used) *Pertinent information associated with drug such as heart rate, BP, serum blood level *Recognizable signature with title *Follow up assessment data (pain scale, nausea) *Exact name and title of other nurses who implemented medication administration for patient you are charting on (when 2 nurses have to sign off on insulin) *Acceptable abbreviations *Military Time *Permanent ink. Correct errors with one line and initials *Write legibly *Clearly indicate that injection sites are rotated *Patient teaching: type and to whom it was delivered *Never document delivery until done so *Always include follow up assessments *If drug is held, document with reason and supporting data *If the patient is responsible for administering own medication, this should be documented.

an adverse event that is expected

usually due to undesirable reactions of drug therapy although AEs do not have to be casually linked with a specific therapy. Usually described in terms of intensity (mild, moderate, severe, life-threatening). Can be described as expected or unexpected.

the level of drug that will result in serious adverse effect ???

a severe type of allergic reaction that involves the massive, systemic release of histamine and other chemical mediators of inflammation that can lead to life threatening shock. Symptoms such as acute dyspnea and the sudden appearance of hypotension or tachycardia following drug administration are indicative of anaphylaxis which must receive immediate treatment

before meals

as desired/as directed

morning

twice a day

capsule

drop

hour

intramuscular

intravenous

number

after meals, after eating

by mouth

afternoon

when needed/necessary

four times per day

every 4 hours also 2,6,8,12

take

immediately, at once

tablet

three times a day

DO NOT USE Instead, use every

DO NOT USE Instead, use hourly or every hour

DO NOT USE Instead, use daily or every day

DO NOT USE Instead, use nightly

DO NOT USE Instead, use every other day

DO NOT USE Instead, use unit

DO NOT USE Instead, use international unit

DO NOT USE Instead, use no trailing zero

Important!

DO NOT USE Instead, use morphine sulfate or magnesium sulfate

write them out

DO NOT USE Instead, use greater than and less than

DO NOT USE Instead, use full drug names

DO NOT USE Instead, use metric units

DO NOT USE Instead, use at

DO NOT USE Instead, use mL