1: Medication Administration Flashcards
Therapeutic effect
expected or predicted physiological response
adverse effect
unintended, undesirable, often unpredictable
Types of adverse effects
side effects
toxic effects
idiosyncratic reaction
side effect
predictable, unavoidable, secondary effect
Toxic effect
accumulation of medication in the bloodstream
idiosyncratic reaction
Overreaction, underreaction, different reaction from normal
Allergic reaction
unpredictable response to a medication, can be life threatening
medication interactions
one medication modifies the action of another
medication tolerance
more medication required to achieve the same therapeutic effect
Medication dependence
Physical and psychological
Medication legislation and standards
federal regulations
state and local regulation of medication
nurse practice acts
PRN order must….
list indication, know why the patient is taking it
Type do communication for orders
Handwritten Computer provider order entry Preprinted telephone verbal
When communicating order verbally or through the phone….
Nurse MUST repeat order back to the prescriber
Types of medication orders
automatic “stop” date
STAT order
Now order
PRN order
Automatic “stop” date
EX) taking an antibiotic daily for 5 days
STAT order
Give immediately
Now order
RN has up to 90 minutes to give the drug
PRN order
As needed
Cutting/crushing/opening medication can alter…
dose
delivery
absorption
efficacy
7 rights
Time Patient Route Drug Dose Documentation Indication
Basic 5 rights during the 3 checks
Patient Drug Dose Route Time
What makes a medication a high risk?
high risk of negative effect when used incorrectly
Examples of high risk medications
Heparin/other anticoagulants Insulin Opioids Chemotherapy Psychotropic drugs
What should you do when a medication error occurs
Asses patient condition and assess medication
When patient is stable, report incident
Document
What should you do when there is a near miss and incidents that cause no harm?
still report
Medication action
Onset peak trough plateau duration
Onset
time needed to produce a response
Peak
time needed to reach maximum efficacy
Trough
lowest blood level of drug immediately prior to next dose
Plateau
When the blood level of drug reaches a therapeutic level after repeated doses
Duration
time drug is present at a level to cause a response
Example of oral medication
Swallow
sublingual
buccal
Examples of topical medication
Ointment liniment lotion paste transdermal disk/patch
Examples of parenteral medication (via needle)
Intradermal
subcutaneous
intramuscular
intravenous
Examples of instillation into body cavities
suppository/troche
creams/drops/ointments
Examples of inhalation medication
inhalers
nebulizers
Examples of intraocular medication
intraocular disc
eye drops
eye ointments
How to pick a syringe during parenteral administration
Use the smallest capacity syringe to administer required volume
2 things to consider when selecting a needle
Length and gauge
If medication is given intramuscularly, how long should the needle be?
longer needle in order to reach the muscle, or if individual has a higher fat content
Id medication is given subcutaneously, how long should the needle be?
Shorter than IM, but longer the ID, it’s just below the skin and into the fat layer
Larger gauge number =
Smaller diameter
If blood is thick, what gauge is preferred? 16 or 25?
16G is preferred as it has a larger diameter
Intradermal route is ____ the skin layers
Between the skin laters
How long should the needle be for a intradermal route
Very short/fine gauge needle
What degree should intradermal be
5-10 degrees
a subcutaneous route is ____ the skin and ____ fat layer
below the skin and into the fat layer
Needle length for a subcutaneous
Slightly longer, larger gauge needle
What degree should a subcutaneous route be used?
45-90 degrees, however it depends on fat content
an individual with less fat, receiving a subcutaneous injection, should receive what degree?
45 degrees
an individual with a higher fat content, receiving a subcutaneous injection, should receive what degree
90 degree
Intramuscular injections require what kind of needle/gauge
Longer and same or larger gauge needles
What degree should an intramuscular injection be injected at
90 degrees!
When are intradermal injections used
Skin testing, like TB or allergies
what type of needle is used for a intradermal injection
Tuberculin or small hypodermic needle
Volume for intradermal injection
Very small, volume of 0.1 mL
What will form during a intradermal injection
A bleb/wheal will form as you inject
Sites for subcutaneous injection
abdomen, legs, back of arm, below scapula, top of buttocks
What type of injection absorbs faster?
Intramuscular
Aspiration
after insertion of needle, BEFORE INJECTION, pull back plunger to see if blood appears in syringe
preferred and safest site for all adults, children, and infants for injection
Ventrogluteal site
injection site used for adults and children, often used for infants, toddlers, and children receiving biologicals
Vastus lateralis
injection site for a volume less than 2 mL, not well developed in many adults
Deltoid
all intramuscular injections should be inserted at an angle of
90 degrees
What area of the body should IM not be used?
buttocks because high risk for injury to the sciatica and presence of major blood vessels near the site
Why are ampules used?
Ampules are 100% glass container and some medications interact with plastic or rubber
Steps for using an ampule
- snap at neck, PROTECT fingers with ampule opener, alcohol pad, gauze
- USE filter to draw to capture shards
- REMOVE or CHANGE needle prior to injecting into tissue, IV line, or IV bag
Should needles be recapped after they have been used?
NO!! but needles can be covered by a sheath/protective cover into the sharps container
What happens with unused needles?
They can be recapped, but use the scoop method to avoid poking finger
