Ch 29 Medications Flashcards
What are medication’s in reference to nursing functions
Medications are basic nursing functions that needs skillful technique to assess patient status
Who signs generic names
what is a trademark name
what is an official name and give a.k.a.
-what is it typically?
Generic names: assigned by manufacturer that first developed drug
Trade name: “ brand-name” Buy company that sells drug
Official name (monograph) a name by which drug is identified in official publications • typically generic name
What are contraindications for enteral (NG) medication
- Vomiting -give suppository or IV instead
- look for pill in vomit - Decrease GI motility
- absence of gag reflex
- Decreased level of consciousness
What are vital nursing interventions to remember when giving oral medication
If elder cannot swallow a pill what can you do
What is a good indicator to let you know medication can be crushed
- patient sitting 45-90
- Promote swallowing with water
- Open medication tell patient what it is
- Give irritating medications with a small amount of food
If Elder cannot fall pill check with pharmacy to see if you can crush and mix with applesauce
If medication is scored it’s a good indicator it can be crushed
Give examples of topical medication
give suppository information
What do you want meeting if you’re applying medication’s to a wound
Topical: -liniment -lotion -ointment -suppository : through mucous membranes, melts transdermal
If apply medications to a wound maintain surgical a sepsis
What differentiates a caplete and a capsule
-what’s vital to remember about a capsule
Describe a tablet
where do enteric coated drugs dissolve
Describe elixir v describe syrup 
Caplet: coated for easy swallow
Capsule: gelatin shell DO NOT OPEN
Tablet: compressed powder
Enteric coated colon dissolve in small intestine
Elixir : water + alcohol + sweetener
syrup: mid + solution

Describe:
- Suspension
- solution
- ointment
- Trans dermal
- paste
Suspension: drug particles in liquid •SHAKE
Solution: water + dissolved compounds
•STERILE
Ointment “salve” : semi solid
Transdermal: semi permeable with drug to skin
Paste: semi-solid thicker than ointment
• slower absorption


What are drug classifications based on
Give the two primary classifications
Drugs classified by effects on body systems 
- Pharmaceutical
- MOA, physiological effects, Chemical structure - Therapeutic class
-clinical indication for drug or therapeutic action
(I.e: analgesic, antibiotic)
What are pharmacokinetics give 4 parts
Pharmacokinetics: body on drug
A
D : after absorption, to body
M: liver
E: kidneys
What are a few factors affect absorption of medication
Route, lipid solubility, pH, blood flow, conditions at the side of administration, dose
What is pharmacodynamics
How do drugs alter body processes
When does drug receptor interaction occur
Pharmacodynamics: drug on body
Drugs alter body by turning on, off, promoting, blocking responses of body processes
Drug receptor interactions occur when drug interacts with one more structures
 What are a few adverse effects Of drugs
Anaphylaxis drug tolerance toxins idiosyncratic effects drug interactions
Define therapeutic range
define trout
Define half-life
Therapeutic range: concentration of drug in the blood that produces the desired effects
Trough level: drug in the lowest concentration in the body
Half life: Anout of time it takes for 50% of a drug to be eliminated
What is another name for a standing order
Standing order = routine order
Give the parts of a medication order
What do you compare the medication to
What determines when the nurse is given medication
why military time used
Medication order parts:
- patient’s name
- date and time written
- drug name, dose, route
- frequency
- signature of prescriber
Compare the medication to the MAR
Hospital policy determines when nurse gives medications
Military time used to decrease errors
What timeframe is considered On time for medication administration
What do you monitor with insulin sliding scales
What are you do after administration
30 minutes pre-/post indicates on time for medication administration
If using insulin sliding scales monitor glucose
DOCUMENT ALL MEDS
Define stock supply
How are medications kept before you get them from the dispensing system
When using the barcode enabled medication cart what must you scan
What do computerize medication dispensing systems control and what are they connected to
Stock supply is the large quantity of medications kept on the unit 
Medication‘s are kept under lock before retrieval
To use barcode medication cart scan the drug and the bracelet to verify
Computerized medication dispensing systems control medication dispense and art networked to a medication record to keep track
When prescribing controlled substances what MUST be included in administration documentation 
What are you do if you only use half of the dispensed narcotic
When are narcotics counted and what happens if the account does not match
Controlled substances administration:
- name of patient receiving
- amount used
- hour given and pooled
- name of prescriber and administering nurse
If you do not use for narcotic have a second nurse see you properly dispose of the medication
Narcotics counted at the beginning and end of shift if numbers off you must report in an investigation must be done
Give the three checks of medication administration
- When reaching four container
- After getting from drawer /before pouring from multidose container
-  at bedside
- before giving/ replacing multidose container back on shelf
What are the steps to take if a medication error happens
#1 check patient IMMEDIATELY!!! -patient is #1 priority
- Tell nurse manager and Dr. within shift
- Write a description of error and remedial steps in the MAR
- Complete error reporting form
- Report to risk manager so they can do a root cause analysis

What is the most common type of medication error
Give a few examples of the types of medication errors
Wrong dose = most common med error
- Inappropriate prescribing
- sounded alike / look-alike
- extra: not documented, omitted, wrong Dose
- wrong patient, wrong route, rate., Time
- wrong prep, deteriorated(expired)

What is a Nurses rule during medication reconciliation
For my kitchen reconciliation nurse messenger right medications and no duplicates
Ensure no medication forgotten
What is vital to remember when it comes to verbal orders
DO NOT TAKE VERBAL ORDERS 
- unless emergency, but ask Doc to put into system
- have two nurses here the order and say it back (REPEAT IT) 
- only use approved symbols
In the prevention of medication errors:
When mixing what do you wanna check
What labs are pertinent to check when giving meds
Can you administer medications prepared by others
- unless?
bedside med Opening med 2x check Deterioration 
To prevent medication errors:
-check compatibility charts if mixing
-check kidney and liver function labs before giving medication
-you CANNOT administer medication prepared by others
• unless you saw them draw up the medication
Never leave mid at bedside, open medication at bedside
Some medication PINCH+ hyper alimentation (TPN) Need a 2nd nurse check
Check expiration date

What are the five basic medication rights
What are the ither med rights
Five rights:
Right: patient, drug, dose, route, time
What are other rights to keep in mind
- reason
- assessment: “preassessment”
- documentation
- response: v adverse
- education
- refusal: find out why, let Dr know 
When you’re identifying patient what do you check on the patient
Give the three patient identifiers how do you confirm identity
Check : wrist band
- Full name —. Checks A&O x3
- DOB. —
- Record number
To confirm ask patient to state name
What factors influence the route of medication. 
Oral injection skin/topical transdermal mucus membranes inhalation
Oral: convenient, easy if swallowable
Injection: rapid absorption, infection risk
Skin/topical: painless, nurse can self absorb
Transdermal: prolonged systemic affects
Mucous membranes: quickly absorbed
Inhalation: rapid local respiratory effects

When giving liquid medication‘s How do you administer
Admin liquid medications into a med cupON TABLE
-look for meniscus lowest liquid line for accuracy
Or use oral syringe
When giving Enteral (NG) how do you confirm placement
For NG tube how much the head of bed be
-suction?
Give NG administration process
Confirm placement with
- initial x-ray
- measure external tubing
- check pH ⬇️5.0
Elevate head if bed to 45°
-stop suction and leave off for 30 minutes POST ADMIN
- Dissolve med in 30 mL of warm water 2. flush tube with 30 mL between meds 3. give each med separately
- flush 30 mL post
- sit up for 1HR to prevent aspiration
What are rules for recapping needles
If a medication is very Viscous what should you do in regards to needle gauge
Never recap needle post use
- scoop up
- pull off from TOP or BOTTOM
If very viscous = get bigger gauge
How should the bevel go with intradermal injections
What is the length of a subcutaneous needle
What does an ampule require to withdraw medication
-how do you get stubborn fluid stuck in neck out
What is needle gauge and what do the numbers represent
ID = bevel up
Sub Q: needle length: 3/8 to 5/8
Use filter needle to withdraw from ampoule
-tap on Neck to get stubborn fluid out
Needle gauge = needle with
18 biggest
30 smallest

Give the angle of insertion for each injection type
Intradermal: 5 to 15°
Subcutaneous: 45° children/thinner
90°: obese/abdomen
Intramuscular: 90°
What is the best site to use for intramuscular injections
What rate do you inject intramuscular medication‘s, how long do you stay after medication has been administered
What does a Z track method do describe how to do it


IM best site: ventral gluteal
Inject IM at rate of 1 mL/ 10 seconds
-stay 10 seconds after administration
Z track method seals medication in decreasing irritation
-  with ulnar side pull skin to side
- inject
- remove
- release skin
Give all related IM information
Sites needle length gauge angle volume
Sites :
-ventral gluteal #1
-Vastus lateralis: middle anterior lateral
-deltoid: 3 fingers below acromion process
•DO NOT EXCEED 1 mL DELTOID
Needle size: 1 to 1 1/2 in
Gauge: 22-25
Angle : 90
volume: 3 ml break up of +3
Give all related ID information
Sites needle length gauge angle volume
Sites:
Inner forearm
upper back under scapula
Needle length: 1/4 to 1/2 inches
Gauge: 25 to 27
Angle: 5 to 15°
Volume: 0.01 to 0.1 ml
What is the absorption rate of intradermal injections
When you administer intradermal injections what is it for
ID injections have the longest absorption time of all injections

Intradermal injections are for sensitivity tests and local anesthesia
Give all related SQ information
Sites needle length gauge angle volume
Sites: outer arm Upper back Abdomen **BEST upper ventral or dorsal gluteal anterior aspect of thigh
Needle length: 3/8 to 5/8
Gauge: 25-27
Ingle: 45 or 90°
Volume:1.5ml
What do you want to remember about administering Enoxaparin (two things)
Give instructions for pinching skin with subcutaneous injections
- insulin
- Heparin
Describe the rotation of sites with subcutaneous injections
Enoxaparin :
- do not expell air bubble
- inject 2 inches around umbellicus R and L
- Insulin: pinch skin and release upon injection
- Heparin: pinch can do not release do not massage
Do not rotate sites around body rotate around anatomical sites
How do you mix insulins
Clear before cloudy
Clean both tops Roll NPH Inject air to NPH Inject air to regular Withdraw regular Withdraw NPH
Where do IV administration medications deliver to
what is the IV route mostly used for
IV delivers directly into bloodstream
IV used for emergencies and pain
Where do you never want to administer eyedrops
Describe the technique for ophthalmic drops
Never administer eyedrops to cornea
-Sit and tilt head back or supine
-Dominant hand on forehead with dropper 1 inch above conjunctival sac
-Nondominant hand creating conjunk type of sack at cheekbone
-Close eyes (include pumped them for 60 seconds if necessary) 

How do you want to administer eardrops (very brief description)
Have patient up right or supine Pull on Pinna Hold 1 CM above canal Instill at side wall so it can roll in Lightly press on tragus and remain for 2 to 3 minutes 
 when placing a transdermal patch how do you protect yourself from the medication
What do you document on the new patch
Where is the placing of the transdermal patch
 glove up to protect from self administration of medication
A new patch document: initials, time, date
Transdermal patches are rotated at same level placed in hairless dry areas
When administering vaginal medication‘s what care do you give before insertion of suppository
What is the position for a vaginal suppository
What lube do you use for a vaginal suppository
When do you administer a suppository
When inserting vaginal suppository perform perineal care
Position:
-supine with knees bent and heels close to butt
Use water soluble lube administer at night
What is the position for recto insertion of a suppository and what do you want to insert past
For rectal suppositories lie in left Sims position insert past internal anal sphincter
What is important to remember with pressurized meter dose inhalers
How is a dry powder inhaler activated what do you not want to do
PMDI: requires hand strength to shake and prime
DPI: breath activated do not shake
When using a metered dose inhaler with a spacer what do you instructed patient to do
Have patient exhale deeply then close mouth on spacer and tilt head a little
Breathing slow and hold for 3 to 5 seconds
When administering the eye ointments where are you administering it and what is the direction
Eye ointments administered in the lower eyelid ribbon
Administer in an inward to our direction
What do you want to document post medication
Post medication document:
-drug
-dose route time
-person administering it
-site (if injection)
-refusal / medication errors

What are patient teachings when it comes to medication
Teach to review medication administration techniques
Take as prescribed for as long as prescribed
Do not alter dose
Do not share medication
