Chapter 15: Medication Administration Flashcards
are glass containers with narrow necks that are opened by breaking the glass
Ampule
when coronary arteries are unable to supply the heart muscle with sufficient nutrients and oxygen, this results in a crushing pain
Angina pectoris
pertaining to the inside of the cheek or to the surface of a tooth or the gum beside the cheek.
Buccal
a laxative preparation
Cathartic
diluting liquid
Diluent
indicates administration of medication directly into the gastrointestinal tract via oral or rectal sites or via a nasogastric (NG) tube
Enteral
refers to the fact that the fluid is outside the vessel
Extravasation
collection of blood in tissues
Hematoma
leakage from the vein into surrounding tissue
Infiltration
the pressure exerted by fluid due to the force of gravity
Hydrostatic pressure
the administration of fluids or medications through an intravenous catheter by gravity flow
Infusion
a small adapter with a diaphragm that is attached to an intravenous catheter when more than one injection is anticipated.
Intermittent injection port
within an artery
Intraarterial
within the dermis layer of the skin
Intradermal
within muscle tissue
Intramuscular (IM)
pertaining to a structure, process, or substance within a sheath, such as within the spinal canal
Intrathecal
into a vein
Intravenous (IV)
pertaining to a liquid that has the same concentration of solute as human body fluid
Isotonic
a 0.9% weight per volume (w/v) solution of sodium chloride in water that is isotonic with blood. It is available as a sterile solution for intravenous injection or infusion
Normal saline solution (NS)
medications are injected directly into the body and bypass the gastrointestinal tract
Parenteral
consists of written directions for a specific medication or procedure, signed by a physician, and used only under the specific conditions stated in the order
Standing order
beneath the skin
Subcutaneous (SC)
drugs placed under the tongue
Sublingual
refers to the application of medication to the surface of the skin or mucous membranes
Topical
These medications are applied to the skin in a paste form or on adhesive disks that allow the medication to be absorbed through the skin into the bloodstream
Transdermal
What is the gastrointestinal tract?
the organs that food and liquids travel through when they are swallowed, digested, absorbed, and leaves the body as feces
- examples: mouth, pharynx, esophagus, stomach, small intestine, large intestine, rectum and anus
What is the radiographer role in medication administration?
- check allergic history of patients
- prepare medication for administration
- verify patient ID
- assist the physician
- monitor the patient after medication has been given
- if state regulations permits radiographers administer and chart the medication or contrast medium
- get proper history
- document everything
When medications are given in the imgaing department what does the physician do?
the physician selects the drug, determines the route of administration, and prescribes the exact dosage
The type of orders made:
- written
- verbal
- standing order
For orders that are given verbal
should be written or countersigned by the physician before leaving the area
what medical order is not permitted in all states and not permitted in some institutions
Verbal
SIX RIGHTS OF MEDICATION
ADMINISTRATION
-THE RIGHT DOSE
-OF THE RIGHT MEDICATION
-TO THE RIGHT PATIENT
-AT THE RIGHT TIME
-BY THE RIGHT ROUTE
-WITH THE RIGHT DOCUMENTATION
When preparing to administer medication the first step is to what?
verify patient identification
*two identifiers are needed
- patient’s full name and brithday
- check the patient’s armband against the order
No medication should ever be given without what?
a physician’s order
Normal dosage is provided where?
in package insert
physicians are not required to prescribe the usual dose true or false
true
Routes of administration:
-ENTERAL ROUTE
-ORAL
-RECTAL
-NASOGASTRIC (NG) TUBE
-MEDICATION INHALATION
-TOPICAL ROUTE
-SUBLINGUAL AND BUCCAL ROUTES
-PARENTERAL INJECTIONS
-INTRAVENOUS (IV)
This type of route indicates administration of medication directly into the gastrointestinal tract
enteral route
the different types of enteral route
-oral
-rectal
-nasogastric (NG)
When a patient is severely nauseated or unable to swallow, medications can be administered by what?
by rectum
portions may be expelled prematurely, making dosage unreliable. An effective alternative for these patients is to administer medications and liquid nutrition through
an NG tube
Common and most familiar administering of medication
*dissolve in the stomach and into the small intestine absorption takes place
-digestive process can reduce therapeutic effect
Oral
ALTERNATIVE FOR THOSE UNABLE TO SWALLOW OR WITH
AN UNRETENTIVE STOMACH
- DOSAGE MAY BE UNRELIABLE BECAUSE OF EARLY
EXPULSION.
Rectal
ALSO AN ALTERNATIVE TO ORAL ADMINISTRATION
* MORE RELIABLE AND MORE EASILY CONTROLLED
Nasogastric NG tube
Oral medication with an enteric coating must be what
swallowed whole, not chewed, crushed, or broken
Provide therapy directly to lungs/respiratory system
* used in nuclear medicine for administration of radioactive gases for lung ventilation studies
- sniffing salts
- for people with asthma
Medication inhalation
are applied for a local effect, such as when calamine lotion is used to relieve the itch caused by poison ivy.
-MAY BE USED TO PROVIDE LOCAL THERAPY, SUCH AS
CREAMS FOR RASHES
-TRANSDERMAL PATCHES PROVIDE THERAPY BY
ADHERING MEDICATION TO THE SKIN, WHICH IS
EVENTUALLY ABSORBED INTO THE BLOODSTREAM.
ex. nicotine patches and birth control
Topical route
Sublingual and buccal routes are not considered what even they are placed in the mouth
they are not considered oral or enteral routes
-ABSORPTION THROUGH MUCOSAL TISSUES INTO THE
BLOODSTREAM
-THIS BYPASSES GI TRACT.
Topical Route Variation
What is use to treat angina pectoris crushing chest pain
nitroglycerin
is the application of glucose paste inside the cheek of an unconscious patient with an insulin reaction.
buccal administration
USED TO DELIVER DRUGS THAT:
-CAUSE IRRITATION OF THE GI TRACT
-CANNOT BE ABSORBED BY THE GI TRACT
-ARE NEEDED RAPIDLY TO SITE OF action
Parenteral injections
medications are injected directly into the body and bypass the gastrointestinal tract
parenteral route
Parenteral routes administration:
-intradermal
-subcutaneous (SC)
-intramuscular (lM)
-intra-arterial
-intravenous (IV)
-intrathecal
are parenteral injections administered between the layers of the skin.
Intradermal Injections
injections deliver medications into the fatty tissue layer beneath the skin.
Subcutaneous Injections
IM; into the muscle) injections are sometimes given in larger amounts than SC injections
Intramuscular injection
involves percutaneous access to the artery by a needle, frequently followed by catheter placement to permit injection at a specific anatomic site.
Intraarterial Administration
is the parenteral method used when a contrast medium is to be injected through a spinal needle directly into the subarachnoid space.
Intrathecal Administration
The most common type of intravascular administration
Intravenous (IV
into a vein
Intravenous (IV)
are those that are introduced to the body by means of injection
parenteral medications
require the use of engineering controls to decrease the risk to health care workers from contaminated needlesticks
needleless systems
sharps with a built-in safety feature
the smaller the gauge size
the bigger the hole
never recap a what
dirty needle
READ THE MEDICATION LABEL THREE TIMES BEFORE
ADMINISTRATION: Parenteral administration
- when selecting the container
- while preparing the dose
- just before injection
* this is essential to be absolutely certain you have the correct drug and the proper strength, and that the expiration date has not been exceeded
Parenteral Injection Procedure
- Greet the patient. Check patient identification and explain the procedure.
- Select the appropriate injection site.
- Perform hand hygiene and don clean gloves.
- Cleanse the selected area with an alcohol wipe.
- Hold the skin taut with your nondominant hand.
- Insert the needle at the correct angle, and pull back slightly on the plunger.
- If no blood is present, inject the medication.
- Withdraw the needle quickly, and wipe the injection site.
- Place the syringe with attached needle in a sharps container.
- See to the patient’s comfort.
- Remove your gloves and perform hand hygiene.
- Chart the medication.
- Discard the container and any remaining medication
-provides most immediate effect
- used for delivering most emergency medications when an immediate response is critical
-also used to deliver parenteral nutrition and chemotherapy
-used to inject contrast media for radiographic examinations of the urinary tract and for some computed tomography (CT) studies, and to provide sedation during invasine procedures and Mri examinations
IV Route
refers to diffusion of the fluid into the surrounding tissues
Infiltration
Important to have no air in the veins true or false
true
sometimes called a drip infusion, is the administration of fluids or medications through an intravenous catheter by gravity flow.
infusion
The most common replacement fluid is
normal saline (NS)
a solution of 0.9% sodium chloride in water.
normal saline (NS)
That is, it has the same has the same concentration of solute as human body fluid.
isotonic
A 5% solution of dextrose in water (D5W) is also a very common fluid true or false
true
sometimes called a saline lock
intermittent injection port
example of an interdermal test
TB test
-skin test
The veins most often used for initiating IV lines
-anterior forearm
-posterior hand
-radial aspect of the wrist
-antecubital space
most common place for injection
anticutible
most common injection
-antecubital
-cephalic vein
-basilic vein
what side is cephalic on
hand thumb side
what side is basilic on
pinky side
concentration of solution
osmolarity
increase atomic number
* iodide, barium
positive contrast
thickness
viscosity
has air
- low atomic number
negative contrast
IV injection used what type of needle
-hypodermic needle
-butterfly set needle
what happens with risk of reaction when osmolarity of contrast agent increases
as osmolarity of contrast agent increases risk of reaction increases
What is the normal drip rate for an IV fluid
15 to 20 drops/min is about 60mL an hour
how to reduce thickness of a medication
put in warmer
rapid injection of contrast
Bolus
bolus injection is also known as
IV push
what happens if the bag is placed too low
IF THE BAG IS PLACED LOWER THAN THE VEIN, BLOOD WILL FLOW BACK
INTO THE CATHETER OR TUBING AND MAY CLOT, CAUSING THE FLUID TO
STOP FLOWING.
How high should an IV bag be above the vein
18 to 20 inches
If the injection site is cool, swollen, and boggy the iv solution is what
may have infiltrated
what happens if the bag is too high
AN IV SOLUTION THAT IS TOO HIGH MAY CAUSE FLUID TO INFILTRATE
INTO THE SURROUNDING TISSUES BECAUSE OF THE INCREASED
HYDROSTATIC PRESSURE.
PAINFUL AND OFTEN DANGEROUS CONDITION
TREATMENT IS TO APPLY COLD PACKS TO THE SITE.
INCIDENT REPORT MUST BE FILED.
Extravasation
what do you do if there is infiltration /extravasation
apply cold packs
agents that cause blistering if infiltrated into subcutaneous tissue
vesicants
steps for DISCONTINUING AN IV
PERFORM HAND HYGIENE AND DON GLOVES.
* EXPLAIN PROCEDURE TO PATIENT.
* CLOSE THE DRIP CONTROL.
* GENTLY REMOVE ADHESIVE TAPE AROUND
CATHETER TO EXPOSE VEIN.
* REMOVE CATHETER WITH A SINGLE LONG,
SMOOTH PULL.
* CHECK TIP TO ENSURE IT IS INTACT.
* APPLY PRESSURE TO SITE WITH DRY COTTON
BALL OR GAUZE FOR 1 MINUTE.
* APPLY STERILE ADHESIVE BANDAGE OR TAPE
COTTON BALL TO SITE.
* DOCUMENT IV REMOVAL IN CHART
* REMOVE GLOVES AND PERFORM HAND
HYGIENE.
materials needed for discontinuing an IV
-gloves
-a sterile adhesive bandage
-bandage scissors
-cotton balls
-gauze sponges
-tape
list some Precautions of all injections
-WEAR GLOVES
-DISPOSE OF ALL SYRINGES AND NEEDLES DIRECTLY INTO
A PUNCTURE-PROOF CONTAINER WITHOUT RECAPPING.
-USE SAFETY-DESIGNED NEEDLES AND NEEDLELESS
DEVICES WHENEVER POSSIBLE.
-ALWAYS FOLLOW ESTABLISHED RULES OF ASEPTIC
TECHNIQUE.
-READ THE LABEL THREE TIMES: BEFORE DRAWING UP
THE MEDICATION, AFTER DRAWING IT UP, AND WITH THE
PHYSICIAN BEFORE ADMINISTRATION.
-LABEL THE SYRINGE WITH THE MEDICATION NAME AND
STRENGTH (CONCENTRATION) IF THE MEDICATION WILL
NOT BE ADMINISTERED IMMEDIATELY.
-CHECK PATIENT ID BEFORE ADMINISTRATION.
-CHECK FOR ALLERGIES.
-MONITOR PATIENT CAREFULLY FOR SIDE EFFECTS.
radiographers who chart medications must use the exact procedure established by the institution
Charting medications
Monitoring IV fluids
- CALL IN ADVANCE TO INFORM THE NURSE OF LENGTHY
PROCEDURES. - PLUG IN THE PUMP RATHER THAN RELYING ON BATTERY
POWER. - WATCH IV FLUID LEVELS, AND ALLOW TIME FOR
REPLACEMENT BEFORE THE IV FLUID IS EXHAUSTED. - IF AN IV SET RUNS OUT, OR IF THE ALARM SOUNDS, CALL
THE NURSING SERVICE IMMEDIATELY RATHER THAN
WAITING UNTIL THE PATIENT IS RETURNED TO THE
NURSING UNIT.
-each entry must be signed
-contrast media are charted as medication
*contrast agent’s name
*volume administered
*date and time of administration
Charting medication
Range for BUN
7-21
above 21 kidneys are not functioning properly
What are the routine entry made in proper section when charting of a medication?
-date
-time of day
-drug name
-dosage
-route of administration
Range for creatinine
0.7-1.5
too high kidneys are not functioning properly to be able to not filter out iodinated contrast
rate at which glomerulus within the kidney filter waste from the blood
Globular filtration rate
Range for GFR
90-120
below 90 is not good indicating kidneys are not filtering adequately
what does GFR stand for
Globular filtration rate
what type of relationship does BUN and Creatinine have with GFR
inverse
schedule these studies in order :
IVU , UGI, BE, KUB
- KUB
- IVU
- BE
- UGI
An IV line is established usig what types of needles
butterfly needle or an IV catheter
increase BUN or Creatine
decrease kidney function (GFR)
how should certain exams be scheduled
no contrast studies first
-iodine studies filter out quicker
-lower gi
-upper gi
intradermal injections used what type of injection
tuberculin syringe
what is the most convenient area for subcutaneous injection
upper arm and outer aspect of thigh
govern the rate of fluid administration or to deliver measured amounts of drugs at regular intervals
medication pumps
