Chapter 19: Medication Administration Flashcards
chemical name
based on its molecular structure
generic name
given by the United States Adopted Names Council and is the drug’s official name throughout its lifetime
trade or brand name
used by the pharmaceutical company for a 17-year period in which it has the exclusive rights to make and sell the drug.
unit-dose system
involves the pharmacy or manufacturer in prepackaging and prelabeling an individual patient dose
Bar Code Medication Administration
Uses a handheld laser scanner, a laptop, and bar codes. Patients wear bar-coded id bracelets. The nurse enters a password to access the computer. When the nurse scans the id bracelet, the computer displays the medication record. The nurse selects medications from a drawer and scans the bar code on each packaged medication. The system confirms patient, medication, dose, and route. It also tracks time and nurse. The system will warn of a potential error if the action does not meet five of the six rights.
self-administered medication system
supplies each patient with prescribed doses
prescription
is a legal order for the preparation and administration of a medication.
SAFETY ALERT
Always determine which nonprescription medications the patient has been taking and ensure that he takes no medications without the healthcare provider’s knowledge.
Tallman letters
minimize the risk of selecting the wrong medication name
SAFETY ALERT
Always clarify with the provider any medication order that is unclear or seems inappropriate.
SAFETY ALERT
If an order specifies a certain route of administration and the patient’s condition changes, making the ordered route inappropriate or possibly unsafe, notify the provider so that he or she can change the route of administration.
SAFETY ALERT
To ensure accuracy when taking telephone orders, always repeat the order to the provider after writing it down. The provider must cosign the order within a specified time, usually 48 hours. Do not take verbal orders except in an emergency situation (code), because the risk for error is very great. Direct the provider to write the order.
Food and Drug Administration (FDA)
Division of the U.S. Department of Health and Human Services. Regulates the manufacture, sale, and effectiveness of medications. Requires drug testing in lab animals and humans before a drug is approved for use. Keeps ineffective or unsafe drugs off the market and recalls inadequately tested or dangerous drugs. Identify which medications can be obtained with or without a prescription, set and enforce standards of purity and potency, oversee all drugs, and control drug advertising to the medical profession.
SAFETY ALERT
You have the right and responsibility to decline to administer a medication if you believe it jeopardizes patient safety.
SAFETY ALERT
Do not give any medication prepared by another nurse unless the unit-dose label identifies the drug and the seals are intact.
6 rights
right patient right medication right dose right route right time right documentation In addition, the patient has the right to refuse.
Controlled substances
drugs that are considered to have either limited medical use or high potential for abuse or addiction.
SAFETY ALERT
The chemically impaired nurse cannot be trusted to exercise optimal clinical judgment. Such individuals must be identified in order to protect patient safety and so that the nurse can obtain treatment.
Pharmacokinetics
Is the process by which a drug moves through the body and is eventually eliminated. It involves the absorption, distribution, metabolism, and excretion of a medication.
Pharmacodynamics
refers to the physiologic and biochemical effects of a drug on the body.
Absorption
process by which a medication enters the bloodstream
Distribution
process by which the medication is delivered to the target cells and tissues
Metabolism
process of chemically changing the drug in the body. It takes place mainly in the liver.
Excretion
process of removing the drug or its metabolites from the body
therapeutic effects
medication’s desired and intentional effects
adverse drug event
effect other than therapeutic
side effects
Minor adverse effects
Tolerance
when a patient develops a decreased response
Medication toxicity
overdose or buildup of medication in the blood due to impaired metabolism and excretion.
medication interaction
when a medication’s effects are altered by the concurrent presence of other medications or food
synergism
increase in drug’s effects
antagonism
decrease in drug’s effects
SAFETY ALERT
Always be aware of the possibility of drug incompatibilities and interactions in order to protect patients from harmful effects. Refer to incompatibility charts and check with the pharmacist for valuable information.
SAFETY ALERT
To avoid potentially fatal anaphylaxis, always check a patient’s allergy history before giving any medication.
SAFETY ALERT
If the calculated dosage of a medication seems unusual or if you have any doubts about the accuracy of your calculation, ask another nurse or a pharmacist to check the dosage calculation.
SAFETY ALERT
Each time you administer a medication, be sure that you give the right patient the right medication, in the right dose, by the right route, at the right time, followed by the right documentation.
SAFETY ALERT
Before giving any medication, always check the patient’s MAR to note when the medication was last administered and if a change has occurred in medication orders.
SAFETY ALERT
To avoid medication errors, always document immediately after giving a medication.
SAFETY ALERT
Never crush enteric-coated or sustained-release tablets. Crushing enteric-coated tablets allows the irritating medication to come in contact with the oral or gastric mucosa, resulting in mucositis or gastric irritation. Crushing a sustained-release medication allows all of the medication to be absorbed at the same time, resulting in a higher-than-expected initial level of the medication and a shorter-than-expected duration of action.
SAFETY ALERT
To avoid medication errors, always label syringes with the name of the medication and dose after you draw up the dose. Deaths have occurred when unlabeled medication has been injected into the wrong patient.
SAFETY ALERT
Never recap a needle (placing the protective cap back onto the needle) after injection because of the increased risk of injury and exposure to bloodborne pathogens.
SAFETY ALERT
If a patient has little or abnormal subcutaneous tissue or abnormal blood flow to subcutaneous tissue, check with the provider to see whether you can use an alternative route of administration.
SAFETY ALERT
If you must use the deltoid site, locate the site carefully, using anatomic landmarks to decrease the risk of injury to the radial nerve and brachial artery.
SAFETY ALERT
Use the dorsogluteal site only for medications that can be safely given into subcutaneous fat. Use the vastus lateralis or ventrogluteal sites to give irritating medications and medications that must be more rapidly and consistently absorbed, such as hepatitis B vaccine.
SAFETY ALERT
Do not use the dorsogluteal site in infants and toddlers. Muscles in this site are not well developed until children begin to walk. Older and debilitated patients who have lost muscle mass elsewhere usually have enough muscle in the dorsogluteal site to allow safe IM injections.
teratogenic
Drugs known to cause birth defects
buccal
placing medications underneath the upper lip or in the side of the mouth
parenteral
medications that are given by injection or infusion
Intradermal
into the dermis, the layer of tissue located beneath the skin surface
Subcutaneous
layer of fat located below the dermis and above the muscle tissue
Intramuscular
beneath the dermis and subcutaneous tissue
medication order must include
patient’s name, the date of the order, the medication’s name, the dose, the frequency, the route of administration, and the provider’s signature
Types of medication orders
routine prn one-time stat telephone verbal electronic
Sites commonly used for IM injections
deltoid ventrogluteal vastus lateralis rectus femoris dorsogluteal
Angiotensin converting enzyme (ACE) inhibitors
end in -pril
Antilipemic medications
end in -statin
Antiviral medication
contain “vir” in their name
B-Adrenergic blockers
end in -lol
Calcium channel blockers
end in -pine
Polypharmacy
when a patient takes two or more medications to treat the same illness, from the same chemical class, with the same actions, or mixes supplements or herbal products with medications.
Antacids
not usually administered with medication
Grapefruit juice
contains a substance that inhibits the metabolism of some drugs. (Inhibits the activity of cytochrome P450)
A nurse administers a medication to a patient at the end of her shift. She brings in a blue pill in a medication cup, places it on the dinner tray, and states “Remember to take that, Betty” before leaving to document and give shift report. Which “rights” were not done?
Patient identity was not confirmed. The medication was not checked against the order or labeled when it was brought into the patient’s room. Documentation may be done, but there is no assurance that the medication was actually taken because it was left on the dinner tray.
A new nurse is hanging a bag of continuous infusion IV fluids. The medication dispensing cart releases the wrong bag, and the nurse infuses the wrong type of fluids. Another nurse notes the error, the correct fluids are infused, and there is no harm done to the patient. Which nursing action would be most appropriate in acknowledging this error?
A Patient Safety Alert should be filed because this error occurred as a result of an improperly functioning system (i.e., the medication dispensing device released the wrong type of intravenous [IV] fluid bag). All errors should be submitted in order to prevent future errors from occurring.
When giving Heparin subcutaneously…
Do not aspirate or massage so no trauma or bleeding is caused in the tissue
