chapter 21 Flashcards
What is the angle for IM, sq and intradermal injections?
90, 45, 15
what is the maximum amount of medication administered at deltoid?
1 ml
medications that cannot be crushed, broken or dissolved in water?
enteric coated, time release or extended release
what would you do if you cannot crush an enteric coated medication?
all physician and get an order for another route
what is the first thing you do when there is a discrepancy between the medication ordered and the medication in the drawer?
hold the medication and check the order
medication absorbed by the skin is called?
transdermal
what should you do when you sew blood during aspiration?
remove needle and prepare another injection
how do you administer medication in the ear of child under 3 years old?
pull pinna back and down
how do you instill ear medication for a child 3 and up?
up and back
how do you administer nose drops?
- supine with head tilted backwards
- hold dropper above nostrils- do not touch the nostrils being treated
- instruct patient not to blow nose for 5 minutes after drop insertion
contraindication for PO route?
- coma
- difficulty swallowing
- vomiting
- absence of gag reflex
- NPO
- Decreased GI motility
The IM site that has the highest risk for injury?
Dorsogluteal site
how do you draw medication from an ampule?
use a filtered needle
how do you administer medications in the eye?
- ask patient to look up and lower conjunctival sac, apply pressure on the innate canthus for 1-2 minutes
what is the purpose of cold applications?
constrict blood vessels
decrease edema
numbs pain
how do you pour liquid medications?
label against palm— to prevent soiling of the label
abbreviation for - p.c, h.s, q hr, b.i.d, t.i.d, a.c, pen, ad lib - as desired
???
need length for an morbidly obese patient for IM
longer than 1 1/2 inches
what is the purpose of Z track injection?
minimize pain and prevent staining of tissues
medications administered through rectum are called?
suppository
gauge for sq injection?
30
five rights of medication administration?
right client right drug right dose right time right route
actions performed by the nurse before giving medications?
check over for accuracy read label 3 times wash hands check expiration date 5 rights
what does routine medications mean
administered on a regular basis until d/ed
what is a stat order?
give immediately
what is a standing order and give an example?
written for special circumstances.
Increased BS
what should you do when administering oral medications?
crush medications if not contraindicated, stay with the client until medication is swallowed
what does MAR stands for?
?
true or false- medication orders are transcribed from physician order from onto the MAR
?
true or false- the prescription label should match the drug listed on the MAR
?
what are the uses of MAR?
- To document all routinely administered medications
- Document PRN medications and their effectiveness
- Document medications not given and the reason
- Document sites of injections administered by nurse
where do you document medication errors?
on a medication error report form
explain controlled substances-in terms of abuse potential, locking system, counting, and wasting-
High potential for abuse
Kept in a double locking system
Each controlled drug when used is entered in a log book
Count before you remove a controlled substance
Counted at the end of every shift- by the incoming nurse and outgoing nurse
If count is incorrect- identify issue before anyone leaves the facility
When wasting- nurse must have a witness
Counted even if it is not given
How do you check placement of an NG tube?
aspirating gastric contents and checking PH.
what would you do if a patient refuses a medication?
patient has the right.
where do you place buccal medication?
between upper molar teeth and cheeks.
before administering enteral tube feedings, a nurse should?
- verify presence of bowel sounds
- check placement
- elevate HOB 30 degrees during and 30-45 minutes after feeding
- Flush the tube before and after with 30-50 ml
what are the signs of infiltration?
coolness to touch pallor pain edema- loosen tape at once - drip flow may decrease
what are the signs of phlebitis
erythema
warmth
edema
pain/discomfort
what is the first thing you do in case of infiltration
discontinue immediately and choose another site
what are the 3 label checks?
A. when taking the container rom the drawer
B. Before/ when removing the dose or before you take it to the patients room
C. Before/when replacing the container back
other checks
What is the acceptable time to administer a medication?
30 minutes before or after the scheduled time
what is the position for PO administration?
90 degree angle
Medication label is checked against what, in the 3 label checks?
MAR
How do you apply an ointment?
ask patient to look upwards
squeeze ointment into the lower conjunctival sac-from inner to outer canthus
Instruct patient to close eyes gently and to move the eyes with lid shut- to spread the medication
what are the signs of anaphylactic shock?
respiratory distress- restlessness, dyspnea, wheezing and cyanosis. From bronchospasms
skin reactions - pruritus (itching) or urticarial (hives)
Circulatory collapse- BP down Pulse Up (weak and thready) or vertigo
GI symtoms- nausea, vomiting and diarrhea
a juice of which fruit can interfere with the metabolism of certain medications?
grapefruit
