chapter 31: medication administration Flashcards
Federal Regulations
Pure Food and Drug Act
FDA
National Formulary
USP
Medwatch
Sate/ Local Govt
adhere to Fed standars
have some say over stuff not covered by Fed standards
regulate alc and tobacco
Health Care Agencies
Meet Fed and State policies
Usually stricter though - e.g. automatic stop of narcotics after certain amt of days
Nurse Practice Acts
define scope of nurses’ professional functions and responsibilities
Med names
3: chemical, generic, and trade/brand name
Capitalize key letters to keep from making a mistake
Pharmacokinetics
study of how meds enter the body, reach their site of action, metabolize, and exit body
Absorption
med molecules pass into blood from site of med administration
Fast to slow:
on skin
oral
mucous memrane / respiratory airway
subcutaneous
intramuscular
Intravenous
which absorbs faster:
liquids or tablets/capsules?
acidic or alkaline meds?
lipid- or water- soluble?
liquids
acidic
lipid
Factors affecting absorption
route
ability to dissolve
blood flow to site of admission
body surface area
lipid solubility
Factors affecting distribution
Circulation –> good blood flow = fast delivery
Membrane permeability –> e.g. BBB only permeable to fat soluble stuff
Protein binding –> most meds partially bind to albumin - the rest is active
Metabolism of drugs
biotransformation occurs thru enzymes that detoxify, break down, and remove active chems
Liver is main one, but lungs, kidney, blood, and intestines do it too
If these organs aren’t working, meds accumulate and become toxic
Excretion
through kidneys, liver, bowel, lungs, and exocrine glands
lungs excrete NO, alc, and anesthesia
exocrine glands secrete lipid soluble stuff
Meds that go through digestion reabsorbed in small intestine - slowed emptying increases effects
KIDNEYS ARE MAIN ONE —> stay hydrated
Therapeutic effect
expected, predicted physiological response caused by the med
Adverse effects: who’s at risk?
young
old
pregnant
multiple meds
overweight
underweight
renal or liver disease
Side effects
predictable and often unavoidable adverse effect
Toxic effects
develop after taking for long time or if it accumulates
death!
Naloxone is antidote for opioids
Idiosyncratic reaction
overreaction, underreaction, or unexpected response to a med
Allergic reactions
-body sees med as antigen and so releases antibodies to fight it
Anaphylactic rxns = constriction of bronchiolar muscles, edema of pharynx/larynx, severe wheezing and shortness of breath
Medication interactions
synergistic effect = increase effect of each other
e.g. alc has synergistic effect on antihistamines, antidepressants, barbiturates, and narcotic analgesics
Medication tolerance and medication dependance
need higher doses to produce same outcome: morphine, nitrates, alc
Dependance is psychological and/or physical
-physical if withdrawal happens
Minimum effective concentration (MEC)
minimum amt of med in plasma needed to make effects happen
safe therapeutic range
tried to attain this consistently
bt MEC and toxic concentration
Biological half life
time it takes for excretion processes to lower serum medication concentration by half
Time intervals to know when administering meds
- Onset of med action = time to take effect
- peak action = time to reach peak
- trough = min blood serum level before next dose
- duration of action = how long the therapeutic effect is working
- plateau = blood serum concentration reached and maintained after repeated fixed doses
Sublingual meds
put under tongue where it dissolves
don’t ingest
don’t drink anything til med is completely dissolved
Buccal administration
solid med put on inside of cheeks to dissolve
don’t eat it
alternate cheeks with each dose
4 typical parenteral routes of administration
6 rarer parenteral routes of administration
2 only for drs
ID = intradermal = just under epidermis
Subcutaneous = into tissues just below dermis
IM = intramuscular = into muscle
IV = intravenous = into the vein
Epidural = epidural space via catheter
Intrathecal = catheter into subarachnoid space
Intraosseous = into bone marrow –> mostly for babies
Intraperitoneal = into peritoneal cavity –> chemo, insulin, and antibiotics
Intrapleural = into plaural space –> chemo or anti-pleural effusion
Intraarterial = into artery –> clot dissolving agents
intracardiac and intraaricular (into joint)
Topical administration
applly to skin/mucous membrane
Transdermal disk/patch has systemic effects – leave on for 1-7 days
- direct application of ointment (eyedrops)
- insertion of medication into body cavity (suppository into rectum)
- intillatino of fluid into body cavity (ear drops)
- irrigation of body cavity
- spraying med – e.g. into nose
Inhalation route
endotracheal, nasal, or oral passages
Intraocular route
contact lens with meds on it –> stays in for a week
How should non OTC meds be measured in hospital?
pharmacy should measure with oral syringe using metric measurements
Solution
mass of solid substance dissolved in known volume of fluid
OR
fluid mixed with fluid
express in g/L or mg/mL or percentages
should you be converting between systems?
not really, but if its necessary then i guess its necessary
Ratio and proportion method
1:2::4:8 —> 1 and 8 are “extremes”; 2 and 4 are “means” –> product of extremes = that of means
Formula method
(dose ordered / dose on hand) x (amount on hand) = how much to give
Dimensional analysis
the fun, multi ratio multiplication thing
Ped doses basic safety measure
have most errors
-use metric only –> round to neares 0.1, 0.5, or 1 ml
-no household measurements
-tailor to BMI
-hands on and return demonstration
-pic based education may be appropriate
How to calculate dose for child
-WEIGHT –> avoid converting bt lbs and kgs
-IM don’t exceed 1 mL for kids or 0.5 mL in babies
-Subcutaneous don’t exceed 0.5 mL
-If less than 1 mL, use syringe with tenths
-Use tuberculin syringe if need to be rounded to thousandth
-estimate first and then compare
-compare amt ordered over 24 hr to recommendations
verbal order
order for med given verbally
-write it, read it back, get confirmation
Indiacte time and name of HCP who gave order
-sign it, indicate it was read back, and get HCP to sign it
DON’T USE ABBREVIATIONS DURING DOCUMENTATION
Standing orders / Routine medication orders
Carried out until HCP cancels it or prescribed number of days passes
prn order don’ts
No ranges if vague
-maybe ranges if given explicit conditions: e.g. increase mmorphine dosage 50-100% if pain is moderate to severe based on use of pain scale
Now vs STAT orders
Now is within 90 mins
STAT is as soon as possible –> emergency!
Prescriptions
orders taken to outside agencies
sometimes, if for controlled substance, have to be written on dif colored prescription pad than other orders
Pharmacists job
dispense correct med in proper dosage and amount with accurate label
don’t really mix stuff except in IV solutions
Unit dose
storage system with individually wrapped doses for patients in individual drawer
usually only 24 hr supply is kept in drawer –> pharmacist refills at particular time
certain amt of prns in drawer
controlled substances kept locked up elsewhere
Automated Medication Dispensing Systems (AMDS)
Nurse enters security code and maybe finger print
Selects patient, med and dose
Drawer opens and the med is documented (in med record) and charged to patient
Might be used with bar-code medication administration system (BCMA) where you have to scan the patient’s bracelet before it’ll give you the meds
Includes controlled substances
Chemo meds
Have to be certified to administer IV chemo meds, but not oral
Chemo drugs are SUPER toxic! DNA damage –> cancer, birth defects, immune issues
Excreted through urine, stool, vomit, sweat, and saliva –> double flush! Toilets are biohazard
Chemo med guidelines
Store in separate, designated place
use special gloves
hand hygiene before and after
don’t break the drug
don’t use same equipment to prep as other drugs
single-use PPE
clothes or sheets with body fluid should be washed 2x in washing machine by themselves on HOT
DON”T LET AP DO ANY OF THIS
FACTS!
Medication error
preventable event that may cause inappropriate med use or jeapordize patient safety
- assess patient’s condition and notify HCP
- report incident (not permanent part of med record)
*****report almost errors too
Medication reconciliation
Compare med that they’re taking with what they should be taking
Often necessary when patient has been/is being transferred
The seven rights
- right med
- right dose
- right patient
- right route
- right time
- right documentation
- right indication
Comparing label on medication with that in the MAR
First: before removing container from drawer
Again: as amount of med ordered is removed from container
Last: at patient’s bedside before giving it to them
YOU CAN”T ADMINISTER MEDS IF YOU DIDN”T PREP THEM
FACTS
What syringe to use when preparing oral medication
enteral syringe –> dif color than others and laeled for oral use
When to give time critical meds
Non time critical?
within 30 mins before or after stated time
within 1-2 hrs befor or after
Patient rights
To be informed ab care
to make decisions ab care
to refuse care
to be listened to by care givers
to recieve info in a way that meets their needs
IMP history stuff to know
allergies
meds
diet history
perceptual or coordination issues
Nursing Dagnoses related to meds
Impaired health maintenance
Lack of Knowledge
Nonadherence
Adverse Med ineraction
Complex med regimen
Components of medication order
Patient’s full name
Date and time order was written
med name
dosage
route
time and frequency of administration
signature of HCP
How often do adverse effects happen in old ppl?
22% of the time!
falls, orthostatic hypotension, heart failure, delerium
Polypharmacy
use of mult meds, use of potentially inappropriate/unnecessary meds, or use of med that doesn’t match diagnosis
