Chapter 32: Medication Administration (IRAT/GRAT #2) Flashcards
___ of American adults take at least one medication.
___ take five or more.
82%
29%
_____ emergency department visits and _______ are due to adverse drug events annually
700,000
120,000
_____ is spent on extra medical costs of adverse drug events annually
$3.5 billion
At least ____ of cost of ambulatory (non-hospital) adverse drug events are estimated to be preventable.
40%
In what steps do nurses play an essential role in safe medication?
- preparation
- administration
- evaluation of medication effects
- documenting patient response to treatment
- patient teaching including side effects
- ensuring adherence to medication regimen
- evaluating the patients or caregivers ability to self-administer
What medication regulations has the most influence on the nursing practice?
your state’s Nursing Practice Act
In relation to medication regulations, be aware of
federal, state and institutional regulations
Violations of the Controlled Substances Act are punishable by
fines, imprisonment, and/or the loss of the nurse’s license
What policies should you follow for the proper storage and distribution of medication and narcotics?
your institution’s policies
Pharmacokinetics: Factors that influence absorption
- route of administration
- ability of the medication to dissolve
- blood flow to site of administration
- body surface area
- lipid solubility of medication
medications placed on mucous membranes and respiratory airways
are absorbed quickly
What form of medications are absorbed more quickly?
medications already in a liquid state are absorbed more quickly
What areas absorb more quickly?
vascular areas absorb more quickly (mucous membranes)
The majority of medications are absorbed in
the small intestine
because small intestine is highly permeable, has high blood flow, and large surface area
What type of medications can cross cell membranes easily?
highly lipid soluble medications cross cell membranes easily.
food in the stomach may also be a factor in absorption.
Pharmacokinetics: Factors that in influence distribution
- circulation
- membrane permeability
- protein binding
The effect of Circulation on distribution of medications
ex) patients with heart failure have impaired circulation, therefore slowing medication delivery
The effect of Membrane Permeability on distribution of medications
blood brain barrier allows only fat-soluble medications to pass into the brain and cerebral spinal fluid
The effect of Protein Binding on distribution of medications
the degree to which medications bind to serum proteins (albumin) affects distribution
Metabolism
failure of organs that metabolize drugs puts patients at risk for medication toxicity
(ex. liver degrades many harmful chemicals before entering the tissues, so if liver is impaired, elimination of drugs is slower, causing an accumulation of drugs and risk for toxicity.)
Excretion
-elimination of drug through lungs, liver, kidneys, bowels, and exocrine glands.
Therapeutic Effects
the expected or predicted response
Side Effects
predictable often unavoidable, r/t normal therapeutic doses
Adverse Effects
unintended, undesirable, often unpredictable. May be severe or life threatening.
What are the type of adverse effects?
- toxic effects
- idiosyncratic reactions
- allergic reactions
- anaphylactic reactions
Toxic effects
develop after prolonged intake of medication: medication accumulates in the blood r/t impaired metabolism or excretion
Idiosyncratic Reactions
reaction other than normal: over or under reacts
Allergic Reactions
allergic response develops from a repeated administration
Anaphylactic Reactions
life threatening.
characterized by sudden constriction of bronchiolar muscles, edema of the pharynx and larynx, and severe wheezing and SOB
Synergistic Effect
combined effect of two medications is greater than either one on its own: ex) alcohol and antidepressants
Polypharmacy
- when a patient takes 2 or more medications to treat the same illness
- when a patient takes 2 or more medications from the same chemical class
- when the patient uses 2 or more medications w/ the same or similar actions to treat several disorders simultaneously
- when a patient mixes herbals or nutritional supplements with medications
Polypharmacy places patients
at risk of adverse reactions and medication interactions
Many patients visit several healthcare providers all
prescribing medications for different or similar complaints
Peak
the highest level of medication concentration in the blood
Trough
the lowest level of medication concentration in the blood. Usually drawn 30 min before the time of administration.
Biological Half-Life
time it takes for the excretion process to lower the amount of unchanged medication by half
What are the effects of aging on metabolism?
- liver mass shrinks
- hepatic blood flow and enzyme activity declines
- metabolism drops to one half to two thirds the rate of young adults
- enzymes lose ability to process some drugs, thus prolonging drug half-life
Routes of Administration: Oral
slower onset of action, more prolonged effect than on parenteral.
When measuring liquid medication in a measuring cup,
measure at eye level on a hard surface
sublingual
under the tongue
buccal
in the mouth against the cheek
Parenteral
- intradermal (ID)
- subcutaneous (SQ)
- intramuscular (IM)
- intravenous (IV)
Epidural
- intrathecal
- intraosseous
- intraperitoneal
- intrapleural
- intraarterial
Between ___________________________ accidental needlesticks and sharp injuries occur annually in the health care setting.
600,000 - 1 million
What are one of the deadliest hazards to which nurses can be exposed to on a daily basis?
bloodborne pathogens
Needlestick injuries most often occur when:
- needles are recapped
- needles are left at the bedside
- mishandling of IV lines
Most needlestick hazards can be prevented by:
- the use of needleless devices
- the use of safety needles
- following hospital protocol for safe needle handling
Subcutaneous medications are administered at a
45-degree angle
Intradermal medications are administered at a
10 - 15 degree angle
Intramuscular medications are administered at a
90-degree angle
Ventrogluteal injection site
..
Topical medications
transdermal ex) patches and discs
Instillation medication
- ear/eye drops and ointments
- irrigations
- suppositories
Inhalation medication
- nasal or oral passages
- endotracheal/tracheostomy tubes
Intraocular medication
-disc like a contact lens can remain up to a week
A nurse should _______ place a leading zero in front of a decimal point
ALWAYS
A nurse should ______________ use a “trailing zero”
NEVER
Unapproved abbreviations
…
Types of Medication Orders
- Routine Orders or Standing Orders
- Verbal Orders
- Telephone Orders
- PRN Orders
- Single Orders
- STAT Orders
- Now Orders
- Prescriptions
The use of a ______________________ reduces medication errors
computerized physician order entry (CPOE)
Routine Orders or Standing Orders
either on an order sheet or electronically
Verbal orders
- given to a RN - preferable only in emergencies.
- physicians should write the order if they are available.
Telephone orders
- given to an RN.
- RN must indicate “read back order” (RBO) w/ his/her signature.
- MD needs to co-sign the telephone order in 24 hours (or by hospital policy)
PRN Orders
- as needed.
- Nurses assess the patient to determine the best course of action and need for PRN orders.
Single (One Time) Orders
such as a pre-op “on call” medication before surgery
STAT Orders
to be given immediately - usually one time order
Now Orders
-to be given as soon as possible - according to hospital policy.
Now Orders are used for
an extra pain medication dose (ex. if the patient needs additional analgesia before the next dose is due)
Prescriptions
given to be filled at the patient’s own pharmacy
What is the nurse’s role in medication administration?
- assessing the patient
- determining if the patient should receive a medication at a given time
- administering medications correctly
- closely monitoring for effects and patient response
- patient and family teaching
Is the nurse able to delegate a part of the medication administration process to nursing assistive personnel?
Nurse should not delegate ANY part of the medication administration process to NAP’s
Common medication errors include:
- inaccurate prescribing
- administering the wrong medication
- give the medication using the wrong route
- giving the medication at the wrong time
- administering extra doses
- failing to administer a medication
- administering medication for the wrong reason
When a medication error occurs, the nurse should
- ASSESS THE PATIENT
- Notify the health care provider ASAP
- Report to the nursing supervisor
- File an incident report
Incident Report
- not a part of the permanent medical record
- no reference to incident report should be made in the nurses notes
- used to track occurrences, near misses, and initiate quality improvement programs
Medication Reconciliation
comparing the medications the patient took in a previous setting to the current medication orders.
-look up each med you don’t know and determine why they are taking each medication.
Medical Reconciliation is performed when
- nurse admits a patient to health care setting
- patient is received from another unit in the hospital
- upon discharge home or to another facility
Frequently medication errors are linked to
not following one of the six rights
It is important to have a __________ in medication administration to prevent medication errors
systemic approach
_________________________ set limits on the nurse’s ability to administer medications
Scope of Practice Standards and Agency policy
Critical Thinking Factors
- knowledge
- experience
- attitudes
- standards
Critical Thinking: Knowledge in relation to medication administration
knowing a drug’s therapeutic effect, absorption, interactions and mechanism of action
Critical Thinking: Experience in relation to medication administration
using the nursing process, psychomotor skills, and patient responses
Critical Thinking: Attitude in relation to medication administration
take the time to do it right! Do not cut corners!
Critical Thinking: Standards in relation to medication administration
actions that ensure safe nursing practice
Six Rights of Medication Administration
- Right Documentation
- Right Dose
- Right Medication
- Right Patient
- Right Route
- Right Time
- Right Reason
Right Medication
Compare:
- written orders w/ the MAR when initially created
- written orders w/ the MAR when new MAR’s are created
- written orders w/ the MAR when patients transfer from one unit to another.
Right Medication: ALSO compare the
label of medication with the MAR 3 times:
- before removing the med from its holding place
- as the med is removed from the container
- at the patient’s bedside before administering
Right Dose
splitting a medication is considered “dosing”. Medications should come to you in the patient’s ordered dose.
Right Patient
use two patient identifiers-compare the Patient’s armband to the written MAR
Right Route
beware of liquid dosages of oral medications that they are not mistakenly given via a parenteral route!!
Right Time
be careful of tid vs q8h.
Record if patient refuses or misses a dose.
Right Documentation
- include any pre-assessment data such as HR or BP.
- include patient response and route of administration.
- *NEVER document before an action has taken place
What are the Patients’ Rights?
right to:
- be informed of name, purpose, action and side effects
- to refuse regardless of consequences
- to have qualified nurses/physicians assess allergies, history and use of herbals
- advised of any experimental nature
- to receive labeled medications
- to receive appropriate supportive therapy
- to not receive unnecessary medications
- to be informed if medications are involved in a research study.
Nursing Process: Assessment
- History
- Allergies**
- Medications
- Diet History
- Patient’s Perceptual or Coordination Problems
- Patient’s Current Condition
- Patient’s Attitude About Medication Use
- Patient’s Understanding of and Adherence to Medication Therapy
- Patient’s Learning Needs
Nursing Process: Diagnosis
- anxiety
- ineffective health maintenance
- deficient knowledge
- noncompliance
- impaired swallowing
- caregiver role strain
Nursing Process: Planning
- goals and outcomes
- setting priorities
- teamwork and collaboration
Nursing Process: Implementation
- health promotion
- patient and family teaching: family assistance
- medication management: special consideration - polypharmacy, older adults
Nursing Process: Evaluate
- Were the patient’s goals/outcomes met?
- Subjective and objective measures
- Observe physiological measures: heart rate and BP
Upon discharge, determine
the patient’s ability to obtain their prescribed medications: Can they afford them? Can they read the medication labels? Do they know how to obtain their medications?
Utilizing collaboration and teamwork, such as case management, to
ensure the patient has adequate resources
Insulin is calibrated in
“units”
Most insulin syringes are
U-100 meaning there are 100 units per/ml
Insulin can also come in U-500
which is 5 times as strong and used only in rare occasions.
ex) when a patient shows resistance to insulin and requires a higher dose
Insulin Administration
- be certain you have the right syringe for the right insulin
- always know the onset, peak effect and duration of the insulin your patient is taking/you are administering
Read “key points” and “review questions” fundamentals of nursing pf 683-5
:)
Examples of elimination through the lungs
-Deep breathing and coughing after surgery helps eliminate anesthetic gases more rapidly.
What is an example that increases the rate of elimination in the GI tract?
factors that increase peristalsis (laxatives) accelerate excretion and vice versa
