Class 5-Medication Administration Flashcards
Nursing drug knowledge
-generic names
-trade names
-classifications
-indications
-pharmakinetics
-metabolism
-excretion
-effects
-adverse reactions
-allergic reactions (mild; anaphylactic)
-tolerance
-toxic
-ideosyncratic
drug dose and serum drug levels
-therapeutic range
-peak level
-trough level
-half-life
therapeutic range
concentration of drug in the blood serum that produces the desired effect without causing toxicity
peak level
the point when the drug is at its highest (draw line after infusing)
trough level
the point when the drug is at its lowest concentration, indicating the rate of elimination (draw before next dose (1hr))
half-life
amount of time it takes for 50% of blood concentration of a drug to be eliminated from the body
medication reconciliation
admission assessment
-prescribed medications
-pta medications
-allergies
-pregnancy and lactation status
-dietary supplements and herbal and “natural” remedies
compare list prescribed meds to prior to admitting to otc meds and allergies
aging and drug response
-decreased gastric motility (sit in stomach)
-decreased total body water (water soluble drug won’t work as well)
-decreased lipid content in skin
-decreased liver function
-decreased kidney function
-adverse cns effects
-altered peripheral vascular tone
critical thinking
-proper order
-calculating adult medication dosages
-patients condition (warrant me giving this med; check vitals)
-equipment decisions
-documenting medication administration
-patient teaching
medication orders
-verbal orders
-telephone orders
-standing orders
-prn orders (as necessary)
-stat orders (now)
-one time order
read back what they say; you say; they confirm
rights
- patient
- medication
- dose
- route
- time
- reason
- assessment
- documentation
- response
- refuse
- educate
three checks (for safety)
- removing medication from med cart (computer to drug)
- comparing medication to MAR (holding drug next to computer)
2.5. students have an additional check: instructor checks all meds - rechecking to emr/mar at bedside prior to admission
frequency of orders
-daily
-BID
-TID
-QID (4x a day)
-ac (before meals)
-pc (after meals)
-HS (hour of sleep)
identifying the patient
utilizing 2 patient identifiers
-name
-birthdate
-MRN
comparing to the EMR (look at computer)
Right time or when is my medication administration considered LATE?
our clinical site medication rules
-for medications given more frequently than q6 hours (q1, q2, q3, q4) or rapid or short acting insulin (regular, aspart/novolog) administer within 30 minutes before or after the scheduled time
-medication given q6 hours or less frequently (q6, q8, q12) administer within 60 minutes before or after scheduled time
-daily, weekly or monthly medications-administer within 2 hours before or after scheduled time
our clinical site half time rule
if you are unable to give a medication on time the next dose is given using the half time rule
-the late dose can be given up to half way to the next scheduled dose. you can give it and then the next dose as scheduled
-if the patient or med are available later than halfway between doses, give the missed dose, skip the next dose and resume schedule
-exceptions: ahminoglycosides & chemotherapy
look at slide 17
oral medication administration
enteral
-PO
-feeding tubes
-sublingual and buccal (cheek) routes
-solid
-liquid
-scored
-SR, XL, CR (controlled release)
-enteric coated
for oral medications
brown syringes mean oral dose only
topical medications
-lotions, creams, ointments and medicated powders
-trans-dermal patches
-eye drops
-nose drops/mists
-ear drops
-rectal-suppositories (3-4 inches up)
-vaginal-creams + suppositories
safe injections
“one and only” campaign
-one needle, one syringe, only one time
where are we dropping the ball?
source: infections person –>contaminated equipment or parenteral medication –> case: susceptible, non immune person
-knowledge gaps
-knowledge not translated into practice
-intentional misuse or harm
do not use the same syringe for more than 1 patient..DUH
LOOK AT SLIDES 29 & 30 & 32
indirect syringe reuse: double dipping
accessing parental medications with a used syringe followed by reuse of the vial or container for additional patients
-single-dose medications commonly involved
fundamentals of safe injection practices
-needles and syringes are single-use devices
-do not administer medications from a single-dose vial or bag to multiple patients
-use right-sized vials and prefilled syringes
misperception: saline bags can be used for more than 1 patient
wrong!
survey of injection practices among clinicians in US healthcare settings
-5500 US healthcare professionals, primarily registered nurses
-1% “sometimes” or “always” reuse a syringe for a second patient-DIRECT reuse
-1% “sometimes” or “always” reuse a multi dose vial after accessing it with a used syringe-INDIRECT reuse
-6% use single-dose or single use vials for > 1 patient
parenteral medications (anything outside the gut)
-intradermal
-subcutaneous administration
-intramuscular administration
intradermal
-TB tests
subcutaneous administration
-insulin administration
-heparin
intramuscular administration
-deltoid site
-ventral gluteal
-vastus lateralis sites
needles
-length
-gauge
-needleless systems
-safety guards
-sharps containers
look at slide 39 & 40
intramuscular
longer needle
-72 or 90 degrees
-into muscle layer
subcutaneous
-90 or 45 degrees
-longer needle=higher degree (than intradermal)
intradermal skin
short needle=less angle
-15 degrees
no more than 1 mL in deltoid
in gluteal up to 3 mL
intradrmal
-1/4-1/2 inch
-25 G, 27 G
-less than 0.5 mL
-angle 5-15 degrees
-no aspiration (pulling back on end of needle) and no massage of sites
subcutaneous
-drug specific syringes
-3/8-5/8 inch
-25 G - 30 G
-1 mL maximum volume
-45-90 degree angle
-to pinch or not to pinch (pinch thin people)
-no aspiration and no massage of sites
-don’t forget to rotate sites (ex: diabetes)
look at slide 43 for subcutaneous sites
intra-muscular
-5/8 inch-1.5 inch needle
-20G-25G
-know your sites
-up to 3 mL volumes in large muscles
-gentle pressure NOT massage
-what is the z-track method? (pull aside tissue; inject)
-never recap used needles
-no aspiration
what is the evidence for the aspiration technique during SC and IM medication administration
evidence says no
there is no reported evidence that aspiration with or without blood return
-confirms needle placement
-eliminates the possibility of an intramuscular injection into a non-subcutaneous blood vessel
aspiration is not…
-indicated for SC injections
-indicated for IM injections of vaccines and immunizations
-aspiration may be indicated for IM injections of large molecule medications, such as penicillin
organizations which state aspiration is not necessary for immunizations and vaccines are
-centers for disease control (CDC)
-advisory committee on immunization practices (ACIP)
-department of health services (DHS)
-american academy of family physicians (AAFP)
-U.K. department of health (DoH)
-World Health Organization (WHO)
look at slide 51-53 for sites
younger nurses are more likely to follow the latest recommendations on IM injections
never recap, bend or break a used needle
straight to the sharps container (throw cap in trash/pocket so not tempted to recap)
controlled substances
-locked
-narcotic counts
-report any discrepancies
-record partial doses
drug diversion
using pt’s drugs for their own use
what we need to document
-electronic charting
-drugs given: sites and parameters
-doses missed: explanation of why
-reused medications
-incident reports for medication errors (SHARE)
-patient teaching
medication errors
-check patient’s condition immediately; observe for adverse effects. VS
-obtain a set of VS
-notify nurse manager and primary care provider
-complete form used for reporting errors, as dictated by the facility policy. (SHARE) not indicate that this form was completed in the patient chart
the basics: one way
-once student and instructor have reviewed meds-enter room
-ID PATIENT AND CHECK ALLERGIES
-inform the patient of the meds you will be giving, gives them an opportunity to refuse
-scan EPIC
-scan patient
-scan all meds on EPIC
-check all meds against EPIC
-open meds and give to patient
the basics: another way
-once student and instructor have reviewed all meds-enter the room
-ID PATIENT AND CHECK ALLERGIES
-inform the patient of the meds you will be giving, gives them an opportunity to refuse
-scan EPIC
-scan patient
-scan one med at a time and check it for accuracy
-open each med individually and administer then check the next med
OR
-when all meds are scanned and checked individually-open meds and give to patient
