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Fundamentals > Class 5-Medication Administration > Flashcards

Class 5-Medication Administration Flashcards

1
Q

Nursing drug knowledge

A

-generic names
-trade names
-classifications
-indications
-pharmakinetics
-metabolism
-excretion

-effects
-adverse reactions
-allergic reactions (mild; anaphylactic)
-tolerance
-toxic
-ideosyncratic

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2
Q

drug dose and serum drug levels

A

-therapeutic range
-peak level
-trough level
-half-life

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3
Q

therapeutic range

A

concentration of drug in the blood serum that produces the desired effect without causing toxicity

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4
Q

peak level

A

the point when the drug is at its highest (draw line after infusing)

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5
Q

trough level

A

the point when the drug is at its lowest concentration, indicating the rate of elimination (draw before next dose (1hr))

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6
Q

half-life

A

amount of time it takes for 50% of blood concentration of a drug to be eliminated from the body

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7
Q

medication reconciliation

A

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

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8
Q

aging and drug response

A

-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

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9
Q

critical thinking

A

-proper order
-calculating adult medication dosages
-patients condition (warrant me giving this med; check vitals)
-equipment decisions
-documenting medication administration
-patient teaching

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10
Q

medication orders

A

-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

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11
Q

rights

A
  1. patient
  2. medication
  3. dose
  4. route
  5. time
  6. reason
  7. assessment
  8. documentation
  9. response
  10. refuse
  11. educate
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12
Q

three checks (for safety)

A
  1. removing medication from med cart (computer to drug)
  2. comparing medication to MAR (holding drug next to computer)
    2.5. students have an additional check: instructor checks all meds
  3. rechecking to emr/mar at bedside prior to admission
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13
Q

frequency of orders

A

-daily
-BID
-TID
-QID (4x a day)
-ac (before meals)
-pc (after meals)
-HS (hour of sleep)

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14
Q

identifying the patient

A

utilizing 2 patient identifiers
-name
-birthdate
-MRN

comparing to the EMR (look at computer)

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15
Q

Right time or when is my medication administration considered LATE?

A

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

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16
Q

our clinical site half time rule

A

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

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17
Q

look at slide 17

A
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18
Q

oral medication administration

A

enteral
-PO
-feeding tubes
-sublingual and buccal (cheek) routes
-solid
-liquid
-scored
-SR, XL, CR (controlled release)
-enteric coated

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19
Q

for oral medications

A

brown syringes mean oral dose only

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20
Q

topical medications

A

-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

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21
Q

safe injections

A

“one and only” campaign
-one needle, one syringe, only one time

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22
Q

where are we dropping the ball?

A

source: infections person –>contaminated equipment or parenteral medication –> case: susceptible, non immune person

-knowledge gaps
-knowledge not translated into practice
-intentional misuse or harm

23
Q

do not use the same syringe for more than 1 patient..DUH

A
24
Q

LOOK AT SLIDES 29 & 30 & 32

A
25
Q

indirect syringe reuse: double dipping

A

accessing parental medications with a used syringe followed by reuse of the vial or container for additional patients
-single-dose medications commonly involved

26
Q

fundamentals of safe injection practices

A

-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

27
Q

misperception: saline bags can be used for more than 1 patient

A

wrong!

28
Q

survey of injection practices among clinicians in US healthcare settings

A

-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

29
Q

parenteral medications (anything outside the gut)

A

-intradermal
-subcutaneous administration
-intramuscular administration

30
Q

intradermal

A

-TB tests

31
Q

subcutaneous administration

A

-insulin administration
-heparin

32
Q

intramuscular administration

A

-deltoid site
-ventral gluteal
-vastus lateralis sites

33
Q

needles

A

-length
-gauge
-needleless systems
-safety guards
-sharps containers

34
Q

look at slide 39 & 40

A
35
Q

intramuscular

A

longer needle
-72 or 90 degrees
-into muscle layer

36
Q

subcutaneous

A

-90 or 45 degrees
-longer needle=higher degree (than intradermal)

37
Q

intradermal skin

A

short needle=less angle
-15 degrees

no more than 1 mL in deltoid
in gluteal up to 3 mL

38
Q

intradrmal

A

-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

39
Q

subcutaneous

A

-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)

40
Q

look at slide 43 for subcutaneous sites

A
41
Q

intra-muscular

A

-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

42
Q

what is the evidence for the aspiration technique during SC and IM medication administration

A

evidence says no

43
Q

there is no reported evidence that aspiration with or without blood return

A

-confirms needle placement
-eliminates the possibility of an intramuscular injection into a non-subcutaneous blood vessel

44
Q

aspiration is not…

A

-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

45
Q

organizations which state aspiration is not necessary for immunizations and vaccines are

A

-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)

46
Q

look at slide 51-53 for sites

A
47
Q

younger nurses are more likely to follow the latest recommendations on IM injections

A
48
Q

never recap, bend or break a used needle

A

straight to the sharps container (throw cap in trash/pocket so not tempted to recap)

49
Q

controlled substances

A

-locked
-narcotic counts
-report any discrepancies
-record partial doses

50
Q

drug diversion

A

using pt’s drugs for their own use

51
Q

what we need to document

A

-electronic charting
-drugs given: sites and parameters
-doses missed: explanation of why
-reused medications
-incident reports for medication errors (SHARE)
-patient teaching

52
Q

medication errors

A

-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

53
Q

the basics: one way

A

-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

54
Q

the basics: another way

A

-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

Fundamentals (13 decks)

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