Essentials Exam 2 Flashcards
Nurse Practice Act: 5 points? (for meds)
– Locked storage
– Change of shift count
– Sign out system for each narcotic
dispensed
– 2nd nurse verification and witness
– Disposal/waste policies
Medication names: chemical, generic, trade/brand. Which one is most important to know
Chemical: N-(4-hydroxyphenyl)acetamide
Generic: Acetaminophen
Trade/Brand/Proprietary: Tylenol
need to know generic names!!!!
can drugs have more than one classification?
yes, it’s the effect of the medication on the body’s system
routes of med administration
non-parenteral
parenteral
absorption: (in med administration terms)
Passage of medication INTO THE BLOOD from administration site
distribution: (in med administration terms)
Distribution occurs within the body to specific sites of action.
metabolism: (in med administration terms)
Medications are metabolized into a less-
potent or an inactive form
half-life:
The time required for a quantity to
reduce to half its initial value
Biotransformation
enzymes detoxify, break
down, and remove active chemicals
where does the most biotransformation occur
occurs in the liver
Excretion (med administration)
How medications exit the body
routes of excretion
– Kidney: Main organ of excretion
– Liver: Excreted in bile (then in stool)
– Bowel
– Lungs: Nitrous oxide (anesthesia) and alcohol
– Exocrine glands
ADME: route of medication
absorption, distribution, metabolism, excretion
Therapeutic effect
– Expected or predicted physiological response
Adverse effect
– Unintended, undesirable, often unpredictable
Side effect
– Predictable, unavoidable secondary effect
Toxic effect
– Accumulation of medication in the bloodstream
» Damaging or lethal effect
idiosyncratic reaction
– Over-reaction/under-reaction or different reaction from normal
allergic vs anaphylactic reaction
allergic: unpredictable response
anaphylactic: life-threatening response. swelling of tongue, throat, constriction of bronchial muscles
Drug-drug interaction
- One drug decreases the efficacy of
another
Synergistic effect
- Combined effect of two
medications are greater than the
effect of the medications given
separately
Time-critical medications
– Within 30 minutes of
scheduled dose
how to count zeros in medical calc
leading zeros but no trailing
can students take verbal orders?
no
can you use abbreviations during medicine orders?
no DO NOT USE abbreviations
ex of bad) subcutaneous: SQ, units: U, daily: qd
components of a medication order
pt name, generic med name, dose, form, route, frequency
PRN orders
as per needed
must include reason
ex) prn constipation
STAT orders
single dose given immediately
NOW orders
single dose within 90 minutes
six rights (there’s actually 7 so wtf)
- Right patient
– 2. Right Medication
– 3. Right Dose
– 4. Right Route
– 5. Right Time
– 6. Right Documentation
– 7. Right Indication
- Right patient
Med administration PMART
P-patient
M- medication
A- amount
R- route
T- time
Types of High-Alert Meds
insulin, heparin, IV push, narcotics
Reconciliation process
comparing order with the MAR
how many times do you check the MAR during medication administration?
3 times
Common routes of non-parenteral meds
oral, topical, inhalation, irrigation
common routes of parenteral
IM, SQ, ID, IV
which two types of tablets can never be crushed?
Enteric-coated or sustained-release tablets should
never be crushed
suspension (liquid meds)
shake container before administration
sublingual route
oral med is placed under tongue
buccal route
oral med is placed in the side of the mouth against the inner cheek
transdermal medications
designed to be absorbed through the skin
for systemic effect
extended release: 12 hours- 7 days
where to dispose of a transdermal med with controlled substances
Dispose of patch in a tamperproof,
childproof storage container/controlled
substance container
how to dispose of transdermal medications
- Wear ‘clean’ gloves to prevent accidental
exposure to the drug
– Fold the patch in half, sticky sides together
– Dispose in trash
why do you remove transdermal patches during a cardiac emergency
prevents burns during defibrillation
Pressurized metered-dose inhalers (pMDIs)
- Need sufficient hand strength and coordination
– Use a ‘spacer’: Enhances absorption
Breath-actuated metered-dose
inhalers (BAIs)
- Release depends on strength of patient’s breath
Dry powder inhalers (DPIs)
- Activated by patient’s breath
– Delivers more medication
Bronchodilators
– Immediate relief of acute respiratory distress
» Asthma attack
Corticosteroids
– Long term effects
* Combination inhalers
why/when to rinse out mouth after inhaler
Steroids can alter normal flora
– Rinse out mouth after use (~2 min after)
Peak flow meter
used for resp assessment
blowing into hard and fast for a single blow
time in between puffs?
30-60 seconds
how to have a patient laying during nasal drops?
supine
cons of using excessive nasal instillation
they may have systemic effects
such as increased heart rate and a rebound effect that increases congestion
eye instillation proper administration
Avoid the cornea
* Look up and place drops in outer third of conjunctival sac
* ‘Ribbon of ointment’ from inner to outer canthus
intraocular route
medicated contact lens
slow release: 1 week
ear instillation “otic” administration
room temp
never occlude ear canal
use sterile solution
how to pull ears (adults and children)
children < 3: down/back
> 3: up and out
vaginal instillation
refrigerated and melts when inserted
allow self-administration if possible
remain supine for 10 minutes at least
how to lay patient for rectal instillation
Left side lying
– Remain supine/side
lying for 5 minutes
Cleansing enema solutions
- Held in for short period of time
(5 minutes)
– Volume or expansion
– Irritant
Retention enema solutions
- Held in for longer period of
time (15 minutes)
– Softens the stool
» Water or oil based
what to document after the use of an epipen
- Document whether the injection was given in the left or right thigh.
– Document the patient’s vital signs and response to the injection
Polypharmacy
– Multiple medications
– Potentially inappropriate or unnecessary
medications
– When a medication does not match a diagnosis.
definition of parenteral medications
administration of meds through a needles
Pros and cons of parenteral meds
pro: faster absorption directly into body tissues. unconscious pt. nausea/vomiting
con: risk of tissue damage
Luer-lock syringe
screw top
hub of needle
connects the needle to the barrel
can read gauge number here
shaft of needle
actual sticky into the skin part
bevel of needle
sharp tip of a needle shaped like a little shovel
gauge
needle diameter
how to choose needle gauge
based on the viscosity of the medication
filter needle
used when drawing meds from an ampule (prevents little glass from getting sucked up)
where to dispose of needless-devices during injections
still red sharps bin
SQ needle size? gauge/mL
1-3 mL 27-25 gauge
insulin needle size? gauge/mL
.5-1 mL (preattached needle) 26-31 gauge
intradermal needle size? gauge/mL
1 mL tuberculin syringe 26-27 gauge
IM Adult needle size? gauge/mL
2-3 mL 20-25 gauge
IM infant needle size? gauge/mL
0.5-1 mL 18-25 gauge
IV needle size? gauge/mL
depends on infusion, typically large gauge
Vial vs Ampule
Vial: best for STABLE elements
ampule: best for UNSTABLE elements
when to wear gloves during injections
not usually necessary for preparation of syringe/meds
MUST wear during injection
sharper vs less sharp bevel
sharper bevel = less pain
angle of IM injection
90 degree
angle of SQ injection
45-90 degree
angle of intradermal injection
15 degrees
where to give heparin and enoxaparin injections?
abdomen ONLY
rotate sites on abdomen
Injection Pens
– Prefilled disposable cartridge
Needleless Jet Injection
– Uses high pressure to penetrate the
skin
Subcutaneous Injection device
– Cannula left in subcutaneous tissue for
several days
IM injection suggested max for adults
3 mL, 1 mL deltoid
IM injection suggested max for children
suggested max 1 mL
steps for mixing meds in a vial and ampule
prepare meds from the vial first then ampule
when preparing insulin which insulin do you draw up first
regular first
NPH second
which insulins should never mix
long-lasting insulins
ex) glargine (lantus), detemir (levemir)
NRRN insulin rule
N- air into NPH
R- air into regular
R- withdraw regular
N- withdraw NPH
4 pros of IVs
- Conscious or unconscious
- Rapid effect
- Only 1 needle stick for multiple medications
- Allows use of drugs that may be unstable
cons of IVs
- Sterile Procedure
- Risk of infection
- Learned skill
- Pain
- Anxiety
- Expense
- Limited to highly soluble medications
- Need ‘usable’ veins
Bolus
- fluid by injection or small volume of medication through an existing
IV infusion line
(NOT for nursing students)
Piggyback
- infusion of solution containing prescribed medication mixed in a small volume of IV fluid through an existing IV line
exit port of IV
hole of IV bag leading to tubing
bulb chamber of IV
where the drips take place
protective cap of IV
end of tubing that’s removed to connect to IV line in patient
5 high alert meds
potassium
insulin
narcotics
chemo
heparin
bolus pros and cons
- Advantageous for a patient who is on ‘fluid
restriction’ - Dangerous method for medication
administration - No time to correct errors
volume-controlled infusions and the pros
- Uses small amounts (50 to 100 mL) of compatible fluids
Types of containers: - Volume-control administration sets
- IV Piggyback sets
- Syringe pumps
- Advantages
- Reduces the risk of rapid-dose infusion by IV push
- Allows for administration of medications that are stable for a limited time in solution
- Allows control of IV fluid intake
volume-control administration
150-mL containers that attach just below the infusion bag or bottle
Isotonic solutions
- Same osmolality of body fluids (NS)
- 0.9% Normal Saline
- LR-contains electrolytes and expands the vascular volume
Hypotonic
- Osmolality less than body fluids
- Moving water into cells
Hypertonic
- Osmolality greater than body fluids
- Move water out of cells into the intravascular space
- 3% Normal Saline
what to do before IV administration
Assess the patency and placement of the IV catheter
* Most common and effective is a normal
saline(NS) flush
what to do after IV administration
The access line must be flushed with a solution to keep it
patent
* Flush with NS
nursing action in the case of pulmonary edema/fluid overload
reduce flow rate of infusion
phlebitis
trauma to veins caused by IV
Major symptoms of phlebitis
red “streak”
palpable cord
extravasation vs infiltration
chemical is more serious
have to aspirate from catheter
possible antidote
extravasation symptoms
burning/stinging pain
what to do first if there’s an error with the IV
stop infusion!
when to calculate flow rate
when pumps are not available
how to know the medication flow rate/calibration to set the iv to
on the package of the medication
normal range for blood glucose levels
70-99 mg/dl
differences between type I/II diabetes
type I:
symptoms typically start in childhood
episodes of LOW blood sugar too
cannot be prevented
type II:
increased cases of diagnosis in childhood but mostly adulthood
NO low blood sugar episodes
can be prevented/delayed
hypoglycemia symptoms
shaking, high HR, sweats, anxious, dizzy, hungry, impaired vision, fatigue, headache, irritable
hyperglycemia symptoms
thirst, frequent urination, dry skin, hunger, impaired vision, drowsy, nausea
Three Ps of hyperglycemia
polydipsia
polyuria
polyphasia
polydipsia
thirst
polyuria
increased urination
polyphasia
hunger
Diabetic ketoacidosis
– Without enough insulin, body begins
to break down fat for fuel
* process produces a buildup of
acids/ketones
» Life threatening condition
accucheck
blood glucose monitoring
Diabetic ketoacidosis symptoms
thirst, urination increase, abdominal pain, SOB
3 domains of learning
- Cognitive (knowledge)
- Affective (attitude)
- Psychomotor (skill)
