Exam 5; Chapter 31 Med Admin Flashcards
1
Q
Chemical drug names
A
Provide exact descriptions of a medications composition.
EX: N-acetyl-para-aminophenol
Rarely used by nursing
2
Q
Generic drug names
A
Manufacturer who first develops the drug assigns the name, and it is then listed in the U.S. pharmacopoeia
EX: Acetaminophen
3
Q
Trade drug names
A
Brand names or proprietary name. This is the name under which a manufacturer markets the medication
EX: Tylenol
4
Q
Classification of drugs
A
classified by the effect on the body system
Classified by symptoms the med relieves
Classified by the medications desired effect
5
Q
Combination medications
A
Medications that include two or more active ingredients combined in a single dosage form
Med Lists trade name, followed by generic name of each drug
Med will list dosage of each drug in order of generic names
6
Q
Common combination drugs
A
Norco (Hydrocodone & acetaminophen) 5mg/325mg
Norco (hydro & acetaminophen) 7.5mg/325mg
Norco (hydro & acetaminophen) 10mg/325mg
Percocet (oxy & acetaminophen) 5mg/325mg
Zestoretic (lisinopril & hydrochlorothiazide) 12.5mg/ 25mg
7
Q
Absorbtion
A
The passage of medication molecules into the blood from the site of administration
8
Q
Factors that influence absorbtion
A
- Route of administration
- Ability of med to dissolve
- Blood flow to site of administration
- Body surface area/weight
- Distribution (dependent on circulation)
- Metabolism
- Excretion
9
Q
Theraputic effect
A
The expected or predicted physiological response
10
Q
Adverse effect
A
Unintended/ undesirable outcome
11
Q
Side effect
A
A predictable secondary, typically undesirable effect
12
Q
Toxic effect
A
Accumulation of medication in the bloodstream causing undesirable outcomes
13
Q
Idiosyncratic reaction
A
Adverse effects that cannot be explained by the known mechanisms of action of the drug, do not occur in most patients, and develops mostly unpredictably in susceptible patients only
14
Q
Allergic reactions
A
Unpredictable response to a medication
15
Q
Medication interactions
A
One medication modifies the action of another medication
16
Q
Medication tolerance
A
More medication is required to achieve the same theraputic effect
17
Q
Medication dependence
A
Can be physical or psychological
18
Q
Polypharmacy
A
- Taking two or more medications to treat the same illness
- Taking two or more medications from the same chemical class
- Uses two or more Medications with the same or similar actions to treat several disorders simultaneously
- Mixes nutritional supplements or herbal products with medications
19
Q
Role of providers
A
•Providers include:
Physicians, Nurse practitioners, Physicians assistants
These individuals determine which medications the patient needs & places the orders.
Orders can be written by hand or electronically. Although highly discouraged they can also be by telephone or verbal.
20
Q
Medication orders require
A
- Patients name
- Order date
- Medication name
- Medication dosage
- Medication route
- Time of administration
- Drug indication
- Prescribers signature
21
Q
Standing orders
A
Administered until the dosage is changed or another medication is prescribed
22
Q
PRN orders
A
Given when the patient requires it/ as needed
23
Q
Single(One-time) orders
A
Given one time only for a specific reason
24
Q
STAT Orders
A
Given immediately in an emergency
25
“Now” orders
When a medication is needed right away but not STAT
26
Prescription orders
Medication to be taken outside of the hospital
27
Pharmacists’ role
•prepares and distributes medication
28
Nurse’s role
* Determines medication orders are correct
* Ensure medication to be administered is correct
* Determines medication timing
* Administers medications correctly
* Closely monitors effects
* Provides patient teaching
* Does not delegate medication administration to assistive personnel
29
Medication frequency
Refers to how often the medication can be given
Med orders can be for “X” times a day or every “X” hours
If a med order says “X” times a day, try to space out administration as evenly as possible
30
Scheduled medications
* Have a specific time they are to he given
* Nurse may give meds up to 1 hour before or after the scheduled time
* nurse should give meds as close to scheduled time as possible
* Use organization skills to group scheduled med administration
31
PRN medication timing
* can be given so many times a day, depending on the order
* Do not have to be given unless the patient requires(needs) them for their current condition or if the patient requests them
* Must pay attention to when they were last given, if it has been given recently is it unsafe to give again
32
Medication error
Any preventable event that may cause inappropriate medication use or jeopardize patient safety
33
What is done when a medication error occurs.?
* Assess the patients’ condition, then notify provider
* When patient is stable, report the incident
* File an incident report
* Report near misses and incidents that cause no harm.!
34
Types of medication errors
* Wrong patient
* Wrong medication
* Wrong dosage
* Wrong preparation
* Wrong route
* Expired medication
* Wrong time
* Incorrectly signing off
* Illegible signature
* Failing to verify controlled substance count
35
Seven rights of medication administration
* Right medication
* Right dose/amount
* Right patient
* Right route
* Right time
* Right documentation
* Right indication/reason
36
TRAMPED stands for..
Time Route Amount Medication Patient Expiration Documentation
* Used to verify meds
* Does not include Indication, but should still be done for PRN meds
37
Patients rights of medication administration
* To be informed about a medication
* To refuse a medication
* To have a medication history
* To be properly advised about experimental nature of medication
* To recieve labeled medications safely
* To recieve appropriate supportive therapy
* To not receive unnecessary Medications
* To be informed if medications are part of a research study
38
Controlled substances
Medications that have a potential for abuse (Addiction) and have higher safety concerns when administered
39
Schedule I drugs
These drugs have no theraputic indication
EX: Heroin, Weed, Ecstasy
40
Schedule II drugs
These drugs are used for limited medical purposes
EX: Vicodin, Cocaine, Methamphetamine, Methadone, Dilaudid, Oxycontin, Fentanyl, Adderall, Ritalin
41
Schedule III drugs
These are drugs with a moderate to low potential for physical and psychological dependence
EX: Tylenol with Codeine
42
Schedule IV drugs
These drugs have common theraputic uses, but are also a risk for abuse and addiction
EX: Ativan, Ambien, Tramadol
43
Schedule V drugs
These drugs have a lower potential for abuse/addiction, and have limited quantities of narcotics
EX: Lyrica
44
Controlled substances (Narcotics)
* Always locked up
* Must verify count on controlled substance log before taking any meds
* Don’t document until the med is is prepped
* When wasting, another nurse must witness the waste and sign off on the waste with you
45
What happens if you take a controlled substance without first verifying the count on the log.?
You will be responsible if the count is off/wrong.!
46
Community medications
These are common over the counter meds found in nursing homes, and are shared amongst all residents
47
How are community meds dispensed.?
The pill must be poured into the cap of the bottle, and then from the cap to the medication cup
•Never place the cap of the bottle face down (Asepsis issue)
48
Slow release medications
Medications designed to release slowly
49
Slow release medication examples
* Extended release (ER)
* Sustained release (SR)
* Delayed release (DR)
* Enteric coated (EC)
* Timed release (TR)
* Controlled release (CR)
50
Crushing medications
* Helps the patient swallow the meds easier
* Reduces risk for aspiration
* Not all meds can be crushed; can be harmful
51
Which medications should NEVER be crushed.?
* Any type of slow release medication
| * Capsules
52
When placing crushed meds or opened capsule medications in food what should be done.?
Place a small amount of pudding or applesauce in the med cup and mix. This way the patient won’t be forced to eat an entire container when they’re not hungry/can’t
53
When only a part of a dose of a pill is needed what can the nurse do.?
The nurse can split the pill in half, if the medication is made to be split in half.
These meds will come pre-scored
* Not all scored pills are to be split, so always read for any contraindications
* Some unscored pills can be split
54
When splitting medications
* A pill cutter must always be used to ensure accuracy
* Place the pill as far back into the device as it will go
* Shut the device, this brings the razor down to split the pill
* Clean the device after use; run under water and allow to air dry
* NEVER touch the razor, do not clean the razor with an alcohol swab
55
Before administering medications the nurse should…
Always assess the patient first.!
56
Medication administration steps
* Make sure patient is awake and alert; get them out of bed if possible
* Take vitals & overall general survey of pt
* Go to nurses station to prep for med pass
* Check orders/MAR before grabbing any meds
* Collect appropriate meds for the time
* Collect all appropriate supplies
* Perform Tramped 2x alone
* Perform Tramped for last time in front of instructor
* Prep meds as needed
* Clean area when done prepping
* Gather necessary supplies and go to PT
* Ask for name, DOB, allergies & verify w the MAR
* Educate PT on what they’re being given
* Administer meds
* document
57
When medication has been administered, what is the next step.?
Document on the MAR (Paper or electronic) immediately after PT has taken their meds
58
Do you need to document in narrative every scheduled medication.?
No. You only document in the narrative for scheduled meds if the patient gives you trouble or refuses their meds. Also if the PT cannot be given their meds due to assessment findings.
59
When should you document medication administration in the narrative charting.?
When giving PRN meds. You need to chart the reason you gave these meds
Document events leading up to giving PRN meds, when the meds are given, and the results of the med.
60
The patients MAR is a legal piece of documentation, this means..
* No erasable pens
* Everything must be legible and correct
* If an error is made, cross it out correctly, initial, and write correct info next to the error
61
How many times does the nurse need to sign their full name, credentials, and initials on the MAR.?
Once per MAR
62
Medication taken PO is..
By mouth
63
The easiest and most desirable route for medications is..
PO, by mouth
64
When can a patient not take medications PO.?
* When they are experiencing GI issues
* When they cannot swallow
* When the patient is unconscious
65
Medications taken PO, but are not to be swallowed…
Are to be dissolved in the mouth. The nurse must give PT education on how to properly take the medication.
These meds are absorbed directly into the blood through the oral tissue, and are absorbed faster.
66
Sublingual (SL) administration
Medication is placed under the tongue, where the medication will dissolve
67
Buccal (BUC) administration
Medication is placed against the cheek, where the med will dissolve.
68
Topical medications
Are applied to the skin, where they provide a local effect, and are absorbed slowly
69
Transdermal patches
Medicated patches placed on the skin
* Skin must be assessed before placing a patch
* Make sure no other patches are present before applying a new patch
* Cleanse old and new area
* Apply new patch in a different spot
* Document, when and where new patch was placed
70
In what direction should nasal spray be sprayed in the nostril.?
Towards the side and NOT in the center of the nostril
71
Is Oral inhalation and PO the same thing.?
No. PO goes through the GI tract. Oral inhalation is inhaled into the lung tissue
72
Opthalmic medications
Madication going into the eyes
| EX: OTC eye drops
73
Where should ophthalmic medications go in the eye.?
Inside the middle of the lower eyelid
* pull the lower lash line open and drop medications directly in the middle of the lower lid.
* NEVER share eye medications
74
Suppository
Medications inserted rectally or vaginally
75
In what position should the nurse place the patient in to administer rectal suppositories.?
Left lateral sims position
76
Should sterile technique be in place when inserting suppositories.?
No. Sterile technique is not necessary
77
In what position should the nurse place the patient in when administering vaginal suppositories.?
Dorsal recumbent position
78
Is sterile technique required when administering an enema.?
No. Sterile technique is not necessary
79
In what position should the nurse place the patient in when administering an enema.?
Sims position
•Left side lying with top leg bent upwards
80
What equipment is necessary when taking a blood glucose measurement.?
* At least 2 pieces of gauze
* Alcohol prep pad
* Lancet
* Glucometer
* Test strip
81
Parenteral injection routes
* Subcutaneous (SQ)
* Intramuscular (IM)
* Intradermal (ID)
* Intravenous (IV)
82
Parenteral injections require what technique before performing.?
Medical Asepsis technique
83
What does the nurse ask patients who are routinely injected.?
“Where was your last injection”.?
•Assess the last used area, and inject in a different area
84
Two types of syringes
* Luer-lok
| * Non-Luer-lok
85
When thinking of needle sizes, what should the nurse know.?
As the guage number decreases, the needle size (diameter) increases
Also, larger gauge needles the smaller in length whereas smaller gauge needles are longer in length
EX: 21gauge- larger
27 gauge- smaller
86
What is the nurse to do after medication has been drawn up in a needle.?
The nurse must recap the needle after drawing medication up from the vial & transporting the medication to the PT.
87
Regarding needles, what should the nurse never do.?
Never recap used needles.!
88
What technique must be used to recap needles.?
The one hand scoop technique
* Place cap on level horizontal surface and slide needle halfway into the cap
* Slowly tip needle up and allow cap to slide into the needle
* Use thumb to secure the cap onto the syringe
89
After an injection has been administered, what is the nurse to do with the syringe.?
Activate the safety with one hand FIRST, then dispose of the syring in the sharps container
90
When measuring doses in syringes, where is the nurse looking.?
At the flat end of the plunger, NOT the tip.
91
Before injecting medications, the nurse must know
* The volume of the medication being administered
* The characteristics and viscosity of the medication
* The location of anatomical structures underlying the injection site
92
Characteristics of an ampule
* Glass container holding medication
* Single dose usage
* For meds that cannot come into contact with rubber
* Must be cracked open
* Must use a blunt filter needle when drawing up med
* All pieces of ampule must be disposed into the sharps container
93
Injection angles
IM- 90 degrees
SQ- 45-90 degrees
ID- 15 degrees
94
Subcutaneous injections
* Injected into fatty layer of skin below dermis
* Pre-attatched needles
* Shorter & smaller needles used
* Given at 90 or 45 degree angle
* Insulin, heparin, & lovenox most common meds administered this way
95
When giving a subcutaneous injection how is the skin prepped.?
Locate the area in which you will administer the injection, squeeze the fat, clean the area with an alcohol swab and administer the injection. DO NOT let go of the fat until the injection has been administered
96
Which medication also injects the air bubble.?
Lovenox (Enoxaparin)
97
Where is Enoxaparin given.?
Only given in the stomach
98
How do you activate the safety on a lovenox syring.?
Remove the needle from the patient, turn the needle away from yourself and the patient & firmly push the plunger.
99
What needle length is used for IM injections.?
Needle length and injection site is tailored to the patient
100
What are some common IM injections.?
* Vaccines
* Antibiotics
* Glucagon
* Sedatives
101
What are IM needle lengths dependent on.?
The site of the injection and the size of the patient
102
What are IM needle gauges dependent on.?
Viscosity of the medication
103
What method is used to administer IM injections.?
Dart method
104
What is the “Z track” method for IM injections.?
Z track method is when the nurse pulls the skin 1-11/2 inches laterally to the side with the ulnar side of the non dominant hand. The skin is kept in this position until after the injection has been administered. This seals the needle track and prevents medication leakage
105
What is aspiration technique.?
Aspiration technique is assessing that the needle placement is correct. To do this place the injection in the patient and secure syringe with the nondominant hand, with the dominant hand pull back of the plunger. No blood should appear, if blood is present remove the needle dispose of the medication & start over.
106
What are some common IM injection sites.?
* Deltoid (upper side of shoulder)
* Vastus lateralis (middle lateral side of thigh)
* ventrogluteal (upper side of hip)
107
Pros and cons of using the deltoid muscle for IM injections
Pro: it is easily accessible
Con: it is not well developed in adults
There is risk for coming into contact with nerves and arteries
108
How much volume can be injected into the deltoid.?
Less than 2mL
109
How to locate the deltoid.?
* Fully expose pt upper arm and shoulder (Do not roll up tight fitting clothing)
* Have pt relax arm at side
* Identify lower edge of acromion process
* Injection point is 1-2in below acromion process (3 fingers can be used to measure)
110
Pros and cons of gluteal medius for IM injections
Pro: deep muscle, away from major nerves and blood vessels
Preferred and safest site for adults, children, and infants
Cons: can be difficult to acess
Pt may be hesitant
111
How much volume can be injected into the ventrogluteal area.?
Up to 5mL
112
Technique for identifying the ventrogluteal area.?
* PT lays on left side, use left hand for placement
* PT lays on right side, use right hand for placement
* Index finger, middle finger and iliac crest forms a V-shaped triangle
* Injection site is at the center of the triangle
113
Pros and cons of injections in the vastus lateralis
Pros: Thick well developed muscle, easily accessible
Cons: can be more difficult to access
Pt may be hesitant
114
How much volume can be injected into the vastus lateralis.?
Up to 2mL
115
Technique to identify vastus lateralis muscle
* Fully expose pt leg (Epipen can go through clothing)
* Have pt lie flat with the knee slighlty flexed and foot externally rotated or to assume a sitting position
* Antherolateral aspect of thigh
* Hand width above knee and hand width below grater trochanter of the femur
* use middle third of available area to administer injection
116
What are intradermal injections used for.?
Commonly used for skin testing
| EX: TB, allergies
117
What is an ideal location for an intradermal injection.?
* Lightly pigmented to allow for color change assessment
* Free of lesions
* Relatively hairless
* Inner forearm & Upper back are most commonly used
118
What type of needle is used for intradermal injections.?
Tuberculin or small hypodermic syringes
•25-27 gauge
•3/8-5/8 in length
119
The intradermal injection should enter the skin…
Bevel up
120
How can you tell the intradermal injection has been placed properly.?
A small bleb will form as you inject, if it does not form, it has been injected too deep
121
General rule for reassessment after medication administration
* Reassess 30min-1hr after administering oral meds
| * Reassess within 30min for parenteral injections
