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Nursing Fundamentals > Exam 5; Chapter 31 Med Admin > Flashcards

Exam 5; Chapter 31 Med Admin Flashcards

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1
Q

Chemical drug names

A

Provide exact descriptions of a medications composition.

EX: N-acetyl-para-aminophenol

Rarely used by nursing

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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

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3
Q

Trade drug names

A

Brand names or proprietary name. This is the name under which a manufacturer markets the medication

EX: Tylenol

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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

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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

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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

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7
Q

Absorbtion

A

The passage of medication molecules into the blood from the site of administration

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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
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9
Q

Theraputic effect

A

The expected or predicted physiological response

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10
Q

Adverse effect

A

Unintended/ undesirable outcome

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11
Q

Side effect

A

A predictable secondary, typically undesirable effect

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12
Q

Toxic effect

A

Accumulation of medication in the bloodstream causing undesirable outcomes

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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

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14
Q

Allergic reactions

A

Unpredictable response to a medication

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15
Q

Medication interactions

A

One medication modifies the action of another medication

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16
Q

Medication tolerance

A

More medication is required to achieve the same theraputic effect

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17
Q

Medication dependence

A

Can be physical or psychological

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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
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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.

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20
Q

Medication orders require

A
  • Patients name
  • Order date
  • Medication name
  • Medication dosage
  • Medication route
  • Time of administration
  • Drug indication
  • Prescribers signature
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21
Q

Standing orders

A

Administered until the dosage is changed or another medication is prescribed

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22
Q

PRN orders

A

Given when the patient requires it/ as needed

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23
Q

Single(One-time) orders

A

Given one time only for a specific reason

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24
Q

STAT Orders

A

Given immediately in an emergency

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25
Q

“Now” orders

A

When a medication is needed right away but not STAT

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26
Q

Prescription orders

A

Medication to be taken outside of the hospital

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27
Q

Pharmacists’ role

A

•prepares and distributes medication

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28
Q

Nurse’s role

A
  • 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
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29
Q

Medication frequency

A

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

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30
Q

Scheduled medications

A
  • 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
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31
Q

PRN medication timing

A
  • 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
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32
Q

Medication error

A

Any preventable event that may cause inappropriate medication use or jeopardize patient safety

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33
Q

What is done when a medication error occurs.?

A
  • 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.!
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34
Q

Types of medication errors

A
  • 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
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35
Q

Seven rights of medication administration

A
  • Right medication
  • Right dose/amount
  • Right patient
  • Right route
  • Right time
  • Right documentation
  • Right indication/reason
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36
Q

TRAMPED stands for..

A

Time Route Amount Medication Patient Expiration Documentation

  • Used to verify meds
  • Does not include Indication, but should still be done for PRN meds
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37
Q

Patients rights of medication administration

A
  • 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
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38
Q

Controlled substances

A

Medications that have a potential for abuse (Addiction) and have higher safety concerns when administered

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39
Q

Schedule I drugs

A

These drugs have no theraputic indication

EX: Heroin, Weed, Ecstasy

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40
Q

Schedule II drugs

A

These drugs are used for limited medical purposes

EX: Vicodin, Cocaine, Methamphetamine, Methadone, Dilaudid, Oxycontin, Fentanyl, Adderall, Ritalin

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41
Q

Schedule III drugs

A

These are drugs with a moderate to low potential for physical and psychological dependence

EX: Tylenol with Codeine

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42
Q

Schedule IV drugs

A

These drugs have common theraputic uses, but are also a risk for abuse and addiction

EX: Ativan, Ambien, Tramadol

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43
Q

Schedule V drugs

A

These drugs have a lower potential for abuse/addiction, and have limited quantities of narcotics

EX: Lyrica

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44
Q

Controlled substances (Narcotics)

A
  • 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
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45
Q

What happens if you take a controlled substance without first verifying the count on the log.?

A

You will be responsible if the count is off/wrong.!

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46
Q

Community medications

A

These are common over the counter meds found in nursing homes, and are shared amongst all residents

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47
Q

How are community meds dispensed.?

A

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)

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48
Q

Slow release medications

A

Medications designed to release slowly

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49
Q

Slow release medication examples

A
  • Extended release (ER)
  • Sustained release (SR)
  • Delayed release (DR)
  • Enteric coated (EC)
  • Timed release (TR)
  • Controlled release (CR)
50
Q

Crushing medications

A
  • Helps the patient swallow the meds easier
  • Reduces risk for aspiration
  • Not all meds can be crushed; can be harmful
51
Q

Which medications should NEVER be crushed.?

A
  • Any type of slow release medication

* Capsules

52
Q

When placing crushed meds or opened capsule medications in food what should be done.?

A

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
Q

When only a part of a dose of a pill is needed what can the nurse do.?

A

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
Q

When splitting medications

A
  • 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
Q

Before administering medications the nurse should…

A

Always assess the patient first.!

56
Q

Medication administration steps

A
  • 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
Q

When medication has been administered, what is the next step.?

A

Document on the MAR (Paper or electronic) immediately after PT has taken their meds

58
Q

Do you need to document in narrative every scheduled medication.?

A

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
Q

When should you document medication administration in the narrative charting.?

A

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
Q

The patients MAR is a legal piece of documentation, this means..

A
  • 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
Q

How many times does the nurse need to sign their full name, credentials, and initials on the MAR.?

A

Once per MAR

62
Q

Medication taken PO is..

A

By mouth

63
Q

The easiest and most desirable route for medications is..

A

PO, by mouth

64
Q

When can a patient not take medications PO.?

A
  • When they are experiencing GI issues
  • When they cannot swallow
  • When the patient is unconscious
65
Q

Medications taken PO, but are not to be swallowed…

A

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
Q

Sublingual (SL) administration

A

Medication is placed under the tongue, where the medication will dissolve

67
Q

Buccal (BUC) administration

A

Medication is placed against the cheek, where the med will dissolve.

68
Q

Topical medications

A

Are applied to the skin, where they provide a local effect, and are absorbed slowly

69
Q

Transdermal patches

A

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
Q

In what direction should nasal spray be sprayed in the nostril.?

A

Towards the side and NOT in the center of the nostril

71
Q

Is Oral inhalation and PO the same thing.?

A

No. PO goes through the GI tract. Oral inhalation is inhaled into the lung tissue

72
Q

Opthalmic medications

A

Madication going into the eyes

EX: OTC eye drops

73
Q

Where should ophthalmic medications go in the eye.?

A

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
Q

Suppository

A

Medications inserted rectally or vaginally

75
Q

In what position should the nurse place the patient in to administer rectal suppositories.?

A

Left lateral sims position

76
Q

Should sterile technique be in place when inserting suppositories.?

A

No. Sterile technique is not necessary

77
Q

In what position should the nurse place the patient in when administering vaginal suppositories.?

A

Dorsal recumbent position

78
Q

Is sterile technique required when administering an enema.?

A

No. Sterile technique is not necessary

79
Q

In what position should the nurse place the patient in when administering an enema.?

A

Sims position

•Left side lying with top leg bent upwards

80
Q

What equipment is necessary when taking a blood glucose measurement.?

A
  • At least 2 pieces of gauze
  • Alcohol prep pad
  • Lancet
  • Glucometer
  • Test strip
81
Q

Parenteral injection routes

A
  • Subcutaneous (SQ)
  • Intramuscular (IM)
  • Intradermal (ID)
  • Intravenous (IV)
82
Q

Parenteral injections require what technique before performing.?

A

Medical Asepsis technique

83
Q

What does the nurse ask patients who are routinely injected.?

A

“Where was your last injection”.?

•Assess the last used area, and inject in a different area

84
Q

Two types of syringes

A
  • Luer-lok

* Non-Luer-lok

85
Q

When thinking of needle sizes, what should the nurse know.?

A

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
Q

What is the nurse to do after medication has been drawn up in a needle.?

A

The nurse must recap the needle after drawing medication up from the vial & transporting the medication to the PT.

87
Q

Regarding needles, what should the nurse never do.?

A

Never recap used needles.!

88
Q

What technique must be used to recap needles.?

A

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
Q

After an injection has been administered, what is the nurse to do with the syringe.?

A

Activate the safety with one hand FIRST, then dispose of the syring in the sharps container

90
Q

When measuring doses in syringes, where is the nurse looking.?

A

At the flat end of the plunger, NOT the tip.

91
Q

Before injecting medications, the nurse must know

A
  • The volume of the medication being administered
  • The characteristics and viscosity of the medication
  • The location of anatomical structures underlying the injection site
92
Q

Characteristics of an ampule

A
  • 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
Q

Injection angles

A

IM- 90 degrees
SQ- 45-90 degrees
ID- 15 degrees

94
Q

Subcutaneous injections

A
  • 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
Q

When giving a subcutaneous injection how is the skin prepped.?

A

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
Q

Which medication also injects the air bubble.?

A

Lovenox (Enoxaparin)

97
Q

Where is Enoxaparin given.?

A

Only given in the stomach

98
Q

How do you activate the safety on a lovenox syring.?

A

Remove the needle from the patient, turn the needle away from yourself and the patient & firmly push the plunger.

99
Q

What needle length is used for IM injections.?

A

Needle length and injection site is tailored to the patient

100
Q

What are some common IM injections.?

A
  • Vaccines
  • Antibiotics
  • Glucagon
  • Sedatives
101
Q

What are IM needle lengths dependent on.?

A

The site of the injection and the size of the patient

102
Q

What are IM needle gauges dependent on.?

A

Viscosity of the medication

103
Q

What method is used to administer IM injections.?

A

Dart method

104
Q

What is the “Z track” method for IM injections.?

A

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
Q

What is aspiration technique.?

A

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
Q

What are some common IM injection sites.?

A
  • Deltoid (upper side of shoulder)
  • Vastus lateralis (middle lateral side of thigh)
  • ventrogluteal (upper side of hip)
107
Q

Pros and cons of using the deltoid muscle for IM injections

A

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
Q

How much volume can be injected into the deltoid.?

A

Less than 2mL

109
Q

How to locate the deltoid.?

A
  • 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
Q

Pros and cons of gluteal medius for IM injections

A

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
Q

How much volume can be injected into the ventrogluteal area.?

A

Up to 5mL

112
Q

Technique for identifying the ventrogluteal area.?

A
  • 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
Q

Pros and cons of injections in the vastus lateralis

A

Pros: Thick well developed muscle, easily accessible
Cons: can be more difficult to access
Pt may be hesitant

114
Q

How much volume can be injected into the vastus lateralis.?

A

Up to 2mL

115
Q

Technique to identify vastus lateralis muscle

A
  • 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
Q

What are intradermal injections used for.?

A

Commonly used for skin testing

EX: TB, allergies

117
Q

What is an ideal location for an intradermal injection.?

A
  • Lightly pigmented to allow for color change assessment
  • Free of lesions
  • Relatively hairless
  • Inner forearm & Upper back are most commonly used
118
Q

What type of needle is used for intradermal injections.?

A

Tuberculin or small hypodermic syringes
•25-27 gauge
•3/8-5/8 in length

119
Q

The intradermal injection should enter the skin…

A

Bevel up

120
Q

How can you tell the intradermal injection has been placed properly.?

A

A small bleb will form as you inject, if it does not form, it has been injected too deep

121
Q

General rule for reassessment after medication administration

A
  • Reassess 30min-1hr after administering oral meds

* Reassess within 30min for parenteral injections

Nursing Fundamentals (5 decks)

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