Final Flashcards
Right Drug
correct drug is given; medication orders must be checked against the medication label or profile three times before giving the medication. During initial preparation of medication; before removing from the storage place. Is drug appropriate? Correctly ordered? Before you place the unit dose package in a medicine cup Before you open the unit dose package at the bedside. Avoid relying on knowledge of peers. Use the drug’s generic name to avoid medication error and enhance patient safety. If you have questions, contact the prescriber. Never make assumptions.
Right Dose
confirm dosage amount is appropriate for age and size, pediatric and elderly patients are more sensitive to medications than adults, thus use extra caution with drug dosage. Check the prescribed dose against the available drug stocks and against normal dosage ranges. Pay special attention to decimal points, could lead to a tenfold or even greater overdose. Serious errors occur when drugs are infused too rapidly. NEVER use trailing zeros, only leading zeros. What recommendations can you make for avoiding making a drug calc error? Use a calculator, recheck your math, have another RN check your math – not just verify your calculations.
Right Time
Include in three checks: frequency of the ordered medication, the time to be administered, and when the last dose was given. Routine drug is to be administered at 0900 and routine medication no more than .5 hour before or .5 hour after. STAT: Give once and immediately, but within ½ hr. of when order was written. Single order: Give only once. Standing order: Written in advance, under specific circumstances. PRN: As needed using nurse’s judgement. Use military time when recording medication in medical records. Many drugs are time sensitive. If the dose is delayed for several hours, 2 doses may be given within a couple hours of each other, need to consult with a pharmacist.
Right Route and Form
Confirm the appropriateness of the prescribed route while making sure the client can take the medication by this route. Errors occur if wrong equipment is used. Maybe a well-intended nurse has opened a capsule or crushed a pill for the client that cannot swallow easily or who has a NG tube.
This can cause potentially harmful, corrosive effects in oral mucosa &/or on the upper GI tract. Crushing can significantly alter the drug’s special pharmaceutical formulations resulting in the pt receiving a bolus of a drug intended to be released over several hrs. Some drugs can stain teeth once released from the protective coating. Some drugs are destroyed by stomach acid if crushed. Crushing can cause drug to be bad tasting or irritating. Controlled Release drugs cannot be crushed or altered.
Right Patient
Check the patient’s identity before giving each medication dose. Confirm the name on the patient and the order. Ask the patient to state his or her name, and then check the patient’s identification band to confirm name, identification number, age, and allergies. Other acceptable identifiers: SS number, home address, and photo. With pediatric pts, the parents &/or legal guardians are often the ones who identify the pt. This identification should then be checked against the pt’s identification band or bracelet. In newborn nursery and L&D, the mother and baby have id bracelets with matching numbers. Other areas to check: Cultural background, preexisting ideas & attitudes, personal beliefs, and religious affiliation.
Right Documentation
Document AFTER the medication has been given. Include: date and time, route, pertinent lab values, VS. Correct documentation is the sixth right of medical administration, document date, time, name, dosage, route, pertinent lab values, VS and site. Only document after the medication has been given, do not use trailing zeros. Document drug action: negative changes in symptoms experienced, AE/SE, toxicity, drug-related physical and/or psychological symptoms, improvement. If a drug is not administered, document why and any actions taken.
Right reason or indication
appropriateness in use of medication, confirm the rationale for giving this medication by reviewing the client’s history and asking the client.
Right response
assess and evaluate the drugs response in the patient; Document assessment findings, interventions, monitoring.
Right to refuse
FIRST determine the reason the client is refusing. Make sure the client understands the medication, Inform the prescriber, document refusal and continue to monitor.
Objective Data
Includes any information gathered through the senses (can be seen, heard, felt or smelled). Methods of data collection: observation, medical records review, head-to-toe assessment, nursing history, past and present med history; results of lab tests, diagnostic studies, or procedures; measurement of vital signs weight, height; medication profile. Examples: age, height, weight, allergies, medication profile, health history.
Subjective Data
Includes information shared through the spoken word by any reliable source, such as the client, spouse, family member, significant other, and/or caregiver. Complaints, problems, or stated needs. Examples: Pt reports dizziness, headache, vomiting, feeling hot.
Pain is always
Subjective
Drug-to-drug Interactions
-Drugs that are highly protein bound. They will compete for binding sites. Can get a high level of serum of that drug which can lead to toxicity.
-When two highly protein bound drugs are given, the drugs may compete for binding sites on the albumin molecule. Because of this competition, there is more free or unbound drug.
-an unpredictable drug response
-Protein Binding of Drugs:
Drugs can be freely distributed to extravascular tissue only when not bound to protein.
This unbound portion is pharmacologically active and considered a “free” drug.
A drug’s efficiency is affected by the degree to which it binds to proteins within the blood. The less bound a drug is, the more efficiently it can traverse cell membranes. A drug’s performance can be enhanced or decreased by protein binding. A drug’s performance can be enhanced or decreased by protein binding.
-Drug-to-drug interactions may occur when:
When 2 highly protein bound drugs are administered at the same time, there is more free, unbound drug available.
This can lead to an unpredictable drug response, called a drug-drug interaction.
-Interactions: Alteration of the action of one drug by another. This can either increase or decrease the actions of one or both of the involved drugs. 2 drugs are combined and results in effects that are greater than the effect that could have been achieved if either 1 drug was given alone.
Understand the components of adverse drug reactions
- Any undesirable occurrence involving medications.
- Pharmacologic: Extension of drug’s normal effects. (Lowers blood pressure to where the patient becomes unconscious).
- Allergic (hypersensitivity): Involves immune response
- Idiosyncratic: occurs unexpectedly in a particular patient. Caused by a deficiency or excess of drug-metabolizing enzymes.
- Drug interactions: When the presence of two or more drugs in the body produces an unwanted effect.
- May cause no problems or be life-threatening. May or may not be prevented.
- Most common are medication errors, caused by caregivers.
Half Life
- Time it takes for one half of the original amount of a drug to be removed.
- Measure of the rate at which drugs are removed from the body.
- Steady state: The amount of drug removed via elimination is equal to the amount of drug absorbed with each dose.
- The time depends on the drug itself. Typically takes 5-6 half lifes for the drug to be out of your system.
- Teach the patient to taking drugs at the right time for the steady state.
Physiologic changes in older adults and how this affects dosing of drugs.
- Drug therapy likely to result in AE’s and toxicities due to:
- Polypharmacy: the use of many drugs.
- Physiologic changes: Decline in organ function. Careful monitoring and dosage adjustment.
- Pharmacokinetics: Absorption is slowed, distribution is decreased, metabolism is decreased; prolonging the half-life and results in drug accumulation, excretion is decreased.
Risk of administering medications during pregnancy
- A fetus is exposed to many of the same substances as the mother, including drugs.
- 1st trimester: greatest danger for drug-induced developmental defects. Drug exposure is more detrimental during the 1st trimester. Congenital birth defects
- 2nd trimester: not as dangerous but must still be mindful
- 3rd Trimester: Drug transfer is more likely, The greatest percentage of maternally absorbed drug gets to the fetus. The baby could be at risk for developing toxicity to the drug if the mom takes too much of the drug. Drug transfering to the baby.
- Transfer of drugs occurs through diffusion across the placenta.
Risk associated with administering medications to a patient who is breastfeeding
A great number of drugs can cross from mother’s circulation into breast milk. Drug levels are usually lower than in maternal circulation. Must consider risks vs. benefits.
Black Box Warning
-Black box warning: A type of warning that appears in a drug’s prescribing information and is required by the US Food and Drug Administration to alert prescribers of serious adverse events that have occurred with the given drug.
-It indicates that serious adverse effects have been reported with the drug. The drug can still be prescribed but the prescriber must be aware, and the patient must be warned.
-These are included in the prescribing information of the drug, and the text of the warning has a solid black border.
-Three types of black box warnings:
Class 1: The most serious type of recall, use of the drug product carries a reasonable probability of serious adverse health effects or death.
Class ll: Less severe, use of the drug product may result in temporary or medically reversible health effects, but the probability of lasting major adverse health effects is low.
Class lll: Least severe, use of the drug product is not likely to result in any significant health problems.
-Numerous reports of severe AE occurring with administration of drugs.
Ex. cause or exacerbate congestive heart failure
-Always be aware of any black box warnings before giving med
Nursing student’s responsibility when a med error is made
- We have a responsibility to our patient. Make sure the patient is alright.
- Report the medication error.
Strategies to prevent medication errors
- Multiple systems of checks and balances should be implemented to prevent medication errors.
- Prescribers must write legible orders that contain correct information, or orders entered electronically, if available.
- Authoritative resources, such as pharmacists or current drug references/literature, must be consulted if there is any area of concern or lack of clarity, beginning with the medication order and continuing throughout the entire medication administration process.
- Check the medication order three times before giving the drug.
- The basic Nine Rights of medication administration should be used.
How to prevent medication erros
2 patient identifiers, do not administer if you did not draw up yourself, minimize verbal or telephone orders; repeat order to prescriber, spell drug name aloud, speak slowly and clearly. List indication next to each order. Avoid abbreviations, acronyms. Never assume anything, Do not try to decipher illegibly written orders, No trailing zeros and always use leading zeros. Use generic names, check patient’s allergies and identification. Always listen to and honor any concerns expressed by patients regarding medications, safeguard meds the patient may have already taken so double-dose is not administered. Mandatory recalculation of every drug dose for high-risk drugs or high-risk patients. Educate patients to know their medications.
Examples of Medication errors
-Giving a drug to the wrong patient.
-Confusing look-alike/sound-alike drugs.
-Administering the wrong drug or the wrong doses
-Giving the drug by the wrong route at the wrong time.
-Wrong indication
-Not checking 3 times before administering:
When getting it out of pixis
At patients bedside
When putting in med cup to give to patient
Providing education to patients with hearing difficulties
Hearing: Perform a baseline hearing assessment. Use tone and volume controlled teaching aids, use bright large print material to reinforce. Speak distinctly and slowly, sit on the side of patients best ear, Speak in a normal voice, but lower pitch. Face the patient so lip reading is possible. Use visual aids, reduce extra noises.
Providing education to patients with vision difficulties
Visual: Ensure the patient’s glasses are clean, use large print that is bright and clearly colored, use black and white, use non glare lighting and avoid contrasts of light, use of touch to gauge depth, keep all teaching within the patient’s visual field
Important aspects to consider when evaluating a patient’s learning needs
-Adaptation to any illnesses, age, barriers to learning, cognitive abilities, compliant with previous and/or current therapies, coping mechanisms, cultural background, Developmental status, education received including highest grade level completed and literacy level, educational resources, emotional status, environment at home and at work, financial status/issues/concerns, alternative complementary therapies, generational differences, health beliefs, health literacy, hierarchy of needs, languages spline, level of knowledge/understanding, languages spoken, level of knowledge/understanding about past and present medical conditions, limitations, medications currently taken, misinformation, mobility and motor skills, motivation level, nutrition, past and present health, race, readiness to learn, relationships, religion, risk for noncompliance, self-care ability, sensory status.
5th grade level is pretty standard. She won’t ask us reading level.
Criteria for drugs to be sold OTC
- OTC criteria: Consumers must be able to easily diagnose the condition and monitor for effectiveness. Benefits outweigh the risks. Drugs must have a favorable event profile, limited interactions with other drugs, low potential for abuse, high therapeutic index. Drugs must be easy to use and easy to monitor.
- Do not require a hc provider’s prescription, bought off the shelf, regulated by FDA through OTC drug monographs.
- Label: Purpose and uses of the product, specific warnings, including when the product should not be used under any circumstances; and when it is appropriate to consult a doctor or pharmacist. Side effects that could occur, substances or activities to avoid, dosage instructions, and active ingredients, warnings, storage information, and inactive ingredients.
Advantages and disadvantages of OTC medications
- Advantages: Convenience, Physicians can spend more time with more ill patients rather than with minor ailments, decreased overall health care costs.
- Disadvantages: May increase out of pocket expense,may delay patients seeking medical care, may postpone effective treatment, delay treatment, may relieve side effects, interactions with current prescription medications, and abuse.
RN’s responsibilities related to gene therapy and pharmacogenomics
The Role of the Nurse is to:
Talk through client, family, and drug histories.
Recognize situations that may warrant further investigation through genetic testing.
Identify resources for clients.
Teaching about genetic testing and counseling.
Maintain confidentiality and privacy.
Ensure that informed consent is obtained.
Assessment data that may be indicative of a client having a genetic disorder
-Family history: Covering at least three generations and includes the current and past health status of each family member.
-Assessment of factors possibly indicating an increased risk for genetic disorders. Examples include:
Higher incidence of a particular disease or disorder in the patient’s family than in the general population.
Diagnosis of a disease in family members at an unusually young age.
Diagnosis of a family member with an unusual form of cancer.
-Unusual reactions to a drug. This may point to a difference in a patient’s ability to metabolize certain drugs.
-Each time a drug is administered the patient’s response should be assessed.
Interventions for safe administration of dopamine
-Check Iv site often for infiltration, extravasation, use only if the solution is clear, administer on an infusion pump, infuse slowly to avoid dangerous CV effects.
-Continuously monitor cardiac rhythm. Can cause cardiac dysrhythmias
-Administering 2 adrenergic drugs together may precipitate severe CV effects. -Monitor for therapeutic effects:
Decreased edema, increased urinary output, return to normal VS, Improved skin color and temperature, increased LOC.
-Assess for allergies, asthma, and history of HTN, dysrhythmias, other CV disease.
-Assess renal, hepatic, and cardiac function,
-Careful titration and monitoring of vital signs and ECG.
Indications of Epinephrine
Used in emergency situations and is one of the primary vasoactive drugs used in many advanced cardiac life support protocols. Also used to treat acute asthma and anaphylactic shock.
