Fundamentals Exam #2 Flashcards
ID characteristics of adverse drug events (ADEs)
— They are unintended, undesirable, and often unpredictable responses to medication
— Can take weeks/months to develop
Patients most at risk: pregnant women, very young patients, have chronic d/o’s (e.g. HTN, epilepsy, CVDs, psychoses)
RN roles + responsibilities in medication administration
The SIX Rights
1) Right patient
2) Right medication
3) Right route
4) Right time
5) Right documentation
6) Right dose
NOTE: Use TWO patient IDs (name & birthday)
Compare + contrast roles of medication administration
Doctor:
Pharmacist: split, label, package, send to RN for administration to ensure patient safety in inpatient settings
RN: administer prescribed/ordered medications using the 6 “Rights”
Medication errors when administering
— Inaccurate prescribing
— Administering the wrong medication, dose, route, and time interval
— Administering to the wrong patient
— Administering extra doses
— Failing to administer a medication
What should the RN do if a med error happens?
— RN assesses and examines patient’s condition
— Notifies Dr. of incident ASAP
— Once patient is stable, RN reports incident to the appropriate institution (e.g. manager, supervisor); provide written occurrence/incident report within 24 hours of incident
— The report should not be referred to in the patient’s medical record as it legally protects the HCprofessional and agency
— Incident reports are used to track errors and patterns and initiate quality improvement programs as needed
A patient has the right to
Be informed about a medication
Refuse a medication
Have a medication history
Be properly advised about experimental nature of medication
Receive labeled medications safely
Receive appropriate supportive therapy
Not receive unnecessary medications
Be informed if medications are part of a research study
Poly-pharmacies increase risk with
Frequent use of OTC medications
Lack of knowledge about medications
Incorrect beliefs about medications
Visits to several health care providers for different illnesses
Oral administrations
Easiest + best route
— Food can affect absorption
— Watch our for aspiration + precautions (e.g. swallow assessment)
Topical medication applications
Skin applications include:
— ointments and pastes | spread evenly over surface
— lotions and creams | apply lightly, do not rub
— transdermal patches | don disposable clean gloves when applying + removing old patch |
Nasal instillations
Sprays
Drops
Advantages of Oral, Buccal, Sublingual Routes
— Convenient, comfortable
— Economical
— Easy to administer
— Often produce local/systemic effects
— Rarely causes anxiety for patient
Types of Inhaled medications + interventions
— Dispersed through an aerosol spray, mist, or powder that penetrates lung airways
pMDIs = pressurized metered-dose inhalers
DPIs = dry powder inhalers
BAIs = breath-actuated metered-dose inhalers
NOTE: all produce local effects in the airway (e.g. bronchodilation)
Advantages of Subcutaneous, Intramuscular (IM), Intravenous (IV), & Intradermal (IM) (Parenteral) Routes
— Can be used when oral medications are contraindicated
— More rapid absorption than with topical or oral routes
— IV infusion provides medication delivery when patient is critically ill or long-term therapy is necessary; if peripheral perfusion is poor
— IV route preferred over injections
Advantages of Topical Routes
— Primarily provides local effect
— Painless
— Limited side effects
Advantages of Transdermal Route
Prolonged systemic effects with limited side effects
Advantages of Mucous Membranes (nasal) Route
— Therapeutic effects provided by local application to involved sites
— Aqueous solutions readily absorbed and capable of causing systemic effects
— Potential route of administration when oral medications are contraindicated
Eye Instillation Interventions
— Avoid the cornea
— Avoid touching parts of. The eye w/ eyedroppers/tubes to decrease the risk of infection
— Use only the affected eye
— Never allow patients to share medication!
Rectal Instillation Interventions
— Medication is thin and bullet-shaped
— Medications expert local effects: promoting defecation or systemic effects (e.g. reducing nausea)
— Must refridgerate
— May require cleansing enema before application
— DOUBLE GLOVE
Ear Instillation Interventions
— Instill drops/solutions @ room temperature
— Use sterile solutions
— Consult a HCP 1st if the patient has ear drainage
— Do not occlude the ear canal w/ dropper/syringe
Advantages of Inhalation Route
— Provides rapid relief for local respiratory problems
— Used for introduction of general anesthetic gases
Advantages of Intraocular Disk Route
Route advantageous because it does not require frequent administration such as with eye drops
Intraocular disks Interventions
— Remains in place for up to 1 week
— Teach patients to monitor for adverse effects
— Explain insertion and removal
Guidelines for Telephone/Verbal Orders
- Only authorized staff members receive and record telephone or verbal orders. Institutional policies identify which members are authorized.
- Clearly identify patient’s name, room number, and diagnosis.
- Read back all orders to health care provider (TJC, 2018).
- Use clarification questions to avoid misunderstandings.
- Write “TO” (telephone order) or “VO” (verbal order) and include date and time, name of patient, and complete order; sign the name of the health care provider and nurse.
- Follow agency policies; some require documentation of the “read-back” or require two nurses to review and sign telephone or verbal orders.
- Health care provider co-signs the order within the time frame required by the agency (usually 24 hours; verify agency policy)
EVERY medication order should have the following parts
— Patient’s FULL NAME
— Date/Time that order was written
— Medication name
— Dosage
— Route of administration
— Time & Frequency of administration
— Signature of HCP
