General Flashcards
Medication errors:
39% do to MD order ( half are caught by nurses), cause death, many look alike packages, bad handwriting, given on time, and have appropriate decimal places
Nurses must have complete….
Knowledge of med., patients age, weight, allergies, diagnosis, preg. Status, lab values, vs, and other important parameters.
7,000 people die from drug errors:
Wrong med., dose, patient, route, time, and documentation.
Legal aspects of medication:
Understand limits of their knowledge and skill (NPA), practice within scope of practice, responsible for our own actions ( always check MD order), when in doubt question orders
Drug standards:
Drugs are natural/synthesized that vary in strength and action, standards to ensure quality, FDA ( deter safety and efficacy of drugs),
Generic name:
Name assigned by manufacture before drug becomes official
Chemical name:
Constituents that make the drugs molecular structure
Brand name:
(Trademark), registered name assigned by manufacture.
Official name:
Name listed in FDA publication
Effects of drugs:
Therapeutic, side effect, drug toxicity, drug allergies, tolerance, interaction, goal of drug therapy/dosing
Therapeutic effect
Desired effect, reason drug prescribed, example: morphine
Side effect
Secondary or unintended effect, predictable, can or can not be harmful, some effects=good effects, severe effects>adverse effects ( may need to stop rx) ex: digoxin helps heart contraction but causes nausea
Drug toxicity
Level of drug too high for body (causing adverse effects), may be taken in wrong route or body has impaired metabolized, may be immediate or slow, monitor for toxicity, can have with OTC meds. And vitamins
Drug allergy
Immunologic reaction to drug, mild to severe, can react immediately or in days
Drug tolerance:
Body requires more of drug for therapeutic effect
Drug interaction:
Alters effect of one or both drugs potentiating or inhibiting effect
Synergistic response:
When 2 or more drugs given together to produce greater effect than if given alone, ex: ASA and codeine
Goal of drug therapy:
To maintain constant level done with repeated doses (onset of action, peak level, duration of action, therapeutic effect)
Therapeutic range:
Enough drug present in plasma to produce desired effect
Drug half life
time required to reduce to 1/2 the concentration
Goal of drug dosing
keep plasma level w/in therapeutic range (minimum, maximum, and maintenance)
Minimum dose
least amount of drug in serum to produce therapeutic effect
maximum dose
greatest amount of drug in serum w/o causing adverse effects
Maintenance dose
maintains desirable drug level over period of time adm. time important
Pharmacokinetics
Absorption, distribution, metabolism, and excretion
absorption
process drug enters bloodstream (movement through body, most PO meds. absorb in the GI tract)
Distribution
delivery of drug to tissue by circulatory system (liver, kidneys, brain) chemical and physical properties of drugs deter. action (fat soluble to fat)
Metabolism
process by which drug transformed to less active form, aka biotransformation or detoxification. Primarily in liver, products are active (pharmacological action) or inactive (has none) metabolites,
Excretion
active drug and by products removed from body. most excreted in urine, some in feces, breath, perspiration, saliva, resp. tract, or breast milk. *kidney function decreases with age, drug dose may need to be smaller
Essential components of MD order (inpatient)
patient name, date, time, medicine, dosage, route, time to be given/frequency, signature of person writing order
Components of a prescription (outpatient)
patient name, address, age, drug information, date written, dose, route, frequency, signature of prescriber, quanity, directions for the patient, refill number if any
Types of orders
verbal, STAT, single/one time dose, standing, PRN,
Routes of administration
Oral, sublingual, parenteral, topical, inhalation, buccal, others (rectal/vaginal/otic/ocular/nasal/irrigation)
Correct adm. of meds
all meds must be checked with MD order first, before adm., Ten rights: RIGHT med, dose, time, route, client, education, documentation, assessment, evaluation, to refuse
Check medicine three times before giving:
- when pulling, 2. before opening, 3. at the bedside-before adm
When at bedside:
check EMR, patient ID band, and have patient state name and DOB, right documentation
Patient education
include in teaching: frequency, how med works, name of med, dose, SE, allergies, what to report to MD
Nurses role:
Knowledge of drugs administering, responsible for actions! Assessment (psychological assessment, medication hx, and clinical assessment)
Assessment includes:
Medication hx- current drugs, rx <6 months, reactions/allergies, compliance, caffeine/tobacco/alcohol use, eating habits
psychological assessment -
prescription of drugs, frequency of self med., can they afford it, dependency issues,
Clinical assessment -
Patient condition, purpose of drug, any factors that may limit effect of drug
Nursing diagnosis:
Deter actual or potential nursing problems r/t drug therapy ( deficient knowledge), planning goals, implementation, charting, process
Planning goals:
Compliance, therapeutic effect, monitor patient response, promote safety and comfort, educate
Implementation:
Correct transcription of EMR order, compare to written MD order, clearly labeled, calculate and have checked, only adm. Meds you prepare, never leave meds unattended, vomiting notify MD, all orders must be rewritten post op, if med error occurs, STT/variance, report to charge nurse/MD
Charting rules:
Real time document, follow prompts, two hour window to give a med. ( hr before and hr after), if given late document why, document assessment (vs), declined or held, NEVER chart before anything is done
Process of giving meds:
Id patient, inform patient, adm med, implications (position pt correctly), document at bedside, evaluate response
Five rights of med administration:
Medicine, dose, time, route, patient
