Jen ch 31 Flashcards
Guidelines for Safe Narcotic Administration and Control
- Store all narcotics in a locked, secure cabinet or container. (Computerized, locked cabinets are preferred.)
- Frequently count narcotics with the opening of narcotic drawers and/or at shift change.
- Report discrepancies in narcotic counts immediately.
- Use a special inventory record each time a narcotic is dispensed. Records are often kept electronically and provide an accurate ongoing count of narcotics used, wasted, and remaining.
- Use the record to document the patient’s name, date, time of medication administration, name of medication, dose, and signature of nurse dispensing the medication.
- A second nurse witnesses disposal of the unused portion if a nurse gives only part of a dose of a controlled substance. If paper records are kept, both nurses sign their names on the form. Computerized systems record the nurses’ names electronically. Follow agency policy for appropriate waste of narcotics. Do not place wasted portions of medications in sharps containers.
pharmacokinetics
the study of how medications enter the body, reach their site of action, metabolize, and exit the body
absorption
is the passage of medication molecules into the blood from the site of medication administration. Factors that influence absorption are the route of administration, ability of the medication to dissolve, blood flow to the site of administration, body surface area (BSA), and lipid solubility of medication
distribution
(after absorption) within the body to tissues and organs and eventually to site of action. rate and extent of distribution depend on the physical and chemical properties of the medication and the physiology of the person taking it
biotransformation
ccurs under the influence of enzymes that detoxify, break down, and remove biologically active chemicals. Most biotransformation occurs within the liver, although the lungs, kidneys, blood, and intestines also metabolize medications
What is so cool about the liver?!?
because its specialized structure oxidizes and transforms many toxic substances. The liver degrades many harmful chemicals before they become distributed to the tissues. If a decrease in liver function occurs such as with aging or liver disease, a medication is usually eliminated more slowly, resulting in its accumulation
therapeutic effect
the expected or predicted physiological response that a medication causes
Side effects
predictable and often unavoidable secondary effects produced at a usual therapeutic dose. They are either harmless or cause injury
adverse effects
unintended, undesirable, and often unpredictable severe responses to medication. Some adverse effects are immediate, whereas others take weeks or months to develop
toxic effects
develop after prolonged intake of a medication or when a medication accumulates in the blood because of impaired metabolism or excretion. Excess amounts of a medication within the body sometimes have lethal effects, depending on its action
idiosyncratic reaction
a patient overreacts or underreacts to a medication or has a reaction different from normal
mild allergic rxns
Urticaria
Raised, irregularly shaped skin eruptions with varying sizes and shapes; eruptions have reddened margins and pale centers
Rash
Small, raised vesicles that are usually reddened; often distributed over entire body
Pruritus
Itching of skin; accompanies most rashes
Rhinitis
Inflammation of mucous membranes lining nose; causes swelling and clear, watery discharge
synergistic effect
When two medications have a synergistic effect, their combined effect is greater than the effect of the medications when given separately
biological half-life
the time it takes for excretion processes to lower the amount of unchanged medication by half. A medication with a short half-life needs to be given more frequently than a medication with a longer half-life
Time-critical medications
medications in which early or delayed administration of maintenance doses (more than 30 minutes before or after the scheduled dose) will most likely cause harm or result in subtherapeutic responses in a patient.
Dosage Abbreviations AC,ac : Ad lib: "nightly" or "at bedtime": PC, pc; prn: qAM: Daily: STAT, stat:
DOSAGE SCHEDULE and ABBREVIATION
Before meals AC, ac
As desired ad lib
At bedtime “nightly” or “at bedtime”
After meals PC, pc
Whenever there is a need prn
Every morning, every AM qAM
Every day Daily
Give immediately STAT, stat
Onset, Peak, Trough, Duration, Plateau
Onset - Time it takes after a medication is administered for it to produce a response
Peak - Time it takes for a medication to reach its highest effective concentration
Trough - Minimum blood serum concentration of medication reached just before the next scheduled dose
Duration - Time during which the medication is present in concentration great enough to produce a response
Plateau - Blood serum concentration of a medication reached and maintained after repeated fixed doses
Parenteral
administration involves injecting a medication into body tissues
the four major sites of injection:
1 Intradermal (ID): Injection into the dermis just under the epidermis 2 Subcutaneous: Injection into tissues just below the dermis of the skin 3 Intramuscular (IM): Injection into a muscle 4 Intravenous (IV): Injection into a vein
additional injection routes
epidural (epidural space via cathetar), intrathecal (catheter placed in the subarachnoid space or one of the ventricles of the brain), intraosseous (bone), intraperitoneal (serous membrane lining the cavity of the abdomen and covering the abdominal organs), intrapleural (lung pleural space), and intraarterial (directly ingto artery)
instillation
fluid retained
Equivalents of measurement
METRIC HOUSEHOLD
1mL 15 drops (gtt)
5mL 1 teaspoon (tsp)
15mL 1 tablespoon (tbsp)
30mL 1 fluid ounce/2 tablespoons (tbsp)
240mL 8 fluid ounces/1 cup (c)
480mL (approximately 500mL) 1 pint (pt)
960mL (approximately 1L) 1 quart (qt)
3840mL (approximately 4L 1 gallon (gal)
irrigation
Process of washing out a body cavity or wounded area with a stream of fluid.
solution
Mixture of one or more substances dissolved in another substance. The molecules of each of the substances disperse homogeneously and do not change chemically. A solution may be a liquid, gas, or solid.
A concentration of a solution can also be expressed as a percentage. For example, a 10% solution is 10 g of solid dissolved in 100 mL of solution
acidic medications
pass through gastric mucosa quickly
basic medications
not absorbed until they reach the small intestine - small intestine also has more body surface
medication reconciliation
Regimented, documented review to avoid drug errors during patient transfers within hospitals
Verify - current list of patient meds
Clarify - dosages and frequency
reconcile - compare new meds with current list (safe?)
transmit - communicate and verify with patient as needed
hypokalemia
low potassium - cause muscle weakness/fatigue
polypharmacy
taking more than one med
