Medication Flashcards
How do we prevent medication errors?
Physician order entry systems
Infusion pumps
Drug software
Barcode scan
IPE simulation
What are the 5 patient rights?
Right patient, drug, dose, time, and route
What if the patient has no ID bracelet?
Don’t administer the medication. Give them a new one.
What is culture of safety?
Reporting errors to identify issues, fix systems, and improve safety.
A ____ culture of safety in the workplace that rewards employees for ceasing work that may be unsafe and encourages employees to be aware of, identify, and address hazards as soon as possible to avoid potential risks
Positive
What are concerns about medication interactions?
Negative interactions. Rendering ineffective or dangerous situations.
Components of medication order
Name
Dose
Route
Frequency
Time
Reason
Provider signature
Types of medication orders
PRN orders
Routine orders
One time orders
Titration orders
Standing orders
Electronic orders
Verbal orders (emergency only)
Pravastatin is ordered to treat
Hyperlipidemia
Glipizide is ordered to treat
Diabetes
Olmesartan is ordered to treat
Hypertension
Nexium is ordered tot reat
GERD
What should be included in the medical assessment/hx of a patient receiving meds?
Med history
Allergies
Diet & Fluid orders
What should be included in the physical assessment of a patient receiving meds?
Ability to swallow
GI motility
Adequate muscle mass
Patient venous access (for IV meds)
Body system assessment
Assessment of knowledge and compliance
What is safe medication administration?
Administering to the 5 rights
Check/Interpret order
Calculate correct dosage, adult, or child
Tell the patient what you are giving
Assess the patient’s understanding and knowledge
Assess patient allergies and history
What is the 6th right of medication administration?
Documentation (includes time, route, dose, date, site, initials and signature).
Document therapeutic and side effects
How many times do you check the label?
3 times
If a medication is not given, do you have to indicate why?
Yes (i.e., patient refusal, but we have to educate them if they refuse). Document that education was done
What are special considerations with children and elderly patients?
Are they able to swallow the pill?
Do parent need to be involved?
May need alternative form of medications (liquid vs pill).
Dilute meds in small amounts of favorite beverage.
Crush pills
What are princples of documentation>
Never record a med before administering
Record only a med YOU give
Record on MAR as soon as possible
Record a refused medication as such
Record positive, negative, and allergic effects of meds
What are unit dose medications?
Prepackaged medications from pharmacy with prelabeled individual doses for the patient.
How are unit dose medications dispensed?
Dispensed via the Pyxis on the unit
Give examples of some high-risk meds
Insulin
Heparin
Narcotics
Potassium
What is a PCA?
Patient Controlled Analgesia
What is a basal rate?
A steady infusion of medication going through the IV. The patient is unable to manipulate this infusion of morphine.
What is a bolus rate?
The bolus or demand dose is the dose of medication delivered each time the patient presses the button
What is the Pain Team’s role?
Develop a treatment plan to relieve, reduce, or manage pain to improve quality of life
What pills can be crushed?
Most of them (pills or tablets)
What pills cannot be crushed?
Enteric-coated pills
Sustained/time release capsules
How do you pour liquid meds?
Pour liquids with meniscus cup
How do you pour multi-dose meds?
Pour multi-dose meds into med cap then into a cup, do not touch
How do you cut a pill?
Pill cutter
When can you break a pill in half?
When it is scored in half
What is reconstitution of medications?
Turning a solvent into another solvent type (i.e., powder to liquid)
When using needles and syringes, how much larger should the syringe be then the amount of medications you are giving?
At least 0.5 to 1 cc larger than the amount of medication
What kinds of needles are best to use? (not size related)
Safety needles (with safety cap that slides up)
What is a subcutaneous injection?
Injection of a medication into the subcutaneous later.
How fast is a subcutaneous injection administered
A slow sustained release of medication
What are some meds we give SQ?
Insulin, Heparin, Vaccines, some narcotics
Sites of SQ injections?
Back of the arm, abdomen, anterolateral mid-thigh, scapula, and buttocks
How much medication can we give SQ in one injection?
0.5 to 1 cc maximum
What length and gauge of needle for SQ injections?
A syringe needle 1/2 to 5/8 inch.
26 to 20 gauge, 25 common.
What angle do we use for SQ?
90 degrees for adults and children.
45 for adults and emaciated children.
What is missing with the insulin order:
5 U of regular insulin.
We have to spell out units. No route, no time indicated.
Correction: 5 units of regular insulin SQ every am with breakfast.
Is regular insulin short or long acting?
Short acting
Is NPH short or long acting?
Intermediate acting
What is the onset, peak, and duration or regular insulin?
Onset: 30 minutes to an hour
Peak: 2 to 3 hours
Duration: 3 to 6 hours, clear like water
What is the onset, peak, and duration or NPH insulin?
Onset: 2 to 3 hours
Peak: 4 to 10 hours
Duration: 10 to 16 hours, cloudy
What syringe do we use to draw up insulin?
Insulin syringe
Why do we use an insulin syringe do we use to draw up insulin?
Insulin syringe is calibrated in units
What is the unit/cc per insulin syringe?
1 cc or 100 units
1/2 cc or 50 units
Which insulin will you draw up 1st, 2nd?
(R before N) Regular before NPH
Short before Long
Clear before cloudy
If you overdraw insulin dose, what do you do?
Start over! Do not attempt to push R insulin into the NPH vial
How do we verify the am dose of insulin?
Verify with a second nurse. You independently check order, medication, insulin, and 5 rights
What route is insulin given?
SQ
What are the side effects of regular insulin? When would you see them? What interventions would you employ?
Hypoglycemia. You see hyperglycemia during the peak (2-3 hours after administration). Try to give a snack (glucose).
What are the side effects of NPH insulin? When would you see them? What interventions would you employ?
Hypoglycemia. You see hyperglycemia during the peak (4-10 hours after administration). Try to give a snack (glucose)
If a patient is difficult to arouse after insulin what do you administer?
Glucagon
What is aspart (novolog) and Lispro (humolog(?
RAPID Fast-acting insulin (15 minutes)
What is the onset, peak, and duration for RAPID fast-acting insulin?
Onset: 15 minutes
Peak: 1-2 hours
Duration: 3-4 hours
What is Glargine (Lantus)?
Long-acting insulin
What is the onset, peak, and duration for long-acting insulin?
Onset: 2-4 hours
Peal: none
Duration: 20 to 24 hours
How do you use a Novolog pen?
The pen has a cap to remove. Alcohol pen and twist needle on top of the pen. You prime the pen with air shot, 2 units/ Dial in the ordered dose. Check 5 rights, clean site, inject, press, hold for 10 seconds
What is Heparin?
An anticoagulant/anti-embolic inhibits the activity of several blood clotting factors.
What is unrefracted Heparin and how is it given?
It is more potent form Heparin, usually given IV continuously. But can be given intermittently via SQ injection
What is the usual dose for unrefracted Heparin
50,000 unit per liter or 25,00 units per 500 mLs IV
What syringe should we use for an SQ heparin dose of 5000 units per cc? 1cc or 3 cc? Why?
Use a 3 c syringe, because it needs to be 0.5-1cc larger than the amount of medication
What are the steps for administering a SQ Heparin injection?
Draw up the correct dose, recap the needle, remove it, replace it with a new needle, then draw up 0.1 to 0.2 ml of air, invert the syringe, tap air to the end of the fluid, and inject. Air will follow fluid into the SQ area.
What is low molecular weight Heparin?
It is an anticoagulant. Has more predictable pharmacokinetics and anticoagulation predictability.
What is a typical form of low molecular weight Heparin?
Lovenox
How does low molecular weight Heparin come prepared?
Different concentrations, pre-measured, has an air bubble in syringe (do not expel) no dose calibrations on syringe.
What is an intramuscular injection?
An injection deep into the muscle
What is the purpose of an IM injection?
Quicker action of onset because of blood vessels
What gauge and needle is used for IM injections for an adult?
20 - 23 gauge
1’ to 1 1/2”
What gauge and needle is used for IM injections for a child?
22 - 27 gauge
1/2 to 1” for infants/children
What degree do you administer an IM injection?
90 degrees
IM injection sites
Ventrogluteal (Hip)
Dorsogluteal (Butt)
Rectus Femoris (Mid-Thigh)
Vasus Lateralis (Outer thigh)
Deltoid (shoulder)
What is the preferred site for IM adult injections?
Ventrogluteal
What is the preferred site for IM children injections?
Vastus Lateralis
What do tou have to do before using site for inejcetion
Correct anatomical landmark.
Deltoid, Find the acromion process (bony area of the shoulder blade) Draw an upside-down triangle, and find the axilla. Needle shorter 5/8, no longer than 1 inch.
What’s the most volume you can give an adult IM injection?
3cc max
What’s the most volume you can give a child IM injection
0.5 to 1 ml for infants & 1 to 2 ml for children
What’s the volume exception for an adult IM injection?
Deltoid (1-2) ml non irritating meds
Where would you give the IM injection of a 9 month old?
Vastus lateralis muscle
What do we NOT do when we give infant IM injections?
Aspirate an IM injection
Massage area with SQ Heparin
What is an intradermal injection?
Med is given in the intradermal tissues between layers of skin. Just below the top layer of skin.
What meds do we give ID?
PPD and allergy
How much do we give ID?
0.1 PPD to 0.5ml allergy testing
What is PPD
Purified protein derivative
What are principles for injection?
Stretch the skin on the forearm, inject the needle BEVEL up, insert the needle just below the surface of the skin, sho you can see it under skin, and inject 0.1 cc slowly.
What in induration
Hard raised area, if present positive PPD, measure the area in mm
