Medication Administration Flashcards
Ionization
pH of the med and site of absorption
Dissolution
Med has to dissolve before absorption takes place
orally disintegrating tablets
readily dissolve when placed on tongue
Is ionized or non-ionized absorbed faster?
Non-ionized is absorbed faster - they can cross the cell membrane by diffusion because they aren’t charged.
Aspirin is non-ionized in the acidic stomach, but becomes ionized (weak base) in the alkaline small intestine for slower absorption
Do high lipid soluble or low lipid soluble meds absorb faster?
highly lipid soluble because lipids acts as carriers that can more easily pass phospholipid bilayers
Iatrogenic
unforeseen or unintended harm from a med or procedure
Steven-Johnson Syndrome
Severe adverse reaction to a medication
Developes 1-14 days post med
resp distress, fever, chills, diffuse rash, followed by blisters
Drug-food interactions
Effects of nutrients on the absorption, distribution, metabolism or excretion of medications.
STAT medications
Medications that are required to be given immediately - within 30 minutes of the order
for emergencies
PRN
As needed. medications given as required for specific conditions or issues, such as pain, nausea, etc.
Urgent, now, or ASAP medications
administered within 30 minutes to 1 hour after the health care provider’s order.
Single prescriptions
Single prescriptions are one-time doses, such as those seen with preoperative medications.
Time-critical meds
Medications that should be given within either 30 minutes before or after the scheduled administration time.
Non-time-critical meds
Medications that can be administered between 1 to 2 hours before or after the scheduled time without causing harm or resulting in substandard pharmacologic effects to the client.
3 types of time-critical meds
- Medications scheduled to be administered routinely less than 4 hours apart
- Medications that are required to be given separately from other medications
- Medications that are administered around mealtimes, such as antidiabetic medication
Which “rights” should the nurse verify 3x before giving a med?
right patient, right medication, right dose, right route of administration, and right time.
When is medication reconciliation performed?
Medication reconciliation is performed upon admission; whenever the client transitions from one level of care to another, both within the facility (e.g., from the intensive care unit [ICU] to the general medical–surgical unit) or from one health care facility to another (e.g., a client transferred from the hospital to a rehabilitation facility); and when the client is discharged home from a facility.
What is involved in med reconciliation?
reviewing the client’s current medications, comparing them to the newly prescribed medications, and addressing omissions, duplications, interactions, and discrepancies.
The nurse considers any potential drug–drug interactions. All types of medications, including over-the-counter (OTC) medications and herbal supplements, should be included in the reconciliation process, as there may be a potential risk for interactions with newly prescribed medications.
Three factors reported by nurses as contributing to medication errors:
identification, interruption, and correction.
When should you assess the patient after med admin. for adverse effects and therapeutic effects?
30 min after
Unit dose medication
Prepared by the pharmacist for the client - just one dose in vial
3 categories of med administration
- Parenteral
- Enteral
- Topical
How often should an EFT be flushed?
Flush the tubing with 30 to 60 mL of water prior to and after administration of medications and to flush with 15 to 30 mL in between medications.
What problems can mixing a med into an enteral feeding formula cause?
Delayed medication absorption, drug–formula interactions, or precipitation of the medication.
What are Luer connectors?
connects syringes to tubing independent of the type of tubing (IV or enteral).
Beware! These increase risk of accidentally administering enteral meds or formula into an IV, or IV fluids/meds into the EFT.
What type of med admin is an inhaler?
topical through the resp tract
Describe procedure for administering ophthalmic meds.
- Strict aseptic technique to avoid contamination or infection.
- Ophthalmic solutions are instilled into the lower margin of the eyelid (conjunctival sac).
- After the nurse instills the eye drop(s) and the client closes the eye, the nurse places an index finger at the inner corner of the client’s eye (punctal occlusion prevents med from entering nasolacrimal duct), maintaining gentle pressure there for 30 to 60 seconds.
- Do not instill medication directly on the cornea, as this can cause the client pain, irritate the cornea, and increase the medication’s systemic effect
* Eye drop medications, such as beta-blockers and alpha agonists, can al
What types of meds can be administered intranasally?
nicotine (smoking cessation), calcitonin (osteoporosis), sumatriptan (migraines), and corticosteroids (allergies)
Risk of decongestant nasal spray
Permanent rebound swelling of blood vessels (decongestant constricts blood vessels in the nose during duration of action)
How long should a patient refrain from pooping after receiving rectal suppository?
20 minutes
Contraindications for rectal administration
Suppositories should not be administered to clients who have had:
* recent rectal surgery
* rectal bleeding
* at risk for bleeding (low platelet count).
If a patient cannot inhale slowly and deeply enough for an inhaled medication, what should be done?
Use a spacer to increase med absorption
Differences between insulin and tuberculin syringes
- Different units (insulin = units, tuberculin = up to 1 mL)
- needle is shorter on TB syringe (intradermal)
Needle length for subcutaneous injections
3/8 - 5/8 inches
Needle length for intramuscular injection
1 1/2 inches
Needle gauge for subcutaneous and intradermal injections
25-27
Needle guage for intramuscular injections
18 (?) - 25
Intramuscular injection angle
90 degrees
Subcutaneous injection angle
45-90 degree
intradermal injection angle
5-10 degree (almost flush with skin)
What is an ampule? How do you open it?
Glass containers that store liquid med
Grasp neck of ampule with gauze
Snap the neck toward you, so glass goes away from you
Discard head of ampule in sharps container
Use filtering needle to draw up med.
How do you clean an injection site before administration?
Rub in circles, starting in the middle and moving outward with an antiseptic pad
Max amount of med that can be injected intradermally
0.1 mL
Considerations for giving an intradermal injection
- When selecting a site for injection, it is important to avoid areas of the skin that are inflamed, have scars or lesion, or are covered by hair.
- Never rub site of injection afterward, as doing so might result in false-positive response.
- Circle area where injection occurred for accurate reading of results.
- If the purpose of the intradermal injection is for diagnosing allergies, closely monitor for a designated period of time for an allergic reaction.
Absorption rate of subcutaneous
Although adipose tissue has a generous supply of capillaries, it lacks larger blood vessels.
Absorption is slower and more controlled than intramuscular or intravenous
Common meds given subcutaneously
Insulin and heparin
What is lipohypertrophy?
formation of small lumps beneath the skin due to irritated fatty tissue.
Occurs in clients who are receiving long-term subcutaneous injections and common in clients who inject insulin.
Why is intramuscular better for viscous or irritating meds?
Fewer pain receptors in large muscles
Max dose for subcutaneous
1.5 mL
How should you determine what angle to use for a subcutaneous injection?
More fat = 90 degree
very thin = 45 degree (to minimize the risk of injection into the muscle underneath)
Max dose for ventrogluteal injection
3 mL
Max dose for deltoid injection
2 mL
Max dose for vastus lateralis injection
1-3 mL
Factors to consider in giving an IV med
- Is it a drip (med is diluted in saline solution) or an IV push (pushed into catheter)?
- Does the med need to be diluted and with what/how much?
- How long should the med be pushed for?
Intermittent piggyback intravenous infusion
- Administration of med via an IV infusion set.
- Med mixed with IV fluid (often 0.9% sodium chloride or dextrose –5% in water) volume (50 to 250 mL) and is administered over a specified period of time (30 to 90 minutes).
- Allows for slow infusion of med that otherwise could be harmful to the client if delivered rapidly or undiluted.
intermittent venous access device
A peripheral IV catheter inserted via a venipuncture. It is placed for administration of intermittent medication administration to prevent a venipuncture being performed each time an intermittent medication is given.
Central venous access devices (CVADs)
- Catheters inserted into a large centrally located vein for the purpose of administering blood products, medications, fluids, and other therapies.
- Medications given through CVADs are delivered directly into the client’s central blood circulation.
- Includes PICC and CVC
How are PICCs inserted and what is their indication?
- Inserted using a percutaneous venipuncture into a peripheral vein in an upper extremity and guided through the vein until the tip of the catheter lies in the superior vena cava at the entrance to the right atrium.
- PICCs are used for clients who require shorter-term (i.e., weeks as opposed to months or years) IV therapy.
How is a central venous catheter (CVC) inserted?
- CVC is inserted and tunneled through the skin (often in the upper chest area) directly into a large vein; it is threaded through the vein until the tip of the catheter lumen lies in the superior vena cava at the entrance to the right atrium.
- A transparent sterile dressing is placed over the insertion site to maintain sterility over the site and avoid accidental removal of the catheter.
What is infiltration?
Intravenous fluid is administered to surrounding tissue as evidenced by pain, swelling, redness, cool skin temperature around insertion site, skin taunt around IV site, oozing of IV fluid at insertion site and repeated alarming of IV pump.
What is phlebitis
Inflammation of the vein
How does the nurse prevent infiltration?
- check for venous blood return from venous access device, before administering a med through the device. If blood return is seen in the catheter, syringe, or tubing, that confirms the catheter is in a vein and nurse can gently flush the blood back through the catheter. The medication can then be administered.
- If no blood return is seen in a peripheral IV, the catheter may still be patent. The nurse can attempt to gently flush the catheter; if resistance is met (catheter occlusion), the medication should not be administered. The nurse would then follow the facility’s procedure on clearing an occluded peripheral IV catheter.
- If no blood return is seen when accessing a CVC, nurse should not infuse any fluid or medication and notify the provider. Nurse can anticipate the provider will order an x-ray to determine the location of the catheter.
How should dosages be rounded?
For dosages less than 1, rounding is completed to the hundredths place. For dosages greater than 1, rounding is completed to the tenths place.
If the number to the right of the tenths or hundredths place (depending on the first factor) is greater than or equal to 5, the number on the** left** is rounded up. For example, if the number was 0.746, it would be rounded to 0.75. Likewise, if the number to the right of the tenths or hundredths place (depending on the whole number) is less than 5, the number to the right is dropped, leaving the number to the left as is. For example, if the number was 0.743, it would be rounded down to 0.74.
What types of insulin can be delivered by IV?
- regular
- insulin aspart
- insulin lispro
- insulin glulisine
How is insulin produced?
recombinant dna technology
When should rapid-acting insulin be administered?
How long does it last?
How can it be administered?
Types?
- Administer before a meal to prevent hyperglycemia
- onset within 10-15 min and duration of 6 hours
- Subcutaneous or intravenous
- insulin aspart, insuline lispro, and insulin glulisine
What is short-acting insulin and how can it be administered?
- regular insulin
- onset in 30 min and duration 12 hr
- subcutaneous or IV
What is intermediate-acting insulin and how can it be administered?
- onset in 1-2 hours
- cloudy appearance
- subcutaneous only
- NPH insulin (includes protein to delay onset and duration and must be agitated)
Long-acting insulin
Duration of 18-24 hrs
glargine (ultralong acting), detimir, and degludec (ultralong acting)
Should be administered at same time everyday
What is pre-mixed insulin
Includes an intermediate and either short or rapid acting insulin
For people who can’t mix themselves
What is the most common insulin unit?
U-100
100 units in 1 ml of solution
