Medication Administration Flashcards
1
Q
MAR
A
medication administration records
2
Q
ADS
A
automatic dispensing system
3
Q
where is medication by central pharm located
A
in patient drawer
4
Q
where is medications metabolized
A
liver
5
Q
where is medication excreted by
A
kidney
6
Q
what should we do with a patient with liver or kidney failure
A
make sure the medication is being metabolized and excreted
7
Q
do we leave meds at bedside
A
no
8
Q
adverse effect is the
A
side effect
9
Q
how do we measure the adverse effect
A
is the side effect so severe does it outweigh benefits
10
Q
if the side effects out weigh the benefits what do we do
A
switch meds
11
Q
opioids for pain, the pain med is working but pt is constipated, so we give a laxitive
does the benefit outweigh the effects
A
yes
12
Q
anti seizure meds are given that cause Steven Johnsons where all the skin falls off
does the benefit outweigh the effects
A
no
13
Q
what is an example of mild allergic reaction
A
itching
14
Q
what is an example if anaphylactic reaction
A
stop breathing
15
Q
what is tolerance
A
pt takes med over extended period of time so the patient will eventually need more drugs to reach therapeutic level
16
Q
toxic
A
failure on the nurse
don’t know what they are doing
EX: push meds over 4 mins and they push over 40 seconds
17
Q
idiosyncratic
A
opposite effect of anticipated affecr
18
Q
therapeutic range
A
concentration of drug in the blood serum that produces the desired effect without causing toxicity
19
Q
how do we know if we are in the therapeutic range
A
draw blood levels
20
Q
how do we reach the therapeutic range
A
give enough medications to get there and then give enough meds to stay there
21
Q
peak level
A
the point when the drug is at its highest
22
Q
when do we draw for peaks
A
30-60 mins after infused
23
Q
trough level
A
the point when the drug is at its lowest concentration, indicating the rate of elimination
24
Q
when do we draw for trough
A
right before next dose
30-60 mins
25
what level indicates the rate of elimination
trough
26
half life
amount of time it takes for 50% of blood concentration of a drug to be eliminated from the body
27
what is a drug that has a fast half life
heparin
28
medication reconciliation
meds taken at home vs at the hospital
29
what is an example of accidental miss of a medication that is taken at home and not in the hospital
pt has blood systolic of 160-180, take BP med at home but not in hospital
30
what is an example of a purposeful miss of a medication that is taken at home and not in the hospital
patient came in with extremely low blood sugar and we chose to hold insulin
31
PTA medications
prior to admision
32
pregnancy and lactation
meds can transfer to baby
33
why is it important to ask about allergies
sometimes allergies are not imputed into epic
34
why is it important to ask "what do you take at home including over the counter"
dietary supplements and herbal and natural remedies
homeopathic can interfere with pharmaceutical meds
35
if someones puts in Q day on epic what time does it put it
9am
36
with the older adult do they have decreased or increased gastric motility
decreased
37
what does it tell you that older adults have decreased gastric motility
medications stay in gastric region longer and if we are giving many medications that could lead to nausea and vomiting which could lead to aspiration
38
do older adults have decreased or increased total body water
decreased
39
do older adults have decreased or increased lipid content in skin
decreased
40
what does it tell you that older adults have decreased titan body water and lipid content in skin
this affects absorption,
lipid soluble vs water soluble
exaggerated reaction/experience
41
do older adults have decreased or increased liver function
decreased
42
do older adults have decreased or increased kidney function
decreased
43
what does this tell you that older adults have decreased kidney and liver function
this will affect metabolism and/or excretion
meds will be in body longer
44
do older adults have increased or decreased CNS efficiency
decreased
45
what does it tell you that older adults have decreased CNS efficiency
this affects pain medication
46
older adults have altered peripheral vascular tone which means they are extremely reactive to
antihypertensive meds
47
what does this mean the older adult pt is at risk for if they take antihypertensive meds
could experience orthostatic hypotension
could lead to falls
we need to educate patient
48
what is the proper order for medications
right patient (name & DOB), drug, dose, time, route
49
if any of the proper order in medication administration is missing what do we do
call physican
50
why is it important to know what medications do
could change vital signs
51
why is it important to check vital signs on patient when we know they are going to receive a vital sign changing medictions
see if they are within an abnormal value, if they are in a normal value we do not want to give medication cause we could drop them down to abnormal medication
52
what is one equipment decision we can make
syringe size
53
what is the protocol for receiving a verbal order
write it down and mandatory read back
54
standing orders
written
in chart
stand until discontinued
55
PRN orders
as needed
56
what is normally a PRN medication
pain meds
57
stat order
immediately
58
one time order
one dose only
59
5 rights of medication administration
medication, patient, route, time, dose
60
how many rights has it expanded to
11
61
what are the three checks
first one
removing medication from Med Cart
62
what are the three checks
second one
comparing medication to MAR
63
what are the three checks
third one
rechecking to EMR/MAR/ at beside prior to admission
64
do students have 3 or more checks
4.
the clinical instructor will check all meds
65
when do we ask questions regarding medications
before handing meds to clinical instructor
66
BID
x2
67
TID
x3
68
QID
x4
69
ac
before means
70
pc
after meals
71
HS
hour of sleep
72
what are the 2 identifiers
name
DOB
or Medical record number
73
what if the patient cannot talk how do we collect the two identifiers
need 2 nurses, one reading the wrist band and the other checking the chart
74
we compare the two identifiers with
the EMR
75
EMR
electronic medical records
76
if we have a medication that is administrated more frequently than Q6 (Q1, Q2, Q3, Q4, Q5) we have how long to give medication prior and after scheduled time
30 mins
77
what is a rapid short acting insulin name
Aspart/Novolog
78
if we have a medication that is Q2 and it is due at 0700. What time prior and after do we have to administer it
30 mins
0630-0730
79
if we have a medication that is given Q6 or less frequently (Q7,Q8,Q9,Q10) we have how long before and after the scheduled time do we have to administer
60 mins
80
if we have a medication that is due Q12 at 0400. what time before and after do we have to administer
60 mins
0300-0500
81
if we have a medication that is due daily, weekly, monthly how long before or after do we have to administer
2 hours
82
if we have a medication that is due at 0900 weekly, what time before and after do we have to administer
2 hours
0700-1100
83
if you are unable to give medication on time the next dose is given using the
half time rule
84
what does the half time rule mean
if the late dose can be given up to half way to the next scheduled dose and you can give it and then the next dose as scheduled
if the patient or med are available later than halfway between doses, give the missed dose, skip the next dose and resume scheduled
85
what are the 2 exceptions to half time rule
ahminoglycosides and chemotherapy
86
if you have a patient that has a medication due at 0600 and 1200 and the patient is off the floor what time do they have to take the medication by to not miss the next dose
0900
87
if you have a patient that has a medication due at 0600 and 1200 and the patient is off the floor and they come back at 1030 what do you do
give the medication but skip the next 1200 dose and then continue the scheduled medication after the purposely skipped dose
88
what type of medication is oral
enteral
89
enteral means
gi tract
90
are injections entral
no they are parental
91
PO
by mouth
92
why might we give a sublingual medication
under the tongue is a rich capillary bed and it disolves
93
if we give a pt a sublingual medication what do we want to not do
let them swallow the medication
or give water
94
are liquid medications entral
yes
95
scored
tablets are able to cut
96
SR
sustained release
97
XL
extended release
98
CR
controlled release
99
enteric coated
special coating to reduce irritation and absorption to gastric lining so its released in small intestine
cannot crush
100
do we crush SR, XL, CR, Enteric coated
NO NEVER
101
why do we not crush SR, XL, CR
because they have a special coating and we could kill someone if we crush them
102
why do we not crush enteric coated
cause gastric irriation
103
what if we have orders for a SR, XL, CR, or extended release pill for a patient who cannot swallow whole pills
call pharmacy
104
brown syringes are only meant for
oral
105
do we need instructor to give topical medications
yes
106
what are some examples of topical medications
lotions, creams, ointments, medicated powders, transdermal patches, eye drops, nose drops/mists, ear drops, suppositories
107
what and when do we write on the transdermal patches
date time and initials and we write this before applying
108
we want to put patches were
hair free area
109
why do we wear gloves when giving a transdermal patches
so our skin doesn't absorb the medication
110
when giving eye drops where do we tell the patient to look
up
111
where do we aim the eye drop
in the conjuctival sac
112
do we wear gloves when giving eye drops
yes
113
after we give eye drops where do we put the tissue and for how long and why
in the inner corner of the eye for 30 seconds so the medication does not drain down the duct
114
what is important to have when giving an inhaler
spacer
115
one and only campaign
one needle
one syringe
only one time
116
direct syringe reuse
using the same syringe for more than one patient
117
is contamination limited to the needle
no
118
if you can't see blood in the syringe it can't contain a blood borne pathogen
no
119
indirect syringe reuse
accessing a parental medications with a use syringe followed by reuse of the vital container for additional patients
120
needles and syringes are
single use devices
121
do we or do not administer medications from a single dose vial or bag to multiple patients
no
122
saline bags can be used for more than one pateint
no
123
ex of intradermal test
tb
124
subq administration of what drugs
insulin
heparin
125
IM administration sites
deltoid
ventral gluteal
vastus lateralis site
126
what is the right equipment
length
gauge
needless system
safety guard
sharps container
127
what is the only part of the syringe and needle that is not sterile
barrel
128
intramuscular degree of insertion
90 degrees
129
subcutaneous degree of insertion
90- 45 degrees
130
intradermal degree of insertion
5- 15 degrees
131
intradermal inch
1/4-1/2 inch
132
intradermal gauge
25, 27
133
how much medication can we administer to the intradermal route
less than 0.5mL
134
do we aspirate the site of intradermal
no
135
do we massage the site of intradermal
no
136
subcutaneous has what type of syringes
drug specific
137
subq needle inch
3/8-5/8
138
subq needle gauge
25-30
139
subq max volume
1mL
140
subq aspiration
no
141
subq massage
no
142
what do we want to remember when giving a subq
rotate sites
143
why do we want to rotate sites when giving subq
if we don't we create knotty type of skin that is not suitable to use because that type of area has decrease absorption
144
subq injection site
backs of arm
abdomen 2cm around belly button
fronts of thighs
above butt
scapular region
145
why do we want to go 2cm around belly button
because the rectus abdomens muscle is there
146
if someone is skinny and we want to give a subq what do we do
pinch skin
147
do we leave the skin pinched or release once the needle is in
release
148
why do we pinch skin
to get subq off of the muscle
149
IM inch
5/8-1.5
150
IM gauge
20-25
151
how much volume can we give IM (in large muscles)
3mL
152
what do we do after we give IM
gentle pressure
153
what is the Z track method
pull skin to side after we remove needle to avoid med uptake
154
do we recap dirty needles
no
155
do we aspirate or massage after IM
no
156
aspiration evidence
no reported evidence that aspiration with or without blood return confirms needle placement
157
where might aspiration may be indicated for IM injection
injections of large molecule medications such as penicillin
158
IM sites
vastus lateralis
deltoid
ventral glueteal
159
the deltoid muscle is small so how much do we administer
1 mL
160
why do we not use dorsal gluteal
sciatic nerve and sciatic artery
161
reconstituting medication
comes in a powder and we add liquid
162
what is a never thing we do with dirty needles
recap, bend, break a used needle straight to the sharps containter
163
controlled substances are
locked
164
narcotics must be
counted
165
make sure to report any _______ doses of narcotics
partial
166
when do we need a witness
for destroying a narcotic
167
cactus smart sink is to prevent
diversion
168
what do we need to document when drugs are given
sites and parameters
169
what do we need to document when doses are missed
explanation of why
170
what do we need to document
patient refused
171
where do we not put the incident report for medication errors
in medical record
172
if we do give a med error what do we do
check patient condition immediately
observe for adverse effects
notify nurse manager/physican
complete form
173
we want to make sure when doing a SHARE that
not indicate that this form was completed in the patient chart
174
what is one thing we always do before giving meds
ID patient and check allergies
175
do we chart the SHARE report
NO
176
is rectal entral or parentral
entral
