Medication Administration Flashcards

1
Q

to administer medications safely; what must nurses have an UNDERSTANDING OF? (7)

A
  • HEALTH CARE
  • PHARMACOLOGY
  • PHARMACOKINETICS
  • LIFE SCIENCES
  • PATHOPHYSIOLOGY
  • HUMAN ANATOMY
  • MATHEMATICS
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2
Q

defintion of PURE FOOD & DRUG ACT

A
  • requires MEDS to be FREE of impure products
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3
Q

describe the FDA; FOOD & DRUG ADMINISTRATION

A

enforces MEDICATION LAWS that ensure that medications on the market go through VIGOROUS TESTING before being sold to the public

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4
Q

describe the MEDWATCH PROGRAM

A
  • type of VOLUNTARY PROGRAM
  • encouragement of REPORTING when meds, products or medical events cause SERIOUS HARM to a patient
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5
Q

what are other MEDICATION LEGISLATIONS to consider?

A
  • STATE & LOCAL REGULATION of medications;
    ex. CA Department of Health
  • HEALTH CARE INSTITUTIONS & MEDICATION LAWS
    ex. Kaiser, Scripps, Palomar
  • MEDICATION REGULATIONS & NURSING PRACTICE
    ex. SON
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6
Q

what are the types/classifications of MEDICATION NAMES?

A
  • CHEMICAL
  • GENERIC/OFFICIAL NAME
  • TRADE/BRAND/PROPRIETARY (TM)
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7
Q

definition of NPAS

A
  • known as the STATE NURSE PRACTICE ACTS
  • defines the SCOPE OF NURSE’S professional functions & responsibilities
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8
Q

definition of CHEMICAL MEDICATION NAME

A
  • this is RARELY USED in medication admin
  • gives the EXACT DESCRIPTION of medication COMP + MOLECULAR STRUC
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9
Q

definition of GENERIC MEDICATION NAME

A
  • known as the OFFICIAL NAME
  • from the MANUFACTURER when first developed
  • listed in U.S. PHARMACOPEIA
  • ex. acetaminophen
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10
Q

definition of TRADE/BRAND/PROPRIETARY NAME

A
  • name of the MARKET DRUG the manufacturer is selling
  • EASY TO SPELL & REMEMBER
  • ex. tylenol
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11
Q

how are MEDICATIONS CLASSIFIED?

A
  • on its EFFECT on the BODY SYSTEM
  • the type of SYMPTOMS the medication relieves
  • the medication’s DESIRED EFFECT
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12
Q

what does PO stand for?

A

by mouth

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13
Q

what are the types of ORAL (PO) MEDICATION FORMS?

A
  • SOLID; tablets, capsules, pills
  • LIQUID; syrup, suspension, elixir
  • OTHERS; lozenge / aerosol
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14
Q

definition of PHARMACOKINETICS

A

the study of how medications enter the body, reach the site of action, metabolize, and exit the body

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15
Q

definition of ABSORPTION

A
  • when medication molecules pass from blood to the SITE of needed administration
  • has factors considered from its specific ROUTE, END SITE, BSA, and LIQUID SOLUBILITY
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16
Q

what are some FACTORS that can influence ABSORPTION?

A
  • ROUTE OF ADMINISTRATION
  • the ABILITY of a MEDICATION to DISSOLVE
  • BLOOD FLOW TO SITE (greater the vascularity = the faster the flow!)
  • BSA
  • LIQUID SOLUBILITY
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17
Q

what are the FASTEST to SLOWEST ROUTES OF ADMIN?

A
  • INTRAVENOUS (IV)
  • INTRAMUSCULAR/SUBQ (IM/SQ)
  • SKIN & PO
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18
Q

what can medications bind to that can DECREASE its effect?

A

albumin

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19
Q

definition of DISTRIBUTION

A
  • follows after ABSORPTION
  • DISTRIBUTION towards other TISSUES, ORGANS, & SPECIFIC SITE
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20
Q

what FACTORS INFLUENCE DISTRIBUTION?

A
  • CIRCULATION; CHF patients
  • MEMBRANE PERMEABILITY; specific BBB - only passes FAT-SOLUBLE MEDS
  • PROTEIN BINDING (albumin)
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21
Q

definition of METABOLISM

A
  • process of BIOTRANSFORMATION; use and influence of enzymes that begin to DETOXIFY, BREAK DOWN, & REMOVE ACTIVE CHEMICALS
  • begins to METABOLIZE medication to more of an INACTIVE FORM/LESS POTENT
  • preparation for EXCRETION
  • typically occurs in the LIVER
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22
Q

definition of EXCRETION

A
  • the EXITING OF MEDICATIONS
  • typically occurs in the KIDNEYS
    (can be excreted through liver, bowels, lungs, exocrine glands) **depends of medication really
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23
Q

what happens if a patient has LIVER OR KIDNEY ISSUES?

A
  • have a greater risk of developing GREATER TOXICITY due to medications
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24
Q

therapeutic effect

A

the EXPECTED OR PREDICTED physiological response

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25
adverse effect
the UNINTENDED, UNDESIRABLE, OR UNPREDICTABLE response
26
side effect
a PREDICTABLE, UNAVOIDABLE secondary effect
27
toxic effect
the ACCUMULATION OF MEDICATION within the bloodstream - often due to result of IMPAIRED METABOLISM & EXCRETION
28
idiosyncratic reaction
an UNPREDICTABLE OVERREACTION, UNDERREACTION, or really just a DIFFERENT REACTION THAN NORMAL
29
urticaria
- also known as HIVES - irregularly shaped eruptions; red margins / pale centers
30
pruritus
the ITCHING of the SKIN; comes with rashes
31
rhinitis
the INFLAMMATION of the MM lining - swelling + watery discharge
32
allergic reaction
- this is DIFFERENT FROM SIDE EFFECTS - type of UNPREDICTABLE REACTION
33
medication interactions
where ONE MEDICATION MODIFIES the ACTION OF ANOTHER - type of SYNERGISTIC EFFECT -- combined effect is greater than singular
34
medication tolerance
- where MORE MEDICATION is required to achieve the same THERAPEUTIC EFFECT - more increased dosages of the med
35
medication dependence
- known as ADDICTION - can be either PHYSICAL (showcase of withdrawal symptoms) or PSYCHOLOGICAL
36
what is the TIMING OF MEDICATION DOSE RESPONSES?
THERAPEUTIC RANGE: consists of the lowest MEC to highest TOXICITY
37
definition of MEC
MINIMUM EFFECTIVE CONCENTRATION (MEC): - the PLASMA LEVEL of a medication below which the effect of the MEDICATON DOES NOT OCCUR
38
definition of TOXIC CONCENTRATION
- TOXIC CONCENTRATION: level at which TOXIC EFFECTS OCCUR
39
definition of PEAK & TROUGH
PEAK - highest level in our therapeutic range TROUGH - lowest level in/entering MEC
40
definition of BIOLOGICAL HALF-LIFE
time it takes for excretion processes to LOWER the serum medication concentration by 1/2
41
when do we ADMINISTER TIME-CRUCIAL MEDICATIONS?
- “You need to administer *time-critical medications* at a precise time, within 30 minutes before or after their scheduled time.” - “You administer *non–time-critical medications* within 1 to 2 hours of their scheduled time.”
42
what are the ORAL ROUTES OF MED ADMIN?
- SUBLINGUAL - BUCCAL
43
what SYSTEM of MEDICATION MEASUREMENT do we use?
- METRIC SYSTEM - use for METER (LENGTH), LITER (VOLUME) & GRAM (WEIGHT)
44
rules to follow when calculating med admin
- ALWAYS USE LEADING ZERO (ex. 0.5) - NEVER USE TRAILING ZERO (5.0 XX)
45
how do we express SOLUTIONS in medication measurement?
- expressed THREE WAYS; g/L or mg/mL percentages proportions
46
what are the types of methods you can use for CLINICAL CALCULATIONS
- the RATIO & PROPORTION METHOD - FORMULA METHOD - DIMENSIONAL ANALYSIS
47
what medications or doses should have HIGHER CAUTION?
- HIGH RISK MEDS; insulin, heparin, narcotics - PEDIATRIC DOSEs
48
who can PRESCRIBE MEDICATIONS?
- physicians - nurse practitioners - physician's assistants
49
how can ORDERS be given?
- WRITTEN (hand or electronic) - VERBAL - TELEPHONE
50
can abbreviations cause errors?
YES; use CAUTION, there are PROHIBITED ONES
51
definition of STANDING or ROUTINE MED ORDERS
have their own SET DOSE, FREQUENCY & DURATION
52
prn orders
as needed
53
STAT orders
given med IMMEDIATELY
54
NOW orders
- needed quickly - around 90 MIN from receiving order
55
what is the PHARMACIST's ROLE in med admin?
preparation & distribution of meds
56
what is the NURSE's ROLE in med admin?
- determining and checking MEDS are CORRECT - monitoring effects - determining timing - correct administration - assessment of self-admin - provides patient teaching
57
what are the type of DISTRIBUTION SYSTEMS we have?
- UNIT DOSE SYSTEMS - AUTOMATIC MEDICATION DISPENSING SYSTEM (AMDS)
58
definition of MEDICATION ERROR
- preventable event that can cause INAPPROPRIATE MEDICATION USE & possible harm to patient safety - failing to administer medication
59
what do you do if a MEDICATION ERROR OCCURS?
- ASSESS PATIENT CONDITION FIRST !! PATIENT SAFETY ALWAYS FIRST - NOTIFY HCP - stable patient; report incident - prep for file/incident report - reporting also any near misses/incidents
60
what are the RIGHTS OF MED ADMIN?
- RIGHT MEDICATION - RIGHT DOSE - RIGHT PATIENT - RIGHT ROUTE - RIGHT TIME - RIGHT DOCUMENTATION - RIGHT INDICATION/REASON +RIGHT RESPONSE +RIGHT ASSESSMENT +RIGHT EDUCATION +RIGHT TO REFUSE
61
definition of POLYPHARMACY
the use of MULTIPLE MEDS - potential use of MEDS THAT ARE UNNECESSARY/do not match diagnosis
62
definition of ORTHOSTATIC HYPOTENSION
sudden BP changes with movement changes - drastic drop of 20+ mm Hg (positive sign)
63
how to continue prevention of medicine errors?
- AVOID DISTRATIONS - CORRECT ADMIN - RECORD MED ADMIN
64
what happens to METABOLIC PROCESSES as we grow older?
- liver begins to SHRINK - declining rate of HEPATIC BLOOD FLOW & ENZYME ACTIVITY - medication stays for a longer duration; may need smaller doses
65
what happens to EXCRETION PROCESSES as we grow older?
- declining of KIDNEY FILTRATION & RENAL BLOOD FLOW - same aging effects of the liver
66
what happens to DISTRIBUTION PROCESSES as we grow older?
- changing of FLUIDS & BODY PROPORTIONS decrease - concentration of WATER-SOLUBLE MEDICATIONS rises - decrease of PROTEINS; less binding of drugs
67
what is the easiest route for medication?
ORAL ADMINISTRATION; the most preferred route *consider food & its effects *prevent aspiration (upright position, chin-down)
68
what are our PARENTERAL ROUTES?
types of INJECTION; 1. INTRADERMAL (ex. TB test) 2. SUBCUTANEOUS (ex. insulin) 3. INTRAMUSCULAR (ex. flu shots) 4. INTRAVENOUS (ex. antibiotics, pain meds) *there are other routes; EPIDURAL, INTRAPLEURAL, INTRAARTERIAL etc...INTRACARDIAC, etc...
69
what is important to note when administering via PARENTERAL ROUTE?
- much more INVASIVE + necessary for ASEPTIC TECHNIQUE; can be a risk for infection & needle sticks - must consider 7 rights always
70
describe TOPICAL ADMINISTRATION
- considers use of ABSORPTION of medication through the SKIN or MUCOUS MEMBRANES
71
describe SKIN APPLICATION (topical)
- application of TRANSDERMAL PATCH; ask if patient has an existing one - be careful; can be prone to OVERDOSE - documentation of LOCATION & REMOVAL on MAR
72
what are the methods of NASAL INSTILLATION?
- sprays - drops - tampons **most commonly uses SPRAY or DROPS
73
describe EYE INSTILLATION
- avoid the CORNEA - avoid DIRECT TOUCH of eye/lid - NEVER SHARE EYE MEDS
74
definition of INTRAOCULAR INSTILLATION
- disk used for medication; often resembles a contact lens - teach patients how insert/remove
75
describe EAR INSTILLATION & IRRIGATION
- allow eardrops to be in ROOM TEMP - never OCCLUDE EAR CANAL - children <3; ear down & back - children >3/adults; ear up & back - irrigation used to REMOVE CERUMEN if wax softeners don't work
76
describe types of VAGINAL MEDS
- foam - jellies - creams (use of applicator inserter) - suppositories (gloved hand)
77
describe RECTAL INSTILLATION
RECTAL SUPPOSITORIES: - exerts LOCAL EFFECTS - often seen for NPO patients & stroke patients - often comes with a small cleansing enema
78
pressurized metered-dose inhalers (pMDIs)
- needs hand strength/hand-breath coordination - can be used with spacer
79
breath-actuated metered-dose inhalers
- depends on strength of patient's breath on INSPIRATION
80
Dry powder inhalers (DPIs)
- activated by PATIENT's BREATH - delivers more med to lungs
81
how do we administer medications by IRRIGATION?
- use of clean technique - use aseptic technique if there is break - use of often saline, sterile water, or other antiseptic solutions
82
describe the type of SYRINGES
- LUER-OK (has ability to SCREW ON or OFF--can be threaded to an IV) - NON-LUER OK
83
describe NEEDLE ANATOMY
- HUB (the connection piece) - SHAFT - BEVEL (has lumen, always looking up) - PLUNGER (what moves up & down) - BARREL (contains medication)
84
how to prepare med from ampule?
- snap OFF AMPULE NECK - use of FILTER NEEDLE; aspirating medication - must REPLACE FILTER NEEDLE to proper needle; just used to filter out any broken glass
85
describe mixing meds from VIAL & AMPULE
- get medication from VIAL FIRST - use the SAME SYRINGE /FILTER NEEDLE from AMPULE
86
describe how to mix insulin
:)
87
define INSULIN & its CLASSIFICATIONS
INSULIN; hormone used to treat diabetes; oral insulin is destroyed; must be INJECTED - use of 100-UNIT INSULIN SYRINGE CLASSIFICATIONS: (by rate of action) - RAPID - SHORT - INTERMEDIATE - LONG-ACTING **CANNOT MIX LONG-ACTING with regular
88
what type of INSULIN can we never mix?
LONG-ACTING INSULIN - GLARGINE - DETERMIR
89
what should we know before injecting the patient?
- VOLUME OF MEDICATION - CHARACTERISTICS & VISCOSITY of MEDICATION - LOCATION OF ANATOMICAL STRUCTURES at injection site - PATIENT LEVEL OF DISCOMFORT
90
describe ANGLES OF TYPES OF INJECTIONS
IM: 90 SUBQ: 45-90 *90 *depends on weight ID: 5 - 15
91
what types of NEW TECHNOLOGIES are being used for SUBQ injections?
- INJECTION PENS - NEEDLELESS JET INJECTION SYSTEMS - SUBQ INJECTION DEVICES
92
describe AMOUNTS of med admin in IM injections
*has FASTER RATE OF ABSORPTION vs. SUBQ ADULTS; 2 - 5 mL CHILDREN, OLDER ADULTS, THIN PATIENTS; -2 mL SMALLER CHILDREN/INFANTS; 1 mL SMALLER INFANTS; 0.5 mL (vasta lateralis)
93
what LOCATIONS can we inject?
VENTROGLUETEAL SITE; in the GLUETEUS MEDIUS--preferred site VASTUS LATERALIS; used for adults & children; using MIDDLE THIRD OF MUSCLE DELTOID; risk for injury; close to nerves & artery
94
Needlestick Safety & Prevention Act
- proper use of prevention of needlestick incidents - use of safety syringes & proper disposal
95
describe IV ADMINISTRATION
1. use to INFUSE LARGE AMOUNTS OF IV FLUID - with medications 2. use to INJECT BOLUS/SMALL AMT OF MED through an EXISTING IV INFUSION LINE *ex. heparin & saline lock 3. use of PIGGYBACK INFUSION
96
describe LARGE-VOLUME INFUSIONS
- the MOST SAFE & EASIEST - large volumes; 500 -1000 mL - IF TOO RAPID; can be at risk for OVERDOSE
97
describe IV BOLUS
- introduction of a CONCENTRATED DOSE OF MED into the circulation - is the MOST DANGEROUS; no time to correct
98
describe VOLUME-CONTROLLED INFUSIONS
- use of SMALLER AMTS 50 - 100 mL - has THREE TYPES; V-C ADMIN SETS, PIGGYBACK SET, & SYRINGE PUMPS - advantages; stability / controls fluid intake
99
piggyback
small IV BAG (25 - 250 mL); connects to primary infusion line or intermittent venous access
100
syringe pump
- BATTERY OPERATED - gives medication in SMALL AMTS, controlled infusion times
101
saline lock/ intermittent venous access
- saves money - effective in saving time; no more constant monitoring