Medication Administration Flashcards
to administer medications safely; what must nurses have an UNDERSTANDING OF? (7)
- HEALTH CARE
- PHARMACOLOGY
- PHARMACOKINETICS
- LIFE SCIENCES
- PATHOPHYSIOLOGY
- HUMAN ANATOMY
- MATHEMATICS
defintion of PURE FOOD & DRUG ACT
- requires MEDS to be FREE of impure products
describe the FDA; FOOD & DRUG ADMINISTRATION
enforces MEDICATION LAWS that ensure that medications on the market go through VIGOROUS TESTING before being sold to the public
describe the MEDWATCH PROGRAM
- type of VOLUNTARY PROGRAM
- encouragement of REPORTING when meds, products or medical events cause SERIOUS HARM to a patient
what are other MEDICATION LEGISLATIONS to consider?
- 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
what are the types/classifications of MEDICATION NAMES?
- CHEMICAL
- GENERIC/OFFICIAL NAME
- TRADE/BRAND/PROPRIETARY (TM)
definition of NPAS
- known as the STATE NURSE PRACTICE ACTS
- defines the SCOPE OF NURSE’S professional functions & responsibilities
definition of CHEMICAL MEDICATION NAME
- this is RARELY USED in medication admin
- gives the EXACT DESCRIPTION of medication COMP + MOLECULAR STRUC
definition of GENERIC MEDICATION NAME
- known as the OFFICIAL NAME
- from the MANUFACTURER when first developed
- listed in U.S. PHARMACOPEIA
- ex. acetaminophen
definition of TRADE/BRAND/PROPRIETARY NAME
- name of the MARKET DRUG the manufacturer is selling
- EASY TO SPELL & REMEMBER
- ex. tylenol
how are MEDICATIONS CLASSIFIED?
- on its EFFECT on the BODY SYSTEM
- the type of SYMPTOMS the medication relieves
- the medication’s DESIRED EFFECT
what does PO stand for?
by mouth
what are the types of ORAL (PO) MEDICATION FORMS?
- SOLID; tablets, capsules, pills
- LIQUID; syrup, suspension, elixir
- OTHERS; lozenge / aerosol
definition of PHARMACOKINETICS
the study of how medications enter the body, reach the site of action, metabolize, and exit the body
definition of ABSORPTION
- 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
what are some FACTORS that can influence ABSORPTION?
- ROUTE OF ADMINISTRATION
- the ABILITY of a MEDICATION to DISSOLVE
- BLOOD FLOW TO SITE (greater the vascularity = the faster the flow!)
- BSA
- LIQUID SOLUBILITY
what are the FASTEST to SLOWEST ROUTES OF ADMIN?
- INTRAVENOUS (IV)
- INTRAMUSCULAR/SUBQ (IM/SQ)
- SKIN & PO
what can medications bind to that can DECREASE its effect?
albumin
definition of DISTRIBUTION
- follows after ABSORPTION
- DISTRIBUTION towards other TISSUES, ORGANS, & SPECIFIC SITE
what FACTORS INFLUENCE DISTRIBUTION?
- CIRCULATION; CHF patients
- MEMBRANE PERMEABILITY; specific BBB - only passes FAT-SOLUBLE MEDS
- PROTEIN BINDING (albumin)
definition of METABOLISM
- 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
definition of EXCRETION
- the EXITING OF MEDICATIONS
- typically occurs in the KIDNEYS
(can be excreted through liver, bowels, lungs, exocrine glands) **depends of medication really
what happens if a patient has LIVER OR KIDNEY ISSUES?
- have a greater risk of developing GREATER TOXICITY due to medications
therapeutic effect
the EXPECTED OR PREDICTED physiological response
adverse effect
the UNINTENDED, UNDESIRABLE, OR UNPREDICTABLE response
side effect
a PREDICTABLE, UNAVOIDABLE secondary effect
toxic effect
the ACCUMULATION OF MEDICATION within the bloodstream
- often due to result of IMPAIRED METABOLISM & EXCRETION
idiosyncratic reaction
an UNPREDICTABLE OVERREACTION, UNDERREACTION, or really just a DIFFERENT REACTION THAN NORMAL
urticaria
- also known as HIVES
- irregularly shaped eruptions; red margins / pale centers
pruritus
the ITCHING of the SKIN; comes with rashes
rhinitis
the INFLAMMATION of the MM lining
- swelling + watery discharge
allergic reaction
- this is DIFFERENT FROM SIDE EFFECTS
- type of UNPREDICTABLE REACTION
medication interactions
where ONE MEDICATION MODIFIES the ACTION OF ANOTHER
- type of SYNERGISTIC EFFECT – combined effect is greater than singular
medication tolerance
- where MORE MEDICATION is required to achieve the same THERAPEUTIC EFFECT
- more increased dosages of the med
medication dependence
- known as ADDICTION
- can be either PHYSICAL (showcase of withdrawal symptoms) or PSYCHOLOGICAL
what is the TIMING OF MEDICATION DOSE RESPONSES?
THERAPEUTIC RANGE:
consists of the lowest MEC to highest TOXICITY
definition of MEC
MINIMUM EFFECTIVE CONCENTRATION (MEC):
- the PLASMA LEVEL of a medication below which the effect of the MEDICATON DOES NOT OCCUR
definition of TOXIC CONCENTRATION
- TOXIC CONCENTRATION:
level at which TOXIC EFFECTS OCCUR
definition of PEAK & TROUGH
PEAK - highest level in our therapeutic range
TROUGH - lowest level in/entering MEC
definition of BIOLOGICAL HALF-LIFE
time it takes for excretion processes to LOWER the serum medication concentration by 1/2
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.”
what are the ORAL ROUTES OF MED ADMIN?
- SUBLINGUAL
- BUCCAL
what SYSTEM of MEDICATION MEASUREMENT do we use?
- METRIC SYSTEM
- use for METER (LENGTH), LITER (VOLUME) & GRAM (WEIGHT)
rules to follow when calculating med admin
- ALWAYS USE LEADING ZERO (ex. 0.5)
- NEVER USE TRAILING ZERO (5.0 XX)
how do we express SOLUTIONS in medication measurement?
- expressed THREE WAYS;
g/L or mg/mL
percentages
proportions
what are the types of methods you can use for CLINICAL CALCULATIONS
- the RATIO & PROPORTION METHOD
- FORMULA METHOD
- DIMENSIONAL ANALYSIS
what medications or doses should have HIGHER CAUTION?
- HIGH RISK MEDS; insulin, heparin, narcotics
- PEDIATRIC DOSEs
who can PRESCRIBE MEDICATIONS?
- physicians
- nurse practitioners
- physician’s assistants
how can ORDERS be given?
- WRITTEN (hand or electronic)
- VERBAL
- TELEPHONE
can abbreviations cause errors?
YES; use CAUTION, there are PROHIBITED ONES
definition of STANDING or ROUTINE MED ORDERS
have their own SET DOSE, FREQUENCY & DURATION
prn orders
as needed
STAT orders
given med IMMEDIATELY
NOW orders
- needed quickly
- around 90 MIN from receiving order
what is the PHARMACIST’s ROLE in med admin?
preparation & distribution of meds
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
what are the type of DISTRIBUTION SYSTEMS we have?
- UNIT DOSE SYSTEMS
- AUTOMATIC MEDICATION DISPENSING SYSTEM (AMDS)
definition of MEDICATION ERROR
- preventable event that can cause INAPPROPRIATE MEDICATION USE & possible harm to patient safety
- failing to administer medication
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
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
definition of POLYPHARMACY
the use of MULTIPLE MEDS
- potential use of MEDS THAT ARE UNNECESSARY/do not match diagnosis
definition of ORTHOSTATIC HYPOTENSION
sudden BP changes with movement changes
- drastic drop of 20+ mm Hg (positive sign)
how to continue prevention of medicine errors?
- AVOID DISTRATIONS
- CORRECT ADMIN
- RECORD MED ADMIN
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
what happens to EXCRETION PROCESSES as we grow older?
- declining of KIDNEY FILTRATION & RENAL BLOOD FLOW
- same aging effects of the liver
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
what is the easiest route for medication?
ORAL ADMINISTRATION; the most preferred route
*consider food & its effects
*prevent aspiration (upright position, chin-down)
what are our PARENTERAL ROUTES?
types of INJECTION;
- INTRADERMAL (ex. TB test)
- SUBCUTANEOUS (ex. insulin)
- INTRAMUSCULAR (ex. flu shots)
- INTRAVENOUS (ex. antibiotics, pain meds)
*there are other routes; EPIDURAL, INTRAPLEURAL, INTRAARTERIAL etc…INTRACARDIAC, etc…
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
describe TOPICAL ADMINISTRATION
- considers use of ABSORPTION of medication through the SKIN or MUCOUS MEMBRANES
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
what are the methods of NASAL INSTILLATION?
- sprays
- drops
- tampons
**most commonly uses SPRAY or DROPS
describe EYE INSTILLATION
- avoid the CORNEA
- avoid DIRECT TOUCH of eye/lid
- NEVER SHARE EYE MEDS
definition of INTRAOCULAR INSTILLATION
- disk used for medication; often resembles a contact lens
- teach patients how insert/remove
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
describe types of VAGINAL MEDS
- foam
- jellies
- creams
(use of applicator inserter) - suppositories
(gloved hand)
describe RECTAL INSTILLATION
RECTAL SUPPOSITORIES:
- exerts LOCAL EFFECTS
- often seen for NPO patients & stroke patients
- often comes with a small cleansing enema
pressurized metered-dose inhalers (pMDIs)
- needs hand strength/hand-breath coordination
- can be used with spacer
breath-actuated metered-dose inhalers
- depends on strength of patient’s breath on INSPIRATION
Dry powder inhalers (DPIs)
- activated by PATIENT’s BREATH
- delivers more med to lungs
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
describe the type of SYRINGES
- LUER-OK (has ability to SCREW ON or OFF–can be threaded to an IV)
- NON-LUER OK
describe NEEDLE ANATOMY
- HUB (the connection piece)
- SHAFT
- BEVEL (has lumen, always looking up)
- PLUNGER (what moves up & down)
- BARREL (contains medication)
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
describe mixing meds from VIAL & AMPULE
- get medication from VIAL FIRST
- use the SAME SYRINGE /FILTER NEEDLE from AMPULE
describe how to mix insulin
:)
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
what type of INSULIN can we never mix?
LONG-ACTING INSULIN
- GLARGINE
- DETERMIR
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
describe ANGLES OF TYPES OF INJECTIONS
IM: 90
SUBQ: 45-90 *90 *depends on weight
ID: 5 - 15
what types of NEW TECHNOLOGIES are being used for SUBQ injections?
- INJECTION PENS
- NEEDLELESS JET INJECTION SYSTEMS
- SUBQ INJECTION DEVICES
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)
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
Needlestick Safety & Prevention Act
- proper use of prevention of needlestick incidents
- use of safety syringes & proper disposal
describe IV ADMINISTRATION
- use to INFUSE LARGE AMOUNTS OF IV FLUID - with medications
- use to INJECT BOLUS/SMALL AMT OF MED through an EXISTING IV INFUSION LINE *ex. heparin & saline lock
- use of PIGGYBACK INFUSION
describe LARGE-VOLUME INFUSIONS
- the MOST SAFE & EASIEST
- large volumes; 500 -1000 mL
- IF TOO RAPID; can be at risk for OVERDOSE
describe IV BOLUS
- introduction of a CONCENTRATED DOSE OF MED into the circulation
- is the MOST DANGEROUS; no time to correct
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
piggyback
small IV BAG (25 - 250 mL); connects to primary infusion line or intermittent venous access
syringe pump
- BATTERY OPERATED
- gives medication in SMALL AMTS, controlled infusion times
saline lock/ intermittent venous access
- saves money
- effective in saving time; no more constant monitoring
