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NURB 232 > Medication Administration > Flashcards

Medication Administration Flashcards

1
Q

Major Principles of Medication Administration

A
  1. Verify MD orders
  2. Know the drug action, dose, route, side effects and why the patient is receiving drug
  3. Utilize the nursing process to determine continue use of the drug and evaluate patient’s response to drug
  4. Provide patient teaching
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2
Q

6 Rights of Drug Administration

A
  1. Right drug
  2. Right dose
  3. Right time
  4. Right route
  5. Right patient
  6. Right documentation
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3
Q

Route of Administration: Enteral

A

Any drug that is administered through the alimentary canal

  1. Oral
  2. Buccal
  3. Sublingual
  4. Rectal
  5. Via nasogastic or gastrostomy tubes
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4
Q

Behaviors to Avoid When Giving Medications

A

Do not be distracted
Do not give or hold meds dispensed by others
Do not pour from containers without labels or difficult to read labels
Do not use expired drugs
Do not guess about dosages
Do not leave at bedside or unattended
Do not give if the patient has concerns about the drug

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5
Q

Route of Administration: Parenteral

A

Any drug given by injection

  1. Intramuscular (IM): vaccine
  2. Intradermal: PPD
  3. Subcutaneous: insulin
  4. Intravenous (IV)
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6
Q

Oral Route

A 
By mouth
Sublingual (under the tongue)
Buccal (side of cheek)
Via feeding tube (NG or GT)
Special considerations for elderly and children: crushing the medication, giving a different form of the medication or putting the medication in something (ie. applesauce)
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7
Q

Oral Medications

A

Most common route
Absorbs into the stomach or small intestines
Contraindications: NPO status, difficultly swallowing (nausea/vomiting), unconscious patient, or absent gag reflex

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8
Q

Oral Meds: Solid Forms

A

Can be pill, tablets, or capsules
May be scored
Enteric coated: delays absorption into the small intestine and CANNOT be crushed
Sustained release (releases over a period of time)

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9
Q

Liquid Medications

A

Syrups
Pour into a calibrated cup with label in palm
Make sure the patient is in a upright position
Bottom of the meniscus line is the desire dose
Measure at eye level
Wipe the rim of bottle with clean paper towel before replacing the cap
Use a needless syringe for dosage under 10 mL

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10
Q

Administration of Oral Meds

A

Assess the pt ability to swallow
For children ask the caregiver if the child takes pills or liquid form (place in back of cheek)
For elderly, crush the medication
Assess the patient 30-40 minutes after administration
Do not allow the patient to eat or drink when giving sublingual or buccal for 15-20 minutes

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11
Q

N/G & Gastrostomy Medication Administration

A

Check with pharmacist for liquid form (prevents clogging of tube)
Check if the medication can be crushed; if so crush into a fine powder and place in at least 30 mL of warm water
Do not administer whole or undissolved medication
Assess the tube placement
Make sure you are getting the juices from the tube
Put 15-30 mL (5-10 mL for children) of water into a syringe to flush tube
Give medications 1 at a time and flush in between
Flush the tube after all medications have been given
If the tube is connected to suction, disconnect and keep the tube clamped to 30 minutes to allow absorption

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12
Q

Choosing the Size of Needle and Syringe

A

Syringe size is determined by type and amount of medication

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13
Q

Size and Gauges of Needles:
IM
Sub Q

A

IM: 1-1.5 inch & 19-23 gauge
Sub Q: 3/8-5/8 inch & 25 gauge
*The smaller the number, the larger the gauge

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14
Q

Aseptic Technique: Needles

A

Wash your hands before preparing and administering
Wear gloves when administering injections
Needles and the inside of syringes remain sterile
Clean the top of the vial with alcohol for at least 10 seconds
Cleanse the patients skin with alcohol

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15
Q

Needle Safety

A

NEVER RECAP A USED NEEDLE! PLACE IN THE SHARPS CONTAINER!

Recap the sterile need with the scoop method

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16
Q

Medication Vial

A

Vial: a small glass or plastic container with a self sealing rubber top or cap
May be single or multi dose
May be liquid or powder

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17
Q

Medication Vial: Powder

A

If a powder then it must be deluded with sterile water or sterile saline
Follow the instructions, add diluent and gently roll under powder is dissolved
Wipe the rubber cap with alcohol before inserting needle
AIR MUST BE ADDED FIRST TO THE VIAL! (Add as much air as amount of liquid needed)

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18
Q

Ampule

A

Glass container with tapered neck for snapping open
ONE TIME USE
Use a filter needle attached to the appropriate syringe
Tap the stem and wrap an alcohol pad around the head the ampule & break away from your body
Replace the filter needle with an administration needle
Discard into a sharps container

19
Q

Mixing Medications

A

If possible, give a patient 1 injection instead of 2

Check the compatibility of the drugs

20
Q

Angles for Injections:
IM
Intradermal
Sub Q

A

IM: 90
Intradermal: 15
Sub Q: 45 or 90

21
Q

Intradermal Injections

A 
Administered on ventral surface of the forearm, upper back, or upper chest
Stretch skin taut to insert needle
DO NOT ASPIRATE
Inject slowly to create a wheal or bleb
Do not massage the site
22
Q

Intramuscular Injections

A

Given into the muscle
Faster rate of absorption
May bunch or stretch skin
May use Z track

23
Q

Sites for IM Injection

A 
Deltoid (1 mL)
Vastus lateralis (2 mL)
Ventrogluteal (3 mL)
Dorsalgluteal
Rectus femoris
24
Q

Vastus Lateralis

A

Used for infants under 12 month and on children & toddlers whose deltoid is small
Locate the greater trochanter & lateral condyle; divide into thirds & give in outer middle third

25
Q

Rectus Femoris

A

Used only occassionaly

Advantage for pt giving IM to themselves

26
Q

Deltoid

A

Used for children who have developed muscle mass & adults
Place 4 fingers across the deltoid muscle with the top on the acromion process; top of the axilla is the lower borderline; a triangle between these landmarks indicate the deltoid muscle

27
Q

Ventrogluteal

A

Preferred site for IM
Used for children over 1 year
Patient positioned on back or side with knee & hip flexed
Place opposite hand from patient side on the greater trochanter, place the index finger on the anterior superior iliac spine, move the middle finger toward the iliac crest, triangle formed by index & third finger

28
Q

Dorsogluteal

A

Avoid this site due to sciatic nerve

29
Q

Injection Technique for IM

A

Verify doctors order
Prepare the medication (3 checks)
Identify the patient (check for allergies)
Choose appropriate site

30
Q

Complications for Injections

A

Infection
Damage to nerves & arteries
Muscle contracture

31
Q

Special Technique: Z Track

A

Skin pulled to 1 side
Injection given
Skin is released
Prevents seepage into sub q

32
Q

Sub Q Injections

A

Given in the layer of tissue between the skin & muscle
Slower absorption rate than IM
May pinch or bunch the skin (thinner individuals pinch)
Aspiration optional
Do not massage injection site

33
Q

Sites for Sub Q Injection

A 
Upper Arm
Anterior thigh
Abdomen
Scapula
Ventro- Dorso- gluteus
34
Q

Special Techniques: Heparin

A

Administer heparin 2 inches away from umbilicus

Do not aspirate or massage after injection

35
Q

Insulin Administration

A

Insulin is given when the pancreas no longer manufactures insulin
Must be given Sub Q or IV
Physician prescribes number of units
Concentrations are 100 mL/unit
Use an insulin syringe when unit concentration matches dosage
Sliding scale prescribes dosage based on the patients blood glucose level
Prior to administration assess the patients glucose level, when they ate or they are going to eat
Each insulin has 3 characteristics: onset of action; peak action (except Lantus) and duration of action

36
Q

Difference between Clear and Cloudy

A

Regular insulin & Lispro are always clear
Others have ingredients added and are cloudy to prolong their action
Cloudy, clear, clear, cloudy (do not mix Lantus)

37
Q

Topical

A

Skin
Vagina
Rectal
Wear gloves and follow directions (be careful not contaminate or double dip)

38
Q

Transdermal Patches

A

Wear gloves
Remove the old patch and clean skin
Rotate sites. Place on a hairless site free from movement.
Mark date, time, and initials

39
Q

Vaginal Application

A

Position in dorsal recumbent or Sim’s position
Insert suppository or applicator along the posterior vaginal wall about 3 inches
Instruct patient to stay in position for 5-10 minutes after medication inserted

40
Q

Rectal

A

Suppositories: laxatives or stool softeners (if pt cannot take oral)
Enemas
Have pt lie on left side
Use gloves and lubricant
Instruct patient to stay in position for 5-10 minutes after medication inserted

41
Q

Ear Medication

A

Warm solution
Hold head back
Pull pinna (up & back=adults; down & back = children)
Place drops on side of canal
Rest head for 5 minutes after instilling and use cotton to prevent leakage

42
Q

Eye Medication

A

Patient can be lying or sitting
Have pt look up
Approach from side
Steady hand by resting heel of head on pt forehead
Hold drops 1/2-1 inch over eye
Instill into conjunctival sac
Press over lacrimal duct to prevent drop from entering tear duct

43
Q

Eye Ointment

A

Squeeze a ribbon of eye ointment into the conjunctival sac using sterile technique
Have pt close eyes for 2-3 minutes

44
Q

Inhalation:
Respiratory treatments
Inhalers
Nebulizers

A

Metered Dose Inhaler (MDI): handheld nebulizer; delivered controlled dose with each compression; activate the device while continuing to inhale; have patient rinse out mouth after inhalation
MDI with Spacer (Reservoir): Used for young children and elderly; dose more predictable

NURB 232 (5 decks)

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