Medication Administration Flashcards
What is pharmacology ?
The study of drugs and their effect on the body
Nurses must have ____________ about the drugs being administered to _____________ care for their patients.
Sufficient knowledge….. safely
Know the difference between a trade name and a generic name
Generic name identifies the drugs active ingredient while a trade name is the brand name selected by the pharmaceutical company
What is pharmacodynamics ?
What drugs do to the body
What is pharmacokinetics ?
What the body does to drugs - this is the study of drug movement through the body
Pharmacodynamics and pharmacokinetics leads to the
individualized patient response
What are the four processes of pharmacokinetics (ADME)
Drug Absorption Drug Distribution Drug Metabolism Drug Excretion
Discuss Absoption
process by which a drug is transferred from its site of entry into the body to the bloodstream May be slowed due to: ICF (increased or decreased?) Gastric pH (increased or decreased?) Gastric blood flow and motility (increased or decreased?) Metabolism and drug absorption (increased or decreased?)
What is a loading dose ?
A larger than normal dose
What is a maintenance dose ?
A lower dose that becomes the usual or daily dosage
Discuss distribution
Distribution occurs after the drug has been absorbed into the bloodstream and the drug is distributed throughout the body, becoming available to body fluids and body tissues Considerations: Changes in circulation Membrane permeability Body temperature Tissue structure Dehydration and hypoalbuminemia decrease drug distribution
What does distribution depend on ?
Blood flow to the tissues, the drugs ability to leave the bloodstream, and the drugs ability to enter the cells
Metabolism (aka biotransformation)
Change of a drug from its original form to a new form
What is the primary site of drug metabolism ?
The liver. Other tissues, such as those of the GI tract, lungs, kidney and skin also have a role in drug metabolism
Drug Excretion
Kidneys excrete most drugs - although changes associated with aging, disease or other factors that impair the functioning of the kidneys can decrease their ability to excrete drugs. In this case, the drug package must list specific implications
At what level do drugs act to achieve their desired effect?
The cellular level
What is pharmacodynamics ?
The process by which drugs alter cell physiology and affect the body
Drugs turn _____, turn _________, promote or _______ responses that are part of the body’s processes.
on; off; block
What are adverse drug effects ?
Undesirable effects other than the intended therapeutic effect of a drug. These can occur at any drug dosage or drug concentration
Effects of aging on medication use ?
Age related changes affect pharmacokinetics and pharmacodynamics, and there is an increased risk for adverse reactions
What is an early sign of an adverse reaction?
Delirium and mental dysfunction
Questions to ask regarding necessity and effectiveness of drugs
* Ensure drugs are selectively and cautiously used* Why is the drug ordered? Is the smallest possible dosage ordered? Is the patient allergic to the drug? Can this drug interact with other drugs, herbs, nutritional supplements? Are there any special instructions accompanying the drug’s administration? Is the most effective route of administration being used?
Safety considerations for Aspirin
Observe for bleeding
Safety considerations for Acetaminophen
monitor daily dose due to liver
Safety considerations for analgesics
Older adults may present differently regarding pain Start low and go slow Titrate and watch for adverse reactions (all meds)
Considerations for Anticoagulants
Anticoagulants (Heparin & Coumadin are common) High risk for bleeding Vitamin K (antidote) Monitor blood levels
Considerations for Antacid
Avoid other meds for 2 hours (prevents absorption interference)
Considerations for NSAIDs
Toxic levels accumulate easier at lower doses in older adults.
What is polypharmacy ?
The simultaneous use of multiple drugs to treat a disease or condition
What are some of the most common polypharmacy drugs
Cardiovascular agents, antihypertensives, analgesics, antiarthritic agents, sedatives, laxatives, and antacids.
What are the different names for a drug ?
Chemical - precise description of the drugs chemical composition Generic - identifies the drugs active ingredient Trade Name - aka the brand name, the common store name it is sold under
In order to give a medication to a patient, what must there be ?
A medication order from a licensed practitioner
What is a standing order ?
Continue as specified until canceled
What does p.r.n. mean?
as needed , determined by the patient and/or the R.N.
Single or one time
medication given only once
STAT order
to be carried out immediately
PO
by mouth
NPO
nothing by mouth
QD
every day * should not be used, easily mistaken- write out daily or every day instead
BID
twice per day
TID
three times per day
AC
before meals
PC
after meals
PR
per rectum
SQ or SC
subcutaneous
IM
intramuscular
IV
intravenous
NG
nasogastric
TPN
total parenteral nutrition
CBC
complete blood count
OGT
oral gastric tube
Parts of the medication order
Patients Name Date and Time the order is written Name of the drug to be administered Dosage of the drug Route by which the drug is to be administered Frequency of administration of the drug Signature of the person writing the order
What are the three safety checks when checking the order ?
Order to MAR MAR to med MAR to patient
When are the three times that you should read the medication label?
READ when you REACH for the medication READ after RETREVIAL -against the MAR READ when REPLACING the container to the drawer and/or before GIVING the medication to the patient
What are the five rights of medication adminstration?
Right Patient Right Medication Right Time Right Dosage Right Route Additional rights include right reason, right assessment, , Right education, Right to refuse, Right response (evaluation), and Right documentation.
It is important to assess the patient for _________ when it comes to drug administration
allergies
What are some signs and symptoms of a drug allergy? ?
Rash, urticaria, fever, diarrhea, nausea, and vomiting. These symptoms can happen immediately upon patient receiving drug or take hours and days to cause an effect
Anaphylactic reaction (anaphylaxis)
The most serious allergic effect - life threatening - results in respiratory distress, sudden severe bronchospasm and cardiovascular collapse
`What is used to treat an anaphylactic reaction?
Vasopressors, bronchodilators, corticosteroids, oxygen therapy, IV fluids and antihistamines
What are some of the nurses legal responsibilities when it comes to medication administration ?
Question the Order Does it make sense? Is the correct dose and preparation ordered? Is this medication appropriate for this patient? Patients condition Patients symptoms Patients health status You can be held responsible
PINCH High alert medications
Potassium Insulin Narcotics Chemotherapy Heparin These are high alert double check medicines
Different routes of medication administration
Intravenous Intramuscular Subcutaneous Oral Parenteral Topical Transdermal Suppositories (Rectal or Vaginal
Med Calc Formula
(D/A) * Q D = Desired Amount of the medication ordered by physician A = strength of the medication that is available Q = the quantity or amount of medication that contains the available strength Desired and available amounts must be in same unit of measurement
Different liquid forms of oral medication
Elixir Clear liquid containing water, alcohol, sweeteners, and flavor Suspension Finely divided, undissolved particles in a liquid medium Solution Drug dissolved in another substance Syrup Medication combined in a water and sugar solution
Things to consider when choosing equipment for injections
Route of administration Viscosity of solution Quantity to be administered Body size Type of medication
The shorter the gauge number, the ______________ the needle
larger
The larger the gauge number the, the _______ the needle
smaller
What method is recommended for all IM injections ?
The Z track technique
Don’t forget to document ______________
medication administration NOT DOCUMENTED NOT DONE
Different sites for IM injection
Different sites of SQ injection
Patient teaching of medication adminstration - what are some different points to touch on ?
Review techniques of medication administration
Remind the patient to take the medication as long as prescribed.
Instruct the patient not to alter dosages without consulting a physician.
Caution the patient not to share medications
What do you do when a medication error occurs ?
REPORT TO YOUR INSTRUCTOR, FIRST!
Check patient’s condition immediately; observe for adverse effects.
Notify nurse manager and primary care provider
Write description of error and remedial steps taken on record
Complete form use for reporting errors, as dictated by the facility policy.
Different parts of a syringe
Safety and technique for Med Admin
Different questions for review
- What are the three checks that must be performed before medication administration?
- What are the 5 rights of medication administration?
- Differentiate between gauge and length of a syringe.
- Identify the different parts of a needle and syringe (See figure 28-4,pg. 775 in fundamentals textbook)
- What angle should you insert a needle for a, SQ injection and IM injection?
- Where (what sites) can an IM or SQ injection be given for an adult?
- What is the rationale for using the Z-track method for IM injections?
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