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NUR350 Midterm > Medication Administration > Flashcards

Medication Administration Flashcards

1
Q

What does one require in order to perform an “act of nursing”/

A

1) Authority
- COULD does not equal SHOULD
2) Competency
- Knowledge
- Skill
- Judgement
- Confidence

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2
Q

Where does nursing authority come from?

A

1) Legislation (legal authority)
- RHPA
- More specific regulations and practice standards (e.g. CNO)
2) Evidence (theory/research)
3) Descriptions of nursing roles (work roles)
4) Organizational policies

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3
Q

What does the RHPA do?

A

Regulated Health Professions Act (RHPA)

  • Provides the legal framework for nursing as a self-regulated profession
  • Gives the CNO the legal responsibility for regulating nursing to protect the public
  • Contains 26 profession-specific acts that apply to each profession individually

Each profession-specific act has:

  • Scope of practice statement
  • “Controlled acts” authorized to that discipline”
  • Regulations that establish what acts may be delegated from one discipline to another
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4
Q

What is nursing’s scope of practice?

A

“The practice of nursing is the PROMOTION OF HEALTH and the assessment of, the provision of, care for, and the treatment of health conditions by supportive, preventive, therapeutic, palliative and rehabilitative means in order to ATTAIN OR MAINTAIN OPTIMAL FUNCTION” - Nursing Act 1991

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5
Q

What are authorized “controlled acts”?

A
  • Physical “acts” that are potentially harmful if performed by unqualified persons
  • Defined in the RHPA
  • Nurses (general class) are authorized to perform 5 controlled acts
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6
Q

What do nurses assess prior to administering medications?

A
  • Vital signs
  • Age
  • Weight
  • History of medications
  • Current medications (interactions)
  • Tolerance
  • Allergies
  • Medical order
  • Current and past medication conditions (why we are giving it)
  • The right person
  • Time of medication
  • Can they sit up and swallow
  • Can/should the medication be crushed
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7
Q

Routes of Medication Administration

A
  • May be oral, parenteral or topical
  • Depends on medication’s properties
  • Desired effect
  • Client’s physical and mental condition
  • Can they follow directions, understand directions, can/should the meds be crushed
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8
Q

Types of Oral Medications

A
  • Solids
  • Liquids
  • Lozenges
  • Aerosol
  • Sustained release
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9
Q

How can you help a patient swallow oral medication?

A
  • Raise the head of the bed
  • Provide a drink of water first
  • Encourage them to drink a full glass of water with the pill
  • Use pill cutter if allowed
  • Crush with applesauce or pudding of not contraindicated
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10
Q

How/Why to crush or cut medications

A
  • Tablets can be scored in order for easy cutting
  • Important to know which meds cannot and should not be crushed or cut
  • Mindful about cross contamination
  • Long acting medications cannot be crushed (comes in a capsule) and it may becomes short acting (gets full dose right away, no capsule to dissolve)
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11
Q

How to protect patient from aspiration

A

Patient has no gag reflex
- Do not have patient swallow pills

Patient has trouble swallowing

  • Crushing, put in applesauce
  • Slow/don’t rush them
  • One pill at a time
  • With sips of water inbetween
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12
Q

Giving meds via tubes

A

(Nasogastric, Intestinal, Gastrostomy, small-born feeding tube)

  • To use a liquid is best, pills clog tubes
  • Any medication that has an interent coating it shouldn’t be crushed; many are available without the coating
  • Sitting the patient ip while they have tube (at least a 30 degree angle or higher)
  • Remember they still need mouth care
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13
Q

Topical Medications

A
  • Lotion
  • Ointment
  • Liniment
  • Paste
  • Disc or patch
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14
Q

Topical medications and patient safety

A
  • Wear gloves
  • Cleanse wound prior to administration
  • If using patch, ensure that old one is removed before putting a new one on
  • Document where medication was applied and document removal if using patch
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15
Q

Ophthalmic Medications

A
  • Eye medication
  • Used with older persons, areas in UCI (dry eyes)
  • Wear gloves, potentially coming in contact with mucous membranes
  • Ointment or drops; can be difficult to administer
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16
Q

Otic Medications

A
  • Ear (otic) drops
  • Adult; straighten out the ear canal, pull back
  • Child under 3; ear pulled down and back
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17
Q

Administering Nasal Instillations

A
  • Use gravity

- Tilt head back in line with nasal cavity

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18
Q

Metered-Dose and Dry Powder Medication

A
  • Spacers; best practice for children and elderly populations (technically for everyone but unrealistic)
  • Need a prescription for a spacer
  • Needs to be washed regularly
  • Powder gets sucked into lungs; reuse inhaler, works quickly
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19
Q

Parenteral Route for Medications Administration

A
  • Giving a drug through injection into body tissues
  • Subcutaneous (subcut/SC)
  • Intradermal (ID)
  • Intramuscluar (IM)
  • Intravenous (IV)
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20
Q

Systems of Drug Management

A 
Metric
- Based on decimal system
- Gram (g) basic unit of weight
- Litre (L) is basic unit of volume
- Metre (m) is the basic unit of length
- Correct notation for metric 
0.5mg NOT .5mg
1mg not 1.0mg
Household
- Commonly used to measure medications at home (e.g. tbsp, tsp, cups, etc)
Equivalencies 
- 1 ounce = 30mL
- 1 pound = 16 ounces
- 1kg = 2.2 pounds
- 1 tbsp = 15mL
- 1 tsp = 5mL
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21
Q

How are medications dispensed?

A
  • Medication cart in hospital setting
  • Blister pack, prescription bottle, pill box
  • Many have to use a code to access the drug dispensing machine
  • Scripts with all of individual’s medicine
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22
Q

Why do nurses need to calculate drug doses?

A

Medications are ordered in different ways

  • Dosage ordered in mg or mL commonly
  • Sometimes ordered in tablets
  • By body weight (often in pediatrics)
  • Sometimes ordered by body surface area
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23
Q

How to calculate medication doses

A

(DD/DH) xQ = Amount to administer
DD = dose desired; taken directly from order
DH = dose on hand; the dose the medication comes in
Q = quantity on hand

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24
Q

Dosage by weight Calculation

A
  • Meds can be ordered by weight; especially for children
  • Nurses need to calculate of the dose ordered is safe
  • Often first step is converting child’s weight from lbs to kgs
    1kg=2.2lbs
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25
Q

Pediatric Drug Claculation

A

1) Calculate daily dose ordered
- The dose for the whole 24hr period
- Need to read: is it 24hr or per dose?
2) Calculate low and high parameters of safe range by checking in drug manual/handbook on unit and using client’s weight
- Is the order within that range?
3) Compare the client’s daily dose to see if it falls within this safe range

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26
Q

What do accurate medication calculations require?

A
  • Accurate READING
  • Accurate CONVERTING
  • Accurate CALCULATING
  • Using common sense to check your answers and look at the whole picture
  • If in doubt, check with another nurse or the pharmacist (indepedent double check)
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27
Q

ac

A

Before meals

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28
Q

ad lib

A

As desired

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29
Q

bid, BID

A

twice a day

cap

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30
Q

cap

A

community acquired pneumonia

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31
Q

elix

A

elixir

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32
Q

g

A

grams

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33
Q

gtt

A

glucose tolerance test

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34
Q

hs, HS

A

can mean half-strength or bedtime; write out directly

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35
Q

OD

A

can be od (daily) or OD (right eye)

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36
Q

OS

A

left eye

37
Q

OU

A

both eyes

38
Q

pc

A

after meals

39
Q

po or PO

A

single (one time) order

40
Q

prn

A

whenever there is a need

41
Q

q

A

meaning “quaque”; every

42
Q

qam

A

every morning, every AM

43
Q

q1h

A

every hour

44
Q

q2h

A

every 2 hours

45
Q

qid, QID

A

four times a day

46
Q

stat

A

give immediately

47
Q

supp

A

suppository

48
Q

susp

A

oral suspension

49
Q

tab

A

tablet

50
Q

tid or TID

A

three times a day

51
Q

u or U

A

means unit; not best practice

52
Q

Roles in Medication Administration

A

1) Prescriber
- Ordering the medication
2) Pharmacist
- Dispensing and giving information
3) Nurse
- All types of nurses and students

53
Q

Prescriber roles: Types of orders

A

1) Medical directives
- Not for a specific client
- Nurse uses assessment and doesn’t need to wait, they have the directive to do what is necessary
- I.e. allergic reactions, pain management
2) Direct order
- For a specific client, for a specific condition
- Routine, prn, single (one time), STAT, now
- Routine orders may indicate a final date or total number of doses
3) Verbal orders
- Not ideal, used for codes or remote areas
- Prescriber not in the building
- Role of nurse; repeat the order back, write it down on the order sheet, get the prescriber signature ASAP (usually a window of 12hr)

54
Q

Components of a complete order

A
  • Patient’s full name; may include unique identification number in a hospital
  • Date and time the order is written
  • Medication name (generic or trade)
  • Dose
  • Route of administration
  • Time and frequency of administration
  • Signature of prescriber
55
Q

Pharmacist’s role in med admin

A
  • Prepares and distributes prescribed medications
  • Administer medications
  • Responsible for filling prescriptions accurately and ensuring the prescriptions are valid
  • Provide information about side effects, toxicity, interactions and incompatibilities
  • In Ontario, able to prescribe some medications or extend prescriptions for ongoing conditions (in community based practice)
56
Q

Nurses Role: Medication Practice Standard (CNO, 2019)

A 
- Described the accountabilities of the nurse when engaging in medication practices
Includes:
- Administration
- Dispensing
- Medication storage
- Inventory
- Management
- Disposal

Based on 3 principles:

  • Authority
  • Competence
  • Safety
57
Q

What is the role of nursing student in medication administration?

A
  • You are accountable and responsible for your actions

- The nurses (if working with you) do have responsibility to make sure you are able to practice safely

58
Q

Authority (Med Admin, CNO, 2019)

A

RNs and RPNs require an order for a medication practice when:

  • A controlled act is involved
  • Administering a prescription medication
  • It is required by legislation that applies to a practice setting
  • Hospital Act; states we need an order for everything, even thing available over the counter
59
Q

Competence (Med Admin, CNO, 2019)

A

Knowledge, skill, and judgement

  • Evidence informed practice
  • Appropriateness of medication practice
  • Know limits on own knowledge and ask for help
  • Do not perform medication practice if not competent to perform
60
Q

What do nurses need to know to give a medication safely?

A
  • Drug classification
  • Why it is being given
  • Normal dosage range
  • Usual routes of administration
  • Usual action of the medication
  • Expected side effects
  • Potential harmful side effects and what to do if they happen
  • Peak action and duration
  • Time of onset of action depending on route
  • Is it necessary to do pre-assessment and evaluation afterwards? YES
61
Q

Safety (Med Admin CNO, 2019)

A

Promote safe care and contribute to a culture of safety

  • Seek information from client
  • Provide education to client
  • Collaborate with client
  • Promote and/or implement secure storage, transportation and disposal
  • Promote or implement strategies to minimize drug diversion and misuse
  • Take appropriate action to help client if medication error or adverse reaction occurs
  • Report errors, near misses or adverse reactions in a timely manner
  • Collaborate in approaches that support safe medication practices
62
Q

Medication and the Nursing Process

A
  • Assessment
  • Problem/Diagnosis
  • Goals/Planning (i.e. organizing care and decrease distractions_
  • Implementation
  • Evaluation (i.e. response and/or effectiveness of medication)
63
Q

Assessment - Medications

A
  • Medical History
  • History of allergies
  • Medication information
  • Diet history
  • Client’s perceptual or coordination problems
  • Client’s current condition
  • Client’s attitude towards medication use
  • Client’s knowledge and understanding of medication therapy
  • Client and family’s learning needs
64
Q

Diagnosis - Medications

A
  • Created from assessment data
  • May be a condition or symptom that is being treated (i.e. Anxiety, pain)
  • May be a considerations for giving the medication (i.e. impaired swallowing)
  • May be related to medication regimen management
65
Q

Planning - Medication

A
  • What are the goals or outcomes?
  • What are the priorities?
  • How does the nurse need to collaborate with others?
66
Q

Implementation - Medications (Guidelines for Giving Meds)

A

Guidelines for giving meds:

  • Prepare the medications alone; no distractions
  • Don’t leave medications unattended
  • Check client ID band; have client state their name (2 unique identifiers)
  • Know generic and trade names
  • Administer only what YOU prepare
  • Watch the patient take the medication
  • If a client refuses a medication, discard it rather than returning it to the original container
  • Unwrap mediation at POC (bedside)
  • Return to original prescriber’s order if questions arise
  • Call pharmacist if you have questions
67
Q

The “RIGHTS” of medication practice

A

1) Right patient
2) Right medication (3 checks)
3) Right reason
4) Right dose
5) Right time and frequency
6) Right route
7) Right documentation
8) Right to refuse
9) Right patient education
10) Right evaluation

68
Q

Right patient

A
  • Check MAR against identification band (&DOB)
  • Ask patient to state their full name
  • Use two unique identifiers
  • Explain what you are giving and why
  • Check allergies
  • Listen to your patient
69
Q

Right medication

A

3 checks

- Check labelling against MAR

70
Q

Right dose

A
  • Unit dose system designed to minimize errors
  • Calculated doses or “high alert medications” should be checked with another RN; independent double check
  • Know customary doses and appropriateness for age and size
  • Use table cutters when necessary; only break scored tablets
71
Q

Right time and frequency

A
  • How often should this medication be given? (hospitals usually have 30min window)
  • When was the last dose?
  • Why is this medication ordered at this particular time?
72
Q

Right route

A
  • po, S/L, topically, ID, subcut, IM, IV, rectally, vaginally, etc.
  • Check order carefully; consult prescriber id route not designated
  • Prepare injections only right before administration
73
Q

Right documentation

A
  • Chart time and site
  • Complete signature
  • Do not pre-sign MAR
  • Chart pre-administration assessment data
  • Chart the effectiveness
74
Q

Right to refuse

A
  • Patients should be informed of this right
  • Patient also need to be fully informed about benefits and risks of medications
  • Who doesn’t have the right to refuse? Ask them why they are refusing
75
Q

Right to patient education

A
  • Clients should be fully informed
  • Education may also involve family members in some situations
  • Education includes reason for taking drug, action and possible side effects
  • Should also include how to take medication
76
Q

Right evaluation

A
  • Evaluate order; is it correct? is the medication available and accessible to the patient?
  • Are there special assessments necessary?
  • What monitoring is needed before and after medication?
77
Q

Practice considerations - medication administration

A
  • Err on the side of safety; check the original prescriber’s order if in doubt
  • Listen to your patient
  • Stay at the beside until medication is taken
  • Bring MAR to bedside
  • Do not sign MAR before giving med
  • Separate drugs that need vital signs prior top administration
78
Q

Medication administration to children

A
  • Variations in size, weight, body surface area
  • Ask child’s parent or guardian about how to best administer the medication
  • Use simple language
  • Try different forms of medication
  • Use a disposable syringe for accuracy
79
Q

Medication administration to older persons

A
  • Physiological changes associated with aging
  • Simplify the medication plan
  • Older adults may be more sensitive to medications
  • Encourage fluids if not contraindicated
  • By mindful of polypharamcy
80
Q

What is a medication error?

A
  • Any event that may cause or lead to a patient either receiving inappropriate medication therapy or failing to receive medication
  • Errors may result in ADE (adverse drug event), near miss or near/actual death
  • Errors of commission; we give the wrong medication
  • Errors of omission; we don’t give the medication
81
Q

Causes and Factors of Medication Errors

A
  • Lack of verification of 10 rights
  • Miscommunication among HCPs (written and verbal)
  • Lack of drug knowledge and drug miscalculations
  • Ambiguities; product names and appearance
  • Interruptions and distractions
82
Q

Hight alert medications

A
  • Drugs that bear a heightened risk of causing significant harm when they are used in error
  • Drug classes:
    opiates
    antiarrhythmics
    antothrombotic agents
    dextrose
    dialysis solutions
    oral hypoglycemics
    total parenteral nutrition solutions
  • ISMP list of high-alert medications in acute care setting
83
Q

TALL man lettering

A

Used to distinguish between medications with similar names

84
Q

Technology and safety in medication administration

A
  • Medication carts
  • Bar codes
  • Blister packs
  • Informatics and medication safety
  • Network computers
  • Prescriber entered orders
  • Intranet resources
  • Automated dispensing systems
85
Q

Considerations for Nursing Students for Med Admin

A
  • Preparing medications for multiple patients
  • Nonstandard times
  • Documentation
  • MAR unavailable
  • Partial drug administration
  • Held or discontinued medications
  • Monitoring issues
  • Nonspecific doses dispensed
  • Oral liquids in parenteral syringes
86
Q

Medication Reconciliation

A

Formal process of:

1) Obtaining a complete and accurate list of each current medications; including name, dosage, frequency and route
2) Using list when writing admission, transfer and/or discharge medication orders, and
3) Comparing the list against the admission, transfer and/or discharge orders, identifying and bringing any discrepancies to the attention of the prescriber and, if appropriate, making changes to the order.

This list should accompany the patient to the next care site

87
Q

What to do if you make a medication error

A
  • Notify prescriber
  • Determine how long client must be monitored and if treatment is needed
  • Treat and/or monitor adverse reaction and document in chart
  • Report error (incident report)
  • Corrective actions
  • Advocate for systems that reduce risk of error
  • Check hospital policy re disclosure to client
88
Q

Medication error incident report

A

Includes:

  • Patient identification information
  • Location and time of the incident
  • An accurate, factual description of the incident and
  • Measure taken to address the error

Most organizations have procedures in place for disclosing incidences to patients and families

89
Q

Best practices in disclosing medication errors (creating a culture of safety)

A
  • Know disclosure policy and procedure of institution
  • Disclose as soon as possible to patient or family
  • Choose an appropriate setting
  • Describe the course of events; nature of mistake, consequences and corrective actions
  • Express regret and apologize; if appropriate
  • Elicit concerns and questions and commit to addressing them
  • Provide follow up
  • Provide personal and professional support and guidance to staff if necessary
  • Learn what happened using an open approach
  • Communication incident to ISMP (Institute for Safe Medication Practices)

NUR350 Midterm (11 decks)

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