Medication Administration : Chapter 35 Flashcards
National Patient Safety Goals
- At least two identifiers to improve accuracy of client ID
- Improve effectiveness of communication among caregivers by record and read back orders and test results, standard abbrev, acronyms, symbols, and dose designations
- Improve safety of using meds by identifying look alike sound alike meds
- Accurately and completely reconcile meds across the continuum of care
Types Of Orders
Standing Order - apart of a protocol (post-op, pre-op), may or may not have a termination date
Written Order - on legal order sheet or EMR
Verbal - only for RN, repeat back for confirmation, then write it down
STAT - carryout immediately and only once
Single Order - only one time for medication to be given at a specific time
PRN Order - as needed, using nursing judgement when carrying out this order if client requires it
Routine - regularly scheduled, usually done so by pharmacy services
MD,NP, PA - can prescribe orders either orally in person written, or by telephone
Components of a Medication Order
- Full name of client
- Date and time of order (eliminates errors when the nursing shift changes
- Name of drug - both brand and generic names are used
- Dosage - amount
- Frequency of administration - time of administration
- Route - PO, IM, Oral, IV
- Signature - makes the drug a legal request; nurse or Dr.
Transcription
Med order is copied by a nurse or unit clerk from the medical record to the MAR (Medication Administration Record)
The nurse should always question the primary care Dr. about any unusual high dosages of meds or contradictions of the clients condition.
1) contact Dr. and voice concerns
2) document when Dr. was notified and what was conveyed
3) If Dr. cannot be reached document the attempts to call and reason for holding medication
4) if someone else gives med document data about clients condition before and after the med
5) if incident report is needed, document factual info
Ten “Rights”
- Right Medication
- Right Dose
- Right Time
- Right Route
- Right Client
- Right Client Education
- Right Documentation
- Right to Refuse
- Right Assessment
- Right Evaluation
Before You Give Meds (1)
Know Drug Information
- Action
- Indication
- Normal dosage range and route
- Adverse reactions
- Contradictions
- Drug Interactions
- Nursing Considerations
Insulin
- check blood glucose levels before giving Insulin or oral hyperglycemic med
What do you Assess the patient for before you give them meds?
Assessment Info
- BP (hypertension med)
- Pulse (cardiac drug Digoxin don’t give pule is below 60)
- Paint rating - pain meds
- Temp - antipyretic
Time Management
- Plan to administer within 30 min of scheduled administration (some facilities allow 1hr)
Labs
- Drug levels
- digoxin, antibiotics, dialantin, anticoagulants (PTT, PT/INR, aPTT), theophyline
Electrolytes
- lasix - check K+ levels
- administering electrolytes,know level before giving meds
Where do I look for Meds ?
Pyxis - automated medication dispensing system
Locked Med Cart - drawers are labeled with the clients name, room #, and med for that shift or 24hrs
Locked Med Room - used for storage of med carts when not in use, stock meds, controlled meds, drug for emergencies, fridge for IV and other meds that need cold storage, med supplies. Access room with a key or code
Med Preparation (1)
- Wash hands
- Assemble meds in the med room or at the cart
- Remove meds from the drawer
- check drug expiration date and 10 rights against the MAR
Med Preparation (2)
- Calculate drug dosage
- prep one med at a time
- leave meds in packages if possible
- use appropriate measuring device
- check 10 rights again before leaving med room
- lock the the med cart/room
Med Administration
- Bring MAR and meds to patients room
- check 10 rights - compare wrist bands
- Ask about allergies
- Open packages at bedside while performing patient education
- Tell patient the name of med, dosage, and indication of use
3 Identifications Before Giving Meds
1st check
* when removing meds
2nd check
*when preparing meds
3rd check
* recheck label on the container before returning to its storage place OR check label against MAR before opening at bedside
Post Administration Documentation
- Document the dose in MAR
- Client response
- BP, Pulse, Pain, Urine, Output, Unintended side effects
Routes of Medication
Oral, Enteral, Buccal, Sublingual, Topical, Transdermal, Inhalant, Opthalmic, Nasal, Otic, Rectal, Vaginal, *Parenteral : Needle such as Intradermal, Subcutaneous, Intramuscular, Intravenous
NG/Gastronomy Tubes and Meds
**Tubes - NPO pts, liquid form of med is less likely to cause an obstruction in NG tube
**Meds - check to see if pill can be crushed (enteric-coated pills should not be crushed), aspirate stomach contents and measure residual if greater than 100 mL check policy, flush w/ 15-30 mL of water prior to giving meds, flush between each med, when finished flush again, if tube is connected to suction disconnect and keep the tube clamped for 20-30 min.
High Risk Meds
Heparin
Coumadin
Insulin
Administering Different Routes of Meds
Transdermal - wear gloves when giving meds, throw away in the sharps container
Inhalant - inhale slowly of 3- sec and breathe deep through mouth, hold breath for 10 seconds or longer, exhale slowly, wait 20-30 seconds to complete
Otic - sterile technique is used when the eardrum is ruptured. adults pull pina upward and backward & children under 3 pull pina downward and backwards, press on the tragus to assist the med in the ear, have pt lay on side for 5 min.
Opthalmic - clean eyelid and eyelashes, put on gloves, look up at ceiling, expose lower conjuctiva sac, hold dropper 1-2cm above the sac, close eyes but not tight, (liquid eye meds press firmly or have the client do so for 30 sec), close or move eye periodically.
Nasal - head is held backwards w/ shoulders on pillow (ethmoid and sphenoid sinuses)
*maxillary and frontal sinus - head turned toward the side and breath through mouth to prevent aspiration to the trachea or bronchi (b) lay in this position for 1min (c) avoid blowing nose for several min
Injection Sites
SubQ- given in the outer thigh, upper arm, or abdomen
- small doses of 0.5 - 1 mL
- 1-2 mL syringes, 25 gauge
- rotate sites for Heparin and Insulin
IM- directly into muscle tissue Vastus Lateralis, (preferred for pts. 1 and younger), Ventrogluteal
- up to 3 mL in adults w/ well developed muscles,21-22 gauge
- no more than 1 mL in the deltoid
- Z track method - pull skin to the side, inject, release skin. This forms a seal over the IM site preventing seepage of med into subQ tissues
