Medication Administration chp 25 Flashcards
the transmission of medications from the location of administration to the bloodstream
absorption
Oral: barriers to absorption
medications must pass through the layer of epithelial cells that line the GI tract
Subcu and IM: barriers to absorption
capillary walls have large spaces between cells. Therefore, there is no sign. barrier
Highly soluble medications have rapid absorption times between __ to ___
10-30 mins
sites with high blood perfusion have ____
rapid absorption
IV absorption pattern
immediate: enters blood directly
complete: reaches blood in its entirety
The transportation of medications to sites of action by bodily fluids
distribution
Factors influencing distribution: (3)
circulation
permeability of the cell membrane
plasma protein binding
changes medication into less active forms or inactive forms by action of enzymes.
metabolism (biotransformation)
A ___ ___ level is in the therapeutic range when it is effective and not toxic.
plasma medication
Short half- lives leave the body in:
4-8 hours
when giving short-dosing intervals or MEC drops between doses you can
- give medications at longer intervals without a loss of therapeutic effects
- medications take a longer time to reach a steady state
the interactions between medications and target cells, body systems, and organs to produce effects.
Pharmacodynamics
oral or enteral medications should be given __ - ___ before meals and ___ after meals
30 mins-1hr
2 hrs
kids are dosed based on their body weight until they reach ____kg
50kg
Secondary effects of Pharmacodynamics are:
Unintended
non therapeutic
usually: predictable, harmless, or harmful
Harmful, unintended, usually unpredicted reactions to a drug administered at the normal dosage.
Adverse reactions
When the immune system identifies medication as a foreign substance that should be neutralized or destroyed
allergic reaction
POLAR OPPOSITE of what you would expect to happen when giving a drug. ( Benadryl can make you wired when its really supposed to make you tired)
Idiosyncratic reaction
Drug Interactions:
when drugs are mixed and cause deterioration of one or both drugs. (Aderol mixed with something else in IV.. forms precipitate)
Incompatible drugs
Components of the medication order/prescription. Must be on there ( 6)
- client’s full name
- date and time
- name of med
- dosage size, frequency, # of doses
- route of administration
- signature of prescriber & DEA #
Common Medication errors are caused by:
- lack of knowledge or info
- faulty communication
- equipment errors
- calculation and measurement errors
- similar names of medication OR patient names
- nurse fatigue, distraction, interrupted
What’s the first thing you do if you commit a med errors?
- ASSESS THE PT!
- Report findings to the primary care provider!
- Report it to your preceptor or charge nurse
When do yo perform the 3 med checks?
- Before you pour- at the med cart compare the label and MAR
- After you pour- verify the label against MAR
- At bedside- before you administer
Buccal and Sublingual medications are meant to be absorbed in the ___ not the ___
mucous membrane
not the GI tract
What’s one thing that you absolutely DON’t do when giving medication through a Enteral tube?
Don’t give HYDROPHILIC meds through feeding tubes. Attract water & will solidify in tubes
When administering Parenteral medications, you should always make sure you do what two things for safety:
- Avoid recapping a dirty needle
2. Use sharps containers
Examples of:
IV push-
IV piggyback-
Medicated drips-
push: single dose over a few minutes (steroids, pain med)
piggyback: antibiotics infused over a certain amt time
drips: insulin, ativan, antihypertensive drips, drips to lower inter-cranial pressure
Stages of Cognitive Development:
- Preoperational (2-7 yrs old)
- Stage of Concrete Operations (7-11yrs old)
- Formal Operational (11-older)
Schedule I narcotic:
Schedule II narcotic:
Schedule III narcotic:
I; ^ abuse, no medical use
II: acceptable medical use, ^ potential abuse
III: medically acceptable drugs that may cause dependency
What type of drug should be given when you want a longer acting effect?
lipid-soluble drugs
Acid drugs are more rapidly absorbed in the:
Basic drugs are more rapidly absorbed in the:
stomach small intestines (sodium bicarbonate)
Ionized molecules are:
Nonionized molecules are:
lipid insoluble- cant pass through phospholipid bilayer
nonionized easily absorbable
An example of when an ionized medication is taken and can be antagonized by another medication in stomach
Taking an antacid before an aspirin
antacid increases the pH of the stomach, aspirin becomes more ionized which impairs its absorption and reduces its effects
Diabetic patients can’t metabolize sugars effectively, so they should never be given:
an elixir ( ^ sugar content)
___ increases the potential for adverse reactions and dangerous drug and food interactions?
Polypharmacy
-administering many drugs to treat different conditions
Other Rights for patients receiving medication include: (3)
- Right reason- given the medication for the right reason
- Right to Know- tell pt name of med, why given, actions, & potential side effects
- Right to Refuse- pt has the right to refuse meds
To prevent choking in infants/toddlers when administering liquid medication you should:
- have mom sit them up or semi-sitting position.
- use a medicine dropper or syringe to place med between the gum & cheek.
- avoid giving too much too fast
What are some examples of a localized topical med and a systemic topical med?
local: zinc oxide put on butt to reduce irritation from bowels/bladder incontinence
systemic: estrogen patches, transdermal medication)
to prevent infection when applying otic medications, what should be done if tympanic membrane is ruptured or surgical procedure has been done?
- use sterile technique
- don’t irrigate with warm saline
- don’t use a metal syringe
- don’t use oral jet irrigation
- don’t use “ear candling” with hot wax
what can happen with long-term use of nasal decongestants?
rebound effect- medication is effective but congestion will recur and ^ when the effect of the decongestant wears off
What are the disadvantages to rectal medications?
- absorption is slow & erratic bc of rectal contents, local drug irritation & uncertainty of drug retention in the rectum
What is the main advantage to rectal medications?
- may provide for higher blood levels of medication compared to oral
When is a rectal medication preferred over an oral?
- has a bad taste/odor
- not safe to use oral (GI issues etc)
- pt has vomiting or unconscious
When is it ok to delegate a rectal medication?
- when it’s a glycerine suppository (non-medicated)
What are the 4 types of Nebulizers?
- Atomizers- medication in large droplets
- Aerosol spray- gas (O2 spray)
- Ultrasonic (handheld) nebulizer- med (1ml) mixed with saline (3mL)
- Metered Dose- measured dose delivered each time
What is the main advantage to using a Meter-dose inhaler?
rapid delivery- produces local effects directly in the airway while avoiding systemic effects
When would you not use a Dry powder Inhaler?
young kids or elderly
- need for dexterity so its hard for those who can’t control hand movements precisely
What are some disadvantages to parenteral medication?
- tissue damage can occur if PH, osmotic pressure, or solubility of med is not appropriate for that tissue
It’s recommended to add air into needles for certain situations (0.2mL at top of syringe) (2)
- when the med is irritating to subcutaneous tissues the air will drive med deep into the tissue
- when you change needles after drawing up the medication
Absorption of subcutaneous injections is ___ than IM injections
slower than IM
** less blood supply than muscle** going into fat
Subcut injection is faster in the site __ and __ and slower in the ___ and ___ sites
faster: abdomen & arms
slower: thigh & upper butt
What should you check before administrating a heparin shot?
activated partial thromboplastin time (aPTT)
- check for signs of bleeding (gums, IV injection sites) or cover bleeding (urine & stool)
For subcutaneous medications, only small amounts of _____ medication should be administered. What should you avoid doing with subq shots?
water-soluble meds
avoid creating sterile abscesses (hardened, painful lumps under skin) from administering in the same spot over and over again.
Heparin is only given by the ___ and ___ route. If given by ___ route it can cause:
IV or subcut
IM route: hematoma & pain (esp older women)
When administering IM injection, ____ site is #1. You should avoid using the ___ site bc ___
Ventrogluteal site
Dorsogluteal site bc of its proximity to the sciatic nerve & superior gluteal artery
what is the preferred site for IM injection for:
infants-
children-
adults-
infant: vastus lateralis (avoid deltoid)
child: anterolateral thigh (deltoid can if they have enough muscle mass)
adults- deltoid 4 vaccines, Ventrogluteal for all other IM
what is a protein and will be destroyed if administered through PO (GI tract)?
Insulin
Categories of Insulin:
Basal- cover body’s energy needs w/o taking diet into account
Prandial & Preprandial- given to prevent ^ bld glucose
Correction: reduce an elevated bld glucose level
Examples of when to hold TB skin testing:
- when pt has history of skin reaction/allergy
- pt is pregnant, receiving chemotherapy, or severe eczema
- pt has topical anesthetic cream on skin (apply on site with no anesthetic cream or reschedule)
- pt received live vaccine @ time of TP skin testing
( TB skin test should be deferred for 1 month post vaccine)
