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Pharmacotherapeutics > Medication Administration Full > Flashcards

Medication Administration Full Flashcards

Thanks Emily S!

1
Q

When administering ophthalmic meds, make a pouch in the _____ lid by pulling skin downward over the ________. Instill the medication in the ______.

A

Lower, bony orbit, conjunctival pouch

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2
Q

What sized syringe and needle should be used for IM injections?

A

1-5mL syringe, needle 21-25g (21-22g most common), 1-3” needle, (1-1.5” most common)

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3
Q

5 rights review: How to check if the right route?

A
  • Double check it is the right route of administration in drug book/MAR
  • If a change in route is needed, request new order from physician
    ex: Tylenol 650mg suppository cannot be changed to PO route without a new order!
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4
Q

What does the RN need to check before giving insulin or any oral hypoglycemic?

A

Blood glucose

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5
Q

Capsules cannot be ______, but they can be ______

A

split, opened

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6
Q
  • Especially document for _____ medications and the first time a ____ medication is administered
A

PRN, new

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7
Q

Name some common sites of SQ injections

A

Back of upper arms, abdomen (1” away from umbilicus), lower back/love handles, anterior aspect of thighs, back of scapula (not common)

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8
Q

In the beginning of medication preparation, after you have assembled the meds, what do you do?

A

Check for drug expiration date, check for the five rights against the MAR

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9
Q

What is a stat order?

A

Administer med as soon as possible; emergent

ex. Morphine 4 mg IV stat

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10
Q

How would you tell someone to take an oral medication that was a lozenge?

A

Dissolve in mouth

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11
Q

Who can write a medication order?

A

Who can write an order?

  • MD, DO
  • Nurse Practitioner
  • Nurse Midwife
  • Physician Assistant
  • Pharmacists & CRNAs
  • Per state and facility policy
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12
Q

Name the 7 components of a medication order

A 
○ Client's Full Name
○ Date and Time of Medication Order
○ Name of Medication
○ Route of Administration
○ Dosage of Drug
○ Frequency of Administration
○ Physician/Provider's Signature
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13
Q

What is the administration angle for intradermal injections

A

5-15 °, almost parallel to the skin

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14
Q

If patient has an NG tube hooked up to suction, turn it off, give the med, and then wait ______ to turn suction
back on to ensure __________.

A

30 min, medication is absorbed

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15
Q

Discuss the steps you would go through to administer an IM injection using the z-track method:

A
  • Prepare medication
    • Change needle after drawing up med b/c know med is irritating
    - Check 5 rights
    • Gather supplies
    • ID site
    • Don gloves
    • Cleanse site w/ alcohol (can use corner of alcohol pad to point to injection site)
    • Displace skin laterally 1-1 ½” from injection site (using side of hand and keep it there while insert the needle)
    • While holding skin, insert needle with darting motion at 90° angle
    • Stabilize needle with thumb and forefinger of hand displacing skin
    • Aspirate
    • If no blood, inject medication slowly and steadily
    • Wait 10 seconds
    • Quickly withdraw needle
    • Release skin
    • Cover site w/ swab and DO NOT MASSAGE
    • DO NOT RECAP. Activate safety feature. Place needle in sharps container uncapped.
    • Remove gloves.
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16
Q

Talk your way through the deltoid landmarks to give an IM injection:

A

o Palpate lower edge of acromion process (bony process end of shoulder)
o Place 3 fingers across deltoid muscle w/ top finger at acromion process. This forms the base of a triangle
o Draw an imaginary line at axilla. This forms apex of the upside down triangle.
o Injection site = center of triangle, 2-3 finger widths (1-2”) below acromion process.
 Should feel belly of muscle here

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17
Q

If we don’t have a filter needle for an ampoule, what should we use?

A

A small gauge needle (25g, 27g)

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18
Q

What initial assessments may be needed before giving medications?

A
  • B/P if giving a HTN medication
  • Pulse if giving cardiac drugs like Digoxin
  • Pain rating if giving pain med
  • Temp if giving antipyretic
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19
Q

On a syringe and needle, what needs to stay sterile?

A
  • Tip of syringe, until needle attached

- Hub of needle, until attached to syringe

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20
Q

What is a routine order?

A

Give order until discontinued

ex: Cephalexin 500mg PO every 6 hours X 7 days

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21
Q

What is the typical volume for a SQ injection?

A

Up to 1 mL (can use 3mL syringe too)

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22
Q

Why should the patient wait a minute between puffs of a MDI?

A

So that bronchodilation can occur

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23
Q

What is the typical volume for intradermal injections?

A

0.1-0.5 ml (very small amount)

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24
Q

It’s time to go to the room and administer medication. What are your first steps?

A
  • Bring MAR and medications to patient room
  • Check 5 “Rights”
  • Compare wristband to MAR
  • Ask about allergies
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25
Q

What is the onset time for an IM injection?

A

Variable

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26
Q

What is a PRN order? What should this order always have on it?

A

PRN: as needed – should always have interval and indication statement
ex. Morphine 2 to 4 mg IV q 4 hours prn pain

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27
Q

Talk your way through the ventral gluteal landmarks:

A

o Palm of hand on greater trochanter of femur
 WHICH HAND IS IMPORTANT: thumb towards peepee
• Right hip, use left hand and vice versa
 Ask person to stick hip out like holding a baby – bony prominence is trochanter OR where hip crease is when sitting
o Index finger pointed toward anterior superior iliac spine (hip bone)
o Middle finger extended toward iliac tubercle (straight up)
o Injection site lies within triangle formed by index and middle fingers
 If pt has heel on ground and moves foot in and out, can feel muscle move, to make sure right location

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28
Q

Name two meds where the Z-track method is commonly used:

A

Hydroxyzine (Vistaril) and iron

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29
Q

How should you manipulate the ear to give otic meds to children under 3 years old?

A

Pull down and back

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30
Q

What is a nebulizer?

A

Aerosolized medication either given by a handheld device or by a face mask (peace pipe)

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31
Q

What is best given via rectal route?

A

Enemas/suppositories

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32
Q

You should/should not cover w/ gauze and massage skin after an ID injection?

A

Should NOT

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33
Q

What can the nurse use for to assist administering oral meds for patients with difficulty swallowing?

A

pudding or applesauce

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34
Q

There are a lot of ways to decrease the pain of an injection. Name a few:

A

o Encourage client to relax muscle
- Position patient prone with feet inverted (toe to toe, heels out) for dorsogluteal injection
o Change needle after preparing medication in syringe
o Avoid injecting into sensitive/hardened skin – want soft site
o Use needle long enough to reach muscle
o “Dart” needle quickly into muscle – quick in and quick out
o Use smallest gauge possible
o Inject medication SLOWLY (or at least steady – depends on drug)
o Do not move needle once inserted
o Withdraw needle quickly
o Use Z-track for IM injections
o EMLA cream may be applied (anesthetic for kids – need to wait 20 minutes)
o Apply pressure/ice to site before injection and pressure to site after

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35
Q

How should you prepare solid meds to be given in an enteral tube?

A

Crush pills individually and mix with 15-30 mL of warm water.

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36
Q

What are the best sites for intradermal injections?

A 
Inner forearm (most common)
•	May use back/upper chest – mostly allergy testing
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37
Q

What is the best position to administer a vaginal suppository?

A

Dorsal recumbent or Sim’s position

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38
Q

Why would you use z-track?

A

Used to “trap” medication in muscle and prevent “tracking” of solution through tissue. Less painful.

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39
Q

What things do you need to review re: the physical assessment of the patient before giving medication?

A
  • Are they alert? Oriented?
  • Ability to swallow
    (Should meds be crushed? Can the meds be crushed?)
  • NPO or not
  • Ability to follow instructions
  • GI motility
    (Post-operative period – maybe GI function hasn’t returned?
  • Muscles mass (IM) – choose needle size based on muscle mass
  • Water at the bedside to take meds
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40
Q

What is a one time order?

A

Give single dose and then discontinue; think: pre-op

ex: Atropine 0.3 mg subcutaneously on call to OR

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41
Q

What drug information do you need to know to give the medication safely?

A

Know the:

  • Action of the drug – mechanism of action/pharmacological classification
  • Normal dose ranges and routes
  • Any contraindications
  • Drug interactions
  • How to evaluate therapeutic effects
  • Give w/ or w/o food,
  • Patient teaching, etc.
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42
Q

Which is the most difficult site to locate but also the preferred IM injection site?

A

Ventral gluteal. Least amt nerve endings, blood vessels, and variability in subQ tissue

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43
Q

Which kind of administration is used for allergy and tuberculin skin testing?

A

Intradermal

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44
Q

What is a spacer?

A

A chamber attached to the end of an inhaler that assists the patient in receiving a higher % of drug
with each inhalation

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45
Q

When possible, what do you tell the patient when you are giving them a medication?

A
  • Name of medication
  • Dosage
  • Indication for use
  • Pertinent patient teaching
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46
Q

What kind of syringe and needle is generally used for intradermal injections?

A

TB syringe (1 mL) small gauge 25-28G, short needle ¼” – 5/8”

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47
Q

Name 8 examples of oral med preparations:

A
  • Capsule
  • Pill
  • Tablet
  • Time-released
  • Elixir, Syrup, Tincture
  • Powder
  • Suspension
  • Troche (lozenge)
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48
Q

What happens after a provider orders a medication?

A
  • Checked by pharmacy
  • Checked by RN
  • If paper system, may be transcribed by unlicensed person.
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49
Q

5 rights review: How to check if the right patient?

A
  • “State your name and date of birth”

- Compare with armband and medical record

50
Q

Where should you instruct the patient to look when administering ophthalmic medications?

A

Toward the ceiling

51
Q

After administration, what/when do you document on the MAR?

A
  • As soon as possible AFTER administration
  • Document time administered
  • Document client response
52
Q

List the steps for RBVO

A

Step 1. Write down order first.

Step 2. Read back what you wrote.

53
Q

What is the best position to administer a rectal suppository?

A

Sim’s position

54
Q

Discuss the steps you would go through to administer and intradermal injection:

A
  • Prepare meds
  • Check 5 rights with MAR
  • Gather supplies
  • ID site (make sure intact skin – look for bruising, irritation, broken skin, tattoos
  • Don gloves
  • Cleanse site w/ alcohol and let dry
  • Pull skin taut (skin towards wrist, if on forearm. Skin pulled opposite direction of needle)
  • Insert needle w/ bevel up (towards ceiling) at 5-15°, 1/8” deep
  • Needle should be visible under skin
  • Push plunger to instill medication creating a WHEAL under skin
  • Withdraw needle at same angle inserted
  • DO NOT RECAP NEEDLE. Activate safety feature, place needle in sharps container uncapped.
55
Q

What is an MDI?

A

Metered dose inhaler

56
Q

For any IM injection below the waist what length needle should be used?

A

1 ¼”- 1 ½” long needle

57
Q

What is the administration angle for a SQ injection?

A

45 or 90° (mostly 90° b/c you can “pinch an inch” on most ppl, but 45° appropriate for thinner people)

58
Q

What should you take special note of with ophthalmic meds?

A

There often needs to be a certain time period to wait between meds if doing multiple eye meds

59
Q

You sometimes need to check electrolytes, name a medication in which you need to do this?

A

Lasix – check K+ levels

60
Q

What is an injection method used w/ irritating medications?

A

Z-track method

61
Q

Beginning of medication preparation, what is the the first step, after proper hand hygiene?

A

Assemble the medications in the medication room/mobile med cart.

62
Q

5 rights review: How to check if the right drug?

A
  • Compare drug to MAR
  • Note expiration date
  • Know indication: “Why is the patient taking this medication?”
63
Q

How do you use an insulin pen?

A

o “Dial” the dose to appropriate units (eg 10)
o Insert needle into patients using SUBQ method
o WAIT
o Dial returns to zero
o Then, remove needle

(Not always used, only at some facilities. Sometimes one pen used on multiple patients. Talk to someone beforehand to make sure you know how a particular insulin pen works.)

64
Q

How is inventory done with controlled substances?

A

Done by 2 nurses at set intervals.

65
Q

Name three rules of topical meds:

A
  • Make sure previous dose is removed, before applying new dose.
  • Apply patches to non-hairy, INTACT areas of the body
  • Do NOT touch topical medications with ungloved hands (!!)
66
Q

What administration angle should be used for an IM injection?

A

90°

67
Q

What is the 3rd leading cause of death in the US?

A

Medication errors

68
Q

What is the most common general medication administration time rule?

A

Give up to 30 minutes before to 30 minutes after (dosage window)

69
Q

Discuss the steps you would go through to administer an IM injection:

A

• Prepare medication
• Check 5 rights
• Gather supplies
• ID site using landmarks
• Don gloves
• Cleanse site w/ alcohol
• Pull skin taut (esp. if below waist, may pinch deltoid only)
• Hold needle like a dart
• Insert needle quickly at a 90° angle
• Stabilize needle
• Aspirate for blood (draw back plunger slightly) NOTE: WE HAVE BEEN TOLD NOT TO ASPIRATE FOR VX IM INJ BY OTHER PROFS
o If see blood, immediately remove needle and put in sharps container.
o Draw up new med and draw into new site to make sure not in blood vessel
• If no blood, instill medication slow and steady
• Quickly remove needle
• DO NOT RECAP. Activate safety feature. Place needle in sharps container uncapped.
• Massage site with alcohol swab.
• Remove gloves

70
Q

What do you do if/when you make a medication error?

A

1) Make sure the patient is okay!!
2) Notify the provider/charge nurse
3) Complete an incident report

71
Q

5 rights review: When is the appropriate window to give meds?

A
  • Medication given 30 minutes before or 30 minutes after time ordered is acceptable.
  • Refer to policy and procedure manual.
  • *Standard administration times are set by each facility.
    ex: Once daily dose: 1000; BID dose 0900, 2100
72
Q

Discuss the steps you would go through to administer a SQ injection:

A 
•	Prepare meds
•	Go through 5 rights
•	Gather supplies
•	ID site ( BIG PINCH - where you can pinch an inch or more)
•	Don gloves
•	Cleanse site w/ alcohol
•	Bunch the skin 
o	Hold needle like dart
•	Pierce skin with QUICK motion at 45-90° angle
•	DO NOT ASPIRATE
•	Inject medication steady rate
•	Quickly remove needle
•	DO NOT RECAP. Activate safety feature. Place needle in sharps container uncapped.
73
Q

What position is best for the patient to be in to administer most meds?

A

High fowler’s

74
Q

How would you tell someone to take an oral medication that was buccal?

A

Between cheek and teeth and let dissolve

75
Q

If a medication is not given/refused, what do you document?

A

Document reason (e.g., blood sugar low – no insulin, pt. refusal)

76
Q

What is the most dangerous IM injection site?

A

Dorsal guteal bc of sciatic nerve location; ONLY USE IF DIRECTED TO DO SO by drug guide/manufacturer

77
Q

Talk your way through the dorsal gluteal landmarks:

A

o Absolutely most dangerous site
o Locate posterior iliac spine (indentation above buttocks, right where bone starts to come up)
o Locate greater trochanter at hip
o Draw an imaginary line between these 2 landmarks
o Injection site is above and lateral to the line (a lot higher than you think it is)
- DO NOT USE OLD TECHNIQUE of dividing buttocks into quadrants. Can hit sciatic nerve and cause foot drop

78
Q

What is a RBVO?

A

Read Back Verbal Order. The practice of repeating back an order that is given verbally in person or over the phone. It is done to ensure accuracy.

79
Q

What is the onset time with SQ injections?

A

Within 30 minutes

80
Q

What is the best way to give nasal medications?

A

Head down and leaning forward different from book

81
Q

If you only need to use a half vial of a medication that is a controlled substance, what do you do with the rest?

A

Waste it. Must be witnessed and documented by another nurse

82
Q

How should you manipulate the ear to give otic meds to an adult?

A

Pull up and back

83
Q

4 Types of Medication Orders

A
  • Written Orders – preferred
  • Verbal Orders (VO) – should only be done in critical situations (e.g., “push epi”)
  • Telephone Orders (TO)
  • Protocols
84
Q

What should you know for any PRN drug?

A

Know the last time of administration

85
Q

More than ____ (ex. vials) to equal a dose is a RED FLAG

A

3

*ex: IV med that takes 10 vials doesn’t seem right…double check the order!

86
Q

How should patients be positioned while giving otic meds?

A

Side lying

87
Q

At what temp should otic meds ideally be given?

A

Room temp

88
Q

What are blunt needs used for?

A

Used for filling meds

89
Q

Never crush what kinds of oral meds?

A

Sustained release, controlled release, or enteric coated pills

90
Q

Can patients bring medications from home?

A

Yes but must have order and checked by pharmacist

91
Q

What should you see under the skin after you inject the medication intradermally?

A

A wheal

92
Q

When administering medications in a enteral tube (e.g., PEG tube, nasogastric tube, etc.), in what form should they be?

A

Liquid

93
Q

Stay with patient until all medications are taken!

A

Just a reminder!

94
Q

Name 3 common SQ injections

A

heparin, lovenox, and insulin

95
Q

How many medications should you prepare at a time?

A

One

96
Q

What do we use filter needles for?

A
  • For ampoules. Mechanism inside to filter glass out
97
Q

How long should the patient who received a vaginal suppository stay in position after so that the medication stays in place and gets absorbed?

A

15-20 minutes

98
Q

What is the process when using an MDI (4 steps)?

A

1) Breathe out
2) inhale slow and steady – push and inhale simultaneously
3) hold breath
4) breathe out slowly

99
Q

Places to find meds! What is often kept in an automated medication-dispensing systems (Pyxis)?

A

Opiods

100
Q

Name the parts of the syringe

A

Tip, barrel, plunger

101
Q

How would you tell someone to take an oral medication that was sublingual?

A

Dissolve under the tongue (NO first-pass effect!)

102
Q

What is the angle used for a SQ injection?

A

45-90° angle

103
Q

What is a now order?

A

Patient not in emergency situation, but want to get meds to patient ~ 15 min; since of urgency

104
Q

What is medication reconciliation?

A

The process of checking home meds vs meds ordered in the hospital when admitted and when discharged

105
Q

Places to find meds! What is a mobile cart?

A
  • Locked cassettes or drawers for each patient

- May have “floor stock” drawer

106
Q

What if you don’t see a wheal after the ID injection?

A

May need to redo

107
Q

Time to give the medication via enteral tube. How do you do this?

A

Check placement – is it in the right spot?, flush with water (~15cc), administer medication, flush with water, administer medication, flush with water.

108
Q

Name 3 common medications that require checking drug levels?

A

Digoxin, Dilantin, Theophylline

109
Q

What are the 3 checks of medications (triple check!!)

A

1) Against MAR before preparing medication (e.g., getting it from Pyxis)
2) Against MAR after preparing the medication
3) At the bedside

110
Q

What do we recommend the patient do after receiving a rectal suppository?

A

Stay in position and “hold it” (if for bowel function)

111
Q

What should you do with syringes if not in the original container BEFORE removing from medication room

A

Label syringes

112
Q

Where are you injecting medication when you administer a SQ injection?

A

In adipose tissue, between skin and muscle

113
Q

What do you monitor for after giving?

A

Effect – did it do what it was supposed to?

114
Q

What volume can you go up to for an IM injection?

A

Up to 4 ml depending on muscle

115
Q

Name some complications that can come from an IM injection:

A

o Pain
o Damage tissue: sterile abscess, hematomas, muscle contraction, bruising, skin discoloration, nerve damage
- Use landmarks to find locations
o Bone injury (hit bone w/ needle)
o Speed shock (if med goes into vein or artery)
o Infection

116
Q

What size needle and syringe should you use for a SQ injection?

A

TB or insulin syringe (can also use 3 ml syringe), 25-27g needle, length ½”- 5/8”

117
Q

5 rights review: How to check if the right dose?

A
  • Know the usual dose and question any dose outside of safe range
  • Validate calculations of divided doses with another nurse
  • Check high alert medications (ie heparin, insulin, digoxin) with another nurse
118
Q

How should you instruct the patient to intake the nasal medication?

A

Steady inhalation

119
Q

If medication should be given on empty stomach: stop tube feeding for _____ minutes before and after med
administration.

A

15-30 minutes

120
Q

What does the RN check after a provider orders a medication?

A
  • Allergies
  • Appropriate med
  • Appropriate dose
  • Checking total order to make sure it is something the patient should be getting (refer back to chart – things can get changed quickly)
121
Q

Talk your way through the vastus lateralis landmarks (outer middle aspect of thigh):

A

o One hand above knee
o One hand below greater trochanter
- Have someone bend at hip, put hand at top of leg, that’s where greater trochanter is
o Locate midline of anterior thigh and midline of lateral thigh
o Injection site is middle third lateral aspect of the thigh
- Front of thigh is a different muscle

122
Q

Why should you avoid tattoos if possible with intradermal injections?

A

It makes it easier to assess skin later for rxns

Pharmacotherapeutics (20 decks)

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