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Medication Administration Simulation Flashcards

1
Q

Rights of Medication Administration

A
  1. Right Patient
  2. Right Medication
  3. Right Dose
  4. Right Route
  5. Right Time
  6. Right Reason (includes necessary assessments, i.e. VS, labs; evaluations to determine if medication should be held or given; i.e. patient NPO, patient on stool softener having diarrhea)
  7. Right Documentation
  8. Right Response
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2
Q

The eight rights of medication administration are…

A

The nurse’s legal obligations when giving any medication to increase patient safety and avoid medication errors!!!!

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3
Q

Rights surrounding medication administration: Patient’s rights

A
  1. Right to be educated about all medications being taken (can include referral to pharmacist)
  2. Right to refuse

THESE ARE NOT THE SAME AS THE NURSE’S LEGAL RESPONSIBILITIES WHEN GIVING ANY MEDICATION!!!!

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4
Q

Abbreviation: PO
Route:
Sample Medication:

A

Abbreviation: PO
Route: Oral
Sample Medication: Amoxicillin

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5
Q

Abbreviation: ID
Route:
Sample Medication:

A

Abbreviation: ID
Route: Intradermal
Sample Medication: PDD

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6
Q

Abbreviation: IM
Route:
Sample Medication:

A

Abbreviation: IM
Route: Intramuscular
Sample Medication: Morphine

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7
Q

Abbreviation: PR
Route:
Sample Medication:

A

Abbreviation: PR
Route: Per Rectal
Sample Medication: Biscadyl

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8
Q

Abbreviation: Transdermal
Route:
Sample Medication:

A

Abbreviation: Transdermal
Route: Transdermal
Sample Medication: Nicotine

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9
Q

Abbreviation: Eye
Route:
Sample Medication:

A

Abbreviation: Eye
Route: Eye
Sample Medication: Erythromycin

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10
Q

Abbreviation: NGT
Route:
Sample Medication:

A

Abbreviation: NGT
Route: Nasogastric Tube
Sample Medication: Crushed/Dissolved Medications

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11
Q

Abbreviation: PEG
Route:
Sample Medication:

A

Abbreviation: PEG
Route: Percutaneous Endoscopic Gastric
Sample Medication: Crushed/Dissolved Medication

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12
Q

Abbreviation: SC
Route:
Sample Medication:

A

Abbreviation: SC
Route: Subcutaneous
Sample Medication: Insulin

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13
Q

Abbreviation: IV
Route:
Sample Medication:

A

Abbreviation: IV
Route: Intravenous
Sample Medication: Normal Saline

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14
Q

Abbreviation: SL
Route:
Sample Medication:

A

Abbreviation: SL
Route: Sublingual
Sample Medication: Nitroglycerin

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15
Q

Abbreviation: Ear
Route:
Sample Medication:

A

Abbreviation: Ear
Route: Ear
Sample Medication: Debrox

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16
Q

Abbreviation: Nares
Route:
Sample Medication:

A

Abbreviation: Nares
Route: Nares
Sample Medication: Saline

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17
Q

Abbreviation: Vag
Route:
Sample Medication:

A

Abbreviation: Vag
Route: Vaginal
Sample Medication: Nuva Ring

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18
Q

Abbreviation: Top
Route:
Sample Medication:

A

Abbreviation: Top
Route: Topical
Sample Medication: Neosporin

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19
Q

Abbreviation: INH
Route:
Sample Medication:

A

Abbreviation: INH
Route: Inhalation
Sample Medication: Albuterol

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20
Q

What is the one route of administration not done in N205?

A

IV

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21
Q

Medication Administration

Needed/Checked first

A

Needed first is physician’s order.

Checked first is physician’s order.

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22
Q

Appropriate physician’s order includes:

A
  1. Order sheet with patient name and MR# stamped on sheet.
  2. Medication with dose clearly written.
  3. Route
  4. Frequency
  5. Start date (date and time order written)
  6. End date, if applicable (narcotic usually good for 72 hours; some antibiotics good for 72 hours, 5 days, 7 days; in long term facilities, medications are renewed every month)
  7. Patient allergies
  8. Patient weight if medication is weight based
  9. Legible physician’s signature.
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23
Q

Medication Administration Record (MAR)

Components of correct medication order on the MAR:

A
  1. Patient’s name and MR# stamped on sheet
  2. Patient allergies OR NKA (no known allergies) to signify that presence of allergies was checked.
  3. Patient weight
  4. Start and end date of medication
  5. Medication with dose clearly written
  6. Route
  7. Frequency
  8. Any parameters as applicable, i.e. hold if HR<60 bpm
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24
Q

Medication Administration Record (MAR)

Computerized MARs generated by pharmacy may be confusing with addition information supplied:

A
  1. How much medication is mixed
  2. Concentration of medication prior to being mixed
  3. What medication is mixed with
  4. Initials of who prepared the medication
  5. Abbreviations ‘UND’ signifying the amount to further dilute the medication or over what period of time to give medication.
  6. Abbreviations not understood or no longer acceptable to use.
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25
Q

With MAR, always ascertain the required information for giving the medication:

A 
MEDICATION
DOSE 
ROUTE 
FRQUENCY
TIME
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26
Q

Abbreviation: µ
Intended meaning:
Misinterpretation:
Use instead:

A

Abbreviation: µ
Intended meaning: Microgram
Misinterpretation: Mg (milligram)
Use instead: Mcg

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27
Q

Abbreviation: AD, AS, AU
Intended meaning:
Misinterpretation:
Use instead:

A

Abbreviation: AD, AS, AU
Intended meaning: Right ear, left ear, each ear
Misinterpretation: OD, OS, OU (right eye, left eye, each eye)
Use instead: Right ear, left ear, each ear

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28
Q

Abbreviation: OD, OS, OU
Intended meaning:
Misinterpretation:
Use instead:

A

Abbreviation: OD, OS, OU
Intended meaning: Right eye, left eye, each eye
Misinterpretation: AD, AS, AU (right ear, left ear, each ear)
Use instead: Right eye, left eye, each eye

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29
Q

Abbreviation: BT
Intended meaning:
Misinterpretation:
Use instead:

A

Abbreviation: BT
Intended meaning: bedtime
Misinterpretation: BID (twice a day)
Use instead: bedtime

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30
Q

Abbreviation: cc
Intended meaning:
Misinterpretation:
Use instead:

A

Abbreviation: cc
Intended meaning: Cubic centimeters
Misinterpretation: U (units)
Use instead: mL (milliliters)

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31
Q

Abbreviation: D/C
Intended meaning:
Misinterpretation:
Use instead:

A

Abbreviation: D/C
Intended meaning: Discharge or discontinue
Misinterpretation: Unclear what is meant
Use instead: Discharge Discontinue

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32
Q

Abbreviation: IJ
Intended meaning:
Misinterpretation:
Use instead:

A

Abbreviation: IJ
Intended meaning: Injection
Misinterpretation: IV (intravenous) or intrajugular
Use instead: injection

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33
Q

Abbreviation: IN
Intended meaning:
Misinterpretation:
Use instead:

A

Abbreviation: IN
Intended meaning: Intranasal
Misinterpretation: IM or IV
Use instead: Intranasal

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34
Q

Abbreviation: HS hs
Intended meaning:
Misinterpretation:
Use instead:

A 
Abbreviation: HS 
                        hs
Intended meaning: Half strength 
                                 Bedtime 
Misinterpretation:   Bedtime 
                                 Half strength 
Use instead: Half strength 
                      Bedtime
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35
Q

Abbreviation: IU
Intended meaning:
Misinterpretation:
Use instead:

A

Abbreviation: IU
Intended meaning: International unit
Misinterpretation: IV or the number 10
Use instead: Units

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36
Q

Abbreviation: o.d. or OD
Intended meaning:
Misinterpretation:
Use instead:

A

Abbreviation: o.d. or OD
Intended meaning: Once daily
Misinterpretation: Right eye
Use instead: Daily

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37
Q

Abbreviation: OJ
Intended meaning:
Misinterpretation:
Use instead:

A

Abbreviation: OJ
Intended meaning: Orange juice
Misinterpretation: OD or OS
Use instead: Orange juice

38
Q

Abbreviation: Per os
Intended meaning:
Misinterpretation:
Use instead:

A

Abbreviation: Per os
Intended meaning: By mouth, orally
Misinterpretation: OS for left eye
Use instead: PO, orally, by mouth

39
Q

Abbreviation: q.d. or QD
Intended meaning:
Misinterpretation:
Use instead:

A

Abbreviation: q.d. or QD
Intended meaning: Every day
Misinterpretation: qid
Use instead: Daily

40
Q

Abbreviation: qhs
Intended meaning:
Misinterpretation:
Use instead:

A

Abbreviation: qhs
Intended meaning: Nightly at bedtime
Misinterpretation: qhr (every hour)
Use instead: Nightly

41
Q

Abbreviation: qn
Intended meaning:
Misinterpretation:
Use instead:

A

Abbreviation: qn
Intended meaning: Nightly or bedtime
Misinterpretation: qh (hourly)
Use instead: Nightly or bedtime

42
Q

Abbreviation: q.o.d. or QOD
Intended meaning:
Misinterpretation:
Use instead:

A

Abbreviation: q.o.d. or QOD
Intended meaning: Every other day
Misinterpretation: q.d. or qid
Use instead: Every other day

43
Q

Abbreviation: q1d
Intended meaning:
Misinterpretation:
Use instead:

A

Abbreviation: q1d
Intended meaning: daily
Misinterpretation: qid
Use instead: Daily

44
Q

Abbreviation: q6PM
Intended meaning:
Misinterpretation:
Use instead:

A 
Abbreviation: q6PM
Intended meaning: Every evening at 6PM 
Misinterpretation: Every 6 hours
Use instead: Daily at 6PM 
                      6 PM daily
45
Q

Abbreviation: SC, SQ, sub q
Intended meaning:
Misinterpretation:
Use instead:

A

Abbreviation: SC, SQ, sub q
Intended meaning: Subcutaneous
Misinterpretation: SL for SC, 5 every for SQ, sub q with q=every
Use instead: Subcut or subcutaneously

46
Q

Abbreviation: ss
Intended meaning:
Misinterpretation:
Use instead:

A

Abbreviation: ss
Intended meaning: Sliding scale (insulin) or 1/2 (apothecary)
Misinterpretation: 55
Use instead: Write sliding scale

47
Q 
Abbreviation: SSRI 
                        SSI
Intended meaning:
Misinterpretation:
Use instead:
A

Abbreviation: SSRI
SSI
Intended meaning: Sliding scale regular insulin
Sliding scale insulin
Misinterpretation: Selective serotonin reuptake inhibitor
Strong solution of iodine (Lugol’s
solution)
Use instead: Write sliding scale (insulin)

48
Q

Abbreviation: i/d
Intended meaning:
Misinterpretation:
Use instead:

A

Abbreviation: i/d
Intended meaning: One daily
Misinterpretation: tid
Use instead: 1 daily

49
Q 
Abbreviation: TIW
                        BIW
Intended meaning:
Misinterpretation:
Use instead:
A 
Abbreviation: TIW
                        BIW
Intended meaning: 3 times a week 
                                 2 times a week 
Misinterpretation: Tid or twice a week
                               BID
Use instead: 3 times weekly
                      2 times weekly
50
Q

Abbreviation: U or u
Intended meaning:
Misinterpretation:
Use instead:

A

Abbreviation: U or u
Intended meaning: unit
Misinterpretation: Number 4, 0, cc
Use instead: Unit

51
Q

Abbreviation: UD
Intended meaning:
Misinterpretation:
Use instead:

A

Abbreviation: UD
Intended meaning: As directed
Misinterpretation: Unit dose
Use instead: As directed

52
Q

Abbreviation: Trailing 0 after decimal point (1.0 mg)
Intended meaning:
Misinterpretation:
Use instead:

A

Abbreviation: Trailing 0 after decimal point (1.0 mg)
Intended meaning: 1 mg
Misinterpretation: 10 mg
Use instead: Do not use trailing 0 for whole numbers

53
Q

Abbreviation: No leading 0 before decimal point (.5 mg)
Intended meaning:
Misinterpretation:
Use instead:

A

Abbreviation: No leading 0 before decimal point (.5 mg)
Intended meaning: 0.5 mg
Misinterpretation: 5 mg if decimal point not seen
Instead: Use 0 if dose not whole number

54
Q

Abbreviation: Numeric dose and unit run together (1 mg, 10mL)
Intended meaning:
Misinterpretation:
Use instead:

A

Abbreviation: Numeric dose and unit run together (1 mg, 10mL)
Intended meaning: 1 mg
10 mL
Misinterpretation: M mistaken for 0
Use instead: Leave space between dose and unit of measurement

55
Q

Abbreviation: Large doses without appropriate commas (1000000 units)
Intended meaning:
Misinterpretation:
Use instead:

A

Abbreviation: Large doses without appropriate commas (1000000 units)
Intended meaning: 1,000,000 units
Misinterpretation: Incorrect 0 count leading to incorrect dose given
Use instead: Use commas or write it out i.e. 1 million units

56
Q

Abbreviation: MgSO4
Intended meaning:
Misinterpretation:
Use instead:

A

Abbreviation: MgSO4
Intended meaning: Magnesium Sulfate
Misinterpretation: Morphine sulfate
Use instead: Use complete drug name

57
Q

Abbreviation: MS, MSO4
Intended meaning:
Misinterpretation:
Use instead:

A

Abbreviation: MS, MSO4
Intended meaning: Morphine sulfate
Misinterpretation: Magnesium sulfate
Use instead: Use complete drug name

58
Q

Abbreviation: X3d
Intended meaning:
Misinterpretation:
Use instead:

A

Abbreviation: X3d
Intended meaning: Times three days
Misinterpretation: Times three doses
Use instead: for three days

59
Q

Abbreviation: / (slash mark)
Intended meaning:
Misinterpretation:
Use instead:

A

Abbreviation: / (slash mark)
Intended meaning: Separates 2 doses or means ‘per’
Misinterpretation: Mistaken for number 1
Use instead: Write ‘per’ to separate doses

60
Q

Abbreviation: >and<
Intended meaning:
Misinterpretation:
Use instead:

A

Abbreviation: >and<
Intended meaning: Greater and less than
Misinterpretation: Mistaken for opposite meaning
Use instead: Write out greater or less than

61
Q

Clinical Preparation for Giving Medications

Drug card required for each medication the patient is receiving with the following components:

A
  1. Drug name (generic and trade)
  2. Purpose of drug specific to patient
  3. Action of drug
  4. Side effects of drug (common ones)
  5. Adverse reactions of drug
  6. Nursing consideration (patient teaching, assessments such as labs, VS, food-drug interaction, drug-herbal supplement interaction)
62
Q

Sample Drug Card
Warfarin (Coumadin)

(Only what is pertinent to the patient)

A

Name: Warfarin (Coumadin)
Purpose: Prevention of further clot formation, patient developed DVT post-operatively
Action: Prolongs clotting by…
Side Effects: Bruising, hematoma, bleeding…
Adverse Effects: Hemorrhage, hemorrhagic stroke, intracranial bleeding–> brain death
Nursing Considerations: Check PT and INR prior to giving medication and notify physician if greater than…, assess patient for bleeding, bruising, monitor H&H, maintain dietary restrictions (limit green leafy vegetables, no cranberry juice, etc…)

63
Q

Checks and Balances in the Process of Giving a Medication

A

FIRST CHECK (Pyxis)
1. Read MAR and remove medication from patient drawer or Pyxis.
2. Compare medication label to MAR.
3. If dose does not match, determine if dose calculation is needed.
4. Check medication expiration date.
SECOND CHECK (Cup/Unopened)
1. While preparing the medication, look at medication label and check against MAR.
2. Preparation of medication may include drawing up, pouring, or placing unopened pill package in medication cup.
THIRD CHECK (Beside before opening)
1. Recheck label on container before returning it OR
2. Check label on medication against MAR before opening package at bedside.
***COMPUTERIZED MEDICATION ADMINISTRATION SYSTEMS INCORPORATE THESE
CONCEPTS.

64
Q

SPECIFIC MEDICATION CHECKS

ALWAYS double check with another licensed person the following medications:

A

Anticoagulants
Insulins
Digoxin
(Hospital protocols vary and other medications may be included.)

65
Q

Site Cods

A 
A. Right upper outer quadrant gluteus 
B. Left upper out quadrant gluteus 
C. Right outer aspect arm
D. Left outer aspect arm
E. Right ventrogluteal 
F. Left ventrogluteal 
G. Avdomen 
H. Right thigh 
I. Left thigh
66
Q

Assessments prior to medication administration:

A
  1. Allergies to any medications
  2. Patient ability to swallow (PO meds)
  3. Presence of nausea, vomiting, diarrhea that would interfere with absorption of medication (PO, NG, GT, rectal suppository)
  4. Specific drug actions, side effects, interactions, adverse effects
  5. Patient knowledge/learning needs regarding medication
  6. Perform appropriate assessments (labs, VS, etc.)
  7. Determine if assessment data influences administration of medication (should it be given or held)
67
Q

Process of administering medication

A
  1. Identify patient using 2 qualifiers
  2. Inform the patient
  3. Administer the medication(s) using the first 5 rights (right patient, drug, dose, route, time)
  4. Provide adjunct interventions as needed (i.e. correct position for injection)
  5. Record medication administered
  6. Evaluate patient response to the medication
68
Q

NGT/Gastrostomy Tube Medication Administration

A 
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
69
Q

Syringe Types

1 mL

A

Tb syringe with or without needle attached

70
Q

Syringe Types

Insulin

A

100 unit, 50 unit, 30 unit sizes with needle attached

71
Q

Syringe Types

3 mL

A

with and without needle attached

72
Q

Syringe Types

5 mL (with and without needle attached)

A

with and without needle attached

73
Q

Other syringe types…

A

10mL
20mL
60mL
60mL piston tip or catheter tip used for GT/NGT medication administration

74
Q

About Needles:

1.

A

Gauge: from #14-29 (the smaller the needle number, the larger the size of the needle)

75
Q

About Needles:

2.

A

Hub: part attaching to syringe

76
Q

About Needles:

3.

A

Cannula/shaft: length of needle from 3/8 to 2 inches

77
Q

About Needles:

4.

A

Slant or bevel: slanted part at tip of needle

78
Q

INTRADERMAL INJECTIONS

A

Syringe size: 1 ml TB syringe
Needle gauge: #25-27
Needle length: ¼-5/8 inch long
Solution amount: 0.1 ml (usually)
Injection sites: R & L scapulas, R & L upper chest, R & L forearms
Common uses: TB testing, allergy testing
How administered Just under skin, bevel side up (will see weal)

79
Q

SUBCUTANEOUS INSULIN

A

Syringe size: 100 unit, 50 unit, 30 unit (orange needle cap)
Needle gauge: #25-29
Needle length: 3/8-5/8 inch
Solution amount: Determined in units, but never more than 1 ml
Injection sites: Abdomen, upper thighs, upper back below scapulas, posterior of upper arms, posterior hips
Common uses: Insulin, which there are several types
How administered: Normal adult size 45 degree angle
Large adult size 90 degree angle
Special considerations: Rotate sites, give at room temperature, do not aspirate

80
Q

SUBCUTANEOUS INJECTIONS

A

Syringe size: 1 ml (TB syringe)
Needle gauge: #25-27
Needle length: 3/8-5/8 inch
Solution amount: 0.5-1 ml, varies but not more than 1 ml
Injection sites: Abdomen, upper thighs, upper back below scapulas, posterior of upper arms, posterior hips
Common uses: Insulins, vaccines, epinephrine, heparin, low molecular weight heparin
How administered: Normal adult size 45 degree angle
Large adult size 90 degree angle
Special considerations: With LMW heparin and heparin, do not aspirate, do not massage, do rotate sites

81
Q

INTRAMUSCULAR INJECTIONS

A

Syringe size: 3-5 ml (3ml most common)
Needle gauge: #20-25 gauge (varies with site being used, size of person and viscosity of injectate
Needle length: 1-2 inches (varies with site used and size of person
Solution amount: 0.5-3ml (varies with site)
Injection sites: Deltoid, ventrogluteal, vastus lateralis, rectus femoris
Common uses: Narcotic and NSAIDs, vitamins, antibiotics
How administered: Use Z track method, 90 degree angle
Special considerations: Deltoid site: 0.5-1 ml, #23-25 gauge, 1 inch
Obese adult may need 2 inch needle
Emaciated adult: may need 1 inch needle
Very viscous solution: may need larger size needle

82
Q

PREPARING MEDICATIONS FROM AMPULES:

List the steps for preparing a medication from an ampule:

83
Q

PREPARING MEDICATIONS FROM VIALS

List the steps for preparing m
edications from a single dose vial and the variation for preparing from a multi-dose vial:

84
Q

PREPARING INSULIN

List the steps for preparing insulin and the variations for mixing 2 types of insulin in one syringe:

85
Q

Types of Insulin:

***Regular (Humulin R, Novolin R, regular insulin)

A

SOLUTION: Clear

ONSET: 1/2-1 hour

PEAK ACTION: 2-3 hours

DURATION: 5-7 hours

86
Q

Types of Insulin:

***Insulin aspart (Novolog)

A

SOLUTION: Clear

ONSET: 15 minutes

PEAK ACTION: 40-50 minutes

DURATION: 3-5 hours

87
Q

Types of Insulin:

***Insulin lispro (Humalog)

A

SOLUTION: Clear

ONSET: <15 minutes

PEAK ACTION: 1/2-1 hour

DURATION: 3-4 hours

88
Q

Types of Insulin:

***Insulin Isophane NPH (Humulin N, Novolin N)

A

SOLUTION: Cloudy

ONSET: 1-2 hours

PEAK ACTION: 4-12 hours

DURATION: 18-24 hours

89
Q

Types of Insulin:

Insulin Protamine Zinc Lente

A

SOLUTION: Cloudy

ONSET: 1-2 hours

PEAK ACTION: 8-12 hours

DURATION: 18-24 hours

90
Q

Types of Insulin:

Insulin Zinc suspension Ultralente

A

SOLUTION: Cloudy

ONSET: 4-8 hours

PEAK ACTION: 16-18 hours

DURATION: 36 hours

91
Q

Types of Insulin:

Insulin Zinc suspension prompt

A

SOLUTION: Cloudy

ONSET: 1/2-1 hour

PEAK ACTION: 4-7 hours

DURATION: 12-16 hours

92
Q

Types of Insulin:

***Insulin glargine (Lantus)

A

SOLUTION: Clear

ONSET: Continuous effects

PEAK ACTION: Continuous effects

DURATION: 10 1/2-24 hours

Uncategorized (2 decks)

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