Medications Flashcards
What are medication errors?
- anything that violates the 5 rights
- mislabeled medications
- incomplete delivery
- incorrect order
What do we do to prevent medication errors?
- POE systems, infusion pumps
- effective communication
- Barcode scanning
- IPE Simulation
What is barcode medication administration?
- scan the barcode on the bracelet
- scan the medication barcode to ensure the 5 rights
What is the culture of safety?
Reporting errors to identify issues, fix systems, and improve safety
What is Positive Culture?
a workplace that rewards employees for ceasing work that may be unsafe and encourages employees to be aware, identify, and address hazards asap to avoid potential risks
What are the concerns about medication interactions?
- some medications can interact with other meds
- rendering ineffective
What are the components of medication order?
- name of medication
- route
- dose
- frequency/time
- reason/purpose
- provider signature
What are the types of medication orders?
- PRN
- IV meds
- Scheduled/Routine orders
- One-time orders
- Stat orders
- Standing orders
- Electronic (EPIC)
- Verbal orders (only in emergency)
Pravastatin used for?
Hyperlipidemia
Glipizide used for?
Diabetes
Olmesartan used for?
HTN
Nexium used for?
GERD
What history should you ask a pt regarding medications?
Medication hxt, allergies, diet, family hxt
What should you include in a physical assessment of a patient receiving medications?
vitals, ability to swallow, skin assessment for allergic reaction, gastrointestinal motility, patient venous access, adequate muscle mass, body system assessment, assessment of knowledge and compliance
What is safe medication administration?
- check/interpret
- calculate right dose for adult vs children vs elderly
- tell the pt what you are giving
- assess the pt’s understanding and knowledge
- assess pt allergies and hxt
- administer according to the 5 rights
What are the 5/6 right rights of medication administration?
- right dose
- right route
- right pt
- right medication
- right time/frequency
- right documentation (includes time, route, dose, date, site, initials, and signature; document meds require 2 signatures; document therapeutic and side effects of meds)
- pt’s right to refuse medication (unspoken rule)
What are special considerations with children and elderly patients?
- ability to swallow
- dosage
- capacity to take medications (adherence)
- dilute medications with their favorite beverage
- crush pills, allow extra time
What are the principles of documentation?
- never record med before giving the med
- record only the med you give
- record on MAR asap
- record refused medication as such
- record positive, negative, and allergic effects of meds
What are unit dose medications?
- prepackaged medications
- prelabeled
- safe and cost-effective
- prepared by the pharmacy for individual pts
What are some high-risk medications?
- potassiums
- insulin
- heparin
- narcotics
What is a PCA?
Patient Controlled Analgesia (ex. “pain pump”)
What is a basal rate?
continuous rate (usually used for end-of-life patients)
What is a Bolus rate?
bolus or demand dose is the dose of medication delivered each time the pt presses the button
What pills cannot be crushed?
- ER meds (sustained/time-released meds)
- capsulated meds
- enteric coated meds
How do you pour a multi-dose med?
pour into med cap then into a cup; do not touch
What is the reconstitution of meds?
mixing a powdered medication
How much larger should the syringe be when giving a medication?
at least .5-1 cc larger than the amount of medication
What kinds of needles are best to use?
safety needles (with safety cap that slides up)
Where is subcutaneous medication given?
delivered in the subcutaneous layer for the purpose of a slow sustained released of medication
What are some meds we give SQ?
insulin, heparin, vaccines, some narcotics, and others
What are some areas for SQ injections?
- abdomen
- lateral aspect of upper arms
- anterolateral mid-thigh
- buttocks
What is the length and gauge of the needle for SQ medication?
a syringe with a short needle 1/2-5/8 inch; gauge 26-30, 25 common
Is regular insulin short or long-acting? What about NPH?
short-acting (regular insulin); intermediate (NPH)
What is the onset, peak, and duration of regular insulin and NPH?
- (reg insulin) onset 30-60 min, peak 2-3 hours
LOOK AT SLIDES
What syringe will you use to draw up insulin?
an insulin-specific syringe to administer (with an orange cap)
Insulin: 1cc = how many units?
100
Which insulin will you draw up first and second?
short-acting before long-acting
(clear before cloudy)
(reg insulin before NPH)
If you overdraw your insulin dose, what do you do?
start over
How would you verify the am dose of insulin?
verify with a second nurse
- two nurses independently check orders, medication, and 5 rights
What are the side effects of reg insulin and NPH insulin? When would you see them? What intervention would you employ?
- side-effect: hypoglycemia (during peak early day w/ reg insulin; during peak mid-day w/ NPH insulin)
- intervention: give a snack
What is Aspart (Novolog) an Lispro (Humulog)?
RAPID acting insulins
What is the onset, peak, and duration of Novolog and Humulog?
onset: 15 min
peak: 1-2 hrs
duration: 3-4 hrs
What is Glargine (Lantus)?
Long-acting insulin
What is the onset, peak, and duration of Lantus?
onset: 2-4 hr
peak: none
duration: 20-24 hrs
How long do you hold down a Novolog pen?
10 SECONDS
What is unfractionated heparin?
most potent form; IV form; given continuously (usually)
What is low molecular weight heparin?
anticoagulant with more predictable pharmacokinetics and anticoagulation predictability (ex. Levonox aka Enoxaparin)
What is the purpose of IM injection?
gets quickly absorbed via blood vessels in the muscular area
What size syringe, needle, and gauge is used for IM injection? adult vs children
needle: 20-23 gauge, 1-1.5 inch (adults); 22-27 gauge, 1/2-1 inch (children)
What is the angle at which you administer IM injection?
90 degrees
What are the sites for IM injections?
- ventrogluteal (hip)
- dorsogluteal (butt)
- rectus femoris (thigh)
- vastus lateralis (thigh)
- greater trochlear (upper thigh)
LOOK AT SLIDES
What is the preferred site for adults? for children?
ventrogluteal (adults); vastus lateralis (children)
What is the highest volume of IM injections given to adults?
3cc max (adults); exception is deltoids which is 1-2. ml
What is the highest volume of IM injections given to children?
LOOK AT SLIDES
What is Intradermal injection? name an example
between the layers of the skin; PPD test and allergy test
How much volume is given for intradermal injection?
0.1 ml (PPD) to 0.5 ml (allergy)
Bevel should be up or down when injecting intradermal injection?
up
