Non parenteral Med Admin Flashcards
7 components of Medication Order
- patient name
- date time/ rx
- provider name/ signature
- type of medication
- dose of medication
- route of medication
- frequency of dose
Where do you usually see reason for med?
only in long term care, not acute
Types of med orders (4)
- written
- verbal
- telephone
- protocols
Help prevent error with telephone and verbal?
write down, read back
safest type of RX
written
When do you use verbal order?
emergency
example of protocol RX
- set protocol to give nitro if patient has chest pain
- NURSE CAN INITIATE
Routine rx (frequency)
-give until you have an order to stop
one time only rx (frequency)
-use with surgery frequently
stat rx (frequency)
-administer this medication immediately because the patient is in dire straights
now rx (frequency)
- sense of urgency but it is not life or death
ex: give laxative to get patient to poop so they can be D/C
PRN rx (frequency)
as needed w/in a TIME INTERVAL + INDICATION stated in order
-can only give PRN med for reason stated in order
Who checks medication order after provider writes it?
pharmacy
Who checks medication order after pharmacist?
RN
What info do you need to know in order to give medication safely?
- action of drug
- contra/indication
- drug interactions
- w/ food/sitting up
- normal dose range
- normal route
- adverse effects
- how to check for therapeutic effect
- patient teaching
What do you do to patient before giving med?
Physical assessment
What are you considering in physical assessment before giving med?
- patient alert?
- able to swallow?
- need to crush? can crush?
- NPO?
- ability to follow instructions
- GI motility
- Muscle mass for IM injections
- water @ bedside
- VS***
What VS to check
B/P (HTN)
Pulse (cardiac med)
Pain rating (pain med)
Temp (antipyretic)
Admin time window
30 min before and after due
-daily med = maybe more room in in admin window vs med due every 4 hours
Labs and med admin
- check prior to admin
- know which labs to check for which meds
Where do you look for meds?
- mobile cart
- automated medication dispensing system (pyxis)
- self- administration
What is special about controlled substance medication storage and disposal?
- med count before and after taking dose that is recorded
- wasted medications must be WITNESSED and DOCUMENTED by another nurse
- inventory done by 2 nurses at set intervals
First step in medication preparation
wash hands
Where do you assemble meds?
in medication room/ mobile cart
When you remove the meds from the drawer what do you check?
- drug expiration date
- 5 rights against MAR - not what you copied from the MAR
When do 3 checks against MAR occur
- before preparing med
- after preparing med
- at the bedside
5 rights
drug, dose, patient, route, time
Why do most med errors occur?
failing one of the 5 rights
Who do you ask to verify name and DOB is patient is nonverbal?
-ask family member in room
5 rights for Drug
- compare drug to MAR
- not expiration date
- know indication
- know nursing considerations
5 rights for Dose
- validate calculations of divided doses with another urse
- check high alert medication with another nurse
- know the usual dose and question dose outside of safe range
5 rights route- what do you do if change of route is needed?
request new order from provider
When administering med when do you take medication out of packaging unless it needs to be removed to prepare it?
bedside
Considerations for syringes- what do you do if not in original packaging?
LABEL if not in original container before removing from emd room
What to verify with patient before admin?
- identity
- 5 rights
- allergies
- education
What do you tell patient before giving med about the med?
- name of med
- dosage
- indication
- pertinent patient teaching
What happens in post administration
- documentation
- monitor effect
When do you document med given?
as soon as possible AFTER med is given
What to document in med administration
- time administered
- client response
- med given
- dose
- route
- if not given or refused - put reason why
- prn meds - response
- 1st time given - response
2 times it is vital to chart response to medication
PRN or first time given
What do you do when you make a med error?
1= patient assessment (v/s)
- notify provider, charge nurse/manager
- incident report
Most common medication route
Oral
What kind of oral meds can NEVER be crushed?
- sustained release
- enteric coated
- controlled substance
Can half doses of capsules be given?
No and they cant be crushed but they can be opened and mixed into food
> ____ pills to make a dose should use caution
3
Can you leave before patient has taken meds?
No, must watch take all meds
types of oral meds
capsule time released elixir syrup liquid tincture powder suspension troche
How do you measure liquids?
eye level
How do you pour liquid med?
so it doesnt spill on label
Syringes for liquid oral meds?
- can draw up in syringe
- only administer with oral syringe
Buccal oral med
place med b/w cheek and teeth to let dissolve
Sublingual oral med
dissolve under tongue
Which kind of oral med is exempt from first pass effect?
Sublingual
Lozenge
dissolve in mouth
Where do you use patch based medication?
-apply to nonhairy intact skin
Special considerations for nurse with topical medication
- take care not to touch topical medication with ungloved hands
- essential to wear gloves to administer
When applying a patch to patient make sure….
previous dose is removed
How to administer opthalmic med
- client look toward cieling
- pull down skin of lower eyelid
- instill medication in conjunctival pouch
- clean/dry from inner to outer canthus
Opthalmic meds: make sure not to touch…
any part of eye with dropper
How to prevent systemic circulation of opthalmic med?
place hand over inner canthus
-only necessary for med that cant go to systemic circulation
Temp for otic medication
room temperature
Patient position for otic med
sidelying
Adults vs children ear canal straightening
AdUlts: pinna UP and back
chilDren <3 : pinna DOWN and back
What do do after otic med administered?
-place cotton ball in ear and lay on side for 5-10 minutes
How to administer nasal med
- patient head down and forward and sniff in
- want med to go to nasal mucosa
Meter Dose Inhaler use
- breathe out
- inhale slow and steady while pushing med
- hold breath
- exhale slowly
How long to wait b/w doses for inhalant?
~1 minute
MDI spacer
chamber attached to end of inhaler that assists the patient in receiving a higher % drug with each inhale
Nebulizer
type or inhaled medication
-aerosolized med given by hand held device or face mask
How many pills to crush at once for enteral tube?
1!
Empty tummy and continuous tube feed
-stop tube feed 15-30 min prior/after dose
Before giving enteral med in tube always check
tube placement and flush with water
When to flush?
before med, after med, and final flush
Suction NG tube and meds
-turn off suction, give med, wait 30 min before turning on suction
Patient position for vaginal medication
dorsal recumbent or Sim’s position
After vaginal med patient…
stay in position for 15-20 minutes to med can be absorbed
Patient position for rectal med
sims position
For vaginal and rectal meds it is important to provide
lubrication
How far to insert rectal med
-push in as far as you can and then it gets sucked in
After rectal med…
patient stay in position and “hold it” if for bowel fxn to increase effect of med
