Notes chapter 17 Flashcards
Millieqivalent ?
Refer to the concentration electronically certain volume of solution express as milliequivalent per liter (mEq/L)
Body surface area is defined ? .
as the total area exposed to the outside environment
dimensional analysis?
method (also called factor labeling or the label factor method )
Dimensions analysis following three ?
1.Drug label
2.Conversion
3.Drug order
PROBLEM: The physician orders 40 mg of furosemide(Lasix). An ampule (small glass container that usually contains a single dose of a solution) of furosemide labeled “Lasix 20 mg/mL” is available.?
Example 1 pg 430
PROBLEM: The physician orders 15 mg of diazepam(Valium). Valium tablets that contain 5 mg / tablet are available.?
Example 2 430
Order calls for acetaminophen (Tyleno) gr xv, PO, prn (15 grains, by mouth, as needed). AVAILABLE:200 tablets -325MG each ?
Example 3
PROBLEM: The average adult dose of a medication is 25 mg. What is an appropriate dose of this medication for a child who weighs 40 Ib?
Example 4
PROBLEM: The average adult dose of a medication is 25 mg. What is an appropriate dose of this medication for a child who is 22 months of age?
example 5
PROBLEM: Trey, an 8-year-old, weighs 60 lb and is 51 inches tall. His body surface area (as determined with the nomogram in Fig. 17.1) is 1.0. If an adult dose is 50 mg, how many milligrams should Trey receive?
example 6
Pharmacology?
is the study of drugs (medications) and their action on the living body.
Lethal dose?
The amount of a drug that causes death
A metabolite?
is a substance produced by metabolic action,which results in the breakdown of the drug
A drug that builds up in the body is said to have a cumulative?
(increasing by increments)
-effect, which sometimes leads to toxic (harmful) or even lethal (deadly) outcomes tor the patient
stat?
-are planned to manage an emergency patient conditions
-they are to be complete before order
-is one time only dose
It is important for the nurse to be familiar with therapeutic ?
(beneficial) dosages of frequently used drugs to administer doses of medication competently to patient ?book
When one drug alters the action of another drug, it is called?
a drug interaction (a modification of the effect of a drug when administered with another drug).
When one drug increases the action or the effect of another drug, it is called ?
potentiation of the drug, or synergism.
Compatibility?
-is the quality or state of harmonious coexistence.
-Drug compatibility is the ability to administer medications together easily without any difficulty for the patient.
A drug that produces a predictable response at the intended site of action is called?
agonist
(its tell the cell to bind to receptor increase the function bind receptor /attract and encourage molecules bind cell)
is a drug that blocks the action of another drug.
- drugs are used to counteract the effects of a previously given drug
. Anatagonist
(-anatagonist is going to bind to the receptor prevent or block any molecules bond with receptor (prevent something to happen)
-A common antagonist prescribed is naloxone hydrochloride (Narcan) It is given when a person has received too much of an opioid medication,such as morphine sulfate.
An idiosyncratic?
reaction to a drug results from the individual’s unique hypersensitivity to it.
A reduced response to a drug over time is called a drug ?
tolerance
-The patient who has developed tolerance to a drug requires a larger dose of the drug to achieve the same effect that a smaller therapeutic dose once produced.
adverse drug reaction ?
(a harmful, unintended reaction to a drug administered at a normal dosage), drug hypersensitivity, or intolerance to the drug
Use the resource to determine the therapeutic dosage?
- indications for use of the drug,
-contraindications (conditions in which the drug should not be used), -
-side effects,
-available formulations and routes of administration,
-generic and trade names, and information regarding how to manage overdoses.
The following factors may affect how patients respond to medication?
-age
-weight
-gender (Women tend to have a higher percentage of body fat than men. Because some drugs are fat soluble ,women with high body fat percentage)
-Ethnicity
-physical conditions
-psychological status
-environment temperature
-amount of food in the stomach
-route of administration
Influence of Aging on Drug Actions in Older Adults Oral Cavity ?
-Loss of elasticity in oral mucous,which becomes dry and easily abraded
Influence of Aging on Drug Actions in Older Adults Esophagus?
Delayed esophageal clearance because of weakened contractions and failure of lower esophageal sphincter to relax
Influence of Aging on Drug Actions in Older Adults Stomach?
Decrease in gastric acidity and peristalsis
Influence of Aging on Drug Actions in Older Adults’ Large Intestines?
Reduced colon muscle tone; loss of defecation reflex; decreased intestinal blood flow
Influence of Aging on Drug Actions in Older Adults Skin and Vascular System ?
Reduced subcutaneous skinfold thickness in extremities (less body fat); reduced elasticity in skin and vascular system; increased fragility of blood vessels
Influence of Aging on Drug Actions in Older Adults Liver?
Reduced liver size; decline in hepatic blood flow
Influence of Aging on Drug Actions in Older Adults Kidneys?
Reduced glomerular filtration; decreased tubular function and renal blood flow
Drugs enter through the central route?
Are absorbed within GI tract
Forms of enter medications Often mixed with a liquid (diluent) before administration?
Powers
Round, solid drug form that must break down into solution form (dissolution) in the stomach?
Pills
Round, spherical, or other-shaped forms that dissolve in the stomach? .
-tablets a
-Scored tablets are intended to allow the tablet to be broken in half.
-Enteric-coated tablets are encased by a coated shell that keeps the tablet from being absorbed in the stomach; absorption takes place in the intestines. Enteric pertains to the small intestine
are powders or pellets enclosed in a gelatin- like, elongated, spherical form; the medications?
Capsules
are sweet mucilage types of tablets that dissolve in the mouth to release medication.?
Capsules (lozenges or torches )
Drugs mixed with a lubricated substance molded to insert into body cavities such as the rectum, vagina, urethra; absorption occurs after the substance melts at body temperature?
Suppositories
The following are terms used to describe how medications are administered eternally?
PO: By mouth (oral) Enema: By rectum
Suppository: By rectum, vagina, or urethra
Tubal: By nasogastric, gastrostomy, or jejunostomy tube
pulverized?
(crushed to a powder) with the use of crushing device for some patients
Applied to the mucous membranes of the mouth?
1.Sublingual ( under the tongue )
2.Buccal ( in the cheek )
An ointment is an ?
oil -based semi solid medication the applies it to the skin or a mucous membrane
-holds a total volume of 1 mL
- It is used to give volumes of medication of 1 mL or less, such as for giving small doses of epinephrine , intradermal skin tests, and subcutaneous medication?
-tuberculin syringe is measured in milliliters
- it is calibrated in units with -Most insulin is made in the concentration of U100. ?
Insulin syringe
-It’s used for most IM injections -given volume medication of 1 to 3mL ?
The 3 mL syringe is calibrated in milliliters or cubic centimeters ( cc )
The opening at the needle’s beveled tip reveals the?
lumen ( the inside of the hollow shaft )
The diameter of the lumen determines?
-gauge (a standard or scale of measurement) of the needle
Intravenous needles?
Two items made especially for IV use are the over- the-needle catheter and the winged type (or butterfly ) needle is useful in administering IV fluids on a short-term basis
An IM injection involves inserting a needle into the ?
-muscle tissue to administer medication -Because muscle tissue has a large blood supply , IM medication is absorbed faster than medication administered subcutaneously
Ventrogluteal site ?
-The gluteal sites are the ventrogluteal and the dorsogluteal .
The ventrogluteal site is located by means of three landmarks?
the greater trochanter, the anterior iliac spine, and the iliac crest (the hip bone)
Locating Sites for Intramuscular Injections VENTROGLUTEAL SITE?
- Positioning the patient on either side, with the knee of the upper leg bent and the upper leg slightly ahead of the bottom leg is also acceptable for the patient to remain supine, lie on side, or lie on abdomen. Instruct the patient to relax the muscles where you are placing the injection.
Locating Sites for Intramuscular Injections VASTUS LATERALIS SITE?
Position patient lying supine or sitting with site well exposed. If the patient is supine, have the patient flex knee on side where medication will be given
Locating Sites for Intramuscular Injections DELTOID SITE?
- Position patient sitting or lying down. Expose the upper arm and shoulder; remove any tight-fitting sleeves, rather than rolling them up.
Use the Z - track method for injecting medications ?
-that may be irritating to the tissues-Z
-track IM administration, the medication is sealed deep within muscle tissue
-reduces the chance of staining or tracking of the medication back into the tissue as the needle is withdrawn.
-Select an IM site in large muscles , such as those in the ventrogluteal site.
An intradermal injection is the introduction of a ?
hypodermic needle into the dermis for the purpose of instilling a substance such as a serum , vaccine , or skin test agent
-Do not aspirate from the site when performing an intradermal injection .
-25-gauge
3/8 -to 5/8 inches
What degree
- Intramuscler
- Subcutanous
- Intradermal
1.90
2.45 or 90
3.15
Subcutaneous injections?
Administer insulin , heparin , enoxaparin ( Lovenox ) , dalteparin ( Fragmin ) , epoetin alfa ( Epogen ) , and filgrastim ( Neupogen ) by the subcutaneous route .
-Inject these types of medications into the loose connective tissue between the dermis and the muscle layer
-1/2 to 5/8 inches
25-gauge
An intermittent venous access device ?
(commonly called a saline lock, previously called a heparin [ hep] lock )
Intermittent infusion (or piggyback)?
IV piggybacks are drug infusions that are given at intervals, such as every 6 hours (q 6 hr)
Continuous infusions?
Medication is added to a bag of IV fluid and infused with the IV fluid.
Electronic IV pumps?
Pumps regulate the flow rate of IV infusions.
Patient-controlled analgesia (PCA) ?
-is a drug-delivery system that dispenses a preset
-IV dose of an opioid analgesic into a patient’s vein when the patient pushes a button that is connected to
(is a type of pain management that lets you decide when you will get a dose of pain medicine. I)
A volumetric chamber?
consists of IV tubing with a chamber that holds a prescribed amount of fluid; it is separate from the drip chamber.
drip factor?
(an apparatus that is used to deliver measured amounts of IV solutions of specific flow rates that are based on the size of drops of the solution).
Reactions range from a mild rash to anaphylactic shock?
(a severe, life-threatening hyper-sensitivity reaction).
The metric system?
-volume-liters
-weight-grams
-length-meters
The apothecary system ?
Volume
-fluid ounce,pint,quart
Weight
-grains,ounce,pound
The household system?
-teaspoon,tablespoon,ounce,cup
Young’s rule?
Give formula
-A rule for calculating the dose of medicine correct for a child by adding 12 to the Child’s age , dividing the sum by the child’s age, then dividing the adult dose by the figure obtained.
Clark’s rule?
Give formula
-–equation is defined as the weight of the patient in pounds divided by the average standard weight of one hundred fifty pounds multiplied by the adult dose of a drug equals the pediatric medication dose, as is
-demonstrated below: (Weight* divided by 150 lbs.) x Adult Dose** = Pediatric Dosage
Fried’s rule?
Give formula
–a method of estimating the dose of medication for a child by dividing the child’s age in months by 150 and multiplying the result by the adult dose
Body surface area?
Give formula
–In physiology and medicine, the body surface area (BSA) is the measured or calculated surface area of a human body
-For many clinical purposes, BSA is a better indicator of metabolic mass than body weight because it is less affected by abnormal adipose mass.
Pharmacology ?
-the study of drug and their action on the living body
Phases of drug action?
-–Pharmaceutical phase
–Pharmacokinetic phase
-Pharmacodynamic phase
Medications absorption and excretion?
Liver-metabolizes drug
Kidneys-eliminate metabolites of drug from the body
Medications produce two general types of actions in a patient’s body?
local and systemic
-A local action by a drug produces an effect only in the area where the drug has been placed .
-A systemic action affects the entire because the drug enters the patient’s systemic circulation
Medication Orders ?
The nurse is legally and ethically responsible for ensuring that the patient receives the correct medication that has been ordered by the health care provider
Drug distribution on systems?
*Unit dose system
-The unit-dose system typically is used with a “portable medication cart that contains drawers. A unit dose is the ordered amount of medication that the patient is supposed to receive at a prescribed times
*Computer
-Computer controlled dispensing are combination of uni-dose and floor stock systems
Six rights of medications adminstrations?
*Right medication
*Right dose
*Right time
*Right route
*Right patient
*Right documentation
Joint Commissions Do not Use List?
*Health care facilities must have a list of abbreviations not to be used in documentation
–Must include those banned by The Joint Commission
Transcribing Orders?
*Verbal orders should be transcribed or entered into a computer, per facility policy
-Clarify unclear information with the health care provider
Controlled Substances?
*Include opioids, barbiturates, and other medications
*High possibility for abuse, addiction, or theft
*Must be kept in a secured area
INTRAMUSCULAR INJECTIONS?
*Ensure site is free of pain, infection, necrosis, ecchymosis, and abrasions
*Consider the location of underlying bones, nerves, and major blood vessels, and amount of solution to be injected
*Ventrogluteal site is preferred, but vastus lateralis and deltoid muscle can be used
Eye, Ear and nose Irrigation?
*Irrigations involve a gentle washing of an area with a stream of solution delivered through a syringe
*Medication instillation into eyes, ears, and nose
RECTAL MEDICATIONS?
-Suppository
-Enema
( injections of fluids used to cleanse or stimulate the emptying of your bowel)
-Douche
(A douche is a device used to introduce a jet of water to the inside of a part of the body so that it can be washed.)
-Cream,foam,jelly
from the manufacturing of the drug until the absorption of the drug in the patient’s body. Absorption occurs when the active ingredient of the drug enters the body fluids?
pharmaceutical phase:
the movement of the drug’s active ingredients from the body fluids into the patient’s system and to the site where the intended action of the drug takes place ?
The pharmacokinetic phase involves
the drug’s active ingredient interacts with the intended body tissues . The body’s cells respond to the action of the drug and change as the drug is metabolized ?
In the pharmacodynamic phase
Ensure that the health care provider’s order includes The following?
-Patient’s name (on the health care provider’s order
sheet)
-Patient’s date of birth
-Date and time of the order (usually on the left side
of the order sheet), written by the health care
provider
-Name of drug (may be brand name or generic name,
or both)
-Dosage of the drug, including dose size and frequency
(e.g.,”650 mg q 4hr prn” [i.e., every 4 hours as needed])
-Route of administration, as prescribed by the health care provider
-Signature of the health care provider
-Any special instructions regarding any aspect of administering the drug (e.g., 650 mg q 4hr i emperature >101°F”)
