Objective 1 Flashcards
1
Q
What are the steps of the nursing process?
A
Assessment
Diagnosis
Planning
Implementation
Evaluation
2
Q
look, listen, smell, read
A
assessment
3
Q
measurable data
A
objective data
4
Q
info given by pt or family
A
subjective data
5
Q
conclusion about pts problem
A
diagnosis
6
Q
goal set using data collected-care plan
A
planning
7
Q
giving appropriate care
A
implementation
8
Q
monitoring pts response to care given
A
evaluation
9
Q
medication is absorbed through mucosa of the GI, lg or sm tract
includes oral, rectal, or nasogastric tube admin, sublingual and buccal
A
enteral
10
Q
medication is injected directly into dermal, subcutaneous, or muscular
A
parenteral
11
Q
creams, pastes, powders, lotions, gels, patches, buccal, sublingual, or inhalation admins
A
topical
12
Q
what are the forms of an enteral medication?
A
capsule, lozenges, tablets, elixirs, emulsions, suspensions, syrup, suppository, oral soluble wafers
13
Q
what are the pros to enteral medication?
A
safe, convenient, cheap, and can be easily reversed if given too much
14
Q
what are the cons to enteral medication?
A
slowest, least dependable
15
Q
where can a parenteral medication be injected?
A
intradermal, subcutaneous, intramuscular, intravenous
16
Q
what are the pros of parenteral medication?
A
fast, convenient with sick pts
17
Q
what are the cons to parenteral medication?
A
increase risk of errors, can cause infection/nerve damage, reverse of effects make take longer, effects can wear off quickly
18
Q
occurs just under the top layer of skin, slow absorption; can usually only give 0.01-0.1ml of fluid per site
A
ID or intradermal
19
Q
administration into the subcutaneous layer of the skim; only 0.5-1.0ml of fluid per site
A
SC or subcutaneous
20
Q
administration into the muscle; faster absorption; rich blood supply; only 1.0-3.0ml of fluid per site
A
IM or intramuscular
21
Q
one of the fastest way to admin meds; goes directly into the blood stream via the vein; usually ordered in small doses
A
IV or intravenous
22
Q
small, single or multiple dose glass or plastic containers; can have solution or powder
A
vials
23
Q
contain one dose of medication in a small, breakable glass container
A
ampules
24
Q
patch, gradually absorbed for systemic results delivers a constant blood concentration
A
TD or transdermal
25
upper respiratory tract, local effect to the lungs
inhaled
26
all drugs (expect most dangerous) stored on nursing unit in stock containers
floor/ward stock system
27
what are the advantages of a floor/ward stock system?
most drug readily available
fewer inpatient prescription orders
minimal return of meds to pharmacy
28
what are the disadvantages of a floor/ward stock system?
potential for med error
danger of unnoticed drug deterioration
chance of jeopardizing pt safety
med misuse
economic loss
storage problems on nursing units
29
Med order is sent to pharmacy where it is loaded
into system by pharmacist
Some systems you have to scan the pt’s wristband
and a barcode on the med and then an automatic
notation is made in electronic patient records
Security required for access
computerized or automated dispensing system
30
what are the different types of computerized or automated dispensing system
stocked cart with meds delivered to unit from pharmacy
drug storage unit is located on unit with pharmacist coming to fill it
31
what are the advantages of a computerized or automated dispensing system?
Provides detailed listing of all medications
administered to pt. and by whom and what time
(tight drug control)
Reduces time for nurses
Dec. Errors
Tight drug control
32
what are the disadvantages of a computerized or automated dispensing system?
costly
nurse is highly dependent on pharmacist accuracy and special equipment
33
Uses single-unit packages of drugs &
dispenses these to fill each required dose as
ordered (May include all drugs pt receives at
one time)
Each packet labeled: generic name,
brand(trade) name, manufacturer, lot
number & expiratory date
Refilled q24h
unit dose system
34
what are the advantages of a unit dose system?
Prep time for nurses drastically
Pharmacist has profile of all meds
pt is taking
drug errors/ checking of
dosage
Less waste/Less inappropriate use
Safest and most economical
35
what are the disadvantages of a unit dose system?
Someone else prepared
medication
Delays starting meds if
no stock is on unit
Requires presence of
pharmacist at hospital -
expensive
36
Medication orders are sent to the pharmacy
where an individual box or bottle is sent for
each drug
Container may hold a 3-5 day supply of the
drug
Stored in a cabinet at the nursing station
individual prescription order system
37
what are the advantages of a individual prescription order system?
review of prescription by
both pharmacist and nurse, less chance of
drug misuse, smaller drug inventories
needed, medications are available for stat
or PRN use
38
what are the disadvantages of a individual prescription order system?
review of prescription by
both pharmacist and nurse, less chance of
drug misuse, smaller drug inventories
needed, medications are available for stat
or PRN use
39
Ordering, dispensing, safe-keeping and
record-keeping controlled by Narcotic Control
Act
* Kept in locked cabinets on all nsg units
* Unit doses
* Charge nurse responsible for key
* Inventory sheet to be signed every time
someone receives a narcotic
* Any discarding – need 2 nurses signatures
narcotic control system
40
Describes drug’s chemical composition & molecular structure
Not capitalized
Used by chemists
Not as common
chemical name
41
Most common name, used by drug
manufacturer
Same in all countries
Not capitalized
Students are encouraged to use this name
generic name (nonproprietary name)
42
Name drug marketed under, usually followed
by trademark symbol
Many trade names used by different
manufacturing companies
Easier for consumer to spell & pronounce.
1st. letter is capitalized
Brand/Trade name (proprietary name)
43
may occur when written or electronic orders
are not possible b/t the prescriber and the nurse.
telephone or verbal order
44
what must a nurse include when receiving a telephone or verbal order?
1. Write the order on the doctor’s order sheet/paper
2. Repeat the order back to the prescriber for verification (document this action)
3. Name of nurse and prescriber are included
4. Prescriber must countersign the original order at a later time (usually within
24hrs)
45
what are the 4 categories of medication orders?
standing order
single order
PRN order
46
Drug will be administered until discontinued or for a certain number of
doses
* All agencies have policies that automatically cancel an order after a certain
# of days passed unless it is reordered
* Can be prewritten and signed by HCP to be used at nurse discretion
standing order
47
One time order to be given at a specified time
including stat and now orders
single order
48
Used on emergency basis
To be given IMMEDIATELY (within 30 mins of
order being written) and only once
stat order
49
Single (one time), to be given within 60-90
mins of being ordered
now order
50
Means administer if needed “as needed”
or “as required”
Allows nurse to judge when med should
be administered
Based on pt’s need & when it can safely
be administered
PRN orders
51
what are the components of a medication order?
1. Patient’s full name
2. Date and time the order was written
3. Drug name (generic or brand)
4. Dose
5. Route of administration
6. Time & Frequency of administration
7. Signature of prescriber
And sometimes includes:
* Duration of order
* IV meds: rate of flow, method of delivery—IV push or
continuous infusion 35
52
Nurse interprets the written order
Will determine using professional judgement (assessment) if the order is appropriate
Consider: what drug is being ordered? why is it being ordered? is it an appropriate dose? does the patient
have an allergy?
If discrepancy or concerns noted consult with prescriber and/or pharmacy
Verification
53
Once order is verified and okay to give, the nurse will note or sign the Dr.’s order and transfer it to the
patient’s profile / Medication Administration Record
A carbon copy of the Dr’s order sheet is sent to pharmacy (unless institution is using an electronic order
system, and most are now)
Black ink for transferring
Transcription
54
what are the 10 rights of medication admin?
Right Drug
* Right Dose
* Right Time
* Right Route
* Right Patient
* Right Reason
* Right Documentation (obj 1.8)
* Right Evaluation
* Right Education
* Right Refusal
55
Ensure spelling (can be ordered by generic or tradename)
* check expiry
* Drug labels MUST be read @ least THREE times
Right drug
56
what are the 3 ways to check a drug before you admin it?
1.Before removing drug from shelf/Cart
2. Before preparation or measuring the prescribed dose
3.Before replacing medication back on shelf or before opening unit
container or just before opening the medication at the time you give it to
the client
57
Order should say when it is to be given; ensure it is the right
time (recall STAT and NOW orders)
* 30 mins either side of the time
* Influenced by:
* Standard abbreviations that specify the times
* Standardized adm times
* hospital policy
* PRN Meds
* when given last & specified time interval has passed
Right time
58
drug dose ordered against the range specified in reference books
* When a dose is outside the normal range for that drug, it should be
verified before administration
right dose
59
what should you consider for the right dose of a drug?
Renal/ hepatic (kidney/liver) function
* Age: Pediatric & geriatric patients
* Health Status/Illness: nausea & vomiting
* Dose forms
60
Order should clearly state
how the drug should be given
* Specified by order: PO, IV, IM,
Subcut, Gtube...
* Never substitute one form for
another unless order for
change is obtained from
physician!
right route
61
ALWAYS Identification Bracelet and ask
pt. to state 2 identifiers
* If pt has no bracelet have someone who is
familiar with patient confirm identity
* Also check for allergies
right pt
62
the nurse must ensure that the medication is being given for the
right reason
* When uncertain, they should always refer to the CPS, pharmacist,
or prescriber for clarification
right reason
63
what should documentation include?
Date & time
* Name of med.
* Dose, route, & site of administration.
* Adverse reactions
* Health teaching & understanding
64
ultimately are responsible for
ordering and directing the care; after assessing and diagnosing...they should have
knowledge of the medication in addition provide the necessary education
Physicians/Nurse Practitioners/Dentists/Podiatrists
65
reviews orders, prepares drugs and distributes them; responsible for
education of staff and patient, often the watchdog for interactions
Pharmacist
66
transcription of orders; assess need for
medication administration of medications and care; advocating; education and
observation
Registered Nurse/ Licensed Practical Nurse
67
are set to ensure hospitals and those who utilize nurses meet the
requirements necessary for the nurse to practice within and to their full scope of
practice
standards
68
are the guidelines or rules which nursing staff follow to ensure
safe competent care is being given
policies and procedures
69
regulates how federal government institutions collect, use, and disclose
personal information
privacy act
70
what do medication errors include?
Inaccurate prescribing
* Administering the wrong medication
* Wrong route
* Wrong time interval
* Administering extra doses, or
* Failing to administer a dose
71
what are the steps to prevent medication errors?
Follow the seven (ten) ‘Rights’ of medication administration.
2. Only prepare meds for one patient at a time.
3. If unfamiliar with a specific medication, refer to pharmacological resources.(pharmacy, lexicomp)
4. Be sure to do your ‘three’ safety checks, reading you labels 3 times!
5. Use at least two patient identifiers when administering the medication, specific to the patient.
6. Administer without disruption/distractions
7. Double check your calculations, and verify with another nurse.
8. Do not try to interpret illegible writing...clarify with prescriber!
9. Question unusually large or small doses.
10. Document all meds as soon as they are given.
When you have made an error, reflect....what went wrong? How could it have been prevented?
What was the context?
12. Take corrective action.
What to do should an error occur?... priority is the patient! Ask...does the error pose a risk to the
patient? If so, call physician to receive further instruction/orders. Notify nurse-in-charge,
document the incident in patient chart and institution’s reporting system/policies; all the while
continuing to monitor for any patient response/change in condition.
13. When repeated med errors occur within a work area... analyze the factors.
14. Attend any education re medication administration, in particular new medications.
15. Personal health and wellness as a nurse... rest is critical to your performance.
16. Involve and educate your patients in medication administration.
17. Follow agency policies/procedures (pay attention to alert warnings)
72
It is the thinking portion of the learning process and incorporates a
person's previous experiences and perceptions. We need to explore past
experiences/perceptions so that we are better able to assist the patient to
build new connections b/t prior and new experiences to make new meanings
cognitive
73
conduct that expresses feelings, needs,
beliefs, values, and opinions. Nurses must listen, be non-judgmental, be
cognizant of both verbal and nonverbal communication
affective
74
involves the learning of a new procedure or skill and is often
psychomotor
75
what is the nursing diagnosis related to learning needs and drug therapy might include?
Knowledge deficit (limited understanding of condition or medication...)
Impaired memory
Nonadherence (explore re cause for nonadherence)
Readiness for enhanced knowledge
Sleep deprivation
76
the teaching and learning process occurs as soon as a
learning need has been assessed and then identified in the patient, family,
or caregiver. Goals are discussed, outcome criteria are identified and time
frames are established.
It is imperative that goals and outcome criteria be realistic, based on patient needs, stated in patient terms, and include behaviors that are measurable, such as list, identify, demonstrate, self-administer, state,
describe, and discuss.
planning phase
77
Keep patient teaching on a level that is most meaningful to the individual.
* Follow teaching and learning principles when developing and implementing patient
education
* Be sure to control the environmental factors, such as lighting, noise, privacy, and
odors. Provide dignified care while preparing the patient for teaching, and respect
personal space. Eliminate or reduce distractions a/w social media, phones, radio, TV
* Make sure that all patient education materials are organized and at hand. If the
patient wears glasses or hearing aids, be sure they are made available prior to
education.
* Patients need to receive information through as many senses as possible, such as
aurally and visually (as with pamphlets, videos, diagrams), to maximize learning.
Information should also be at the patient's reading level and in the language the
patient speaks most fluently.
* Implement strategies to enhance patient education and reduce barriers to learning
implementation phase
78
of patient learning is a critical component of safe and effective
drug administration. To verify the success—or lack of success—of patient
education:
* ask specific questions
* request that the patient repeat information or give a return demonstration
of skills
* monitor patient's behaviour for adherence and/or complications,
inaccuracies
evaluation
79
is based primarily upon genetically passed down outward
appearances, among which skin color is a dominant, but not the sole,
attribute. We often attribute the outward appearance to reflect our inner
qualities , such as temperament and character. Yet, we know it is
impossible to know a patient’s genotype by either physical appearance
or health care history
race
80
the effect of a patient’s age, gender, size,
body composition, and other characteristics on the pharmacokinetics
(what the body does to the drug) of specific drugs. Factors contributing to
drug polymorphism may be categorized into environmental factors (e.g.,
diet and nutritional status), cultural factors, and genetic (inherited) factors.
drug polymorphism
81
what are the 3 steps of med reconciliation?
verification
clarification
reconciliation
82
To ensure ongoing accuracy of medication use these steps should occur on?
admission
after status change
pt transfer
with discharge
