pod 3 Flashcards
why do we give meds by different ways?
Different absorption and different area (pink eye –> drops)
Sublingual & buccal
Bypass metabolism route
Start to work right away
Eye drops
Coach how to put it in themselves
Ointment or drops when ordered
Irritation and inflammation and pain assess before drops
Assess for contact lens
Warm wash cloth, told eye open, drop it in
Order needs to be clear, left or right or both, no irritation, no contact lens (test)
Ear
Kids usually
Need to look in the ear canal to ensure intact ear drum (before order)
Ear infection in kids – not uncommon for ear drum to rupture
Ear canal straight in kids (pull ear back and down)
Adults (pull back and up)
Lay down, turn ear up that give meds, pull up and back, drop in drops, cotton ball in to make sure the meds stay in place, keep them laying down for 5 mins
Nose
Decongestants, vaccines (flu, covid, narcan)
Nose bleeds = cocaine because it does vasoconstriction
Plug one nostril, spray, inhale at same time
Goes into sinuses
Swab = nasopharyngeal cavity
TEST QT = NARCAN & VACCINES
Sublingual
Ativan = work almost the same as subcut
Nitroglycerine
Suboxone
Zofran (anti-nausea)
Works almost immediately
Small liquid = can be absorbed
Highly concentrated methadone in buccal area to manage pain (palliative)
Gloves
Nothing in someone’s mouth who may bite you (kids & seizure disorders)
Topical
Subcut butterflies
Fentanyl patches for pain management
Hydromorphone (subcutaneous butterfly catheter)
Butterfly = secured in the skin for a week
Has to be primed with MEDICATION nothing else
Used a lot in semester 4
Medication patches
Fentanyl 72 hours
2 witnesses when wasting the used patches
Note on MAR where you put the patch
Take patch off BEFORE you put a new one on
Needs to be in an accessible stop
Belly, upper arms – wherever you can get subcutaneous tissue
Nicotine therapy
As nurse, you can initiate first dose of nicotine and then get a doc order
Need to know how much they smoke
Cannot go outside and smoke while have patch on
Will last through shower – try to not get them too wet
Vaginal or rectal
Rectal = same mucous membrane as mouth – right into bloodstream, doesn’t go into stomach
Can use for someone who is vomiting
Don’t want to poke/injection
Used a lot in kids
Will melt nicely with no urge to make it feel like BM
Left side, in sims position
Left side = straighten out rectum
Flat end in first to prevent expulsion
Push it quite far
Induce BM = need to have it in for 15 mins
Anti-seizure meds can go rectum
Kids usually
Intervaginal
Suppository or cream
Usually let them do it themselves
Applicator, far enough to almost hit cervix
Usually done at night because they are lying down
Have a pad on, because there is going to be an excessive discharge (yeast infection & meds)
Instruct client to do it themselves unless they are older and need help
Intervaginal estrogen on post-menopausal people
Helps with incontinence & helps with vaginal dryness
Into wound
Silver, methadone, ketamine, tricyclic antidepressant (that helps with nerve pain)
Bronchodilators first and then the steroid second
true
Nebulizer
Wheezes and decreased O2 stats *** this is on test
Turn the oxygen to about 7 and let them breath the mist in (medication)
After about 10 mins of the medication being done, do a lung assessment, you should hear no wheezes and make sure the intervention was effective
How is a sublingual medication administered?
Placed under the tongue and allowed to dissolve completely
What is an example of a sublingual medication?
Suboxone, nitroglycerin
Review the administration procedures of Nitroglycerin spray
1 or 2 sprays on or under the tongue at the first sign of an chest pain. Sprays may be repeated every 5 minutes as needed. You must wait 5 minutes before administering a third spray if 2 sprays are used initially.
What does buccal mean?
cheek
How is a buccal medication administered?
Placing solid medication in the mouth and against the mucous membranes of the cheek until the medication dissolves
What should the psychiatric nurse consider prior to administering any dermatological medications?
Before applying a transdermal patch, remove the old patch if it is still in place. Clean area thoroughly.
Observe for signs of skin irritation at old patch and document as per agency policy.
Assess for allergies and skin integrity
What type of administrative system is a patch and how does it work?
Topical and has systemic effects that allows the transfer of medication through the skin
What should the psychiatric nurse consider before applying the patch medication?
Assess skin integrity, previous site – sites should be rotated, and assess vitals prn
What kind of medications can be given via the transdermal route?
Nicotine, nitroglycerin
Describe how to apply a transdermal medication patch
Remove the patch from its pouch and peel off half of its protective liner. Place the adhesive side on the skin, then peel off the other half of the liner. Press the skin patch firmly with the palm of your hand for at least 30 seconds, making sure it adheres to the skin, especially at the edges.
Identify aspects of the assessments of the client, prior to administration of ophthalmic (eye) instillations
Irritation and inflammation and pain assess before drops
Assess for contact lens
Describe how to administer eye instillations such as eye drops or eye ointments
Roll meds in hand to resuspend
Ask pt to look up at ceiling to reduce blinking reflex
Do not touch eyelid or tip of applicator to eye
With dominant hand resting on pt forehead, hold med approx 1-2cm above conjunctival sac
Use cotton to absorb medication that escapes eye
Why does the nurse wipe/clean the clients\’s eye from the inner canthus to the outer canthus?
not to introduce debris or dirt into the lacrimal ducts that could cause an infection.
What are the purposes of instilling otic (ear) medications?
Treat ear infections and used to prevent infections
What is the technique for administering ear medications for an adult and for a child?
Children = down and back
Adults = up and outward
Describe how to administer otic medications
Straighten ear canal by pulling the auricle (outside of ear) down and back for children 3 years or younger or upward and outward for adults
Hold medication 1cm above the ear canal and instill medication drops
Describe how to administer nasal medications
Nasal drops
Resuspend medication
Instruct pt to clear/blow nose
Put pt in supine position & position head properly to facilitate nasal passages
Instruct pt to breathe through mouth, which reduces chance of aspirating
Hold dropper 1 cm above nares to avoid contamination, administer drops
Have pt remain supine for 5 minutes to prevent premature loss of medication
Nasal spray
Assist pt to high fowlers position
Administer spray with pt head upright, tipping the opening of nasal spray container downward to administer
What kinds of medications are given by inhalation?
Bronchodilator used first to open airway and then steroid
Ventolin
Flovent
What is the purpose of the extender or spacer, which is attached to the metered-dose inhaler?
Traps medication released
Slows down medication particles, enhancing the amount of medication received by pt
Describe how you would administer a nebulizer
Pour nebule of medication into nebulizer chamber and place nebulizer mask on pt face
Turn up oxygen to 6L or until steady mist is achieved
What are some clinical signs of hypoxia?
Apprehension, restlessness, decreased LOC, dizziness, vital sign change (increased pulse, increased rate & depth of respiration), cyanosis
Identify psychiatric nursing interventions that will enhance the respiratory function of a client
Apply oxygen and titrate to keep SPO2 >92%
Position patient in upright high fowlers
Use pulse oximeter to measure oxygen saturation
Encourage patient to perform deep breathing and coughing
What is the sequence for chest auscultation that allows for comparison of sounds from left to right?
Bilateral listening from apexes to bases
When would the nurse teach deep breathing and coughing exercises?
Increase inhalation, increase chest expansion, moves more air through the lungs
Coughing mobilizes secretions
Breath in slowly through your nose for 3 counts, keeping mouth closed
Exhale slowly through mouth and cough at the end of exhale
What does pursed lip breathing do?
Simplest way to control SOB
Easy way to slow your pace of breathing
Improves ventilation
Releases trapped air
Keeps the airways open longer
Causes relaxation
Describe how to teach the client pursed lip breathing
Relax neck and shoulders
Breath in slowly through your nose for 2 counts, keeping mouth closed
Pucker or “purse” lips as if you are going to whistle while counting to four
Why is an incentive spirometer used?
Encourages voluntary deep breathing by providing a visual feedback
Prevents or treats atelectasis in post op pt (lung collapse)
Aim is to encourage pts to breath their normal inspiratory capacity
When would a client use an incentive spirometer?
Every hour while awake
Describe how you would teach a client to use an incentive spirometer
Put the mouthpiece in mouth and close lips tightly around it
Inhale slowly and deeply through mouthpiece to raise indicator
When you can’t inhale any longer, remove mouthpiece and hold breath for at least 5 secs
Exhale normally
What safety precautions are used with oxygen therapy?
fire hazard
Why do clients with COPD (chronic obstructive pulmonary disease) that are receiving oxygen therapy need to be observed carefully?
Supplemental O2 removes a COPD patient’s hypoxic (low level of oxygen) respiratory drive causing hypoventilation which causes higher carbon dioxide levels, apnea (pauses in breathing), and ultimately respiratory failure
What types of oxygen delivery systems are available?
Low flow
Oxygen prongs, simple face mask, nonbreahting mask
Refers to oxygen mixing with room air
High flow
Venturi mask or star wars mask
Deliver O2 rates above normal inspiratory flow rate and provided a fixed F2O2 regardless of pt inspiratory flow and breathing pattern
Used for pts who require larger flowrates of oxygen to maintain saturations (face masks are generally temporary for transport or until RT can setup high flow systems)
What is the flow rate associated with a nasal cannula?
1-6L/min
What does a simple face mask consist of and how is it applied?
Side port openings located on either side of mask to allow room air to mix with delivered O2 and allow exhaled air to escape
What is the flow rate associated with a simple face mask?
5-8L/min
What are some important nursing responsibilities associated with oxygen therapy?
Perform a focused respiratory assessment including airway, respiratory rate, pulse oximetry rate, and lung sounds.
What is Star Wars high flow oxygen?
High-flow nasal cannula (HFNC) therapy is an oxygen supply system capable of delivering up to 100% humidified and heated oxygen at a flow rate of up to 60 liters per minute.
When and why are sputum specimens collected?
Used to identify microorganisms growing in the sputum & to identify drug resistance and sensitivity
Takes 24-48 hours for results
Assess effectiveness of treatment
Assess for TB
Assess for cancer in lungs
Describe how you would collect a sputum sample from a client
Position pt in high fowlers (promotes full lung expansion & facilitates ability to cough)
Provide sterile appropriate container
Instruct pt to take slow deep breath & cough after a full inhalation
Instruct pt to expectorate sputum directly in container
Label with date, time, initials, and what sample is
Best done in the morning
Why are throat cultures collected?
Identify microorganism
Describe how you would collect a throat culture sample from a client
Ask person to tilt head back, open mouth
Depress person’s tongue and ask them to “ahhh”
Collect culture by rubbing sterile swab tip on surface of tonsils
Label specimen with date, time, initials and type of sample
How is proper oral airway size determined?
Measure distance from corner of mouth to angle of jaw below ear
Too small = tongue won’t be held in place
Too big = may force tongue toward epiglottis & obstruct airway
If gag reflex intact you don’t put it in as this means pt can protect airway
