Pottery & Perry Cp 34 (Topical Meds) Flashcards
1
Q
Guidelines for safe narcotic administration and control
A
- store all narcotics in a locked, secure cabinet or container
- count narcotics frequently-inventories to be count on a continuous basis (esp when the draw is open or during shift change)
- report discrepancies in narcotic counts immediately
- after dispensing a narcotic, use the record to document the its name, date, time of administration, name of med, dose, and signature
- if you dispense only part of a premeasured dose of a controlled substance, a second nurse must witness disposal of the unused portion
- never place waste portions in the sharps containers
- medications are never to be disposed into sink, toilet, or garbage can- must be returned to pharmacy or disposed of in a pharmacy-designated container
- controlled liquid are never left in their vials-draw up using a needles syringe and disposed of as a liquid
2
Q
blood flow to the site of administration
A
when the site of administration contains rich blood supply, the body absorbs medications more rapidly.
more blood supply=enhanced absorption
3
Q
body surface area and medication
A
the larger the surface area, the medication will be absorbed at a faster rate
4
Q
lipid solubility of a medication
A
- cell membranes have lipid layer
- high lipid soluble medication easily cross the cell membrane and are absorbed more quickly
- medication is also affected by the presence of food in the stomach
- food can change the structure of a medication and impair absorption
5
Q
protein binding and elders
A
- elders have a decrease in albumin in their bloodstream=a change in liver function
- the same is true for pts who have liver disease or are malnourished
- causes the potential for medication to be unbound and thus may be at risk for increase in medication activity or toxicity (or both)
6
Q
why is liver function important for medication?
A
a decrease in liver function results in a medication to usually be eliminated more slowly and results in an accumulation of the medication
-pt is at risk for toxicity
7
Q
how much fluid intake is needed to promote proper elimination of medication in an average adult?
A
50mL/kg/day
8
Q
therapeutic effect
A
The therapeutic effect is the expected or predictable physiological response that a medication causes.
9
Q
side effects
A
are the unintended, secondary effects that a medication predictably will cause
10
Q
adverse effects
A
are severe, negative responses to medication
-When adverse responses to medications occur, the prescriber immediately discontinues the medication. Some adverse effects are unexpected effects that were not discovered during drug testing. When this situation occurs, health care providers should report the adverse effect to the Health Protection Branch of the federal government
11
Q
toxic effects
A
develop after prolonged intake of a medication or after a medication accumulates in the blood because of impaired metabolism or impaired excretion.
12
Q
idiosyncratic reactions
A
when a patient overreacts or underreacts to a medication or has a reaction different from the normal reaction.
13
Q
allergic reaction
A
are unpredictable responses to a medication
- Some patients become immunologically sensitized to the initial dose of a medication. After repeated administration of the medication, the patient develops an allergic response
- antibiotics cause a high incidence of allergic reactions
14
Q
anaphylactic reaction
A
are severe reactions that are life-threatening and are characterized by sudden constriction of bronchial muscles, edema of the pharynx and larynx, severe wheezing, shortness of breath, and circulatory collapse. Immediate use of antihistamines, epinephrine, or bronchodilators is required to treat anaphylactic reactions.
15
Q
allergic reactions (mild) include:
A
urticaria, rash, pruritus, and rhinitis
16
Q
how do we achieve constant blood level in a medication within a therapeutic range?
A
Repeated doses are required to achieve a constant therapeutic concentration of a medication because a portion of a drug is always being excreted.
17
Q
peak concentration
A
highest serum concentration of a medication usually occurs just before the body absorbs the last of the medication
-IV meds-peak concentration occurs quickly, but the serum level also begins to fall immediately
18
Q
trough level
A
point at which the lowest amount of drug is detected in the serum is called trough concentration.
-usually drawn 30 minutes before the drug is administered, and the peak level is drawn whenever the drug is expected to reach its peak concentration
19
Q
onset
A
The time it takes for a medication to produce a response after it has been administered.
20
Q
duration
A
the time during which a medication is present in sufficient concentration to produce a response.
21
Q
plateau
A
Blood serum concentration of a medication has been reached and is maintained after repeated fixed doses
22
Q
serum half-life
A
the time it takes for the excretion processes to lower the serum medication concentration by half.
- to maintain a therapeutic plateau, the patient needs to receive regular fixed doses
- most effective when pain medications are given “around the clock”
23
Q
considerations for sublingual route
A
- medication should not be swallowed b/c it will not have the desired effect
- avoid giving the pt liquids
- instruct the pt not to drink anything until the medication is completely dissolved
24
Q
buccal administration considerations
A
- to avoid mucosal irritation, teach patients to alternate cheeks with each subsequent dose
- Advise patients not to chew or swallow the medication or to take any liquids with it
- A buccal medication acts locally on the mucosa or systemically when it is dissolved in a person’s saliva.
25
intradermal
Injection into epidermis
26
Subcutaneous (subcu)
injection into tissues just below the dermis
27
Intramuscular (IM)
-Injection into a muscle
28
Intravenous (IV):
Injection into a vein
29
contraindications/disadvantages with oral meds
- avoid when pt has alterations in GI function (e.g., nausea, vomiting), reduced motility (after general anaesthesia or bowel inflammation), or surgical resection of a portion of the gastrointestinal tract
- unable to swallow (e.g., patients with neuromuscular disorders, esophageal strictures, mouth lesions).
- oral meds can irritate the lining of the GI tract, discolour teeth, or leave an unpleasant taste
- unconscious or confused pts
- hold with pt's that have gastric suctions
- before medical tests/surgeries
30
contraindications for subcut, IM, and ID routes
-are avoided in patients who have bleeding tendencies.
-risk of introducing infections
-risk of tissue damage with subcutaneous injections.
IM and IV routes have higher absorption rates, which places the patient at higher risk for reactions.
31
topical medication contraindications
Patients with skin abrasions are at risk for rapid medication absorption and systemic effects.
32
mucous membranes contraindications
- pts with ruptured eardrums cannot receive irrigations
| - rectal suppositories are contraindicated if pt has had rectal surgery or if active rectal bleeding is present
33
what to consider when giving topical medications?
- wear gloves to prevent absorbing medication through the applier's skin and for hygienic reasons
- systemic effects can occur if the pt's skin is thin/broken down, if the med concentration is high, or if the med contact with the skin is prolonged
34
intraocular route
medication delivered in a form of a contact lens directly into the pt's eye. the disc can remain in the pt's eye for up to 1 week
35
what to do when a nurse receive a verbal order?
- must read it back and receive confirmation from the prescribed to ensure accuracy
- must immediately enter the order into the pt's medical record and records the time and the name of the prescriber who gave the order
- nurse must sign the record
- within 24 hours the prescriber needs to sign the order
- nursing students cannot receive verbal orders
36
routine medication orders
-the order is carried out until the prescriber cancels it by writing a new order or until a prescribed number of days have elapsed
37
as-needed (prn) orders
a medication is to be given only when a pt requires it
38
single (one-time) orders
-prescriber will often order a medication to be given only once at a specified time
39
STAT orders
signifies that a single dose of a medication is to be given immediately and only once
usually in emergencies
40
NOW orders
more specific than a one-time order; used only once; when a pt need a medication quickly but not immediately
-nurse has 90 minutes to give the medication
41
a medication error
any event that could cause or lead to a patient either receiving inappropriate medication therapy or failing to receive appropriate medication therapy. Most errors made by nurses are medi- cation errors
42
what are the most common types of medication errors may by students?
- (a) omission (i.e., a patient does not receive a prescribed medication)
- (b) a patient is given the improper dose or quantity -
- (c) the patient is given the medication at the wrong time
- (d) the patient is given an extra dose
- (e) the medication is given to the wrong patient
43
what to do when a medication error occurs?
- pt's safety is the top priority. assess the pt's condition
- notify the physician/prescriber asap
- nurse may need to take measure to counteract the error
- once the pt is stable, the incident should be reported
- a written incident report -needs to be filled w/in 24 hours of the error
- report all med errors, including those that don't cause obvious or immediate harm
- near misses also must be reported
44
what is included in a medication error report?
report includes the patient identification information; the location and time of the incident; an accurate, factual description of the error that occurred and measures taken to address the error; and the nurse’s signature
45
steps to take to prevent med errors
- follow the rights of medication administration
- read the label at least 3 times comparing it to the MAR
- use 2 pt identifiers
- remove any other activity or interruptions
- double-check all calculations with another nurse
- do not interpret illegible handwriting- clarify with the prescriber
- question usual small or larger doses
- document all meds as soon as they are given
46
process for medication reconciliation?
used when pts are transferred to another agency or in a different unit w/in the hospital
1. verify- obtain current list of pt's meds
2.clarify-ensure accurate med, dose, and frequency
clarify / pt, caregiver, HCP, pharmacy
3. reconcile- compare new med orders against current list
4. transmit- communicate the updated and verifies list to caregivers and pt
47
components of med orders
- pt full.name
- date/time the order is written
- medication name
- dose
- route
- time
- signature of prescriber
48
what is polypharmacy
occurs when the patient takes two or more medications to treat the same illness, when the patient takes two or more medications from the same chemical class, when the patient uses two or more medications with the same or similar actions to treat several disorders simultaneously, or when a patient mixes nutritional supplements or herbal products with medications
49
rational polypharamcy
ccurs when patients need to take several medications to treat their health conditions, which is often the case for older persons.
50
irrational polypharmacy
occurs when the pt takes more medications that needed
51
nonadherence
defined as a deliberate misuse of medication, such as not taking a prescribed medication or altering the dose of a medication
52
how much water should be administered with oral medication administration?
60-100 mL
53
aspiration precautions
- determine pt's ability to swallow
- assess pt's cough
- gag reflex
- ensure pt is in a side-lying or upright position
- if pt has unilateral weakness, place the med in the stronger side of the mouth
- administer pills one at a time, ensure each one is swallowed properly before the next one
- thicken regular liquids or offer fruit nectars if the pt cannot tolerate thin liquids
- if aspiration is severe administer med through another route
- if possible, medications should be timed to coincide with mealtimes or when the patient is well rested and awake
54
what is not an acceptable identifier of a pt?
room number
55
cold carbonated water and oral medication purpose?
carbonated water helps passage of the tablet through the esophagus
56
considerations w/ oral meds?
- poor liver/kidney function affect the metabolism/excretion of meds
- check if the pt is NPO
- assess vital signs
- conduct pre assessments (e.g. HR/BP for HTN meds)
- prepare meds for one pt at a time
- all calculations are verified with another nurse
- controlled substance-check the MAR to determine the last time the med was administered
- don't touch the meds with your fingers (clean technique)
- place all meds to a pt in one medicine cup with the pt's identification labelled attached
- check if med can be crushed (capsules/enteric-coated meds cannot)
- meds are administered w/in 30 mins before/after the prescribed time to ensure intended therapeutic effect
- stay at the bedside until the pt has completed swallowed all meds. check pts mouth
57
for highly acidic meds (aspirin) why can we offer pt a nonfat snack? (crackers)
reduces the possible gastric irritation from highly acidic medication
58
why can't you swallow sublingual medications?
med is absorbed through the blood vessels of the undersurface of the tongue. if it is swallowed, it is destroyed by gastric juices or detoxified by the liver so rapidly that the therapeutic blood levels are not attained
59
for skin applications when do you use sterile technique?
-if the pt has an open wound
60
when do topical medication not produce their therapeutic effect?
skin encrustation and dead tissues harbour microorganisms and block contact of the medications from the tissues to be treated.
61
what to document when you administer topical meds?
- note the area where the med was applied
- the name of the med
- condition of the skin
62
biggest risk for topical meds?
overdose- by inadvertently leaving old transdermal patched in place.
- ensure you assess the pt's skin and the old patch is removed before applying a new patch
- label the patch (date, time, signature)
63
guidelines to ensure safe administration of transdermal or topical meds
- document the area where the med was applied
- when applying a transdermal patch, ask the pt whether they have an existing patch
- never assume the pt has fallen off of has already been removed
- assess skin thoroughly before administration of med
- ask pt if they take meds in form of patches, topical creams, or another other route that is not oral
- apply a noticeable label to patch
- document remove of the patch
64
when can serious systemic effect occur in decongestant solutions?
when excess decongestant solution is swallowed, serious systemic effects can develop, especially in children
65
contraindicate in asking a pt to blow their nose prior to nasal instillation?
intracranial pressure
| or nosebleeds
66
considerations for nasal instillation
-use penlight to inspect the condition of nose/sinuses
-palpate sinuses for tenderness
-educate pt on sensations to expect: burning, stinging of the mucosa, choking sensation as the med trickles into the throat
clear the nose- removes mucus and secretions that can block med distribution
-instruct pt to breath through the mouth which reduces the changes of aspiration nasal drops into the trachea and lungs
-hold dropper 1cm above to avoid contamination
-instil prescribed number of drops towards the midline of the ethmoid bone to facilitate distribution of med over the nasal mucosa
-observe for any adverse effects 15-30 min after administration
-ask if they are able to breathe through the nose after decongestant administration. sometimes they need to occlude one nostril at a time and breathe deeply
-determine drug effective
67
to access the posterior pharynx (nasal drops)
tilt the pt head backwards
68
to access the ethmoid and sphenoid sinuses (nasal drops)
-title the head back over the edge of bed, or place a small pillow under the pt's shoulder and tilt the head back
69
to access the frontal and maxillary sinuses (nasal drops)
tilt the head back over the edge of the bed or pillow with the head turned toward the side to be treated
70
how long should a pt remain lying for nasal instillation?
5 minutes to prevent premature loss of medication through the nares
71
position for nasal drops vs nasal sprays
nasal drops-supine-head hyperextended
| nasal spray- high Fowler's position or sitting position. pt's head should be upright
72
instruct the pt to not _after med -nasal instillation?
blowing the nose for several minutes
73
principles when administrating eye meds
- avoid the cornea. it is richly supplied with pain fibres (very sensitive)
- risk of transmitting infection is high
- avoid touching the eyelids or other eye structures w/ eyedroppers on ointment tubes
- use eye meds only for the pt's affected eye
- never allow a pt to use another pt's eye med
74
why do we instil room temperature in the ear?
b/c internal ear structures are very sensitive to different temperatures. cold temperature can cause vertigo or nausea
75
considerations for ophthalmic medication administration?
- assess allergies (including latex)
- gently roll the container (do not shake- shaking cause bubbles, which makes medication administration difficult)
- explain to pt they may feel burning or stinging
- if there is crust/drainage along the eyelid- wash away from the inner to outer canthus -soak any crusts that are dried and difficult to remove by applying a damp washcloth/cotton ball for a few mins
- always wipe from inner to outer canthus
- hold dropper 1-2cm about the conjunctival sac
- ask the pt to look up, to retract the sensitive cornea up and away from the conjunctival sac and it reduces the blink reflex
- if pt blinks/closes eye, or drop lands on the outer lid margin, repeat the procedure
- after instilling drops ask pt to close their eyes (to distribute the med)
- apply gentle pressure w/ fingers on the pits nasolacrimanl duct for 30-60 seconds
- for eye ointment have pt close eyes and use a cotton ball to rub the lid lightly in a circular motion
- if pt needs med in both eye, use a different tissue/cotton ball for each eye to prevent cross-contamination
76
intraocular disc administration considerations
- position the convex side of the disc on your fingertip and w/ the other hand (non-dom) gently pull the pts lower eyelid away form the eye. ask pt to look up
- place the disc in the conjunctival sac, so that it floats on the sclera between the iris and the lower eyelid
77
how long do you wait if pt has more than one eye medication in the same eye, at the same time?
5 minutes before administering the next medication to avoid interaction between medication
78
for children under 3 how do you position the ear for drops?
grasp the auricle of the ear and pull it down and back
79
for children (over 4) and children how do you position the ear for drops?
pull the auricle upward and outward
80
position for ear drop administration?
pt assume a side-lying position, with the ear to be treated facing up. pt can also sit in a chair or at the bedside with ear up
81
consideration for ear drop administration
- hold the dropper 1cm above the ear canal to instil the prescribed drops
- ask the pt to remain side-lying for 2-3 minutes
- apply gentle massage or pressure to the tragus of the ear
- if a cotton ball is needed, place the cotton ball into the outermost part of the ear canal- remove after 15 mins
82
considerations for ear irrigations
- assess for eardrum perforation- contraindicate for ear irrigation
- place a towel under the pt's head/shoulder and have pt hold a kidney-shaped basin under affected ear
- fill the syringe w/ approx 50ml of the solution
- grasp ear down and back for children under 3, and upward and outward for children 4 years and older
- slowly instil the irrigating solution by holding the tip of the syringe 1cm above the ear canal-continue until the canal is clean, or until all the solution is used
83
what position should pt be in for vaginal medication?
-dorsal recumbent position- allows full exposure and easy access to the vaginal canal and allows the suppository to dissolve without escaping through an orifice
84
considerations for vaginal suppository administration?
-for suppository-ensure there is enough lube
-lubricate the gloved index finger of your dominant hand
-insert the suppository along the posterior wall of the vaginal canal 7.5-10cm (length of your finger aprox)
offer a perineal pad when she resumes ambulation to prevent vaginal discharge from spreading to clothes
-inspect the appearance of discharge from the vaginal canal and the condition of external genitalia between applicators to evaluate the med effectiveness
85
considerations for cream or foam vaginal suppository administration?
- w/ non-dominant gloved hand expose the vaginal orifice by retracting the labia folds
- w/ dominant gloved hand, insert the application approx 5-7.5cm
- push the applicator plunger to deposit the medication into the vagina to allow equal distribution of med
- offer a perineal pad when she resumes ambulation to prevent vaginal discharge from spreading to clothes
- inspect the appearance of discharge from the vaginal canal and the condition of external genitalia between applicators to evaluate the med effectiveness
86
how long should you instruct the pt to remain on her back after a suppository/foam/cream/ vaginal instillation?
10 minutes
87
what position should a pt be in for a rectal suppository?
left lateral side- Sims position to exposure the anus and facilitate relaxation of the external anal sphincter
88
how long should you instruct the pt to remain flat after a rectal suppository?
Ask the patient to remain flat or on the side for 5 minutes, to prevent
expulsion of the suppository
89
how far do you administer a rectal suppository? for children? and adults?
through the anus, past the internal sphincter and against the rectal wall
- 10cm in adults
- 5cm in children and infants
90
considerations for rectal suppository
- palpate the rectal wall to assess for presence of faces
- assess for rectal bleeding, diarrhea, hemorrhoids
- lubricate your index finger of dominant hand w/ water-soluble lube
- ask pt to take slow, deep breaths through the mouth to relax the anal sphincter
- insert past the internal sphincter and against the rectal wall
- apply gentle pressure to hold the buttocks together momentarily to keep med in place and facilitate medication distribution/absorption
- remain flat for 5 mins
- place call bell w/in reach
91
what is the purpose of an MDI space?
- allows the particles of medication to slow down and break into smaller pieces, improves drug absorption in the pt airway
- spacers are equipped w/ face mask when they are used by infants and children younger than 4 yrs
- spaces are esp useful when pt have difficulty coordinating the puffer
92
which type of inhaler always goes first?
bronchodilator is always give first
93
Considerations for using metered-dose inhalers
- if it is new ensure you do a test spray
- remove the mouthpiece cover from inhaler
- shake vigorously 5-6 timex (fine particles are aerosolized)
- take a deep breathe and exhale- empties the lungs and prepares the pts airway to receive the medication
- instruct pt to hold the inhaler using a 3-point lateral hand position -index finger and middle finger at the top, thumb at the bottom
- instruct pt to tilt the head back and slightly and inhale slowly and deeply through the mouth for 3-5 seconds while depressing the canister fully
- instruct pt to hold their breath for apox 10 seconds- allows tiny drops of aerosol to reach the deeper branches of the airways
- instruct pt to remove the MDI and heal through pursed lips -opens the small airways during exhalation
94
proper position for MDI (2 ways)
1. close the mouth around the MDI with the opening towards the back of the throat
2. position the device 2-4 cm in front of the mouth (this is the best way to deliver the medication)
95
considerations when using a MDI spacer
- insert the MDI into the end of the spacer
- shake vigorously 5-6 times
- have pt exhale completely before closing the mouth around the mouthpiece of the spacer
- instruct pt to inhale deeply and slowly through the mouth for 3-5 seconds
- instruct pt to hold breath for 10 mins
- remove MDI and spacer before exhaling
96
considerations for DPI (dry powder inhaler)
-no need to shake the inhaler
-hold the inhaler upright and turn the wheel to the right and then to the left until a click is heard, load the medication
-instruct pt to exhale away from the inhaler before inhalation
-position between pt's lips
-instruct pt to inhale deeply and forcefully though the mouth
-instruct pt to hold their breath for 5-10 seconds
-instruct pt to wait 20-30 seconds between inhalation of meds
pt does not need to coordinate puffs with inhalation. the device is activated by the its breath
-DPI's can clump in humid conditions
97
floating the MDI?
no longer recommended b/c extra propellant may cause buoyancy even if no medication remains in the inhaler
