Safety & Quality Medication Administration Flashcards
*Don’t give to unconscious.
-Easy to administer, convenient, & comfortable.
*Avoided in patients with alterations in GI function, NPO patients & people unable to swallow.
Oral, Buccal (in cheeks & mostly given to children), & Sublingual Routes
-Can be used when oral medications are contraindicated.
*There is a risk of introducing infection & some are expensive. Avoid in patients with bleeding tendencies.
*Usually, syringe: 1 to 3 mL 0.5 to 1 mL of solution given
*Larger dose of 2ml may be divided/administered at two sites.
*Needle: 25- to 27-gauge; ⅜ inch needle (shorter needle should be given at 45 degrees to ⅝ inch needle (longer needle should be given at 90 degree)
Parenteral (Subcutaneous-Insulin absorbs faster in belly/Heparin) Can also be given in upper arms or anterior thighs
*Subcutaneous injections, such as with insulin and heparin.
*Two finger breadths from umbilicus
Intradermal-TB certified to do these-
*Preferred areas are lightly pigmented, free of lesions, and hairless, such as the ventral mid forearm, clavicular area of the chest, or scapular area of the back
*Needle: 25- to 27-gauge, ¼ to ½ inch long, tuberculin syringe
*Given at 10-15 degree
Parenteral:Intradermal (TB certified to do)
-More rapid absorption than topical or oral routes.
*Higher absorption rate, thus placing patient at higher risk for reactions. Avoided in patients with bleeding tendencies.
*Given in deltoid (acromium process-form a upside down triangle & small) or femur(invasive)-Syringe: 1ml, or 3ml, or 5ml Needle:23- to 25-gauge, ⅝- to 1½-inch needle.
*Aspirate needle before gloving
*Max dose given in deltoid is 1ml because the muscle is small. Even smaller in child o.5 ml.
*Given at 90 degrees
*Can be lateral, prone, sitting, or supine when getting a deltoid injection
Intramuscular-Needle has to be sterile
-Ventrogluteal (Supine or lateral position. Located near the gluteus medius, a deep muscle, away from major nerves, this site is well suited for Z-track injections. It is administered with an 18- to 25-gauge, 1½-inch needle
*Slightly angle the needle toward the iliac crest. The ventrogluteal is the preferred site for most injections given to adults and all children, including infants of any age.
Intramuscular site
-The vastus lateralis is a good site for multiple injections. It is frequently used in infants (less than 12 months) and is often used in older children and toddlers receiving immunizations. If a long needle is used, insert it with caution to avoid sciatic nerve or femoral structures.
*0.5mL infants max 1mL ,1mL in peds, 1mL to 1.5 mL in adults (2mL) max
*Patient can be sitting or supine-flex knee to help relax the muscle if supine
Intramuscular Site
-Provides mediation delivery when patient is critically ill, or long-term therapy is necessary; if peripheral perfusion is poor, IV route preferred over injections.
*Higher absorption rate, thus placing patient at higher risk for reactions.
*Needle
* Adults: 20- to 21-gauge, 1 to 1½ inches
* Children: 22-gauge, 1 inch
* Infants: 24-gauge, 1 inch
Intravenous (IV)-Sterile process
-Primarily provides local effect, painless, & limited side effects.
*Patients with skin abrasions are at risk for rapid medication absorption & systemic effects. Medications are absorbed slowly through the skin.
*Apply with gloves, tongue blade, or cotton-tipped applicator
Topical (Skin)
Ex. Steroid cream or Bacterin-Infection, or Neosporin
-Prolonged systemic effects with limited side effects. Not invasive.
*Medications leave oily or pasty substance on skin & sometimes soils clothing.
*Skin breakdown/irritation, don’t place on rashes & check for other patches
Transdermal (Pain patch, Nicotine patch, or Lidocaine, or Birth control patch)
-Potential route when oral medications are contraindicated. Water solutions readily absorbed & capable of causing systemic effects.
*Highly sensitive to medication concentrations. Ruptured eardrum. Patients can’t receive ear irrigations.
Mucous membranes
(Sublingual nitro-burns-If it doesn’t its expired)
-Provides rapid relief for local respiratory problems/used for introduction of general anesthetic gases.
*Some local agents cause serious systemic effects.
Inhalation (Inhaler-Causes anxiety, tachycardia-Assess the HR before giving
-Doesn’t require frequent administration like eyedrops do.
*Don’t use with eye infections & medications are expensive.
*Teaching-Have to be taught how to put in & take out.
Intraocular Disk
-Instillations are liquid medications usually administered as drops, ointments, or sprays in the following forms:
-Fast absorption/burning
Instillation
Ex. catheter/Dialysis, eye drops/ointments, ear drops, nose drops & sprays
-Drop in conjunctiva sac of eye
*Wear gloves
*Can contaminate tube of ointment when touching eye.
Eye Drops
-Can be used as fever reduction meds/constipation
*Don’t insert in patients with rectal bleeding.
*Refrigerate
*Use gloves & lube (Left lateral Sims position)
*Can be embarrassment/when inserted go pass anal spincter
Rectal (Suppositories)
-Use gloves/given at night
-Drainage will happen-use panty liner, educate what will happen
-Some have applicators/Some don’t
*Can be embarrassment
Vaginal Suppositories
-Faster absorption/burning
Nasal
Less expensive/Can cause damage
*< 3 yrs. old pull ear down & back
*> 3 yrs. old pull ear up & out
(Ear)
- Right Patient (2 Identifiers-Name & DOB)
- Right Medication (Check removing meds, pills against mar, & at bedside (final check)
- Right Dose
- Right Route
- Right Time
- Right Documentation (After given)
- Right Indication
- Right to refuse
8 Rights of Medication Administration
-Never force a needle into a container that is 3/4 full. When preparing medicines a clean needle can be recapped.
List one rule when it comes to the disposal of sharps.
-Nurses need to be comfortable & never fear being corrected when an error has occurred.
How can creating a “Just & Safe Culture” assist with safe medication administration?
-The process of comparing the medication that a patient should be taking with any newly ordered medication to prevent errors.
*Should be done on admission, transfer, & discharge
Define medication (drug) reconciliation
-Orthopedic Unit
-Rehab Unit
-Home Health
List 3 places within the acute care setting where medication reconciliation could take place
-Prescribes medications by writing an order on a form in a patient’s medical record in an order book, or a legal prescription pad.
Healthcare provider
-Prepares & distributes prescribed medications. They have to be sure that they are going by the orders the physicians put in.
Pharmacist
- Patient’s full name
- Date/Time the order is written
- Medication Name
- Dosage
- Route of Administration
- Time & frequency of Administration
7.Signature of health care provider
What components must be present to implement a healthcare provider’s prescription?
-Medication orders are used in places like hospital, nursing homes, & other institutions. Medication prescriptions are normally used in outpatient care.
*Fundamental book-Box 31.10/Pharmacology book Figure 9.2
What is the difference between a medication order & a medication prescription?
- Standing or Routine Order-until cancelled
- PRN Order
- Single or one time Order (Lorazapem-1ml IV in call to MRI-before procedure or meds given before diagnostic exam)
- Stat Order-Single dose given one time immediately
List the 4 types of medication orders. Provide one example of each.
-SBAR is a standard approach to communication that helps you obtain & organized information about patients when problems develop. This helps with reducing medication errors by making sure that all relevant information is stated clearly & concisely.
What role does SBAR play in the medication administration process?
Med errors or Transcription errors are why these abbreviations were developed
-q.d.-Daily
-QOD-Every other day
-U-Unit
-MS-Morphine Sulfate
-MS04-Magnesium Sulfate
-Lack of a leading zero -0.x mg
-IU-International Units
-Trailing zero- 1mg
*Never have a trailing zero, but you always lead with one.
Write out what would be used instead of the abbreviations.
S-Specific
M-Measurable
A-Attainable
R-Realistic
T-Time-Sensitive
Goals should be:
