SG Ch: 32 - Medication Administration Pt. 2 Flashcards
Identify the components of medication orders.
- Patient’s full name
- Date and time that the order is written
- Medication name
- Dose
- Route of administration
- Time and frequency of administration
- Signature of provider
The recording of medication includes:
- The name of the medication
- Dose
- Route
- Exact time of administration
- Site
Explain the reasons why polypharmacy happens to a patient.
When patients need to take several medications to treat their illnesses, take two or more medications from the same chemical class, use two or more medications with the same or similar actions or mix nutritional supplements or herbal products with medications, polypharmacy happens
Identify two goals for safe and effective medication administration.
- Patient responds to therapy.
- Patient has the ability to assume responsibility for self-care.
Identify the precautions to take when administering any oral preparation to prevent aspiration.
- Determine the patient’s ability to swallow and cough and check for gag reflex.
- Prepare oral medications in the form that is easiest to swallow.
- Allow the patient to self-administer medications if possible.
- If the patient has unilateral weakness, place the medication in the stronger side of the mouth.
- Administer pills one at a time, ensuring that each medication is properly swallowed before the next one is introduced.
- Thicken regular liquids or offer fruit nectars if the patient cannot tolerate thin liquids.
- Avoid straws because they decrease the control the
- patient has over volume intake, which increases
- the risk of aspiration. h. Have the patient hold the cup and drink from it if
- possible. i. Time medications to coincide with meal times
- or when the patient is well rested and awake if
- possible. j. Administer medications using another route if risk
- of aspiration is severe.
Identify the guidelines to ensure safe administration of transdermal or topical medications.
- Medication history and reconciling medications
- Assess if patient has an existing patch before application.
- Wear disposable gloves when applying and removing patches.
- Apply a noticeable label to the patch.
- Document removal of medication on the MAR.
- Document the location of the patient’s body where the medication was placed on the medication administration record (MAR)
The most common form of nasal instillation is:
Decongestant spray or drops
List four principles for administering eye instillations.
- Avoid instilling any eye medication directly onto the cornea.
- Avoid touching the eyelids or other eye structures with eye droppers or ointment tubes.
- Use medication only for the patient’s affected eye.
- Never allow a patient to use another patient’s eye medications
Failure to instill ear drops at room temperature causes:
- Vertigo
- Dizziness
- Nause
Vaginal medications are available as:
- Suppositories
- Foam
- Jellies
- Creams
Rectal suppositories are used for:
Exerting local effects (promoting defecation) or systemic effects (reducing nausea)
Explain the following types of inhalation inhalers:
a) Pressurized metered-dose inhalers (pMDIs):
b) Breath-actuated metered-dose inhalers (BAIs):
c) Dry powder inhalers (DPIs):
a) Delivers a measured dose of medication with each push of a canister often used with a spacer
b) Releases medication when a patient raises a level and then inhales
c) Hold dry, powdered medication and create an aerosol when the patient inhales through a reser- voir that contains the medication
Identify the four aseptic techniques to use to prevent an infection during an injection.
- Draw medication from ampule quickly; do not allow it to stand open.
- Avoid letting the needle touch contaminated surface.
- Avoid touching the length of the plunger or inner part of the barrel.
- Prepare the skin, use friction and a circular motion while cleaning with an antiseptic swab, and start from the center and move outward.
Identify the two factors that must be considered when selecting a needle for an injection.
- The patient’s size and weight
- Type of tissue into which the medication is to be injected
Describe each of the following.
- Ampule:
- Vial:
Ampule: Contain single doses of medications in a liquid
Vial: A single dose or multidose container with a rubber seal at the top (closed system)
List the three principles to follow when mixing medications from two vials.
- Do not contaminate one medication with another.
- Ensure that the final dose is accurate.
- Maintain aseptic technique.
Insulin is classified by:
Rate of action (rapid, short, intermediate, and long acting); each has a different onset, peak, and duration of action.
Identify the principles to follow when mixing two types of insulin in the same syringe.
- Need to maintain their individual routine when preparing and administering their insulin
- Do not mix insulin with any other medication or diluents.
- Never mix insulin glargine or insulin detemir with other types of insulin.
- Inject rapid-acting insulin mixed with NPH within 15 minutes before a meal.
- Verify insulin dosages with another nurse while preparing them.
List the techniques used to minimize patient discomfort that is associated with injections.
- Use a sharp beveled needle in the smallest suitable length and gauge.
- Position the patient as comfortably as possible to reduce muscle tension.
- Select the proper injection site. d. Apply a vapocoolant spray or topical anesthetic to the site if possible.
- Divert the patient’s attention from the injection.
- Insert the needle quickly and smoothly.
- Hold the syringe while the needle remains in
tissues. - Inject the medication slowly and steadily.
Identify the three best sites for subcutaneous injections.
- The outer posterior aspect of the upper arms
- The abdomen (below the costal margins to the
iliac crests) - The anterior aspects of the thighs
What is the maximum amount of water-soluble medication given by the subcutaneous route?
0.5 to 1 mL
What angles should be used when administering a subcutaneous injection, and with which needle should they be used?
- 25-gauge, 5/8-inch needle inserted at a 45-degree
angle - 1/2-inch needle inserted at a 90-degree angle
What is the angle of insertion for an intramuscular (IM) injection?
90°
Indicate the maximum volume of medication for an IM injection in each of the following groups.
- Well-developed adults:
- Older children, older adults, and thin adults:
- Older infants and small children:
- 2 to 5 mL into a large muscle
- 2mL
- 1mL
Describe the characteristics of the following intramuscular injection sites.
- Ventrogluteal:
- Vastus lateralis:
- Deltoid:
- Deep site away from nerves and blood vessels; preferred
site for medications for adults; children and infants for
large volumes and viscous and irritating solutions - For adults and children, muscle is thick and well
developed; anterior lateral aspect of the thigh - Easily accessible but muscle not well developed; use small amounts; not used in infants or children; potential for injury to radial and ulnar nerves; immunizations for children; recommended site for hepatitis B
and rabies injections
Explain the rationale for the Z-track method in IM injections.
Minimizes local skin irritation by sealing the medication in muscle tissue
Explain the rationale for intradermal injections.
Skin testing; injected into the dermis where medica-
tion is absorbed slowly
List the methods a nurse can use to administer medications intravenously.
- As mixtures within large volumes of IV fluids
- Injection of a bolus or small volume of medication
- Piggyback infusion
Identify the advantages of the intravenous (IV) route of administration.
- Fast-acting medications must be delivered quickly.
- It provides constant therapeutic blood levels.
- It can be used when medications are highly alkaline and irritating to the muscle and subcutaneous tissue
The disadvantages of IV bolus medications are:
- It is the most dangerous method because there is no time to correct errors.
- A bolus may cause direct irritation to the lining of blood vessels
List the advantages of using volume-controlled infusions.
- They reduce risk of rapid infusion by IV push.
- They allow for administration of medications that are stable for a limited time in solution.
- They allow for control of IV fluid intake
What is a piggyback set?
A small (25- to 250-mL) IV bag connected to short tubing lines that connects to the upper Y port of a primary infusion line
What is a volume-control administration set?
A small (50- to 150-mL) container that attaches below the primary infusion bag
What is a syringe pump?
A battery-operated machine that allows medications to be given in very small amounts of fluid (5 to 60 mL)
List the five advantages of using intermittent venous access devices.
- Cost saving
- Convenience
- Increased mobility
- Safety
- Patient comfort
The study of how drugs enter the body, reach their sites of action, are metabolized, and exit from the body is called:
- Pharmacology
- Pharmacopoeia
- Pharmacokinetics
- Biopharmaceutical
- Definition of pharmacokinetics
Which statement correctly characterizes drug absorption?
- Most drugs must enter the systemic circulation to have a therapeutic effect.
- Oral medications are absorbed more quickly when administered with meals.
- Mucous membranes are relatively impermeable to chemicals, making absorption slow.
- Drugs administered subcutaneously are absorbed more quickly than those injected intramuscularly.
- Absorption refers to the passage of medication molecules into the blood from the site of administration
The onset of drug action is the time it takes for a drug to:
- Produce a response
- Accelerate the cellular process
- Reach its highest effective concentration
- Produce blood serum concentration and maintenance
- Definition of onset
Which of the following is not a parenteral route of administration?
- Buccal
- Intradermal
- Intramuscular
- Subcutaneous
- An oral route
The nurse is preparing an insulin injection in which both regular and NPH will be mixed. Into which vial should the nurse inject air first?
- The vial of regular insulin
- The vial of NPH
- Either vial, as long as modified insulin is drawn up first
- Neither vial; it is not necessary to put air into vials before withdrawing medication
- If mixing rapid- or short-acting insulin with intermediate-acting insulin, take the insulin syringe and aspirate a volume of air equivalent to the dose of insulin to be withdrawn from the intermediate-acting insulin firs
