Skills Exam 5 part 1 Flashcards
to safely and accurately administer medications, you need knowledge related to
- legal aspects of health care
- pharmacology
- life sciences
- pathophysiology
- human anatomy
- mathematics
drug names: chemical
provides the exact descriptions of medications composition (rarely used by nursing)
drug names: generic
the manufacturer who first developed the drug assigns the name, and it is then listed in the U.S Pharmacopeia
ex: acetaminophen
drug names: trade
also known as brand or propriety name. this is the name under which the manufacturer markets the medication
ex: tylenol
how do you classify medications?
- effects of medication on body systems
- symptoms the medication relieves
- medications desired effect
combination medications
- a medication that includes two or more active ingredients combines in a single dosage form
- the medication lists the trade name, followed by the generic name of each drug
- the medication will list the dosages of each drug in order of generic names
ex: Norco (Hydrocodone- Acetaminophen) 5mg/325mg
absorption
passage of medication molecules into the blood stream from the site of administration
what are some factors that influence absorption?
- route of administration
- ability of a med to dissolve
- blood flow to the site of administration
- body surface area
- distribution
- metabolism
- excretion
therapeutic effect
expected or predicted physiological response
adverse effect
unintended, undesirable outcome
side effect
a predictable secondary, typically undesirable, effect
toxic effect
accumulation of medication in the bloodstream causing undesirable outcomes
idiosyncratic reaction
adverse effects that cannot be explained by the known mechanisms of action of the drug, do not occur in most patients, and develop unpredictable in susceptible individuals only
allergic reaction
unpredictable response to a medication
medication interactions
one medications modifies the action of another
medication tolerance
more medication is required to achieve the same therapeutic effect
medication dependence
- physical
- psychological
what is polypharmacy?
- takes two or more medications to treat THE SAME ILLNESS
- takes two or more medications from THE SAME CHEMICAL CLASS
- uses two or more medications WITH THE SAME OR SIMILAR ACTIONS to treat several disorders simultaneously
- mixes nutritional supplements or herbal products with medications
who are the providers?
- physicians
- nurse practitioners
- physicians assistants
what is their role?
- determine the medication the pt needs
- place the order for the medication
what can orders be?
- written
- verbal/telephone
each medication order must include what?
- pt’s name
- order date
- medication name
- dosage
- route
- time of administration
- drug indication
- prescriber’ signature
standing or routine order
administered until the dosage is changed or another medication is prescribed
single (one time)
given one time only for a specific reason
now
when a medications is needed right away, but not STAT
PRN
given when the pt requires it
STAT
given immediately in an emergency
prescriptions
medications to be taken outside of the hospital
what is the pharmacists role?
prepare and distribute medications
what is the nurses role?
- determine medications ordered are correct
- ensure medication to be administered is correct
- determine medication timing
- administer medication correctly
- closely monitors effects
- provides pt teaching
- does not delegate medication administration to assistive personnel
medication frequency refers to …
how often a medication can be given
if an order is written for “____ times a day”…
you should pay attention to when it was last given and try to space is out as evenly as possible, even though there isn’t a specific time associated with the order
the nurse has a window to give scheduled medications
may give scheduled medications up to an hour before and up to an hour after scheduled time
tip!
use critical thinking to organize skills to group medication administration together is possible. cluster your care!
order: give 2mg
available: 0.5mg tablets
how many tablets will you give?
4 tabs
review basic medication dosages
slide 20
medication error
any preventable event that may cause inappropriate medication use or jeopardize pt safety
when an error occurs
- first assess the pt condition, then notify the provider
- when pt is stable, report the incident
- prepare and file an occurrence or incident report
- report near misses and incidents that cause no harm
medication errors
- wrong pt
- wrong medication
- wrong dose
- wrong preparation
- wrong route
- wrong time
- medication expired
- forgetting to sign off correctly
what are the seven rights of administration?
- right medication
- right dose/amount
- right pt
- right route
- right time
- right documentation
- right indication
TRAMPED
- time
- route
- amount
- medication
- patient
- expiration
- documentation
the pt’s rights
- to be informed about a medication
- to refuse a medication
- to have a medication history
- to be properly advised about experimental nature of medication
- to receive labeled medications safely
- to receive supportive therapy
- to not receive unnecessary medications
- to be informed if medications are part of a research study
medical history
- allergies
- medications
- diet history
- compliance to therapy
- pt’s perception of problems
- pt’s current condition
- pt’s attitude about medication use
- pt’s understanding of and adherence to medication therapy
frequency is not part of the TRAMPED process but is it a part of the order
when a medication is scheduled, there is no need to mention the frequency
before administering medications, always assess the pt first
- make sure the pt is awake and alert, ready for meds
- get a set of vitals and a head to toe if possible
- go to nurses station to prepare for med pass
- check orders before grabbing any meds
- collect appropriate meds for the time
- collect appropriate supplies
- perform TRAMPED twice by yourself
- get instructor for third TRAMPED
- after third TRAMPED, prep each med
- after meds are prepared clean area
- ask name, DOB, allergies and compare to MAR
- educate pt on what your giving them
- administer meds
- document
do you need to document in your narrative every scheduled medication that you gave?
no, you don’t have to document at all, unless the patient gives you trouble/refuses or if you can’t give the medication based on assessment findings
when should you document medication administration in the narrative charting?
- PRN medication administration
- why? because you give a PRN for a specific reason/complaint
scheduled medications
initial box for correct date/time
PRN medications
- initial box for correct administration
- include time administered
ensure full name, credentials, and initials are included on MAR signature box
only need to perform this once per MAR
random pieces of information
- never leave any medications unattended, even if you are staying in the same area and simply turning your back
- never sign off medications until the patient has taken them completely
- if you notice a trend with your patient and medication refusal, ask your patient if they will take their medications before you go prep them all
- bring your patient’s favorite drink to wash down their medications
- if a patient with dementia initially refuses medications, try a different approach versus giving up
- walk away and come back
- if a patient with dementia doesn’t know their name, DOB, allergies – still ask. Then verify with instructor or staff member.
keys to accuracy
- avoid distractions and follow the same routine
- administer only medications you prepare, and never leave prepared medications unattended
- document medications immediately after administration
- use clinical judgment in determining the best time to administer prn medications
- when preparing medications, check the medication container label against the medication administration record (MAR) three times
- TRAMP in order of the MAR
what are the controlled substances we need to know for med pass?
- tramadol
- hydrocodone
- oxycodone
- ativan (lorazepam)
- norco (hydrocodone with acetaminophen)
- percocet (oxycodone with acetaminophen)
controlled substances
- all controlled substances are locked up
- as soon as you access a controlled substance for a pt, you must verify the count
- if you walk away before verifying, you are responsible if the count is wrong
- TRAMP the med with all other medications to be administered
- document that count, sign/time/date
- if you waste the medications, another nurse must witness that you wasted it
when comparing the log with the medication in hand, what must the nurse look at to ensure accuracy?
- pt’s name
- pt’s DOB
- medication name
- medication dose
- medication route
- once the above has been matched correctly, then analyze the ending count on the log with the amount of pills in the blister pack
medication routes: oral
- easiest and most desirable route
- medication is swallowed, enters GI tract, gets digested and absorbed
- this route is avoided if pt is experiencing GI issues, pt cannot swallow, or is unconscious
- food sometimes affects absorption
- you must protect pt’s from aspiration
types of oral meds
- pills
- liquids
crushing oral medications
- may be crushed to be swallowed more easily
- crushing reduces the risk for aspiration
- after meds are crushed, place in food or fluid for pt to consume
NEVER crush
extended release (ER) enteric coated (EC)
additional oral routes
all of these routes avoid the GI system and are absorbed directly into the blood through the oral tissue
- sublingual (under the tongue)
- buccal (place against the cheek)
medication routes: topical
- apply to skin
- ointments, lotions, paste, transdermal patches
transdermal patches
- assess skin
- ask if pt has an existing patch
- apply gloves before removing or applying a new patch
- remove old before applying new
- cleanse the area
- apply new patch in a different location
- document location of new patch
medication routes: oral inhalation
- medications are administered for nasal congestion/allergies/ sinus issues
- they do not have any effect on the lungs and bronchioles
how to administer
- help pt into upright position with head tilted slightly forward
- insert tip into the appropriate nare and occlude other nare with finger
- point spray tip toward side and away from the center of the nose
- spray and inhale at the same time
- help pt remove nozzle from nose and instruct to breath through the nose
- offer face tissues, but caution against blowing for several minutes
medication routes: oral inhalation
- medication inhaled through mouth to enter lung tissue
- they are not considered PO medications because they do not enter the GI tract
general instructions for inhaler
- instruct pt to breath out through the mouth
- place inhaler to lips, seal lips around mouthpiece
- take a deep, slow breath in
- keep lips sealed and hold breath for about 10 seconds
- release breath and remove inhaler from lips
metered dose inhalers
- inhaler is pressurized and will release medications when the container is pressed down on
- requires hand strength and hand-breath coordination
- pt must inhale as they simultaneously press down on the medication container
- may use a spacer with this
dry powder inhalers
- diskus inhalers
- activated by pt’s breath
- delivers more medications to the lungs
