skills lecture 7 Flashcards
to safely and accurately administer medications, you need knowledge related to what
-legal aspects of health care
-pharmacology/pharmacokinetics
-life sciences
-pathophysiology
-human anatomy
-mathematics
legal aspects of health care in regards to medication administration
scope of practice
controlled substance regulations
pharmacology/pharmacokinetics in regards to medication administration
how the medication works
life sciences in regards to medication administration
how medications work in the body
how underlying issues have an impact on medications
pathophysiology in regards to medication administration
how medications work in the body
how underlying issues have an impact on medications
human anatomy in regards to medication administration
how to safely give a medication
mathematics in regards to medication administration
how to calculate doses
what are the three types of drug names
-chemical
-trade
-generic
provides the exact description of medications composition that is rarely used in nursing
chemical name
the manufacturer who first develops the drug assigns the name, and it is then listed in the U.S. pharmacopeia
generic name
also known as brand or proprietary name this is the name under which a manufacturer markets the medication
trade name
Effect of medication on body system, Symptoms the medication relieves, Medication’s desired effect are examples of what
classification of a medication
what is the classification for lisinopril?
treatment for htn
what is a combination medication
a medication that includes two or more active ingredients combined in a single dosage form
how are combination drug names listed on medications packs?
list the trade name followed by the generic name of each drug
how is the dosage listed for a combination medication
in order of the generic names listed
norco
hydrocodone-acetaminophen
percocet
oxycodone/acetaminophen
the passage of medication molecules into the blood from the site of administration
absorption
factors that influence absorption
-route of administration
-ability of a medication to dissolve
-blood flow to the site of administration
-body surface area
exercise and heat can increase blood flow to a site, speeding up and increasing what
medication absorption
why does parenteral medications absorb quicker than oral medication
because it goes in the blood and not in the stomach
what is pharmacokinetics
a drugs journey through the body
what are the pharmacokinetics of medication actions
-absorption
-distribution
-metabolism
-excretion
how medication is moved through the body
distribution
circulation
medications are _________ into a less-potent or an inactive form
metabolized
what organ is important in medication metabolism
liver
if there is decreased liver function medication will not be metabolized and can cause what
toxic affects
excretion of medications occurs through what?
kidney and bowels
if kidneys are not filtering out the medication what happens to it?
it stays in the blood
what tests can be ran to determine if the kidneys are filtering out medications
egfr
how does age affect drug-receptor interaction
brain receptors become more sensitive making psychoactive drugs very potent
how does age affect circulation of medication
vascular nerve control is less stable
how does age affect metabolism of medication
liver mass shrinks, hepatic blood flow and enzyme activity decline.
metabolism drops to one-half to two-thirds the rate of young adults
enzymes lose ability to process some drugs thus prolonging drug half-life
how does age affect absorption of medication
gastric emptying rate and gastrointestinal motility slows. absorption capacity of cells and active transport mechanism decline
how does age effect excretion of medication
in kidneys, renal blood flow, glomerular filtration rate, renal tubular secretion and reabsorption and number of functional nephrons decline. blood flow and waste removal slow. age-related changes lengthen half-life for renally excreted drugs. antidiabetic drugs, among others stay in the body longer
how does age affect distribution of medication
lean body mass falls. adipose stores increase. total body water declines, raising the concentration of water-soluble drugs, such as digoxin, which can cause heart dysfunction. plasma protein diminishes reducing sites available for protein bound drugs and raising blood levels of free drugs
types of medication actions (9)
-therapeutic effect
-adverse effect
-side effect
-toxic effect
-allergic reaction
-medication interactions
-medication tolerance
-medication dependence
-psychological dependence
what do we expect the medication to do, expected or predictable outcome
therapeutic effect
unpredicted outcome or undesired outcome
adverse effect
predictable secondary undesirable response
side effects
accumulation of the medication in the blood stream, undesirable affect
toxic effect
adverse effects that cannot be explained by the known mechanisms of action of the drug, do not occur in most patients, and develop mostly unpredictably in susceptible individuals only
idiosyncratic reaction
who is at risk for toxic effects of medication and why?
older adults because everything slows down
unpredictable medication reaction
allergic reaction
one medication modifies the action of another
medication interactions
more medication is required to achieve the same therapeutic effect
medication tolerance
the body needs it
medication dependence
the body thinks you need the medication
psychological dependence
if a patient has an allergic reaction to a medication what does the nurse need to do
-assess
-assess respiratory
-document
-notify provider
A postoperative patient is receiving morphine sulfate via patient-controlled analgesia (PCA). The nurse assesses that the patient’s respirations are depressed. The effects of the morphine sulfate can be classified as:
A. allergic.
B. idiosyncratic. SPECIFIC GROUP OF PEOPLE
C. therapeutic.
D. toxic. BECAUES THE PT IS GETTING TOO MUCH AND IT IS DEPRESSING THE RESPIRATORY
d toxic
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 determines the medication the patient needs, places the order for the medication
provider
what info does the provider need to include on an order
-patients name
-order date
-medication name
-dosage
-route
-time of administration
-drug indication
-prescriber’s signature
types of orders
-standing or routine
-prn
-single
-stat
-now
-prescriptions
administered until the dosage is changed or another medication is prescribed
standing or routine
given when the patient requires it
prn
given one time only for a specific reason
single one time dose
given immediately in an emergency
stat
when a medication is needed right away but not stat
now
medication to be taken outside of the hospital
prescriptions
who prepares and distributes medication
pharmacists
what are a nurses role for medications
-determines medications ordered are correct
-ensure medication to be administer is correct
-determines medication timing
-administers medications correctly
-closely monitors effects
-provides patient teaching
can you delegate medication administration to assistive personnel?
no
can you hand medication to patient then leave the room?
no
who can you delegate medication pass to?
another RN
if you think it is not safe to give a medication what should you do?
hold medication and contact dr
when medications are given more than once a day, it is important they are what?
spaced out evenly
scheduled medications are to be given what times?
at specific times
what is the time window medications can be given?
one hour before and one hour after it is scheduled
use critical thinking and organization skills to group medication administration ________ if possible
together
medications that can be given so many times a day, that is dependent on the order and can be found on the mar
prn medications
when preparing to administer a prn medication it is important to determine what?
when the last time it was given
any preventable event that may cause inappropriate medication use or jeopardize patient safety
medication error
when a med error occurs what do you need to do
-first asses the patients condition, then notify the health care provider
-when the patient is stable, report the incident
-prepare and file an occurrence or incident report
do you need to report near misses and incidents that cause no harm?
yes
examples of medication errors
-wrong dose
-wrong patient
-wrong time
-wrong medication
-expired medication
-wrong preparation
-wrong route
-forgetting to sign off correctly
-signing off before the patient takes the medication
-signature without credentials
-not verifying the controlled substance count on the correct log
-not signing out the controlled substance on the correct log
if a nurse experiences a problem reading a physicians medication order, the most appropriate action will be to
call the physician to verify the order
seven rights of medication administration
-medication
-dose/amount
-patient
-route
-time
-documentation
-indication/reason
what are the patients rights of medication administration
-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 appropriate supportive therapy
-to not receive unnecessary medications
-to be informed if medications are part of research study
if a patient refused a medication what are the next steps
-ask why and find out the problem and see if there is a way to fix it, educate, document
Nurses are legally required to document medications that are administered to patients. The nurse is mandated to document which of the following?
A. Medication before administering it.
B. Medication after administering it.
C. Rationale for administering it.
D. Prescriber rationale for prescribing it.
b medication after adminstering it
control substances scheduled
schedule I
schedule II
schedule III
schedule IV
schedule V
examples of schedule I drugs
heroin
marijuana
ecstasy
examples of schedule II drugs
vicodin
cocaine
methamphetamine
methadone
dilaudid
oxycontin
fentanyl
adderall
ritalin
examples of schedule III drugs
tylenol with codeine
examples of schedule IV drugs
ativan
ambien
tramadol
examples of schedule V drugs
lyrica
medications that have the potential for abuse and have a high safety concern when adminstering
controlled substances
what are the controlled substances that will be on med pass that we need to know
-tramadol
-hydrocodone
-oxycodone
-ativan (lorazepam)
-norco (hydrocodone with acetaminophen)
-percocet (oxycodone with acetaminophen)
lorazepam
ativan
hydrocodone with acetaminophen
norco
oxycodone with acetaminophen
percocet
as soon as you access a controlled substance for a patient you must verify what
the count
what do you document on the controlled substance log
current count
amount popped
date
time
initials
when do you document on the controlled substance log?
when you pop the medication
when documenting on the controlled substance log what are you indicating?
that you have pulled and dispensed a controlled substance
documenting on the controlled substance log does not indicate what?
that the patient took the medication
if you have to waste a controlled substance what must occur
another nurse must witness and sign off on it
rules on wasting medications will depend on what
the facilities procedure
do not leave medication cart before you ________ it is the correct medication
verify
when comparing the controlled substance log with the medication in hand what must the nurse look at to ensure accuracy?
-patients name
-patients dob
-medication name
-medication dose
-medication route
you do not perform _______ with the controlled substance log
tramped
common over the counter medications found in nursing homes
community medications
if you place a community medication cap of a bottle face down what does this cause
asepsis issues
medications that cannot be crushed
-extended release
-sustained release
-delayed release
-enteric coated
-timed release
-controlled release
why should you not crush time released medications
they are designed to slowly release medication and crushing them can be harmful
what do you do if some medications can be crushed and some cannot?
a consult to see if medication can be changed to a liquid
how can you administer medications that cannot be crushed in a way the patient can easily take them?
put it in pudding or applesauce to see if they can swallow it or see if it comes in liquid
when preparing a patients medication what should you ask them?
their preference on how they like their medications
what is a reason pills will be split?
medication dose is lower than medication strength
whats the smallest you should split a medication?
in quarters