week 2 Flashcards
The 8 Rights of Med Administration
- Right Medication
- Right Dose
- Right Time
- Right Route
- Right Client
– Always check the Pt’s ID band - Right Documentation
- Right Reason
- Right Frequency
- For refusal
right time
In most instances, the medication can be considered given “on time” if administered within ½ hour prior to or ½ hour after the time ordered.
The right documentation
- The right documentation refers to the charting of the time when the medication was given.
- This needs to be charted immediately after the client has taken his/her medication
- The nurse needs to witness the client taking the medication before she can sign off
- This documentation should be placed on the medication record under the correct date and time.
The Right Reason
- refers to the nurses’ knowledge as to why the patient is on the medication
- The nurse verifies that the medication ordered is correct for the clients illness or diagnosis
- The nurse can refer to the CPS under “drug uses” to determine that this is an appropriate medication for the reason in which this patient is being treated
The Right Frequency
- The nurse must know why a medication is ordered for certain times of the day and whether the time schedule can be altered
- Medications that must act at certain times are given priority (ie. Insulin should be given at a precise interval before a meal)
- Give medications according to their action: ie. Sleeping pills are given at bedtime whereas as diuretics are given in the morning
Medication errors (MEs)
failure to complete or use the correct planned action for pnt when providing meds
Adverse drug events (ADEs)
injury that is cb a med or failure to admin a med. May or may not cause harm to pnt
Adverse drug reactions (ADRs)
injury occurring at the time a drug is used.
idiosyncratic
is a rxn that is specific to the pnt
Two types of Adverse Drug Reactions (ADRs)
Allergic reactions
Idiosyncratic reactions
Parenteral Drugs
IM (intramuscular) SubQ (subcutaneous) ID (intradermal) IV (intravenous) you need to be certified to do IVpush
Parenteral Drugs x2
Never recap a used needle!
May recap an unused needle with the “scoop method”
Filtered Needle
ampules
for narcotics
you need to double count them on your shift
DONT MASSAGE HEPARIN
.
HOLD Z TRACK FOR
10 SECONDS
AIR LOCK
0.2mL of air IN THE NEEDLE AND IT LOCKS THE MEDICATION INSIDE.
Ventrogluteal site
preferred site for adults and children over 18 months
Vastus lateralis site
(preferred site for infants)
First trimester
is the period of greatest danger for drug-induced developmental defects
Nausea medications
During the last trimester
the greatest percentage of maternally absorbed drug gets to the fetus
FDA classifies drugs for pregnancy according to their safety
Pain meds, any opioids, can cause respiratory depression. Look for apneic spaz on baby.
Absorption
peds
Gastric pH less acidic (-increase abrop rate)
Gastric emptying is slowed (-peristalsis is slower)
Topical absorption faster through the skin (thin and more permeable)
Intramuscular absorption faster (-because there is more fluid) and irregular (-developing muscle)
More drug enters the brain because of the immature blood-brain barrier (-watch baby for neurological e
Distribution
peds
TBW (total body water) is 70% to 80% in full-term infants, 85% in premature newborns, 64% in children 1 to 12 years of age
Greater TBW means fat content is lower
Decreased level of protein binding (more free drug in the tissues)
Immature blood-brain barrier
Metabolism
peds
Liver immature, does not produce enough microsomal enzymes
Less Cytochrome P-450 enzyme is produced (necessary for metabolism of drugs) ( –the drug becomes more potent)
Older children may have increased metabolism, requiring higher doses
Excretion
peds
Kidney immaturity affects glomerular filtration rate and tubular secretion (drugs not readily excreted)
Decreased perfusion rate of the kidneys
Increased susceptibility to drug overdoses and side effects as metabolites (by-products of the drugs) are not excreted
NEVER GIVE ASPRIN TO CHILDREN IT LINKS TO RYES SYNDROME
YOU CAN GIVE TYLONOL AND ADVIL
NEVER GIVE 2 Y/O A PILL
. FOR THE POTENTIAL OF ASPRIATON.
. The child receives a dose of 1 teaspoon per directions according to his weight of 28 lb. Later, when his 5 yr-old sister needs a dose, she receives 1.5 teaspoons because her weight is 45 lb.
If the concentration of the drug contains 160 mg per teaspoon, then how much medication (mg) did the 5 year-old receive with her dose? Change all weights to kilograms.
25/2.2=11.36* 160
?
- What should the parents look for when evaluating the children’s response to a dose of acetaminophen
DECREASE FEVER
Polypharmacy
(the use of many different medications from various physicians or OTC for the same illness. They doctor shop)
Decreased albumin:
geriatrics
Reduced protein, therefore higher unbound drugs resulting in enhanced symptoms (-DRUG-DRUG INTERCTIONS)
Increased leakage into the tissues (therefore poorly excreted)
Protein bound drugs are too large to pass through the vessel walls therefore, they cannot pass into the tissues to illicit a drug response only unbound drugs are “free” to attach to the receptor sites
excretion in geriatrics
LOOK FOR HIGH SERUM CREATINE (LOW KIDNEY FUNC
LOOK FOR ENZYMES IN LIVER (AST AND ALT) HIGH LEVELS INDICATE LIVER IS IN POOR FUNCTION.
- Injections given in the outer layers of the dermis in very small amounts
- id
- Another term for IV push medications-
bolus
- Injections that deposit drugs deep into muscle tissue-
im
- This route allows for rapid absorption of drugs into the bloodstream through oral mucous membranes.-
c
sublingiual
- The IM site that is not preferred for use due to the proximity of the sciatic nerve and major blood vessels-
dorsal gluteal
- The preferred IM site for adults and children older than age 18 months
ventrogluteal
- The IM site located in the upper arm
deltoid
- Topical medications may be administered via these patches to the skin
.transdermal
- This type of needle should be used when withdrawing medications from a glass ampule.
filter
- Topical medications for asthma may be administered through a metered-
dose inhaler.
- Abbreviation for small-volume IV medication admixtures –
iv piggyback
Vitamins
Essential for normal physiological and metabolic function
Available from natural sources from both plants and animals (fruits, veggies, meat and fish)
Also available synthetically
Insufficient amounts result in various deficiencies, can be due to:
Poor diet intake
Swallowing disorders
Digestive disorders
Absorption disorders
Financial difficulties leading to poor nutritional intake
Vitamin K and Vitamin B
complex vitamins are obtained by synthesis in the small intestine by normal bacterial flora
Vitamin D
can be synthesized by the skin when exposed to sunlight
Water-Soluble Vitamins
B-complex group and vitamin C
Can be dissolved in water
Excreted via the kidneys
Cannot be stored by the body in large amounts
Daily intake required to prevent deficiencies
Fat-Soluble Vitamins
Vitamins A, D, E, K Present in both plant and animal foods Stored in the liver and fatty tissues in large amounts Most excreted via feces Daily intake not required
Deficiency occurs only after prolonged deprivation
Can become toxic if excessive amounts are consumed resulting in hypervitaminosis
Vitamin A
Fat soluble obtained from plants and animals
Vitamin A (retinol) derived from animal fats (butter and milk), eggs, meat, liver, fish liver oils
The vitamin A in animal tissues is derived from carotene, which are found in plants (green and yellow vegetables and yellow fruits)
Required for growth and development of bones and teeth
Necessary for other processes
Reproduction
Integrity of mucosal and epithelial surfaces
Cholesterol and steroid synthesis
Essential for night vision
Dietary supplement Infants and pregnant and nursing women Deficiency states Hyperkeratosis of the skin Night blindness Other eye disorders Skin conditions Acne and psoriasis
Ingestion of excessive amounts causes toxicity
Irritability, drowsiness, vertigo and delirium
Increased intracranial pressure in infants
Generalized peeling of the skin and erythema over several weeks
Brittle nails, hair loss
Symptoms resolve once the vitamin is discontinued
Decreased absorption with lubricating laxatives
Vitamin D
Fat soluble
“Sunshine vitamin”
Responsible for proper utilization of calcium and phosphorus
Essential for calcification of bone
Regulation of serum calcium via the parathyroid hormones
Vitamin D-containing foods Fish oils, salmon, sardines, herring Fortified milk, breads, cereals Animal livers, tuna fish, eggs, butter Endogenous synthesis in the skin from the sun
Regulates absorption of and use of calcium and phosphorus
Necessary for normal calcification of bone and teeth
Dietary supplement
Treatment of vitamin D deficiency
Treatment and correction of conditions related to long-term deficiency: Rickets, Tetany (muscular contractions), osteomalacia (softening of the bones)
Prevention of osteoporosis
Hypertension
Arrhythmia (when combined with Digoxin)
Fatigue, muscle weakness and pain, ataxia and gi distress
Decreased absorption with lubricating laxatives
Risk of cardiac arrhythmia with Digoxin preparations
Vitamin E
Fat soluble Dietary plant sources Fruits, grains, cereals, vegetables, oils, wheat germ Animal sources Eggs, chicken, meats, fish
Exact biologic function of vitamin E is unknown
Believed to act as an antioxidant
Dietary supplement
Antioxidant, prevents formation of toxic chemicals in the body
Treatment of deficiency
Highest risk of deficiency in premature infants
Nausea
Vomiting
Headache
Fatigue
Vitamin K
Fat soluble
Three types: K1, K2, K3
Dietary sources of K1
Green leafy vegetables (cabbage, spinach), meats, milk
Vitamin K2 synthesized by the intestinal flora
Essential for synthesis of blood coagulation factors in the liver
Vitamin K–dependent clotting factors
II
VII
IX
X
Vitamin K1 deficiency results in coagulation disorders
Dietary supplementation
Treatment of deficiency (rare as the intestinal flora synthesizes sufficient amounts)
Antibiotic therapy (wipes out the normal flora)
Newborn infants (due to mal-absorption from decreased bile, therefore newborns are given a dose of Vitamin K1 injectable after birth)
Mal-absorption
Reverse the effects of certain anticoagulants (warfarin)
Adverse Effects: Headache
Anemia
Rash
Water-Soluble Vitamins
Vitamin B complex thiamine (B1) – pyridoxine (B6) riboflavin (B2) – folic acid (B9) niacin (B3) – cyanocobalamin (B12) pantothenic acid (B5) Vitamin C ascorbic acid
Can dissolve in water
Not stored in the body
Body excretes what it doesn’t use via the kidney
Intake must be adequate and regular or deficiency may develop
Toxic reactions are very rare
Vitamin B1 (Thiamine)
Essential for carbohydrate metabolism
Integrity of the peripheral nervous system
Integrity of the cardiovascular system
Integrity of the gastrointestinal tract
Used as a dietary supplement for mal-absorption due to alcoholism
Available in: whole grains, liver and beans
Vitamin B2 (Riboflavin)
Water soluble vitamin Essential for tissue respiration Generally safe, no reports of toxicity May discolor urine to yellow-orange Deficiency is rare and does not usually occur in healthy people
If present: Alcoholism is a major cause Deficiency also caused by: Intestinal malabsorption Long-term infections Liver disease Malignancy
Food sources Leafy green vegetables Eggs Nuts Meats Yeast
Vitamin B3 (Niacin)
Water soluble
Food sources
Meats, beans, liver, yeast, wheat
Works as an antihyperlipidemic agent (lowers cholesterol and triglyceride levels)
Essential for carbohydrate, protein and lipid metabolism and tissue respiration
Adverse Effects Flushing (most frequently reported effect) Pruritus Gi distress Generally subside with continued use
Vitamin B6 (Pyridoxine)
Deficiency results in anemia and peripheral neuropathy (paraesthesia)
Available in whole grains, nuts, yeast, fish and organ meats
Vitamin B9 (Folic Acid)
Essential for the production of nucleoproteins (DNA and RNA)
Prevention of fetal neural tube defects (ie spina bifida)
Folic Acid deficiency leads to anemia
Available: dried beans, peas, oranges and green vegetables
Vitamin B12 (Cyanocobalamin)
Essential for the metabolism of fat, carbohydrates and protein synthesis
Required for growth, cell replication and CNS (myelin synthesis)
Available in: organ meats, liver, kidney, fish, shell fish, meat and dairy
Deficiency leads to anemia, degeneration of the CNS and nerve atrophy
Vitamin C (Ascorbic Acid)
Water soluble Natural sources Citrus fruits and juices Tomatoes Cabbage Cherries Liver
Deficiency: Prolonged deficiency results in scurvy Gingivitis and bleeding gums Loss of teeth Anemia Subcutaneous hemorrhage Bone lesions Delayed healing of soft tissues and bones
Indications: Dietary supplement Prevention and treatment of scurvy Urinary acidifier Prophylactic for the common cold (not proven)
Megadoses:
Nausea, vomiting, headache, abdominal cramps
Acidified urine, with possible stone formation
Discontinuing megadoses may result in scurvy-like symptoms
Minerals
Are inorganic elements or salts
Bind with enzymes or other organic molecules
Help to regulate many body functions
Act as building blocks
Needed for intracellular and extracellular electrolytes
Calcium
Most abundant mineral element in the body
Accounts for 2% of body weight
Highest concentration in bones and teeth
Efficient absorption requires adequate amounts of vitamin D
Calcium Deficiency: Calcium deficiency: hypocalcemia Infantile rickets Adult osteomalacia Osteoporosis Calcium requirements high for Growing children Women who are pregnant or breast-feeding
Magnesium
One of the principal cations of intracellular fluid
Essential for enzyme systems associated with energy metabolism
Required for:
Nerve physiology
Muscle contraction
Causes of Deficiency: Hypomagnesemia Malabsorption Alcoholism Long-term IV feedings Diuretics Metabolic disorders (hyperthyroidism, diabetic ketoacidosis)
Zinc
Trace element
Essential in metabolic reactions of proteins and carbohydrates
Important for normal tissue growth and repair, especially wound repair
Vitamins and Minerals:Nursing Implications
Assess nutritional status
Assess baseline lab values (WBC, RBC, protein, albumin levels)
Assess history and medication history
Assess for contraindications
