Week 8 Objectives Flashcards
Pharmacokinetic process
Absorption: Site of administration -> bloodstream
Slowest->fastest: Skin, Oral, Inhalation, IM, IV
ACIDIC MEDS DISSOLVE QUICKLY IN STSOMACH, BASIC MEDS DISSOLVE IN SMALL INTESTINE
absorption influences: route, dissolvability, blood flow, body surface area (larger BSF means quicker absorption), lipid solubility (cell membrane has a lipid layer so lipids cross quicker and easier), food in stomach alters absorption
Distribution: Bloodstream -> Site of Action
circulation: impaired circulation inhibits distribution of meds (ex. heart failure)
membrane permeability: ability of meds to pass tissue/membrane of target cells (ex blood brain barrier only allows lipids to pass)
protein binding: degree to which meds bind to serum protein in albumin affects distribution. most meds bind to albumin, reducing pharmacological activity. reduced liver activity increases med toxicity.
Metabolism: Inactivation of medication by metabolism
biotransformation: occurs under enzymes that detoxify, breakdown, and remove biologically active chemicals. mostly occurs in the liver
decrease liver function means meds are eliminated slower resulting in accumulation. this can lead to med toxicity
Excretion: After metabolism of med, they are excreted through the kidneys, liver, bowels, lungs, and exocrine glands.
lungs: gas/volatile compounds; nitrous oxide, alcohol. deep breathing/coughing helps eliminate analgesics.
exocrine: lipid soluble meds (sweat glands, mammary nursing risk
gi tract: meds entering through the hepatic (liver) circulation broken down by liver and excreted into the bile. through the biliary tract, the intestines absorb them.
kidneys: main organ for excretion. adequate fluid intake promotes proper med elimination. declined renal function means kidneys cant excrete meds. risk for med toxicity
Identify roles + responsibilities of the interdisciplinary team in med admin
Provider: physician, Nurse practitioner, Physicians Assistant.
- prescribe meds by putting order in med rec, order book, prescription pad
- Computerized Physician Order Entry (CPOE)
- order by TO or VO
Pharmacist: prepares, distributes meds
- main task: dispensing correct medication in proper dosage and amount with accurate label. also provides info about medication side effects, toxicity, interactions, and incompatibilities.
Distribution System:
- unit dose system: single dose packages that contain ordered dose of meds for px. narcotics not contained her
- automated dispensing system includes narcotics. stores, records, charges px. bio identification, barcode med admin
Nurse
- 1st determine meds are correct
- asses px ability to self-administer, whether px should receive meds at given time, and closely monitors effects
- px and caregiver education asap
Med Admin Procedure
Oral (PO): most common route
- sublingual: under the tongue; nitroglycerin
- buccal (BCC): between the cheek and gum; certain opiates, transmucosal route
- CONTRAINDICATION: herbal supp, impaired ability to swallow
- small bore feeing tube consider tube location. Iron dissolves in teh stomach only and absorbs in the duodenum. Jejunum tube contraindicated for iron. use liquid meds when possible
Topical: creams/patches.
- transdermal patches: remove old patch, label hard to see patches, document patch location, flush narcotic patches
Nasal
- blow nose prior
- administering drops: supine, tilt head back, breathe through mouth, hold dropper 1/2 inch above nares, remain supine 5min
- administering spray: spray+ breathe in through nose, out through mouth
Ophthalmic: ointments, drops, disks
- drops in conjunctiva
- gel, hold pressure on eye for 2 min i think
Ear
- children down and back, adults up and back
- apply pressure after drops, place cotton for 15 minutes
Vaginal
- posterior wall of vagina using entire length of finger 3-4 inches
Rectal: refrigerated meds
- adults 4 inch, children 2 in
Med admin across lifespan
Infants/Children
- Parents give meds
-explain using age-appropriate words, provide choices
- rewards after procedure
Older adults: adverse med events occur 22% more
serious manifestations: falls, orthostatic hypertension, heart failure, delirium
- nursing considerations: minimize adverse meds by discontinuing meds, sparingly giving px new meds, reduce number of providers, frequently reconcile new meds,
- safety: simple instructions in large print, assess functional status, med sensitivity (esp cns meds), liquid for choking risk, med alternative (proper diet instead of laxatives)
Chemotherapy Safety
Risk for exposure: urine, stool, sweat, saliva. Toileting should be double flushed for 48 hours after admin. Handling (packing, unpacking, storage, admin, disposal). Wash clothes and sheets in washing machine. use detergent and wash twice in hot water alone. seal in tight bag if cant wash
Safety Education
- stored in designated area away from noncytotoxic agents
- gloves manufactured for chemo handling
- hand hygiene
- no crushing, splitting, chewing chemo
- separate eqip to prepare
- disposable ppe for handling
Enteral Feeding Med Admin
Tablets: crush in 30mL warm water
Capsule: open capsule and empty contents into 30mL of warm water. 15-20 min with capsule
7 Rights of Medication Administration
Right Medication: confirm/verify drug name, form, expiration date
Right Dose: verify dose against MAR/prescription/order
Right Patient: two different identifiers
Right Route: verify order (oral, IM, IV, etc)
Right Time: when, how, frequency, last dose given
Right Documentation: Px full name, date/time order written, med name, dose, route, time/frequency, provider signature
Right Indication: match diagnosis with meds
