Wk 7 Medication safety

Question 1

Pharmacokinetics As the Basis of Medication Actions

The study of how medications?

Answer 1

Enter the body
Are absorbed and distributed into cells, tissues, or organs
Reach their site of action
Alter physiological functions 
Are metabolized
Exit the body

Question 2

Forms of Medication

Answer 2

Solid form
Liquids
Topical routes
Other oral forms
(The form of medications determine the route of administration. The composition of a medication enhances its absorption and metabolism)

Question 3

Forms of Medication

SOLID FORM

Answer 3

caplet, capsule, tablet, enteric coated tablet (Enteric coated tablets instead of dissolving in the stomach it dissolves in the intestine Medications is available in a variety of different forms

Question 4

Forms of Medication

LIQUIDS

Answer 4

elixir, extract, syrup, aqueous solutions and suspension

Question 5

Forms of Medication

TOPICAL ROUTES

Answer 5

Ointment, lotion, liniment, paste, transdermal disk or patch

Question 6

Forms of Medication

OTHER ORAL FORMS

Answer 6

Troche ( lozenges) Aerosols, sustained released
Parenteral Routes
Solutions and powders
Installation in body cavities
Intraocular disk and suppository

Question 7

Narcotic Administration

Answer 7

Store in lock cabinet

Maintain running count

Use special inventory

Use record to document

Second nurse witness to dispose

Question 8

Drug Action

THERAPEUTIC

Answer 8

Therapeutic effect: Expected or predicted physiological response

Question 9

Drug Action
ADVERSE
SIDE EFFECT
TOXIC EFFECT
IDIOSYNCRATIC EFFECT

Answer 9

Adverse effect: Unintended, undesirable, often unpredictable
Side effect: Predictable, unavoidable secondary effect
Toxic effect: Accumulation of medication in the bloodstream
Idiosyncratic reaction: Over/under reaction or not normal reaction

Question 10

Drug Tolerance

Answer 10

Drug tolerance—decreasing response to repeated doses of a medication. Patient then requires more of the drug to achieve desired effect

Question 11

Drug interaction

Answer 11

One medication modifies the action of another
Common with multiple prescribed meds
Some medication increase or diminish through absorption, metabolism, or elimination from the body
Synergistic effect

Question 12

Allergic Reactions

Allergic reaction

Answer 12

Allergic reaction: unpredictable response to a medication

Question 13

Allergic Reactions

Medication interactions

Answer 13

Medication interactions: when one medication modifies the action of another

Question 14

Anaphylactic reaction

Answer 14

Life-threatening
Occurs immediately after administration with sudden constriction of bronchioles, edema of larynx and pharynx.
Severe shortness of breath, wheezing and severe hypotension.
Immediate treatment includes Discontinue medication, give epinephrine, IV fluids, steroids and antihistamines.
Respiratory support from oxygen to intubation and ventilation

Question 15

Routes of administration Oral routes

SUBLINGUAL

Answer 15

Sublingual Administration. Some medications (e.g., nitroglycerin) are readily absorbed after being placed under the tongue to dissolve.

Instruct patients not to swallow a medication given by the sublingual route or drink anything until the medication is completely dissolved to ensure that the medication will have the desired effect.

Question 16

Routes of administration Oral routes

BUCCAL

Answer 16

Buccal Administration. Administration of a medication by the buccal route involves placing the solid medication in the mouth against the mucous membranes of the cheek until it dissolves.

Teach patients to alternate cheeks with each subsequent dose to avoid mucosal irritation.

Warn patients not to chew or swallow the medication or to take any liquids with it.

A buccal medication acts locally on the mucosa or systemically as it is swallowed in a person’s saliva.

Question 17

Routes of medication Parenteral routes

Four major sites of injection

Answer 17

Intradermal

Subcutaneous

Intramuscular

Intravenous

Question 18

Routes of medication Topical

Answer 18

Skin

Inhalation route

Intraocular route

Mucous Membrane

Question 19

Topical Med Applications

Answer 19

Use gloves and applicators; clean skin first.
Use sterile technique if the patient has an open wound.
Follow directions for each type of medication.
Transdermal patches:
Remove old patch before applying new.
Document the location of the new patch.
Ask about patches during the medication history.
Apply a label to the patch if it is difficult to see.
Document removal of the patch as well.

Question 20

Inhalation Route

Answer 20

Spray
Drops
Tampons

Question 21

Eye Instillation

Answer 21

Instillation
Avoid the cornea.
Avoid the eyelids
Use only on the affected eye.
Never share medications.

Question 22

Eye Instillation

INTRAOCULAR

Answer 22

Intraocular instillation
Disk resembles a contact lens.
Teach patients how to insert and remove the disk.
Teach about adverse effects.

Question 23

Ear Installation

Answer 23

Instill eardrops at room temperature.

Use sterile solutions.

Check for eardrum rupture if patient has ear drainage.

Never occlude the ear canal

Question 24

Needle PARTS

Answer 24

Hub

Shaft

Bevel

Question 25

Ampules

Answer 25

Preparing an injection from an ampule Snap off ampule neck Aspirate medication into syringe using filter needle Replace filter needle with an appropriate size needle or needless device Administer injection

Question 26

Vial

Answer 26

``` Preparing an injection from a vial If dry, use solvent or diluent as needed Inject air into vial Label multi-dose vials after mixing Refrigerate remaining doses if needed ```

Question 27

Insulin preparation

Answer 27

100-Unit insulin syringe or an insulin pen to prepare U-100 insulin Insulin is classified by rate of action: Rapid, short, intermediate, and long-acting Know the onset, peak, and duration for each of your **It is administered by injection because the GI tract breaks down and destroys an oral form of insulin. Use the correct syringe

Question 28

Rights of Medication | RIGHT TIME

Answer 28

Right time scheduled meds may be given within a window of ½ hour before to ½ hour after scheduled time. This also refers to timing of oral meds in relation to meals. Is your patient NPO?

Question 29

Rights of Medication | RIGHT DOCUMENTATION

Answer 29

Right documentation name of medication given, dose of medication given, route of administration, and injection sites for parenteral medication, date and time administered, name and initials of administering nurse

Question 30

Rights of Medication | RIGHT DRUG

Answer 30

``` Right drug (1) BEFORE you pour, mix or draw up a medication check its label against the entry on the MAR. Be sure the name, route, dose, and time, match the MAR entry ``` (2) AFTER you prepare the medication, and before returning the container to the medication cart or discarding anything, check the label against the MAR entry again. (3) AT THE BEDSIDE, check the medication again before actually administering it

Question 31

Rights of Medication | RIGHT DOSE

Answer 31

Right dose after calculating the doses, the nurse prepares the medication according to agency protocol using standard measurement devices

Question 32

Rights of Medication | RIGHT PATIENT

Answer 32

Right patient check the MAR against the patient’s ID band, ask their name and birthdate. ASK, don’t tell!! Let the patient know it is routine, to ensure their safety

Question 33

Rights of Medication | RIGHT ROUTE

Answer 33

Right route if prescriber’s order does not indicate a route, the nurse must consult the prescriber. KNOW YOUR DRUGS!!! The injection of a liquid designed for oral use can have catastrophic effects—including death.

Question 34

Choosing a Subcutaneous Site

Answer 34

Avoid areas lying beneath burns, birthmarks inflamed tissue, or scars Do not use sites with lesions, bony prominences, large underlying vessels or nerves Do not inject closer than 5cm (2in,) from the umbilicus For repeated injections should be at least an inch apart Always rotate sites **Medications placed into loose connective tissue under dermis

Question 35

Intramuscular Site

Answer 35

Injections given in the muscle tissue Absorbed faster then adipose related to rich supply of blood in the muscles Muscles tolerate more fluid/ However the smaller the muscles the less fluid No need to aspirate because shallow depth of the needle

Question 36

Choosing Intramuscular Site

Answer 36

Choose site that is a safe distance from nerves, large blood vessels, and bones Choose a site free from injury, abscess, tenderness, necrosis, abrasion, or other pathology Site should be large enough to accommodate the volume of medication to be given The muscle commonly used are Vastus Laterus, ventrogluteal and deltoid

Question 37

IM Vastus Lateralis Injection

Answer 37

Vastus lateralis - Anterior lateral aspect of the thigh - Middle third of the muscle - 1 to 2 ml - 1 to 1.5-inch 18- to 23-gauge needle depending on viscosity of medication - Infant and children 5/8 to 1/25 inch - Often used for immunizations - 90° angle

Question 38

IM Deltoid Injection

Answer 38

Deltoid - Located in the middle third of the upper arm - Small muscle mass with little sub Q tissue - No more than 0.5 to 1 ml - 1 to 1.5-inch, 18- to 23-gauge needle - 90° angle

Question 39

IM Ventrogluteal Injection

Answer 39

Ventrogluteal - Preferred site for adults - Best site for large amounts of medication - 2 to 3 ml (except in thin or older adults) - 1.5-inch, 18- to 23-gauge - 90° angle

Question 40

Z track IM Technique

Answer 40

Seals the needle track to keep medication from leaking out of the muscle Used for irritating medications Recommended for all IM injections

Question 41

HeparinSQ

Answer 41

``` Abdomen above iliac crest 45 to 90 degree angle 5/8th inch, 25 gauge Pinch skin throughout injection No aspiration No massage ```

Question 42

Cortisone injections IM

Answer 42

Cortisone injections (IM) Make sure IM is in the Muscle If not in the muscle could cause damage to the muscle