yoost chapter 35 medication administartion Flashcards
Schedule I means
High potential for abuse
No currently accepted medical use in treatment in the United States
Schedule I examples
Heroin, lysergic acid diethylamide (LSD), and methaqualone
Schedule II means
High potential for abuse; may lead to severe psychological or physical dependence
Has a currently accepted medical use with severe restrictions
Schedule II examples
Morphine, cocaine, methadone, and methamphetamine
Schedule III means
Lower potential for abuse compared with the drugs in schedules I and II in regard to moderate dependence
Has a currently accepted medical use
schedule III examples
Anabolic steroids, narcotics such as codeine or hydrocodone with aspirin or acetaminophen, and some barbiturates
Schedule IV means
Lower potential for abuse relative to the drugs in schedule III; may lead to limited dependence
Has a currently accepted medical use
Schedule IV examples
Pentazocine, meprobamate, diazepam, and alprazolam
Schedule V mean
Low potential for abuse relative to the drugs in schedule IV
Has a currently accepted medical use in treatment in the United States
Schedule V examples
Over-the-counter (OTC) cough medicines with codeine
Pharmacokinetics is the study of
the journey of medication is in the body
therapeutic means
intended effect, is the desired result or action of a medication
Absorption is
the passage of a drug from the administration site into the bloodstream
what is the 5 categorize of food and drug for pregnant women least to most harmful
A
B
C
D
X
what is a drug half life
expected time it takes for the blood concentration to measure one-half of the original drug dose
what is onset of action
the time the body takes to respond to a drug after administration
peak plasma level indicates
highest serum (blood) concentration
what is the trough
lowest serum level of the medication
Side effects are
predictable but unwanted effects
adverse effects are
often unpredictable and unwanted effects
Toxic effects are
overdose or the buildup of medication in the blood due to impaired metabolism and excretion
Allergic reactions
unpredictable response from immune system
anaphylactic reaction is
severe allergic reaction
idiosyncratic reaction is
unpredictable patient response to medication
Medication interactions happen when
a certain food or herb or another medication is present in the patient body
synergistic effect is
combined effect is greater than the effect of either substance if taken alone
Antagonism is
when the drug effect is decreased by taking the drug with another substance, including herbs
drug incompatibility is
Mixing medications in a solution that causes precipitation or combining a drug with another drug that causes an adverse chemical reaction
Factors to consider when selecting an OTC medication
- understanding the desired effect and potential side and adverse effects of all ingredients in the medication
2.possible allergic reactions
3.potential interactions with other medications and herbs
4.warnings
5.directions and dosage
- features (such as safety caps)
dangers of using vitamin
excess can build up in the liver
They can have side effects
vitamin B3 (niacin) adverse effects
Flushing, redness of the skin, upset stomach
vitamin B6 (pyridoxine, pyridoxal, and pyridoxamine) adverse effects
Nerve damage to the limbs, which may cause numbness, trouble walking, and pain
vitamin C (ascorbic acid) adverse effects
Upset stomach, kidney stones, increased iron absorption
vitamin Folic acid (folate) adverse effects
At high levels, especially in older adults, may hide signs of B12 deficiency
vitamin A (retinol, retinal, retinoic acid) adverse effects
Nausea, vomiting, headache, dizziness, blurred vision, clumsiness, birth defects, liver problems, possible risk of osteoporosis
vitamin D (calciferol) adverse effects
Nausea, vomiting, poor appetite, constipation, weakness, weight loss, confusion, heart rhythm problems, deposits of calcium and phosphate in soft tissues
Herb uses: Echinacea
Stimulates the immune system; facilitates wound healing; fights flu and colds
Herb uses: Garlic
Lowers blood pressure and cholesterol and triglyceride levels
Herb uses: Ginkgo biloba
Improves memory and mental alertness
Herb uses: Ginseng
Increases physical stamina and mental concentration
Herb uses: Saw palmetto
Helps with enlarged prostate and urinary inflammation
Herb uses: St. John’s wort
Alleviates mild to moderate depression, anxiety, and sleep disorders
herb side effects and drug interations: Echinacea
Possible liver inflammation and damage if used with anabolic steroids or methotrexate
herb side effects and drug interations: Garlic
Increased bleeding; potentiates action of anticoagulants
herb side effects and drug interations: Ginkgo biloba
Increased bleeding; potentiates action of anticoagulants
herb side effects and drug interations: Ginseng
Can increase heart rate and blood pressure; decreases effectiveness of anticoagulants; may cause hypoglycemia in patients taking oral hypoglycemics or insulin
herb side effects and drug interations: Saw palmetto
Interacts with other hormones
herb side effects and drug interations: St. John’s wort
Interacts with anti-anxiety medications, antidepressants, anticoagulants, birth control pills, cyclosporine, digoxin, statins, and human immunodeficiency virus (HIV) and cancer medications
legally valid medication prescription include
- Patient’s name
- Date and time the order is written
- Name of drug to be administered
- Dosage of the drug
- Route of drug administration
- Frequency of drug administration
- Signature of the person writing the order
Types of Medication Orders: Routine order
Administered until the health care provider discontinues the order or until a prescribed number of doses or days have occurred.
Types of Medication Orders: PRN order
Given only when the patient requires it. Use determined by objective and subjective assessment and clinical judgment of the nurse.
Types of Medication Orders: One-time or on-call order
Given only once at a specified time, often before a diagnostic or surgical procedure.
Types of Medication Orders: Stat order
Given immediately and only once in a single dose; frequently given for emergency situations.
Types of Medication Orders: Now order
Used when a medication is needed quickly but not as immediately as a stat medication; given one time.
7 routes of administration are
oral (by mouth)
buccal (against the cheek)
sublingual (under the tongue)
parenteral (by injection or infusion)
topical (on skin or mucous membranes)
inhalation
medical tube
what does PO mean
by mouth
Common Forms of Medication: Tablets
Medication is compressed with binding substances and disintegrating agents; may have flavoring added to improve taste; used for oral, sublingual, and buccal routes.
Enteric-coated tablets have a special outer covering that delays absorption as it dissolves in the intestines.
Common Forms of Medication: Capsules
Medications are enclosed in cylindrical gelatin coatings.
Time-release capsules have medication particles encased in smaller casings that deliver medication over an extended period.
Common Forms of Medication: Powders
Ultrafine drug particles in a dry form; depending on the medication, may be inhaled, mixed with food, or dissolved in liquids immediately before administration.
Common Forms of Medication:Troches or lozenges
Medications prepared to dissolve in the mouth
Common Forms of Medication: Solutions
Medications already dissolved in liquid.
Syrups are mixed with sugar and water.
Suspensions are finely crushed medications in liquid.
Elixirs are medications dissolved in alcohol and water with glycerin or other sweeteners.
Drops are a sterile solution or suspension administered sublingually or directly into the eye, outer ear canal, or nose.
Injectable solutions are sterile suspensions supplied in ampules, vials, prefilled syringes, bags, or bottles.
Common Forms of Medication: Inhalants or sprays
Medications inhaled or sprayed into the mouth or nose; may have local or systemic effects.
Some are delivered in fixed doses.
Common Forms of Medication: Skin preparations
Ointments (spreadable, greasy preparations), creams (not greasy but used on skin only), and lotions (solutions or suspensions used on skin and not as sticky as creams or ointments).
Transdermal patches contain medication absorbed through the skin over an extended period.
Common Forms of Medication: Suppositories
Bullet-shaped gelatin tablets commonly administered rectally or vaginally depending on the medication. Urethral preparations are used for erectile dysfunction.
Medication Administration Routes advantages/ disadvantages: oral
advantages:Certain oral tablets formulated to dissolve on contact with the tongue
disadvantage: Inappropriate for patients with nausea or vomiting
contraindicated for patients with swallowing difficulty
Can irritate the gastrointestinal lining, have an unpleasant taste, or discolor teeth
Patient must be alert and oriented to safely administer
Cannot be used with simultaneous gastric suctioning or before various diagnostic or surgical procedures
Possible irregular or slow absorption
Medication Administration Routes advantages/ disadvantages: sublingual or buccal
advantages: As above plus more potent because the drug bypasses the liver and enters the bloodstream directly
disadvantages: May be inactivated by gastric juices if swallowed
Medication Administration Routes advantages/ disadvantages: Topical
advantages: Local effect with few side effects
disadvantages: Absorption may be irregular if skin breaks are present, and it may be slow
Medication Administration Routes advantages/ disadvantages: Transdermal
advantages: Prolonged systemic effects without gastrointestinal absorption problems
disadvantages: May leave residue on clothes or skin. May cause localized skin irritation.
Medication Administration Routes advantages/ disadvantages: Mucous membranes (eyes, ears, nose, vagina, rectum, ostomy)
advantages: Local effects to involved sites with systemic effects possible; readily absorbed; may be used if the oral route is contraindicated
disadvantages: Mucous membranes are highly sensitive to concentrated medications
Dose absorption may be unpredictable
Procedure may be messy
Medication Administration Routes advantages/ disadvantages: Inhalation
advantages: Rapid localized effect; may be administered to unconscious patients
disadvantages:May cause serious systemic effects; can be administered only through the respiratory system
Medication Administration Routes advantages/ disadvantages: Parenteral (intradermal, subcutaneous, IM, IV)
advantages: Can be used if the oral route is contraindicated; more rapid response than the oral or topical route; can be used for critically ill patients or for long-term therapy
IV route can decrease discomfort and can better control absorption if peripheral perfusion is compromised
disadvantages: Sterile technique must be used, as the skin barrier is compromised
More costly to formulate and administer; useful for small volumes only, except by IV route; affected by circulatory status; can produce patient anxiety
Intradermal
Shallow injection into the dermal layer just under the epidermis
Subcutaneous
Injection into the subcutaneous tissue just below the skin
Intramuscular (IM)
Injection into a muscle of adequate size to accommodate the amount and type of medication
Intravenous (IV)
Injection or infusion directly into the bloodstream via a vein
Proper needle length depends on
age and size of the patient and the route of administration
Syringe and Needle Sizes: Subcutaneous
Syringe Selection:1⁄2–3mL
Insulin syringe: U-100, U-50, or U-30
Needle Selection: 25–31 gauge, 3⁄8–5⁄8 inch (up to 1 inch for an obese patient)
Preattached to Insulin syringe: 29–33 gauge, 1⁄8–5⁄16 inch (4–8 mm)
Site Selection:Abdomen, lateral aspects of the upper arm and thigh, scapular area of the back, and upper ventrodorsal gluteal area
Syringe and Needle Sizes: Intradermal
Syringe Selection:1-mL tuberculin syringe
Needle Selection: Preattached 25–27 gauge, 1⁄4–5⁄8 inch
Site Selection: Inner forearm, upper arm, and across the scapula
Syringe and Needle Sizes: Intramuscular (IM)
Syringe Selection: Adults: 1–5mL
massInfants, small children: 0.5–1 mL
Needle Selection: 19–25 gauge, 1–3 inch (adult)
22–25 gauge, 5⁄8–1 inch (pediatric)
Oil-based solutions: 18–20 gauge
Site Selection: Infant: Vastus lateralis
Children: Vastus lateralis or deltoid
Adult: Ventrogluteal or deltoid
Syringe and Needle Sizes: Infant: Vastus lateralis
Children: Vastus lateralis or deltoid
Adult: Ventrogluteal or deltoid
Syringe Selection: Depends on amount of medication to be infused
Needle Selection: Typically, a large-gauge, 1-inch needle; needleless, blunt-tip cannula or Luer-Lok used with associated IV ports. (Do not use needles in a needleless system to access IV ports.)
Site Selection: Vein
Common Abbreviations Related to Medication Administration: ac
Before meals
Common Abbreviations Related to Medication Administration: pc
After meals
Common Abbreviations Related to Medication Administration: h or hr
hour
Common Abbreviations Related to Medication Administration: bid
Two times per day
Common Abbreviations Related to Medication Administration: tid
Three times per day
Common Abbreviations Related to Medication Administration: qid
Four times per day
Common Abbreviations Related to Medication Administration: q
every
Common Abbreviations Related to Medication Administration: g or gm
gram
Common Abbreviations Related to Medication Administration: mcg
Microgram
Common Abbreviations Related to Medication Administration: mg
Milligram
Common Abbreviations Related to Medication Administration: mL
Milliliter
Common Abbreviations Related to Medication Administration: IM
Intramuscular
Common Abbreviations Related to Medication Administration: IV
Intravenous
Common Abbreviations Related to Medication Administration: PO or po
By mouth, orally
Common Abbreviations Related to Medication Administration: NPO or npo
Nothing by mouth
Common Abbreviations Related to Medication Administration: PRN or prn
As needed
Common Abbreviations Related to Medication Administration: SL
Sublingual
Common Abbreviations Related to Medication Administration: STAT
Immediately
Six Rights of Medication Administration:
- The right drug
- The right dose
- The right time
- The right route
- The right patient
- The right documentation
Additional checks before medication administration
- Check prescriber order.
- Check patient allergies.
- Check medication expiration date.
Complete an assessment and verify the observations:
- The appropriate vital signs are taken before and after administration.
- The patient has no allergies to the drug.
- The appropriate laboratory data are obtained.
- The appropriate physical assessment data are collected.
- The patient’s pain levels are known.
patient rights
- If the patient questions or refuses the medication, stop the administration, verify the information, and proceed accordingly.
- The patient has the right to refuse medications.
- The nurse investigates the patient’s reasons for refusing the medication and provides, reinforces, or clarifies information to ensure that the patient understands the risks of refusing the medication.
- The prescriber needs to be notified of the patient’s refusal of the ordered medication.
- Documentation of refusal of medication should include the patient’s concern, the information provided by the nurse, and the name of the prescriber who was notified of the patient’s refusal.
Do not document administration of the medication until?
it is given to the patient.
Nursing Intervention Classification (NIC)
Teaching: Prescribed Medication
Instruct patient on possible adverse side effects of each medication.
Nursing Outcome Classification (NOC)
Knowledge: Medication
Medication adverse effects
types of topical medications
Creams or oils (for lubrication)
* Lotions (to protect and soothe)
* Powders (for drying surface moisture and decreasing friction)
* Ointments (to provide prolonged contact with the medication and to soften)
* Transdermal patches or disks (for continuous medication administration for several hours to several days)
Parenteral Medications are
Parenteral medications are administered by injection into tissue, muscle, or a vein.
Ampules are
a small glass container that holds a single liquid dose of medication
A vial is
glass or plastic container holding one or more doses of a solution or medication
intramuscular are giving in what degree angle
90
subcutaneous are giving in what degree angle
45 and 90
intradermal is giving in what degree angle
15
The EpiPen and Adrenaclick are specialized devices that look like a large pen and consist of a needle and a syringe; both contain one dose of
epinephrine
Patient education regarding medications is an important responsibility for the
nurse
the nurse administers an opioid analgesic to postoperative patient who reports pain at a level of 9 out of 10. which vital sign does the nurse delegate to the unlicensed assistive personnel for frequent monitoring
respiration
Types of ophthalmic medication
- Eyedrops (for treatment of eye diseases or irritations)
- Ointments (for infections or irritations)
- Irrigations (to remove secretions or foreign bodies or to cleanse and sooth the eye)
- Disks (for continuous medication administration up to a week), which are similar to a contact lens, usually placed in the eye at night because they may cause blurriness of vision, and may stay in place for a week
which form of medication is most rapidly absorbed
inhalers
the nurse works in the postoperative unit. which type of primary care provider order warrants an assessment by nurse to determine if the patient requires medication
PRN order
Types of rectal suppositories
antipyretics, antiemetics, and laxatives
what position is required to administer a requtal suppository to patient
lateral recumbent position
who determine the route for administering medication
the prescriber
nurse observe paitent has a rash, itchy skin, inflammation, and swelling of nasal passages, and raised skin eruptions after iv drug, what drug effect is the patient experincing
allergic effect
which route of administation is suitable for administering a suppoitory
rectal
