Chpt 35 Safe Medication, Glucose

Front 1

Patients SIX rights of medications

Back 1

right medication
right dose
right patient
right route
right time or frequency
right documentation.

Front 2

check medications how many times and when?

Back 2

3 Times
before taking it out of the drawer
before placing it in a medicine cup or taking it to the room
before giving it to the patient. per mosby video.

Book says last one after putting it into medicine cup and taking it to the patients room on last check

Front 3

Time of medications.
Stat
Now
Oncall
ac
pc
prn

Back 3

Stat is immediately
Now is as soon as the drug is available. usually within 1 hour
On call when OR or treatment requires it.
ac before meals
pc after meals
prn as needed

Front 4

Documentation of medications

Back 4

Medications name
time given
Dose
route
name and initials

Front 5

Insulin sites and rate of absorption

Back 5

Abs
arms
thigh
butt

Front 6

TB test range

Back 6

15 mm normally
10 if resent immagrant or drug user
5 mm if hiv positive or other immune suppression is present

Front 7

Medication preparations. can it be delegated

Back 7

Can not be delegated

Front 8

PHARMACOKINETICS

Back 8

Study of drug movement throughout the body

Front 9

4 types of pharmcokinetics

Back 9

Absorption. process of movement of substance from site of injection in to the blood stream.
Distribution- how the agents are transported thoughout the body. Blood flow is key on how fast it is distributed.
Metabolism- bio transformation of the drug. typically after metabolized, it's easier to remove from the body.
Excretion- removal from the body, kidneys, bowels, sweat

Front 10

Therapeutic effect

Back 10

the intended or desired physiological response
Ex: Morphine, an analgesic, relieves pain.

Front 11

Adverse drug reactions

Back 11

harmful, unintended, usually unpredicted rxns to drugs administered at usual dosage



Side effects – predictable and often unavoidable secondary effects that are usually well tolerated by patient.
Ex: Codeine, given for analgesia, has constipation as a side effect

Toxic Effect – dangerous, damaging effects to organ or tissue.
Ex: Toxic levels of Morphine causes severe respiratory depression and death

Front 12

MEDICATION ACTION

Back 12

Idiosyncratic reactions – unpredictable effect; Patient overreacts or underreacts to med or has a rxn different than normal.
Ex: Ativan, an antianxiety medication, may cause agitation and delirium in older adults

Allergic reactions – the immune system identifies a med as a foreign substance that should be neutralized or destroyed.
Ex: Antibiotics have a high incidence of allergic reaction

Front 13

Drug tolerance and dependence:

Back 13

Tolerance – when there is a decreased physiologic response after repeated administration of a drug or chemically related substance
Ex: Opium alkaloids, nitrites, barbiturates, alcohol

Front 14

Dependence – 2 types

Back 14

Psychological – emotional desire to maintain an effect
(marijuana)

Physical – physiological adaptation to a drug that manifests itself by intense physical disturbance when the drug is withdrawn
(codeine)

Front 15

Drug interactions

Back 15

when one drug modifies the action of another drug. May potentiate or diminish the action of other drugs and may alter the way in which another drug is absorbed, metabolized, or eliminated from the body

Summation - combined effects of two drugs equals the sum of the individual effect of each drug (1+1=2)

Synergistic effect – Additive effect (1+1=3)
The effect of both drugs together is greater than the individual effects

Front 16

Knowledge of the following time intervals of a drug action helps to anticipate a drug’s effect:

Back 16

Onset of drug action
Peak action
Duration of action
Plateau
Therapeutic levels of certain drugs can be monitored by blood levels – “peak and trough

Front 17

Terms associated with medication actions

Back 17

onset- time it takes after a medication is administered for it to produce a response
Peak- time it takes for a medication to reach its highes effective concentration
Trough- minimun blood serum concentration of medication reached just before the next scheduled dose
Duration- Time during which the medication is present in concentration great enough to produce a response
Plateau- Blood serum concentration of a medication reached and maintained after repeated fixed doses

Front 18

ROUTES OF ADMINISTRATION

Back 18

The route chosen depends on the drugs properties and desired effect and on the patient’s physical and mental condition

Oral – Solid or liquids, Buccal, Sublingual, Troche
Parenteral (SQ, IM, IV, Intradermal, Intrathecal, Epidural)
Skin (Topical, Transdermal)
Mucous Membranes (eyes, ears, nose, vaginal, rectal, buccal, and sublingual)
Inhalation
Intraocular Disk
Suppository

Front 19

Patients at Risk for Adverse Effects

Back 19

First time
Young and elderly
Taking more then 4 or 5 medications
With history of adverse drug reactions
Treat selves with OTC medications

Front 20

Seven Rights

Back 20

Right Medication
Right Dose
Right Patient
Right Route
Right Time
Right Documentation
Right Rationale

Front 21

NURSING PROCESS IN MEDICATION ADMINISTRATION

Back 21

Front 22

sub lingual route

Back 22

Assist patient to a sitting position

Have patient place medication under the tongue and allow it to dissolve completely

SL route results in rapid onset of action due to rich blood supply

Multiple drugs ordered – Administer SL preparations after oral meds have been swallowed

Instruct pt not to move drug with tongue or eat or drink anything until medication is completely dissolved

Front 23

buccal route

Back 23

Medication is placed in oral cavity between tongue and cheek

Instruct patient not to manipulate med with tongue. If displaced can be moved to SL area where it would be more rapidly absorbed. Could also be swallowed.

Buccal mucosa less permeable to most medications than the SL area, providing for slower absorption

Buccal has a larger mucosal surface area than SL route.

Front 24

liquid route

Back 24

Used more for children and older adults

Remove bottle cap and place upside down on work surface

Hold bottle with label against palm of hand while pouring

Medication cup is at eye level while pouring

Discard excess liquid into sink

Small doses may be drawn up into oral syringe

Front 25

Injection route

Back 25

IM, Sub Q, Intradermal.

Front 26

Intradermal

Back 26

Administer medications just below the skin
Inject only small amounts (0.01 to 0.1 mL)
Most common – skin testing
TB test
Allergy testing
Sites
Inner Forearms and upper back
Needle and syringe size
25 or 27 gauge needle, 3/8 - 5/8 inch
TB or small syringe (1 mL)

Front 27

Subcutaneous Injections

Back 27

Administer medications into loose connective tissue below dermis
Insulin, tetanus, heparin, epinephrine
Only give small doses of medication (0.5-1 mL)
Large volumes (> 1 mL) may cause sterile abscess
Common sites
Outer aspect of upper arms
Abdomen
Anterior aspect of thighs
Rotate sites
Needle and syringe
25 gauge, ½ to 5/8 inch
1-3 mL syringe
Insulin syringe for insulin

Front 28

Syringes

Back 28

Tip to fit needle or needless device
Leur lock connection
Non – leur lock
Single use…disposable
Various sizes
0.5 mL - 60mL