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126 Cards in this Set
- Front
- Back
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which government agency regulates drugs
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FDA
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what are the responsibilities of the prescriber
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med history, PE, diagnose symptoms, prescribe meds, monitor response, modify med orders
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who has prescriptive authority
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physician, dentist, podiatrist, physician assistant, advanced practice nurse, nurse practitioner
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describe a standing prescriptive order
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follow until cancelled
aka routine order |
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describe a contingency or PRN prescriptive order
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based on client need and nurse's judgement; may include a range
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describe a one time prescriptive order
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pre-op, today, this pm, on call to OR, etc
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describe a stat/now order
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carried out immediately as in arrest or acute adverse event
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how many drugs can be listed on an order
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only 1 ie not "tylenol or ibuprofen"; prescriber must pick one
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describe how the time the drug is given should be written on an order
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medicate every 4 hours
should NOT be 4-6 or range of time; must be specific amount |
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what is a range order
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when the dose of the drug is negotiable such as 1-3 tablets; must be a reasonable range
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how many meds can be listed as contingents on orders
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only one
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what is a reasonable range on an order
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1-2 times the base dose
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the maximum dose of an order cannot exceed what
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4 times the minimum
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how soon must a prescriber sign a telephone order
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within 24 hours
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what must you do immediately after taking a telephone order and how should you document it?
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you must READ IT BACK; document as "read back"
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when taking a telephone order, what should you spell back
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sound alike meds or sound alike numbers
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what kind of drugs should we not take telephone orders for?
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chemotherapy
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when are verbal orders considered acceptable
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only under urgent or emergent situations
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what criteria guide verbal orders
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same as telephone orders
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are students allowed to take orders
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NO
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do registered nurses have presciptive authority
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NO
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list the 7 elements of a prescriptive order
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name of patient
date and time written name of med dosage route of admin time and frequency of admin signature or prescriber |
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describe the process for filling a med order
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secretary or nurse transcribes order
scanned/faxed to pharm pharm delivers meds or enters in profile |
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which medicine is always refrigerated
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insulin
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how do we safeguard narcotics
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by counting them each shift
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list the duties of pharmacists at the hospital
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select obtain store drugs
interpret med orders dispense/monitor med usage educate public stock pharm check for outdated meds ensure return of unused meds clarify med orders written by doctors |
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what form must order clarifications be in
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written clarifications only
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list some of the responsibilities of a nurse regarding med admin
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up to date knowledge base
skills ensuring correct admin assist people to use meds safely safeguard store care for meds serve as role model by educating others advocate for individuals by protecting rights and responsibilites question incorrect or incomplete med orders know when to hold meds know appropriate routes |
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what features of a drug should a nurse know
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generic and brand name
normal dose or range of doses route of admin desired action common side effects contraindications specific considerations for specific meds |
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if you suspect a co worker of drug diversion what is your responsibility
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to report that info to the employer, not coworkers or friends!
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what must you have when you waste narcotics?
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witness
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list the responsibilites of the patient as related to drug use
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understand the therapy and question what they do not understand
understand their role adhere to the regimen (take meds correctly) report adverse effects of meds or changes in medical condition avoid misuse or abuse of meds store meds safely |
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list the rights of the patient
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receive qualified nursing assessment
be informed about the drug refuse to take a med receive labeled meds be advised of experimental drugs receive supportive therapy receive the right drug NOT to receive unnecessary medications |
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list the routes of administration
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topical
enteral parenteral intra arterial intra cardiac intra osseous intrathecal clysis intraincisional |
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six rights of medication
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drug
dose route time person documentation |
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how many times must we check the rights of admin
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3
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what is a super important thing to check at bedside (record and patient)
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allergies!!
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what should you do if another nurse hands you a med to give
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toss it and redraw
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when we draw up meds in a syringe what do we do with them?
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label them
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why do we assess ability to swallow
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indicates risk level for aspiration
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if a patient is npo, how does this relate to meds
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cannot take orally unless physician has specifically ordered
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what should we know about our patients before giving meds
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diagnosis
history symptoms status allergies current med list best time to take the meds ability to swallow safely current diet |
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difference between adverse effects and side effects
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adverse are unpredictable and severe
side are predictable |
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describe MOA
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how med is going to produce the desired effect
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what is tallman lettering
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alerts you to similar drugs
look alike, sound alike |
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how many identifiers do we check with patients
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3 (name, dob, med record number)
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what must we advise patients of before giving meds
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what it is
how much how often they will get it why they are getting it |
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what happens if a patient refuses a med
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chart it and return it to the med room as long as it is unopened
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when should we avoid po meds
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altered loc
npo status altered gi function poor absorption stomach irritation |
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when can changes in the route of admin be made
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only when doctor approves it
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what are the advantages of oral meds
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least stressful route
simple to administer doesn't break the skin typically less expensive |
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what are some types of oral meds
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pills (tablets, caplets)
capsules enteric coated effervescent liquids, powders liquids |
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why are meds enteric coated
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designed to be dissolved in the small intestine
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describe difference between syrup, suspension and elixir
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syrup - sugar, water, med
suspension - shake elixir - water, alcohol, med (usually clear) |
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who can make changes to prescriptions
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only the prescriber
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how many pills can be taken at once and why
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only 1 at a time to reduce risk of aspiration
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how should we position patient to give meds
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high fowlers; upright
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which meds cannot be crushed
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enteric coated
sustained release time release sublingual buccal |
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forms of topical meds
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powder, cream, paste, drops, ointment, patch, aerosol or spray
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why should we avoid heat with topical meds
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increases absorption; may cause blistering
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when are suppositories most commonly used
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when patient is unconscious vomiting or unable to swallow
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what are some disadvantages of suppositories
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uncomfortable
incomplete drug absorption may stimulate vagal nerve |
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what happens if vagal nerve is stimulated
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lowers blood pressure
caution in cardiac patients |
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what position should patient be in for suppository
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left lateral side lying (SIMS)
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where do we deposit suppository
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past anal sphincter
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what are vaginal suppositories primarily used for
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infections
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what position for vaginal suppository
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lithotomy or child bearing
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where do we deposit vaginal suppository
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vaginal vault
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what are eye drops most commonly used for
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infections, dry eye, glaucoma
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where do we place eye drops
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lower conjunctiva
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what should we do when administering glaucoma meds to eyes
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press down on lacrimal duct so meds do not absorb systemically; may cause drop in blood pressure
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what are ear drops commonly used for
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infection, ear wax removal
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what temp should drops be
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room temp
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how do we hold the ear for drops
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up and back for adults
down and back for kids |
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what are inhalants most commonly used for
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asthma and copd
pneumonia and bronchitis |
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what forms are inhalants given in
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generally oral but can be nasal
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what is the MOA of inhalants
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to open airway by reducing inflammation and restriction
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explain procedure to take inhalants
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take deep breath
exhale all depress canister inhale slowly hold breath about 5 secs or more wait 20-30 secs bw puffs |
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how many minutes to wait between inhaled meds
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2-5 mins
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what inhalants should be used first
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bronchodilators
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what should patient do after taking inhalants
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rinse out their mouth to prevent thrush
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what should you do before giving inhalants
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measure pulse ox so you have something to compare after meds
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define parenteral
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giving meds/solutions by injection
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list parenteral routes
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im, subq, id, iv
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what angle is IM given at
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90 degrees
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how much volume can IM accomodate
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3 mL
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what should you do before injecting meds IM
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aspirate!
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angle of subq
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45 or 90
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volume of subq injection
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up to 1 mL
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volume of id injection
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no more than 0.5 mL
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angle of id injection
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5-15 degrees
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what does syringe choice depend on
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volume of meds
med prescribed method of measurement |
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lenght for IM needle
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1 to 1 1/2 inches
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length for subq needle
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3/8 to 5/8
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low gauge needle is used for
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thick solutions
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high gauge needle is used for
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thin solutions
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when are filter needles required
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with ampules and vials
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how long are vials good for
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30 days unless designated as one dose vial
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how long are ampules good for
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one use only
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describe process to draw up injection
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aspirate air into syringe equal to dose
pierce top of vial and inject air invert vial and place tip of needle into fluid pull plunger and fill syringe purge air and move to correct dose withdraw, remove needle replace with NEW needle for patient |
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what do we need to write on the container when we open it
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date opened
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what are the most common meds to combine in a syringe
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insulin
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what are 4 things to remember when preparing injections
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always review order
always research meds always check expiration date always properly label any vial opened |
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how do we recap syringes
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one handed technique ONLY
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how fast do we inject med
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1 mL per 10 secs
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what method do we use for IM injections
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Z track
locks med into target muscle preventing seepage into subq tissue |
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what is the max vol for IM injections at chs
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2 mL; up to 3 in large muscles
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recommended gauge for IM injections
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18-23
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what is the preferred IM site
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ventrogluteal
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list other IM sites besides preferred
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dorsogluteal
vasus lateralis deltoid |
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gauge for subq injections
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23, 25, 29
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rule for subq injections to determine angle
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if you can pinch 2 inches or more and length is half of width or less use 90 degrees; if you can pinch less than 2 inches and/or needle is longer than half the width use 45 degrees
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what is the most common angle with subq injection
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45 degrees
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what are common sites for subq
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posterior lateral aspect of upper arm (middle or lower 1/3)
abdomen anterior aspect of upper leg back love handles |
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where is lovenox always given
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love handles
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what is a special precaution with lantus
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cannot be mixed with anything
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which insulin should always be drawn up first when mixing them
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fast acting
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when do we draw up and administer insulin with regards to other meds
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draw up last and give first
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recommended gauge for ID injections
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25, 27, 29
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sites for ID injections
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middle third of inner forearm
upper back over scapula dorsal aspect of upper arm |
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what direction should bevel face on ID injection
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up
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what should be seen with ID injection
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a wheal or bubble
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what do we NOT do with ID injection
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no aspiration
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what is the linea alba
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fibrous band that runs vertically along center of anterior abdominal wall
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difference between now and stat
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now is not as urgent as stat (about a 90 minute window)
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where is heparin given
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abdomen
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