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67 Cards in this Set
- Front
- Back
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Pharmacology
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study of science of drugs
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JCAHO DO NOT USE LIST
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U, IU – Unit, International Unit
QD, QOD – (Write it out) daily, every day, every other day. Trailing Zero – 1.2500 MS, MSO4, MgSO4 – morphine, morphine sulfate, magnesium sulfate |
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Who can order medications
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Physician – MD or DO
Nurse Practitioner – NP Physician Assistant - PA Dentist – DDS or DMD Podiatrist - DPM |
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Who can dispense medications
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licensed pharmacist
R.Ph. or Pharm.D. |
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Who can give medications
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Registered Nurse – RN
Licensed Practical Nurse – LPN Respiratory Therapist – CRT, RRT Paramedic – prehospital only |
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Who regulates nursing practice?
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Professional Regulation
Standards Accreditation Certification Legal Regulation The Board of Nursing - State Agency Nurse Practice Act Scope of Practice Voted by State Legislat |
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Resources for Medication Administration
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Nursing & Pharmacology Textbooks
Nursing Drug Guides Preprinted Drug Cards Physician Desk Reference (PDR) Hospital Formulary Pharmacy Internet Resources |
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Nursing Responsibilities for Administering Drugs
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Assessing the client and understanding the need for medication.
Ensuring the rights of medication administration. Preparing the medication to be administered using accurate dosage calculation. |
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Nursing Responsibilities for Administering Drugs – con’t
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Administering medication and documenting it was given.
Monitoring client response. Educating client regarding medication regimen. |
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Safety Considerations in Medication Administration
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Knowledge about the medication.
The five/six rights. Three checks. Safe dosage. Safe environment. |
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Knowledge Needed to Administer Drugs Safely
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Drug name, preparations, and classifications.
Mode of action and purpose of medication. Side effects and contraindications for medication. Antagonist of medication. |
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Knowledge Needed to Administer Drugs Safely – con’t
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Safe dosage range for medication.
Interactions with other medications. Precautions to take prior to medication. Proper administration technique. |
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What are the five rights?
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Right patient
Right medication Right dosage Right route Right time Right documentation Right reason med is given |
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What are the six rights?
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Who?
What? When? Where? How much? Write it down Why? |
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Client always has the right to?
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Right to Refuse.
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What are the three checks?
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Container or unit dose package compared with MAR
Compare with MAR immediately before removing from package or multi-dose container. Returning container to shelf or before giving the unit dose to the client compared with MAR. |
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How do we know the dosage ordered is safe?
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Knowledge of the drug
Accurate calculations |
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To maintain safe patient dosage
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Monitor blood levels
Safe dosage levels May be ordered as: Loading dose Maintenance dose Example – blood thinners, some antibiotics |
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What is a safe environment?
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Well lighted
Quiet, minimal distractions Work alone when possible, except as students NEVER leave meds unattended. |
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Legal/Ethical Factors
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Nursing Responsibility
Documentation Physician’s Prescriptions Medication Errors Agency Policies Narcotic/Control Drugs |
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Nursing Responsibility
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To properly and correctly prepare, administer, document medication administration, observation, and teaching of client.
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Nursing Responsibility
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PATIENT EDUCATION
IS A MAJOR NURSING INTERVENTION |
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MAR – Medication Administration Record
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Legal document
Chart each dose of medication ASAP Never chart ahead of time CMAR – computerized User ID/password |
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Medical Record Documentation
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Intentional or inadvertently omitted drugs
Refused drugs Medication errors |
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Proper Signature on MAR
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Signing when medications are administered
Signing when medications are held Where to put signature and corresponding initials |
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CAREFUL DOCUMENTATION
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THE KEY TO
COMPETENT PRACTICE |
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Physician’s Prescriptions
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Who can??
CPOE – Computer Prescriber Order Entry Written Verbal/telephone Never students Agency Policy |
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Executing HCP Prescriptions
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Nurse is legally liable for administering medications.
Nurse Practice Act Agency/institution policy Get written orders when possible |
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Executing HCP Prescriptions
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Double check any order that client questions
Question any order that is: Ambiguous Contraindicated by- Normal practice Client’s present condition |
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Types of Medication Orders
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Standing order
PRN order One-time order Stat order Telephone/verbal order Stop order Automatic stop order |
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Parts of the Medication Order
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Client’s Name
Date and time order written Drug name Dosage Route Frequency Signature of person writing order |
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Medication Supply System
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Stock supply
Individual supply Medication cart Computerized/automated medication system Bar coded medication cart |
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Drugs from Home
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Self administered medications
Use of meds from home Must have order for self administration and to have meds at bedside Document given by client |
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Metric
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meter (linear), liter (volume), gram (weight)
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Apothecary
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less convenient and concise; basic unit or weight is grain
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Household
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least acurate system; teaspoons, tablespoons, teacup, glasses used
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Conversions
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Medications not usually ordered in household measurements
(Home oral med for children may be ordered in tsp. Must use measuring device with that med) |
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Some still may be ordered in apothecary—grains
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Acetaminophen & aspirin
Morphine, Nitroglycerin, & Phenobarbital |
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Signs & Symptoms of Drug Allergy
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Rash
Uticaria Pain Fever Diarhea Nausea/Vomiting Angioedema Anaphylactic reaction- involves 2 or more body systems |
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Local-
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Urticaria (hives)
Edema Warmth Erythema |
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Systemic
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Urticaria
Angioedema flushing, Wheezing Dyspnea Increased mucous production N&V Feeling of generalized anxiety |
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Anaphylactic reactions
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local
and systemic reactins |
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Types of Medication Errors
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Inappropriate prescribing of the drug
Extra, omitted, or wrong doses Wrong patient Wrong route or rate Failure to give drug within prescribed time Incorrect preparation of a drug Improper technique when administering drug Giving a drug that has deteriorated |
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Narcotic/control drugs
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Controlled /substance Act
Schedule I-V C-I – no aceptable medical use (heroin) C-II – high abuse potential (morphine) C-III – intermediate abuse potential (hydrocodone, valium) C-IV – less abuse potential (benzodiazepines) C-V – limited abuse potential, recorded as transaction (cough syrup with codeine) |
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Which agency has control?
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Which governmental Agency has jurisdiction?
Drug Enforcement Agency |
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Medication AdministrationNursing Process
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Assessment
Diagnosis Planning Implementation Evaluation |
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Assessment
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Health history
Previous and current drug use Ask about OTC/herbal preparations Schedule Response Attitude Compliance Storage Always assess before, during, and after administration |
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Planning - Nursing Diagnosis
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Varies with abnormal data found/problems identified
Planning- goal-outcome for that diagnosis Interventions and rationales Evaluate the stated outcome |
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Implementation Utilizing the “6 Rights”
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Preparing
Right drug Right reason Right dose and preparation Before Right client (2 methods of ID—not room number according to The Joint Commission National Patient Safety Goals) Right medication Right dose, route, time After Right documentation Right response |
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Implementation
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Stay with client
Give each drug separately Never leave medications Document promptly |
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Implementation
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Oral medications- most common; convenient and comfortable for client
Many forms To crush or not to crush-that is the question. “Cheeking” Special techniques Special considerations Children Older adults Enteral tubes |
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Instilling Nose Drops/sprays
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Used to treat allergies, sinus infections, and nasal congestion
Medications with a systemic affect may also be instilled in the nose Medical asepsis should be observed when instilling drops |
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Transdermal patch
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Remove old patch, fold in half (adhesive sides together and discard per agency policy
Assess skin Clean with soap and water Wear gloves (don before opening/handling patch) Apply patch: Remove patch from packaging Write date, time, (initials) on patch Apply to site, use palm of hand to press firmly for 10 seconds Certain medications are to be applied to specific sites. |
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Administering a Vaginal Medication
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Creams, foams, tablets, and suppositories melted by body heat can be applied intravaginally
May use a narrow tubular applicator with an attached plunger Administration should be timed to allow patient to sit down afterward to retain medicine May need to lubricate tablet or suppository to ease insertion |
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Administering a Rectal Suppository
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Must be placed past the internal anal sphincter and against rectal mucosa
Positioning of client? Used primarily for local action Laxatives Fecal softeners Systemic effects also achieved Lubricate suppositories to ease insertion |
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Pulmonary medications
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MDI (metered dose inhaler)
With or without spacer Small-volume nebulizer DPI (dry powder inhaler) |
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medication administration
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Reconcile MAR with orders
Prepare medication Administer medication Document administration |
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TEACHING
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General info—what
How and when to administer Expected side effects and adverse effects When to follow up when to call/report Special instructions |
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Patient Teaching
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Review techniques of medication administration
Remind client to take the medication as prescribed for as long as prescribed Instruct client not to alter dosages without consulting physician Caution client not to share medications |
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WHO DO WE TEACH?
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Client
Family Caregivers |
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Teaching Acronym
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T – tune into the patient
E – edit patient information A – act on every teaching moment C – clarify often H – honor the patient as partner in the education process |
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Client Teaching
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First determine what the client knows
Identify learning needs Identify ethnic, socioeconomic, and physiological factors that influence medication usage Explain &/or demonstrate how to take the medication Ask for a return demonstration |
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Evaluation
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Effectiveness of drug
Clinical observation Subjective data Objective data Drug levels Monitoring devices |
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Pharmacodynamics
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Mechanism of action
Receptor interactions e.g., Beta blockers Enzyme interactions e.g., ACE inhibitors Nonselective interactions |
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Pharmacokinetics
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Absorption—drug is transferred from site of entry into bloodstream
Distribution—drug is distributed throughout the body Metabolism—drug is broken down into an inactive form Excretion—drug is excreted from the body |
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Drug Classifications
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Can be classified by
Body system Symptoms relieved Clinical indication |
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drug info you must know
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Name of drug
Classification Expected therapeutic effect (action) Reason medication given to client Dosage, route, time of administration Common Side Effects Contraindications Contingencies-common nursing actions Expected therapeutic outcome Patient education needs |
