Medication Administration Fall 2010.db

Front 1

Ok Medication Abbreviations

Back 1

- start at 8 am
- meds given on time if given 30(60) mins before or after the scheduled time
-b.i.d, t.i.d, q.i.d (within daytime hours)
- q2h, q4h (around the clock)
- a.c., p.c. - give 1/2 hr before or after meals
- STAT - immediately

Front 2

Caplet v Capsule

Back 2

Caplet = solid form, easy to swallow
Capsule = gelatin container

Front 3

Enteric Coated

Back 3

- coated to dissolve in small intestine

Front 4

Elixir v Syrup

Back 4

Elixir - sweetened, aromatic solution of alcohol + medicine, can drink with water

Syrup - aqueous solution of sugar to disguise bad taste. Do not follow with water

Front 5

Inhalation

Back 5

- inhaled or aerosol

Front 6

Intradermal v Transdermal

Back 6

Intradermal - just beneath the skin, technically parenteral

Transdermal - disk or patch semi permable membrance absorbed constantly thru skin

Front 7

Parenteral

Back 7

- administered via injection b/c of precise dosage, rapid absorb, rapid drug action, nature of medication (ex. insulin)
1. Sub-cu - approx 1-2 mL drug diffuses into capilllary per hr, sustained effect, used for non-irritating drugs, slower onset than IM
2. Intramuscular (IM) - absorption rate depends on injection site, faster than sub-cu, used for irritating drugs
3. Intravenous (IV) - into vein, medication immediate
4. Intradermal - under epidermis. ex. TB skin test

Front 8

Ophthalmic v Otic

Back 8

Ophthalmic = eye drops, ointment

Otic = ear drops, ointment

Front 9

Suppository v Tablet

Back 9

Suppository = rectal or vaginal insertion

Tablet = PO, powdered med compressed into disc, sometimes scored, some enteric coated

Front 10

Tincture v Troche

Back 10

Tincture - alcohol or aqueous solution prepared from plant derived drugs

Troche - lozenge

Front 11

Name the 7 rights

Back 11

Right Patient
Right Drug
Right Dose
Right Route
Right Interval Time
Right Date & Time
Right Authorization (signature)
*Right Documentation

Front 12

Name the Health Team & each of their responsibility

Back 12

Doctor - writes order
Pharmacist - dispenses meds
Nurse - prepares, administers, evaluates effectiveness, and teaches
CSN - only administers under supervision of instructor

Front 13

What are the 5 general guidelines for administering meds?

Back 13

1. Administer as soon are YOU prepare it
2. Check the Medication Administration Record (MAR)
3. If in doubt, contact MD who wrote the order
4. Prepare according to 5 rights

Front 14

What is the MAR?

Back 14

Medication Administration Record
- records medications, tracks meds, who gave what and when

Front 15

Describe the elements of the Doctor's Orders

Back 15

- Only MD's, Dentists, Adv. Nurse Practitioners, Phys. Asst can write orders
- Correct orders contain the 7 rights
- Must be written on Order Sheet, good for however long Dr. orders them for.
- RN can take verbal orders - Dr. co-signs in 24hrs
- RN can take phone orders - read back to verify, have 2nd RN online to verfity
- correct abbreviations only
- Orders can be Standings or Combo

Front 16

Describe the 6 types of Doctor's Orders

Back 16

1. Standing - give as ordered until doctor discontinues
2. STAT - give immediately, 30 mins
3. Now - give within 60 mins
4. Single - only time only, Dr. will tell you when
5. PRN - as needed. Refers to pain, nausea, fever, agitation, itching
6. Combo - combined with Standing ex. 20 mg q6h and 40 mg STAT. ex. 2 meds given together

Front 17

Who sets the life span of a narcotic?

Back 17

The hospital sets how long a narcotic is good for, ex. 72 hours

Front 18

Give an example of a med that needs to be verified by another RN

Back 18

Herapin

Front 19

Describe Automatic Stop Orders

Back 19

You discontinue administering meds when:
-Patient is transferred to another service ex. to surgery
- Routine meds are good for 30 days or lenght of hospital stay
- Certian meds are automatically out of date, pharmacy will tell you ex. anti-coagulants, antibiotics

Front 20

9 Nursing Medical
Administration Guidelines

Back 20

1. Administer & Document ONLY meds YOU prepare
2. Check Client ID - ask them to state name & DOB, check bracelet
3. Remain with patient
4. Omitted meds - document if they miss meds or given late ex. if they are in Xray
5. Documentation - chart after you give meds
6. Administer within time frame
7. Investigation meds - rare, med will have number not name
8. Follow Automatic Stop Orders
9. Meds brought to hospital by patient generally considered out of date. Document meds. Sometimes Dr. will allow conintued use - ex. otic drops, birth control - Document! Ask of client took. Document!

Front 21

Describe the Triple Check System procedure

Back 21

1. Check the meds vs MAR when you are pulling the meds from storage
2. Check meds v MAR when you are preparing meds
3. Check meds v MAR before leaving NO Interruption Zone storage room.
* 4th - before administering ask client to state name and DOB, check v MAR

Front 22

Describe procedure if there is a medication error

Back 22

- write out name of incorrect drug, dosage, patient, route, interval time
- report immediately to instructor
- document on chart
- fill out incident report

Front 23

Routes of Administering

Back 23

1.Oral
2. Sublingual
3. Buccal
4. Enteral - ex. PEG (via abd wall), NG tube, duodenostomy (via mouth), jejunostomy (via abd wall)
5. Parenteral - sub-cu, IM, IV, Intradermal, Intrathecal, Intraspinal, Intra-arterial, Epidural
6. Topical - ex. ophthalmic, otic, nasal, inhalation, creams, suppository
7. Transdermal - patch. place of hairless area of least friction

Front 24

Procedure for administering otic drops

Back 24

Child - pull ear Down & Back

Adult - Up & Back

Front 25

Procedure for administering ophthalmic drops

Back 25

Ask client to look up, pull lower lid down, apply med to conjunctiva, gently rub, put pressure on lacrimal space to keep meds in. 1 min.

Front 26

Describe Oral Absorption

Back 26

Orally, little is absorb in mouth. Oral mucosa is capable of absorbing certain drugs only if they dissovle rapidly in salivary secretions. ex. SL or Buccal

Front 27

Sublingual Medications

Back 27

absorbed under the tongue, Ex. nitroglycerine for cardiac patients - vasodilation
effects within 2 mins

Front 28

Buccal

Back 28

rapid absorbed, bypassing hepatic portal enters general circulation. Buccal administer avoids drug destruction via GI fluid & liver

Front 29

Gastric absorption

Back 29

Acidic drugs rapidly absorbed

Majority of drugs are weak bases thus absorbed on entry to small intestines. Subject to 1st pass effect. An empty stomach will enhance absorption as drugs pass rapidly into small intestines

Front 30

Small Intestine Absorbtion

Back 30

the intestines are highly vascular. Absorption occurs in upper portion of small intestines. ph 7-8. subject to 1st pass effect

Front 31

Rectal Absorption

Back 31

Rectum is highly vascular - absorption goo. Not subject to 1st pass effect b/c blood that perfuses in this area bypasses liver.

Front 32

Rectal Administration

Back 32

Wear Gloves. Lubricate suppository
1. Lay patient on left lateral
2. Push suppository about 4 inches to pass internal schincter
3. push to back of of rectal wall
2. HOLD

Front 33

Advantages of Oral Meds

Back 33

Convenient, least expensive, safe, causes minimal anxiety, easy route

Front 34

Disadvantages of Oral Meds

Back 34

1. Unpleasant taste - vomit!. Use shot juice/applesauce + med mix. Suck on ice to numb tongue
2. Irritates gastric mucosa. Give with food/directly p.c. Try dissolve & dilute meds before administer
3. Harmful to teeth. Try mix with water/juice dilute. Drink w straw. Rinse mouth with water
4. With oral drugs the amount of drug absorbed can't be determined accurately - peristalisis will decrease, destroyed by GI secretions, circulation affects absorb, vomiting, diarreha. 1st pass effect
7. Oral meds only to those people who can swallow

Front 35

Contraindications of Oral Meds

Back 35

Do not give oral meds to patients who are unconscious, vomiting, swallowing impairments, gastric suctioning, NPO

Front 36

Describe 7 guidelines for Oral Medication Administration

Back 36

1. Follow med with water. Offer water before to wet GI tract. ALWAY administer a drug with adequate fluid
2. Do not crush enteric coated or time released tablets. Only scored tablets can be split in two
3. Administer effervescent powders & tabs immediately after dissolving in water
4. Never allow clients to chew or shallow lozenges
5. Mix powdered drugs and administer immediately
6. Avoid giving fluids immediately after syrups
7. Give one tab at a time. Client in Sitting or Side-Lying position. Prevents aspiration

Front 37

Guidelines for Enterally Administer Meds

Back 37

1. Determine placement of tubes
2. Administer meds in liquid form to prevent tub obstruction
3. Read labels carefully before crushing tablet or opening capsule. Dissovle in warm water.
4. Do not administer buccal, SL, or enteric coated tabs or sustain release tabes via enteral feeding tube
5. Do not mix meds w enteral feeding formula
6. Flush tube before & after meds with 30-50ml of warm water or agency policy. Give each med separately rinsing w 5 mL inbetween
7. If tube obstructed use warm water flush

Front 38

PEG v NG tube

Back 38

PEG tube = more long term

NG tube = for feeding, causes nasal sking irritation

Front 39

Describe PRE procedure for admin meds via enteral tube

Back 39

PRE: ensure end of tube is in client's stomach (greenish brown with flecks). Check for pH. If pH akaline - tube is in lung
Check that patient is Open & Draining
Prepare meds - mix in warm water (sterile), each med in each cup
1. Auscultate bowel sounds
2. Check for tube placement
*for NG tube do A, B, C
**for gastronomy tube B, C only
A. Inject 5-10 mL of air thru feeding tube will aucultating the LUQ and listen for whooshing sound
B. Check for residual by aspirating gastric contents. If large volume (200mL) return aspirate to client and withold meds
c. measure pH of aspirate

Front 40

Describe procedure for admin meds via enteral tube

Back 40

1. Hold syringe 6-18in above head (or abdominal area if G or PEG tube)
2. Keep HOB elevated when administering meds and 20-30 mins after the procedure unless contraindicated
3. 30 mL of water into tube syringe
4. administer medication
5. clear with 5 mL of water
6. administer next medication
7. clear with 5 mL of water
8. finish with 30mL of water to ensure meds flushed out of tube.
9, Keep track of how much water used. DOCUMENT it.

Front 41

List advantages for parental drug route

Back 41

Accurately measure amount absorbed
Complete absorption
Can be administered to client with altered LOC, who has difficultly swallowing, vomiting/diarrhea, gastric suction, NPO
Not affected by gastric distrubances
Medication irritating to sub-cu given IM ONLY if ordered. (b/c of fewer pain receptors)
Large volume of med can be given IM
IM absorbs faster than Sub-cu

Front 42

LIst disadvantages for parental drug route

Back 42

Potential for infection (broken skin), damaing major nerves & blood vessels
Pain/discomfort
Sterile abscess (collection of undissolved med) - caused by injecting too fast
Hypertrophy - caused by multiple injections
Lipodystrophy - atrophy of skin - caused by multiple injections in same site
Periostitis - inflammed periosteum caused by needle hitting bone (happens in deltoid mostly)

Front 43

Guideline for Intradermal injection

Back 43

Inject in area easily seen. Into dermis,
15 degree angle
Belve Up

Front 44

Characteristics of sub-cu injection sites

Back 44

Pinch an inch - insert at 45 degrees
Pinch two inches - insert at 90 degrees
Locations:
Abdomen (two diameter away from umbilicus) FASTEST Sub-cu absorb
Anterior thigh
Flank (love handle)
Scapular (below apex)
Buttocks (one hand breadth below iliac crest)
Outer aspect of upper arm (tricep flab)
Insulin users follow Intra-site injections so rate of absorb stays the same and know where you inject for next time

Front 45

what is seen on stress EKG when there is exercise induced ischemia

Back 45

subendocardial ischemia --> ST segment depression

Front 46

Describe Z Track procedure

Back 46

Z track is a procedure to ensure safe & effective IM injection
- push skin back ulnar side of non dom hand
- Aspirate to check for blood
- inject slowly with dominant hand
- while pushing back with non-dom hand - hold syringe - Wait 10 secs
- pull skin taut, release quickly
- apply pressure

Front 47

Preparation of Parental Medication

Back 47

1. Vial (single or multi dose)
2. Ampule
3. Syringe
A. Sterile parts - tip, plunger, inside barrel, shaft & bevel of needle
B. Nonsterile parts - outside of barrel & flange. outside of the hub of the needle

Front 48

Types of Syringes

Back 48

Insulin (units)
TB (1 ml divided into 1/100th)
2 mL, 3mL (most common), 5mL, 10mL, 30mL, 50mL, 60mL, prefilled

Front 49

Subcutaneous needle sizes & max volumes

Back 49

Sub-cu Needles:
Gauge: 24-30, 25 is avg adult

Length: 3/8"-5/8" range, 5/8" is avg adult. 1/2" ok!

Angle of Insertion: 45 to 90 degrees

Max Volume: 1 mL, 0.5-1 mL common

Front 50

Intramuscular needle sizes & max volumes

Back 50

IM Needles:
Gauge: 20-23, 22 is avg adult

Length: 1"-3", 1.5" is avg adult

Angle of Insertion: 90 degrees

Max Volume: Deltoid 1 mL
(Pharmacology 3 mL max for other sites)

Front 51

Withdrawing medication from vial

Back 51

Clean top of vial
draw air into syringe = amt of medication
insert needle into vial, inject air to air
upside vial, draw medication

Front 52

What are unique 3 unique elements of withdrawling medication from an ampule?

Back 52

1x use
Use a filter needle to withdraw medication
then Change the needle

Front 53

What are the 2 methods of preventing medication tracking?

Back 53

Change the needle when medication can discolor or irriate the skin
Use the Z track technique

Front 54

Guidelines for changing the needle on a syringe

Back 54

1. Some situations that require needle change:
a. if medication irritates sub-cu tissue or stains the skin
b. after puncturing the vial multiple times (dulls needle)
c. if needle becomes contaminated
d. as recommended in pharma-literature ex. Herapin b/c it's an anticoagulant

Front 55

Describe the procedure for changing the needle

Back 55

1. Prepare the injection
2. Pull plunger down to draw the medication out of the needle & it's hub
3. Change the needle
4. Push the plunger up to remove airand replace the medication in the needle
5. Follow procedure for administering the injection

Front 56

Ways to reduce Injection Pain

Back 56

Talk to client to decrease the client's anxiety
Changle needle after w/drawing med from vial
Avoid sensitive areas
Avoid medication tracking
Position & inject into relaxed muscle
Unless otherwise indicated, allow refrigerated meds to warm to room temp. ex. Insulin
Allow alcohol to dry
Do not give more than allowed
Insert and remove quickly & smoothly
Hold skin taut when removing
Insert med slowly
apply firm pressure immediately after w/drawl
Rotate sites ex. Insulin

Front 57

Guidelines for administering medication to older adults

Back 57

1. Allow time for assessment, explanation, and administration
2. Observe for drug toxicity - the physio changes of aging enhance the possibility of cumulative effects of toxicity
3. Position client in Sitting to prevent aspiration, provide ample fluid
4. Obtain liquid form of meds if diffifculty swallowing
5. Inject in area of much muscle mass
6. Determine if client can obtain medication after discharge (transportation, financial issues)

Front 58

Guidelines for Medication Administration

Back 58

1. Take drug history
2. Check for drug allergies
3. Be aware of drug-drug, food-drug interactions
4. Employ the 5 rights, Triple check system
5. Document each drug administered
6. Teach clients about their drugs
7. Evaluate client's responses to meds and Document

Front 59

The Don'ts of Medicaton Administration

Back 59

Do NOT be distracted when prepping medications
Do NOT give drugs poured by others
Do NOT pour drugs from containers with labels that are difficult to read, or whose labels are partially removed/fallen off
Do NOT transfer drugs from one container to another
Do NOT pour drugs into your hands
Do NOT give expired drugs
Do NOT guess about drugs and dosages
Do NOT leave meds by the bedside or with visitors
Do NOT leave prepared medication out of sight
Do NOT give drugs if client says is allergic to
Do NOT call the client's name as sole indentifier
Do NOT give drug if client states it's diffierent from what he recognizes
Do NOT re-cap contaminated needles.
Do NOT mix with large amt of food
Do NOT give with contraindicated foods

Front 60

How do you determine if special teaching or administratoin strategies are required in Home Care?

Back 60

You mus assess the client's or family member's:
Knowlege of drug therapy
Sensory function
ability to read medicaton labels

Front 61

Home Care consideration part 2

Back 61

Instruct client or family regarding:
purpose of medication
dosage schedule
common side effects
who should be called about problems
drug safety
what to do about missed doses

Front 62

Home Care consideratoin part 3

Back 62

Devise learning aides as needed.
Ex. egg cartons with color-coded sections for medications to tkae at specific times
Ex. commercially prepared divided containers to provide one week at time

Front 63

IM Injection Procedure

Back 63

1. Verify medication v MAR
2. Wash hands
3. Prepare syringe for injection
4. Draw med from vial
5. Select, locate and clean free of lesions/swelling/tender etc site
6. Don gloves
7. Allow skin to dry
8. Inject following procedure
9. Discard uncapped needle into sharps container
10. Document
11. Evaluate effectiveness of medication at onset.

Front 64

What would the process to verify the medication orders?

Back 64

Verify 7 rights

Front 65

What are the 2 identifiers to confrim your clients identity?

Back 65

Ask client to state name and DOB, look at bracelet

Front 66

You have run the A.C. accu-check on patient. Her blood sugar is 349. How do you identify the insulin?

Back 66

Refer to MAR, look at Insulin dosage scale. For 301-350 mg/dl - Regular Insulin 9 units sub-cu is needed.

Front 67

It is 1030. Paitent has turned on call light to tell you she vomited and is requesting medication for N/V. How do you check?

Back 67

Refer to Orders and MAR
Orders indicate can have IM PRN q6h. MAR will tell you dates, times, document

Front 68

Patient has Practi Digox PO ordered to improve her developing CHF. Patient vitals are BP 156/98, P 48, R 24, T 99. What will be your course of action

Back 68

Hold medication if apical pulse is less than 60 bpm.

Document.

Front 69

During assessment you note that your client is taking two types of antihypertensive medications prescribed by two different physicians.

Back 69

Check to see if 2 medications were prescribed for summation effect, if physicians where aware of each other's prescriptions.

Front 70

Be Aware of how to read drug guide.

Back 70

Look up generic name, chemical name, trade name
What classification of drug - kind of know side effects. Think about nursing implications.
At clinical be prepared with drug book, get pharm insert if needed
ensure it's a safe dose. Drug book will help you be specific in evaluation of client
Understand that you ask patient to rate pain at drug's PEAK time

Front 71

What must you be knowledgable of for med administration during Clinical?

Back 71

Be familiar with and be able to verbalize rationales, actions, major side effects etc
Know generic & trade name, classification, drug action, physiological effects, rationale, route and range of dosage, side effects, toxic/adverse reaction, contraindications, Nursing implications.

Front 72

Guidelines for controlled substance administration

Back 72

- Only instructor will handle
- narcotics valid for 72 hrs
- do not handle/accept narcotic keys
- review orders to ensure it's not expired
- verify narcotic account correct prior to obtaining info
- sign out for medication correctly
- if narcotic is wasted, it must be witnissed by another RN
- Doument: including assessment of client condition, required measurements, Implementation,
Evaluation

Front 73

Hypertrophy

Back 73

multiple injections in same area, skin becomes tough. Limits absorption

Front 74

Lipodystrophy

Back 74

appear as indentation or dimple.
tissue atrophy
caused by multiple injection in same site

Front 75

Periostitis

Back 75

inflammation of periosteum caused by the needle hitting the bone during IM injection

Front 76

Sterile abscess

Back 76

collection of undissolved medication caused by injecting to fast