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82 Cards in this Set
- Front
- Back
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What is the first thing to consider when administering a medication? |
The Patient's Condition (Safety First) |
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What role does the Doctor play in medication administration? |
Prescribes the medication |
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What role does the Pharmacist play in medication administration? |
Prepares the medication |
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What role does the Nurse play in medication administration? |
Administers the medication |
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What is the Nurse's responsibility in medication administration? |
Evaluating the effects of medication on the patient's ongoing health status, teaching them about their medications and side effects, ensuring adherence to the medication regimen, and evaluation the patient's (and family's) ability to self-administer medications upon release. |
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What is the Nomenclature of Medications? |
It is the process of naming medications
1. Chemical Name 2. Generic Name 3. Official Name 4. Trade Name |
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What is a chemical name? |
Provides a description of the of the medications composition and molecular structure Ex. N-acetyl-para-aminophenol is Tylenol |
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What is a generic name? |
Name given by the developers prior to being sent to the FDA for testing and approval Ex. Acetaminophen is Tylenol |
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What is an official name? |
The name that is published upon FDA approval. The generic name will become the official name. |
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What is a trade name? |
Name that the medication is marketed as. Trade name will always start with an upper case letter and may have have the symbol (TM) at the upper right to indicate the name has been trademarked. Ex. Tylenol (TM) |
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Which name classification(s) should the nurse be familiar with? |
Generic and Trade Names *these are the names found in the drug book. Listed by generic with trade name in parentheses. |
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Medication Form / Preparation |
A medication can be prepared in many forms. Tylenol can be given as solid, liquid or other (suppository). The form determines the route of medication. |
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Medication Classification |
Medications can be classified by: 1. the effects on the body system (cardiac drug) 2. the symptoms it relieves (antipyretic) 3. the desired effect (antihypertensive) |
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Pharmacodynamics |
Explains what the drug does to the body |
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Pharmacokinetics |
Explains what the body does to the drug 1. Absorption - how the drug enters the body 2. Distribution - how the drug reaches the target site 3. Metabolism - how the drug is broken down 4. Excretion - how the drug is eliminated |
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Absorption of a Medication |
Passage of a medication from administration site to bloodstream. Influenced by: 1. Route of Administration (Injection quicker than oral) 2. Solubility (Liquids quicker than solids) |
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Which route of administration is absorbed the most rapidly? |
IV's because they are administered directly into the bloodstream |
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How can the absorption of injectibles be slowed? |
By adding oil, hormones or proteins |
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Which route of administration provides the most dependable dosage? |
IV's since they are administered directly into the bloodstream, less of the medication is lost during transportation/breakdown |
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Distribution of a Medication |
After absorption, medications are sent to the target tissues and organs. Circulation influences how quickly is will be transported. |
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Metabolism of a Medication |
Breakdown of the medication once it reaches the target site via biotransformation. Most common site is the liver. |
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What is biotransformation? |
When enzymes detoxify, break down, and remove biologically active chemicals. |
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Excretion of a Medication |
After being metabolized, medications exit the body through the kidneys, liver, bowel, lungs, and exocrine glands. Most common site is the kidneys. |
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How does development affect drug interaction? |
A smaller does is required for children since they are smaller and their functions/organs are still maturing.
Elderly may require a different dose as functions decrease |
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How does weight affect drug interaction? |
The recommended dose is based on a healthy man age 18-65, 160 lbs. As weight varies, the dose varies |
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How does psychological factors affect drug interaction? |
Patient's expectation of the drug reaction causes their perception to change. ex. Placebo is given in place of pain meds and patient perceive the pain as diminishing because they think they got a pain med |
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How does pathology affect drug interaction? |
Presence of a disease can prevent or alter medications action Liver disease -> slows, prevents drug breakdown Kidney disease -> slows, prevents drug excretion |
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How does time of administration affect drug interaction? |
Circadian cycles (human cycles and rhythms) and presence of food can alter. Food in the stomach slows oral absorption but will decrease side effects such as upset stomach. |
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What are therapeutic effects? |
Expected, predicted, desired responses Ex. pain relief by taking Tylenol |
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What are side effects? |
Predictable and unavoidable secondary effects. Generally harmless Ex. drowsiness with benadryl |
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What are adverse effects? |
Unintended, undesirable, and unpredictable severe responses Ex. Seizures from antibiotics |
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What are Iatrogenic effects? |
Adverse effect in which medical problems occur as a result of medical treatment. Ex. Vancomycin can cause ototoxicity (hearing loss) and nephrotoxicity (kidney dysfunction). |
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What are idiosyncratic reactions? |
Adverse effect in which has a different reaction than expected. Ex. Hyperactive instead of drowsy from Benadryl |
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What is an Allergic Reaction? |
Adverse effect which triggers antibodies. -Can occur immediate or after initial administration. |
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What is a toxic effect? |
Excessive amounts of a medication from prolonged use or inability to metabolize or excrete. Ex. Morphine, an opioid, can cause severe respiratory depression or death when reaching toxic levels. An opioid antagonist, such as naloxone (Narcan) would be used as an antidote to reverse the effects. |
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What is drug tolerance? |
Patient becomes accustom to the medication and it no longer works. Can result in addiction. |
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What is cumulative effect? |
The body cannot metabolize the previous dose prior to the next dose. |
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What is a synergistic effect? |
Drugs are combined for a greater effect. Bad effects- alcohol increases hallucinations when taking opioids Good effects- antibiotic with beta-lactame inhibitors helps antibiotic to be more effective |
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Medications from home |
Must be sent home or kept in the safe. Do not want the patient to take more than ordered.' Exception: if hospital does not have the medication. Hospital will take it, label it and keep it in the pyxis not in the patients possession |
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Medication Orders |
Must be given on Physician's Order (must be legible and have signature)
-All previous medication orders are discontinued and reordered by the Dr. (medication reconciliation needs to occur anyway) -Medication orders become part of the record |
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Types of Medication Orders |
1. Standing/Routine Order - Order carried out until it is cancelled. "Give Rx daily for 7 days" 2. PRN - As needed (requires nurse's judgment) 3. Single Order - One time order at a specific time 4. STAT - Single Order but given immediately |
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At what time should drugs be administered? |
On time specified by the order or (legally) up to 30 minutes before/after specified time. Computer may give up to 59 minutes but legally 30 minute allowance. Exception: STAT and on-call-to-the-OR orders must be immediate |
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What are the parts of of the medication order? |
1. Patient Name 2. Date and Time 3. Drug Name 4. Drug Dosage 5. Route 6. Frequency 7. Dr. Signature |
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What action should be taken if Medication Order is not legible? |
Call the Physician |
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What action should be taken if suspected medication error or allergy and needs to challenged? |
You can:
-Look it up in the drug book -Ask the pharmacist -Ask the charge nurse/ supervisor -Ask the prescribing physician *If you do withhold a med, tell charge nurse and dr. asap and document. |
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What is a medication unit dose system? |
Medication supply cart holding 24-hour supply for each patient. Pharmacist restocks at a designated time daily. Cannot hold controlled substances. |
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What is a medication stock room |
Large room with a large supply of medications available |
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Pyxis |
Computerized system that distributes the drugs |
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3 checks prior to medication administration without pyxis |
1. Check when reaching for container 2. Check right before removing/pouring medication from container 3. Check when returning the container |
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3 checks prior to medication administration with pyxis |
1. Check when you select the drug on the computer 2. Check after you have removed the drug from the cube 3. Check when you are about to give the medication to the patient (Scanning med package & patient ID bracelet) |
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6 Rights of Medication Administration |
"Please Do Da Right Thing Dude" 1. Patient 2. Drug 3. Dose 4. Route 5. Time 6. Document |
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Steps of Administration |
1. 3 checks 2. 6 rights 3. Assess the patient (safety first) - make sure med is relevant 4. Patient's positioning 5. Fluids - check prior to bringing in meds 6. Keeps meds packaged - administer at bedside 7. Offer each med separately 8. Supervise swallowing |
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Administering Narcotics |
Controlled meds are kept in a double locked cabinet or special drawer in the pyxis. -monitored in intervals -if any missing, report asap -if patient refuses opened med, it must be wasted with a witness and documented. |
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When documenting narcotic administration, what is in included? |
The patient's name, the amount of narcotics given, the physician who ordered it, and the nurses signature. Also include if it was wasted and who witnessed it. |
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When documenting medication administration, what is in included? |
The medication name, the dose, route, site of injection, time, nurse initial and nurse signature. |
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When do you document medication administration? |
After it has been administered in case patient refuses it
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Digoxin |
Pulse has to be 60+ |
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Beta Blockers |
"Beta be 50" Pulse has to be 50+ |
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Why would drugs be omitted intentionally? |
1. If you assess the patient and med is considered irrelevant. 2. NPO (must specify meds as an exception) 3. Problem no longer exist 4. Suspect of toxic effect |
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What does a nurse do when intentionally omitting medications? |
Advise the charge nurse/supervisor in case alternative measures need to be taken and call the physician. Document the reason for admitting. |
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What does a nurse do when patient refuses medications? |
Persuade patient to take it. If they still refuse, document, advise charge nurse and physician. |
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What are the reasons for medication errors? |
1. Nurse is unfamiliar with the medication 2. Nurse does not identify the patient 3. Nurse puts med down and doesn't recheck 4. Nurse did not accurately read the label |
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What does the nurse do when a medication error occurs or is suspected? |
1. Assess the patient (safety first) to make sure they are stable. 2. Call the physician 3. Chart the occurrence and the steps taken to correct the occurrence (don't specify error) 4. Fill out incident report within 24 hours which is kept with risk management, not in the record. |
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What is the most frequently used medication and why?
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Oral medications 1. They are the most convenient 2. They are the safest because it has a slower onset and less potent (due to travel time from mouth to stomach/small intestine) 3. The action is prolonged since it takes a longer time to absorb |
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Where are Oral Medications absorbed? |
The stomach & small intestine |
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What are the two forms of oral medications? |
Solid and Liquid forms |
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What type of medications are solid oral forms? |
1. Caplets - similar to capsule, coated for ease 2. Capsules - med in a gelatin shell 3. Tablets - compressed powder disk 4. Enteric-coated tablets- coated so it is absorbed in the small intestine instead of the stomach (used for GI issues such as stomach ulcers or GI bleeds) |
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Enteric-coated and extended release tablets |
Cannot be crushed, cut, or chewed |
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What type of medications are liquid oral forms? |
1. Elixir - alcohol based 2. Syrups - sugar based (mostly for pediatrics) 3. Suspensions |
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How do you administer liquid oral medications? |
1. Use proper measuring device 2. Pour using the side with no label (do not want to distort label if spilling occurs) 3. Pour to the designated line |
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Sublingual Medications |
Absorbed under the tongue (blood vessels allow medication to go to the blood stream). Do not swallow or allow patient to drink until it is completely dissolved. Systemic effects. Ex. Nitroglycerin |
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Buccal Medications |
Absorbed in the mucous membranes of the cheek. Do not swallow or allow patient to drink until it is completely dissolved. |
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What is parental routes of medication administration and what are the major sites? |
Injecting medication into the body tissue 1. Intradermal (ID) - into the dermis 2. Subcutaneous - into the tissue below the dermis 3. Intramuscular (IM) - into the muscle 4. Intravenous (IV) - into the vein |
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What is topical application of medication administration? |
Medication applied to the skin or mucous membranes. Systemic and local effects. |
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Topical application for the skin |
Can be an ointment, cream, gel Application: Clean and dry skin, make sure previous dose is completely removed, and then rub in the medication so it can be absorbed into the subcutaneous gland. *Wear gloves - Can have systemic effect & potential wounds, use sterile technique. |
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Topical application via transdermal patch |
-must be applied to the appropriate site and do not reuse the same site back-to-back. Avoid sites with friction. Generally for 12 hours - 7 days. Application: Clean and dry skin, make sure previous dose is completely removed (use mild soap or plain water), don't shave the area, and apply the patch *Wear gloves and wash hands before & after. Systemic effects. |
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Topical application of the eye |
Application: Offer tissue & cleanse eyelid of any drainage. Have patient tilt head and look at the ceiling. Put drops into the conjunctiva sac, not directly onto the eyeball. Close eye and apply pressure to inner canter so drops do not enter the tear ducts. -Must be sterile even though eye is not sterile -for ointment, rub lid with cotton ball while eye is closed |
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Topical application of the ear |
Application: clean external ear of drainage, lay on unaffected side, straighten ear canal (adults: up and out, peds: down and back), drop into side of canal not directly on ear drum, press tragus to move medication toward ear drum. Remain on side 2-3 min. -solution should be body temp to prevent vertigo, dizziness, and nausea -sterile solution to prevent ear infection -use gloves in case of drainage |
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Topical application of the nose |
Used for sinus infection and nasal congestion Application: Provide tissues to blow nose first, tilt head back, insert drops 1/3 into the nostril, administer rx amount of drops. Repeat for other nostril. Keep supine position for a couple minutes to keep solution against the membrane. -Medical asepsis technique is used even though nares are not sterile. Use gloves if there is nasal drainage. |
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Vaginal Application
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Cream or suppository Application: Have patient void first, dorsal recumbent position, GLOVES, spread labia and clean area using clean technique, and insert plunger. Patient needs to remain supine 5-10 minutes. Provide peripad, if necessary. |
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Rectal Application |
Application: Sims position, GLOVES, lube site and index finger, and insert finger beyond sphincter (4in for adult, 2 in for peds) with medication. Patient needs to remain in sims for 5 minutes. |
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Inhalation Application |
Bronchiodialators -enlarge airways to increase air flow -hand nebulizer and administer premeasured doses. Hold breath for 10 seconds. *Pressurized metered-dose inhalers (pMDIs) *Breath-actuated metered dose inhalers (BAIs) *Dry Powder Inhalers (DPIs) |
