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149 Cards in this Set

  • Front
  • Back
Generic name
Sterile technique must be used.
Breaks skin barrier.
Only small volume can be used.
Can irritate tissues.
Can produce anxiety.
More expensive than oral.
Trade name
Sterile technique must be used.
Breaks skin barrier.
Can irritate tissues.
Can produce anxiety.
More expensive than oral.
Therapeutic effect
aka:
Also known as the desired effect, is the primary intended effect, that is, the reason the drug is prescribed.
Side effect
aka
Also known as a secondary effect, is an unintended effect of the drug, but usually predictable.
Adverse effect
More severe unwanted effects of a drug that may warrant discontinuation of a drug.
Drug toxicity
Deleterious effects of a drug on an organism or tissue. May be caused by overdose, improper route, or buildup because of metabolism or excretion problems.
Drug allergy
An immunologic reaction to a drug.
Anaphylactic reaction
Severe, systemic allergic reaction.
Drug interaction
Two kinds:
When one drug alters the effect of another or both get altered.
Two kinds: Potentiating or Inhibiting
Potentiating effects may be of two kinds:
Explain them:
Additive or Synergistic
Additive: when two of the SAME TYPE of drugs increase the action on each other.
Synergistic: when two DIFFERENT drugs increase the action of just one of them or both of them.
Agonist
A drug that produces the same effects as an endogenous substance.
Antagonist
A drug that inhibits other drugs or endogenous substances by blocking receptor sites.
Absorption
The process by which a drug passes into the blood stream.
Distribution
The transportation of a drug from its site of absorption to its site of action.
Metabolism
Also called biotransformation, the process by which a drug is converted to a less active form.
Excretion
The process by which metabolites and drugs are eliminated from the body.
Pharmacogenetics
The individual variation in client response to a drug based on genetic variations such as gender, size, and body composition.
Oral
The most common, least expensive, and most convenient route of administration.
Sublingual
Where the drug is placed under the tongue, where it dissolves.
Buccal
Where the drug is held against the cheek
Parenteral
Route that is "other than the alimentary or respiratory canal - that is, by needle.
Subcutaneous
Into the subcut tissue.
Intramuscular
into a muscle.
Intradermal
under the epidermis
Intravenous
Into a vein.
Topical
Applied to a surface of the body - include:
Dermatological preparations, Instillations & Irrigations, and Inhalations.
Single order
A one-time order for meds to be given once, at a specific time.
Standing order
An order that may, or may not have a termination date.
Prn order
An as-needed order, permits the nurse to give a medication when, in the nurse's judgement, the client requires it.
Medication reconciliation
the process of creating the most accurate list possible of all medications a pt is taking - including drug name, dosage, frequency, and route - and comparing that list against the physician's admission, transfer, or discharge orders, with the goal of providing correct medications to the pt at all transition points within the hospital.
Gauge of shaft
Varies from #18 to #30. The larger the number, the smaller the diameter of the shaft.
The nursing scope of practice for med admin is somewhat loose, e.g... nurses cannot push propaphol, but they can give it:
through IV
LVNs cannot:
push IV drugs, titrate vasoactive drugs, dopamine, NTG. They CAN give oral meds and ointments.
A book containing a list of products used in medicine, with descriptions of the product, chemical tests for determining identity and purity, and formulas and prescriptions.
pharmacopiea
This lists drugs and their therapeutic value and can include drugs that may still be ed but not listed in the USP.
The United States' National Formulary
Under the law, nurses are responsible for their own actions, regardless of:
whether or not there is a mistake on a written order, i.e. if a PCP writes an incorrect order: (e.g. morphine 100mg instead of 10mg), a nurse who administers the incorrect dose is just as responsible as the Dr.
Since nurses are just as responsible as the PCP for med mistakes, they should:
QUESTION any order that appears unreasonable and REFUSE to give the medication until the order is clarified.
Controlled substances are kept in:
a locked area.
Controlled substances, as well as insulin and heparin require:
double RN verification.
What is the procedure when discarding controlled substances?
A second RN must witness the discarding and both must sign the form.
The action of a drug in the body can be described in terms of:
its half-life: the time it takes for the body to reduce the drug concentration by one-half.
The time after administration when the body initially responds to the drug:
Onset of action
The highest plasma level achieved by a single dose.
Peak plasma level
The time required for the body to reduce the concentration of a drug to half what it was at initial administration.
Drug half-life
A maintained concentration of a drug in the plasma during a series of scheduled doses.
Plateau
The products of biotransformation are called:
metabolites
Explain the changes in elderly patients that affect pharmacokinetics and pharmacodynamics.
The elderly have decreased gastric motility and blood flow, which affects absorption. Increased percentage of proportional body fat and decreased body fluid can lead to toxicity. Changes in the blood-brain barrier can permit fat soluble drugs to access the brain, causing dizziness and confusion.
The blood-brain barrier effects which can cause confusion in the elderly are particularly evident with these drugs:
beta-blockers
The study of the effects of racial and ethnic differences on drug response.
Ethnopharmacology
What are some advantages of the oral route?
Convenient, Inexpensive, Safe - does not break skin barrier.
What are some disadvantages of the oral route?
Can't be used if pt can't swallow or is unconscious.
Drug can be aspirated by pt.
Affected by pts with NV & reduced gastric motility; may have unpleasant odor or taste, GI upset, harm to teeth (ferrous sulfate).
First pass effect.
What are some advantages of the sublingual route?
convenient, Inexpensive, Safe - does not break skin barrier.
Can be used for local effect.
More potent that oral because it enters blood directly and bypasses liver.
What are some disadvantages of the sublingual route?
If swallowed, may be inactivated by gastric juices.
Must remain under tongue until it dissolves.
May cause stinging of mucosa.
Drug is rapidly absorbed into blood stream.
In the buccal route, the drug may act _________ or ___________:
locally on mucous membranes, or systemically when swallowed in the saliva.
What are some advantages of the buccal route?
convenient, Inexpensive, Safe - does not break skin barrier.
Can be used for local effect.
More potent that oral because it enters blood directly and bypasses liver.
Can be used when drug tastes bad or smells.
Released at a slow, steady rate.
What are some disadvantages of the buccal route?
If swallowed, may be inactivated by gastric juices.
Must remain in place until it dissolves.
May cause stinging of mucosa.
Drug is rapidly absorbed into blood stream.
Dose absorbed is unpredictable.
May be perceived as unpleasant to pt.
Limited use.
What are some advantages of the vaginal route?
Provides local effect.
What are some disadvantages of the vaginal route?
May be messy and soil clothes.
What are some advantages of the topical route?
Few side effects.
What are some disadvantages of the topical route?
Drug can enter blood stream through abrasions and cause systemic effects. Leaves residue on skin that can soil clothes.
What are some advantages of the transdermal route?
Prolonged systemic effect.
Few side effects.
Avoids GI absorption problems/first pass effect.
Onset is faster than oral.
What are some disadvantages of the transdermal route?
none listed
What are some advantages of the Subq route?
Absorption is slower (an advantage for insulin and heparin admin).
What are some disadvantages of the Subq route?
Sterile technique must be used.
Breaks skin barrier.
Only small volume can be used.
Can irritate tissues.
Can produce anxiety.
More expensive than oral.
What are some advantages of the IM route?
Can administer larger volume than subq.
Drug is rapidly absorbed.
What are some disadvantages of the IM route?
Sterile technique must be used.
Breaks skin barrier.
Can irritate tissues.
Can produce anxiety.
More expensive than oral.
What are some advantages of the ID route?
Absorption is slow (advantage when testing for allergies).
What are some disadvantages of the ID route?
Amount of drug must be small.
Breaks skin barrier.
What are some advantages of the IV route?
Rapid effect.
What are some disadvantages of the IV route?
Limited to highly soluble drugs.
Drug distribution is inhibited by poor circulation.
What are some advantages of the Inhalation route?
Introduces drug throughout resp. tract.
Rapid localized relief.
Can be administered to unconscious client.
What are some disadvantages of the Inhalation route?
Drug can have systemic effects.
Limited use (respiratory system).
Topical applications are those applied to:
a circumscribed surface area of the body and act locally.
Topical applications include the following:
Dermatologic preparations, Installations and irrigations, and Inhalations.
Dermatologic preparations are applied to:
the skin.
Installations and irrigations are applied to:
body cavities or orifices, such as the urinary bladder, eyes, ears, nose, rectum, or vagina.
Inhalations are applied to:
the respiratory tract by a nebulizer or pos. pressure breathing apparatus.
A Stat order indicates:
that a medication is to be given immediately and only once.
The Single Order, also called the One-Time order, indicates:
that a medication is to be given once at a specified time. e.g. Morphine 10mg before surgery.
The Standing Order is:
on order that may or may not have an expiration date. May be carried out indefinitely, for a certain number of days, or until a cancel order is written.
The PRN order is:
an order that permits a nurse to administer meds, within their discretion, if a pt needs it.
The drug order has these 7 parts:
Pt (full name)
Drug
Dose
Route
Frequency of administration
Time and Date order is written (day, month, year, time)
Signature of prescriber
An unsigned medication order has no:
What should be done this case?
validity; the prescriber should be notified.
How should telephone medication orders be handled?
Avoid it if you can. If you must take a phone order, (emergency situation), make sure you read it back to the Prescriber. Then note: "RB or Read Back" on the order.
If your client receives new medication orders, what should be done?
Double-check the transcribed information with the PCPs order.
What steps does a nurse need to take if they question and refuse to administer a medication order?
Contact the PCP and discuss why you think the order is inappropriate.
Document in the notes: what was conveyed to the PCP and the PCP's response.
If the PCP cannot be reached, document all attempts to reach them, and the reason for withholding the medication.
If someone else gives the medication, document data about the client's condition before and after administration.
What should a nurse always do before administering a medication?
Assess the client's health status and obtain a medication Hx.
What should a nurse do if a liquid medication is cloudy or has changed color.
Don't give it.
What are the 6 things the nurse must do when administering any drug?
1. ID the Pt.
2. Inform the pt & ask about any KA. (explain the intended effect and side effects). Also, listen - pt might tell you they don't take a med for HTN.
3. Administer the drug.
4. Provide adjunctive interventions PRN - physical assistance, teaching, reassurance to ease anxiety.
5. Document the administration of the drug.
6. Evaluate the pt's response to the drug.
The oral route is the route of choice as long as:
the pt can swallow and retain the drug in the stomach.
The Oral route in contraindicated in pts who:
is unconscious or unable to swallow, is vomiting, or has GI suction.
To what extent can nurses delegate med admin to UAPs?
Med admin cannot be delegated to UAPs. The nurse can inform the UAP of the intended/side effects of the med and can request the UAP to report specific client observations for follow-up.
What is the procedure for preparing solid oral meds?
1. Wash hands.
2. Unlock drug cart.
3. Select the drug and do first check; check exp.
4. Do the second check - Calculate & Prepare the med.
5. Do third check before returning bottle.
6. Lock the drug cart.
What is the procedure for administering solid oral meds?
1. 2 ID checks & ask about allergies.
2. Assist client to sitting position.
3. Conduct pre-admin assessments, if necessary.
4. Inform client.
5. Give client med cup and water (place med cup to their mouth if necessary).
6. Stay with client until med has been swallowed (nurse must witness swallowing before drug admin can be recorded).
7. Document drug administration.
8. Evaluate effects (observe desired effect or side effects).
When preparing medications that require an assessment before giving them, e.g. opioids that require respiration measurements, what should you do?
Place them off to the side, separate from the others. This will remind you to do the assessment.
If, when taking a med out of the drawer during the first check, the medication is not identical to the order, what should you do?
Check the prescriber's order. If there is still a discrepancy, check with the nurse in charge or the pharmacy.
What do you do with expired meds?
Return them to the pharmacy.
What is the procedure for preparing Liquid Meds?
1. Wash hands.
2. Unlock drug cart.
3. Select the drug and do first check; check exp.
4. Do the second check; Mix med before pouring. Remove cap, place upside-down. Hold bottle next to palm-pour med away from label. Pour at eye level. Meniscus should be at line. Wipe lip of bottle with paper towel.
5. Do third check before returning bottle.
6. Lock the drug cart.
What is done when giving a small amount of liquid medication (less than 5mL)?
Prepare the medication in a sterile syring w/out a needle or an oral syringe. Label the syringe with the drug name and route.
What are the steps for NG & gastrostomy tubes?
Placement - push in 20mL of air and auscultate.
Residual - suck out contents, measure, & return.
Flush - w/ 30mL of water.
Meds - crush meds and mix with 15mL water, push in.
Flush - w/ 30mL of water.
What are the three parts of the syringe?
the tip, barrel, and plunger.
The nurse should avoid touching these parts of the syringe:
the tip, inside of barrel, or shaft of plunger.
What are the parts of the needle?
the bevel, shaft, and hub.
The length of shaft normally varies from:
The gauge of the shaft normally varies from:
1/2in. to 2 in.
#18 - #30
What gauge and length needle are used for subq injections?
#24 to #26 and 3/8 to 5/8 in. Obese clients may require a 1in. needle.
What gauge and length needle are used for IM injections?
#20 to # 22 and 1 to 1 1/2 in.
What needle should be used to withdraw medication from both vials and ampules? Why?
A filter needle - for two reasons.
1. To prevent rubber or glass particles being picked up in vials & ampules respectively.
2. To prevent tracking of the medication through the client's tissues from drug residue on the outside of the needle during withdrawal from the vial.
When drugs have been reconstituted, what should be marked on the vial?
date, time, and exp.
What is the procedure for preparing meds from an ampule?
1. Wash hands.
2. Unlock drug cart.
3. Select the drug and do first check; check exp.
4. Calculate dose twice.
5. Flick ampule to bring down meds trapped in neck. Break ampule away from you. Place ampule on flat surface and withdraw with filter needle. Replace filter needle with reg. needle. Do second check.
6. Do third check and discard ampule in sharps bin.
7. Lock the drug cart.
What is the procedure for preparing meds from a vial?
1. Wash hands.
2. Unlock drug cart.
3. Select the drug and do first check; check exp.
4. Calculate dose twice.
5. Remove cap or sanitize top with alcohol for 15 sec. Inject appropriate amount of air ABOVE surface of drug. Withdraw with filter needle. Replace filter needle with reg. needle. Do second check.
6. Do third check and replace vial to cart.
7. Lock the drug cart.
What is the procedure for preparing 2 meds from a vial into 1 syringe?
1. Wash hands.
2. Unlock drug cart.
3. Select the drugs and do first check; check exp.
4. Calculate dose twice.
5. Sanitize each top with alcohol for 15 sec.
6. Draw air for total of R and N units into syringe.
7. Inject air into N then R.
8. Withdraw R then N.
9. Do third check and replace vial to cart.
10. Lock the drug cart.
Regular insulin is labeled:
NPH is labeled:
Saying:
Regular insulin is labeled: R
NPH is labeled: N
"Clear before Cloudy" - when WITHDRAWING.
Amount of drug for each method
ID:
Subq:
IM:
ID: up to 0.1mL
subq: 0.5mL to 1mL
IM: deltoid = 1mL; other places 2 -3mL.
What are the sites for ID injections?
inner forearm, upper chest, and back - over the scapulae.
What is the procedure for ID injection?
Angle?
Grasp syringe close to hub. Hold needle almost parallel to skin - bevel up. Pull skin taught. Insert needle - Outline of bevel should be visible under skin surface. Inject medication slowly. Withdraw the needle quickly at the same angle at which it was inserted. Do not massage the area. Circle the injection site with ink for later evaluation. 5 - 15˚ angle.
What areas are used for subq injections?
upper arm, anterior thigh, abdomen, ventro/dorsogluteal sites, and scapular region.
What needle/angle combinations are used?
3/8in. needle in usually inserted at a 90˚ angle.
5/8in. needle is usually inserted at 45˚ angle.
One method nurses used to determine the length of needle to use for subq injections is:
to pinch the tissue at the site and select a needle length that is half the width of the skinfold.
When you can pinch an inch, use a ____ angle.
Can't pinch an inch, use a ____ angle.
When you can pinch an inch, use a 90˚ angle.
Can't pinch an inch, use a 45˚ angle.
Aspirate for subq injections?
NO
What is the procedure for subq injection?
Wash hands and apply gloves.
Clean site and allow to dry.
Determine need to pinch or not / use angle.
Inject slowly and hold in place for 5 sec.
Remove needle at same angle as insertion while depressing client's skin.
If bleeding occurs, apply pressure with gauze.
Insulin is absorbed most quickly when injected into these sites, and most slowly when injected into these:
most quickly when injected into the abdomen and arms, and most slowly when injected into thighs and buttocks:
Injection sites for insulin should be rotated:
weekly
What is the procedure for double-checking heparin or insulin with another nurse?
ask "what do I have in the syringe." The other nurse then needs to check the MAR, drug vial name and concentration, and calculate the dosage.
What is the procedure for injecting heparin?
Select site on the abdomen at least 2 in. away from the umbilicus and above the iliac crest.
Use 3/8in. needle or smaller.
Give Subq. Do NOT aspirate. Do NOT massage after injection. Arms or thighs may be used as an alternate site.
What are the sites for IM injections?
Ventrogluteal, Vastus Lateralis, Dorsogluteal, and Rectus Femoris.
The body positions for Ventrogluteal are:
supine, prone, or side.
How is the Vastus Lateralis landmark located?
Divide the area between the Greater Trochanter and Lateral Condyle of the femur into thirds, and select the middle third.
What is the position for giving an IM injection using the Vastus Lateralis location?
supine or sitting.
Should you use the Dorsogluteal site?
No, it should no longer be used.
When is the Rectus Femoris site used?
When people need to self-administer shots.
How is the deltoid site located?
The upper landmark is 3-4 fingers down from the acromion, and the lower landmark is a horizontal line drawn from the axilla.
Research evidence supports the use of the Z-track IM method because:
it has been found to be LESS PAINFUL than the traditional technique and DECREASES LEAKAGE of irritating medications into the subq tissues.
What is the procedure for giving IM injections?
1. Wash hands and glove up.
2. Locate the site.
3. Clean site in 2in. diameter and allow to dry.
4. Use Z-track technique - offset skin 1in.
5. Pierce skin quickly and smoothly at 90˚angle.
6. Aspirate for 5-10 sec.
7. Inject slowly @ rate of 10 sec./mL.
8. Wait 10 sec., then withdraw needle at same angle.
Two types of intermittent IV infusions:
tandem and piggyback.
Tandem setup:
a second container is attached to the line of the first container at the lower, secondary port. Permits intermittent or simultaneous infusion with the primary solution.
Piggyback setup:
a second container is connected to the tubing of the primary container at the upper port. Used solely for intermittent drug admin.
What should a nurse do before administering an IV bolus?
look up the max. recommended concentration of the drug and the rate of administration.
Considerations for transdermal patch admin:
Avoid applying to areas subject to excessive movement, ie. apply to trunk or lower abdomen, side, lower back, buttocks. Avoid distal extremities. Women should not apply to breasts. If hair removal is necessary, don't shave (breaks the skin); clip hair instead.
What is the procedure for applying a transdermal patch?
Wear gloves! Apply to clean, dry, hairless skin. Label with time, date, & initials. Each new patch should be applied to a different site. Remove old patches and clean the skin thoroughly before applying a new one.
What should be done before applying a dermatologic preparation?
Thoroughly clean area with soap and water and pat dry. Wear gloves!
What is the procedure for applying opthalmic preparations?
1. Clean the eyelid and lashes - use a cotton ball moistened with sterile saline and wipe from inner canthus to outer canthus.
2. If ointment is used, discard the first bead (first bead is considered contaminated).
3. Instruct client to look up at ceiling.
4. Put pressure downward on cheek/lower eyelid to expose conjunctiva.
5. Hold medication in other hand, with hand on forehead to stabilize hand.
6. Place drops in outer 1/3 of lower conjunctival sac with dropper 1 - 2cm away.
7. Instruct client to close eyes but not to SQUEEZE eyes shut.
8. Instruct client to press firmly on nasolacrimal duct for 30 sec. to prevent medication from draining into nasopharynx.
What is the procedure for irrigating the eye?
1. Hold the eyes open by exerting outward pressure at the bony prominences.
2. Hold irrigator 1in. above the eye.
3. Irrigate the upper and lower conjunctiva from inner to outer canthus.
4. Instruct client to close and move the eye periodically.
5. Gently wipe/dry eyelids from inner to outer canthus.
Otic irrigations require _________ technique, unless:
aseptic technique, unless the eardrum is perforated, in which case sterile technique is needed.
What is the procedure for administering Otic medications?
1. Clean the pinna and meatus of the canal.
2. Warm medication in hand or warm water.
3. Pull pinna back and upwards.
4. Administer drops and press on the tragus.
5. Have client remain in position for 5 min.
6. Loosely place cotton at meatus for 15-20 min.
How should pt be taught self-admin of nasal drops/spray?
1. They should blow their nose first.
2. Seated pos. with head tilted back.
3. Place tip just inside nares and time inhalation with spray.
How are ethmoid and sphenoid sinuses treated?

How are the maxillary and frontal sinuses treated?
1. Have client lie down with head over edge.
2. Administer drops.
3. Breath through mouth to prevent aspiration.
4. Remain in position for 1 min.
5. Avoid blowing nose for several min.

1. Same position but with head turned towards side being treated.
2. Admin. drops.
3. Breath through mouth to prevent aspiration.
4. Remain in position for 1 min.
5. Avoid blowing nose for several min.
What is the procedure for applying a Vaginal Suppository?
1. Have client pee.
2. Clean perineum.
3. Lubricate rounded end of suppository, which is inserted first.
4. Lubricate finger.
5. Separate labia.
6. Insert suppository 3 to 4in. along posterior wall of vag canal or as far as it will go.
7. Have client remain in supine position for 5-10 min.
8.
What is the procedure for applying a rectal suppository?
1. Place client in Sim's or left lateral position.
2. Lubricate smooth end of suppository.
3. Lubricate finger.
4. Encourage client to relax by breathing through mouth.
5. Insert suppository gently 4in.
6. Avoid embedding it in feces.
7. Press client's buttocks together for a few minutes.
8. Have client remain in position for 5min.