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149 Cards in this Set

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What pop. of people are especially prone to polypharmacy? Why?
-older adults bc they typically take several meds prescribed for chronic diseases and many self medicate.
What is noncompliance?
failure to follow the treatment plan.
ID some reasons a person might be non-compliant.
-limited budget
-visual and motor deficits
-lack of symptoms
-inability to tolerate side effects
-forgetfulness
-impaired mental capacity
According to study by AJN, what % of med doses were administered incorrectly by nurses?
19%
List ex of reported med errors.
-giving dose at wrong time
-omitting dose
-giving the wrong dose
-giving the dose w/o authorization
What are the 3 times a med should be checked?
1.Before you pour,mix or draw up a med.
2.After you prepare the med and before returning the container to the med cart.
3.at the bedside before administering it.
What precautions regarding the appearance or name of a drug may help ensure the right drug is given?
-Avoid selecting meds based on size and color
-Be alert for similar-looking labels and similarly spelled names.
What precaution may be taken when repeating back verbal orders that may ensure the right drug is given?
Spell the med name
How should the nurse break a tablet to help ensure the right dose is given?
use a knife or cutting device. If it doesn't break evenly,discard it.
What time window is usually allowed in order for a scheduled medication to be considered given at the right time?
1/2 hr before or 1/2 hr after the scheduled time.
According to the JC, how many forms of ID should be used to ID pts to help ensure meds are given to the right pt?
2
Give an example of a bad med habit that may lead to a med being given to the wrong pt.
Asking are you Mary Smith? instead of saying "please tell me your name."
When is administration of a med documented on the MAR?
immediately after it is administered.
When documenting a med on a preprinted MAR, what should the nurse include?
-time you gave the med
-initial each med
-sign the form once
What should a nurse document if a scheduled med is not given?
document that it wasn't given on the MAR and write a nurse's note explaining why it wasn't given.
What should the nurse include in the documentation of a PRN med?
-nurse's note documenting assessment and time drug given.
-after allowing time for drug to take effect, evaluate and docu. pts response.
How should a calibrated cup be held when pouring a liquid to measure the dosage?
at eye level
What alternative technique may be used to administer liquid med if a pt has difficulty taking liquids from a cup? List 2 precautions to help prevent aspiration.
can use a syring w/o a needle to place med in mouth.
-place pt in a side-lying or upright position.
Name 3 enteral tubes that may be used to give oral med.
-nasogastric
-gastrostomy
-jejunal tubes
List 5 methods a nurse may use when giving a pt an oral med w/ an objectionale taste.
-unless contraindicated,have pt drink a liberal amt of flavored liquid or water to dilute med.
-have pt suck on ice chips for several min.
-store med in fridge
-use syringe to place med on back of tongue
-offer oral hygiene after giving med
List 3 examples of situations when oral meds should not be given to pts.
What could a nurse do in these situations?
-pts. that can't swallow fluids
-pts that have nausea or vomiting
-pts that are NPO
~obtain medical order for an alternative route or for NPO, get permission to give med w/ small sips of H20.
What precaution should the nurse take to protect oneself when administering transdermal med?
wear gloves to protect yourself from the med.
What statement should appear on all packaged ophthalmic meds?
for ophthalmic use only
Why should otic meds be administered at room temp?
to prevent vertigo,nausea and pain.
Why are suppositories usually kept in the fridge?
to keep them firm enough to insert.
Give 3 reasons why the rectal route might be preferred over the oral route.
-may provide higher blood levels of med than oral route
-when drug has bad taste or odor
-when not safe to use oral route
To whom may an RN delegate med administration?
to an LPN
What med related tasks may be delegated to UAP?
can instruct UAP in the therapeutic effect and side effects of meds and report any side effects observed.
If a state allows a UAP to administer meds, what is the RN still responsible for?
-evaluating client responses,both therapeutic effects and side effects.
List 9 factors that should be assessed prior to administering any med.
-your knowledge of the med.
-whether the RXed dosage is appropriate for the pts age and weight.
-check for history of allergies to meds or food
-assess pts knowledge about meds being given.
-assess pts ability to cooperate during procedure.
-any factors that would interfere w/drug absorption.
-vital signs and check lab studies
-pt findings tha might affect absorption and/or metabolism
-any reasons that would preclude admin med.
What does it mean when meds have cross-sensitivity?
e.g. a pt w/ a penicillin allergy is at high risk for also being allergic to cephalosporins.
/after time indicated admin procedure ok to follow on all meds?
no bc some meds need to be admin. at an exact time
Prior to preparing med, what should nurse to min. transmission of microorganisms?
wash hands
When is the first check for the 5 rights of med admin?
when selecting the ordered med and comparing it w/MAR
What are the 5 rights of med administration?
1.right drug
2.right patient
3.right time
4.right dose
5.right route
When is the second check for the 5 rights of med admin?
after preparing the med, check again.
When is the 3rd check for the 5 rights of med admin?
after ID'ing pt, right before administering.
What are 2 important reasons to explain med to the pt?
-increases pts understanding of and compliance w/ treatment.
-pt may ID potential errors in med admin.
What should a nurse do if a pt questions a med?
believe them and determine why it is different from what the pt is used to taking.
How long should a nurse remain w/ a client after providing the med?
until you are sure they have taken the med.
What are 4 factors a nurse should assess as part of the evaluation process following med admin?
-any assessments to evaluate therapeutic effects of med.
-adverse rxns
-side effects
-allergic rxns
List 3 med documentation "Do Not's."
-don't document before giving the drug
-don't docu for anyone else
-don't ask another nurse to docu a drug you have given.
What action should the nurse take if the client is unable or refuses to take med?
Document on the MAR that med was not admin,along w/reason and inform the doc.
LIst 4 places a food or drug allergy should be recorded.
-admission notes
-front of pts chart
-MAR
-Kardex
In add to listing the type of allergy, what other info should be noted?
-dzs and illnesses
-txs
-list of all docs pt sees
What info should be included in a list of the pts current med?
-length of time each has been taken & current dosage
-reason for taking them
-responses(expected,actual,& adverse effects)
When taking a med history, what 2 questions should be asked of all women bw the ages of 14 and 60?
whether they are or might be pregnant or whether they are breastfeeding.
Name 4 drug factors that may be monitored by lab tests.
-serum drug levels
-med effects
-med side effects
-proper dosages for pt
What considerations may need to be taken regarding oral meds if a pt is scheduled for surgery and has an order for NPO?
plan of care must be discussed w/ anesthesiologist. may use alternate route or take med w/ a few sips of H2O
List 3 locations in inpatient HC facilities where meds may be stored and prepared by nurses?
-central room
-mobile cart
-locked cabinet in or near pts room
Describe stock supply system.
Meds are in a bulk quantity and dose must be measured out each time a pt needs it.
Name 1 advantage and 1 disadvantage of stock supply.
advantage: cost-effective
disadvantage: potential for msmt error each time a dose is poured.
Describe the storage unit for the unit-dose system.
locked, mobile cart w/ drawers containing separate compartments for each pts meds.
For what interval of time will med be supplied using the unit dose system?
drawers refilled each shift or every 24 hrs.
What is "unit dose?"
ordered amt of drug the pt receives at a single time.
Name 2 advantages for the unit-dose system.
-saves nursing time
-safest method bc of double-check system
Describe a few functions of the automated dispensing system.
tracks dispensed meds for billing and controlled-substances monitoring.
contains records and counts of meds and pt. med orders.
What would you consider as major advantages to the automated dispensing systems?
-allows for immediate admin of newly ordered meds, PRN meds,controlled substances, emergency meds bc drugs are available on unit, no need to wait for pharmacy.
What are the nursing responsibilities regarding self-admin of drugs?
remind pt to tell you when they take drug so that you can evaluate pts ability to manage meds safely and accurately.
What must a nurse do b4 administering any med?
-obtain a med order from the care provider and verify that it is complete and correct.
List 6 essential elements of a complete med. order.
-pts full name
-date and time order was written
-name of med.
-dosage(size,frequency,# of doses)
-route of admin
-signature of prescriber
Once a nurse determines a med order is legible enough to read accurately, what questions should be asked about the ordered drug?
-Is the ordered dose w/in the normally RXed dosage range?
-Is the ordered route appropriate?
-Is the drug appropriate for the pt?
-Is the pt allergic to the med ordered?
-Are the admin times appropriate?
When is the term "prescription" used to describe a med order?
when given to the pharmacy to obtain meds for self-administration.
When is the term "physicians order" used to describe a med order?
when meds are to be used in the hospital or ambulatory care setting.
What is the safest way to write words when dealing w/ meds?
out in full
Where would a nurse check for appropriate abbrev. to use in a medical facility?
institutional policies
What term is used for an order that is applied indefinitely until the prescriber writes an order to alter or discontinue the med?
standard written orders
What term is used for protocols that hospitals use for discontinuing med after a certain length of time?
automatic stop dates.

most narcotic orders are in effect for 7 days only.
What term is used for an order of a single dose of med to be given immediately and only once?
STAT order
What are 2 terms used for an order of a med to be given only once at a specified time?
single order or one-time order.
ex:preoperative meds
What term is used for an officially accepted set of orders to be applied routinely by nurse for the care of pt under certain cond or under certain circumstances and are estab guidelines for treating a particular dz or set of symptoms?
standing orders
What term is used for an order of a med to be given whenever a pt requires? 2 limitations that must be specified?
PRN orders.
1)cond for which med is to be given
2)min time intervals bw doses
What are 3 types of meds that are usually given PRN?
-pain meds
-antiemetics
-laxatives
List 3 ways orders may be communicated.
-written orders
-verbal orders
-telephone orders
Why are verbal orders avoided?
When are they appropriate?
-increase the risk for miscommunication and errors
-appropriate in urgent situations
When are telephone orders usually needed?
in response to a call you have placed to report a change in pts cond or results of lab or other tests.
What must the physician do after giving verbal or telephone orders?
must cosign w/in 24 hrs.
Name 7 responsibilities of the nurse when administering a drug order.
-interpret the order
-prepare the exact dosage of the RXed drug
-ID the pt.
-administer the proper dosage by RXed route,at RXed time intervals
-educate the pt regarding the med
-record the admin of the RXed drug
-monitor the pts response for therapeutic and adverse effects
List the 7 parts of a legal drug order.
1)Name of the pt.
2)Name of the drug to be admin
3)dosage of the drug
4)route by which the drug is to be admin
5)frequency, time & special instructions related to admin
6)date & time when the order was written
7)signature & licensure of the person writing the order
What is the sequence a drug order is written in?
name of the drug is written first, followed by the dosage,route & frequency
After the prescriber writes an order, where is it transcried?
transcribed to the MAR
ID 3 nursing actions using the MAR.
-check the drug order
-prepare the correct dosage
-record the drug administration & time
ID 4 advantages for computerized med administration systems.
-can look at pts cumulative med admin record
-document admin times and comments
-can keep printed copy of info obtained and entered
-data analysis, storage, and retrieval abilities make them essential tools
What is an adverse drug rxns?
any noxious,unintended,& undesired effect that occurs @ normal drug doses.
What conditions are excluded from the defn of adverse drug rxn?
undesired effects that occur when dosage is excessive.
Name 4 adverse drug rxns that might be considered "mild."
-drowsiness
-nausea
-rash
-itching
Name 5 adverse rxns that would be considered serious and potentially could result in death.
-respiratory depression
-neutropenia
-hepatocellular injury
-hemorrhage
What is neutropenia?
profound loss of neutrophilic WBC's
What are 2 age groups that are more vulnerable to adverse drug rxns?
-elderly
-very young
Name 2 factors, besides age, that increase the risk of an adverse drug rxn.
-severe illnesses
-pts receiving multiple drugs
What is a side effect?
a nearly unavoidable secondary drug effect produced at therapeutic doses
What can be said about the predictability,intensity, and time of onset of "side effects?"
generally predictable, intensity is dose dependent, onset can develop soon or after weeks or months.
Define toxicity. What has toxicity come to mean in more common everyday usage?
toxicity is an adverse drug rxn caused by excessive dosing. Has come to mean any severe ADR, regardless of dose that caused it.
What is an allergic rxn?
An immune response caused by prior sensitization and then re-exposure to a drug.
What primarily determines the intensity of an allergic rxn?
the degree of sensitization of the immune system.
Name the family of drugs that causes the most serious allergic rxns.
Penicillins
Define idiosyncratic effect.
An uncommon drug response resulting from a genetic predisposition.
Explain what is meant by an iatrogenic dz caused by a drug.
1)drug induced
2)essentially identical to a naturally occuring pathology.
What is physical dependence?
a state in which the body has adapted to prolonged drug exposure in such a way that an abstinence syndrome will result if drug use is discontinued.
Define carcinogenic effect.
the ability of certain meds & environmental chemicals to cause cancer.
Define teratogenic.
a drug-induced birth defect
Name 4 organs that are common sites of injury due to drug toxicity.
-kidneys
-heart
-lungs
-inner ear
What is the most common reason for withdrawing an approved drug from the market?
ability to cause severe liver damage.
If a pt needs to take a drug that is hepatotoxic what should be monitored?
2 liver enzymes: aspartate aminotransferase and alanine aminotransferase levels should stay low.
Name 8 signs of liver injury that should be included in pt teaching for persons taking hepatotoxic drugs.
-jaundice
-dark urine
-light-colored stools
-nausea
-vomiting
-malaise
-abdominal discomfort
-loss of appetite
What is the very serious adverse effect some drugs can have on the heart that may result in death?
QT interval drugs cz risk for serious dysrhythmias which can progress to potentially fatal ventricular fibrillation.
How may a nurse report a previously unknown adverse effect suspected to be a result of a drug?
report it to medwatch
How can the pharmaceutical industry contribute to reduction of adverse drug rxns?
can strive to produce the safest possible meds
How can the prescriber contribute to the reduction of adverse drug rxns?
select least harmful med for a particular pt.
How can the nurse contribute to the reduction of adverse drug rxns?
must evaluate pts for ADRs and educate pts in ways to avoid or minimize harm
How can pts and families contribute to the reduction of adverse drug rxns?
watch for signs that an ADR may be developing and should seek med attention if one appears
What is done to monitor for toxic effects to the liver?
monitored for s/s of liver damage (jaundice,dark urine,light-colored stools,nausea,etc.
What is done to monitor for toxic drug effects to the kidney?
pt should undergo routine urinalysis and msmt of serum creatine. Periodic tests of creatine clearance performed.
What is done to monitor for toxic drug effects to bone marrow?
periodic blood cell counts required.
What is a med error?
any preventable event that may cause or lead to inappropriate med use or pt harm, while the med is in control of the HC prof,pt, or consumer.
Who is the pts last line of defense and the last person w/ the opportunity to make a med error?
the nurse
Name the 3 categories of med errors that account for 90% of all errors.
1)human factors
2)communication mistakes
3)name confusion
What is done to monitor for toxic drug effects to the kidney?
pt should undergo routine urinalysis and msmt of serum creatine. Periodic tests of creatine clearance performed.
What is done to monitor for toxic drug effects to bone marrow?
periodic blood cell counts required.
What is a med error?
any preventable event that may cause or lead to inappropriate med use or pt harm, while the med is in control of the HC prof,pt, or consumer.
Who is the pts last line of defense and the last person w/ the opportunity to make a med error?
the nurse
Name the 3 categories of med errors that account for 90% of all errors.
1)human factors
2)communication mistakes
3)name confusion
Describe the full process of med administration in the hospital setting.
It begins with physician writing RX.
Then someone transcribes the order.
Then in the pharmacy someone enters order into computer.
Then a pharmacy tech prepares the order.
Then a pharmacist checks it.
Finally a nurse checks the order again & then administers the drug.
What are the 3 most common human factors causing med errors?
1)performance deficits(ex: admin a drug IV instead of IM)
2)Knowledge deficits
3)Miscalculation of dosage
What are 4 factors involved in miscommunication that frequently lead to med errors?
-illegible handwriting
-misreading or failure to read
-careless use of zeros & decimal pts
-confusion bw metric & apothecary units
What is the central theme in the efforts to change the institutional culture regarding med errors?
Instead of focusing on "naming,shaming and blaming" focus on designing institution-wide processes & systems to prevent errors 4m happening.
What can be the result if an institutional environment is primarily punitive in regards to med errors?
-errors may not be reported
-doesn't help new systems to be developed
What are 12 things that a nurse should consider including when planning to teach pts about thier meds?
1)generic&brand names of med
2)purpose of the med
3)dosage & how to take med
4)what to do if a dose is missed
5)duration of therapy
6)minor side effects & what to do if they occur
7)serious side effects & what to do if they occur
8)meds to avoid
9)foods to avoid & other precautions
10)how to store the med
11)follow up care
12)what not to take
Why is it important to give pt written instructions to take home?
so they can be reviewed when stress levels are lower & practical difficulties in maintaining the med plan are known
Name 3 reasons that IV fluids may be used.
1)replacement of lost fluids
2)maintain fluid & electrolyte balance
3)to administer IV meds
What are replacement fluids?
fluids ordered because of losses that may occur from hemorrhage,vomiting or diarrhea.
What are maintenance fluids?
sustain normal fluid & electrolyte balance. for pts. beginning to show signs of depletion or those at risk for depletion
What is continuous infusion?
replace or maintain fluid & electrolytes & serve as a vehicle for drug admin.
What is intermittent infusion?
IV PB & IV push: used for IV admin of drugs & supplemental fluids
Saline or heparin locks: used to maintain venous access w/o continous fluid infusion
What is the responsibility of the nurse who is monitoring IV infusions?
ensure that the correct IV fluid is admin to the correct pt at the RXed rate.
What units of msmt is usually used to regulate a primary IV infusion using an electronic infusion pump?
mL/h
0.9% sodium chloride =
___g or ____mg sodium chloride in ___mL.
0.9% sodium chloride = 0.9g or 900 mg sodium chloride in 100 mL.
0.45% sodium chloride = ___g or ____mg sodium chloride in ___mL.
0.45% sodium chloride = .45g or 450 mg sodium chloride in 100 mL.
0.225% sodium chloride = ___g or ___mg sodium chloride in ___mL.
0.225% sodium chloride = .225g or 225 mg sodium chloride in 100 mL.
Normal Saline = __% sodium chloride.
normal saline = 0.9% sodium chloride
D5W=
D5NS=
LR=
D5LR=
D5W= 5% DEXTROSE IN WATER
D5NS= 5% Dextrose in normal saline
LR=LACTATED RINGER'S
D5LR=LACTATED RINGER'S & 5% DEXTROSE
What is a primary IV/tubing?
primary IVs are used for a typical IV, tubing is long enough to be attached to hub of IV catheter in pts vein
What is a secondary IV/tubing?
secondary IVs are used when giving meds. This tubing is "piggybacked" into the primary line. tubing is shorter, hung higher than primary IV so that 2nd set of meds infuses 1st.
In order to manually regulate an IV rate, what will the calculated drip rate be based?
# of drops per minute.
What is the drop factor for a manually regulated IV based on?
gtt per mL
All microdrip tubing has what drop factor?
60 gtt/mL
What is the formula to calculate IV flow rates for manually regulated IVs?
V/T X C = R
volume(mL)/time(min) X calibration or drop factor(gtt/mL) = Rate(gtt/min)
What is the drop factor always expressed in?
gtt/mL
What is the drip rate for manually regulated IVs always expressed in?
gtt/min