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34 Cards in this Set

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Nurses Responsibilities in administering or supervising drug use is to include knowledge and understanding of the following:
1. What drug is ordered a. Name (generic and trade) and drug classification b. Intended or proposed use c. Effects on the body d. contraindications e. special considerations (how age, weight, body fat distribution, and individual pathophysiological states affect pharmacotherapeutic response) e. side effects 2. Why medication has been prescribed for this particular patient
Nurses Responsibilities in administering or supervising drug use is to include knowledge and understanding of the following: Part 2
3. How the medication has been prescribed for this particular client 4. how the medication is supplied by the pharmacy 5. How the medication is to be administered, including dosage ranges 6. What nursing process considerations related to the medication apply to this client
A major goal of pharmacology
To limit the number and severity of adverse drug events. Some are not preventable
Allergy reaction
is an acquired hyperresponse of body defenses to a foreign substance. Signs vary in severity: skin rash (w/ or w/out rash), edema, runny nose, reddened eyes w/ tearing. Gets worse ea. time! Must alert all personnel by listing it in: medical record, applying labels to the chart, and MAR, and bracelet placed on client
Anaphylaxis
Severe Type of allergic reaction that involves system release of histamine - can lead to life-threatening shock. Acute dyspnea, hypotension or tachycardia
7 Rights of Drug Administration (Operational basis for the safe delivery of medications)
1. Right Client 2. Right medication 3. Right Dose 4. Right route of administration 5. Right time of delivery 6. Right documentation 7. Right of reason (also, right to refuse medication, right to receive drug ed., the right preparation)
3 Checks of drug administration (helps to ensure client safety and drug effectiveness)
1. Checking the drug with the MAR (medication administration record) or the medication information system when removing it fr. the medication drawer, refrigerator, or controlled substance locker 2. checking the drug when preparing it, pouring it, taking it out of the unit-dose container, or connecting the IV tubing to the bag
3 Checks of drug adm Contd
3 Checking the drug before administering it to the client
Primary role of the nurse in drug administration . .
is to ensure that prescribed medications are delivered in a safe manner. Incorporates all aspects of the nursing process.
Compliance
Taking a medication in the manner prescribed by the practitioner, or in the case of OTC drugs, following the instructions on the label. Nurses must be vigilant in asking clients about their medications (did you take them!). Non-compliance could be a reason drug treatment failed. Compliance declines when doses per day increase.
Enteric coated tablets
p32 Hard, waxy, covering. Designed to resist the acidity of stomach until it reaches the alkaline environment of the sm. int.
Route of Drug Administration guidelines
p32
Drug Administration Abbreviations
p30
Sustained Release tablets and capsules
p32 Designed to dissolve slowly, called - extended release (XR), long-acting (LA), or slow-release (SR) medications. convenience of once or twice a day dosing. Do not crush!!
Disadvantages
client must be conscious and able to swallow properly, may be inactivated by digestive enzymes in st and sm. int, or inactivated in liver before it hits T.organs - First Pass Metabolsim , variance in motility in GI tract creating diff. in bioavailability
Advantage of Sublingual and Buccal drug administration and other notes
1. Is not subject to heaptic first pass metabolism. 2. should be done second to enteral drug admin. 3. buccal drug admin. absorption is slower
Topical Drug Administration
1. Dermatologic preparations 2. Instillations and irrigations -applied into body cavities or orifices (eyes, ears, nose, urinary bladder, rectum, and vagina) 3. Inhalations - most common indication for need is bronchoconstriction due to bronchitis
Info on Advantages/Disadvantages of Topical
Topical delivery produces fewer side effects compared with oral or parenteral admin. of the same drug. Topical absorption is slower! Local drugs, absorption is undesirable!
Transdermal Patches
ex nitroglycerin for angina pectoris. Rte of delivery and actual dose received may vary. Patches are changed on a regular basis, using a site rotation map wh. should be documented in the MAR.
Advantages for Rectal Administration
Local or systemic drug. Safe and effective for clients who are comatose, or who are experiencing nausea and vomiting. But absorption is slower than other routes. First pass effect avoided
Parental admin.
refers to the dispensing of medications by routes other than oral or topical. 1. skin layers, subcutaneous tissue, muscles, or veins. Advanced parenteral admin: admin. into arteries, body cavities (intrathecal), and or organs. Uses Aseptic techniques.
Advantages and Disadvantages of parenteral routes
p38 able to administer to those who can't take it orally, avoids hepatic first-pass effect and dig. enzymes. Dis. -only SMALL volumes can be administered, and injections can cause pain and swelling at injection site
Intradermal (ID) Injection
p38 More BV's in dermis than subcutaneous: more easily absorbed. Used for: allergy and disease screening, local anesthetic delivery prior to venous cannulation. VERY Small doses .1-.2 ml. @ 10-15 deg. Sites: upper back, over the scapulae, high upper chest, and inner forearm
Subcutaneous Injection
p38 Insulin, heparin, vitamins, some vaccines, and other medications. Rapid absorption, sites readily available, Doses .5 to 1ml needle size varies w/ body fat. Insulin done in same anatomical area for consistent glucose levels
Area sites for subcutaneous injection
p38,39 area above the triceps muscle (lateral), middle 2/3's of anterior thigh, subscapular areas of upper back, upper dorsogluteal and ventro gluteal areas, abdominal areas: above iliac crest and below diaphragm, 1.5 to 2 inches out from umbilicus. No need to aspirate prior to injection
Intramuscular (IM) injection
p39 Better site for blood supply: More rapid absorption than the ID, subcutaneous or oral! It can receive a larger dose (up to 4ml, norm 2-3ml).
Sites for IM injection determined by
away fr. bone, large bvs, and nerves. Size and length of needle depends on body size and muscle mass, type of drug to be given, amount of adipose tissue overlying muscle, age of client.
Sites for IM
Ventrogluteal site (preferred, anyone over 7 months, less fat, etc). p41 Deltoid site: well-developed teens and adults (not to exceed 1ml, same for tricep injection). Used for Hep B vaccines.
Sites for IM part 2
Used for adults and for children walking at least 6 mos. (careful of sciatic nerve and more). Vastus Lateralis - 1/3 middle.
Study Tables!!!
Study Tables!!!
Intravenous Administration
p43 Directly into bloodstream, immediately useable for the body. FASTEST onset of drug action, most dangerous! Pathogens can also go straight into bloodstream. Clients should be closely monitored - adverse reactions vary from immediate to days. Antidotes should be readily available
Large Volume Infusion IV
p43 Fluid maintenance, replacement or supplementation. Drugs may be mixed w/ saline or Ringer's lactate.
Intermittent Infusion IV
p43 Sm amount of IV solution that is piggybacked to primary large-volume infusion. Instill adjunct medications - antibiotics, analgesics over short period (Baxter infusion pump-electric)
IV Bolus (push) Administration
concentrated dose delivered directly to circulation via syringe to administer SINGLE dose medications. Bolus injections may be given through intermittent injection port or by direct IV push.