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138 Cards in this Set

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The 6 “rights” are
1. right medication
2. right dose
3. right time
4. right route
5. right patient
6. right documentation
Things to keep in mind when preparing to give medications are:
- wash hands
- Hesitate? Double check
- Be punctual (time, dose)
- Obtain drugs one patient at a time
- Check drugs three times: with MAR, before and after opening.
- Check expiration dates
- Check patients bracelet
- Explain drugs, side effects etc
- Open medication on bedside, try not to touch with hands
- Discard drugs that fell on ground
- Chart medication on MAR directly after giving
Administering oral drugs
- wash hands first: standard precautions
- check for latest MAR, with chart
- beware of some oral medication that require special assessment
- check for allergies/identity patient
- with dysphagia: some tablets can be crushed: one at a time (remember three checks), mix with soft food
- verify if medication can be crushed (not for enteric coated/long acting)
- patient should be sitting
- offer water to drink (4 to 6 ounces) if patient wants other drink: check first
- if placing medication in mouth: wear gloves
- effervescent powders and tablets: mix with water
- stay with patient, check if drug is swallowed
Effervescent means
Gently boiling or bubbling, by means of the disengagement of gas
Standard precautions:
- wear gloves when needed
- wash hands after wearing gloves and in between patients
- wear mask, gown, eye protection with spraying blood/mucus
- remove protective gear after exposure
- no: recap/cap/.break/ bend needles
- get rid of contaminated stuff
Dysphagia is
Difficulty swallowing
Sublingual and buccal:
- Absorbed by mucous membrane, prevents destruction by GI tract
- Sublingual under tongue, buccal in cheek
- Wear cloves
- Dissolve before swallowing
- No fluids
- Instruct patient not to swallow tablet
- Alternate sides when using buccal route
Liquid medication
- Can come in single dose, or multi dose bottle: pour in cup or draw in oral –dosing syringe
- Shake bottle, open, put cap upside down, don’t spill on the label.
- Overfill cup? Discard excess in sink.
- Liquid medication under 5 ml: use needle-less syringe
Oral medication and infants
- use liquids
- use disposable oral dosing syringe
- prevent aspiration: sitting position
- place syringe in mouth next to tongue
- nipple can be used
- prevent aspiration: crying child can easily aspirate
- do not mix with bottle of formula
- make sure all the medication is taken
NG tube
- wash hands
- position patient in semi fowler position
- asses fluid restriction (need to give water to flush tubing
- check if drug should be taken with full or empty stomach
- if possible give liquid medicine to prevent clogging
- if tablet: crush, administer separately
- follow institutional policy with tubes
- dilute crushed tablets with water (15 to 30 mL)
- put in tube/clamp etc.
- if no flow: put pressure
- after drug: flush
- keep patient in high fowler
- document on MAR
Rectal
- wash hands/standard precaution
- asses patient for rectal bleeding/diarrhea
- don’t break medicine in smaller pieces
- Sims position (left side, top leg flexed toward waist, provide privacy)
- Palpitate rectum for stool; have patient defecate first, do not put drug in stool: No palpitation after surgery on rectum
- Unwrap and lubricate medication
- Let patient breath and exhale through mouth and insert about 1 inch deep
- Let patient lay on side for about 15/20 minutes, infants sometimes need to keep buttocks together
- Enemas the same way
- Document on MAR
Advantages of Transdermal drug delivery
- fewer side effects
- improved bioavailability
- more uniform plasma levels
- longer duration of effect
- improved therapeutic effect
Drug name
- brand ™
- generic name (USAN)
- chemical name
Caplet
Coated capsule easy swallowing (solid)
Capsule
Powder, liquid or solid in gelatin shell
Elixir:
clear fluid with water or alcohol
Enteric coated tablet
Solid, coated to not dissolve in stomach
Extract
Concentrated medication form
Glycerite
Solution of medication with glycering (at least 50%)
Intraocular disk
Three layers, middles is medication, dissolves in ocular fluids
Liniment
Preparation for skin containing oil, alcohol or soapy emollient, applied on skin
Lotion
Liquid suspension to protect skin
Ointment
Semisolid, containing medication, externally applied
Paste
Semisolid preparation, thicker than ointment, slower release of medication
Semisolid preparation, thicker than ointment, slower release of medication
Solid dosage, not often used because of tablet
Solution
Water with solute
Suppository
Solid dosage shaped with gelatin for rectal or vaginal use
Suspension
Finely divided drug particles, floating in liquid: oral only
syrup
Medication dissolved in sugary liquid
Tablet
Powdered dosages, compressed into hard disk or cylinder, contains binders, disintegrators, lubricants and or fillers
Tincture
Alcohol or water-alcohol medication solution
Transdermal disk or patch
Medication in semi permeable patch that administers the medication through the skin
Troche (lozenge)
A small, circular medicinal lozenge; a pastille.
Medication dose responses
Goal is
Constant blood level within a safe therapeutic range
Peak concentration
Highest concentration
Through concentration
Lowest concentration
Serum half-life
Time it takes to lower the concentration to 50%
Parental administration is
Injecting in body tissue
4 ways are
Intradermal (ID)
Subcutaneous (sub-Q)
Intramuscular (IM)
Intravenous (IV)
Into dermis, just under epidermis
Injection into tissue just below dermis
Injection into a muscle
Injection into a vein
Epidural
Intrathecal
Intraosseous
Intraperitoneal
Intrapleural
intraarterial
Epidural space
Subarachnoid into ventricles of brain
Into bone marrow
Lines abdominal cavity
Through chest wall in pleural cavity
Directly into arteries
Topical administration
Though skin (Transdermal disk/patch) or mucous membrane
Inhalation
Inhale
Administering medication
Types of orders
Standing or routine medication orders
Is carried out until new prescription or with end date
PRN orders
When patient requires it
Single orders
Given once at certain time
Stat orders
Emergency
prescriptions
For outside of hospital
Distribution systems
Stock supply: large containers
Unit dose: portable carts containing drawer with 24 hour supply
Automated medicine dispense (modern)
Impact of HR 1685 “ generic drug access act of 2001” is
Requires therapeutic equivalence for generic drugs (so cheaper medicine)
Chemical classification of medicines describes
Chemical base of Rx
physiologic classification of medicines describes
Effects on body systems
Therapeutic classification of medicines describes
It’s use in therapy
Can drugs have more than one class?
yes
Describe 3 checks
1. check Rx with order on MAR when obtaining med from source
2. check Rx with order on Mar prior to placing it in dispensing container
3. check Rx at clients bedside prior to administering Rx
QD means
Every day
Stat means
Immediately
Bid means
Twice a day
Tid means
Three time a day
Qid means
Four time a day
PRN means
When necessary
PO means
oral
NPO means
Nothing by mouth
IM means
intramuscular
SC/SQ means
Subcutaneous
IV means
Intravenous
SL means
sublingual
PR means
By rectum
g means
gram
gr means
grain
Pc means
After meals
s.o.s. means
Once if needed
dr means
dram
Qod means
Every other day
OS means
Left eye
OD means
Right eye
OU means
Both eyes
AS means
Left ear etc…
AC means
Before meal
Gtt means
drop
IN means
intranasal
On means
Every night
If patients refuses Rx
Record date, time and reason for refusal
Č should be little line
with
Š should be little line
without
P with little line on top
after
Emulsions and suspensions don’t forget to
Shake before use
3 important things for safety
- sufficient light
- away from distractions
- clean surfaces and hands
Nursing process
- assessment
- nursing diagnosis
- planning
- implementation
- evaluation
Parts of MAR
- clients full name
- date and time of order
- drug name
- route
- dosage
- time and freq, of administering
- signature of physician ordering drug
- prescription
- also: allergies, type of drug, therapeutic intent, usual dose, clients tolerance of dose, who to notify if administration is inappropriate.
Important with verbal order:
Must be signed within 24 hours
Important with telephonic order
- read the order back to MD, later countersigned by MD, best if 2 nurses listen.
Renewal order for narcotics
48 hours
Renewal order for ATB
7 days
State practice act:
- LPN must be under supervision of an RN or physician
- RN must have an order from a physician to give ANY drugs
- Nurse practitioners van now have prescribing privileges
Important when preparing Rx
- check name/medication/prescription on mar
- check allergies
- check expiration date
- one patient at a time
- one medication at a time
- verify time and route
- calculate proper dose
- pour/prepare exact
- set up Rx in order of mar
How much water with oral medication
4-6 ounces
MDI is
Metered Dose Inhalers
Important with MDI is
- remove cap, hold inhaler upright, shake inhaler
- tilt head of patient back slightly, breath out
- open mouth with inhaler 1-2 inches from mouth (or with use of spacer in mouth)
- press when patient inhales slowly
- let patient breath slow for 2-3 seconds
- hold breath for 10 seconds
- when second puff is needed, wait 1 minute
- register in MAR
5 categories of controlled substances”
1. schedule I (high abuse, no medical need, heroin, pot, GHB) 1 prescription for research only
2. schedule II (high abuse, severe dependence, morphine, methadone) triple prescription only
3. schedule III (less abuse than I and II, nonbarbiturate sedatives, some opioids like codeine, order refilled 5 x in 6 mo)
4. schedule IV less abuse than III , anxiolytics, benzodiazepine rewrite after
6 months or 5 x
5. schedule V limited abuse, without prescription: small amount of narcotics (codeine), used as anti-tussives or anti-diarrheals
Injections
Subcutaneous angle
45-90 °
Intramuscular angel
90 °
Intradermal angle
5-15°
Subcutaneous needle gauge
25 gauge
Intramuscular needle gauge
21-25 gauge
Intradermal needle gauge
26-27 gauge
Subcutaneous needle length
½ - 5/8 inch1
Intramuscular needle length
½ inch
Intradermal needle length
¼ - ½ inch
Subcutaneous max amount
1 ml
Intramuscular max amount
3 ml
Intradermal max amount
0.1 ml
Subcutaneous sites
Abdomen, lower back, top of arm, top of leg, shoulder blade, lower back
Intramuscular
Dorsoglueal, ventrogluteal, vastus lateralis, rectus femoris, deltoid
Intradermal
Inside lower arm, shoulder blades, breast ….BEVEL UP…..
IM
- stick
- stabilize
- aspirate
- inject
Mixing insulin
Air, air, draw clear, draw cloudy…
How many mg in one g
1000 mg
How many ml in a liter
1000 ml
One g is how many gr
15 gr
1 gr is how many mg
60 mg
1 ounce is how many ml
30 ml
1 tsp (t) is how many ml
5 ml
1 tbs (T) is how many ml
15 ml
1 cup is how many ml
240 ml
1 cup is how many ounces
8 ounces
1 pint is how many ml
500 ml (half a liter)
1 pint is how many ounces
16 ounces
1 quart is how many ml
1000 ml (liter)
How many g in a kg
1000 g
Celsius to Fahrenheit
°F = 1.8 (°C) + 32
Fahrenheit to Celsius
°C = (°F – 32) ÷ 1.8
I kg is how many pounds
2.2 pounds
One pounds is how many kg
0.452
How many ounces in a pound
16 ounces
So 2 ounces is how many pounds
2 ÷ 16 = 0.12 pounds
How many cm in an inch
2.54 cm
How many cm in a meter
100
How many mm in a cm
10