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metrology and Medications

Medication Substance administered for the diagnosis, cure, treatment, relief of symptoms, and prevention of disease.
Chemical name identifies drug’s atomic and molecular structure
Generic name assigned by the manufacturer that first develops the drug
Official name name by which the drug is identified in official publications USP and NF
Trade name brand name copyrighted by the company that sells the drug
Sources of Medication Information Pharmacology Pharmacy,Pharmacopoeia,Formularies, Medication handbooks
Legal Aspects of Medication Administration Controlled by law and Nursing Practice Acts define and limit nursing function in medication administration
Safe Nursing Practice Nurses are responsible for their own actions regardless of what was written by MDs. If a nurse administers a wrong dose even if written by MD both are held responsible for the mistake. Question if inappropiate.
Controlled substances Locked, Record on Inventory forms,Special prescriptions required Must witness discarding
Pharmacokinetics - how the body metabolizes the drug (Onset,Peak,½ life,Plateau)
Pharmacodynamics -process by which a drug changes the body-alters cell physiology
Therapeutic effec desired effect
Side effect adverse effects-secondary, unintended and predictable, maybe harmless or harmful and may justify discontinuation of the drug
Drug toxcity -overdosage, ingestion of drug for external use, build up of drug, or impaired metabolism
Drug allergy -immunologic reaction to the drug can be mild or severe/anaphylactic
Drug tolerance -unusually low physiologic response
Cumulative effect increasing response to a drug, rate of administration exceeds metabolism
Idiosyncratic effect -unexplained individual to a client
Drug interaction -administration of one drug before, at the same time or after alters the effect of one or both drugs
Synergistic effect -2 drugs increase the action of each
Signs and Symptoms of Drug Allergy Rash Urticaria,Fever,Diarrhea,Nausea,Vomiting,Anaphylactic reaction
Factors that effect drug actions Developmental,Gender,Weight,Culture, ethnicity and genetics,Diet Environment, timing of administration,Psychological,Illness, disease
Factors Affecting Drug Absorption Route of administration,Lipid solubility,pH,Blood flow.Rotes of Medication AdministrationLocal conditions at site of administration Drug dosage
Rotes of Medication Administration Oral, Topical, Parental(Subcutaneous,Intramuscular - IM intradermal- ID,Intravenous- IV,Intrathecal or intraspinal Epidural)
Criteria for Choosing Equipment for Injections Route of administration Viscosity of the solution,Quantity to be administered,Body size Type of medication
Preparing Medications for Injection Ampules,Vials , Prefilled cartridge
Topical Administration of Medications Skin applications Eye instillations and irrigations Ear instillations and irrigations,Nasal instillations,Vaginal applications,Rectal instillations
Patient Assessment for Medications Assess clients' health and medication history,Ask about supplements,Drug allergies,Client’s ability to self administer Socioeconomic factors, Medication reconciliation on admission, during transfer and at discharge
Patient Teaching Review techniques of medication administration,Remind the patient to take the medication as prescribed for as long as prescribed, Instruct the patient not to alter dosages without consulting a physician. Caution the patient not to share medications.
Type of Medication Errors Inappropriate prescribing of the drug,Extra, omitted, or wrong doses, Administration of drug to wrong patient,Administration of drug by wrong route or rate,Failure to give medication within prescribed time,Incorrect preparation of a drug,
Type of Medication Errors Contiuned Improper technique when administering drug,Giving a drug that has deteriorated
Medication Errors Procedures Check patient’s condition immediately; observe for adverse effects. Notify nurse manager and physician, Write description of error and remedial steps taken on medical record.,Complete special form for reporting errors.
Role of the Nurse: Medication administration correct dosage calculation!!: Reminder: Break scored tablets only!
Apothecary System: older than the metric system brought to US from England no longer recommended.
Household: least reliable but familiar(tsp., Tbsp., gtts., cup)
1 ounce = 30 ml
1 quart = 1000 ml
1 tsp = 5 ml
2.2 lbs = 1Kg
“Desired over Have” desired dose/dose on hand X quantity on hand Leave units of measure in problem
Reconstitution of Medications from Powder Form see power point
Intravenous Calculations Order must include: Amount and type of solution, amount of additives, period of infusion time. See power point
Medication Supply Systems Stock supply Individual unit dose supply,Medication cart,Computerized automated dispensing system,Bar code–enabled medication cart
absorption process by which a drug is transferred from its site of entry into the body to the bloodstream. Influenced by route of administration.
absorption of lipid solubility drug that is more lipid soluble can be absorbed more readilu and pass more easily into cell membrane
absorption of acidic drugs Well absorbed in stomach. More basic drugs remain ionized or insoluble in acid environ.
blood flow absorption is increased with increased blood flow. Impaired circulatory drugs absorded less quickly.
Conditions at site of adminstration More extensive absorbing area increase absorption. Burns difficulty with intramuscular aborption. Food in stomach can delay or enhance rate. Absorption manipulated with xr or enteric -coatd
enteric coat resistance to the digestive system.
drug loading larger than normal does given to patient in acute distress and need maximum therapy
maintenance does lower dosage that becomes usual or daily dosage
distribution depends on blood flow to tisuee , drug's ability to leave bs and drug's ability to enter cells.
metabolism or biotransforemation is the change of drug to a new form . liver primary site for drug meta.
excretion process of removing the or its meabolites from the body. Inactive form of drug. kidneys job. drug route excretion bile , sweat, salivary and mamary gland.s
antagonist effect combined effects of two or more drugs acting simultaneously produces an effect of less thatn that of the drug s alone.
teratogenic drugs know to hae potentila to cause development defectis in embryo or fetus.
placebo pharmacologically inactive substance
standing order drug orders are carried out as specified util it is cancelled by another order.
p.r.n. order as needed : patient request or required
one time ordre directive is carried out only once at a time stated by prescriber.
stat order single order carried out immediately
Parts of medicatio order Pat. name, date/time of written order, name of drug, dosage, route of drug adminstration, frequence of adminl, and signature.
name of drug can be brand or generic : most hospitals believe generic is safesft
inunction rubbing drug into skin
CMAR/MAR nurse is responsibl for checking that the medication order was transcribed corrrectly by comparing it with the orginal order
Things to do when preparing to give meds Make sure right drug, right reason (symptoms warrant it), right dose and preparation (ensure label is legible and clear)
Things to de immediately before adminstering Meds Right patient (verify nm and bd) Right time (Check the last time), and right route.
Things to do after medication is admin Right drug , right does, right rate (how is patient responding) and right documentation
paternal outsie the intestines or alimenatary canal
needle gauges diameter increases the guage number decreases. The finer needle the larger gauge number.
ampule glass flask that contains a single dose of medication - discard remainder
vial glass bottle with self sealing stopper through which medication is removed. Can remove several doses from container (good 24 hr so record time 1st used) Wipe top with alchol swab.
intradermal injections inject into dermis which is just below epidermis. Longest absorption time of all parenteral. Used for sensitivity test - tB allergies
subcutaneous injection inject into adipose tissue layer juste dermis. Few BV so slow sustained rate of Absoprtion(insulin & heprin) Sites abs, upper arm, anterior leg. 3/8" to 5/8" needles used
intramuscular injections through skin and subcutaneous into muscles. Usual cites deltoid, vastus lateralis, vetroglutal cite - betwee iliac crest aand iliac spine Needle lenght based on site and patient age and fat. Gauge is determined by medication being adminstered 18-25
intramsucular injections. volume is 1 ml to 4 ml with 1 ml max at deltoid
transdermal route applying to skin a disk or patch that contains medication intended for daily use or longer intervals. Patch for hormones , nictone, narcotic analgesics, cardiac medication.
Created by: cjnnovak