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Class 2
HCC 2008 Medication Administration
| Question | Answer |
|---|---|
| Medication Order includes: | Patient's full name, date&time of order, drug name (brand or generic), dose, route, time/frequency, signature of provider |
| Types of medication orders: | Standing (ongoing)PRN (as needed)One-time-only (single)STAT (within one hour) |
| 5 Rights of Medication Administration | Right patientRight DrugRight DosageRight RouteRight Time |
| Right Patient | Armband- check name, DOB, medical record #Ask patient there name |
| Right drug | Check the name 3 times (when reaching for package, right before opening, and before giving). May be written with generic or brand name, always check ALLERGIES. |
| Right dose | In apothecary or metric system.Is the order a safe dose for patient? |
| Right time | QD: everyday, daily (write out word now)QID vs Q6H: 4xday, every 6 hrsAC and PC:before and after mealsHS:hour of sleep; bedtime QAM QPM: 30min before/after |
| Right route | IV-intravenous, IM-intramuscular, SL-sublingual, SC-subcutaneous, PR-Perectal, ID-intradermal |
| What to teach patient about drug: | name, dose, frequency, purpose, common side effects, when to contact doctor, information about med. |
| what is the type of order and what is wrong with this: Lasix 40 bid x 5 days, p.o. | This is a standing order. There is not unit after 40. |
| type of order and why it is not correct: Aspirin gr x q4h prn for temp>100.2 | This is a AS NEEDED order. There is no route for the order. No dosage. |
| type of order and why it is not correct: Tylenol 2 tabs po q4hr prn | This is a AS NEEDED order. The 2 tabs is not specific enough. |
| type of order and why it is not correct: Digoxin 0.125mg p.o. | This is a one time only order. There is no frequency. |
| type of order and why it is not correct: Demerol mg q3-4h prn IM | This is a AS NEEDED order. There is no dosage amount. No route. |
| type of order and why it is not correct: Novolin-R insulin 10U now | This is a STAT order. The unit needs to be written out. There is no route. |
| Charting: Transcription: Medication Administration Record includes: | Patient, Date&time, signature, dosage, route, frequency, nurse signature, automatic stop dates |
| Nurse documents after giving meds: | date, what you did, nurse signature. There are special MAR's for PRN,STAT,One-time |
| If patient refuses drug: | Try reasonable persuasion, notify physician, not reason and chart in progress notes, follow agency policy |
| When would nurse refuse to give a drug? | incorrect dosage, incomplete order, bad w/other drug, patient condition bad for drug, harmful to patient |
| After refusing to give drug: | notify physician, notify charge nurse/pharmacist, chart: reason,your action, response of MD |
| Oral med administration: What to check | liquid/crushed meds w/fluid, room temp, placement, flush before/after, each med seperately,disconnect suction/feeding 30min, document fluid including flushes(I&Os). |
| Sublingual and Buccal | sub-under tongue, buc-between cheek &gum. Absorbed directly into blood vessels, rapid absorption, do not swallow, pills should dissolve. |
| Rectal Instillations | Local or systemic effect(laxatives, antipyretics). Don gloves, lubricate med and fingers, patient on side (left), go in 4 in.adults, 2 in.child, stay in position 5 min and retain med for 35min. |
| Parenteral Medications: Injections | absorption rapid,complete, used for unconscious patients, NPO, those w/GI problems or when rapid onset is needed, always palpate site for discomfort/hardness |
| Intradermal injection | TB syringe, not more than 0.5ml, usually inner surface of forearm, diagnostic. |
| Subcutaneous Injection | TB or insulin syringe, not more than 1ml. 1/2-1inch needle. ex.insulin,heparin,immunizations. |
| Locations for subcutaneous injections | Outer aspect upper arm, abdomen from costal margin to iliac crests, anterior thigh, upper back, upper ventral or dorsal gluteal |
| Intramuscular injections | used for meds that can irritate, no more than 5ml (deltoid 1ml), minimum 1 inch needle, if aspirate blood=bad (pull out), can do Z injection |
| Locations for intramuscular injections | ventrogluteal, vastus lateralis, deltoid, dorsogluteal |
| Checks for injection | Discard if has unusual precipitation, correct syringe size and needle, surgical aspesis (alcohol), discard in sharps |
| Topical medications | local or systemic, powders/creams/ointment/transdermal patch, wear gloves, remove old path, assess skin, apply pressure w/new patch 10 secs, date/time/initials on it |
| Eye medications | gloves, tissues ready, can be drops/ointment/irrigations/disks, instill into conjunctival sac |
| 2 diff. drugs in eyes? what do you do? | Wait 1-5 minutes between meds |
| Ear drops & Irrigations | Local effect (soften wax, destroy organisms, pain), room temp, gloves, child-down&back, adult-up&back. wait 5min in between ears |
| Nasal Instillations | local or systemic effect (allergies, sinus infections, congestion), gloves and tissue, may sting or burn, atomizer or drops. Head back. |
| Vaginal Applications | local effect, creams or suppositories, supine position, gloves, void before, stay position 5-10min |
| Inhalation therapies | Local or systemic effect (bronchodilators or decongestants), inhalers or nebulizers (Metered Dose Inhaler)MDI |
| Directions for inhaler | Shake canister, hold upright about 1in.from mouth, inhale through mouth, hold breath, one spray per breath |
| 10% RUle for medication (pills) | If in the final calculation of a dosage, there is less than 10% difference between the amount ordered and the amount on hand, the medication may be given. |
| More 10% rule | *it must be retained if it is more than 10%*tablets only-not liquid*NEVER with pediatric patients |
| Example of 10% rule: Order- Ferrous Sulfate 325mg/tab. On hand- 300mg/tab | It is ok to give the 300mg as 10% of 325 is 32.5 and 25 mg is less than that |
Created by:
babymazz23
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