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pharm
med administration, considerations, and calculations
| Question | Answer |
|---|---|
| ten rights of medication administration | right patient, right medication, right dose, right time, right route, right documentation, right education, right reason, right response/evaluation, right to refuse |
| right patient | verify patients identity using at least 2 identifiers (name, DOB) |
| right medication | confirm the correct medication is given, check spelling and concentration |
| right dose | ensure dose is correct and prescribed amount is safe |
| right time | administer the medication at the scheduled time, accounting for frequency |
| right route | give the medication vis the correct pathway (oral, IV, IM) |
| right documentation | record the administration accurately and immediately after giving the medication |
| right education | inform the patient about the medications purpose, side effects, and expected outcomes |
| right response/evaluation | assess the patients reaction to the medication and its effectiveness |
| right to refuse | respect the patients decision to not take the medication after being fully informed |
| common types of medication errors | prescribing errors, transcription errors, incorrect patient, incorrect dose or medication, allergic reactions, renal or liver function dosing errors |
| poor communication | poor handwriting, written or verbal transcription errors |
| high volume | distraction, # of nurse-to-patient ratio |
| lack of monitoring | age related considerations, co-morbidities, allergies, contraindications |
| harm | impairment of the physical, emotional, or psychological function or structure of the body and/or pain resulting therefrom |
| monitoring | to observe or record relevant physiological or psychological signs |
| intervention | may include change in therapy or active medical/surgical treatment |
| intervention necessary to sustain life | includes cardiovascular and respiratory support (CPR, intubation, defibrillation, etc) |
| do not use lists | o.d., OD Q.D, QD, q.d., qd qhs qn |
| routes of medication administration | enteral, parenteral, topical, inhalation |
| enteral | oral, sublingual, rectal |
| parenteral | IM, subcu, IV, intradermal, local injection |
| topical | epidermal, instillation, irrigation |
| inhalation | intranasal, inhaled, vaporization, nebulization, gas inhalation |
| IVP | iv push |
| IVPB | iv piggy back |
| ID | intradermal |
| IT | intrathecal |
| IP | intraperitoneal |
| IN | intranasal |
| TOP | topical |
| vag | vaginally |
| syringe size | sizes vary based on volume capacity in cubic cm or mL |
| needle length | sizes vary based on types of injections |
| needle gauge | sizes indicate thinness or thickness of the needle |
| gauge is lumen size | larger number = smaller lumen |
| length of needle depends on | route, patient size, and thickness |
| IM needle length | 22-25 G, 1-1.5" |
| SQ needle length | 25-30 G, 1/2 - 5/8" |
| physician responsibilities | Orders med Type of fluid Volume to infuse Rate and total amount of time |
| pharmacist responsibilities | Verifies order for safety Prepares med |
| nurse responsibilities | Double checks order for safety Administers med Regulates infusion |
| benefits of IV peripheral or central | Rapid effects Precise amounts Consistent blood levels Less irritation to subcutaneous tissue Good for poorly soluble meds Good for large volume |
| disadvantages of IV peripheral or central | Little room for error Vein lining irritation Risk of infection Phlebitis Circulatory fluid overload Catheter embolus Infiltration Extravasation |
| infiltration | Occurs when a non-vesicant fluid leaks into surround tissues Does not typically irate tissue Redness and discoloration |
| extravasation | Occurs when a vesicant fluid leaks into surrounding tissues Irritation and damage to tissues Pain, burning, swelling and redness |
| systemic medication delivery systems | oral, nasogastric, inhalation |
| systemic medication delivery systems: oral types | capsules, tablets, liquids, sublingual, buccal |
| local medication delivery systems | topical (creams, lotions), suppositories, ear drops, eye drops |
| other medication delivery systems | transdermal patches, pump delivery, injections |
| other medication delivery systems: injections types | Intradermal SubQ IM IV Epidural |
| pediatric considerations | Weight based dosing is key Body Surface Area (BSA) or body weight (mg/kg) |
| pediatric absorption | Gastric pH generally higher (more alkaline) than adults Gradually becomes acidic over time around age 2-3 Irregular/Delayed gastric emptying Increased topical absorption (thinner skin) |
| pediatric distribution | Total body water (80%) - water soluble drugs have lower drug levels Low plasma protein - protein bound drug levels can build up & be toxic Blood-brain barrier underdeveloped - CNS affecting medications can be toxic |
| pediatric metabolism | Liver enzyme activity matures over time, slow to breakdown drugs |
| pediatric elimination | Kidney function immature, slower renal clearance |
| Acetaminophen child dose | 10-15 mg/kg per dose, no more than 75mg/kg/day |
| Ibuprofen child dose | 5-10 mg/kg per dose, no more than 40mg/kg/day |
| Acetaminophen adult dose | 500-1000mg every 4-6 hours, not to exceed 3 grams per day (OTC) or 4 grams per day (Rx) |
| Ibuprofen adult dose | 200-400mg every 4-6 hours, not to exceed 1200mg per day OTC |
| geriatric absorption | Decreased gastric acidity Delayed absorption Delayed onset Delayed gastric emptying |
| geriatric distribution | Shift from muscle mass to higher body fat Decreased Total Body Water Decreased protein-binding sites |
| geriatric metabolism | Liver function slows – decreases breakdown |
| geriatric excretion | Kidney function slows – decreased glomerular filtration and creatinine clearance Decreases elimination |
| 1 kg | 2.2 lbs |
| 1 tsp | 5ml |
| 1 tbsp | 15 ml = 3 tsp |
| 1 oz | 30 ml = 30 gm |
| 1 cup | 240 ml (236 ml) |
| 1 in | 2.54 cm |
| 1 gtt | 0.05 ml |
| 1 kg | 1000 gm |
| 1 gm | 1000 mg |
| 1 mg | 1000 mcg |
| 1 L | 1000 ml |
| types of calculations | Solid oral medication Liquid oral medication Injectable medication Correct doses by weight IV infusion rates |
| methods of dose calculations | Ratio and Proportion Formula (desired over have) Dimensional Analysis |
| ratio and proportion | A/B = X/Y |
| formula (desire over have) | A/B x X X = desired x quantity / have |
| Dimensional Analysis | A/B = Y/X |
| doses less than 1 | round to nearest hundreth |
| doses more than 1 | round to nearest tenth |
| avoid common calculation mistakes | Avoid miscalculations by always double checking Ensure correct concentrations of solution Does the calculation make sense? Were the right units used for conversions? Do units of measurement cancel out? |
Created by:
leh195