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med admin
pharm exam 1
| 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 via the correct pathway (oral, IV, IM, etc) |
| Right documentation | record the administration accurately and immediately after giving the medication |
| right education | inform the patient about the medication's purpose, side effects and expected outcomes |
| right reason | understand why the patient needs this specific medication, indication for use |
| right response/evaluation | assess the patient's reaction to the medication and its effectiveness |
| right to refuse | respect the patient's decision to not take the medication after being fully informed |
| common types of medication errors | prescribing errors, transcription errors, incorrect patient, incorrect medication or dose, incorrect dose preparation or timing, allergic reactions, renal or liver function dosing errors |
| common causes of medication errors | poor communication, high volume, lack of monitoring |
| common causes of medication errors: poor communication | poor handwriting, written or verbal transcription errors |
| common causes of medication errors: high volume | distraction, # of nurse to patient ratio |
| common causes of medication errors: lack of monitoring | age related co-morbidities, allergies, contraindications |
| NCC MERP index for categorizing medication errors: A | circumstances or events that have the capacity to cause error |
| NCC MERP index for categorizing medication errors: B | an error occurred but the error did not reach the patient |
| NCC MERP index for categorizing medication errors: C | an error occurred that reached the patient but did not cause patient harm |
| NCC MERP index for categorizing medication errors: D | an error occurred that reached the patient and required monitoring to confirm that it resulted in no harm to the patient and/or required intervention to preclude harm |
| NCC MERP index for categorizing medication errors: E | an error occurred that may have contributed to or resulted in temporary harm to the patient and required intervention |
| NCC MERP index for categorizing medication errors: F | an error occurred that may have contributed to or resulted in temporary harm to the patient and required initial or prolonged hospitalization |
| NCC MERP index for categorizing medication errors: G | an error occurred that may have contributed to or resulted in permanent patient harm |
| NCC MERP index for categorizing medication errors: H | an error occurred that required intervention necessary to sustain life |
| NCC MERP index for categorizing medication errors: I | an error occurred that may have contributed to or resulted in the patient's death |
| 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, defibrillation, intubation) |
| what is on the do not use list? | error prone abbreviations |
| routes of medication administration | enteral, parenteral, topical, inhalation |
| enteral administration | oral, sublingual, rectal |
| parenteral administration | intramuscular, subcutaneous, intravenous, intradermal, local injection |
| topical administration | epidermal, instillation, irrigation |
| inhalation administration | intranasal, inhaled, vaporization, nebulization, gas inhalation |
| po | by mouth |
| iv | intravenous |
| ivp | intravenous push |
| IBPB | intravenous piggy back |
| IM | intramuscular |
| SubQ (SC) | subcutaneously |
| ID | intradermal |
| IT | intrathecal |
| IP | intraperitoneal |
| IN | intranasal |
| TOP | topical |
| Vag | vaginally |
| IV injection sites | basilic vein, cephalic vein, accessory cephalic vein, median antebrachial vein, radial artery, ulnar artery, median cubital vein, brachial artery, dorsal venous arch, metacarpal veins, digital veins |
| IM injection sites | deltoid, vastus lateralis and rectus femoris, ventrogluteal |
| Sub- Q injection sites | abdomen, mid interior thigh, scapula, lateral-posterior arms |
| 3 basic principles of needle and syringe sizing | syringe size, needle length, needle gauge |
| syringe size | sizes vary based on volume capacity in cubic centimeters or milliliters |
| needle gauge | sizes indication thinness or thickness of the needle |
| needle length | sizes vary based on types of injection |
| larger gauge number | smaller lumen |
| what does length of needle depend on | route, patient size and thickness |
| IM needle | 22-25 G, 1-1.5" |
| SubQ needle | 25-30 G, 1/2-5/8" |
| IV responsibilities physician | orders med, type of fluid, volume to infuse, rate and total amount of time |
| IV responsibilities pharmacist | verifies order for safety |
| IV responsibilities nurse | double checks order for safety, administers med, regulates infusion |
| IV benefits | rapid effects, precise amounts, consistent blood levels, less irritation to subcutaneous tissue, good for purely soluble meds, good for large volumes |
| IV disadvantages | little room for error, vein lining irritation, risk of infection (phlebitis), circulatory fluid overload, catheter embolus, infiltration, extravasation |
| when does infiltration occur? | when a non-vesicant fluid leaks into surrounding tissues |
| does infiltration typically irritate tissue? | no |
| signs of infiltration | redness and discoloration |
| when does extravasation occur? | when a vesicant fluid leaks into surrounding tissues |
| Does extravasation cause irritation and damage to tissues? | no |
| signs of extravasation | pain, burning, swelling and redness |
| systemic medication delivery system | oral, nasogastric, inhalation |
| systemic medication delivery system: oral | capsules, tablets, liquids, sublingual, buccal |
| local medication delivery system | topical, suppositories, eye drops, ear drops |
| local medication delivery system: topical | creams/lotions |
| other medication delivery systems | transdermal patch, injections, pump delivery |
| other medication delivery systems: injections | intradermal, subQ, IM, IV, epidural |
| what kind of dosing do you use for pediatric patients? | weight based dosing- Body surface area or body weight |
| pediatric considerations- absorption | gastric pH generally higher (more alkaline) than adults, irregular/ delayed gastric emptying, increased topical absorption (thinner skin) |
| when does the gastric pH gradually become acidic? | around 2-3 |
| pediatric considerations- distribution- total body water | 80%)-> water soluble drugs have lower drug levels |
| pediatric considerations- distribution- plasma protein | low plasma protein-> protein bound drug levels can build up and be toxic |
| pediatric considerations- distribution- blood brain barrier | blood brian barrier underdeveloped-> CNS affecting medications can be toxic |
| pediatric considerations- metabolism | liver enzyme activity matures over time, slow to breakdown drugs |
| pediatric considerations- elimination | kidney function immature, slower renal clearance |
| why do we use weight based dosing for pediatrics? | children's weight varies widely |
| pediatric dose acetaminophen | 10-14mg/kg per dose, no more than 75 mg/kg/day |
| pediatric dose ibuprofen | 5-10mg/kg per dose, no more than 40mg/kg/day |
| what are adult doses calculated on? | standardized dosing schedules |
| 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, not to exceed 2400mg Rx |
| geriatric considerations- absorption | decreased gastric acidity, delayed absorption, delayed onset, delayed gastric emptying |
| geriatric considerations- distribution | shift from muscle mass to higher body fat, decreased total body water, decreased protein-binding sites |
| geriatric considerations- metabolism | liver function slows- decreases breakdown |
| geriatric considerations- excretion | kidney function slows- decreased glomerular filtration and creatinine clearance, decreases elimination |
| gtt | drop |
| 1 kg | 2.2 lbs |
| 1 tsp | 5ml |
| 1 tbsp | 15ml=3tsp |
| 1 oz | 30ml or 30 gm |
| 1 cup | 240ml (236ml) |
| 1 inch | 2.54 cm |
| 1 gtt | 0.05 ml |
| 1 hour | 60 minutes (3600 seconds) |
| 1 kg | 1000gm |
| 1 gm | 1000mg |
| 1 mg | 1000 mcg |
| 1 L | 1000mL |
| 1 kg | 1000gm=1,000000mg=1000000000mcg |
| 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, dimensional analysis |
| dosage calculations: ratio and proportion | A/B= X/Y |
| dosage calculations formula | desired/have- A/Bx X X=desired x quantity/have |
| dosage calculations: dimensional analysis | A/B x Y/X |
| what do you round to for doses less than 1? | to the nearest hundredth |
| round 0.746mL | 0.75mL |
| what do you round to for doses greater than 1? | nearest tenth |
| round 1.38mL | 1.4mL |
| how to 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:
camrynfoster