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foundations
exam 1: med administration part 2
| Question | Answer |
|---|---|
| standing order | aka routine order carried out until cancelled by another order |
| PRN order | as needed |
| single or one time order | ordered to be completed once |
| stat order | carried out immediately |
| parts of med order | pt name date and time of order name of drug dosage of drug route of drug frequency of administration signature of person writing the order |
| medication supply systems | stock supply individual unit dose supply medication cart computerized automated dispensing system bar code-enabled medication cart (BCMA) |
| medication administration key rule | three checks |
| 1rst check of med admin | the nurse reaches for the container or unit dose package |
| 2nd check of med admin | after retrieval from the drawer and compared with the eMAR, or compared with the eMAR immediately before pouring from a multi-dose container |
| 3rd check of med admin | before giving the unit dose medication to the pt or when replacing the multi-dose container in the drawer or shelf |
| rights of medication administration | right med, right pt, right dose, right route, right time, right reason, right assessment data, right documentation, right response, right to education, right to refuse |
| controlled substances required information | name of pt receiving, amount used, hour the drug was given, name of the prescriber, name of the nurse administering |
| for controlled substances, what do we do that's special? | need to manually count the meds in the drawer and must get another nurse to waste the med with you |
| identifying the patient | checking ID band (first identifier) validating the pt name, ID #, medical record number, and/or birth date (second identifier) comparing with the eMAR asking pt to state name and DOB if possible |
| medical record documentation | name and dose route and time name of admin site used for injection location of topical or transdermal application intentional or inadvertently omitted drugs refused drugs medication errors |
| types of med errors | wrong prescription extra, omitted, or wrong dose wrong pt wrong route or rate not given within the prescribed time incorrect preparation improper technique med is expired |
| if medication error occurs: | check pt's condition immediately; observe for adverse effects notify nurse manager and PCP complete form used for reporting errors need to own it! |
| ways to prevent errors | med reconciliation prepare meds for one pt at a time follow the rights double check calculations and verify w friend question weird doses read labels atleast 3x use 2 pt identifiers verify allergies reporting educate and involve pt |
| why errors occur | errors occur when nurses "work around" technology (overrides, or BPA) |
| patient teaching | review techniques, remind pt to take for entirety of prescription, do not alter doses without consulting DR, do not share meds |
| oral routes solid | tablets, capsules, pills |
| oral routes liquid | elixirs, spirits, suspensions, syrups available in syringe, multi-dose vial with a dropper, single dose cover label to avoid destruction incase of a spill |
| oral route | having the pt swallow the drug |
| enteral route | administering the drug through enteral tube |
| oral routes sublingual | placing drug under tongue to dissolve ex nitroglycerin |
| oral routes buccal | placing drug between tongue and cheek between back teeth and cheek is very vascular rapid absorption into bloodstream bc it avoids the GI tract |
| oral route (PO) | most common- slower onset given with fluid or food absorbed in GI tract (sm Intestine) need to assess if the pt can swallow and has diet orders |
| what may affect a pt taking meds via oral route | LOC? can they swallow? do they have gag reflex? any persistent N/V? any of these may indicate a possible aspiration risk |
| what if the pt is NPO | check if they can eat and have meds or water |
| what do you check after the med was taken? | check that they actually swallowed it |
| things to remember with the oral route | some pt "pocket it" in their cheeks difficulty swallowing alternatives dont leave a medication at the bedside! |
| when giving oral meds: | make sure pt HOB is upright to prevent choking some pts like one at a time or all at once tell the pt what med you are giving and what it is for open it infront of them |
| what should you not give with buccal and sublingual meds? | don't give any liquid |
| technique for giving liquid meds | liquid should be shaken before pouring place med cup at eye level before pouring correct an incorrect dose pour, do not pour back into the bottle make sure the bottle is clean before replacing |
| enteral med admin | through gastric tube or naso-gastric tube |
| PEG tube | percutaneous endoscopic gastrostomy goes right into the stomach from outside the skin |
| J tube | jejunostomy tube aka GJ tube has 3 ports: gastric, jejunal, BAL. |
| ENFit connectors | designed to provide secure and unique adaptors and connectors for enteral feeding systems |
| other GT's | levin tube salem sump tube - what we use most often, it has a large lumen for suctioning of gastric contents |
| levin tube | flexible rubber or plastic single-lumen you can add connector for feeding and med admin tubes are inflexible and cause pt discomfort |
| salem sump tube | a flexible double lumen tube allows air to escape and suction to occur you can add a connector for feeding and med admin these are not for long term use |
| NG tube (dobhoff) | single lumen verify correct placement prior to use can be used for med admin or enteral feedings note the insertion length for comparison later!!! |
| NG tube (duo-tube) | double lumen verify correct placement prior to use can be used for med admin or enteral feedings note the insertion length for comparison later!!! |
| kangaroo pump | pump for tube feeds |
| NG tube med admin | verify correct placement prior to use, by checking the mark from insertion to make sure it did not migrate. all meds that are crushed should be given separately because we dont know how they will react together. |
| what meds cannot be crushed? | EC, ER, IR |
| checking the placement of NG tube | xray marking at nose after confirmation checking residuals (Pulling back) flush orders |
| positioning for pt with NG tube | pt elevated in semi-fowlers or fowlers postion for atleast 30 minutes suction |
| what is pt is NPO with NG tube? | limit flushed in between meds |
| what to remember with NG tube | remember to properly document I&O's |
| topical route | application to the skin has slow absorption because of the physical makeup of the skin. meds places on the mucous membranes and respiratory airways are absorbed quickly because of blood vessels. |
| topical doesn't go through what? | first pass effect |
| inhaled: metered dose inhaler | rapid absorption and relief for breathing difficulties (anesthesia) given during inhalation, spacer may be used for patients that have difficulty getting the whole dose |
| what to do if the pt has multiple inhalers | give bronchodilator first. want to give corticosteroids last and rinse out mouth after. this will prevent fungal infection |
| nebulizers | liquid medicine placed in dispenser and inhaled through mask |
| nasal drops | gloves, tilk head back or supine, stay for 1-2 minutes, not sterile but maintain asepsis, clean tip off after use |
| nasal spray | sitting up or with head tilted, spray during inhalation |
| otic (ear) drops | treats ear infections or softens wax, drops should be at room temp, side-lying, ear up, drops alongside the canal, gently massage the tragus to move medication if needed, stay on side about 5-10 minutes |
| ear drop technique for adults | pull up |
| ear drop techniques for a child | pull down |
| transdermal (skin) route | absorbed through the skin rotated sites- include date, time, and initials on patch do not place on abrasions unless ordered that way |
| ophthalmic (eye) drops | gloves, tilt head back, wipe eyes if any secretions, apply drops to conjunctival sac, apply pressure to naso-lacrimal duct |
| ophthalmic (eye) ointment | apply from inner canthus to outer canthus, apply pressure to inner canthus for a minute to stop it from going into the tear duct, wipe away any excess on the outside of the eye, do not touch tip of the applicator/dropper to the eye |
| how to administer multiple eye drops | wait 5 minutes in between administration of each |
| rectal medications | suppositories-antipyretic (fever), laxative, or stool softener given because relief is needed quickly, very vascular area |
| rectal med administration | position pt on left side with upper leg flexed (gravity helps here towards the colon) |
| technique for rectal med admin | wear gloves and unwrap med, add lubricant to rounded end, have pt take deep breath and exhale, proceed to insert into the rectum at least 1 inch past the anal sphincter |
| vaginal route | foams, creams, liquids, gels, suppositories used for infection or contraception |
| technique for vaginal med admin | gloves, preform peri-care first, position in lithotomy position on pad in case of secretions. best to do at bedtime to allow medicine to remain in place. do not use tampons |
Created by:
ago24