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Med Admin P&P

Potter and Perry 7th Edition Chapter 35

Pharmacokinetics is? The study of drug concentrations, how medications enter the body, reach their site, metabolize, and exit the body.
1st American law to regulate medications? Pure Food and Drug Act of 1906.
Who enforces medication laws? Food and Drug Administration (FDA)
What is the government program that encourages health care workers to report harmful medications? MedWatch which is located on the FDA website.
Who regulates alcohol and tobacco use? Local government.
Nurse Practice Acts (NPAs) are what? Laws defining the scope of a nurse's professional functions and responsibilities.
Primary intent of NPAs is what? Protect the public from unskilled, undereducated, and unlicensed personnel.
Controlled substances are called? Narcotics.
How many drug names do medications usually have? 3
What are the 3 names of medications? Chemical name, Generic/common name, Trade/Brand name.
What is a common mistake amongs med admin involving drug names? Similarities in names causing mix ups.
Medication classification indicates what? Effect of medication on the body system.
Absorption refers to what? Passage of meds into the blood stream from the site of admin.
Is med admin to the skin fast or slow? Slow.
Is med admin to the mucous membranes fast or slow? Fast.
Is oral med admin fast or slow? Slow.
What is defined by administered to "mucous membranes"? Membranes of mouth, eyes, nose, rectally.
Is IV med admin fast or slow? FASTEST route of admin.
What determines the speed of a route of admin? How long it takes for medication to reach the blood supply from the admin.
What is absorbed faster liquid/solutions or tablets? Liquids.
Acidic medications pass through the gastric mucosa fast or slow? Fast.
Basic medications are absorbed where? Small intestine.
Does large surface area of admin increase or decrease speed of absorption? Increases.
Would an oil based medication be absorbed easier or more difficult? Easier based on lipid solubility across lipid based cell membranes.
Oral medications taken with food is good idea or bad? Bad, some food alter the medication causing slow absorption.
What factors affect a drug once it is absorbed and on its way to destination site? Circulation, membrane permeability, protein binding.
Why would heart failure influence a medication? Poor circulation caused poor absorption.
Blood-brain barrier only lets WHICH type of medications to pass? Fat-soluble.
What type of barrier does the placenta have and why is this important? Nonselective; any and all medications can pass through the barrier and cause fetal defects.
How does albumin affect medication effects? Most medications bind to albumin to an extent, binded medications are "not active" and do not cause pharmacological activity.
Metabolism of medication includes what? Biotransformation: detoxify, degrade, and remove biologically active chemicals.
Most biotransformation occurs where? Liver.
Where are meds metabolized other than the liver? Lungs, kidneys, blood, and intestines.
Why can an average sedative dose cause a liver disease patient to lapse into a coma? Decreased liver function means that the med is not being filtered out of the blood as much as normal, therefore more time for it to be absorbed.
Medications are excreted from which organs? Kidneys, liver, bowels, lungs, and exocrine glands.
What determines where it is excreted? Chemical makeup.
Where would gaseous/volatile compounds be excreted? Lungs.
Lipid-soluble medications are excreted from where? Exocrine glands.
If meds are degraded by the liver, where are they excreted? In bile.
What does slow peristalsis do to medication? Prolong its effects.
What is the main source of medication excretion? Kidneys.
What is a therapeutic effect? Intended effect.
What are side effects? Predictable and often unavoidable secondary effects.
What are adverse effects? Unintended, undesirable, and often unpredictable effects.
What is an idiosyncratic reaction? Over/under reaction to a med.
Toxic effects would happen because what? Impaired metabolism or excretion of med.
Allergic reactions happen when? Client becomes immunologically sensitized to the med.
What has a high incidence of allergic reactions? Antibiotics.
Anaphylactic reactions are characterized by? bronchiolar constriction, edema of the pharynx and larynx, wheezing, shortness of breath.
Medication interaction is what? When one medication modifies another.
Synergistic effect is what? Combined effect of the 2 medications is greater than if they were separate.
What is an example of synergistic effect? Alcohol's effect on antihistamines, antidepressants, barbiturates, and narcotic analgesics.
What is the goal when a med is prescribed at a specific time/rate? Constant blood levels within safe ranges.
When is the highest serum concentration? Just before body absorbs the last of the medication.
When is the lowest serum concentration? 30 mins before administering the drug.
What is the highest serum concentration called? Peak.
What is the lowest serum concentration called? Trough.
What is a serum half-life? Time it takes for half of the dose of medication to be lowered via excretion.
Pain meds are most effective when admin when? Around the clock.
What is the easiest med route? Oral.
What is med admin under the tongue called? Sublingual.
What is a very common sublingual route medication? Nitroglycerin for heart attacks.
How would something be admin via buccal mucosa? Placed next to inside of cheek and allowed to dissolve.
What are the 4 major Parenteral admin routes? Intradermal, Subcutaneous, Intramuscular, Intravenous.
What are some other more advanced Parenteral admin routes? Epidural, intrathecal, intraosseous, intraperitoneal, intrapleural, intraarterial.
Where is an epidural placed? Epidural space of the spinal column.
Where is an intrathecal placed? Subarachnoid space or one of the ventricles of the brain.
Where is an intraosseous placed? Infusion directly into bone marrow.
Where is intraperitoneal placed? Peritoneal cavity of the abd.
Where is the intrapleural placed? Pleural space in the chest.
Where is the intraarterial placed? Arteries, usually for clots.
Transdermal disks have localized effects as well as? Systemic effects.
What does "instillation" mean? Fluid is retained.
Inhalation route is a quick way to admin drugs because? The deeper passages of the resp system provide for large surface area that is highly vascular.
What is the most common intraoccular medication used to treat? Glaucoma.
Why is the metric system used for medical dosages? Easy to convert, units organized into factors of 10.
Which zero should you always have, and which should you never have in a med calculation? Never = trailing, Always = leading.
What is the disadvantage of household measurements? Inaccuracy
What are some examples of household measurements? Cup, tablespoons, teaspoons, quarts, gallons.
What is a solution? Mass of solid substance (solute) is dissolved in a liquid (solvent)
How are solutions represented? Percentages or proportions
What is the smallest amount a tablet can be admin? 1/2
What is the smallest amount a capsule can be admin? 1
How many people should check a dosage calc before admin certain drugs such as insulin or heparin? 2
Why are premature and newborns at risk for adverse drug reactions? Immature liver and kidneys.
What should be taken into consideration when calc child's dosages? Age, weight, body surface area, hydration status.
What formulas are used to calc a child's body surface area ? Mosterller's formula or nomogram.
Who is accountable for admin a dose to a client? Nurse.
When a verbal order is given, what must ALWAYS be done? Repeat it back.
What are 5 common orders in acute care? Standing, prn, Single, STAT, Now.
What is a prn order? As needed.
What is a STAT order? Immediately.
What is a Now order? Within the next 90mins.
When a med admin error occurs, what is 1st priority? Stabilize patient.
When should an incidence report be filed? Within 24 hrs.
Can you look in a patient's medical record to find old incidence reports? No, they are not permanent.
What is medication reconciliation? Checking medications taken prior to this time with the meds currently being admin.
What happens if a patient does not have enough potassium (K) in their bodies, what is it called? Muscle fatigue, weakness, dysrhythmias; hypokalemia.
What are the 6 rights of med admin? Medication, dose, client, route, time, documentation.
How do you ensure right medication? Compare prescriber's written orders with the medication administration record.
What do you use to prepare and admin a med? MAR
How many times do you check label of a med? 3
How many patient identifiers do you use each time a procedure/med is admin? 2
Who can prepare a medication that you are going to admin? Licensed pharmacist only.
What should be done if a client refuses narcotics? Dose should be destroyed while another staff member witnesses.
Why should the client's fav food/drink not be used to admin foods? It alters the taste making the client not want it anymore.
Who is this "fav food" policy most immportant for? Children and cancer patients.
What is an order does not have a specific route? Consult the prescriber.
Why is the right time important? It may conflict with the client's schedule and the nurse should know why this time in case it may be possible to change the time.
Why is the right documentation important? If incorrectly documented, the next nurse will not know that this was an error.
What should be documented? Name of med, dose, time, route, site, client's responses.
Who has the right to refuse medication? Anyone 18 y/o or older and an emancipated minor.
Who should not receive propofol and why? It contains egg lecithin and soybean oil, so anyone with these allergies should not take.
What should be provided first the proper med admin technique or the treatment for overdose? Treatment of "overdose" and sign/symps should be taught 1st.
What is polypharmacy? More than one med is taken to treat the same illness, usually because the client is being treated for several individual symptoms.
What are the 2 types of polypharmacy? Rational and irrational.
What is the difference between rational and irrational polypharmacy? Rational when the meds are necessary, irrational is when the meds are not necessary.
What is the most common measurements for a nurse to make to test the effectiveness of the NI? Physiological such as BP, Heart rate, Visual acuity... easy to check and monitor.
How much fluid should oral admins be taken with? 60-100 mL of fluid if allowed.
What is a possible side-effect of over use of nasal spray? Rebound effect.
Why is epinephrine applied to nares during a nose bleed? It reduces blood flow.
What part of the eye has many nerve fibers and should be avoided? Cornea.
What would happen is ear drops are admin at anything other than room temp? Vertigo, dizziness, or nausea.
When placing ear drops how must the canal be straightened? Adult: pulled up and out. Young Child: Down and back
Where are suppositories stored and why? Refrigerator, they will melt at higher temperatures.
Where should rectal suppositories be placed? Against the rectal mucosa.
Where is the effect of Metered-dose inhalers and dry powder inhalers? Locally, bronchodilation.
How are insulin syringes calibrated? In units instead of mL or both.
What ranges are needles' lengths? 1/4 - 3 inches.
As the gauge becomes smaller, the diameter of a needle becomes? Larger.
Why are some medications dry and must be reconstituted? They are unstable for long term storage as liquids.
When mixing insulin doses, which vial do you inject air in 1st? Cloudy.
What is the order to mix insulin doses? Air cloudy, air clear, aspirate clear, aspirate cloudy.
When preparing insulin, what is the difference between "R" and "NPR"? R= regular fast acting insulin NPR= intermediate acting insulin.
Can NPR be given via IV? No, only regular.
Why is the cloudy NPR solution aspirated last? To prevent the clear, fast acting insulin from being mixed with the slower acting NPR.
Where is subQ placed? Connective/fatty tissue; outer posterior of arms, abd, anterior aspects of thighs.
When injecting the abd, how far away from the umbilicus should it be? 2 inches minimum.
What is the maximum sized dose for subQ? 1 mL water soluble med.
What are the subQ insertion angles? If you can pinch 2in of skin, 90 deg... if pinch 1in of skin, 45 deg.
Where are IM placed? Deep muscle tissue.
What is the max IM admin? 3 mL, 2 mL for children, older adults, and thin people, 1 mL for infants.
What angle is IM inserted? 90 deg.
What are some IM sites? Ventrogluteal, vastus lateralis, deltoid.
Which IM site should no longer be used? Dorsogluteal.
What is different about a Z-track method? The skin is pulled taut, injected, released. This makes it difficult for the fluid to return up the injection track.
What angle are intradermals? 5-15 degs.
What is the only approved re-capping method? 1 handed.
What are 2 commonly added to IV fluids? Vitamins and Potassium chloride.
What is another name for an intravenous bolus? IV Push.
Which bag should be placed higher primary or piggy back? Piggy back.
Which should be higher if there is a tandem bag being used? Same height.
What is another name for an intermittent venous access? Heparin/saline lock.
Created by: Babble05