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1227 Final BP

Six Rights of Drug Administration Right Drug, Right dose, Right drug by right route, right drug at the right time, right drug to the right patient. & Three Checks.
Synergism one drug increases the action of another
Medication Interaction the effect of two meds combined is greater than the effects of the meds when given seperately.
Peak action occurs when the highest blood or plasma concentration of drug is achieved
The length of time the drug exerts pharmacologic effect is the duration
Adverse effect very undesirable effects with more serious consequences
Absorption refers to the passage of medication molecules into the blood from the side of admin
absorption is affected by route of admi, ability of med to dissolve, blood flow to area of absorption, body surface area, lipid solubility of the med, presence of food in tummy
Unit dose system is considered the safest.
Not taking medications as prescribed is common and is called noncompliance. Often pts may not understand why they need the meds.
Reasons for Noncompliance side effects, cost, just plain don't like taking it!
Using the nursing process to help the noncompliant people: ASSESS medication reconciliation, look for allergies or other contraindications, look at the MAR, physical impairments..
Using the nursing process to help the noncompliant people: DIAGNOSE deficient knowledge or noncompliance
Using the nursing process to help the noncompliant people: PLAN verbalize understanding of why they are taking meds, list adverse effects, take all meds.
STAT immediately and only once
NOW after the STATs givfe the "NOW"s
PRN Give as needed
Routine usually scheduled per the policy of the institution. Nurses have a 30 minute window to give the routine meds. Sometimes referred to as standing orders.
Medication Orders medication order lists the drug name and directions for its administration.
Who writes medication orders? Physicians and dentists write med orders.
Advanced practice nurses and nurse practitioners can write medication orders if legally designated by state statutes.
Prescribers role: writes an order on a form in the pts medical record, in an order book, on a legal prescription pad, or though a computer terminal.
TO or VO are given when written or electronic communications between the prescriber and the nurse is not possible. The prescriber will countersign the order at a later time, usually within 24h.
Clients name, Date and time order is written, Drug name, Dose, Route, Frequency, and Signature are all part of a medication order.
Nurses never implement a questionable med order until after consulting with the person who as written the order.
Timely documentation prevents medication erros
Documentation demonstrates implementation of the medication order.
if a nurse withholds a medication, he or she documents its omission according to agency policy.
Circle the time of administration the medication is withheld.
The reason for the omission is documented in the comment section or in the client's record.
As soon as the medication error is recognized the nurse check's the clients condition and reports the mistake to the prescriber and the nursing super.
An incident report is filled out and is not a permanent part of the client record.
Topically applied drugs have what kind of effect? local or systemic. Administered to achieve a direct effect on the tissue to which they are applied.
Cutaneous applications are drugs rubbed or placed in contact with the skin. (injunctions and transdermal patches or pastes)
Different types of topical route medications cutaneous, opthalmic, otic, nasal, sublingual, buccal, vaginal rectal.
Administration of medications to the skin or mucous membranes can be applied externally or internally. Topical applied drugs
Injuction Medication incorporated into an agent that is administered by rubbing it into the skin.
Applying an injunction: wash hands. ID pt. Don Gloves. Cleanse area w/soap & water. Warm or shake injunction. Apply with fingers, cotton ball, or gauze. Rub. Apply heat if indicated.
Transdermal Applications drug incorporated into patches or paste (method of applying a drug on the skin allowing it to become passively absorbed).
Skin patches drugs bond to an adhesive bandage and applied to the skin
drug paste paste that contains a drug within a thick base and is applied but not rubbed into the skin.
Applying Nitroglycerine Paste wash hands. ID pt. Squeeze paste from tube onto application paper. Fold the paper to spread the paste. DO NOT touch w/bare fingers. Place on nonhairy part of bod. Cover with square of plastic. Remove other applicators before applying. Rotate sites.
Opthalmic Application Method of applying drugs onto the mucous membrane of one or both eyes. liquid, drops, ointments, applied to lower lid, blinking distributes meds over surface of eye.
Otic applications drug instilled into the outer portion of the ear. Manipulate the ear to straighten the auditory canal.
Child Otic Application Pull ear down and back. Tilt head away. Instill meds. Have client remain in position briefly. Cotton ball may be placed.
When applying Otic applications you should wait at least 15 minutes before treating other ear.
Nasal applications topical applications are dropped or sprayed within the nose. Proper instillation is important to avoid displacing med into nearby structures such as the back of the throat. Warn pt of rebound effect.
Sublingual Application drug placed under the tongue and is left to dissolve slowly and become absorbed by the rich blood supply in the area.
Buccal application drug placed against the mucous membranes of the inner cheek.
Vaginal application topical vaginal applications are used to treat local infections. Early and appropo self treatment restores normal tissue integrity.
Vaginal application pt teaching use before bedtime, empty bladder, put drug in applicator, lube tip with water-soluble lube, lie down, bend knees, spread legs. Seperate labia, insert 2-4 cm. depress plunger. remove applicator. sanitary pad if preferred. remain recumbent for 10-30min.
THROW AWAY THE APPLICATOR vaginal application pt teaching
Rectal applications drugs administered rectally usually in the form of suppositories, creams or ointments.
Rectal application application wash hands. id pt. sims position. drape. don gloves. INSTRUCT TO TAKE SEVERAL SLOW DEEP BREATHS. insert TAPERED END FIRST beyond internal sphincter (finger distance. Do not put in stool. Wipe excess. stay in position for at least 15min. remove gloves.
Inhalant route admin of drugs in lower airways. Distribution of medication to the distal areas of the airways, liquid meds are converted to an aerosol.
Provide devices for these people to instill eye meds independently older adults
Be sure when instilling more than one eye meds that the client knows to wait 5 minutes between administration
lack of subQ tissue causes more rapid absorption of topical meds than in younger adults.
Arthritis may interfere with applyin gmeds within the vagina or rectum or to skin of lower extremities.
Provide space devices to assist in administration of inhalers
Monitor heart rate and blood pressure with bronchodilators
Enteric coated tablet solid drug covered by a substance that dissolves beyond the stomach to protect from irritation
scored tablet solid drug manufactured with a groovein the center and is convenient when only part of a tablet is needed.
sustained release drug that dissolves at timed intervals and should never be opened or crushed.
Spansule time-released pellets put into a capsule.
Oral route of administration swallowing or instillation through an enteral tube.
Insulin is a hormone required for clients with diabetes
Insulin is administered with an insulin syringe (calibrated in units)
Various insulin syringes hold volumes of 0.3,0.5, and 1mL
The standard dosage strength of insulin is 100U/mL
Low dose insulin syringes are used to deliver insulin in 30-50 U or less
A standard insulin syringe can administer up to 100 U of insulin
Regular insulin which is additive free is combined with intermediate-acting insulins such as Humulin
Order of insulin into syringe clear to cloudy
When combined insulin is injected within 15 minutes of being combined their unique characteristics are offset by each other.
Parenteral route route of drug administration other than oral or though the gastrointestinal tract. Also, Meds given by injection.
Preparation and administration of injections follow the principles of asepsis and infection control.
Intradermal syringe mL 1mL
Intradermal syringe calibration 0.01ml or minums
Intradermal needle gauge size 25, 26, or 27 gauge
Intradermal needle size 1/2 or 5/8 inch
SubQ syringe mL 1, 2, 2.5, or 3mL
SubQ syringe Calibration 0.1mL
SubQ needle gauge 23, 25, or 26 gauge
SubQ needle length 1/2 or 5/8 inch
SubQ Insulin syringe mL 1mL
SubQ Insulin syringe calibration Units
SubQ Insulin needle gauge 25, 26, or 27 gauge
SubQ Insulin needle length 1/2 or 5/8 inch
Intramuscular syringe mL 3 mL
Intramuscular syringe calibration .2mL
Intramuscular needle gauge 20, 21, 22, or 23 gauge
Intramuscular needle length 1 1/2 or 2 inch
Intradermal injections are commonly used for diagnostic purposes. Small Volumes of .01-.05
Intradermal injection sites inner aspect of the forearm, back and upper chest can be used (usually with allergy testing)
SubQ injections are administered between skin and muscle
SubQ injected medications usually act within 30 minutes of administration
Common IM site dorsogluteal: UOQ of buttocks
IM injections are given at what angle? 90 degrees
Syringe parts barrel - holds meds / plunger - in the barrel moves back and forth / tip - needle is attached
Give only the meds that you prepare
Do not leave the medications at the bedside
keep narcotics locked
When administering heparin do you aspirate? NO.
Heparin is administered in which ways? subQ or IV
Important teaching for Heparin admin change needle before injecting client. rotate sites. DO NOT MASSAGE.
Vastus Lateralis outer thigh. No Large nerves and blood vessels. Desirable site for: infants and small children, thin or debilitated pts.
Ventrogluteal uses gluteus medius and gluteous maximus in hip. Has no large nerves or blood vessels. Safe site for children. Identify correctly.
Dorsogluteal site UOQ of buttocks, common IM site
Reconstitution process of adding liquid, known as diluents, to a powdered substance.
Common diluents for injectibel drugs are sterile water or sterile normal saline
When reconstitution is necessary, the drug label lists the following: type of diluents to add, amount of diluents to use, dosage per volume after reconstitution, Directions for storing the drug.
Continuous IV instillation of a parenteral drug over several hours also called a continuous drip.
Saline Lock: Prepare flush solutions according to hospital policy. Clean injection port with antiseptic swab. Connect to the IV lock or injection port. Aspirate for blood return. Flush IV site with NS by pushing slowly on the plunger. Observe the skin above the IV cath. Note any puffiness or swelling. Remove Saline syringe. Insert med syringe. Inject. Remove. Flush with NS.
Infiltration (IV Complications) escape of fluid into the tissue
phleibitis(IV complication) inflammation of a vein
Secondary infusion also know as piggyback the administration of a parenteral drug that has been diluted in a small volume of IV solution, usually 50-100mL over 30-60mL
Hypertonic solutions 10% dextrose in water
Hypotonic solutions 0.45% Normal saline
Colloid solution blood and blood products
Whats the first step to a blood transfusion? obtain and doc the clients VS to provide a baseline for comparison should the client have a transfusion reaction.
Administer blood transfusion through a 16-20 gauge, preferred 18 gauge blood tranfusion tubing Y set. Administer with normal saline.
Attach IV tubing, if fluid flows secure with transparent dressing, loop tubing and tape which way? down.
1mg = mcg 1000 mcg
1L = mL 1000mL
2.2lbs = kg 1kg
1 hour = minutes 60minutes
1g = mg 1000mg
At least two pt identifiers must be used to ensure that the med is administerd to the correct pt. Say to the pt: "state your name for me, please." do not call the pt by name, some do not hear well will say yes. Look at the pt's identification armband or number. Some facilities may also require birthdate.
For safety check the five rights how many times? 3
When medication is given what information do you record on the MAR? drug, dose, time, route and your intials. Eventually the reaction should also be noted.
If the medication is PRN what would you record on the MAR? date, reason, dose and route, and location if by injection, signature. The reaction should also be noted.
Skin (transdermal) absorption slow
mucous membranes absorption quick
respiratory tract absorption quick
oral absorption slow (liquids are faster than pills, tabs, or capsules)
intramuscular absorption depends on form of the drug: aqueous is quicker than oil, which slows absorption.
SubQ absorption slow
intravenous absorption Most rapid absorption
ACE Inhibitors "prils" Antihypertensive that relaxes areterial vessels
Angiotensin receptor blockers "sartans" antihypertensive that blocks action of vasoconstriction effects of angiotensin 2
Beta blockers "olols, alols, and ilols" antihypertensives/antianginals that block beta adrenergic receptors in vascular smooth muscle.
Antilipemics "statins" inhibit HMG-COA reductase enzyme reducing cholesterol syntheseis
Peripheral vessel calcium channel blockers "dipines" antihypertensives/antianginals that produce relaxation of coronary smooth muscle and vascular muscle; dilate coronary arteries.
erectile agents "afils" peripheral vasodilator that promotes a penile erection.
broad-spectrum antiinfectives "floxacins" inhibits bacteria by interfering with DNA
proton pump inhibitors "prazoles" suppress gastric secretions preventing gastric reflux and gastric and duodenal ulcers.
block histamine-2 receptors "tidines" inhibits histamine at H2 receptor sites decreasing gastric secretions.
Antifungals "Azoles" Cause direct damage to fungal membrane
Antiherpetic "Cyclovirs" interferes with DNA synthesis causing decreased viral replication.
Schedule 1 drugs are drugs with no acceptable medical use, a high potential for abuse, and lacking accepted safety measures. Group includes some opioids , psychedelics, cannabis derivatives, methaqualone, and phencyclidine.
Schedule 2 drugs are drugs with a medical use, a high potential abuse, with severe psychological or physical dependance. Group includes many opioids, psychostims, barbits, and cannabinoids.
Schedule 3 drugs are drugs that are mediccally useful but with less potential for abuse that lead to mod or low physical and high psychological dependence. Group includes lesser opioids, stimulants, some barbits, miscellaneous depressants, and anabolic steroids.
Schedule 4 drugs that are medically useful, but with less potential for abuse than the schedule 3 drugs, their abuse causing limited physical orpsycho dependence. Group includes some lesser opioids, stimulants that suppress appetite, some barbits, benzos, and depressants.
Schedule 5 drugs with medical use, low potential for abuse, and producing less physical dependence than the schedule 4 drugs. Group includes few opioids.
tolerance decrease in susceptibility to the effects of a drug due to its continued administration.
idiosyncratic reaction are unpredictable adverse drug reactions that do not occur in most patients but when they do occur they can be life-threatening.
Drug metabolism Drug metabolism is the process by which the body breaks down and converts medication into active chemical substances.
anaphylaxis is a type of allergic reaction in which the immune system responds to otherwise harmless substances from the environment. may begin within minutes or even seconds of exposure. rapidly progress to cause airway constriction, skin and intestinal irritation, and altered heart rhythms.
Considered the safest IM injection site to avoid damage to nerves or blood vessels in adults ventrogluteal
The IM site of choice for infants younger than 12 months vastus lateralis
For children older than 13 months of age there are two different IM sites to choose from... vastus lateralis or ventrogluteal can be used
When you open a multidose vial of med what should you do? date it! if you find one not dated, discard it.
Intramuscular injection route 90 degrees
Up to 3 mL can be safely injected in the ventrogluteal, vastus lateralis, and rectus femoris sites in any pt. larger amounts may be given in one injection in a large adult muscle in some instances (see agency policy)
For most intramuscular injections the nurse would aspirate for blood before injecting the mdication, to avoid injecting directly into a blood vessel.
Ways to decrease injection discomfort apply ice pack before, use smallest needle, select site free of inflammation, lesions, or bony prominces and without large vessels or nerves. assume prone position with the feet turned inward or sims to relax muscles. allow alcohol time to dry.
Critical nursing responsibilites when administering a parenteral drug are to check for allergy to the drug prior to administration and to observe the pt for 30 mins after the drug has been given for the first time.
Created by: christinego
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