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med amin

Factors that influence the rate of absorption Admin Route Ability to dissolve Blood flow to admin site Body Surface Area Lipid Solubility
Rate and extent of distribution factors circulation and protein binding
excretion exits lungs exocrine glands bowels kidney liver
mild allergic reactions Urticaria (hives) Eczema (rash) Pruritis (itching) Rhinitis (Runny Nose)
severe allergic reactions Sudden constriction Edema of Larynx Edema of Pharynx Severe Wheezing Shortness of Breath
iv im sq time 15-30 sec
6 rights of med admin right medicine right dose right patient right time right route right documentation
chart on documentation name date of order meds given route and frequency dose given time given pt response complaints or ADR
what should medication order include Patient Surname First Name Medical Record # Ward/Clinic Drug Name Drug Dose Drug Route Dr’s Printed Name Dr’s Signature Date of Order
verbal orders EMERGENCY situations only RN writes order on MAR & repeats back to Dr Enter into medical record BOTH Dr & RN names are signed
telephone order given via phone usually after you update the Dr about the condition Transcribe the same way as a verbal order Requires a read-back by person receiving the order
if med error occurs RN assesses & examines Patient RN Contacts Dr ASAP Once Patient is stable, notify the supervisor RN fills out a written incident report w/in 24 hrs
included in incident report Patient Info Location Time of Incident Description RN Response Patient Outcome Signature of RN
meds that cant be crushed Capsules Enteric coated Long acting release Slow acting release
meds that can be crushed pre-scored use pillating device
eye ointment bedtime
nose drops for infants 20-30 min before feeding
renal suppositorys 2 Inches
intradermal in childen only up to 0.1ml
subcutaneous in children 26-30 gauge needle 1/2 in inserted 90 degrees
intramuscular for children gauge 25-30 gauge
intramuscular needle toddlers 1 - 1 1/4 inch
intramuscular needle for infants 1 in
preferred sites for children first vastus lateralis 2nd deltoid
inches of IM needles usually 1 - 1 1/2 in
inches subcut or intradermal needle usually 3/8 - 5/8
IM syringe 1-3 mL
subcut syringe 1-3 mL
tb syringe for intradermal or other subcut injections or for small doses for children
intradermal injection syringe TB syringe
intradermal injection gauge 25-27
intradermal injection needle length 3/8 -5/8 in
intradermal insert angle 15 degrees
subcut injections syringe Insulin for insulin tb for others
subcut gauge 25 (26-30 for children)
subcut needle length 5/8 at 45 degree angle 1/2 in at 90 degree angle
intramuscular injections syringe 3 mL
intramuscular gauge for aqueous solution 20-25
intramuscular gauge for viscous solution 18-25
intramuscular gauge for children 25-30
intramuscular needle length for obese pt 1 1/2 +
intramuscular needle length thinner pt 1/2 - 1 in
intramuscular needle for infants 1 inch
intramuscular needle for toddlers 1 - 1 1/4
intramuscular angle admin 90 degrees if possible
intramuscular ventrogluteal 1/2 - 2 inch
intramuscular lateris 1/2 - 2 inch
intramuscular deltoid 1/2- 1 1/2 inch
ampule glass container 1 time use snap off top use filter needle
vial glass or plastic rubber top for multi use must inject air to get it out
ampule + vial use vial first
insulin measured in units
Lypoatrophy Small depressions in the subcutaneous fat
Lypohypertrophy Lump under the skin caused by accumulation of extra fat
lovenox injection admin what route? subcutaneous
lovenox injection site between the left or right anterolateral & left or right posterolateral abdominal wall
lovenox injection angle 90 degrees
OD Right eye
OS left eye
OU both eyes
nasoenteric or ng tube what position high fowlers
flush nasoenteric or ng tube before and after each med (15-30) mL
pt gastric ph 4 or less
elevate head ng tube 1hr after admin
check ng tubes every 4-6 hours
meds that require double check insulin anticoagulant (heparin)
count narcotics during opening of drawer during shift changes
admin narcotic document pt name date time of admin name of med dose rn signature
if give only part of narcotic another nurse has to watch you dispose not in sharps container both have to sign
absorption passage of meds into blood from site of admin
distribution passage of meds to tissue and organs
metabolism metabolized med into inactive form
excretion meds leaving body depends on med chem makeup
therapeutic effect desired / expected
side effect predictable / unavoidable N/V, dry mouth, constipation, dizziness, drowsiness
adverse side effect not predictable unintended undesirable take weeks-months to develop
toxic effect after prolong intake of med builds up in blood system due to not excreting or metabolizing high dose certain antidotes available to fix
idiosyncratic reactions unpredictable reactions over/ under/ diff than normal
allergic reactions unpredictable meds act as amtigen --> antibodies being produced -->allergic reaction *antibiotics high risk
always record pt allergies where MAR
Buccal route by mouth
sublingual route under tongue
topical route on skin
suppository route rectal vaginal
non parental routes buccal sublingual topical suppository
parental routes intramuscular subcutaneous intradermal epidural intravenous
peak level of meds when admin med just before body absorbs last bit of med after peak.. serum falls quickly drawn when drug is expected to reach peak
trough level of meds pt at which lowest amount of drug in serum drawn 30 min before next dose
check label of meds with MAR... 3 times
when do you check the label of meds with MAR before preparing meds, when pulling out, check expiration date while preparing med before giving med to pt
giving med that you didnt prepare yourself NEVER
preparing med not labeled NEVER
medication order requires for what drugs? every drug
compare med order with.. MAR
verify med info when new MARs written PT transfer
preparing right dose nursing should check admin record and physicians orders
check label on container of med for what? concentration of med
calculations for med verified with another nurse esp. narcotics heparin tovenox
assess appropriate dose with pt age, diagnoses, gender
check patient for identification... twice bring MAR with you to room pt name birthdate allergies
medications administered to routes.... ONLY from route indicated in order
meds can be given in what time frame 30 min before or 30 min after
documentation should be done when? ASAP after meds given
legal med order given by physician, NP, Pa
verbal and telephone orders must be sign within 24 hours
medication error rn... assess and examine pt call doctor asap tell supervisor once pt is stable fills out incident report DO NOT PUT IN MAR
standing order specific orders for various situations routine orders
NOW orders within 30 min to hour
liquid med less than 10 ml draw in calibrated oral syringe
using inhalers spacer device recommended for small children watch for ADR of brochidialaters: tremors restlessness dizziness
turn ampule or vial upside down to draw? ampule
z track injection purpose to decrease skin irritation by sealing off meds in muscle tissue
z track injection technique inject med deep into muscle pull skin tightt over laterally over skin 1- 1 1/2 insert & inject slowly leave needle in place 10 sec withdraw needle and release skin
clear insulin Regular & Humalog (Lispro); Novolog (Aspart)
cloudy insulin NPH; Lente
mixing cloudy and clear insulin roll cloudy until mixed take cloudy bottle fill with air DONT w/draw liquid take clear bottle fill with air withdraw liquid take syringe insert into cloudy bottle and withdraw liquid
prevention of lypoatrophy and lypohypertrophy rotate injection sites
Ventrogluteal Site place heal of hand over greater trochanter of patient’s hip point thumb toward patients groin, index finger points the anterior superior iliac spine, extend middle finger along iliac crest toward buttock the center of the triangle the pinch skin
Vastus Lateralis site muscle located on anterior lateral aspect of the thighfrom a hand above the knee to a hand below the greater trochanter of the femur, use the middle one third of the muscle for injection can use other portions for multiply injections patient lie flat
deltoid site located by fully exposing the patients arm and shoulder and relax arm lower edge of acromion process 2.5 - 5 cm below acromion process apex-4 fingers across deltoid muscle. top finger along acromion procress then I.S. 3 fingers below acromion process
dorso site lateral aspect of upper arm subcutanous- lower portion of upper arm, later side-3 finger up form elbow 3 finger down from deltoid insertion.
forearm intradermal site 4 fingers from end or elbow, and 4 fingers up from wrist, 15 degree angle, just upper dermis see bubble of med
Abdomen (subcutaneous) repeated injections -2 in around belly button, not above costal margin or below pubic area and not going past the anterior/superior iliac spine. -multiple sites
Created by: ksarichburg