Medication Administration Dr. Hagan NWACC 13
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| Drugs are categorized by ___________ | Body system
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| Learn drugs by same __________. | Category
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| drug providers most commonly prescribe | prototype
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| address how various drug forms affect: dissolution, absorption rate, onset of action | pharmaceutics
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| Parenteral | Injectable
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| Two categories of Parenteral Drugs | Intravenous & Subcutaneous/Intramuscular
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| Absorption of Intravenous drugs is ______ and _______. | Immediate and complete which makes the onset also immediate
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| Subcutaneous/Intramuscular absorption rate can be either ______ or ______. | Rapid or Slow
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| Subcutaneous/Intramuscular absorption rate will be rapid if what? | if Highly water soluble and good circulatory blood flow
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| Describes the absorption, distribution, metabolism, and excretion of drugs | Pharmacokinetics
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| movement of drug from site of administration to various tissues of body | Absorption
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| for absorption of _______ drugs must enter the intestinal wall into the portal vien and into the liver and then into the body's circulation | oral
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| ________ drugs absorb either directly thru a vein or indirectly thru a muscle or subcutaneous tissue into the blood and then liver. | parenteral
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| Some drugs may inactivate when it passes thru the liver, the actual amount available to the body may be less than the patient originally ingests | first pass effect
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| the amount of drug available after passing thru the liver | Bioavailability
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| movement of drug by circulatory system to intended site of action | Distribution
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| Livers kidneys and heart that have a rich supply of blood receive the ______ level of the drug | Highest
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| changes that occurs in a drug: to a more or less potent form, to a more soluble form, to an inactive form is _________ | metabolism
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| the ____ is responsible for most of the metabolism of drugs in the body | liver
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| A majority of a drugs biotransformation occurs in the __________. | liver
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| a change that occurs in drug's chemical nature | biotransformation
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| a new or altered version of a drug | metabolite
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| the elimination of a drug or its metabolites | excretion
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| urine, skin, lungs, gastrointestinal tract are all ways that drugs can be __________. | excreted
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| the time it takes for a drug to enter the body and decrease in amount by half | half-life of a drug
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| reflects how quickly and efficiently a drug metabolizes and excretes | half-life of a drug
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| short half-life drug administration : could be ____ time(s) per day | several
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| Long half-life drug administration could be ____ per day | once
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| _________ in functioning of liver or kidneys increases half-life of drugs | Decrease
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| Patients with liver or kidney problems can experience adverse and toxic much more easily if the provider doesn't decrease the ______ & _______. | dosage and frequency
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| the amount of time it takes for a drug to demonstrate a therapeutic response | onset of action
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| the time it takes a drug to demonstrate its FULL therapeutic effect | peak effect
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| is the length of time the drugs therapuetic effect lasts | a drugs duration of action
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| the point in time is when the drug is at its highest level in the body | peak
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| the point in time is when the drug is at its lowest level in the body | trough
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| Example of a drug that you must maintain at constant therapeutic level in the blood in order for them to exert their maximum therapeutic effect | antibiotics
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| You can determine the peak and trough levels of a drug in a patients by | taking samples of blood through out the day and have a laboratory analyse
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| Biochemical changes that occur in body as result of taking a drug | Pharmacodynamics
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| intended effects of drug | therapeutic
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| unintended effects of drug | side or adverse
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| ____ ____ ______occur secondary to changes in: how cells function, cellular environment, action of enzymes in body | effects from drugs
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| drugs that bind with receptor and precipitate greater than typical response | agonists
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| drugs that bind with receptor and block responses or less than typical response | antagonists
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| There are two types of antagonists drugs that change cellular function | Competitive & Non competitive
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| competes with agonist for receptor sites | competitive
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| blocks agonist's access to receptor site | noncompetitive
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| changes in the cellular environment occur when | drugs interfere with the structure of a cell such as cell wall or one of the cells processes like replication.
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| inhibit the replication of certain type of bacteria by preventing folic acid from helping to make DNA n RNA | Sulfatides antibiotics ( an example of changes in cellular process)
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| Through a process called ____ ______, a drug may change a target molecule's typical response by inhibiting or enhancing the action of an enzyme that effects the target molecule | selective interaction
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| same as side effects except that the unintended and unexpected effects are more severe and can be life threatening in nature | adverse
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| Example of adverse effects of Benadryl are: | Older adults: confusion, incoordination, dizziness, convulsions/ In children: hyperactivity, excitation
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| Most severe type of adverse effects is an ___________ | allergic reaction
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| Administration of epinephrine for treatment of anaphylactic shock is used to _______ and _________ | raise blood pressure and dilate bronchi
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| Tolerance to narcotic pain drugs can result after ____ to _____ consecutive days of therapy. | 10-14
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| Occur when amount of drug patient receives is greater than rate its excreted | cumulative drug effect
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| Cumulative drug effects are common in _________________ and will need decrease in drug dosages accordingly | *older adults who have decrease in cardiac and kidney function *patients who have liver or kidney disease
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| Patients taking drugs with a small margin of safety need to have _____ drug level regularly and monitor for signs and symptoms of _________. | serum/toxicity
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| If a patient experiences stroke and requires anticoagulant therapy and has a peptic ulcer disease what extra precautions might a nurse take to prevent gastric bleeding? | physical assessment and laboratory monitoring
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| drugs providers should not prescribe because they have potential to cause serious or life-threatening adverse effects | Contraindications (example: certain populations or in combination with other drugs and certain foods)
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| when one drug changes the way another drug affects the body | drug-drug interactions
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| 1+1 combined effect of two drugs you give together is the same as the each drug you give alone in similar doses an ______ effect occurs | additive (opioids + alcohol)
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| 1+1>2 when the effect of one drug is greater if you give it with another drug | synergistic (aspirin and warfarin)
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| 1 + 1 < 2when the effect of one drugs effect is decreased or blocked when you give it with another drug | antagonistic (asthma to open a patients airway & another drug for its cardiovascular effects that has a side effect of constricting the airways)
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| _______ during first trimester of pregnancy can put the fetus at risk for birth defects | Teratogenic
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| Possible fetal risk; must weigh potential benefits against risks | "D"
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| POSITIVE fetal risk, not normally used during pregnancy | "X"
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| Physiological changes with aging are: | kidneys and gastrointestinal tract, liver, circulatory system
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| Determine _____ and _____ function PRIOR to surgery due to amount of anesthetic and recovery time from anesthetic varies | kidney and liver
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| To ensure safe administration A patient needs to have what drug knowledge of medications prescribed? | *purpose of drug * generic and brand name *proper method and schedule for administration *potential side effects *adverse effects * precautions to take during therapy
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| What are three ways to evaluate a patients knowledge of drugs prescribed? | *ask specific questions * require a return demonstration (insulin injections)* ask patient to repeat information
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| What are the 5 Plus 5 rights of drug administration? | 1.right client 2.right drug 3.right dose 4.right time 5.right route
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| The NURSE's 6 rights are: | 1.right to complete & clear order 2.right to correct drug route3.right to access info4.right to policies to guide safe med administration5.right to administer meds safely & to identify system problems6.right to stop, think,&vigilant when administrate meds
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| 5 additional Rights essential to professional nursing: | 1.right assessment 2.right documentation 3. clients right to education 4.right evaluation 5.clients right to refuse
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| Administering meds to the right pt is essential. The joint commission requires 2 forms of identification before medicine is given. Nursing implications include the following: | *verify the pt by checking the ID bracelet*distiguish 2 clients w the same last name;have warnings HIGHlighted in bright color on ID tools such as med cards, bracelet, or Kardex*Some institutions have ID bracelets coded for allergy status
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| True or False? If the pt does not have an ID band (schools,health dept,healthcare provider) it is the NURSE's responsibility to accurately identify the pt. | TRUE
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| Medication orders may be prescribed by a _____, ______,______, ______. | Physician, dentist, podiatrist, Advanced Practice RN.
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| For institutional clients, the drug orders may be written on "_____ ____" and signed by the duly authorized person. | order sheets
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| A telephone order (TO) or (VO) for medication must be cosigned by the prescribing health provider within ____ hours. | 24
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| The nurse must comply with the institution's policy regarding TO, which sometimes requires that two ______ ______ listen AND sign the order. | licensed practitioners
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| The information included on a medication order is: | *date&time its written*drug name(generic preferred)*dosage*route of admin*frequency & duration of admin*any special instructions for withholding or adjusting dosage based on nursing assessment,drug effectiveness,or lab results*doctor sign
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| If one of the components is missing, the drug order is ________ and the drug should not be administered. | incomplete
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| True or False? Nurses are legally liable if they give a prescribed drug and the dosage is incorrect or the drug is contraindicated for the client's health status. | TRUE
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| Once the drug is ______, the nurse becomes liable for the predicted effects of the drug. | administered
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| To avoid drug error, the drug label should be read ____ times. | 3 *at the time of contact with drug*before measuring drug*after measuring drug
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| The first dose, one-time, and "as needed"(PRN) medication orders should be checked against the _____ _____. | original orders
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| Examples of meds that sound alike | *digoxin & digitoxin *quinidine & quinine *Keflex and Kantrex *Demerol & dicumarol *Percocet & Percodan
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| contains oxycodone & acetaminophen | Percocet
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| contains oxycodone & aspirin | Percodan
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| Nursing interventions related to a drug order include the following: | *be well versed in pts health history & prev performed assessments*ck med order is complete & legible*know pts allergies*know reason why pt is receiving med*ck drug label 3x's*know the date med was ordered & ending date
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| If the med order is not complete or not legible, notify the ______ or ______. | nurse manager / health care provider
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| Controlled drug orders need to be renewed every ____ hours. | 48
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| Antibiotics need to be renewed ___ to ____ days, and cancellations of all medications when the client goes to surgery. | 7-14
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| The right dose is more than just the dose prescribed. The nurse must calculate each drug dose accurately, considering the variables: | *the drug's availability *prescribed drug dose
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| The pt's ____ and ____ function are important considerations because many drugs are cleared through the kidneys. | renal / hepatic
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| The ____ drug method and the ____ dose method are the two most frequently used methods of drug _______. | stock/unit/distribution
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| drugs are stored on the unit and dispensed to all clients from the same container | stock drug method
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| drugs are packaged in doses for 24 hours by the pharmacy | Unit dose
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| Advantages/Disadvantages for the stock drug method are: | always available and cost effeciency of large qtys/ drug errors are more prevalent with multiple ="pourers", more risk of abuse by coworkers, less accountability for amount used, unable to track usage,increased opportunity for contamination
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| Advantages/Disadvantages for the unit dose method are: | *saves time for nurse, no dose calculation required,billed for specific doses,more accountability,less chance for contamination/Disadvantages: *potential delay in receiving drug, not immediately replaceable if contaminated, more expensive
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| Drugs may be given within __ hour before OR after the time prescribed. | 1
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| Nursing interventions related to the right time include the following: | *administer drugs at specified times*admin drugs that are affected by foods b4 meals*Admin drugs that can irritate the stomach W food*adjust the med schedule to fit pts lifestyle*ck whether or not the client is scheduled 4 diagnostic procedures*exp date
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| A drug that is affected by food is tetracycline. Give before ______. | meals
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| _____ and _____ are two examples of meds that can irritate the stomach (gastric mucosa) | Potassium/aspirin
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| Some meds are absorbed better ____ eating. | after
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| Nursing interventions related to the right route include the following: | *assess the pts ability to swallow b4 admin oral meds*do not crush or mix meds in other substances b4 consulation with pharmacist*Use aseptic technique when admin drugs*sterile technique required 4 parenteral routes*stay with pt until drugs been swallowed
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| If medication must be mixed with another substance, _____ this to the pt. | explain
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| Examples of assessment data include apical heart rate before admin of digitalis preparations or serum blood sugar levels before the admin of ______. | insulin
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| The right documentation requires the nurse to ______ record the appropriate info about the drug administered. | immediately
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| The right documentation requires the following info be documented: | *name of drug*dose*route (injection site if applicable)*time & date*nurse's sign or initials.
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| Documentation of the pts response to the medication is required with a variety of meds: | *narcotics*sedatives*antiemetics*unexpected reactions, such as GI irritation or signs of skin sensitivity
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| Patient teaching requires that pts receive accurate and thorough info about the meds and how it relates to their particular situation. This includes: | *therapeutic response*expected result of med*possible side effects*dietary restrictions or requirements, skill of aministration, & lab test result monitoring
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| The ____ _____ requires that the effectiveness of the medication be determined by the pts response to the medication | right evaluation
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| It is essential for the nurse's practice to evaluate the _____ ______ of the medication as well as any ____ _____ and ____ ____. If the nurse does not do this, the nurse runs the risk of being sued. | therapeutic effect/ side effects/ adverse reactions
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| When a pt refuses a medication the nurse must do the following: | *determine when possible the reason for refusal*explain to the client the risk of not taking & reinforce the reason 4 the med*document refusal immediately*follow up is ALways required
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| When a pt refuses a medicaiton, the nurse manager or doctor should be informed when the omission may pose a ____ ______ to the pt, and when a change is expected in the lab test values, such as with warfarin (Coumadin) or insulin. | specific threat
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| A ____ _____ may be defined as "any preventable event that may cause or lead to inappropriate medication use or harm to a pt" | medication error
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| With barcoding, the pts _____ _____ _____ (MAR), a part of the database that is encoded in the client's wristband, is accessible to the nurse using a handheld device | medication administration record
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| The following abreviations, acronyms, and symbols are no longer used because they can be misinterpreted or misread: | * U,u (for unit)
*IU (for international unit) *QD,Q.D.qd,q.d.(for every day)
*QOD, Q.O.D., qod, q.o.d. (for every other day)
*trailing zero and lack of a leading zero
*MS, MSO4, MgSO4
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| Do not _____ medications, where they will pollute the enviroment UNLESS specifically instructed. | flush
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| When disposal of a drug, it is recommended that you remove the drug from its original container and dispose of it in a sealed bag with an undesirable substance such as _____ or _____. | cat litter or coffee grounds
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| Do not crush any medicatin that has the suffix ____ or ___ as these are extended release or sustained release and crushing will change the speed at which the drug is delivered. | ER or SR
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| ____ are sweetened, hydroalcoholic liquid used in preparation of oral liquid medications. | Elixirs
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| ____ are a mixture of two liquids that are not mutually soluable. | Emulsions
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| _____ are liquids in which particles are mixed with but not dissolved in another fluid. | Suspensions
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| In regards to liquid medications, read the labels to determine whether _____ or_____ is required. | dilution or shaking
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| The _____ is at the line of desired dose. | meniscus
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| _____ medication is stored in a patch placed on the skin and absorbed through the skin, thereby having a systemic effect. | transdermal
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| ______ medications require documentation of the reason for administration. | PRN
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| There is a controversy regarding how to mix insulins in suspensions. _____ insulin, which is clear, does NOT need to be mixed before withdrawl. | Regular
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| True or False? Because the vial is sealed, the medication inside remains sterile and can be used for future injections. | True= label the opened vials with the date and time
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| An unexpected situation comes up. The nurse notices that the combined amount of the mixed medications is not the ordered amount. What is the appropriate intervention? | Discard syringe and start over. There is no way of knowing for sure which dosage is wrong or which medication should be expelled.
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| What if the nurse injects medication from the first vial into the second vial? | Discard vial and syringe and start all over.
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| In regards to an Intradermal injection: if the unexpected situation comes up of no noteable wheal or blister at site of injection or medication leaks out of injection site before needle is withdrawn what is the nursing intervention? | Document according to facility policy and inform primary care provider. A nurse may need to obtain an order to repeat the procedure.
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| When administering a subcutaneous injection: hold the syringe in the dominant hand and inject the needle QUICKLY at a _____ to _____ degree angle. | 45-90
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| For a person with little subcutaneous tissue, it is best to insert the needle at a ____ degree angle. | 45
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| The purpose of releasing the skin fold after the needle is in place when administering a subcutaneous injection is because: | Injecting the solution into compressed tissues results in pressure against nerve fibers and creates discomfort
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| When administering a subcutaneous injection, you must administer the medication SLOWLY at a rate of ____ seconds per _____. | 10/mL
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| _____ injection of the solution creates pressure in the tissues, resulting in discomfort. | Rapid
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| You want to inject medication ______ and pull needle out _______ when done. | slowly/rapidly
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| _______ after a heparin administration can contribute to hematoma formation. | massaging
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| _____ after an insulin injection may contribute to unpredictable absorption of the medication. | massaging
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| Many elderly pts have less adipose tissue. Why does the nurse adjust the angle of the needle and angle of insertion accordingly? | you do not want to inadvertently give a subcutaneous medication intramuscularly.
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| When administering an IM injection: displace the skin in a Z-track manner by pulling the skin down or to one side about ____ inch with your non-dominant hand and hold the skin and tissue in this position. | 1
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| What is the purpose of using the Z-track method when giving IMs? | This ensures medication does not leak back along the needle track and into the subcutaneous tissue
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| When giving an IM injection: Quickly dart the needle into the tissue so that the needle is _________ to the pts body. This should ensure that it is given using an angle of injections between ___ and ___ degrees. | perpendicular/ 72 to 90 degrees
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| Why does the nurse insert the needle at a ____ to ____ degree? | facilitates entry into muscle tissue
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| When giving an IM, the nurse injects the solution slowly at a rate of ____ seconds per ____ of medication. | 10/ mL
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| _____ is NO longer required when giving IMs and is considered an outdated procedure. | aspiration
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| Once the medication has been instilled , wait ____ seconds before withdrawing the needle. (IM) | 10
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| Why does the nurse need to wait 10 seconds before withdrawing the needle? (IM) | This allows medication to begin to diffuse into the surrounding muscle tissue
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| Applying _____ _____ around the injection site helps to prevent pulling on the tissue as the needle is withdrawn. | counter traction
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| During an IM injection, pt pulls away from needle BEFORE meds is delivered fully. What is the nursing intervention? | Remove and appropriately discard needle. Attach new needle to syringe and administer remaining medication at a DIFFERENT site.
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| When giving IMs, special considerations in older adults is to evaluate the pts muscle mass and body composition. Use appropriate needle ____ and gauge for pts body ______. | length / body compostion
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| When administering meds by IV, always assess the IV site for presence of _______ or ______. | inflammation or infilteration
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| ____ medication must be given directly into a vein fir safe administration. | IV
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| Needle gauges (diameter) are number 18-30. The smaller the guage, the _______ the needle. | larger the needle lumen
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| What factors affect the size of needle necessary for an injection? | *route of administration IM-longer, subQ-shorter *quantity to be administered-pick syringe size based on mL *body size-obese people require longer needle & elderly thin would require shorter needle*type of medication-special syringes used for insulin
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| Should you ever recap a needle? | NO, but if unavoidable use one handed method
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| What infection control technique is used when administering a parental injection? | surgical asepsis and sterile technique be followed
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| What parts of the syringe and needle should be kept sterile? | inside barrel , plunger than enters barrel, tip of barrel, needle except the exterior of needle hub
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| How should the skin be cleaned prior to injection? | clean with alcohol or other antimicrobial, circular motion- center outwards
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| What must be the first consideration when mixing medications in one syringe? | that they are compatible
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| What is reconstruction? | adding a dilunt to a powder drug
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| Where are Intradermal injections given? What are they given for? | administered into the dermis, just below the epidermis./ given for sensitivity tests such as tuberculin and allergy tests, and local anesthesia.
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| What is the common site for intradermal injections? what is the usual dose? | Inner surface of forearm, upperback, under scapula./less than 0.5 mL.
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| What angle is used for an intradermal injection? | 5 to 15 degrees
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| What size needle (length & guage) is generally used for an intradermal injection? | 1/4 to 1/2, 26-27 gauge
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| Where are subcutaneous injection given? | including the outer aspect of the upper arm, the abdomen (from below the costal margin to the illiac crests), the anterior aspects of the upper thigh, the upper back, and the upper venteral or dorsogluteal area.
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| What are the drugs most commonly given subcutaneously? | herparin, insulin, Enoxaparin (Lovenox)
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| What sites can be used for subcutaneous injection? |
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