Pharmacology
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| What information must a drug order contain? | Pt's full name, date, drug name, route, dose, frequency, duration, signature of prescriber.
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| What is a standing order? | Orders written by a physician for all pt's on a particular unit.
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| What is a stat order? | A one time order to be given immediately.
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| What is a single order? | One order to be given at a specific time.
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| What are PRN orders? | Given on an as needed basis.
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| What are the guidelines for verbal orders? | Taken in an emergency or when MD not in faciity, taken by RN, Repeat back to MD, must be signed by MD within 24 hrs
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| What are the 6 rights of med administration? | Right:
1)Patient
2)Med
3)Dose
4)Route
5)Time
6)Documentation
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| How can you check for the right patient? | Check ID band, compare ID band to Kardex/Computer, ask pt name and DOB,sheck for allergies.
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| How can you check right drug? | Compare drug with Kardex, check spelling, read label 3 times.
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| How can you assure med is given at right time? | Half an hour before or after scheduled time.
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| What do coumadin, dilantin, lithium, theophylline and digoxin all have in common? | Blood levels of medication are routinely monitored.
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| How can you be sure a patient is receiving the correct antibiotic? | Check the culture and sensitivity report.
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| How can you assure the correct dose? | Only break scored tablets, never crush or break extended release tabs, always use insulin syringes for insulin, double check calculations with another nurse, know safe dosages.
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| How can you assure correct route? | Make sure to follow MD orders for route, IV is the fastest route, then IM. SubQ is slow. Oral is safe.
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| How can you assure correct documentation? | If not documented, wasn't given. Never give med you haven't measured out yourself. Record reason for withholding. Check with charge nurse before holding. Get witness for narcotic waste.
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| What should be assessed before BP med administration? | BP
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| How does a systemic drug affect body? | Affects entire body.
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| What are the expected results on the body after a med administration? | Desired effect/action
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| What are side effects? | Action of drugs other than desired effect, sometimes undesirable.
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| What are S/S of allergic reaction to med? | Hives, itching, bronchospasm
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| What is an anaphylactic reaction? | A life threatening allergic reaction, systemic, respiratory distress
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| What is tolerance to a drug? | A reduced response requiring a higher dose.
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| What is dug dependence? | Can be physical and/or psychological addiction to drug.
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| What is a cumulative effect of a drug? | An excessive amount of drug built up in the body.
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| What is the therapeutic dose of a drug? | The smallest amount of the drug that will produce a therapeutic effect on the pt's condition w/o causing an adverse reaction.
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| What is a drug interaction? | When the action of one drug is altered by the action of another.
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| What is an additive effect of a drug? | Two drugs with similar actions taken for an increased effect.
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| What is a synergistic effect? | The combined effect of two drugs given together is greater than either alone. They boost the effects.
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| What is an antagonist? | A drug that blocks the action of another drug.
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| What is drug incompatibility? | A chemical reaction between two drugs causing the drugs to be ineffective.
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| What are enteral medications? | Those given via the GI tract (oral, rectal, PEG, NG).
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| Why must some meds, such as iron, be given through a straw? | It discolors teeth.
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| What do tablets consist of? | Dried powdered drugs compressed into discs
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| What do elixirs consist of? | Drugs mixed with alcohol, sugar and water.
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| What do emulsions contain? | Small droplets of water in oil-must be shaken!
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| What are suspensions? | Insoluble particles in liquid base-must be shaken!
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| What steps in administering liquid meds should you observe? | Pour into cup away from label, at eye level and give to patient without touching.
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| In what order should PO meds be given? | 1) Tablets/capsules with H2O
2) Liquids
3) Cough medicines - do NOT follow with H2O
4) Sublingual
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| What steps should be observed for administering meds via PEG or NG? | Check placement, use liqs if possible, don't crush enteric coated or time released tabs, do not mix meds in same cup, flush with 30ml H2O before meds, after each med, clamp tube for 30 minutes after if attached to suction.
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| What should patient do after rectal suppository is inserted? | Lie on for 15-20 minutes
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| What steps should you observe when administering transdermal disks? | Use gloves to avoid self medication, remove old patch and wipe off old residue, rotate sites, choose site with little or no hair, date, time and initial.
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| How should eye drops be applied? | Clean eye from inner outward, have pt look upward, pull down on lower eye exposing conjunctival sac, place drops in sac.
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| What measurements are used for insulin? | Units
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| What is the total volume a tuberculin syringe will hold? | 1 ml (cc)
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| Which needle gauge is larger: 14 or 22? | 14
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| What is the maximum volume that may be injected SubQ? | 1ml
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| What needle gauge may be used SubQ? | 25 or 26
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| What angle should be used SubQ? | 45 degrees if thin or child. 90 for overweight and pinch.
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| What is proper technique for SubQ injection? | Wipe with alcohol, aspirate unless heparin or insulin, inject slowly and then massage unless heparin.
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| What are benefits of IM? | Good blood zippy and more rapid than SubQ.
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| What is the maximum volume that may be inkjeted IM info deltoid? | 2ml
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| What is the maximum IM dosage that may be injected into dorsogluteal and ventrogluteal? | 3ml, not used in children
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| What angle is used for IM? | 90 degrees
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| What is the proper technique for IM injections? | Wipe with alcohol, have pt take deep breath, inject dart-like, massage.
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| What volume is used for tuberculin injections? | 0.1ml
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| What is proper technique for tuberculin injection? | Wipe with alcohol, inject at 15 degree angle with bevel up, create a wheal.
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| What length and gauge needle is used for tuberculin injections? | 25-26 G and 3/8-5/8 in
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| What gauge and length needle is used for SubQ? | 25-26G and 1/2-5/8 in
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| What gauge needle and length may be used for IM? | 20-22G and 1-1 1/2 inch
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| Under what conditions may a nurse have narcotics in her possession? | If she is administering them, is in charge of the keys/lock-box for the shift, or the patient to whom the narcotics belong.
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| What are some schedule I narcotics? | LSD, Marijuana, STP, Heroine, Hashish
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| What are some schedule II narcotics? | Seconal, Phenobarbital, Amphetamines, Morphine, Meperidine, Methadone, Oxycodone
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| What are some schedule III narcotics? | Empirin with Codeine, Fiorinal, Paregoric, Nolduar, Tylenol with Codeine
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| What are some schedule IV Narcotics? | Equinal, Chloral Hydrate, Paraldehyde, Librium, Valium, Dalmane
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| Which schedule of narcotics has the highest potential for abuse? | Schedule I, then II, III, IV
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| How often are narcotics counted on a unit? | At the change of shift
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| How are narcotics stored on a unit? | Double locked, signed out by each nurse for use.
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| How many nurses are required to record a narcotic waste? | 2 nurses, second is a witness.
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| Describe a drugs action on the body. | Ingredients move from body fluids to body's system and to needed site. Body's cells respond to drug. Then the drug is metabolized.
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| What lab values are commonly used when dosing drugs? | Liver and renal function, PTT, INR
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| Describe how a chemical bond is formed by a drugs interaction with body. | Drugs (key) form chemical bonds with receptor sites (lock) on cells: lock & key. The better the fit, the better the response.
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| What is ADME? | Drug movement involves:
Absorption
Distribution
Metabolism
Excretion
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| What organ metabolizes (inactivates) most drugs? | The liver
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| Which populations are liver enzymes less active in and are therefore more likely to have enhanced drug effects? | The young and elderly
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| What organs excrete most drugs from the body? | The kidneys and intestines
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| What is the fastest route for medications? | IV
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| What are idiosyncratic reactions to drugs? | Unpredictable and unexpected reactions
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