Safety in Medication Administration - TAS, NP2, Test 1
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| What are the four different types of names for drugs? | Generic, Official, Chemical, Brand
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| What is an example of a drug administered for diagnosis? | Barium
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| What is and example of a drug administered as a cure? | Chemo
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| What is an example of a drug administered as a treatment? | Lasix for CHF
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| What is an example of a drug administered for the relief of a symptom? | Morphine
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| What is an example of a drug administered for the prevention of disease? | Immunizations
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| What are the three natural drug sources? | Plants, Animals, Minerals
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| Why are lab synthesized drugs safer than natural drugs? | Regulatory agents require uniformity in purity and strength to ensure quality so they are more predictable.
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| When is the generic name used for a drug? | Before the drug is approved
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| When is the chemical name used for a drug? | In the scientific process
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| When is the brand name used for a drug? | After the drug is approved, may differ from company to company
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| Therapeutic Effect | The desired effect, The intent or reason the drug is prescribed.
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| Side Effect | An effect of a drug that is not intended, but is usually predictable.
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| Adverse Effect | More severe reaction to a drug that may require discontinuing the medication regime. May be dose related.
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| Drug toxicity is the result of | Overdose, Ingestion of drug intended for external use, Cumulative effect
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| What is the cumulative effect? | When a drug builds up to a toxic level in the system due to impaired metabolism or excretion, especially in the elderly.
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| T or F. The signs and symptoms of drug toxicity appear within 24 hours. | False. The signs and symptoms of drug toxicity may appear immediately or over several weeks.
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| What is a drug allergy? | An unpredictable response of the immune system.
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| Phase 1 of a drug allergy | Exposure to drug, body develops a sensation but there is no allergic reaction.
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| Phase 2 of a drug allergy | The body produces antibodies against the drug.
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| Phase 3 of a drug allergy | The body's immune system has a heightened response against the drug
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| Anaphylactic Reaction | Severe reaction immediately following administration that may be fatal if not treated immediately.
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| Symptoms of Anaphylactic Reaction | swelling of mouth and tongue, acute shortness of breath, acute hypotension, tachycardia
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| Drug Tolerance | An unusually low physical response to medication that requires a higher dose to maintain therapeutic effect.
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| What drugs commonly produce tolerance? | Opiates, Barbiturates, Alcohol, Tobacco
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| Drug Interaction | Beneficial or harmful interaction of one drug with another drug.
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| Two categories drug interaction | potentiating, inhibiting
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| Potentiating Drug Interaction | Increased effect of one or both drugs
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| Inhibiting Drug Interaction | Decreased effect of one or both drugs
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| Synergistic Drug Effect | Two different drugs increase the action of one or the other drug.
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| Idiosyncratic Drug Effect | Unexpected, unpredictable and unexplainable over or under response to a drug
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| Iatrogenic Drug Effect | Caused by medication
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| Examples of iatrogenic drug effect | hepatic toxicity, fetal deformities, Stevens-Johnson Syndrome
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| Half life | The time it takes for the body to reduce drug concentrations by one-half.
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| Onset of action | Time after administration when the body initially responds to the drug
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| Peak Plasma Level | The highest drug serum level achieved by a single dose
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| Plateau | Maintained concentration of a drug in plasma during a series of scheduled doses.
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| Receptor based drugs | Drugs that exert their effects by chemically binding with receptors at the cellular level.
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| Agonist drugs | Drugs that produces the same type of response as the endogenous substances in the body. Heightens the reaction.
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| Endogenous | growing or developing from within
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| Antagonist drug | drug that inhibits cell function by occupying receptor sites
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| What are the four parts of pharmacokinetics? | The study of absorption, distribution, biotransformation, and excretion of drugs.
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| What are some other terms for biotransformation? | metabolism, detoxification
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| Absorption | the process by which the drug passes into the blood stream
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| Which route administers the drug immediately with no absorption? | Intravenous route
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| Which route is the second most rapid route due to the vascular nature of the tissue? | Intramuscular route
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| Which route is variable due to the variance in absorption by the stomach? | Oral route
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| Which route provides for slow absorption due to poor blood supply? | Subcutaneous route
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| Which route has an unpredictable absorption rate and therefore is reserved when no other routes are available? | Rectal route
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| Define distribution. | transportation of a drug from the absorption site to the site of action
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| Which areas of the body typically experience distribution first? | liver, kidneys, brain
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| Which drugs will accumulate in the fatty tissues? | fat soluble
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| When dealing with drugs that bind to the plasma proteins, what kind of reaction can you expect from a client that is deficient in protein? | A high reaction would occur because there is not enough protein available to bind to the drug and preoccupy it.
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| What values are important to evaluate before administering drugs that bind to plasma proteins? | TP(total protein), albumin, pre-albumin
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| What takes place during biotransformation (metabolism)? | The process of a drug being transformed or converted into a less active form.
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| Where does biotransformation mostly occur? | liver
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| What component in the body completes the process of biotransformation (metabolism)? | Enzymes
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| What is the end product of biotransformation (metabolism) called? | metabolite
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| An active metabolite ________ pharmacological action, while an inactive metabolite has _____ action. | possesses, no
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| In biotransformation, explain the first pass effect. | Oral drugs first pass through the liver and are partially metabolized prior to reaching the target organ which results in the necessity of a higher dose of the drug.
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| Why can nitroglycerin NOT be given orally, but instead sublingually? | Because of the first pass effect. Nitro must be kept out of the liver.
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| Give the name of the process of removing metabolites and drugs from the body. | Excretion
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| Excretion primarily occurs in the _______ via _______. | kidneys, urine
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| What are other possible routes of drug excretion? | feces, respiration, perspiration, saliva, breast milk
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| What are two developmental factors impact the action of drugs? | pregnancy and age
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| What factors affect the impact of drugs pharmacogenetically? | gender, size and body composition such as body fat fluids and hormones.
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| What are the ethnopharmacologic factors affecting the impact of drugs in the body? | effects of ethnicity on response to prescribed meds, cultural factors and practices concerning medication regimes.
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| Diet, Environment(hot/cold), mindset and timing of administration are factors that impact the _____ of drugs. | action
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| AC | before meals
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| PC | after meals
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| PCN | penicillin
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| What variable encompasses the medication's action on the body, the client's response to the medication and drug compatibilities and interactions? | Physiological
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| The client's motivation, compliance with regime, outlook, and history of medication therapy affect which variable? | Psychological
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| The placebo affect and alteration of thought process or mood concerning medication action affect which variable? | Psychological
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| The client's access to health care affects which variable? | Sociocultural
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| The client's education level, cognitive abilities, language, and physical abilities affect which variable? | Developmental
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| How might a client be affected spiritually in regards to medication administration? | Some religions restrict medical interventions.
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| Name the routes of medication administration. | oral, sublingual, buccal, parenteral, topical, transdermal, inhalation, opthalmic, rectal and vaginal
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| Name the advantages of orals meds. | safer/non-invasive, usually less expensive, convenient
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| Name the disadvantages of oral meds. | GI irritation, slowed/predictable absorption, requires functional GI tract, requires ability to swallow
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| Names the advantages of sublingual/buccal meds. | safe/non-invasive, usually less expensive, convenient, more potent effect
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| Why does administering meds sublingually/buccally have a more potent effect than administering meds orally? | The drug bypasses the liver and enters directly into the blood stream.
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| Name the disadvantages of administering meds sublingually/buccally. | If swallowed, drug may be inactivated by gastric acid, localized stinging and irritation, must wait for tablet to completely dissolve
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| What is the correct technique for administering opthalmic drugs? | Place inside the lower eyelid
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| What must a nurse remind a patient to do after receiving inhaled meds and why? | Patients must rinse out the oral cavity to minimize the risk of thrush developing.
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| T of F. The nurse should be concerned if the client's sublingual medication does not sting or itch at the time of administration. | Lack of stinging or irritation with sublingual/buccal meds may indicate and expired due date.
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| Name the advantages to administering medication using the transdermal or topical routes. | Few side effects, Avoids GI side effects, Onset of med faster than oral
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| Name the disadvantages to administering medication via the transdermal/topical routes. | Unpredictable absorption, skin irritation, visible evidence of illness, risk for error in failing to remove old applications.
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| Name the advantages of administering meds via the inhalation route. | rapid delivery of meds into the respiratory tract, localized effect, can be administered to unconscious client.
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| What is the advantage to administering meds via the intravenous route? | rapid effect
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| Risk of infection, limits to drug distribution in a case of poor circulation, systemic effects, required skill and cost are the disadvantages to what route of medication administration? | Intravenous
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| Intramuscular administration of meds has what advantages? | Can administer larger doses than SQ sites, and the drug is rapidly absorbed.
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| What are the disadvantages of intramuscular administration of meds? | anxiety producing, localized pain trauma and irritation, breaks skin barrier, requires skill, cost
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| The requirement of skill, breaks in skin barrier, high cost, anxiety, localized pain and trauma, slow absorption and low limits on permissible drug volume are the main disadvantages of what route of drug administration? | subcutaneous
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| Intradermal drug administration has a _______ rate of absorption. | slow
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| What route of drug administration is characterized by very small amount of drug, broken skin barrier, the appearance of a wheal and localized skin irritation and pain? | Intradermal
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| Complete medication orders include... | client's name, birthday and MR/HR number, name of drug, dose, route, frequency, length of treatment, signature of MD, PA or ARNP
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| STAT order | immediately and only once
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| Single or one-time order | given once at specific time
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| Standing order | Order carried out until canceled or time frame fulfilled
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| PRN order | as-needed, nurse able to give med when client needs it, within order parameters
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| A good nurse always documents the ______ of a PRN med. | effectiveness
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| What are Accudose, Suremed, and BCMA? | computerized medication dispensing systems
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| The ten "rights" of medication administration... | The right medication, dose, time, route, client, education, documentation, right to refuse, assessment and evaluation.
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| T or F. Once the MD has sign the order to administer medication, it must be carried out immediately. | False. The nurse must verify the prescription before giving.
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| What makes up the assessment done before administering medications? | med history, allergies, current meds, illegal drug use/dependency, past reactions, assistance needed.
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| The FIRST check of giving meds... | Read MAR and select correct med, compare label against MAR, double check math calculation, check expiration
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| The SECOND check of giving meds... | Prepare med and compare label against MAR again.
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| The THIRD check of giving meds... | Check the label against the MAR at the bedside just prior to administration.
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| The 6 step process of administering meds... | ID client, educate client, administer med, provide interventions as needed, document, evaluate
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| How many identifiers are necessary when identifying clients? | two
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| How many times should a nurse check the label of a drug against the client's MAR before administering? | At least three
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| What type of syringe is always orange? | insulin
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| What type of syringe is always black? | TB syringe
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| 50 units equals... | 0.5mL
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| What can insulin syringes be used for? | ONLY to administer insulin.
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| Insulin is measured in... | units.
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| What are the two sizes an insulin syringe comes in? | 50 units or 100 units
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| What is the volume of a TB syringe? | 1mL
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| T or F, Luer-Lock needles may be used with TB syringes. | False
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| Needle selection for an IM injection in the Deltoid... | up to 1mL of volume, 20G-22G, 1 to 1 1/2 inch needle
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| Needle selection for an IM injection in the Vastus Lateralis and Ventrogluteal... | up to 2mL of volume, 21G-22G, 1 to 1 1/2 inch needle
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| Needle selection for an IM injection in the Dorsogluteal... | up to 3mL of volume, 21G-22G, 1 1/2 to 2 inch needle
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| Needle selection for SQ injection... | 24G-26G, 1/4 to 5/8 inch needle
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| Needle selection for Intradermal injection... | 25G-27G, 1/4 to 5/8 inch needle
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| ampule | glass container of 1mL to 10mL, holding single dose, no need to inject air as ampule is broken.
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| vial | single or multi-dose container, must inject air prior to withdrawing medication
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| IM angle of needle insertion | 72 degrees
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| SQ angle of needle insertion | 45 or 90 degrees
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| Intradermal angle of needle insertion | 15 degrees
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| Process for IM injection... | aspirate and observe, inject medication slowly, remove needle quickly, apply gentle pressure
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| Landmark for Deltoid injection | lower edge of the acromion process
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| Landmark for Vastalis Lateralis injection | divide the thigh into thirds, both horizontally and vertically, use outer middle area
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| What is the preferred injection site for infants one year and younger? | Vastalis Lateralis
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| What is the preferred IM injection site and why? | Ventrogluteal because there are no large nerves or blood vessels, it provides the greatest thickness of muscle, it is sealed off by bone, there is less fat than the buttock
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| Landmarks for Ventrogluteal IM injection | Palm on greater trochanter, Index finger towards the anterosuperior iliac spine
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| What are the precautions for IM injections in the Dorsogluteal muscle? | should not be used for children under 3, use caution to avoid sciatic nerve
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| What are the landmarks for the Dorsogluteal injection site? | lateral and slightly superior to the midpoint of a line drawn from the trochanter to the posterior superior iliac spine
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| Always check injections sites for... | skin integrity, bruising, swelling, discoloration
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| What size needle is best for blood? | 18G
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| SQ injection process... | Wash hands, put on gloves, review MAR and allergies, ID client with two identifiers, choose site, inspect skin, wipe with alcohol in circular pattern, dry, stretch or pinch, insert needle with bevel up, 45 or 90 degrees.
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| How does an intradermal injection differ from a SQ? | the angle of the needle is 10-15 degrees instead of 45 or 90 degrees, advance until bevel is just under the skin, inject slowly to form a small bleb/wheal.
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| What are the components of effective pain reduction? | use real words
describe procedure
teach breathing
pinch
pull
distract
use local anesthetic if ordered
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| How does implementing the "Z-track" injection method contribute to pain reduction? | prevents backflow of medication into subcutaneous tissue.
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| How can a nurse strengthen his/her lines of defense concerning medication administration? | know laws, nurse practice act and agency policies, practice 10 rights, always know the client and the medication, triple check each dispensed med, know resources, continue education, report errors timely
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| What should a student nurse know about giving meds for clinicals? | reason why client receiving med
drug classification
contraindications
usual dosage range
side effects
nursing considerations
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| Always _________ client education. | document
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| What are the guidelines for effective patient education concerning medications? | clean out supply ev 2-3 months
keep in cool dry place
know two names for meds
know reasons for taking
know dosage and amount
know the time to take
use same pharmacy
call week ahead for refills
keep med list handy
read label before each when to ca
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