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Fundamentals of Nursing > chapter 31: medication administration > Flashcards

chapter 31: medication administration Flashcards

1
Q

Federal Regulations

A

Pure Food and Drug Act
FDA
National Formulary
USP
Medwatch

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2
Q

Sate/ Local Govt

A

adhere to Fed standars
have some say over stuff not covered by Fed standards
regulate alc and tobacco

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3
Q

Health Care Agencies

A

Meet Fed and State policies
Usually stricter though - e.g. automatic stop of narcotics after certain amt of days

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4
Q

Nurse Practice Acts

A

define scope of nurses’ professional functions and responsibilities

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5
Q

Med names

A

3: chemical, generic, and trade/brand name

Capitalize key letters to keep from making a mistake

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6
Q

Pharmacokinetics

A

study of how meds enter the body, reach their site of action, metabolize, and exit body

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7
Q

Absorption

A

med molecules pass into blood from site of med administration

Fast to slow:
on skin
oral
mucous memrane / respiratory airway
subcutaneous
intramuscular
Intravenous

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8
Q

which absorbs faster:
liquids or tablets/capsules?
acidic or alkaline meds?
lipid- or water- soluble?

A

liquids
acidic
lipid

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9
Q

Factors affecting absorption

A

route
ability to dissolve
blood flow to site of admission
body surface area
lipid solubility

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10
Q

Factors affecting distribution

A

Circulation –> good blood flow = fast delivery
Membrane permeability –> e.g. BBB only permeable to fat soluble stuff
Protein binding –> most meds partially bind to albumin - the rest is active

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11
Q

Metabolism of drugs

A

biotransformation occurs thru enzymes that detoxify, break down, and remove active chems

Liver is main one, but lungs, kidney, blood, and intestines do it too

If these organs aren’t working, meds accumulate and become toxic

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12
Q

Excretion

A

through kidneys, liver, bowel, lungs, and exocrine glands

lungs excrete NO, alc, and anesthesia
exocrine glands secrete lipid soluble stuff
Meds that go through digestion reabsorbed in small intestine - slowed emptying increases effects
KIDNEYS ARE MAIN ONE —> stay hydrated

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13
Q

Therapeutic effect

A

expected, predicted physiological response caused by the med

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14
Q

Adverse effects: who’s at risk?

A

young
old
pregnant
multiple meds
overweight
underweight
renal or liver disease

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15
Q

Side effects

A

predictable and often unavoidable adverse effect

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16
Q

Toxic effects

A

develop after taking for long time or if it accumulates

death!

Naloxone is antidote for opioids

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17
Q

Idiosyncratic reaction

A

overreaction, underreaction, or unexpected response to a med

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18
Q

Allergic reactions

A

-body sees med as antigen and so releases antibodies to fight it

Anaphylactic rxns = constriction of bronchiolar muscles, edema of pharynx/larynx, severe wheezing and shortness of breath

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19
Q

Medication interactions

A

synergistic effect = increase effect of each other

e.g. alc has synergistic effect on antihistamines, antidepressants, barbiturates, and narcotic analgesics

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20
Q

Medication tolerance and medication dependance

A

need higher doses to produce same outcome: morphine, nitrates, alc

Dependance is psychological and/or physical
-physical if withdrawal happens

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21
Q

Minimum effective concentration (MEC)

A

minimum amt of med in plasma needed to make effects happen

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22
Q

safe therapeutic range

A

tried to attain this consistently

bt MEC and toxic concentration

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23
Q

Biological half life

A

time it takes for excretion processes to lower serum medication concentration by half

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24
Q

Time intervals to know when administering meds

A
  1. Onset of med action = time to take effect
  2. peak action = time to reach peak
  3. trough = min blood serum level before next dose
  4. duration of action = how long the therapeutic effect is working
  5. plateau = blood serum concentration reached and maintained after repeated fixed doses
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25
Q

Sublingual meds

A

put under tongue where it dissolves
don’t ingest
don’t drink anything til med is completely dissolved

26
Q

Buccal administration

A

solid med put on inside of cheeks to dissolve

don’t eat it

alternate cheeks with each dose

27
Q

4 typical parenteral routes of administration

6 rarer parenteral routes of administration

2 only for drs

A

ID = intradermal = just under epidermis
Subcutaneous = into tissues just below dermis
IM = intramuscular = into muscle
IV = intravenous = into the vein

Epidural = epidural space via catheter
Intrathecal = catheter into subarachnoid space
Intraosseous = into bone marrow –> mostly for babies
Intraperitoneal = into peritoneal cavity –> chemo, insulin, and antibiotics
Intrapleural = into plaural space –> chemo or anti-pleural effusion
Intraarterial = into artery –> clot dissolving agents

intracardiac and intraaricular (into joint)

28
Q

Topical administration

A

applly to skin/mucous membrane

Transdermal disk/patch has systemic effects – leave on for 1-7 days

  1. direct application of ointment (eyedrops)
  2. insertion of medication into body cavity (suppository into rectum)
  3. intillatino of fluid into body cavity (ear drops)
  4. irrigation of body cavity
  5. spraying med – e.g. into nose
29
Q

Inhalation route

A

endotracheal, nasal, or oral passages

30
Q

Intraocular route

A

contact lens with meds on it –> stays in for a week

31
Q

How should non OTC meds be measured in hospital?

A

pharmacy should measure with oral syringe using metric measurements

32
Q

Solution

A

mass of solid substance dissolved in known volume of fluid
OR
fluid mixed with fluid

express in g/L or mg/mL or percentages

33
Q

should you be converting between systems?

A

not really, but if its necessary then i guess its necessary

34
Q

Ratio and proportion method

A

1:2::4:8 —> 1 and 8 are “extremes”; 2 and 4 are “means” –> product of extremes = that of means

35
Q

Formula method

A

(dose ordered / dose on hand) x (amount on hand) = how much to give

36
Q

Dimensional analysis

A

the fun, multi ratio multiplication thing

37
Q

Ped doses basic safety measure

A

have most errors

-use metric only –> round to neares 0.1, 0.5, or 1 ml
-no household measurements
-tailor to BMI
-hands on and return demonstration
-pic based education may be appropriate

38
Q

How to calculate dose for child

A

-WEIGHT –> avoid converting bt lbs and kgs
-IM don’t exceed 1 mL for kids or 0.5 mL in babies
-Subcutaneous don’t exceed 0.5 mL
-If less than 1 mL, use syringe with tenths
-Use tuberculin syringe if need to be rounded to thousandth
-estimate first and then compare
-compare amt ordered over 24 hr to recommendations

39
Q

verbal order

A

order for med given verbally
-write it, read it back, get confirmation

Indiacte time and name of HCP who gave order
-sign it, indicate it was read back, and get HCP to sign it

DON’T USE ABBREVIATIONS DURING DOCUMENTATION

40
Q

Standing orders / Routine medication orders

A

Carried out until HCP cancels it or prescribed number of days passes

41
Q

prn order don’ts

A

No ranges if vague
-maybe ranges if given explicit conditions: e.g. increase mmorphine dosage 50-100% if pain is moderate to severe based on use of pain scale

42
Q

Now vs STAT orders

A

Now is within 90 mins

STAT is as soon as possible –> emergency!

43
Q

Prescriptions

A

orders taken to outside agencies

sometimes, if for controlled substance, have to be written on dif colored prescription pad than other orders

44
Q

Pharmacists job

A

dispense correct med in proper dosage and amount with accurate label

don’t really mix stuff except in IV solutions

45
Q

Unit dose

A

storage system with individually wrapped doses for patients in individual drawer

usually only 24 hr supply is kept in drawer –> pharmacist refills at particular time

certain amt of prns in drawer

controlled substances kept locked up elsewhere

46
Q

Automated Medication Dispensing Systems (AMDS)

A

Nurse enters security code and maybe finger print
Selects patient, med and dose
Drawer opens and the med is documented (in med record) and charged to patient

Might be used with bar-code medication administration system (BCMA) where you have to scan the patient’s bracelet before it’ll give you the meds

Includes controlled substances

47
Q

Chemo meds

A

Have to be certified to administer IV chemo meds, but not oral

Chemo drugs are SUPER toxic! DNA damage –> cancer, birth defects, immune issues

Excreted through urine, stool, vomit, sweat, and saliva –> double flush! Toilets are biohazard

48
Q

Chemo med guidelines

A

Store in separate, designated place
use special gloves
hand hygiene before and after
don’t break the drug
don’t use same equipment to prep as other drugs
single-use PPE
clothes or sheets with body fluid should be washed 2x in washing machine by themselves on HOT

49
Q

DON”T LET AP DO ANY OF THIS

A

FACTS!

50
Q

Medication error

A

preventable event that may cause inappropriate med use or jeapordize patient safety

  1. assess patient’s condition and notify HCP
  2. report incident (not permanent part of med record)
    *****report almost errors too
51
Q

Medication reconciliation

A

Compare med that they’re taking with what they should be taking

Often necessary when patient has been/is being transferred

52
Q

The seven rights

A
  1. right med
  2. right dose
  3. right patient
  4. right route
  5. right time
  6. right documentation
  7. right indication
53
Q

Comparing label on medication with that in the MAR

A

First: before removing container from drawer

Again: as amount of med ordered is removed from container

Last: at patient’s bedside before giving it to them

54
Q

YOU CAN”T ADMINISTER MEDS IF YOU DIDN”T PREP THEM

A

FACTS

55
Q

What syringe to use when preparing oral medication

A

enteral syringe –> dif color than others and laeled for oral use

56
Q

When to give time critical meds

Non time critical?

A

within 30 mins before or after stated time

within 1-2 hrs befor or after

57
Q

Patient rights

A

To be informed ab care
to make decisions ab care
to refuse care
to be listened to by care givers
to recieve info in a way that meets their needs

58
Q

IMP history stuff to know

A

allergies
meds
diet history
perceptual or coordination issues

59
Q

Nursing Dagnoses related to meds

A

Impaired health maintenance
Lack of Knowledge
Nonadherence
Adverse Med ineraction
Complex med regimen

60
Q

Components of medication order

A

Patient’s full name
Date and time order was written
med name
dosage
route
time and frequency of administration
signature of HCP

61
Q

How often do adverse effects happen in old ppl?

A

22% of the time!

falls, orthostatic hypotension, heart failure, delerium

62
Q

Polypharmacy

A

use of mult meds, use of potentially inappropriate/unnecessary meds, or use of med that doesn’t match diagnosis

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