Class 5-Medication Administration

Question 1

Nursing drug knowledge

Answer 1

-generic names
-trade names
-classifications
-indications
-pharmakinetics
-metabolism
-excretion

-effects
-adverse reactions
-allergic reactions (mild; anaphylactic)
-tolerance
-toxic
-ideosyncratic

Question 2

drug dose and serum drug levels

Answer 2

-therapeutic range
-peak level
-trough level
-half-life

Question 3

therapeutic range

Answer 3

concentration of drug in the blood serum that produces the desired effect without causing toxicity

Question 4

peak level

Answer 4

the point when the drug is at its highest (draw line after infusing)

Question 5

trough level

Answer 5

the point when the drug is at its lowest concentration, indicating the rate of elimination (draw before next dose (1hr))

Question 6

half-life

Answer 6

amount of time it takes for 50% of blood concentration of a drug to be eliminated from the body

Question 7

medication reconciliation

Answer 7

admission assessment
-prescribed medications
-pta medications
-allergies
-pregnancy and lactation status
-dietary supplements and herbal and “natural” remedies

compare list prescribed meds to prior to admitting to otc meds and allergies

Question 8

aging and drug response

Answer 8

-decreased gastric motility (sit in stomach)
-decreased total body water (water soluble drug won’t work as well)
-decreased lipid content in skin
-decreased liver function
-decreased kidney function
-adverse cns effects
-altered peripheral vascular tone

Question 9

critical thinking

Answer 9

-proper order
-calculating adult medication dosages
-patients condition (warrant me giving this med; check vitals)
-equipment decisions
-documenting medication administration
-patient teaching

Question 10

medication orders

Answer 10

-verbal orders
-telephone orders
-standing orders
-prn orders (as necessary)
-stat orders (now)
-one time order

read back what they say; you say; they confirm

Question 11

rights

Answer 11

1. patient
2. medication
3. dose
4. route
5. time
6. reason
7. assessment
8. documentation
9. response
10. refuse
11. educate

Question 12

three checks (for safety)

Answer 12

1. removing medication from med cart (computer to drug)
2. comparing medication to MAR (holding drug next to computer)
   2.5. students have an additional check: instructor checks all meds
3. rechecking to emr/mar at bedside prior to admission

Question 13

frequency of orders

Answer 13

-daily
-BID
-TID
-QID (4x a day)
-ac (before meals)
-pc (after meals)
-HS (hour of sleep)

Question 14

identifying the patient

Answer 14

utilizing 2 patient identifiers
-name
-birthdate
-MRN

comparing to the EMR (look at computer)

Question 15

Right time or when is my medication administration considered LATE?

Answer 15

our clinical site medication rules
-for medications given more frequently than q6 hours (q1, q2, q3, q4) or rapid or short acting insulin (regular, aspart/novolog) administer within 30 minutes before or after the scheduled time
-medication given q6 hours or less frequently (q6, q8, q12) administer within 60 minutes before or after scheduled time
-daily, weekly or monthly medications-administer within 2 hours before or after scheduled time

Question 16

our clinical site half time rule

Answer 16

if you are unable to give a medication on time the next dose is given using the half time rule
-the late dose can be given up to half way to the next scheduled dose. you can give it and then the next dose as scheduled
-if the patient or med are available later than halfway between doses, give the missed dose, skip the next dose and resume schedule
-exceptions: ahminoglycosides & chemotherapy

Question 17

look at slide 17

Question 18

oral medication administration

Answer 18

enteral
-PO
-feeding tubes
-sublingual and buccal (cheek) routes
-solid
-liquid
-scored
-SR, XL, CR (controlled release)
-enteric coated

Question 19

for oral medications

Answer 19

brown syringes mean oral dose only

Question 20

topical medications

Answer 20

-lotions, creams, ointments and medicated powders
-trans-dermal patches
-eye drops
-nose drops/mists
-ear drops
-rectal-suppositories (3-4 inches up)
-vaginal-creams + suppositories

Question 21

safe injections

Answer 21

“one and only” campaign
-one needle, one syringe, only one time

Question 22

where are we dropping the ball?

Answer 22

source: infections person –>contaminated equipment or parenteral medication –> case: susceptible, non immune person

-knowledge gaps
-knowledge not translated into practice
-intentional misuse or harm

Question 23

do not use the same syringe for more than 1 patient..DUH

Question 24

LOOK AT SLIDES 29 & 30 & 32

Question 25

indirect syringe reuse: double dipping

Answer 25

accessing parental medications with a used syringe followed by reuse of the vial or container for additional patients -single-dose medications commonly involved

Question 26

fundamentals of safe injection practices

Answer 26

-needles and syringes are single-use devices -do not administer medications from a single-dose vial or bag to multiple patients -use right-sized vials and prefilled syringes

Question 27

misperception: saline bags can be used for more than 1 patient

Answer 27

wrong!

Question 28

survey of injection practices among clinicians in US healthcare settings

Answer 28

-5500 US healthcare professionals, primarily registered nurses -1% "sometimes" or "always" reuse a syringe for a second patient-DIRECT reuse -1% "sometimes" or "always" reuse a multi dose vial after accessing it with a used syringe-INDIRECT reuse -6% use single-dose or single use vials for > 1 patient

Question 29

parenteral medications (anything outside the gut)

Answer 29

-intradermal -subcutaneous administration -intramuscular administration

Question 30

intradermal

Answer 30

-TB tests

Question 31

subcutaneous administration

Answer 31

-insulin administration -heparin

Question 32

intramuscular administration

Answer 32

-deltoid site -ventral gluteal -vastus lateralis sites

Question 33

needles

Answer 33

-length -gauge -needleless systems -safety guards -sharps containers

Question 34

look at slide 39 & 40

Question 35

intramuscular

Answer 35

longer needle -72 or 90 degrees -into muscle layer

Question 36

subcutaneous

Answer 36

-90 or 45 degrees -longer needle=higher degree (than intradermal)

Question 37

intradermal skin

Answer 37

short needle=less angle -15 degrees no more than 1 mL in deltoid in gluteal up to 3 mL

Question 38

intradrmal

Answer 38

-1/4-1/2 inch -25 G, 27 G -less than 0.5 mL -angle 5-15 degrees -no aspiration (pulling back on end of needle) and no massage of sites

Question 39

subcutaneous

Answer 39

-drug specific syringes -3/8-5/8 inch -25 G - 30 G -1 mL maximum volume -45-90 degree angle -to pinch or not to pinch (pinch thin people) -no aspiration and no massage of sites -don't forget to rotate sites (ex: diabetes)

Question 40

look at slide 43 for subcutaneous sites

Question 41

intra-muscular

Answer 41

-5/8 inch-1.5 inch needle -20G-25G -know your sites -up to 3 mL volumes in large muscles -gentle pressure NOT massage -what is the z-track method? (pull aside tissue; inject) -never recap used needles -no aspiration

Question 42

what is the evidence for the aspiration technique during SC and IM medication administration

Answer 42

evidence says no

Question 43

there is no reported evidence that aspiration with or without blood return

Answer 43

-confirms needle placement -eliminates the possibility of an intramuscular injection into a non-subcutaneous blood vessel

Question 44

aspiration is not...

Answer 44

-indicated for SC injections -indicated for IM injections of vaccines and immunizations -aspiration may be indicated for IM injections of large molecule medications, such as penicillin

Question 45

organizations which state aspiration is not necessary for immunizations and vaccines are

Answer 45

-centers for disease control (CDC) -advisory committee on immunization practices (ACIP) -department of health services (DHS) -american academy of family physicians (AAFP) -U.K. department of health (DoH) -World Health Organization (WHO)

Question 46

look at slide 51-53 for sites

Question 47

younger nurses are more likely to follow the latest recommendations on IM injections

Question 48

never recap, bend or break a used needle

Answer 48

straight to the sharps container (throw cap in trash/pocket so not tempted to recap)

Question 49

controlled substances

Answer 49

-locked -narcotic counts -report any discrepancies -record partial doses

Question 50

drug diversion

Answer 50

using pt's drugs for their own use

Question 51

what we need to document

Answer 51

-electronic charting -drugs given: sites and parameters -doses missed: explanation of why -reused medications -incident reports for medication errors (SHARE) -patient teaching

Question 52

medication errors

Answer 52

-check patient's condition immediately; observe for adverse effects. VS -obtain a set of VS -notify nurse manager and primary care provider -complete form used for reporting errors, as dictated by the facility policy. (SHARE) not indicate that this form was completed in the patient chart

Question 53

the basics: one way

Answer 53

-once student and instructor have reviewed meds-enter room -ID PATIENT AND CHECK ALLERGIES -inform the patient of the meds you will be giving, gives them an opportunity to refuse -scan EPIC -scan patient -scan all meds on EPIC -check all meds against EPIC -open meds and give to patient

Question 54

the basics: another way

Answer 54

-once student and instructor have reviewed all meds-enter the room -ID PATIENT AND CHECK ALLERGIES -inform the patient of the meds you will be giving, gives them an opportunity to refuse -scan EPIC -scan patient -scan one med at a time and check it for accuracy -open each med individually and administer then check the next med OR -when all meds are scanned and checked individually-open meds and give to patient