Med Administration Exam Flashcards
(93 cards)
1
Q
therapeutic effects
A
intended or desired response to med
2
Q
adverse drug reactions
A
unintended, undesirable and often unpredictable
effects of med
3
Q
side effects
A
predictable and often unavoidable secondary effects of a med at usual therapeutic dose
4
Q
toxic effects
A
med accumulates in blood because impaired metabolism or excretion, or when too high of dose is given
5
Q
idiosyncratic effects
A
patients overact or underreact to a med or have
reactions different than normal
6
Q
medication tolerance
A
more medication is required to achieve the same therapeutic effect
-tolerance is decreased physiological response that occurs after repeated administration of med.
7
Q
medication dependence
A
Dependance can be physical or
psychological
-described in the past as addiction
8
Q
medication misuse
A
overuse, underuse, nonadherence, polypharmacy
9
Q
medication interactions
A
med modifies action of another med
-may result in an increase or decrease in therapeutic effect of each medication
10
Q
absorption
A
passage of medication molecules into the blood from site of administration
11
Q
what factors influence absorption
A
-first pass effect
-blood flow to site
-administration route
-patient size
-ability of med to dissolve
-lipid solubility of med
12
Q
distribution
A
process of transporting a drug to the site of action
13
Q
what factors influence the extent of distribution
A
-binding to albumin/protein binding (unbound goes to site)
-circulation
-cell membrane permeability
-perfusion
14
Q
What do nurses need to be aware of with older adults and patients with liver disease?
A
-older patients and patients with liver disease have less albumin and decreased metabolism so there is more free and unbound drug causing toxicity
15
Q
metabolism
A
medication is broken down to remove the active chemicals
16
Q
where does metabolism occur?
A
mostly in liver but lungs, kidneys, blood and intestines play a role
17
Q
excretion
A
process of medication exiting the body
18
Q
peak plasma level
A
when a drug is at its highest concentration, not necessarily at its most therapeutic level
19
Q
trough serum levels
A
lowest level of concentration of a medication that correlates to the rate of elimination
-happens 30 minutes before next dose
20
Q
serious adverse drug event
A
life threatening reaction that requires medical intervention to prevent death or permanent disability
-must be reported to FDA to improve safety outcomes, revise drug labels and warnings and when to withdraw drugs from the market
21
Q
black box warning
A
issues on medications that may produce lethal and iatrogenic results
22
Q
medication reconciliation
A
performed anytime a patient is transferred from one health care professional to another
-reviews patients current medications with newly prescribed medications. getting rid of duplicates
23
Q
verify all new orders
A
one time for every new order
-check order from provider and compare to the MAR to make sure it matches exactly
24
Q
3 safety checks for medication administration accuracy.
A
- when retrieving medication from storage bin
- before placing in medication cup or before taking to the patients room (leave meds in wrappers to explain meds)
- at bedside before giving to the patient
25
What are the guidelines for administering opioids (narcotics)?
special handling:
-securely locked
-counted
-waster
-witness
-tamper evident syringes
Draw up all medicine in a bottle, discard extra in designated spot with another witness and both nurses fill out disposal form
26
What are the principles for safely handling chemotherapy medications?
-hand hygiene before and after gloving
-do not crush, cut or split medication
-use separate equipment
-know the agency spill policy
-dispose of single use clothing
-wash clothes or sheets contaminated by body fluids: wash twice in hot water, do not wash with other items
27
who can give chemotherapy?
any nurse can give PO chemo, certified nurse gives IV chemo
28
standing order
give until discontinued or prescribed number of days elapse
29
PRN order
as needed
30
single order
one time
31
STAT order
carried out immediately
32
NOW order
within 90 minutes
33
time critical medications
administer within 30 minutes before or after the scheduled time
-antibiotics, anticoagulants, insulin, immunosuppressives
34
non critical medications
administer 1-2 hours before or after scheduled time
35
unit dose
drug dosage system that provides prepackaged, prelabeled, individual medications that are ready for immediate use by the specific patient patient
-decreases med errors and saves steps in dispensing medications
36
standard measurement devices
-graduated cups
-syringes
-scaled droppers
37
can we split pills
only if medication is scored
38
How should we administer crushed medication
-mix with food or liquid
-clean device
-check do not crush list
39
do not crush list
-enteric coated
-long acting tablets
-contents of capsules
-sublingual medications
40
oral route of medication administration
-most desired (po)
-know if should be taken with or without food
-can the patient swallow safely
41
enteral feeding tube route of medication administration
-always verify placement first
-do not administer medication in tube if used for gastric decompression
-use liquid med if possible
-HOB 30-45 degrees
-check gastric residual volume
-flush with 30-60mL of water
42
enteral feeding tube route of medication administration with multiple medications
flush between each medication with 15-30mL of water
43
topical route of medication administration
apply to mucous membranes, skin, tissues
-need gloves and or applicators
-apply to intact skin
-never apply new med over old
-remove old patches
-never apply heat to patch
-clean skin first
44
ophthalmic route of medication administration
eye medications in the form of drops, ointments or intraocular disc
-expose conjunctival sac (never press on eyeball)
-rest dominant hand on forehead
-hold eye dropper 1/4 to 1/2in above conjunctival sac
45
ophthalmic route of medication administration potential of systemic effects
apply gentle pressure to nasolacrimal duct with tissue 30-60secs
46
otic route of medication administration
ear medications usually drop form
-drops at room temp
-dont force solution into ear
-after administration keep patient in side lying position for a few mins
-dont occlude ear canal with dropper
-apply gentle pressure to tragus
-use cotton ball if ordered
47
nasal route of medication administration
nose medications in form of drops, sprays, tampons
-drops: patient in supine position, tilt head backward, hold dropper 1/2in above nares and instill, remain supine for 5 mins
-spray: upright position with head tilted forward and occlude other nostril
48
inhaler route of medication administration
medications dispersed through aerosol spray, mist or powder that penetrates airways
-pMDI: pressure metered-dose inhalers
-BAI: breath-actuated-metered-dose inhaler
-DPI: dry powder inhaler
49
vaginal installations route of medication administration
forms of foam, jelly, cream or suppository
-stored in fridge
-insert with applicator or gloved hand
-patients can administer themselves if taught and able
-dorsal recumbent position
-insert suppository entire length of finger (3-4in)- applicator (2-3in)
-remain supine for 10 mins
50
rectal suppositories route of medication administration
inserted in rectum and absorbed into rectal mucosa
-stored in fridge
-4in in adult
-2in in infants and children
-patients can administer themselves if taught and able
-contraindicated after rectal surgery
-left side lying sims with upper leg flexed forward
-use lubrication
51
parenteral route of medication administration
enters body tissues and circulation by injection
-intradermal (ID)
-subcutaneous
-intramuscular (IM)
-intravenous (IV)
-sterile procedure
52
parenteral route of medication administration ampule
use filter needle
53
Know how to select equipment (syringe size, needle length and gauge) for each type of injection
Length: depends on pt size, gender, condition, weight, type of tissue injected and route.
Gauge: depends on viscosity and volume of med
-Smaller gauge number= larger diameter needle (thicker)
54
intradermal route of medication administration
-needle size: 25-27g pre-attached 3/8"-5/8"
-just under the skin inject very small amount 0.01-0.1 mL
-do not aspirate
-5-15 degree angle
-use TB (tuberculin) syringe
-for TB screening or allergy tests
55
subcutaneous route of medication administration
beneath dermis, poor blood supply
-0.5-1.5mL total volume
-5/8" inserted at 45 degree angle, pinch 1in of tissue
-1/2" inserted at 90 degree angle, pinch 2in tissue
56
subcutaneous insulin administration
-U 100 insulin
-1mL insulin syringe
-28-31 gauge
-pre attached needle: 5/16-3/16 length
-needle 3/16in administered at 90 degree angle to reduce pain and achieve adequate control of blood sugars
-abdomen or outer aspect of thighs preferred, rotating within site
-pinch skin and insert needle, release pinch (unless using a pen)
-do not aspirate
-do not massage site
57
Mixing insulins in one syringe
1. inject air in A (cloudy or long acting)
2. inject air in B (clear or rapid acting), then draw up dose
3. with B dose syringe draw up dose from A
4. inject A and B dose from syringe into vial
58
mixing insulins in one syringe requirements
-dont mix insulin with other meds
-never mix insulin glargine (lantus) or insulin detemir (levemir) with other types on insulin
-verify insulin doses with another nurse while preparing
59
subcutaneous heparin or lovenox administration
-abdomen preferred
-use tuberculin (TB) syringe
-25-27 gauge
-3/8-5/8 length
-2" around umbilicus
-dont expel air bubble
-pinch skin, insert needle, hold pinch
-inject over 30 secs
-dont aspirate or massage site
60
intramuscular (IM) route of administration sites
deep muscle tissue with rich blood supply
-ventrogluteal (hip) preferred site
-dorsogluteal (upper buttock) not used anymore
-vastus lateralis (leg)
-deltoid (arm)
61
intramuscular (IM) route of administration requirements
- 2-3mL syringe
- 22-25g aqueous solutions
- larger gauge viscous solutions
- 90 degree angle
- 1-3mL volume
- aspirate for blood (no longer aspirating when administering vaccines or toxoids)
-inject slowly
62
ventrogluteal site for IM injections
-reduces risks of muscle and nerve injury
-preferred and safest site
-can hold longer volumes and viscous meds
-little side effects
-inject at 90 degrees, dartlike, to the hub of the needle at 10 seconds per mL
-wait 10 seconds before withdrawing the needle
63
vastus lateralis site for IM injections
-preferred site for toddlers 1-2 years
-grasp muscle in young children or cachectic patients to be sure med is deposited into tissue
64
deltoid site for IM injection
-easily accessible
-only small doses, 2mL or less
65
steps of administering Z track method injection (IM)
Deep into muscle, pull skin over taught with hand 1-1/2in laterally, hold skin and insert needle and inject slowly, leave needle in place 10 sec, withdraw needle and release skin
66
what is the purpose of Z track method injection
minimize local skin irritation by sealing off medication in muscle tissue
67
how to minimize pain of an injection
-position and flex patients limbs to reduce muscular tension
-sharp beveled needle in shortest length and smallest gauge
-insert needle rapidly, inject slowly and withdraw rapidly
-change needle if liquid med coats shaft of needle
-apply vapocoolant spray
68
how to prevent contamination of solutions to avoid patient infection when using ampules
ampules should not sit open, remove med quickly
69
how to prevent needle contamination to avoid patient injection
-avoid letting needle touch outer edges of ampule or vial, outer surface of needle cap, your hands, countertop, table surface.
-avoid touching length of plunger or inner part of barrel
-keep tip of syringe covered with cap or needle
70
advantages and disadvantages of IV bolus push method
administer into vein
-advantages: rapid onset
-disadvantages: small volumes, not all medications, higher risk
71
how to keep patients free from infection by preparing the skin properly
-wash skin soiled with dirt, drainage, or feces with soap and water
-use friction and circular motion while cleaning with antiseptic swab
-swab from center of site and move outward in 2in radius
72
needle safety
-never ever recap used needle after medication administration
-use needleless systems
-properly dispose of used needle in sharps container
-use plastic guard to prevent needle sticks
73
verbal or telephone orders
-students cant take these
-clearly ID patient name, room number, and diagnosis to HCP
-write order then read it back
-use VO for verbal order and TO for telephone order
-document read back and name of HCP
-HCP will countersign
-verbal orders are discouraged except for emergent situations
74
what to do if you make a medication error
-make sure patient is safe first
-report error by recording all meds in record (even drugs administered in error)
-do not document med was given in error
-complete occurrence or incident report (not part of the health record or nurses notes)
-notify prescriber
75
What are the steps to prevent medication errors?
Follow 7 rights, prepare meds for one patient at a time, check med label 3 times comparing to MAR, 2 patient identifiers, no distractions, double check calculations and high risk meds with another nurse, don't attempt to clarify ineligible or smudged writing, question unusually large or small doses, document as soon as meds given, ensure well rested
76
generic name of a drug
the official name that is listed in official publications such as the United States Pharmacopeia (USP).
77
trade name of a drug
the name used to market the medication; it suggests the action of the drug
78
IV medication administration absorption
most rapid absorption because going directly into a vessel
79
IM medication administration absorption
absorb rapid but not as fast as IV
80
subcutaneous medication administration absorption
absorb faster than oral but not as fast as IM or IV
81
oral medication administration absorption
absorb slowly
82
Every medication order must include:
patients name, the drug ordered, dosage, route of
administration, and time(s) of administration.
83
adults and children older than 3 years old otic medication administration
gently pull pinna up and outward
84
children younger than 3 years old otic medication administration
pull the pinna down and back
85
ampules
-single doses of injectable medication
-glass/constricted restored neck you snap off
-use filter needle
-open system
86
vial
-single or multidose
-inject air
-closed system
87
mixing medications from vial and ampule
Prepare medication from the vial first.
Use the same syringe and filter needle to withdraw medication from the ampule.
88
what does viscous mean
syrupy: having a relatively high resistance to flow, or having a glutinous consistency and the quality of sticking, or adhering.
89
BID
twice a day
90
TID
three times a day
91
ac
before meals
92
hs
at bedtime, hour of sleep
93
pc
after meals
