Med Test Flashcards
(60 cards)
Where can you find info about high alert medications?
SARHintranet > sharepoint >Pharmacy > HAM reference
For all routes of HAM _____.
Two licensed staff will check order and medication
When will 2 licensed staff check IV meds independently?
- each time a new back or syringe is hung/initiated
- Transfer from unit to unit or nurse to nurse
- At the beginning of the shift
- Maintenance drip rate changes (heparin,insulin)
How will PO, SQ and IV bolus HAMs be checked?
By 2 licensed staff; they will both check the drug and dose simultaneously (NOT INDEPENDENTLY)
They will then document that pt, MD order, dose, and drug are correct
What happens if a peds pt needs mag sulfate?
If it is needed in an emergency it will be prepared by Rx and sent to pediatrics stat.
Precautions for Heparin infusions
Don’t use micrograms or unapproved abbreviations for order
Store separately from insulin
Standardize concentrations to 100 units/mL
What additional precautions are needed with concentrated electrolytes?
Restrict K+ infusions to 20mEq/25mL or greater storage and dispensing by Rx
Use premixed products
Additional precautions for magnesium sulfate
Use premixed
Standardize concentrations to 4 g/100mL
Additional precautions for opiate infusions including PCA
Standardize concentrations for MS, meperidine, fentanyl, and hydromorphone
Put HAM sticker on high concentration products
What are additional precautions for methadone
Monitor pain relief, RR, LOC, BP, ECG
Monitor concomitant use with other narcotics, benzos, or CNS depressants
What will the highest risk medications have on them?
Stickers from Rx
Mild hypoglycemia; BG less than 65
- nausea
- hunger
- nervousness and jitters
- Cold, clammy, diaphoretic
- tachycardia
- numbness and tingling in fingers or lips
- trembling
Moderate hypoglycemia; BG less than 50
- mood changes (anger and restlessness)
- confusion, trouble thinking and concentrating
- blurred vision, dizziness, HA
- weakness and fatigue
- poor coordination
- staggering and slurred speech
- lethargy and drowsiness
Severe Hypoglycemia; BG less than 30
- seizures and convulsions
- coma
Hypothermia
Emergency hypoglycemic supplies
- lemon-lime soda
- insta-glucose
- glucagon 1 mg IM + syringe
- IV start kit with tubing
- D5W 500mL, D50; 50 mL each (2)
Hypoglycemic patient that is able to swallow
- give 4 oz soda or 1 tube of glucose gel 15 g PO
- repeat BG check in 10 min
- if still symptomatic repeat tx and check BG in 15 min
- give carb and protein snack
- tell MD
If patient is unconscious with hypoglycemia or NPO
- give D50 in 50mL IVP immediately or give Glucagon 1 mg IM
- Give D5W or change IV fluid to D5W and set pump to KVO
- Recheck BG in 5 min
- if no response repeat D50 in 50 mL IVP
- Tell MD about actions and BG result
- Recheck BG at 30 min and again at 60 min after response to tx ; watch for reoccurrence if hypoglycemia is severe
What do you document in EMR when the pt is hypoglycemic?
Time and by whom
Clinical symptoms
POC BG readings
Call to MD
Tx and pt response
Other MD orders that were carried out
Labs for Heparin
Initial: aPTT
Ongoing: aPTT daily and CBC q 3 days
SQ Heparin labs
Initial: aPTT
Ongoing: CBC q 3 days
LMWH labs
Initial: PT, PTT, CBC, Cr, BUN, GFR
Ongoing: CBC q 3 days, Cr q 3 days
Warfarin Labs
Initial: INR
Ongoing: INR daily in the morning
Pradaxa labs
Initial: Cr, PT, PTT
Ongoing: Cr Q 3 days
Xarelto/Eliquis labs
Initial: Cr, PT, PTT
Ongoing: Cr q 3 days
