Medication Administration

Question 1

Pharmokinetics definition

Answer 1

How medications travel through the body. Medications undergo a variety of biochemical process that result in absorption, distribution, metabolism, and excretion.

Question 2

Routes of Absorption

Answer 2

Oral
Barriers: layer of epithelial cells that line the GI tract

Subcutaneous and intramuscular
Barriers: no significant barrier

Intravenous
Barriers: None

Question 3

Factors influencing Distribution

Answer 3

Circulation: peripheral vascular problems or cardiac disease can delay medication distribution
Permeability of the cell membrane : Medication must be able to pass through tissue
Plasma protein binding : medications compete for protein binding sites within the bloodstream, primarily albumin.

Question 4

Factors influencing medication metabolism rate

Answer 4

Age : infants have a limited medication-metabolism capacity. Older adults require smaller doses of medications due to the possibility of accumulation in the body.
An increase in some medication metabolizing enzymes : can require an increase in dosage of that medication to maintain therapeutic level
First pass effect :the liver inactivates some medications on their first pass through the liver. Thus they require a non enteral route (sublingual, IV because of their high first-pass effect.
Similar metabolic pathways : When the same pathway metabolizes two mediations, it can alter the metabolism of one or both of them.
Nutritional status : Clients who are malnourished can be deficient in the factors that are necessary to produce specific medication-metabolizing enzymes thus impairing medication metabolism

Question 5

Excretion

Answer 5

The elimination of medications through the body are primarily through the kidney.
Also, the lungs, liver, intestines, and exocrine glands (in breast milk).

Question 6

Therapeutic Index

Answer 6

Medications with high therapeutic index has a wide safety margin
Medications with low therapeutic index require close monitoring of medication levels.
Nurses should consider the route of administration when monitoring for peak levels (highest plasma level when elimination=absorption).

Question 7

Pharmacodynamics (Mechanism of Action)

Answer 7

The interactions between medications and target cells, body systems, and organs to produce effects.
Examples:
Agonist- mimic receptor activity
Antagonist - block the usual receptor activity
Partial agonists - act as an agonist and antagonist

Question 8

Sublingual and bucal

Answer 8

Sublingual: under the tongue
bypasses the liver, goes directly in bloodstream
Bucal: between the cheek and gum
Keep medication in place until complete absorption occurs

Question 9

Topical medication

Answer 9

Do not apply with a bare hand
For skin applications, wash the skin with soap and water. Pat dry before application

Question 10

Transdermal medication

Answer 10

Apply patches as prescribed to ensure proper dosing
Wash the skin with soap and water, and dry it thoroughly before applying a new patch
Place the patch on a hairless are and rotate sites to prevent skin irritation

Question 11

Eye drop medication

Answer 11

Hold dropper above the conjunctival sac about 1 to 2 cm, AVOID PLACING IT DIRECTLY ON CORNEA, and have them close the eye gently. If they blink repeat the procedure
Apply gentle pressure with finger and clean facial tissue on the nasolacrimal duct for 30 to 60 seconds
Wait 5 min in between medications in same ye.

IF APPLYING OINTMENT, APPLY THIN RIBBON FROM THE INNER TO OUTER CANTHUS

Question 12

Ear medication

Answer 12

Have clients sit upright or lie on their side.
Hold the dropper 1 cm above the ear canal, instill medication, and then gently apply pressure with finger to the tragues of the ear.
Have clients remain in the side-lying position if possible for 2-3 min after installation of ear drops

Question 13

Nasal medication

Answer 13

Have clients lie supine
Use dominant hand to instill the drops, supporting head with other.
Instruct clients to breathe through mouth and do not blow nose for 5 min after
Spray med into nose while client inhales

Question 14

Metered Dose Inhalers (MDI)

Answer 14

Shaker the inhaler vigorously five or six times
Hold the inhaler about 2 to 4 cm (1-2 inches) away from mount with the opening pointing toward the back of the throat
Take a deep breath, and then exhale
Tilt head back then begin o press the inhaler then inhale slowly and deeply for 3 to 5 seconds to facilitate delivery to air passages
Hold breath for 10 seconds to allow medication to deposit in airways
Resume normal breathing

Question 15

Dry powdered inhalers

Answer 15

Do not shake the device
Exhale completely
Place mouthpiece between your lips and take a deep inhalation breath through mouth
Hold your breath for 5 to 10 seconds
Exhale through pursed lips after removing inhaler from mouth.
Clients who need more than one puff should wait the length of time the provider specifies before second puff
RINSE MOUTH WITH WATER OR BRUSH YOUR TEETH IF USING CORTICOSTEROID INHALER TO REDUCE RISK OF FUNGAL INFECTIONS

Question 16

Nasogastric and gastrostomy tubes nursing action

Answer 16

Verify proper tube placement
Use a syringe and allow the medication to flow in by gravity or push it in with the plunger of the syringe

administer each medication separately.

Completely dissolve crushed tablets and capsule contents in 15 to 30 mL of tepid water prior to administration

To prevent clogging flush the tubing before and after each medication with 15 to 30 mL of water. Flush with another 30 -60 mL of water after all medications

WITH ENTERAL FEEDINGS: KEEP BED ELEVATED AT A MINIMUM OF 30 DEGREES. ( PREFERABLY 45 DEGREES) FOR ABOUT AN HOUR AFTER MEDICATION

Question 17

Parenteral examples

Answer 17

Intradermal
Subcutaneous
Intramuscular
Intravenous

Question 18

Parenteral nursing actions

Answer 18

Vastus lateralis is best for infants 1 year and younger
Ventrogluteal site for IM injections and injecting volumes exceeding 2 mL
Deltoid site can only accommodate up to 1 mL of fluid
Tuberculin syringe for solution less than 0.5 mL
DO NOT USE INJECTION SITES THAT ARE EDEMATOUS, INFLAMED, OR HAVE MOLES, BIRTHMARKS, OR SCARS

Question 19

Intradermal nursing actions

Answer 19

Use for tuberculin testing or checking for medication or allergy sensitivities
Use 1 mL tb syringe
Use 0.001 - 0.1 mL solution in syringe
1/4 to 5/8 inch needle size
25-27 gauge
inner surface of the mid-forearm or scapular area of the back
10-15 degree angle
Bevel should be up
DO NOT MASSAGE SITE AFTER INJECTION

Question 20

Subcutaneous nursing actions

Answer 20

Use small doses for non irritating, water soluble medications
SubQ gauge 25-27
Example: insulin and heparin
Use 3/8 to 5/8 inch needle
25-31 gauge for insulin
Use insulin syringe for insulin. No more than 1.5 mL of solution.
Select sites with adequate fat-pad size
abdomen, upper hips, lateral upper arms, thighs
For average size clients, pinch the skin and inject at 45 - 90 degree angle. For obese, use a 90 degree angle.

Question 21

Intramuscular nursing action

Answer 21

Use for irritating medications, solutions in oils, and aqueous suspensions
Common sites: ventrogluteal, deltoid, and vastus lateralis (pediatric)
use 5/8 to 1 1/2 inch needle
18 to 25 gauge (usually 22-25 gauge) syringe
Inject at 90 degree angle
solution is usually 1-3 mL
Divide larger volumes in two different syringes and different sites
Use Z-track method for IM injections of irritating fluids or fluids that can stain the skin
Example : iron preparations
(Prevents medication from leaking back into subQ tissue

Question 22

Intravenous nursing actions

Answer 22

Use for administering medications fluid and blood products
16 gauge for clients who have trauma 18 gauge during surgery and blood admin
Use 22 to 24 gauge for children, older adults, and clients who have medical issues or are stable post op
Sites: peripheral veins in the arm or hand are preferable.

NEWBORNS : use veins in the head, lower legs, and feet

Question 23

Routine or standing prescriptions

Answer 23

Medications nurses give on a regular schedule with or without a termination date (prescription will be in effect until provider discontinues or discharges the client)

Providers must re-prescribe some medications within a specific amount of time or they automatically discontinue

Question 24

Single or one time prescriptions

Answer 24

Common for pre operative or pre procedural medications
Example: a one time prescription instructs the nurse to administer warfarin 5 mg PO at 1700

Question 25

Stat prescriptions

Answer 25

Only for administration once and immediately

Ex: a stat prescription instructs the nurse to administer digoxin 0.125 mg IV bolus stat

Question 26

Now prescriptions

Answer 26

a prescription only for administration once, but up to 90 min from when the nurse received the prescription.

Question 27

PRN prescriptions

Answer 27

Specifies what dosage, what frequency, and under what conditions a nurse can administer the medication.
Nurse uses clinical judgment to determine the clients need for the medication.
Ex: a PRN prescription instructs the nurse to administer morphine 2 mg IV bolus every hour PRN for chest pain.

Question 28

Other prescriptions

Answer 28

Provider might write prescriptions for specific circumstances or for specific units.
Ex: a critical care unit has standing prescriptions for treating clients who has asystole.

Question 29

Components of a medication prescription

Answer 29

Clients full name
Date and time of the prescription
Name of medication
The strength and dosage of medication
Route of administration
Time and frequency of administration: exact times or number of times per day
The quantity to dispense and the number of refills
Signature of the prescribing provider

Question 30

Taking a telephone RX

Answer 30

Only when absolutely necessary.
Read back to provider
Should include clients name, name of med, dosage, time to give it, frequency, and route.
Remind the provider to verify the prescription and sign it within the amount of time the facility’s policy.
Have a second nurse listen on extension or on speaker in a private area

Question 31

Medication Reconciliation When is it done

Answer 31

Takes place at admission, transferring between units and facilities, and at discharge.

Compiling a list of each clients current medication with correct dosages and frequency.

Question 32

Rights of safe medication administration

Answer 32

Right client
Right medication
Right dose
Right time
Right route
Right documentation
Right client education
Right to refuse
Right assessment
Right evaluation

Question 33

Regular insulin (IV and SubQ)

Answer 33

Onset: 0.5 - 1 hour
Peak: 1 hr - 5 hr
Duration: 6 hr - 10 hr

Question 34

Intermediate Acting insulin: NPH (cloudy)

Answer 34

Administered SubQ only

Onset: 1-2 hrs
Peak: 4 hr -14 hr
Duration: 12 hr - 24 hr

Question 35

Steps to preparing insulin

Answer 35

Use insulin syringe
Obtain cloudy and clear insulin vials
Roll only the cloudy insulin (SLOWLY)
Sterilize the top of both vials
Use aseptic technique on the site of administration (clients abdomen, thigh, hip, lateral arm)
Aspirate the amount of mL to be administered into the cloudy vial primarily
Inject the air into the cloudy vial
Remove syringe
Aspirate again with the amount of mL to be administered into the clear insulin
Without removing the syringe from the clear insulin, obtain clear insulin into the syringe.
Remove syringe
Obtain the needed cloudy insulin into the syringe
Verify with another nurse the total amount of insulin in the syringe
Administer the insulin into the client subcutaneously (45 to 90 degree angle)

Question 36

Vastus lateralis

Answer 36

Recommended for intramuscular injections

Maximum amount of medication/dose: 1 - 3 mL

Question 37

Deltoid

Answer 37

Used frequently for immunizations

Maximum amount of medication/ Dose: 2 mL

Question 38

Ventrogluteal

Answer 38

Safe because of the lack of major nerves

Maximum dose: 3 mL