Medication Administration chp 25

Question 1

the transmission of medications from the location of administration to the bloodstream

Answer 1

absorption

Question 2

Oral: barriers to absorption

Answer 2

medications must pass through the layer of epithelial cells that line the GI tract

Question 3

Subcu and IM: barriers to absorption

Answer 3

capillary walls have large spaces between cells. Therefore, there is no sign. barrier

Question 4

Highly soluble medications have rapid absorption times between __ to ___

Answer 4

10-30 mins

Question 5

sites with high blood perfusion have ____

Answer 5

rapid absorption

Question 6

IV absorption pattern

Answer 6

immediate: enters blood directly
complete: reaches blood in its entirety

Question 7

The transportation of medications to sites of action by bodily fluids

Answer 7

distribution

Question 8

Factors influencing distribution: (3)

Answer 8

circulation
permeability of the cell membrane
plasma protein binding

Question 9

changes medication into less active forms or inactive forms by action of enzymes.

Answer 9

metabolism (biotransformation)

Question 10

A ___ ___ level is in the therapeutic range when it is effective and not toxic.

Answer 10

plasma medication

Question 11

Short half- lives leave the body in:

Answer 11

4-8 hours

Question 12

when giving short-dosing intervals or MEC drops between doses you can

Answer 12

• give medications at longer intervals without a loss of therapeutic effects
• medications take a longer time to reach a steady state

Question 13

the interactions between medications and target cells, body systems, and organs to produce effects.

Answer 13

Pharmacodynamics

Question 14

oral or enteral medications should be given __ - ___ before meals and ___ after meals

Answer 14

30 mins-1hr

2 hrs

Question 15

kids are dosed based on their body weight until they reach ____kg

Answer 15

50kg

Question 16

Secondary effects of Pharmacodynamics are:

Answer 16

Unintended
non therapeutic
usually: predictable, harmless, or harmful

Question 17

Harmful, unintended, usually unpredicted reactions to a drug administered at the normal dosage.

Answer 17

Adverse reactions

Question 18

When the immune system identifies medication as a foreign substance that should be neutralized or destroyed

Answer 18

allergic reaction

Question 19

POLAR OPPOSITE of what you would expect to happen when giving a drug. ( Benadryl can make you wired when its really supposed to make you tired)

Answer 19

Idiosyncratic reaction

Question 20

Drug Interactions:
when drugs are mixed and cause deterioration of one or both drugs. (Aderol mixed with something else in IV.. forms precipitate)

Answer 20

Incompatible drugs

Question 21

Components of the medication order/prescription. Must be on there ( 6)

Answer 21

1. client’s full name
2. date and time
3. name of med
4. dosage size, frequency, # of doses
5. route of administration
6. signature of prescriber & DEA #

Question 22

Common Medication errors are caused by:

Answer 22

• lack of knowledge or info
• faulty communication
• equipment errors
• calculation and measurement errors
• similar names of medication OR patient names
• nurse fatigue, distraction, interrupted

Question 23

What’s the first thing you do if you commit a med errors?

Answer 23

1. ASSESS THE PT!
2. Report findings to the primary care provider!
3. Report it to your preceptor or charge nurse

Question 24

When do yo perform the 3 med checks?

Answer 24

1. Before you pour- at the med cart compare the label and MAR
2. After you pour- verify the label against MAR
3. At bedside- before you administer

Question 25

Buccal and Sublingual medications are meant to be absorbed in the ___ not the ___

Answer 25

mucous membrane | not the GI tract

Question 26

What's one thing that you absolutely DON't do when giving medication through a Enteral tube?

Answer 26

Don't give HYDROPHILIC meds through feeding tubes. Attract water & will solidify in tubes

Question 27

When administering Parenteral medications, you should always make sure you do what two things for safety:

Answer 27

1. Avoid recapping a dirty needle | 2. Use sharps containers

Question 28

Examples of: IV push- IV piggyback- Medicated drips-

Answer 28

push: single dose over a few minutes (steroids, pain med) piggyback: antibiotics infused over a certain amt time drips: insulin, ativan, antihypertensive drips, drips to lower inter-cranial pressure

Question 29

Stages of Cognitive Development:

Answer 29

1. Preoperational (2-7 yrs old) 2. Stage of Concrete Operations (7-11yrs old) 3. Formal Operational (11-older)

Question 30

Schedule I narcotic: Schedule II narcotic: Schedule III narcotic:

Answer 30

I; ^ abuse, no medical use II: acceptable medical use, ^ potential abuse III: medically acceptable drugs that may cause dependency

Question 31

What type of drug should be given when you want a longer acting effect?

Answer 31

lipid-soluble drugs

Question 32

Acid drugs are more rapidly absorbed in the: | Basic drugs are more rapidly absorbed in the:

Answer 32

``` stomach small intestines (sodium bicarbonate) ```

Question 33

Ionized molecules are: | Nonionized molecules are:

Answer 33

lipid insoluble- cant pass through phospholipid bilayer | nonionized easily absorbable

Question 34

An example of when an ionized medication is taken and can be antagonized by another medication in stomach

Answer 34

Taking an antacid before an aspirin antacid increases the pH of the stomach, aspirin becomes more ionized which impairs its absorption and reduces its effects

Question 35

Diabetic patients can't metabolize sugars effectively, so they should never be given:

Answer 35

an elixir ( ^ sugar content)

Question 36

___ increases the potential for adverse reactions and dangerous drug and food interactions?

Answer 36

Polypharmacy | -administering many drugs to treat different conditions

Question 37

Other Rights for patients receiving medication include: (3)

Answer 37

1. Right reason- given the medication for the right reason 2. Right to Know- tell pt name of med, why given, actions, & potential side effects 3. Right to Refuse- pt has the right to refuse meds

Question 38

To prevent choking in infants/toddlers when administering liquid medication you should:

Answer 38

- have mom sit them up or semi-sitting position. - use a medicine dropper or syringe to place med between the gum & cheek. - avoid giving too much too fast

Question 39

What are some examples of a localized topical med and a systemic topical med?

Answer 39

local: zinc oxide put on butt to reduce irritation from bowels/bladder incontinence systemic: estrogen patches, transdermal medication)

Question 40

to prevent infection when applying otic medications, what should be done if tympanic membrane is ruptured or surgical procedure has been done?

Answer 40

* use sterile technique - don't irrigate with warm saline - don't use a metal syringe - don't use oral jet irrigation - don't use "ear candling" with hot wax

Question 41

what can happen with long-term use of nasal decongestants?

Answer 41

rebound effect- medication is effective but congestion will recur and ^ when the effect of the decongestant wears off

Question 42

What are the disadvantages to rectal medications?

Answer 42

- absorption is slow & erratic bc of rectal contents, local drug irritation & uncertainty of drug retention in the rectum

Question 43

What is the main advantage to rectal medications?

Answer 43

- may provide for higher blood levels of medication compared to oral

Question 44

When is a rectal medication preferred over an oral?

Answer 44

- has a bad taste/odor - not safe to use oral (GI issues etc) - pt has vomiting or unconscious

Question 45

When is it ok to delegate a rectal medication?

Answer 45

- when it's a glycerine suppository (non-medicated)

Question 46

What are the 4 types of Nebulizers?

Answer 46

1. Atomizers- medication in large droplets 2. Aerosol spray- gas (O2 spray) 3. Ultrasonic (handheld) nebulizer- med (1ml) mixed with saline (3mL) 4. Metered Dose- measured dose delivered each time

Question 47

What is the main advantage to using a Meter-dose inhaler?

Answer 47

rapid delivery- produces local effects directly in the airway while avoiding systemic effects

Question 48

When would you not use a Dry powder Inhaler?

Answer 48

young kids or elderly | - need for dexterity so its hard for those who can't control hand movements precisely

Question 49

What are some disadvantages to parenteral medication?

Answer 49

- tissue damage can occur if PH, osmotic pressure, or solubility of med is not appropriate for that tissue

Question 50

It's recommended to add air into needles for certain situations (0.2mL at top of syringe) (2)

Answer 50

1. when the med is irritating to subcutaneous tissues the air will drive med deep into the tissue 2. when you change needles after drawing up the medication

Question 51

Absorption of subcutaneous injections is ___ than IM injections

Answer 51

slower than IM | ** less blood supply than muscle** going into fat

Question 52

Subcut injection is faster in the site __ and __ and slower in the ___ and ___ sites

Answer 52

faster: abdomen & arms slower: thigh & upper butt

Question 53

What should you check before administrating a heparin shot?

Answer 53

activated partial thromboplastin time (aPTT) | - check for signs of bleeding (gums, IV injection sites) or cover bleeding (urine & stool)

Question 54

For subcutaneous medications, only small amounts of _____ medication should be administered. What should you avoid doing with subq shots?

Answer 54

water-soluble meds avoid creating sterile abscesses (hardened, painful lumps under skin) from administering in the same spot over and over again.

Question 55

Heparin is only given by the ___ and ___ route. If given by ___ route it can cause:

Answer 55

IV or subcut | IM route: hematoma & pain (esp older women)

Question 56

When administering IM injection, ____ site is #1. You should avoid using the ___ site bc ___

Answer 56

Ventrogluteal site | Dorsogluteal site bc of its proximity to the sciatic nerve & superior gluteal artery

Question 57

what is the preferred site for IM injection for: infants- children- adults-

Answer 57

infant: vastus lateralis (avoid deltoid) child: anterolateral thigh (deltoid can if they have enough muscle mass) adults- deltoid 4 vaccines, Ventrogluteal for all other IM

Question 58

what is a protein and will be destroyed if administered through PO (GI tract)?

Answer 58

Insulin

Question 59

Categories of Insulin:

Answer 59

Basal- cover body's energy needs w/o taking diet into account Prandial & Preprandial- given to prevent ^ bld glucose Correction: reduce an elevated bld glucose level

Question 60

Examples of when to hold TB skin testing:

Answer 60

- when pt has history of skin reaction/allergy - pt is pregnant, receiving chemotherapy, or severe eczema - pt has topical anesthetic cream on skin (apply on site with no anesthetic cream or reschedule) - pt received live vaccine @ time of TP skin testing ( TB skin test should be deferred for 1 month post vaccine)