Medication Administration Simulation Flashcards
(92 cards)
1
Q
Rights of Medication Administration
A
- Right Patient
- Right Medication
- Right Dose
- Right Route
- Right Time
- Right Reason (includes necessary assessments, i.e. VS, labs; evaluations to determine if medication should be held or given; i.e. patient NPO, patient on stool softener having diarrhea)
- Right Documentation
- Right Response
2
Q
The eight rights of medication administration are…
A
The nurse’s legal obligations when giving any medication to increase patient safety and avoid medication errors!!!!
3
Q
Rights surrounding medication administration: Patient’s rights
A
- Right to be educated about all medications being taken (can include referral to pharmacist)
- Right to refuse
THESE ARE NOT THE SAME AS THE NURSE’S LEGAL RESPONSIBILITIES WHEN GIVING ANY MEDICATION!!!!
4
Q
Abbreviation: PO
Route:
Sample Medication:
A
Abbreviation: PO
Route: Oral
Sample Medication: Amoxicillin
5
Q
Abbreviation: ID
Route:
Sample Medication:
A
Abbreviation: ID
Route: Intradermal
Sample Medication: PDD
6
Q
Abbreviation: IM
Route:
Sample Medication:
A
Abbreviation: IM
Route: Intramuscular
Sample Medication: Morphine
7
Q
Abbreviation: PR
Route:
Sample Medication:
A
Abbreviation: PR
Route: Per Rectal
Sample Medication: Biscadyl
8
Q
Abbreviation: Transdermal
Route:
Sample Medication:
A
Abbreviation: Transdermal
Route: Transdermal
Sample Medication: Nicotine
9
Q
Abbreviation: Eye
Route:
Sample Medication:
A
Abbreviation: Eye
Route: Eye
Sample Medication: Erythromycin
10
Q
Abbreviation: NGT
Route:
Sample Medication:
A
Abbreviation: NGT
Route: Nasogastric Tube
Sample Medication: Crushed/Dissolved Medications
11
Q
Abbreviation: PEG
Route:
Sample Medication:
A
Abbreviation: PEG
Route: Percutaneous Endoscopic Gastric
Sample Medication: Crushed/Dissolved Medication
12
Q
Abbreviation: SC
Route:
Sample Medication:
A
Abbreviation: SC
Route: Subcutaneous
Sample Medication: Insulin
13
Q
Abbreviation: IV
Route:
Sample Medication:
A
Abbreviation: IV
Route: Intravenous
Sample Medication: Normal Saline
14
Q
Abbreviation: SL
Route:
Sample Medication:
A
Abbreviation: SL
Route: Sublingual
Sample Medication: Nitroglycerin
15
Q
Abbreviation: Ear
Route:
Sample Medication:
A
Abbreviation: Ear
Route: Ear
Sample Medication: Debrox
16
Q
Abbreviation: Nares
Route:
Sample Medication:
A
Abbreviation: Nares
Route: Nares
Sample Medication: Saline
17
Q
Abbreviation: Vag
Route:
Sample Medication:
A
Abbreviation: Vag
Route: Vaginal
Sample Medication: Nuva Ring
18
Q
Abbreviation: Top
Route:
Sample Medication:
A
Abbreviation: Top
Route: Topical
Sample Medication: Neosporin
19
Q
Abbreviation: INH
Route:
Sample Medication:
A
Abbreviation: INH
Route: Inhalation
Sample Medication: Albuterol
20
Q
What is the one route of administration not done in N205?
A
IV
21
Q
Medication Administration
Needed/Checked first
A
Needed first is physician’s order.
Checked first is physician’s order.
22
Q
Appropriate physician’s order includes:
A
- Order sheet with patient name and MR# stamped on sheet.
- Medication with dose clearly written.
- Route
- Frequency
- Start date (date and time order written)
- End date, if applicable (narcotic usually good for 72 hours; some antibiotics good for 72 hours, 5 days, 7 days; in long term facilities, medications are renewed every month)
- Patient allergies
- Patient weight if medication is weight based
- Legible physician’s signature.
23
Q
Medication Administration Record (MAR)
Components of correct medication order on the MAR:
A
- Patient’s name and MR# stamped on sheet
- Patient allergies OR NKA (no known allergies) to signify that presence of allergies was checked.
- Patient weight
- Start and end date of medication
- Medication with dose clearly written
- Route
- Frequency
- Any parameters as applicable, i.e. hold if HR<60 bpm
24
Q
Medication Administration Record (MAR)
Computerized MARs generated by pharmacy may be confusing with addition information supplied:
A
- How much medication is mixed
- Concentration of medication prior to being mixed
- What medication is mixed with
- Initials of who prepared the medication
- Abbreviations ‘UND’ signifying the amount to further dilute the medication or over what period of time to give medication.
- Abbreviations not understood or no longer acceptable to use.
25
With MAR, always ascertain the required information for giving the medication:
```
MEDICATION
DOSE
ROUTE
FRQUENCY
TIME
```
26
Abbreviation: µ
Intended meaning:
Misinterpretation:
Use instead:
Abbreviation: µ
Intended meaning: Microgram
Misinterpretation: Mg (milligram)
Use instead: Mcg
27
Abbreviation: AD, AS, AU
Intended meaning:
Misinterpretation:
Use instead:
Abbreviation: AD, AS, AU
Intended meaning: Right ear, left ear, each ear
Misinterpretation: OD, OS, OU (right eye, left eye, each eye)
Use instead: Right ear, left ear, each ear
28
Abbreviation: OD, OS, OU
Intended meaning:
Misinterpretation:
Use instead:
Abbreviation: OD, OS, OU
Intended meaning: Right eye, left eye, each eye
Misinterpretation: AD, AS, AU (right ear, left ear, each ear)
Use instead: Right eye, left eye, each eye
29
Abbreviation: BT
Intended meaning:
Misinterpretation:
Use instead:
Abbreviation: BT
Intended meaning: bedtime
Misinterpretation: BID (twice a day)
Use instead: bedtime
30
Abbreviation: cc
Intended meaning:
Misinterpretation:
Use instead:
Abbreviation: cc
Intended meaning: Cubic centimeters
Misinterpretation: U (units)
Use instead: mL (milliliters)
31
Abbreviation: D/C
Intended meaning:
Misinterpretation:
Use instead:
Abbreviation: D/C
Intended meaning: Discharge or discontinue
Misinterpretation: Unclear what is meant
Use instead: Discharge Discontinue
32
Abbreviation: IJ
Intended meaning:
Misinterpretation:
Use instead:
Abbreviation: IJ
Intended meaning: Injection
Misinterpretation: IV (intravenous) or intrajugular
Use instead: injection
33
Abbreviation: IN
Intended meaning:
Misinterpretation:
Use instead:
Abbreviation: IN
Intended meaning: Intranasal
Misinterpretation: IM or IV
Use instead: Intranasal
34
Abbreviation: HS hs
Intended meaning:
Misinterpretation:
Use instead:
```
Abbreviation: HS
hs
Intended meaning: Half strength
Bedtime
Misinterpretation: Bedtime
Half strength
Use instead: Half strength
Bedtime
```
35
Abbreviation: IU
Intended meaning:
Misinterpretation:
Use instead:
Abbreviation: IU
Intended meaning: International unit
Misinterpretation: IV or the number 10
Use instead: Units
36
Abbreviation: o.d. or OD
Intended meaning:
Misinterpretation:
Use instead:
Abbreviation: o.d. or OD
Intended meaning: Once daily
Misinterpretation: Right eye
Use instead: Daily
37
Abbreviation: OJ
Intended meaning:
Misinterpretation:
Use instead:
Abbreviation: OJ
Intended meaning: Orange juice
Misinterpretation: OD or OS
Use instead: Orange juice
38
Abbreviation: Per os
Intended meaning:
Misinterpretation:
Use instead:
Abbreviation: Per os
Intended meaning: By mouth, orally
Misinterpretation: OS for left eye
Use instead: PO, orally, by mouth
39
Abbreviation: q.d. or QD
Intended meaning:
Misinterpretation:
Use instead:
Abbreviation: q.d. or QD
Intended meaning: Every day
Misinterpretation: qid
Use instead: Daily
40
Abbreviation: qhs
Intended meaning:
Misinterpretation:
Use instead:
Abbreviation: qhs
Intended meaning: Nightly at bedtime
Misinterpretation: qhr (every hour)
Use instead: Nightly
41
Abbreviation: qn
Intended meaning:
Misinterpretation:
Use instead:
Abbreviation: qn
Intended meaning: Nightly or bedtime
Misinterpretation: qh (hourly)
Use instead: Nightly or bedtime
42
Abbreviation: q.o.d. or QOD
Intended meaning:
Misinterpretation:
Use instead:
Abbreviation: q.o.d. or QOD
Intended meaning: Every other day
Misinterpretation: q.d. or qid
Use instead: Every other day
43
Abbreviation: q1d
Intended meaning:
Misinterpretation:
Use instead:
Abbreviation: q1d
Intended meaning: daily
Misinterpretation: qid
Use instead: Daily
44
Abbreviation: q6PM
Intended meaning:
Misinterpretation:
Use instead:
```
Abbreviation: q6PM
Intended meaning: Every evening at 6PM
Misinterpretation: Every 6 hours
Use instead: Daily at 6PM
6 PM daily
```
45
Abbreviation: SC, SQ, sub q
Intended meaning:
Misinterpretation:
Use instead:
Abbreviation: SC, SQ, sub q
Intended meaning: Subcutaneous
Misinterpretation: SL for SC, 5 every for SQ, sub q with q=every
Use instead: Subcut or subcutaneously
46
Abbreviation: ss
Intended meaning:
Misinterpretation:
Use instead:
Abbreviation: ss
Intended meaning: Sliding scale (insulin) or 1/2 (apothecary)
Misinterpretation: 55
Use instead: Write sliding scale
47
```
Abbreviation: SSRI
SSI
Intended meaning:
Misinterpretation:
Use instead:
```
Abbreviation: SSRI
SSI
Intended meaning: Sliding scale regular insulin
Sliding scale insulin
Misinterpretation: Selective serotonin reuptake inhibitor
Strong solution of iodine (Lugol's
solution)
Use instead: Write sliding scale (insulin)
48
Abbreviation: i/d
Intended meaning:
Misinterpretation:
Use instead:
Abbreviation: i/d
Intended meaning: One daily
Misinterpretation: tid
Use instead: 1 daily
49
```
Abbreviation: TIW
BIW
Intended meaning:
Misinterpretation:
Use instead:
```
```
Abbreviation: TIW
BIW
Intended meaning: 3 times a week
2 times a week
Misinterpretation: Tid or twice a week
BID
Use instead: 3 times weekly
2 times weekly
```
50
Abbreviation: U or u
Intended meaning:
Misinterpretation:
Use instead:
Abbreviation: U or u
Intended meaning: unit
Misinterpretation: Number 4, 0, cc
Use instead: Unit
51
Abbreviation: UD
Intended meaning:
Misinterpretation:
Use instead:
Abbreviation: UD
Intended meaning: As directed
Misinterpretation: Unit dose
Use instead: As directed
52
Abbreviation: Trailing 0 after decimal point (1.0 mg)
Intended meaning:
Misinterpretation:
Use instead:
Abbreviation: Trailing 0 after decimal point (1.0 mg)
Intended meaning: 1 mg
Misinterpretation: 10 mg
Use instead: Do not use trailing 0 for whole numbers
53
Abbreviation: No leading 0 before decimal point (.5 mg)
Intended meaning:
Misinterpretation:
Use instead:
Abbreviation: No leading 0 before decimal point (.5 mg)
Intended meaning: 0.5 mg
Misinterpretation: 5 mg if decimal point not seen
Instead: Use 0 if dose not whole number
54
Abbreviation: Numeric dose and unit run together (1 mg, 10mL)
Intended meaning:
Misinterpretation:
Use instead:
Abbreviation: Numeric dose and unit run together (1 mg, 10mL)
Intended meaning: 1 mg
10 mL
Misinterpretation: M mistaken for 0
Use instead: Leave space between dose and unit of measurement
55
Abbreviation: Large doses without appropriate commas (1000000 units)
Intended meaning:
Misinterpretation:
Use instead:
Abbreviation: Large doses without appropriate commas (1000000 units)
Intended meaning: 1,000,000 units
Misinterpretation: Incorrect 0 count leading to incorrect dose given
Use instead: Use commas or write it out i.e. 1 million units
56
Abbreviation: MgSO4
Intended meaning:
Misinterpretation:
Use instead:
Abbreviation: MgSO4
Intended meaning: Magnesium Sulfate
Misinterpretation: Morphine sulfate
Use instead: Use complete drug name
57
Abbreviation: MS, MSO4
Intended meaning:
Misinterpretation:
Use instead:
Abbreviation: MS, MSO4
Intended meaning: Morphine sulfate
Misinterpretation: Magnesium sulfate
Use instead: Use complete drug name
58
Abbreviation: X3d
Intended meaning:
Misinterpretation:
Use instead:
Abbreviation: X3d
Intended meaning: Times three days
Misinterpretation: Times three doses
Use instead: for three days
59
Abbreviation: / (slash mark)
Intended meaning:
Misinterpretation:
Use instead:
Abbreviation: / (slash mark)
Intended meaning: Separates 2 doses or means 'per'
Misinterpretation: Mistaken for number 1
Use instead: Write 'per' to separate doses
60
Abbreviation: >and<
Intended meaning:
Misinterpretation:
Use instead:
Abbreviation: >and<
Intended meaning: Greater and less than
Misinterpretation: Mistaken for opposite meaning
Use instead: Write out greater or less than
61
Clinical Preparation for Giving Medications
Drug card required for each medication the patient is receiving with the following components:
1. Drug name (generic and trade)
2. Purpose of drug specific to patient
3. Action of drug
4. Side effects of drug (common ones)
5. Adverse reactions of drug
6. Nursing consideration (patient teaching, assessments such as labs, VS, food-drug interaction, drug-herbal supplement interaction)
62
Sample Drug Card
Warfarin (Coumadin)
(Only what is pertinent to the patient)
Name: Warfarin (Coumadin)
Purpose: Prevention of further clot formation, patient developed DVT post-operatively
Action: Prolongs clotting by...
Side Effects: Bruising, hematoma, bleeding...
Adverse Effects: Hemorrhage, hemorrhagic stroke, intracranial bleeding--> brain death
Nursing Considerations: Check PT and INR prior to giving medication and notify physician if greater than..., assess patient for bleeding, bruising, monitor H&H, maintain dietary restrictions (limit green leafy vegetables, no cranberry juice, etc...)
63
Checks and Balances in the Process of Giving a Medication
FIRST CHECK (Pyxis)
1. Read MAR and remove medication from patient drawer or Pyxis.
2. Compare medication label to MAR.
3. If dose does not match, determine if dose calculation is needed.
4. Check medication expiration date.
SECOND CHECK (Cup/Unopened)
1. While preparing the medication, look at medication label and check against MAR.
2. Preparation of medication may include drawing up, pouring, or placing unopened pill package in medication cup.
THIRD CHECK (Beside before opening)
1. Recheck label on container before returning it OR
2. Check label on medication against MAR before opening package at bedside.
***COMPUTERIZED MEDICATION ADMINISTRATION SYSTEMS INCORPORATE THESE
CONCEPTS.
64
SPECIFIC MEDICATION CHECKS
| ALWAYS double check with another licensed person the following medications:
Anticoagulants
Insulins
Digoxin
(Hospital protocols vary and other medications may be included.)
65
Site Cods
```
A. Right upper outer quadrant gluteus
B. Left upper out quadrant gluteus
C. Right outer aspect arm
D. Left outer aspect arm
E. Right ventrogluteal
F. Left ventrogluteal
G. Avdomen
H. Right thigh
I. Left thigh
```
66
Assessments prior to medication administration:
1. Allergies to any medications
2. Patient ability to swallow (PO meds)
3. Presence of nausea, vomiting, diarrhea that would interfere with absorption of medication (PO, NG, GT, rectal suppository)
4. Specific drug actions, side effects, interactions, adverse effects
5. Patient knowledge/learning needs regarding medication
6. Perform appropriate assessments (labs, VS, etc.)
7. Determine if assessment data influences administration of medication (should it be given or held)
67
Process of administering medication
1. Identify patient using 2 qualifiers
2. Inform the patient
3. Administer the medication(s) using the first 5 rights (right patient, drug, dose, route, time)
4. Provide adjunct interventions as needed (i.e. correct position for injection)
5. Record medication administered
6. Evaluate patient response to the medication
68
NGT/Gastrostomy Tube Medication Administration
```
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
```
69
Syringe Types
1 mL
Tb syringe with or without needle attached
70
Syringe Types
Insulin
100 unit, 50 unit, 30 unit sizes with needle attached
71
Syringe Types
3 mL
with and without needle attached
72
Syringe Types
5 mL (with and without needle attached)
with and without needle attached
73
Other syringe types...
10mL
20mL
60mL
60mL piston tip or catheter tip used for GT/NGT medication administration
74
About Needles:
1.
Gauge: from #14-29 (the smaller the needle number, the larger the size of the needle)
75
About Needles:
2.
Hub: part attaching to syringe
76
About Needles:
3.
Cannula/shaft: length of needle from 3/8 to 2 inches
77
About Needles:
4.
Slant or bevel: slanted part at tip of needle
78
INTRADERMAL INJECTIONS
Syringe size: 1 ml TB syringe
Needle gauge: #25-27
Needle length: ¼-5/8 inch long
Solution amount: 0.1 ml (usually)
Injection sites: R & L scapulas, R & L upper chest, R & L forearms
Common uses: TB testing, allergy testing
How administered Just under skin, bevel side up (will see weal)
79
SUBCUTANEOUS INSULIN
Syringe size: 100 unit, 50 unit, 30 unit (orange needle cap)
Needle gauge: #25-29
Needle length: 3/8-5/8 inch
Solution amount: Determined in units, but never more than 1 ml
Injection sites: Abdomen, upper thighs, upper back below scapulas, posterior of upper arms, posterior hips
Common uses: Insulin, which there are several types
How administered: Normal adult size 45 degree angle
Large adult size 90 degree angle
Special considerations: Rotate sites, give at room temperature, do not aspirate
80
SUBCUTANEOUS INJECTIONS
Syringe size: 1 ml (TB syringe)
Needle gauge: #25-27
Needle length: 3/8-5/8 inch
Solution amount: 0.5-1 ml, varies but not more than 1 ml
Injection sites: Abdomen, upper thighs, upper back below scapulas, posterior of upper arms, posterior hips
Common uses: Insulins, vaccines, epinephrine, heparin, low molecular weight heparin
How administered: Normal adult size 45 degree angle
Large adult size 90 degree angle
Special considerations: With LMW heparin and heparin, do not aspirate, do not massage, do rotate sites
81
INTRAMUSCULAR INJECTIONS
Syringe size: 3-5 ml (3ml most common)
Needle gauge: #20-25 gauge (varies with site being used, size of person and viscosity of injectate
Needle length: 1-2 inches (varies with site used and size of person
Solution amount: 0.5-3ml (varies with site)
Injection sites: Deltoid, ventrogluteal, vastus lateralis, rectus femoris
Common uses: Narcotic and NSAIDs, vitamins, antibiotics
How administered: Use Z track method, 90 degree angle
Special considerations: Deltoid site: 0.5-1 ml, #23-25 gauge, 1 inch
Obese adult may need 2 inch needle
Emaciated adult: may need 1 inch needle
Very viscous solution: may need larger size needle
82
PREPARING MEDICATIONS FROM AMPULES:
List the steps for preparing a medication from an ampule:
STEPS:
83
PREPARING MEDICATIONS FROM VIALS
List the steps for preparing m
edications from a single dose vial and the variation for preparing from a multi-dose vial:
STEPS:
84
PREPARING INSULIN
List the steps for preparing insulin and the variations for mixing 2 types of insulin in one syringe:
STEPS:
85
Types of Insulin:
***Regular (Humulin R, Novolin R, regular insulin)
SOLUTION: Clear
ONSET: 1/2-1 hour
PEAK ACTION: 2-3 hours
DURATION: 5-7 hours
86
Types of Insulin:
***Insulin aspart (Novolog)
SOLUTION: Clear
ONSET: 15 minutes
PEAK ACTION: 40-50 minutes
DURATION: 3-5 hours
87
Types of Insulin:
***Insulin lispro (Humalog)
SOLUTION: Clear
ONSET: <15 minutes
PEAK ACTION: 1/2-1 hour
DURATION: 3-4 hours
88
Types of Insulin:
***Insulin Isophane NPH (Humulin N, Novolin N)
SOLUTION: Cloudy
ONSET: 1-2 hours
PEAK ACTION: 4-12 hours
DURATION: 18-24 hours
89
Types of Insulin:
Insulin Protamine Zinc Lente
SOLUTION: Cloudy
ONSET: 1-2 hours
PEAK ACTION: 8-12 hours
DURATION: 18-24 hours
90
Types of Insulin:
Insulin Zinc suspension Ultralente
SOLUTION: Cloudy
ONSET: 4-8 hours
PEAK ACTION: 16-18 hours
DURATION: 36 hours
91
Types of Insulin:
Insulin Zinc suspension prompt
SOLUTION: Cloudy
ONSET: 1/2-1 hour
PEAK ACTION: 4-7 hours
DURATION: 12-16 hours
92
Types of Insulin:
***Insulin glargine (Lantus)
SOLUTION: Clear
ONSET: Continuous effects
PEAK ACTION: Continuous effects
DURATION: 10 1/2-24 hours
