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Flashcards in Medications Deck (44)
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1
Q

How are meds handled in OR?

A

Prepared and delivered to sterile field by circulator
Scrub nurse prepares and labels
Meds are administered by surgeon
Circulator documents

2
Q

5 steps of medication process?

A
Med procurement 
Prescribing 
Transcribing/documenting
Dispensing/preparation 
Administration
Pt monitoring
3
Q

Pre op assessment/interview related to meds?

A

Med Rec
- what is patient currently taking
- prescriptions, OTC, herbal, street drugs
When were meds last taken?
Were any meds d/c’d as per pre op instructions
- notify surgeon and anesthesia if meds were taken or not taken
Allergies
Pt weight, age, med hx

4
Q

Near miss of med admin?

A

Detected before administration

Can occur at any point of med admin process

Errors influenced by many factors

5
Q

What do you need to know about meds when administering?

A
Usual route
Routes of admin
Limits on rate & max dose
Duration of action 
Changes expected 
Normal and abnormal reactions
Appropriate actions to take if unwanted reaction occurs
6
Q

What are you monitoring for after administering meds?

A

Side effects

  • CNS disturbances
  • hypersensitivity

Adverse reactions

  • N/V
  • diaphoresis
  • palpitations

Allergic reactions

  • laryngeal edema
  • high temp
  • tachy
7
Q

Documentation of meds?

A
Timely manner
Legible 
Easily accessible
No abbreviations
Consistent format
8
Q

What is a consistent format for documentation of meds?

A
Name of med
Concentration 
Date and time administered 
Time completed 
Team member administering
Pt response 
Admin rate 
Route 
Amount of multiple injections of same med
9
Q

Who can give med orders?

A

Anesthesiologist
Surgeons
Advance practice RNs

10
Q

Safety for procurement of meds?

A

Use single dose units
Use prefilled syringes
Limit # of concentrstions available
Purchasing in a size close to anticipated dose

11
Q

Scheduling of medications?

A

1 - no medical use - heroin
2 - high potential for abuse/dependence - methadone
3 - low/moderate potential for dependence - codeine
4 - low potential for abuse - ativan
5 - lowest potential for abuse

12
Q

Storage of medications?

A

All meds and rekated supplies must be stored securely in areas with likited access

All class 2, 3, 4 & 5 must he in locked location

13
Q

Orgaization of med storage?

A

Standardized manner

Seperate by generic name and packaging
Seperate high alert meds
Seoerate bins/dividers for all meds
Labelling with tall man lettering 
Position so label visible
AVOID alphabetical storage
14
Q

Writting verbal orders?

A

No trailing zeros
Use leading zeros
No abbreviations

15
Q

Problem with verbal orders?

A

High chance of errors

  • confirm by reading order back to surgeon
  • record in pt chart
  • have surgeon review, validate and sign order
16
Q

What is required on preference card?

A

Helps streamline process of ibtaining supplies
Allows to focus on pt care

Needs:
Procedure name
Pt position/devices
Instruments
Meds 
Irrigation solution 
Sutures 
Dressings
17
Q

Can you retrieve meds for multiple pts at once?

A

No
High chance of error

1 pt at a time

Verifying med to original order

18
Q

What is compounding meds?

A

Combining 2 or more meds together

Never compound more than 3

Preferred to be done in pharmacy
- sterile

When done in OR compound for immediate use

Administer within 1hr of compounding, continually observe for contamination

19
Q

Steps to compounding?

A

Hand hygiene
Disinfect surfaces
Aseptic technique
Use dispensing equipment or a sterile syringe to remove
Verify correct medication, amount and concentration
Visually inspect
Apply label if not being used immediately

20
Q

Labelling compound solution off sterile field?

A
Pt identification
Names and amounts of all ingredients 
Name of who prepared
Date of prep
The beyond use date and time
Different colour labels with multiple concentrations 
Full medication name
Tall man lettering
21
Q

Labelling compound meds on sterile field?

A

Med name, strength, dilution and dilutent
Date and time accepted onto sterile field
Full med name
Tall man lettering

22
Q

Who performs double checks on high alert meds?

A

2 licensed individuals

Ex. Heparin, insulin

23
Q

Common causes of med errors?

A
Dose miscalculation 
Name mix ups
Omission errors
Wrong time 
Syringe swap 
Neglecting MIFU
24
Q

Rights to med admin?

A
Patient
Med
Dose
Route
Time
Strength/concentration 
Rate
Infusion pump settings
25
Q

What orders must be documented?

A

Verbal orders
Standing orders
Orders on preference cards
Order sets

Documented, dated, timed wnd authenticated

26
Q

Routes of med admin transfered onto sterile field?

A

Injection
Topical
Irrigation
Flush

27
Q

What reverses effects of heparin?

A

Protamine

28
Q

What does papaverine hydrochloride do?

A

Muscle relaxant

Treat spasms

29
Q

Medications common in OR?

A
Local anesthetic 
Antibiotics 
Anticoags
Cardiac agents
Epinephrine
30
Q

Chemo therapy agents?

A

Hazardous
Follow MIFU when mixing
Limit exposure

Wear PPE
- change gloves q30min

31
Q

What does contrast media do?

A

Enhances the visibility of blood vessels, fluid and other structures

32
Q

2 fluid related complications?

A

Extravasation - absorbed into surrounding space

Intravasation - absorbed into bloodstream

33
Q

Tools to increase accuracy of fluid measurement?

A

Drapes designed for fluid collection
Closed suction containers
Fluid pumps

34
Q

Steps of fluid management?

A
Consultation with surgeon 
Monitor I&O during procedure
Report fluid deficits
Monitor pt for retention
- edema, labs, temp, VS
Document
35
Q

Non electrolyte fluids?

A

Low viscosity
Often used with monipolar instruments
Hypotonic fluids
Cause cause TUR syndrome

Ex mannitol, glycine, sorbitol

36
Q

Normal saline?

A

Often used in bipolar
Isotonic
Safer is absorbed

37
Q

High viscosity fluids?

A

Do not blend with blood
Provides good visibility

Ex. Dextran
- can draw 6x its own volume into blood stream

38
Q

Methylene blue dye?

A

Common dye/staining agent

Main purpose of using is to check for leaks

39
Q

Examples of hazardous chemical agents?

A
Anesthetic gases
Toxic fumes
Cytotoxic agents 
Cleaning agents
Tissue preservatives
Methyl methacrylate
40
Q

Handling hazardous agents?

A
As per MIFU
Store as per requirements
PPE
Dispose PPE in hazardous disposal containers
Hand hygiene 
Leak proof containers
Follow safety data sheets
Have spill kits available
Immediate attention if exposed
Never spray cleaners when cleaning
Follow MFIU when cleaning
41
Q

Eye wash station?

A

Easily accessible
- 10sec away from chemical use/storage
Deliver warm water between 60-100F at rate of 1.5L/min
Flush stations weekly

42
Q

What is drug diversion?

A

When prescription drugs are used/obtained illegally

43
Q

What is mannitol used for?

A

Treat intracranial pressure

Diuretic

44
Q

Common anaphylactic symptoms?

A
Headache
Anxiety
Stridor
Abd pain
Tachy
Hypotension
Itchiness
Swelling