Medications Flashcards
(88 cards)
1
Q
What are medication errors?
A
- anything that violates the 5 rights
- mislabeled medications
- incomplete delivery
- incorrect order
2
Q
What do we do to prevent medication errors?
A
- POE systems, infusion pumps
- effective communication
- Barcode scanning
- IPE Simulation
3
Q
What is barcode medication administration?
A
- scan the barcode on the bracelet
- scan the medication barcode to ensure the 5 rights
4
Q
What is the culture of safety?
A
Reporting errors to identify issues, fix systems, and improve safety
5
Q
What is Positive Culture?
A
a workplace that rewards employees for ceasing work that may be unsafe and encourages employees to be aware, identify, and address hazards asap to avoid potential risks
6
Q
What are the concerns about medication interactions?
A
- some medications can interact with other meds
- rendering ineffective
7
Q
What are the components of medication order?
A
- name of medication
- route
- dose
- frequency/time
- reason/purpose
- provider signature
8
Q
What are the types of medication orders?
A
- PRN
- IV meds
- Scheduled/Routine orders
- One-time orders
- Stat orders
- Standing orders
- Electronic (EPIC)
- Verbal orders (only in emergency)
9
Q
Pravastatin used for?
A
Hyperlipidemia
10
Q
Glipizide used for?
A
Diabetes
11
Q
Olmesartan used for?
A
HTN
12
Q
Nexium used for?
A
GERD
13
Q
What history should you ask a pt regarding medications?
A
Medication hxt, allergies, diet, family hxt
14
Q
What should you include in a physical assessment of a patient receiving medications?
A
vitals, ability to swallow, skin assessment for allergic reaction, gastrointestinal motility, patient venous access, adequate muscle mass, body system assessment, assessment of knowledge and compliance
15
Q
What is safe medication administration?
A
- check/interpret
- calculate right dose for adult vs children vs elderly
- tell the pt what you are giving
- assess the pt’s understanding and knowledge
- assess pt allergies and hxt
- administer according to the 5 rights
16
Q
What are the 5/6 right rights of medication administration?
A
- right dose
- right route
- right pt
- right medication
- right time/frequency
- right documentation (includes time, route, dose, date, site, initials, and signature; document meds require 2 signatures; document therapeutic and side effects of meds)
- pt’s right to refuse medication (unspoken rule)
17
Q
What are special considerations with children and elderly patients?
A
- ability to swallow
- dosage
- capacity to take medications (adherence)
- dilute medications with their favorite beverage
- crush pills, allow extra time
18
Q
What are the principles of documentation?
A
- never record med before giving the med
- record only the med you give
- record on MAR asap
- record refused medication as such
- record positive, negative, and allergic effects of meds
19
Q
What are unit dose medications?
A
- prepackaged medications
- prelabeled
- safe and cost-effective
- prepared by the pharmacy for individual pts
20
Q
What are some high-risk medications?
A
- potassiums
- insulin
- heparin
- narcotics
21
Q
What is a PCA?
A
Patient Controlled Analgesia (ex. “pain pump”)
22
Q
What is a basal rate?
A
continuous rate (usually used for end-of-life patients)
23
Q
What is a Bolus rate?
A
bolus or demand dose is the dose of medication delivered each time the pt presses the button
24
Q
What pills cannot be crushed?
A
- ER meds (sustained/time-released meds)
- capsulated meds
- enteric coated meds
25
How do you pour a multi-dose med?
pour into med cap then into a cup; do not touch
26
What is the reconstitution of meds?
mixing a powdered medication
27
How much larger should the syringe be when giving a medication?
at least .5-1 cc larger than the amount of medication
28
What kinds of needles are best to use?
safety needles (with safety cap that slides up)
29
Where is subcutaneous medication given?
delivered in the subcutaneous layer for the purpose of a slow sustained released of medication
30
What are some meds we give SQ?
insulin, heparin, vaccines, some narcotics, and others
31
What are some areas for SQ injections?
- abdomen
- lateral aspect of upper arms
- anterolateral mid-thigh
- buttocks
32
What is the length and gauge of the needle for SQ medication?
a syringe with a short needle 1/2-5/8 inch; gauge 26-30, 25 common
33
Is regular insulin short or long-acting? What about NPH?
short-acting (regular insulin); intermediate (NPH)
34
What is the onset, peak, and duration of regular insulin and NPH?
- (reg insulin) onset 30-60 min, peak 2-3 hours
LOOK AT SLIDES
35
What syringe will you use to draw up insulin?
an insulin-specific syringe to administer (with an orange cap)
36
Insulin: 1cc = how many units?
100
37
Which insulin will you draw up first and second?
short-acting before long-acting
(clear before cloudy)
(reg insulin before NPH)
38
If you overdraw your insulin dose, what do you do?
start over
39
How would you verify the am dose of insulin?
verify with a second nurse
- two nurses independently check orders, medication, and 5 rights
40
What are the side effects of reg insulin and NPH insulin? When would you see them? What intervention would you employ?
- side-effect: hypoglycemia (during peak early day w/ reg insulin; during peak mid-day w/ NPH insulin)
- intervention: give a snack
41
What is Aspart (Novolog) an Lispro (Humulog)?
RAPID acting insulins
42
What is the onset, peak, and duration of Novolog and Humulog?
onset: 15 min
peak: 1-2 hrs
duration: 3-4 hrs
43
What is Glargine (Lantus)?
Long-acting insulin
44
What is the onset, peak, and duration of Lantus?
onset: 2-4 hr
peak: none
duration: 20-24 hrs
45
How long do you hold down a Novolog pen?
10 SECONDS
46
What is unfractionated heparin?
most potent form; IV form; given continuously (usually)
47
What is low molecular weight heparin?
anticoagulant with more predictable pharmacokinetics and anticoagulation predictability (ex. Levonox aka Enoxaparin)
48
What is the purpose of IM injection?
gets quickly absorbed via blood vessels in the muscular area
49
What size syringe, needle, and gauge is used for IM injection? adult vs children
needle: 20-23 gauge, 1-1.5 inch (adults); 22-27 gauge, 1/2-1 inch (children)
50
What is the angle at which you administer IM injection?
90 degrees
51
What are the sites for IM injections?
- ventrogluteal (hip)
- dorsogluteal (butt)
- rectus femoris (thigh)
- vastus lateralis (thigh)
- greater trochlear (upper thigh)
LOOK AT SLIDES
52
What is the preferred site for adults? for children?
ventrogluteal (adults); vastus lateralis (children)
53
What is the highest volume of IM injections given to adults?
3cc max (adults); exception is deltoids which is 1-2. ml
54
What is the highest volume of IM injections given to children?
LOOK AT SLIDES
55
What is Intradermal injection? name an example
between the layers of the skin; PPD test and allergy test
56
How much volume is given for intradermal injection?
0.1 ml (PPD) to 0.5 ml (allergy)
57
Bevel should be up or down when injecting intradermal injection?
up
58
What are Pharmacokinetics?
absorption, distribution, metabolism, and excretion
59
What are pharmacodynamics?
Therapeutic effects, adverse effects, side effects, tolerance, allergic reactions, toxicity
- drug interactions
60
SC injections: what size and gauge needle and at what angle do you inject?
- 1/2 to 5/8 inch, 25-27 gauge
- avg adult: 90 degrees
- small child or emaciated adult: 45 degrees
61
What cap color is an insulin syringe?
- orange
62
What is considered a regular dose of insulin?
100 units = 1cc
63
Regular Insulin is _____ acting/
short
64
What is the onset, peak, and duration of regular insulin?
- onset: 30-60min
- peak: 2-3 hours
- duration: 3-6 hours
65
NPH is ____ acting.
intermediate
66
What is the onset, peak, and duration of NPH insulin?
- onset: 2-4 hours
- peak: 4-10 hours
- duration: 10-16 hours
67
What is the onset, peak, and duration of Aspart (Novolog) and Lispro (Humolog)?
- onset: <15min
- peak: 1-2 hours
- duration: 3-4 hours
68
Aspart and Lispro are ____ acting.
rapid
69
Glargine (Lantus) is ____ acting.
long
70
What is the onset, peak, and duration of Glargine (Lantus)?
- onset: 2-4 hours
- peak: none
- duration: 20-24 hours
71
When you mix regular and NPH insulin, which do you draw up first?
regular (clear first then cloudy)
72
When do you use an Accu-Check machine?
for glucose monitoring pre-meals and at bedtime for diabetic patients or patients on TPN/CPN
73
What is Unfractionated Heparin?
usually given IV for pulmonary embolus related to DVT and can be used SC
74
Why do you draw up air when drawing up Heparin?
to prevent leakage of heparin into intradermal layers
75
Do you massage or run after a Heparin injection?
NO
76
What is an example of a low molecular weight heparin (LMWH)?
Lovenox (Enoxaparin)
77
What is the purpose of IM injection?
used for medications that are irritating, so less likely to cause tissue necrosisWh
78
What has a quicker onset onset of action: SC or IM injection?
IM injection
79
What degree should you inject for IM?
90 degrees
80
What degree should you inject for Intradermal?
15 degrees
81
What size syringe should you use for IM?
- 20 to 23 gauge, 1 to 1.5 inch for adults
- 22 to 27 gauge, 1/2 to 1 inch for infants/children
82
What are the sites for IM injection? Which is the preferred site for adults and then for children?
1. Ventrogluteal (preferred site for adults)
2. Vastus Lateralis (preferred site for children)
3. Deltoid
4. Rectus Femoris
5. Dorsogluteal (not likely due to sciatic nerve)
83
What is the max safe amount to give injections for infants/toddlers?
0.5cc to 2cc
84
How to find the deltoid site?
1-3 fingers breaths below edge of Acromium Process
85
What is the safe volume for deltoid IM injection for younger children?
0.5cc
86
What is the safe volume for deltoid IM injections for older children?
1cc
87
What is the volume amount to be given for an intradermal injection?
0.1cc to 0.5cc
88
When is a PPD test positive?
- 15mm for a healthy person
- 10 mm for a person w/ underlying disease or healthcare worker in a high risk setting
- 5mm for a person w/ underlying autoimmune disease
