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Taylor Fundamentals of Nursing Chapter medication 28
Concepts of Nursing
Terms in this set (114)
Physician, dentist, PA, and advance practice nurses (clinical nurse specialist, NP, CRNA, and nurse midwife)
Principles of pharmacology
drug nomenclature, types of drug preparation, drug classification, mechanism of drug action, adverse drug effects, and factors affecting drug action, as well as drug blood level monitoring.
classified by effect on body systems, chemical composition, or by clinical indication for the drug or therapeutic effect
Mechanism of drug action
absorption, distribution, metabolism, and excretion
process by which a drug is transferred from its site of entry into the body to the bloodstream.
route of admin, lipid solubility, pH, blood flow, local conditions at the site of admin, drug dosage.
Goal of drug dosing
to give a dose that achieves the desired therapeutic effect of the drug without causing other undesirable effects
depends on blood flow to the tissues, the drug's ability to leave the bloodstream, and the drug's ability to enter the cells.
biotransformation of a drug from its original form to a new form. Liver is the primary site.
the process of removing a drug, or its metabolites, from the body. The kidneys excrete most drugs.
Elderly implications r/t excretion
manufactures are required by law to include specific information regarding implications on geriatric patients. the law effects psychotropic drugs, nonsteriodal anti-inflammatory agents, oral hypoglycemic agents, anticoagulants, certain broad spectrum ABX, and cardiac drugs.
Drug receptor interaction
the drug interacts with one or more cellular structures to alter cell function
Drug enzyme interaction
a drug combines with an enzyme to achieve desired effects
Adverse drug effects
secondary undesirable effects other than the intended therapeutic effect of a drug
Types of adverse effects
allergic effect, drug tolerance, toxic effects, idiosyncratic effects, drug interactions, predictable, iatrogenic disorder
is an immune response that occurs when the body interprets the administered drugs as foreign substance and forms antibodies against the drug
Allergic effect s/s
rash, urticaria, fever, diarrhea, n/v, and anaphylaxis (a life threatening response due to respiratory distress)
the body becomes accustomed to the effects of a particular drug over a period of time
are specific groups of symptoms related to drug therapy that carry risk for permanent damage or death.
Toxicities can occur from this. It occurs when the body cannot metabolize one dose of a drug before admin of the next dose.
is any unusual or peculiar responses to a drug that may manifest itself by over response, under response, or even the opposite response
one drug is affected in some way by another drug, or another substance that is taken at the same time
combined effect of two or more drugs acting simultaneously produces an effect less than that of each drug alone
combined effect of two or more drugs acting simultaneously produces an effect greater than that of each drug alone
Factors affecting drug action
developmental considerations, patient's body weight, patient's gender, genetic and cultural factors, psychological factors, pathology, environment, and timing of medication admin
Parts of a medication order
patients name, date and time the order was written, name of the drug, dosage, route, frequency, and signature of person writing the order
1st check of medication administration
when the nurse reaches for the container or unit dose package
2nd check of medication administration
after retrieval from the drawer and compared with the CMAR or compared with the CMAR immediately before pouring from multidose containers
3rd check of medication administration
when placing the container to the drawer or shelf or before giving the unit dose medication to the patient
right medication, patient, dosage, rouse, time, reason, documentation
Safety measures while preparing drugs
Three checks and the rights of medication administration, maintaining a safe environment, handling controlled substance safely, identifying patient
Required information for narcotics
name of patient receiving the narcotic, amount of the narcotic used, hour the narcotic was given, name of the physician who prescribed it, name of the nurse who administered it.
the most commonly used route of admin. it is usually the most convenient and comfortable for the pt. drug action has a slower onset and a more prolonged, but less potent, effect.
Sold oral drugs
tablets, capsules, and pills
Don't chew or crush...
enteric coated tabs, extended release forms such as SR (sustained release), XL (extended release), CR or CRT (controlled release), SA (sustained action), or LA (long acting)
Liquid oral drugs
elixirs, spirits, suspensions, and syrups
Administering liquid oral drugs
syringe should be placed between the gums and cheek with pt sitting up or lying on side, medication admin slowly
Enamel discoloring drug admin techniques
have the pt take the medication mixed with liquid through a straw, and encourage the pt to drink water after admin
Bad tast drug admin techniques
crush the med and mix with a food or a drink, allow the pt to suck on a small piece of ice for a few minutes before admin, store oily meds in refrigerator, place the meds in a syringe and place the syringe well back on the tongue, offer oral hygiene immediately after admin, give with generous amounts of fluid
Children drug admin techniques
use a dropper while holding in sitting or semi sitting, crush uncoated tablets or empty soft capsules and mix with food, offer a flavored ice pop before admin, praise the child for taking the med
Geriatric drug admin techniques
allow extra time, crush or give meds in liquid form, reevaluate the drug dosage, assist with setting up a med schedule, monitor closely for adverse effects, teach the pt the names of drugs rather than distinguishing between color or shape.
Successful self management of medication in geriatric patients
establishing habits, adjusting routines, tracking medications, simplifying medication practices, and improving patient education related to the relationship of medications to maintaining health.
GI tube drug admin techniques
use liquid meds when possible, crush and combine with liquid, certain capsules may be opened and emptied into a liquid, bring liquid meds to room temp, elevate HOB, remove the clamp from the tube and use the recommended procedure for checking tube placement before admin, flush the tube with 15-30ml of water before and after admin, give meds separately and flush with water between each drug, disconnect from suction, d/c continuous tube feeding, document water and liquid medication intake.
Sublingual and buccal drug admin techniques
medications should not be swallowed, but rather held in place so that complete absorption can occur. Before admin off the pt a drink or provide oral care to an NPO pt.
Administering parenteral medications
Injecting meds into an artery, the peritoneum, heart tissues, the spinal canal, and bones
Gauge of needle
refers to diameter of needle, as the diameter increases the gauge decreases
Route of admin
a longer needle is required for an IM injection than for an intradermal injection.
Viscosity of the solution
some medications are more viscous than others and require a large lumen needle to inject the drug
Quantity to be administered
the larger the amount of med to be injected, the greater the capacity of the syringe
an obese person requires longer needles to reach the muscle than does a thin person.
Type of medication
there are special syringes for certain uses.
use filter needle to remove meds. then place an unfiltered needle to admin.
good for 24 hours. Label the vial with date and time of opening. Wipe down rubber stopper before each use, and inject the equivalent amount of air in vial before removal of med.
Prefilled cartridge or syringe
single dose of medication. Overfilled usually so eject until exactly correct amount remaining for admin.
admin into the dermis just below the epidermis. Has the longest absorption time of all parental routes. Used for sensitivity tests and local anesthesia
inner surface of the forearm and the upper back under the scapula.
TB syringe, a 1/4" to 1/2", 26-27 gauge needle.
usually less than 0.5ml
Intradermal angle of admin
are administered into the adipose tissue layer just below the epidermis and dermis. This tissue has few blood vessels so drugs have a slow sustained rate of absorption.
outer aspect of arm, abd, anterior aspect of thigh, upper back, and the upper ventral or dorsogluteal area. avoid areas that are bruised, tender, hard, swollen, inflamed, or scarred.
abd quickets, arms, thighs, and upper ventral or dorsogluteal slowest
25-30 gauge, 3/8" to 1" needle. the 3/8" and 5/8" needle most common. choose needle length based on the amount of sub-q tissue present.
no more than 1ml
Sub-Q angle of admin
pinch or fold skin, insert needle, release skin, inject meds. If blood or fluid comes out after removal of needle apply gentle pressure to spot. Massaging area is not necessary and can damage tissue. Rotate sites.
28-30 gauge 5/16" to 1/2" needle, and 3/10mL to 1mL sizes.
larger and greater blood vessels allow for faster onset of action than sub-q. Some have longer durations.
IM sites inaccurate complications
abscesses, cellulitis, injury to blood vessels, bones, and nerves, lingering pain, tissue necrosis, and periostitis. Avoid areas that are bruised, tender, hard, swollen, inflamed, or scarred
ventrogluteal, vastus lateralis, deltoid,
involves gluteus medius and gluteus minimus muscles in hip area. to relax the muscle pt may flex knees while supine, point toes inward while lying in prone, and flex upper leg in front of lower leg in side lying.
place the palm of your hand over the greater trochanter, with your fingers facing the patient's head. the right hand is used for the left hip. place the index finger on the anterosuperior iliac spine and extend the middle finger dorsally, palpating the iliac crest. A triangle is formed and the injection goes in the middle of the triangle.
involves the quadriceps femurs muscle and is located along the anterolateral aspect of the thigh.
Vastus lateralis location
divide the thigh into thirds horizontally and vertically and administer the injection in the outer middle third.
lateral aspect of the upper arm. used for vaccines in adults and children 1-18. Damage to radial nerve and artery is a risk. Limited to 1mL.
palpate the lower edge of the acromion process. A triangle is formed at the midpoint in line with the axilla on the lateral aspect of the upper arm, with the base of the triangle at the acromion process.
Needle length based on location and age of pt. Gauge determined by med being admin. Biological agents with a 20-25 gauge needle. Oil based solutions 18-25 gauge.
IM angle of admin
administer IM so that needle is perpendicular to pts body. recommended z-track is used
attach clean needle once syringe filled with med, pull skin down or to one side about 1" and hold this position with nondominant and. Insert needle, aspirate, and inject meds. Withdraw needle and release displaced skin. Massaging site is not recommended, but gentle pressure may be applied
delivered directly to blood, and produce immediate effect. It is the most dangerous route of admin because it is placed directly into the blood. It cannot be recalled and actions can't be slowed.
may be added to infusion solution. check for adverse effects at least every hour
IV meds via bolus or push
involves a single injection of a concentrated solution. drugs is admin very slowly over at the least 1 min.
IV meds via intermittent IV infusion
drugs is mixed with a small amount of IV solution, such as 50-100mL, and admin over a very short period of time. Can receive via piggyback, volume controlled admin set, or mini infusion pump
requires the intermittent or additive solution to be placed higher than the primary solution container.
Volume control admin set
intermittent iv infusion. Med diluted with small amount of solution and admin through IV line.
Mini infusion pump
intermittent infusion is battery operated and allows medication mixed in syringe to be connected to the primary line and delivered by mechanical pressure applied to the syringe
applied to skin and mucus membranes. usually intended for direct action at a particular site, although some can have systemic effects and are given for systemic effect.
clean skin thoroughly with soap and water before admin and then rubbing the medicated preparation into the skin can enhance absorption.
when a drug is incorporated in an agent such as an ointment and rubbed into the skin for absorption
used to promote drying of the skin and prevent friction on the skin. use caution to prevent inhalation. apply the powder to a square gauze and then apply to the desired site to minimize inhalation
provide prolonged contact of a medication with the skin and soften the skin. they are usually thoroughly massaged into the skin
Creams and oils
lubricate and soften the skin and prevent drying of the skin. if a large area of the body is to be covered, warm the preparation in hand to prevent chilling
protects and soothes the skin. shake lotion well and apply with cotton balls or gauze
utilize reservoirs, micro reservoirs, adhesives, or matrices. these systems are a sandwich of layers each with a specific job. drug is rate controlled.
Eye instillations and irrigations
meds are placed onto or instilled or irrigated into the lower conjunctival sac. should be sterile. do not touch the eye with instiller and wash hands. eye drops, ointments, irrigation, medication disks
small amount distributed along the exposed lower conjunctival sac after the eyelids and eyelashes have been cleansed. about 1/2" applied to inner canthus to outer can thus. After application close eye; the warmth helps to liquefy ointment
Eye medication disks
flexible resemblance of contact. contain meds that is released gradually into conjunctival sac. can remain for a week before needing to be changed.
Ear instillations and irrigations
instilled for local effect. used to soften wax, relieve pain, apply local anesthesia, destroy organisms, or destroy an insect lodged in canal. it too swollen a wick is inserted so that one end is in the middle of the ear and the other outside of the ear. Meds are wicked to the correct location. ear drops, ear irrigation
used to treat allergies, sinus infections, and nasal congestion.
creams, foams, and tablets can be applied intravaginally using a narrow, tubular applicator with an attached plunger. suppositories that melt when exposed to body heat are also admin vaginally. Pt to void before admin. pt lying on back with knees flexed.
used primarily for local action, such as laxatives and fecal softeners. systemic effects can also be met with suppositories. after inserted pt to remain in left lateral position for 5 minutes, if a laxative remain in position for 35-45 min
they are aerosolized. drugs are absorbed easily from lower resp tract. inhalation may be used to admin several different classes of drugs with varying properties of indications. may be admin with hand atomizer or nebulizer.
Common types of med errors
inappropriate prescribing of the drug, extra omitted or wrong dose, admin of a med to a pt that was not ordered, admin of a drug by an incorrect route or rate, failure to give med within prescribed time, incorrect preparation, improper technique, giving drug that is deteriorated.
Steps after med error made
check the pts condition immediately, notify nurse manager and the primary care provider, write description of the error on the pt MAR, complete the form used for reporting errors as directed by facility.
Patient should be able to verbalize after teaching...
how and when to admin med, when to notify healthcare provider, expected adverse effects
Oral route advantages
most convenient, easiest, safest, slower onset of action, more prolonged effect, preferred route by pt, less stress, most economical
Oral route disadvantages
absorption is dependent on pH motility and presence of food in GI system, drugs can irritate stomach, unpleasant taste, contraindicated in pt with swallowing difficulties n/v unconscious, restrictions before diagnostic tests, NPO, and gastric suctioning.
peripherally inserted central catheter. small flexible catheter inserted in a peripheral vein then threaded so that the tip is positioned in the heart.
to draw blood. to administer fluids such as blood chemotherapy drugs and nutrition
Risk of PICC insertion
catheter movement from site damage to the tube or malfunction, infection, pain or spasms in the shoulder neck arm or where the line enters the body, numbness and/or tingling in arm or hand
Central Line Access Device
inserted directly into the subclavian or the internal jugular veins for short term use. can be tunneled through the sub-q skin to the subclavian vein for long term placement
Type of CVAD used depends on..
the length of therapy, the pt condition, the type of solution or medication needed.
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