PNR 120 Exam 1

nursing responsibilities in medication administration
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nursing responsibilities in medication administration
-be accurate during all steps of medication administration
-follow exactly all procedures related to medication administration
-report any error promptly
-interpret the medication order correctly, then give the correct medication to the pt
-make an assessment of the pt after medication has been administered
-follow the 6 rights of medication administration
Rights of Medication Administration
-right pt
-right drug
-right dose
-right route
-right time
-right documentation
Routine or scheduled medication order
-maintain desired level of medication in the bloodstream, often given several times a day
-physician's order will specify how often the medication is to be given
-three times a day (tid), every 4 hours (q4hr), etc.
prn medication orders
-Some PRN medication orders specify when or how often the medication can be given
-hs PRN, meaning "hour of sleep as needed"
-q4hr PRN, meaning "as often as every 4 hours as needed"
one time (single) and stat orders
-may consist of more than one drug or may involve spacing drops or tablets over a short period
-stat orders indicated that the order has TOP priority and medication must be administered without delay
renewal orders
many hospitals have medication policies limiting the time for which certain types of medication orders are valid
* opiate analgesics generally have a 48 or 72 hour limit
* sedatives and antibiotics may have a 5 or 7 day limit
* a 30 day limit may be imposed by some agencies on all medications
orders by protocol
-may exist in specialty units such as the ER, labor and delivery, or ICU
-students must be able to recognize an emergency situation and immediately report it to their instructor or charge nurse
ac
before meals
ad lib
freely
BID or bid
twice a day
g or gmgramGttdropsh or hrhourI.D.intradermalIMintramuscularIVintravenousIVPBintravenous piggybackKgkilogramKVOkeep vein openLliterMcgmicrogrammEqmilliequivalentmLmilliliterMDImetered dose inhalerNGTnasogastric tubePCApatient controlled analgesiaPcafter mealsPRper rectumPRN or prnas neededQeveryQID or qidfour times a dayRxtakeSTAT or statimmediatelysibling or SLsublingualSub-Q or subcutsubcutaneousSRsustained releaseTID or tidthree times a dayconcept map Nurses responsibilities in medication administration-know which drugs are " alert drugs" -have calculations checked -know interferences with lab test -check for drug allergies -know about drug and dosage limits -assess for therapeutic effect -teach about each drug -follow 6 rights -document after drug given -assess for side and adverse effects -know drug interactions -calculate dose accuratelydosages-dosages may be ordered in the metric system (most often used) or in the apothecary system -nurses must be able to calculate the dosage in either system -nurses must be able to convert from one system to the other -check conversions with another nurse may prevent medication errors from conversionsroutes of oral medicationsPO (by mouth) solid or liquid medications (oral, sublingual, buccal), or via feeding tube -pts with difficulty swallowing may need pills crushed or changed to liquids -medications that should not be crushedmedications that should not be crushed-Sublingual medications -enteric-coated medications -sustained-release preparationsroutes of topical medicationapplied in the form of: -drops (eye or ear) -ointments, pastes, or lotions -rectal suppositories -transdermal medication -inhalantsMedication administration and technology-improves medication administration safety -computerized physician order entry systems (CPOE) -bar code scanners -smartphones and mobile devices -personal digital assistantsCPOE (Computerized Physician Order Entry)prescriber directly enters the medication order in the computer; this decreases potential for transcription errorsbar code scannersscan the medication package and the patient ID bandspersonal digital assistantsdownload and upload specific pt information to a PDA that is connected to the larger hospital information systemmedication administration systems-stock supply of medicines -individual medication system -unit-dose methodunit-dose system-provides premeasured, prepackaged, prelabeled dose -safest because dose prescribed is dose dispensed -may be dispensed from mobile cart, or the fixed medication preparation centerbenefits of unit-dose system-Pharmacy supplies the exact dose of medication ordered -Saves time for the nurse -Patient is charged only for medications used -Allows keeping a minimum amount of drugs on the nursing unitsprescription system-Prescription is written for each drug ordered and is filled by the pharmacist, who provides individual containers holding doses for several days -In the long-term care facility, a week's or month's supply of each medication is often provided in a bubble packPreparation of oral controlled substances from a dispenser-a controlled dispensing system is used for distributing opiate analgesics and hypnotics -legally controlled substances must be under lock and key -automated controlled substance dispensing machines are often used in the clinical setting to monitor and control narcotic use -when not in a dispensing machine, drugs are supplied in a controlled dispenser or a commercially prepared packagetopical drugs-common forms of topical drugs include ointments, creams, pastes, liniments, and lotions that are used to treat local conditions -medication can also be dissolved in solutions and applied topically in the form of irrigationssuppositories-Small cylinder-shaped, semisolid medicated substances -Contain medication that is absorbed through mucous membranes -Inserted into the body orifices such as the rectum, vagina, urethra, or ostomy stomacomplete drug orders must contain-Full name of the patient -Name of the drug and how it is to be given -Dosage to be given and route of administration -Date, time, and signature of the prescribing physicianoral medication-oral drugs may be supplied as tablets, capsules, spangles, lozenges, gelcap, caplets, oral powders, incurs, emulsions, and liquids -any water that is used must be entered on the intake sheet if the pt is on intake and output recording -pour the dose into a graduated medicine cup when preparing liquid medicationsPreparing liquid medications-pour dose into a graduated medicine cup. -the exact level of the dose is read at the Lowest point oof the meniscus (curved upper surface) of the liquid in the cup when held at eye level. -always pour the liquid out of the side of the bottle, away from the label, so that any residual liquid will not run down the label and distort the words on it.eye and ear medications-ophthalmic (eye) medications may be in the form of drops, ointment, or eye disk -the word ophthalmic must be clearly visible on container -otic (ear) medications are usually administrated as drops or irrigationnasal medications-come in atomizers or dropper bottles -have pt block one nostril and inhale through nose as atomizer is squeezed -drops should be administered with pt lying on the back with neck hyperextended while medication is dropped into the nostrilsinhalation medications-May be administered through a nebulizer, spray, or atomizer to penetrate the lungs -may require a spacer for effective usemetered dose inhalerprescribed amount of medication is administered in each spray; it is held in front of the mouth and medication is inhaled as the inhaler is triggeredvaginal medications used to:-cleanse the vagina for surgery -reduce bacterial growth -remove odors and discharge -apply heat or cold to inflamed tissues -absorb medication into local mucosarectal medicationsDispensed in the form of suppositories; used to: - Prevent vomiting - Soothe hemorrhoids - Prevent bladder spasms - Promote bowel evacuation - Reduce fevertopical skin medications-supplied in the form of lotions, ointments, creams, and patches, can be applied to the skin. Should be applied to clean, hairless area and left in place -transdermal medicationstransdermal medicationare supplied in a sustained-release patch that is applied to clean, dry, hairless skin and left in place, or as a paste that is spread on a small area of skinadministering med via feeding tube-if pt unable to swallow meds -med in liquid form best -tablets can be used if place in liquids -do not mix meds with formula or tube feedingmedication errors-all medication errors must be reported -an incident or occurrence form is filled out for the medication error -after notifying the physician, orders are carried out to safeguard the pt -the goal is to prevent harm to the pt from the error and to prevent similar errors from happening againPrinciples of Parenteral InjectionsUse when: Patient is NPO Digestive juices counteract oral drugs Use to: Hasten the action of the drug Ensure the delivered dose is accurate Always: Select the correct site Use sterile equipmentsafe, effective administration of parenteral medications-know the medication you will administer and observe for side effects and therapeutic action -check for drug allergies before administration of injection -use only sterile needles and syringes -select the appropriate length of needle to deposit the medication in the proper tissue layer -label the syringe with the pts are, the name of the drug, and the dose -obtain assistance as needed when the pt is a frightened child, or an uncooperative adult -rotate injection sites for pts receiving repeat injections by establishing a predetermined plan -select an injection site that is relatively free of hair, lesions, inflammation, rashes, moles, and freckles -select the injection site carefully to avoid major nerves, blood vessels, and underlying organsroutes for parenteral administration intradermal-medication is deposited into layers of skin -usually used for skin testing for TB or other diseases (allergy testing) -use a small needle with a 15 degree angle of insertion (24, 27, or 29 gauge) -use tuberculin syringe -forms a skin bleb or small pumproutes for parenteral administration: subcutaneous-injects small amount of medication (0.5-1 mL) into tissue below the dermal layer into subcutaneous fat -usual sites: upper portion of the arm, anterior surface of the thigh, or the abdomen -25 or 27 gauge needle, 3/8 to 1/2 inch long -insulin syringe or tuberculin syringe usually used -a 45-90 degree angle used, depending on the amount of subcutaneous tissue on the ptroutes for parenteral administration: intramuscular-injected into muscle layer at 90 degree angle -most common sites: deltoid, dorsogluteal, ventrogluteal, vastus lateralis, and rectus femoris -Needle usually 19-23 gauge, 1-3 inches long -volume up to 3 mL for most IM injections -the absorption for IM medications chiefly depends on the form of the drugintramuscular route: Z track method-may be used any time an intramuscular injection is given -used for deep IM injections of drugs such as iron dextran or Vistaril -reduces pain caused by irritating drugs leaking into subcutaneous tissue -seals the medication in the muscular layersyringes-3 mL syringe - U- 100 syringe -Tuberculin syringes -unit dose cartridge3 mL syringepopular because large enough for subcutaneous and most IM injectionsU-100 syringe-Used with U-100 strength insulin -Calibrated in unitstuberculin syringe-1 mL in size -calibrated to measure as small as 0.01-mL drug dosesunit-dose cartridge-requires a special holder for the cartridge and needleneedle and gauge and length-Available in standard sizes from 13 to 30 -The larger the number, the smaller the needleintradermal injection needle size25, 27, or 29 gaugesubcutaneous injections needle size25 gaugeintramuscular injections21-23 gaugepreventing needle sticks-HIV, hep B, and hep C can be spread by a needle stick from an infected pt -safety syringes prevent needle sticks to health care workers and should be used when available -if regular syringes must be used, the needle must not be recapped after injection but taken to the nearest sharps disposal unit and discarded----NEVER RECAP A NEEDLE -report ALL needle stickspreparing the syringe for use-Use aseptic technique in handling the syringe and needle -Protect surfaces that must remain sterile: the needle, tip, inner barrel, and plunger -Discard syringe or needle if it becomes contaminated during drug preparation for administration -Label the syringe with the patient's name, name of medication, and dosefilter needles-Medications drawn from an ampule may have glass in them from the breaking of the ampule -Filter needles should be used when medication is withdrawn from ampule to trap the glass particles -Filter is discarded and new needle attached to syringe for injecting medication into the patientparenteral solutionsMay be available in: Ampules Vials •Single dose and multidose Mix-O-Vials •Medication in powder form and diluent present in two halves of a vial separated by a rubber stopper Unit-dose cartridges •Requires Carpuject or Tubex holdersampules-glass or polyurethane; consist of body, neck, and stem; usually contain a single medication dose -all medication must be in the ampule body before the neck is broken -before opening, medication must be removed from the neck or stem (tap or flick the stem several times with a finger to free the trapped solution) -the open ampule is handled very carefully when withdrawing the medication with the filter needlesvials-a small bottle with a rubber stopper attached by a metal band -may contain one or more dosages of medication -sizes from 1 to 50 mL -may be in powder from requiring reconstitution (label or package insert provides mixing instructions) before mixing two medications in a syringe, check for compatibility.reconstitution of a drugdrugs that are unstable in liquid form are prepared in powdered form - solute (the powder) is mixed with diluent to dissolve the drug before drawing up into the syringe for injection - diluents are usually sterile water or saline -follow directions on the vial or package for proper reconstitutioncompatibility of medication-a reaction occurs when a drug combines with an incompatible drug -range from color, change, precipitation, and clouding to invisible chemical changes rendering the drug inactive -charts are often available that outline which drugs are compatibleadministering intradermal injections-most frequently used for TB or allergy testing -a small amount of solution is injected -solutions are capable of producing severe reactions -a tuberculin syringe and a short need, 1/4 - 1/2 inch in length, are usedadministering subcutaneous injection-used for a variety of medications, including insulin, heparin, and some preoperative medications and narcotics to relieve pain -preferred sites are the lateral surfaces of the upper arm or the anterior and lateral aspects of the thigh -encourage patients to be actively involved with medication administrationadministering intramuscular injections-used if pt cannot take medicine orally, medication not prepared in oral form, or faster action is desired -improper site selection can result in damaged nerves, abscesses, necrosis, sloughing of skin, and paininjection sites for intramuscular injection-the mid-deltoid muscle is a common for IM injection -the ventrogluteal area involves the gluteus medius and and minimus muscles -vastus lateralis muscle -the rectus femoris muscleair lock techniqueused for IM injection to clear the needle of medicaiton and to seal the track so the medication does not flow backintramuscular injections in children-the vastus lateralis and the ventrogluteal sites can be used -it is preferable to find another way to give medication to children because IM injections are painful and traumaticThe Z-track technique-reduces pain caused by irritating drugs that leak or escape along the track into subcutaneous tissue when needle is withdrawn -must be used whenever a deep IM injection of iron dextran (DexFurrum) and other irritating solutions are givenWhat is anaphylactic shock?circulatory failure from an allergic reactionsymptoms of anaphylactic shock-urticaria -bronchiolar constriction -edema -circulatory collapseallergic reactions are more commonthe second or successive times the medication is receivedintravenous fluid therapy-maintenance fluids -oral and parenteral replacement -parenteral nutrition -blood and blood products -plasma expandersThe goal of nursing care for a patient receiving an IV infusion are to:-prevent infection -minimize physical injury to the veins and surrounding tissues -administer the correct fluid at the prescribed time and at a safe rate of flow -observe the pts reaction to the fluid and medications being administeredrights of iv therapy-Right solution with or without additives as ordered; the correct solution to follow what has been infusing -Right dose (amount) of solution and additive as ordered -Right route (peripheral IV, peripherally inserted central catheter [PICC], central line, port) -Right time (to infuse) -Right patient as identified with two identifiers -right documentationIVs are given to supply the body with:-fluids and electrolytes that the pt is unable to take orally in sufficient amounts -medications that are more effective when given by this route or cannot be given any other way -blood, plasma, and other blood components -nutritional formulas containing glucose, amino acids, and lipidsthe average adults needs how much fluid in a 24 hour period to replace those eliminated by the body1500-2000 mLfluids are lost by:-Hemorrhage -Severe or prolonged vomiting or diarrhea -Excessive wound drainage -Wounds (especially burn wounds) -Profuse perspirationtypes of iv solutionsGlucose saline electrolytes vitamins amino acids blood and blood productsisotonic solutions-have the same solute concentration, or osmolality, as blood -used to expand the fluid volume of the bodyhypotonic solutions-Contain less solute than extravascular fluid -May cause fluid to shift out of vascular compartmenthypertonic solutions-have a greater tonicity than blood -replace electrolytes; when given as concentrated dextrose solutions, produce shift in fluid from intracellular to the extracellular compartmentTypes of isotonic solutions-0.9% Saline -5% dextrose in water -5% dextrose in 0.225% saline -ringer's lactatetypes of hypotonic solutions-0.45% salinetypes of hypertonic solutions-10% dextrose in water -5% dextrose in 0.9% saline -5% dextrose in 0.45% saline -5% dextrose in ringer's lactateprimary intravenous setConsists of bag of solution, regular tubing set, needleless connector, and IV standsecondary or piggyback intravenous setMedications to be given intravenously often added to an existed IV line by using the piggyback methodparallel or Y intravenous setY-type administration set used to infuse certain blood productscontrolled volume setInfusion pump administers small volumes of fluid or medicationintermittent intravenous device (saline or PRN lock)-established by applying Luer-lock cap or an extension set to the IV cannulaFiltersTrap small particles such as undissolved medication or salts that have precipitated from solutionWinged-Tip or Butterfly Needle-Meant for short-term therapy -Supplied in odd-numbered gauges (17, 19, 23, and 25)over the needle catheter-Consists of a needle with a catheter sheath over it -the needle is removed, leaving the flexible catheter in the vein -18, 19, 20 to 22 gauge needlescentral venous catheters-May be left in place for 6 to 8 weeks -Positioned in right atrium or superior vena cava -Some are tunneled long-term catheters such as a Hickman, Broviac, Groshong catheter -PICC lines are the first choice in home IV therapy -Correct placement is verified by x-ray