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Med administration
Concepts Exam 1
| Question | Answer |
|---|---|
| How many deaths may result each year from medical errors in hospitals alone? | between 44,000 and 98,000 |
| How many deaths each year are related to medications? | more than 7,000 |
| According the the Institute of Medicine, how many medication errors per day are patients subject to? | at least one per day |
| How many people in U.S. each year are injured due to medication errors? | 1.3 million |
| How much do medications errors cost the U.S. per year? | $4 billion |
| What are 4 reported common medication errors? | wrong medication or dose in IV, dangerous interactions, wrong dose dispensed by pharmacy, wrong dose given by nurses |
| What are the 5 of the 10 elements needed for medication safety according the the Institute for Safe Medication practices? | patient information, drug information, adequate communication, drug packaging, labeling, and nomenclature, medication storage, stock, standardization, and distribution |
| What are the 5 of the 10 elements needed for medication safety according the the Institute for Safe Medication practices? | drug device acquisition, use, and monitoring, environmental factors, staff education and competency, patient education, quality processes and risk management |
| What happens if not all 10 key elements of medication safety are not present? | error occurs |
| What are 3 Patient safety goals of 2013 | identify patients correctly improve staff communication use medications safely |
| How do you identify patients correctly? | use 2 patient identifiers |
| 2 ways to improve staff communication | get important test results to right staff person on time standardize list of approved abbreviations |
| 4 ways to use medications safely | label medications record correct information about patient's meds compare new meds to old meds make sure patient knows what meds to take at home and to take up to date list to doctor |
| elements identified in medication preparation assessment | drug dose route frequency time rationale |
| What should you know about the drug in preparation assessment? | generic and trade name |
| What should you know about the dose in preparation assessment? | is it within specified parameters any abnormal labs accurate calculations |
| What should you know about the route in preparation assessment? | how it is administered PO sublingual intradermal sub-q IM topical |
| What should you know about the frequency in preparation assessment? | how often |
| What should you know about the time in preparation assessment? | standardized maximum absorption |
| What should you know about the rationale in preparation assessment? | why patient is receiving this drug patient history current condition lab values drug guide under nursing considerations |
| What is our job as nurses according to the rationale in preparation assessment? | know when to hold medications |
| What are other areas to assess during preparation assessment? | allergies other medications on MAR specific orders to hold medication specific parameters is it a STAT, PRN, or one time only order |
| What are MORE areas to assess during preparation assessment? | stop order high alert patient's swallowing ability fluid availability/restrictions acceptable "window" of timely medication administration |
| What should you do if patient is having difficulty swallowing when administering oral medications? | put medication in thick substance |
| What is the "acceptable window" of timely medication administration? | 30 minutes before or after ordered time to give meds |
| 3 examples of high alert medications | anticoagulants narcotics hypoglycemic medications |
| Medication dispensing equipment | MAR automated dispensing system bar coding and eMAR medication cups or syringe pill crusher or splitter |
| Can students directly access automated dispensing systems? | No, must be licensed nurse instructor RN caring for patient |
| What must you have to dispose of controlled substances? | co-signer of a licensed nurse |
| What does administration of insulin require? | double checked by 2 licensed nurses |
| What are the rights of medication administration? | right drug right patient right dose right route right time right documentation |
| procedure for medication administration before arriving at bedside | clean hands prepare meds for one patient remove meds per MAR check medicaiton label with MAR 2 times place unopened package into med cup |
| When should you check medications with faculty? | on the 3rd medication label check |
| procedure for medication administration at bedside | identify patient reconfirm allergies perform patient teaching open and administer meds position patient assess patient swallows meds wash hands document med was given |
| When should you leave medications at the bedside? | never |
| What are appropriate patient identifiers? | name date of birth medical record number |
| When should you document that medication was given? | after med was given |
| procedure for medications held or refused | document medication held or refused and why notify physician if needed |
| 3 reasons why medication would be held | at test NPO for surgery not needed |
| 5 forms of oral medicaitons | solids capsules enteric coated liquids crushed medications |
| Can enteric coated meds be crushed? | no coated to prevent gastric juices from dissolving meds so it can be absorbed in small intestine |
| characteristics of sublingual medication | under the tongue rapid acting very vascular area |
| example of sublingual medication | nitroglycerin for angin |
| where are buccal medications given? | between gums and cheek |
| procedure for administering eye drops | clean away drainage give patient a tissue extend head upwards retract lower eyelid place in conjunctival sac close eye and press on nasal-lacrimal duct for 30 seconds |
| Where should eye drops be administered? | in conjunctival sac |
| What should you do after administering eye drops? | close eye and press on nasal-lacrimal duct for 30 seconds |
| procedure for administering eye ointment | thin line from inner canthus to outer do not touch eye with tube |
| What should you do after administering eye ointment? | rub eyelid |
| Should you wear gloves when administering eye drops? | yes |
| procedure for administering ear drops in adult | position on side pull pinna up and out instill drops holding dropper 1 cm above ear canal keep patient on side for a few minutes apply gentle pressure and massage tragus with finger |
| procedure for administering ear drops in child | position on side pull pinna down and back instill drops holding dropper 1 cm away from canal keep patient on side for a few minutes apply gentle pressure and massage tragus with finger |
| How should you straighten out ear canal in adults? | pull pinna up and back |
| how should you straighten out ear canal in children? | pull pinna down and back |
| Where should you massage after giving ear drops | on tragus with finger |
| procedure for administering nasal spray | clear patient passage way occlude opposite nasal passage shake spray insert tip to nostril squeeze bottle to give dose inhale while squeezing |
| when should patients self administer nasal sprays? | when they are able |
| How long should you shake inhalers? | 2 to 5 seconds |
| procedure for administering inhalers | shake container place in mouth have patient exhale inhale slowly as inhaler is depressed hold breath for 10 seconds |
| How long should you hold breath after administering inhaler? | 10 seconds |
| How long should you wait between puffs from same inhaler? | 20 to 30 seconds |
| How long should you wait between puffs from different inhalers? | 2 to 5 minutes |
| When should patients self administer inhalers/ | when they are able |
| procedure for administering topical medications | absorbed through skin wear gloves assure clean skin apply per order |
| procedure for administering paste/transdermal patch | remove old patch check skin for irritation apply new patch in new site squeeze out amount ordered do not massage date, time, initial patches |
| procedure for administering rectal medicaitons | simms position only expose rectal area don gloves lubricate suppository and index finger patient take deep breath insert suppository into anus remain on side |
| How far should you insert suppository in anus of adults | 4 inches |
| How far should you insert suppository in anus of children | 2 inches |
| How long should patient remain on side after insertion of rectal suppository | 5 minutes |
| Equipment needed for parenteral medication administration | syringes needles vials ampules alcohol swabs |
| Syringe size ranges for parenteral medication administration | 0.3 ml to 3 mL |
| What are the 3 components of a needle | hub shaft bevel |
| Needle size ranges for parenteral medicaiton adminstration | 1/4 inch to 3 inches |
| what should you assess for parenteral medication administration | circulation adipose tissue muscle atrophy |
| procedure for administering all injections | assessment prepare medicaiton wash hands/gloves select site patient in comfortable position cleanse site remove cap hold syringe between thumb and forefinger inject dispose in sharps |
| purpose of intradermal injections | skin testing |
| needle gauge needed for intradermal injections | 25 - 27g |
| needle length needed for intradermal injections | 3/8 inch to 5/8 inch |
| site of intradermal injection | into dermis inner aspect of arm |
| liquid amount of intradermal injection | 0.01 mL to 0.1 mL |
| procedure for intradermal injection | needle angel 5 to 15 degrees pull skin taut, insert bevel up do not aspirate inject solution slowly small bleb |
| is intradermal test valid if bleb does not appear? | no |
| purpose of subcutaneous injections | slow absorption sustained effect |
| syringe size for subcutaneous injections | 0.5 to 3 mL |
| Needle gauge for subcutaneous injections | 25 to 27g |
| needle length for subcutaneous injections | 3/8 to 5/8 inch |
| sites for subcutaneous injections | abdomen thigh back ventrodorsal gluetal area |
| liquid amount of subcutaneous injection | 1mL or less |
| procedure for subcutaneous injection | choose site cleanse site pinch skin inster 45 to 90 degrees release tissue and inject slowly remove and apply gentle pressure discard in sharps container |
| If you grasp 2 inches of subcutaneous tissue what angel should you insert the needle at? | 90 degrees |
| If you grasp 1 inch of subcutaneous tissue what angle should you insert the needle at? | 45 degrees |
| Is it necessary to aspirate with subcutaneous injections? | no |
| What route is insulin administered? | subcutaneously |
| What is sliding scale for insulin based on? | blood glucose level |
| What does insulin do? | controls blood glucose levels |
| What should you monitor before giving insulin? | blood glucose level are they going to eat |
| Does insulin need to be verified? | Yes with 2 licensed professionals |
| With what insulins should you administer withing 15 minutes of eating? | short acting or regular insulin |
| What does long acting insulin look like in vial? | cloudy |
| What does short acting or regular insulin look like in vial? | clear |
| In what order should you draw up insulins | clear into cloudy short acting into long actin |
| What is the onset of rapid acting insulin? | 15 to 30 minutes |
| What is the peak effect of rapid acting insulin? | 1.5 to 2.5 hours |
| What is the duration of action for rapid acting insulin? | 3 to 6.5 hours |
| What is the onset of short acting insulin? | 30 to 60 minutes |
| What is the peak effect of short acting insulin? | 1 to 5 hours |
| What is the duration of action of short acting insulin? | 6 to 10 hours |
| what is the onset of intermediate acting insulin? | 1 to 2 hours |
| What is the peak effect of intermediate acting insulin? | 6 to 14 hours |
| What is the duration of action of intermediate acting insulin? | 16 to 24 hours |
| What is the onset of long acting insulin? | 1 hour |
| What is the peak effect of long acting insulin | plateau |
| what is the duratiton of action for long acting insulin? | 24 hours |
| What should you check when giving coumadin (po)? | INR |
| What should you check when giving heparin? | PTT (partial thromboplastin time) |
| what should you check when giving lovenox? | clearance is predictable and requires little monitoring if needed use PTT insensitive |
| What sites should you avoid when giving anticoagulant injection/ | ecchymotic scars lesions |
| Site of anticoagulant injections | lower abdomen fat pad |
| do you aspirate when administering anticoagulant injections? | no |
| purpose of intramuscular injections | promote rapid absorption irritating medicaitons |
| syringe size for intramuscular injections | 1-5 mL |
| needle gauge for deltoid injection | 23-25g |
| needle gauge for vastus/ventrogluteal injection | 18-23g |
| needle length for deltoid injection | 5/8 inch to 1 inch |
| needle length for vastus/ventrogluteal injection | 1 to 1.5 inch |
| Sites for intramuscular injections | ventroglueteal vastus lateralis deltoid |
| liquid amounts for intramuscular injections in adults | up to 3mL |
| liquid amounts for intramuscular injections in old adult and thin patients | 2mL |
| liquid amounts for intramuscular injections in infants and small children | 1mL |
| procedure for administering intramuscular injections | choose site clean site pull skin taut in z track fashion insert needle at 90 degrees aspirate, if no blood inject slowly remove needle and apply gentle pressure discard syringe in sharps contain |
| What is the preferred method for all IM injections? | z track |
| define z track fashion | laterally 2.5 to 3.5 cm and hold until medication injection |
| landmarks for deltoid injections | 1 to 2 inches below acromion process four fingers across deltoid |
| advantages of deltoid intramuscular injection | faster absorption easily accessible with minimal exposure less pain fewer local side effects |
| disadvantages of deltoid intramuscular injection | small muscle limits liquid amount possible radial nerve and axillary nerve damage |
| liquid amounts for deltoid intramuscular injection | 0.05 to 1.0 mL |
| landmarks for vastus lateralis injection | greater trochanter and lateral femoral condyl mid 3rd and anterior lateral aspect of thigh |
| advantages of vastus lateralis injection | large muscle tolerate large amount of fluid easily accessible |
| disadvantages of vastus lateralis injection | thrombosis of femoral artery from injection of mid thigh more painful site |
| landmarks for ventrogluteal injection | greater trochanter, palm at site point index finger toward patient's groin middle finger along posterior iliac crest form "V" |
| advantages of ventrogluteal injection | free of important nerves/vessels easily identified accommodates large amount of fluid less painful |
| disadvantages of ventrogluteal injection | nurses are unfamiliar with site |
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cdc52591
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