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Pharm Ch. 3
Principles of Drug Administration
Question | Answer |
---|---|
List the nurses' six rights of medication administration. | (1) right to a complete and clear order; (2) right to have the correct drug, route (form), and dose dispensed; (3) access to info; (4) policies to guide safe med admin; (5) admin med safely & ID system probs; (6) stop, think, and be vigilent to give meds |
List the 5 rights of medication administration. | (1) right client; (2) right drug; (3) right dose; (4) right time; (5) right route |
What are the 5 additional rights that are essential to nursing practice? | (1) right assessment; (2) right documentation; (3) client's right to education; (4) right evaluation; (5) client's right to refuse |
How would you make sure that you had the right patient? | 2 forms of identification prior to the administration of medication (The Joint Commission) |
List the components of a drug order. | date and time order was written, drug name (generic), drug dosage, route of administration, frequency and duration of administration, any special instructions, physician or other HCP signature or name if TO or VO, sig. of HCP taking TO or VO |
To avoid error, at what times should the drug label be read? | (1) at time of contact with the drug bottle or container; (2) before pouring the drug; (3) after pouring the drug |
List the four main categories of drug orders. | (1) Standing; (2) one-time (single; (3) PRN; (4) STAT (at once) |
What should a nurse do before calculating a drug dose? | the nurse should have a general idea of the answer based on knowledge of the basic formula or ratios and proportions |
What are the 2 most frequently used methods of drug distribution? | (1) stock drug method; (2) unit dose method |
Define stock drug method. | drugs are dispensed to all clients from the same containers |
Define unit dose method. | drugs are individually wrapped and labeled for single doses |
Describe a standing order. | may be an ongoing order or may be given for a specific number of doses or days; may have special instructions to base administration on laboratory values; may include PRN orders |
Give an example of a standing order. | Digoxin 0.25 mg PO daily; Colace 100 mg PO daily PRN; Digoxin, maintain blood level of 0.5-2 ng/ml |
Describe one time standing/single order. | given once and usually at a specific time |
Give an example of a one-time/single order. | Versed 2 mg IM at 7 AM on 10/5/05 |
Describe a PRN order. | given at the client's request and nurse's judgement concerning need and safety |
Give an example of a PRN order. | Tylenol 650 mg q3 to 4h PRN for headache |
Describe a STAT order. | given once, immediately |
Give an example of a STAT order. | Morphine sulfate 2 mg IV STAT |
Define sublingual. | under the tongue |
Define buccal. | between gum and cheek |
Define topical. | applied to the skin |
Define instillation. | in nose, eye, ear |
List the 4 parenteral routes of medication adminstration. | (1) intradermal; (2) subcutaneous (subQ); (3) intramuscular (IM); (4) intravenous (IV) |
What information should be documented when giving the client medication? | (1) name of drug; (2) dose; (3) route; (4) time and date; (5) nurse's initials or signature |
Which medications require documentation of the client's response? | (1) narcotics; (2) nonnarcotic analgesics; (3) sedatives; (4) antimetics; and (5) unexpected reactions to the meds, such as GI irritation or signs of skin sensitivity |
What is informed consent? | a principle based on the individual having the knowledge necessary to make a decision |
What should a nurse do if a client refuses to take a medication? | determine the reason for refusal; explain the risk of refusing the med and reinforce the reason for taking med; inform nurse manager; document |
What is a major factor affecting medication errors? | the increase in the number of drugs: from 3000 in 1990 to more than 30,000 in 2008 |
List the factors that modify drug response. | (1) absorption, (2) distribution, (3) metabolism, (4) toxicity, (5) pharmacogenetics, (6) tolerance, (7) cumulative effect |
What may affect drug absorption? | any GI disturbances (e.g., nausea, vomiting) |
What may affect drug distribution? | protein-binding; blood-brain barrier, which only allow lipid-soluble drugs to pass; placental barrier |
What may affect drug metabolism? | liver function, immature liver and kidney function in neonates |
How may the excretion of drugs be affected? | through normal aging process and chronic disease or kidney failure, there is a decrease in the functioning cells of the kidney, resulting in decreased excretion of drugs |
How may age affect drugs? | infants and elderly are more sensitive to drugs |
How may body weight affect drugs? | drug doses may be ordered accroding to body weight; obese persons may need increased drug doses, and very thin persons may need decreased doses |
Toxicity and the drug response | toxicity is more prevalent in persons with liver or renal impairment and in the very young and old |
Pharmacogenetics and the drug response | if a parent has an adverse reaction to a drug, the child may also |
route of administration and the drug response | drugs administered by IV act more rapidly than those administered by mouth |
time of administration and the drug response | the presence or absence of food in the stomach can affect the action of some drugs |
emotional factors and the drug response | suggestive comments about the drug and its side effects may influence its effects |
preexisting disease state and the drug response | liver, kidney, heart, circulatory, and GI disorders are examples of preexisting states that can affect a response to a drug; e.g., a person with diabetes should not be given elixirs or syrups that contain sugar |
drug history and the drug response | be aware that past use of the same or different drugs may reduce or intensify the effects of the drug |
tolerance and the drug response | the ability of a client to respond to a particular dose of a certain drug may diminish after days or weeks of repeated administration; a combination of drugs may be given to decrease or delay the development of tolerance for a specific drug |
cumulative effect and the drug response | occurs when the drug is metabolized or excreted more slowly than the rate at which it is being administered |
drug-drug interaction | effects of a combination of drugs may be greater than, equal to, or less than the effects of a single drug; some drugs may compete for the same receptor sites; an adverse reaction may lead to toxicity or complications such as anaphylaxis |
food-drug interaction | the effects of selected foods may speed, delay, or prevent absorption of specific drugs |