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NP2 - Safety Med Adm
Unit 1 - Safety in Medication Administration (Brainard)
| Question | Answer |
|---|---|
| What are the four names for a drug? | Generic, Official, Chemical, Brand |
| What is a generic name? | The name given to a drug before it's officially approved. |
| What is a brand name? | The name given to a drug by the drug company that is selling and marketing it. This name is usually trademarked. |
| What is a chemical name? | The name for a drug based on the chemicals that are in the drug. |
| For what purposes is a medication administered? | Diagnosis, Cure, Treatment, Relief of a symptom, Prevention of a disease. |
| What sources might a drug come from? | Natural sources, Lab Synthesized |
| What are natural sources for drugs? | Plants Minerals Animals |
| Name two drugs obtained from plant sources | Digitalis (foxglove plant) Opiates (opium poppy) |
| Name two drugs obtained from minerals | Iron, sodium |
| Name two drugs that can come from animals? | insulin, vaccines |
| What source of drugs is generally the safest/most reliable when it comes to purity and strength? Why? | Lab-synthesized, because we have more control over its composition. |
| In examining a drug, regulatory agencies require uniformity in ____ and ____ to ensure quality. | Purity and strength |
| What is the relationship between a Nurse Practice Act and medication administration? | Defines and limits our practice as nurses within our state. Nurse must recognize limits of own knowledge and skill. Recognize appropriate and question inappropriate orders for clarification. |
| True or False - A doctor orders a dosage for a drug that is twice the normal dosage range. The nurse should trust the doctor's order and administer the drug in the ordered dosage. | False. It is very important that the nurse question orders that seem inappropriate. |
| What regulating agencies/mechanisms monitor drugs and their administration in the state of Florida? | The FDA (US Food and Drug Administration) Florida Department of Health Federal and State Laws (legislature) Facility Policies and Procedures |
| The 1938 Food, Drug, and Cosmetic Act | Gave the FDA authority to oversee safety of food, drugs, and cosmetics. Modified numerous times, now includes bioterrorism preparation requirements. |
| Durham-Humphrey Amendment of 1952 | Purpose was to divide drugs into two basic categories - legend and over-the-counter. |
| What is a legend drug? | Same as a prescription drug, obtained by prescription only. |
| What is an OTC drug? | Over-the-counter, sold in pharmacies and stores, no prescription needed. |
| Harris-Kefauver Amendment (1962) required what? | Drugs must be proven safe and effective before marketing. Drug manufacturers must register annually with FDA with inspections once every two years. Generic names must appear on all labels and must be used in advertisements. |
| Comprehensive Drug Abuse Prevention and Control Act (1970) | AKA Controlled Substance Act Established five schedules of drugs depending on the potential for abuse and dependency. |
| Which drug schedule has the highest potential for abuse and/or dependency? | Schedule 1. |
| Which drug schedule has the lowest potential for abuse and/or dependency among controlled substances/ | Schedule 5. |
| What schedule is morphine? | 2. |
| What schedule is LSD? | 1. |
| What schedule is codeine? | 5. |
| What schedule is heroin? | 1. |
| What schedule are sedatives? | 3. |
| What schedule are non-barbituates? | 3. |
| What schedule are hypnotics? | 4. |
| What schedule are amphetamines? | 2. |
| What schedule are CNS stimulants? | 3. |
| What schedule are anti-anxiety meds? | 4. |
| What schedule are benzodiazepines? | 4. |
| Therapeutic effects | Intent, reason drug is prescribed |
| Analgesia is a/the ____ effect of morphine. | Therapeutic. |
| Side effect | An effect that is not intended. |
| T or F - Side effects are harmful or undesired. | F. Some side effects are harmless, an can be positive. |
| T or F - Side effects are usually predictable. | True. |
| Nausea and vomiting are ____ effects of digoxin. | Side. |
| Off-label use. | Use of a drug for a side effect(s) rather than for its intended use. |
| If someone takes Benadryl to sleep better, this is an example of ___. | Off-label use. |
| Adverse effects | More severe effects or reactions |
| T or F - Adverse effects may require discontinuation of medication regimen | True. |
| T or F - Adverse effects are not dose-related. | False. They can be dose-related, or they could have other causes. |
| What are the ways in which a drug toxicity can occur? | Overdose Ingestion of drug intended for external use Cumulative effect |
| What are some conditions that can contribute to drug toxicity due to an accumulation of the drug in the body? | Impaired metabolism (liver disease) or excretion (kidney disease). |
| T or F - Oxygen is not considered a drug, and can be administered by the nurse without a doctor's order. | F. Oxygen is considered a drug, but the nurse can give oxygen without asking the doctor first. The nurse should, however, contact the Dr. if this is done. |
| T or F - a drug toxicity will produce signs and symptoms immediately. | F. Signs and symptoms may present immediately, but could also present over several weeks. |
| Unpredictable and adverse reaction of the immune system to a drug | Drug Allergy |
| T or F - On the first exposure to a drug to which the client is allergic, the client will likely have no reaction. | True. On the first exposure, the immune system has not yet produced antibodies. The antibodies will be produced using the first exposure. |
| What happens to the client upon second and subsequent exposures to a drug to which he or she is allergic? | The antibodies that were produced with the first exposure cause a heightened reaction from the immune system. |
| What is an anaphylactic reaction? | A severe reaction that immediately follows administration. |
| T or F - an anaphylactic reaction isn't likely to be fatal. | F. May be fatal if not treated immediately. |
| What are the signs and symptoms of anaphylactic reaction? | Swelling of the mouth and tongue, acute shortness of breath, acute hypotension, tachycardia |
| What are some drugs that commonly produce a tolerance? | Opiates, Barbiturates, Alcohol, Tobacco |
| What will happen in a client with a drug tolerance? | The client will have unusually low physical response to the medication. He or she will require higher dose of medication to maintain therapeutic effect. |
| Drug Interaction | One or both drugs will act differently in the presence of the other. |
| Potentiating effect | Drug interaction that increases the effect of one or both drugs. |
| Inhibiting effect | Drug interaction that decreases effect of one or both drugs |
| Synergistic effect | Drug interaction in which two different drugs increase the action of one drug or another drug. |
| Idiosyncratic effect | Drug interaction that is unexpected and can be either an under-response or over-response. Unpredictable and unexplainable symptoms. |
| Iatrogenic | Something the health care team does or causes. |
| Iatrogenic Disease | Caused by medication Examples: hepatic toxicity, fetal malformations, Stevens-Johnson Syndrome |
| Stevens-Johnson Syndrome | Epidermis separates from dermis. Skin sloughs off. |
| Half-life (as it pertains to medications) | Time it takes body to reduce drug concentration by one-half |
| Onset of Action | Time after administration when the body initially responds to the drug |
| Peak Plasma Level | Highest drug serum level achieved by a single dose when the elimination rate and administration rate are equal |
| Plateau | Maintained concentration of drug in plasma during a series of scheduled doses. |
| Peak | The point at which an administered drug reaches its highest point in the therapeutic range. Measured a certain amount of time after drug is given. |
| Trough | Lowest drug level needed to be in therapeutic range. Usually measured just before next dose. |
| On a graph with one axis being serum drug concentration and the other being time since administration of the drug, how will an IV administration differ from an oral administration? | The IV administration will immediately produce a high serum drug concentration and then rapidly that concentration will decrease. The serum concentration for an oral drug will gradually increase, then gradually decrease. |
| Pharmacodynamics | How the drug acts upon the body |
| Receptor-based | Drug chemically binds with receptors at the cellular level. True of most drugs. |
| Agonist | Drug that produces the same type of response as the endogenous substance. Epinephrine is an example. |
| Antagonist | Drug that inhibits cell function by occupying receptor sites. Example - Narcan blocks receptor sites that morphine might otherwise occupy, and so it is given for a morphine overdose. |
| Pharmacokinetics | What the body does to the drug |
| What are the four aspects of pharmacokinetics | Absorption, distribution, biotransformation, and excretion of drugs. |
| Absorption of drug | Drug passes into bloodstream. |
| Absorption of oral drugs | Rate of absorption in the stomach is variable |
| Absorption of IV drugs | Immediately enters bloodstream without absorption. Most rapid route of administration. |
| Absorption of intramuscular drugs | Second most rapid route of administration, due to highly vascular nature of muscle tissue. |
| Absorption of subcutaneous drugs | Poor blood supply means slow absorption. |
| Absorption of rectal drugs | Absorption rate unpredictable. Normally used when other routes are not available. |
| Distribution | Transportation of drug from absorption site to the site of action. |
| What organs are drugs delivered to first? | Highly vascular organs like liver, kidneys, and brain, then other areas. |
| What kinds of drugs will accumulate in adipose tissue? | Fat-soluble drugs. |
| What drugs bind to plasma proteins? | Drugs other than fat-soluble drugs. |
| Albumin | Protein present in blood. |
| T or F - A drug is not affected by the amount of protein in the blood. | False. The client's reaction can be affected by blood protein levels. |
| Low protein in the blood will produce a ________ (under or over?) reaction to a drug. | Overreaction. The drug is made less active when it binds to plasma proteins. When less of those proteins are present, more of the more active form of the drug will remain. |
| What sort of diet may affect a client's reaction to a drug? | Low-protein diet. |
| Metabolism is also known as ____. | Detoxification. |
| Metabolism of a drug | Process of a drug being transformed or converted into a less active form. |
| What kind of protein is responsible for metabolizing drugs? | Enzymes. |
| Where does most drug metabolism occur? | In the liver. |
| Once a drug is metabolized, what is it called? | A metabolite. |
| Active metabolite | Possesses a pharmacological action. |
| Inactive metabolite | Has no pharmacological action. |
| First Pass Effect | Oral drugs first pass through liver and are partially metabolized prior to reaching target organ |
| T or F - A drug subject to first pass effect must be administered in a lower dose. | False. Because the first pass effect results in the liver partially metabolizing the drug, the drug will need to be given in a higher dose. |
| Why is it important that sublingual nitroglycerin not be swallowed? | This is to avoid its going through the liver. First pass effect would render it useless. Oral NTG is chemically protected against this. By administering sublingually, NTG goes directly into the bloodstream in the highly vascular area under the tongue. |
| Excretion | Process of removing metabolites and drugs from the body |
| Where does excretion primarily occur? | In kidneys via urine |
| What are routes of excretion besides urination? | Feces, respiration, Saliva, Breast milk, sweat |
| What developmental factors impact action of meds? | Age, pregnancy |
| What pharmacogenetic factors impact action of meds? | gender, size, body composition (body fat, fluids, hormones) |
| What ethnopharmacological factors impact action of meds? | Cultural factors and practices impact medication regimens. Certain ethnicities may respond to certain medications in different ways. |
| T/F: Temperature can affect the action of a drug | True. |
| T/F: Timing of administration has no affect on the action of a drug. | False. |
| T/F: A person's diet can affect the action of a drug. | True. |
| What are physiological variable considerations for the administration of a drug? | Medication's action on the body Client's response to medication Drug incompatibilities or interactions |
| What are psychological varible considerations for the administration of a drug? | Client: Motivation Compliance with regimen Outlook/mindset History of medication therapy Medication action: Placebo effect Alteration of thought process or mood |
| The placebo effect accounts for what portion of the chance of whether or not a drug will work? | 1/3 |
| A male client is on antihypertensives. He resists taking his medication. You suspect that the side effect of impotence is behind his resistance. What variable is being affected? | Psychological. |
| Your client says, "I really think this medicine will work." This will result in a ___ effect, and involves the _____ varible. | Placebo, psychological |
| What are sociocultural varible considerations for the administration of a drug? | Ethnic beliefs and values Socioeconomic status Access to healthcare |
| What are developmental variable considerations for the administration of a drug? | education level Cognitive abilities Language Physical abilities |
| Your client is unable to purchase his medication. This involves the ___ variable | Sociocultural |
| Your client expresses that he does not have insurance, and doesn't think he can keep regular appointments as a result. This involves the ___ variable | Sociocultural. |
| Your client is mentally disabled and cannot fully understand your instructions on how to take his medicine. This involves the ___ varible. | Developmental. |
| Your client has not yet learned to speak. This involves the ___ variable | Developmental. |
| Your client refuses a treatment or medication because of his religious beliefs. This involves the ___ variable | Spiritual |
| What are spiritual considerations for the administration of a drug? | Some religions restrict medical interventions. |
| What are the ten routes of administration? | Oral Sublingual Buccal Parenteral Topical Transdermal Inhalation Ophthalmic Rectal Vaginal |
| What are the four types of parenteral administration? | Subcutaneous Intramuscular Intradermal Intravenous |
| What are the advantages of oral administration? | Safer/non-invasive Usually less expensive Convenient |
| What are the disadvantages of oral administration? | GI irritation Slowed/unpredictable absorption Requires functional GI tract Ability to swallow |
| What are the advantages of sublingual/buccal administration? | Same as oral, plus - More potent effect, bypasses liver and directly enters bloodstream. |
| What are the disadvantages of sublingual/buccal administration? | If swallowed, drug may inactivate when exposed to gastric acid. Localized stinging/irritation Must allow tablet to completely dissolve |
| What might it mean if a patient's nitroglycerin doesn't sting a little? | The drug *may* be outdated. |
| What are the advantages of transdermal and topical administration? | Few side effects Avoids GI side effects Onset of med faster than oral |
| What are the disadvantages of transdermal and topical administration? | Unpredictable absorption Skin irritation Visible evidence of illness Failure to remove old applications |
| What are the advantages of inhalation administration? | Rapid delivery of medication througout respiratory tract Localized effect Can be administered to an unconscious client |
| What are the disadvantages of inhalation administration? | Can cause systemic effects Bad or altered taste Additional equipment potentially needed |
| What are the advantages of IV administration? | Rapid effect |
| What are the disadvantages of IV administration? | Risk of infection Drug distribution limited by poor circulation Systemic effects Requires skill/technique Cost |
| What are the advantages of Instramuscular administration? | Can give larger volumes than subcut. sites. Rapidly absorbed. |
| What are the disadvantages of intramuscular administration? | Anxiety producing Localized pain, trauma, and irritation Breaks skin barrier Requires skill/technique Cost |
| Advantages of subcutaneous administration | None over other routes. |
| Disadvantages of subcutaneous administration | Requires skill/technique Breaks skin barrier More costly Produces anxiety Localized pain, trauma, and skin irritation Slow absorption Small amount of med delivered in site |
| How much medicine is typically administered in a subcutaneous injection? | 1/2 to 1 mL. |
| What are the advantages of intradermal administration? | Slow absorption |
| What are the disadvantages of intradermal administration? | amount of drug very small Skin barrier broken Localized skin irritation and pain. |
| What are the components of a complete medication order? | Client's name, date of birth, MR/HR number. Name of the drug to be administered. Dose of drug Route Frequency Length of treatment Signature of MD, PA, or ARNP. |
| T or F - The nurse receives an medication order for a client, and notices that the doctor left out the frequency of administration. The nurse should go ahead and give the first dose, then contact the doctor to update the order. | False. A nurse cannot act on an incomplete order. |
| STAT order | Give immediately and only once. |
| Single or one-time order | Given once at a specified time |
| Standing order | Order carried out until order to cancel is written or is carried out over ordered time frame. |
| PRN | Nurse is able to give medication when client requires it, within order parameters. |
| T or F - The doctor writes an order for a drug, PRN, not to exceed 1000 mg in a 24 hour period. The portion of the order limiting the amount per 24 hours is the ____ of the PRN order. | Parameters. |
| PRN effectiveness | Nurse assesses effect of PRN meds, contacting patient's behalf if ineffective. |
| A nurse gives a client her PRN pain medication. After half an hour, the nurse assesses the client's pain again. This is an example of ____. | PRN effectiveness. |
| T/F: When administering Lovenox, you should leave the air bubble in the syringe. | True. |
| MAR stands for: | Medication Administration Record |
| Equipment used for medication dispensing | Med carts Med rooms Computerized Systems |
| What are three examples of computerized medication dispensing systems? | Accudose Suremed BCMA |
| What are the Five Rights of Medication Administration? | Right Medication Right Dose Right Time Right Route Right Client |
| What are the *added* five Rights of Medication Administration? | Right Client Education Right Documentation Right to Refuse Right Assessment Right Evaluation |
| What are the nurse's responsibilities concerning medication and its administration? | Accurate transcription Accurate administration Check that order is clear and unambiguous Check for abrupt change in dose, discontinuation of drug Assess for change in patient condition |
| What aspects of medication history may affect drug administration? | Current prescriptions, OTC, herbal and dietary supplements Illegal drug use, dependencies Allergies Past reactions or intolerances |
| What assessments are needed before administration? | Does patient need help with sitting up? Does patient have water? Can patient swallow? etc. |
| T or F - A nurse should check the chart to learn about a patient's allergies before giving the patient an oral drug. | F. Though checking the chart is fine, the nurse should ask the patient if he or she has any allergies EVERY TIME before a drug is given. If the patient is receiving an oral med, the patient is conscious and can probably answer such a question. |
| How many checks is the nurse to complete before giving a medication? | Three |
| What is the first check? | Read MAR, select correct medication Compare label against MAR Double check math calculation Check expiration |
| What is the second check? | Compare label against the MAR again |
| What is the third check? | Check label against MAR at the bedside just prior to opening the package. |
| What are the five steps in the administration of meds? | Identify client Educate client about medications Administer medications Provide adjunctive interventions as needed Document administration Evaluate client's response to medication |
| Orange syringes are used for ___. | Insulin |
| What is the volume range of a dose of insulin? | 50 to 100 units. |
| How many mL are in 50 units? 100 units? | 0.5 mL, 1 mL |
| T or F - You can use the orange syringe for meds other than insulin if needed. | False. You should use them for insulin only. |
| Use of tuberculin syringe | Used to draw up small amounts accurately, up to 1 mL. |
| Tuberculin syringes are usually what color? | Black |
| A syringe with a volume capacity of 60 mL would be used for ___-. | Wound irrigation, NG tubes, etc. |
| Tubex/Carpujet | Prefilled syringe, overfilled. Nurse should prime needle and waste excess with another licensed nurse. |
| What needle would you use for a vastus lateralus or ventrogluteal injection? | Up to 2 mL vol. 21 - 22 gauge 1 to 1 1/2 inch |
| What needle would you use for a dorsogluteal injection? | Up to 3 mL vol. 21 - 22 gauge 1 1/2 to 2 inches |
| What needle would you use for a subcutaneous injection? | 24 - 26 gauge 3/8 to 5/8 inch |
| What needle would you use for an intradermal injection? | 25 to 27 gauge 1/4 to 5/8 inches |
| Ampule | Glass container holding a single dose |
| What is the volume of an ampule? | 1 to 10 mL |
| T or F - You should inject air into an ampule, because the ampule contains a vacuum inside. | False. The ampule does not contain a vaccuum, and you should not inject air. |
| How should you open an ampule? | You should break the top away from yourself and others. |
| How should you draw up the medication from an ampule and why? | With a filter needle, to eliminate shards of glass. |
| Vials | Single or multi-dose containers. |
| What should you do before inserting a needle into a vial to draw up medication? | Wipe the top of the vial with an alcohol prep pad. |
| What must you do once you insert the needle into the vial? | Inject air. The vial contains a vaccuum. Without injecting air, there will be too much resistance. As soon as you let go of the plunger, the medication would be sucked right back into the vial. |
| Angle of insertion for a intradermal injection? | 15 degrees |
| Angle of insertion for a subcutaneous injection? | 90 degrees or 45 degrees. Use 90 for people with more subcutaneous tissue (such as an obese person). Use 45 degrees for a person with less subcut tissue (such as an emaciated or elderly person). |
| What is the process for administering an intramuscular injection? | Aspirate and observe for blood. Inject medication slowly. Remove needle quickly. Gently apply pressure to site with dry, sterile gauze. |
| Considerations for deltoid injection? | Smaller muscle Rapid absorption Can tolerate only 1 mL solution Good for clients that self-inject May cause greater discomfort |
| What is the landmark for the deltoid? | Lower edge of acromion process. |
| Considerations for vastus lateralus injection | Preferred site for infants 1 year and younger. Usually nicely developed muscle No major blood vessels or nerves |
| Vastus lateralus landmark? | Divide the thigh into thirds vertically and horizontally. Use outer middle area. |
| Considerations for ventrogluteal injection? | No large nerves or blood vessels Provides greatest thickness of muscle Sealed off by bone Less fat than the buttock |
| Ventrogluteal landmarks? | Palm on greater trochanter Index finger toward the anterosuperior iliac spine |
| Considerations for dorsogluteal injection? | Thick gluteal muscle of the buttocks Should not be used for children under 3 use caution to avoid sciatic nerve |
| Dorsogluteal landmarks? | lateral and slightly superior to the midpoint of a line drawn from the trochanter to the posterior superior iliac spine. |
| Process for subcut. injection | Wash hands, gloves Review order, check for allergies ID client (2 identifiers) Select proper syringe Choose and inspect site Wipe site with alcohol Allow to dry Stretch/pinch site Insert needle, bevel up 45 or 90 degree angle |
| T or F - When giving insulin, use a syringe marked in mLs. | F. Insulin is measured in units. |
| Intradermal injection process | Wash hands, gloves Review order, check for allergies ID client (2 identifiers) Proper syringe Choose/inspect site, wipe w/ alcohol pad Let dry Insert needle, bevel up, 10 - 15 degree angle Advance needle until bevel under skin Inject slowly, formi |
| How should you wipe a site with an alcohol pad before an injection? | In a circular motion. |
| What steps can you take to minimize pain of injection? | Use real words Describe procedure Teach breathing technique Pinch Pull Distraction Local anesthetic if ordered |
| What is a Z-track? | Before injection, displace skin to one side. After injection, allow skin to go back into normal position. This breaks up the path of the needle so that medication doesn't seep back out. |
| When do you use a Z-track? | Especially in the dorsogluteal site. |
| What is the purpose of aspiration before an intramuscular injection? | To make sure you haven't entered a blood vessel. |
| If you aspirate before a intramuscular injection and you see blood, what should you do? | Withdraw the needle immediately and start over. |
| How often should the client clean out his or her medicine supply? | Every two to three months. |
| What is the proper environment for medicine storage at a client's home? | A cool, dry place (not in a bathroom cabinet). Some medicines may require refrigeration. |
| What should the client know about his or her medication? | The trade and generic name, the reason for taking the med, the dosage and amount prescribed, the time when it should be taken, the side effects and under what circumstances the Dr. should be called. |
| What should the nurse tell the client about which pharmacy to use? | That the client should always use the same pharmacy. |
| When should a client call for refills? | A week ahead of time. |
| T/F: A client who has been taking a medication for a long time doesn't need to read the label. | False. The client should read the label before each use. |
| T or F - You should tell the client to keep a list of all medications handy. | True. |
| How can you protect yourself legally in the administration of meds? | Know laws, nurse practice act, facility policies Practice 10 Rights Know client and medication Triple check each med Know your resources Continue education Report errors timely |
| What should you know about medication administration before clinicals? | Reason why client is receiving med (priority) Drug classification (pharmacological) Contraindications Usual dosage range Side Effects Nursing considerations |
| What needle would you use for a deltoid injection? | Up to 1 mL volume 20 - 22 gauge 1 - 1 1/2 inch |
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