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Adm. Meds
Ch. 16 Nsng 105
| Question | Answer |
|---|---|
| To safely and accurately administer med, you need to know | pharmacokinetics growth and dev mathematics nutrition |
| what is pharmacokinetics | how drug moves to site in body, metabolize and exit |
| What three different drug type names are there | chemical, generic, trade |
| what is the dangerous MAP(mean arterial pressure) | 65 |
| If a med is ordered, do you have to adm it? | NO |
| What will the form of the drug dictate? | route |
| Medication classification indicates what? | effect of medication on body system, symptoms med relieves, meds desired effect |
| what are oral agents and what are the five classifications | oral meds sulfonylureas, biguanides, thiazolidinedione derivatives, a-glucosidase inhibitors, meglitinides |
| A doctor chooses an oral agent based on what | pt characteristics, cost, efficacy, dosing freq, exp w/ med |
| Aspirin is part of more than one class what are they | analgesic, antipyretic, antiinflammatory |
| What does the Pure Food and Drug Act require | all meds to be free of impure products |
| what is the Medwatch program | vol program encourages nurses and others to report when med causes serious harm |
| Which regulation has the most influence over nursing practice | State Nurse Practice Act, defines scope of nurses' professional fx adn responsibilities |
| What is the primary intent of state Nurse Practice Act | protect public from unskilled, undereducated and unlicensed nurses |
| what are the 6 R's | right dose, time, pt, route, med, documentation, |
| Which name should a medication be ordered by | generic name, brand names look alike |
| What should the nurse do when given a verbal order | repeat back to dr and spell name of drug |
| what is a critical step in identifying med errors at the time or pt counseling | reinforce prescriber's instructions |
| What is "Tall Man" letters | replace CAP letters where two drugs are similar ex. hydrALAzine Hydrocholoride...HydrOXYzine Hydrochloride |
| You drew up too much med and need to waste an opioid, what should you do | Have second nurse to witness disposal, both nurses record names on controlled substance record |
| what is difference between medication abuse and medication dependence | abuse happens when pt repeatedly use addictive subst dependence is pt exp withdrawal when med is stopped |
| what % pts don't adhere | 50% |
| what can cause nonadherence | poor education, fear of addiction, med not needed, $, insurance |
| what 5 things affect absorption | route, ability of med to dissolve, blood flow to site, BSA, lipid solubility of med |
| where are acidic meds absorbed better vs alkaline | acidic in gastric mucosa, alkaline in sm intest |
| do meds absorb and take effect faster in stomach or sm intest | sm intest |
| why are lipids more easily soluble | readily x cell membranes |
| how long does it take for oral meds to be broken down IM IV | oral 30 - 45 min IM 20-25min |
| The BBB allows which kind of meds to pass through | lipid soluble to pass into brain and cerebrospinal fluid. Lipids and nonlipids pass into placenta(nonselective) |
| what does distribution of drug depend on | physical/chemical properties of drug adn pt physiology incl: circulation membrane permeability protein building metabolism excretion |
| What do most meds bind to | albumin |
| what happens when a drug binds to albumin | do not exert pharmocological activity, the unbound or "free" med is active form of medication |
| what is biotransformation | enzymes detoxify(remove toxics), degrade(break down), remove biologically active chemicals |
| what do most meds get excreted by | kidneys(main), liver,GI tract, bowel, lungs, exocrine glands(mammary) |
| when meds undergo biotransformation in the liver before kidneys excrete them is known as | 1st pass effect |
| how much fluid intake promotes proper elimination of meds | 50ml/kg/day |
| what is kaeyxila | pulls K to bowels to decrease K |
| what is the therapeutic effect | intended or desired physiological response of med |
| what is a side effect | predictable and unavoidable secondary effect produced at a usual therapeutic dose |
| most common side effects | anorexia, N/V/D, constipation, drowsiness |
| what is an adverse effect | undesired, unintended, unpredictable responses |
| what are toxic effects | effects that can cause injury/death |
| What is an idiosyncratic reaction | unpredictable efect, where pt overreacts/underreacts or has diff. reaction than expected. |
| what is an allergic reaction | med acts as an antigen, triggering release of body's antibodies |
| what is medication allergy | pt immune system casues abnormal reactions to med |
| what is medication interaction | one med modifies action of another |
| what is synergistic effect | effect of two meds combined is greater than effect of med given separtely. Ex: alcohol has synergistic effect on CNS depressants or opioids |
| what is biological half life | time it takes for body to lower amt of unchanged med by half |
| If you have a half life of 4 hrs, and give 10,000 unts, pt will excrete how much in 4 hours | 5,000, then 2500 |
| If you give 15,000 units, will the half life change? | no |
| what is pruritis, uticaria, angioedema | itching, hives, swelling of face, neck |
| what are the 4 major parenteral routes | subc, IM, IV, ID |
| 1tbsp, 1tsp = how many ml 1 cup = 1 quart = 1 gallon = | 15 ml, 5ml 8 oz, 1 pint, 240mL 960 ml 3840 mL |
| what is most common glaucoma med used in and what form | Pilocarpine, intraocular disc |
| When will a dr sign verbal orders | 24 hrs |
| Name 5 types of medication orders | standing prn single orders state now |
| Standing orders last how long | until dr cancels by another order or until days elapse ex: tetracycline, 500 mg PO q6h |
| what should never be allowed as a verbal order | antineoplastic agents |
| what should always happen wtih verbal orders | reduced to written, signed by ind receiving order adn documented, reviewed, countersigned by prescriber |
| what is MgS04 what is MS04 | magnesium sulfate morphine sulfate |
| what is the difference b/n state and now orders | stat is immediately, once now is one time order, quickly, but not right away, up to 90 min |
| what are some reasons for medication errors | inaccurate prescribing, adm of srong meds, route, time interval, adm extra doses or failing to adm med |
| when adm meds, how often should you check the label and when | 3 times, before removing from shelf/drawe, as drug is removed from container, as drug container is returned to shelf/drawer |
| when are IV's effective IM SQ PO | IV, immediately IM 10-20 min SQ 20-30 min po 30-40 min, days, weeks |
| when should you give all routinely ordered meds | within 60 min....30 before or 30 after |
| what might you assess before giving drugs | med hx, hx or allergies, diet hx, pt ability to prepare doses, physical/mental status, cultural/personal beliefs, knowledge/understanding, expectations |
| african americans are greater risk for | type II diabetes, HTN, high cholesterol, end stage renal disease |
| what can happen if you don't adm eardrops at room temp | cause vertigo or nausea |
| when adm eardrops how should you open the ear canal on a child | down and back <3yrs up and outward >3yrs |
| how far should you insert a suppository | about 4 in in adults 2" children |
| what is a metered dose inhalers(MDIs) or pressurized metered dose inhalers (pMDIs) | device to produce bronchodilation, release med on inhalation. Spacer allows med to go deeper and enhance absorption |
| A dry powder inhaler (DPI) is different from MDI how | powdered med creating aerosol when pt inhales. Works with breathing |
| how do you calculate how many inhalations are in inhaler | Divide number of doses in container by the nuber of doses pt takes per day |
| When giving meds in NG-G tube how much solution do you flush the tube wtih | 30-60ml water |
| what is parenteral medication | adm by injection, need asepsis, invasive |
| what are the parts of a syringe | barrel, plunger(sterile), tip |
| what are the 4 types of syringes | Luer-Lok- twist on needle and lock Non-Luer-Lok- preattached needles or needles can slip on to tip Tuberculin- TB skin test Plain tip(tenths), Insulin(units) |
| What are the range of sizes for needles | 0.5 to 60mL |
| Which syringe is typical for an IM injection For SQ injections | IM-1 - 3 mL, 1-1/2" SQ- 1/4"-5/8" |
| what are the parts of a needle | hub, fits tip of syringe, shaft, bevel |
| What determines which needle length you use | depends on pt size, wt, route of adm |
| As the needle gauge gets smaller, what happens to the diameter | the needle diamter becomes larger |
| what do you use special when drawing and adm med from an ampule | filter needle, then replace needle before adm |
| what is important when drawing med out of a vial | inject air first |
| when you mix meds from vial and ampule which do you draw from first | vial first, then draw from ampule with same syringe, but filter needle |
| How do you draw meds and mix from two vials | inject air in vial A inject air in Vial B, then draw med from Vial B Draw med from Vial A |
| when drawing insulin, you have 100 adn 500 unit insulin. What syringe should you use to draw 500 insulin | tuberculin syringe |
| what four types of insulin are there | rapid acting, short acting, intermediate acting and long acting |
| If you need to prepare regular and intermediate acting insulin, which do you prepare first | prepare regular insulin first to prevent contamination with intermediate |
| insulin glargine(Lantus) and detemir(Levemir) need what precautions | never mix with other types of insulin |
| What is important to remember about Lente insulins | do no mix with short acting unles pt sugar levels are under control wtih this mixture Also, do not mix with phosphate buffered insulins |
| Before injecting a med, what should you be aware of | volume of med to adm, meds characteristics and viscosity, location of anatomical structures under injection site. |
| what is sliding scale insulin | insulin dose is based on pts blood glucose that is done prior to meals or at a set interval |
| where should you give SQ shots | outer arms, abd, ant thighs, also back, and upper buttocks |
| which site is best to adm heparin Low weigh heparin | abd rt/left side of abd 2" from umbilicus |
| SQ injections can be up to how many mL | 2mL in adults Powerpoint says .5-1mL children 0.5mL |
| what indicates the depth of a SQ injection | pt wt. |
| when inserting a 25-gauge, 5/8" needle, what angle is used? What about 1/2" | 45-degree angle 90-degree angle |
| what is the best site for thin person to be injected | upper abd |
| If you are able to grasp 2" of tissue inject needle at what angle? If you grab 1" tissue | 90-degree 45-degree |
| what is the typical IM dosage given to adult | 2-5mL No more than 1mL to sm. children, older infants No more than 0.5mL to sm. infants |
| what is the preferred site for adults, children, infants? what is two other good sites | ventrogluteal Vastus Lateralis Deltoid(use for sm. med vol or when other sites not available) |
| What is the Z-track method? | prevents deposit of med into sensitive tissues |
| what is the best ID site | lightly pigmented, free of lesions, relatively hairless; inner forearm/upper back |
| what can the tuberculin syringe be used for beside ID | heparin |
| what appears on the skin in an ID injection | a small bleb |
| when do you adm IV meds | as mixes of lg vol of IV fluids by injection of bolus or sm. vol of med thru existing IV line or intermittent venous access(heparin or saline lock) By piggyback |
| When adm narcotics or potent meds, what should you assess | VS before, during, after infusion |
| what is a danger of IV continuous infusion | circulatory fluid overload |
| what are two types of meds commonly added to IV fluids | vitamins and K Cl |
| What does clear to cloudy mean | inject air in cloudy, inject air in clear, draw clear, draw cloudy |
| what should you remember to not do when giving heparin | do not aspirate, massage, wait 10 sec before withdrawing needle, Lovenox is exception to the rule |
| what is best way to mix lg vol 500mL or 1000mL | NS most common |
| what is adv of bolus | introduces med directly into systemic circulation adv for pt on fluid restriction most dangerous route, no room for error may cause direct irritation to veins |
| When IV bags are already hanging, what should you never do | do not add meds b/c there is no way to determine exact concentration of med. only add to new IV fluid containers |
| With volume controlled infusion, what are diff types of containers | piggyback, tandem, buretrol, mini-infusion pump |
| how long is vol. controlled infusions | 30-60min, iv fluid is controlled |
| what is intermittent venous access | commonly called heparin lock/saline lock is IV catheter wtih sm "well" or chamber covered by rubber cap |
| Adv of intermittent venous access | cost savings, save nurses' time by not monitoring constant flow, incr mobility, safety, adn comfort for pt. |
| what is important to remember when giving pt corticosteroid | have pt rinse mouth with water/salt water or brush teeth to reduce risk for fungal infection |
| syringe and needles: SQ syringe/needle IM | SQ syringe 1-3mL; needle 25-27 gauge, 1/4"-5/8" IM- sy 2-3mL adult, 0.5-1 infant/child |
| ventrogluteal site child adult | 1/2-1" 1 1/2" |
| vastus lateralis child adult | 5/8-1" 5/8-1" |
| deltoid child adult | 1/2-1" 1-1 1/2" |
| aqueous solutions use which gauge oil based solutions use | 20-25 gauge 18 - 25 gauge |
| what are contraindications with SQ injections | circulatory shock or reduced local tissue perfusion |
| contraindications for IM injections | muscle atrophy, reduced blood flow, circulatory shock |
| contraindications for ID injections | hx of severe advers reactions or necrosis that happened after |
| what should I remember when giving IM injections | apirate |
| when giving IV push in existing line, what is a critical point when adm IV meds | never in tubing infusing blood, blood products or parenteral nutrition |
Created by:
palmerag
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