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med amin
| Question | Answer |
|---|---|
| Factors that influence the rate of absorption | Admin Route Ability to dissolve Blood flow to admin site Body Surface Area Lipid Solubility |
| Rate and extent of distribution factors | circulation and protein binding |
| excretion exits | lungs exocrine glands bowels kidney liver |
| mild allergic reactions | Urticaria (hives) Eczema (rash) Pruritis (itching) Rhinitis (Runny Nose) |
| severe allergic reactions | Sudden constriction Edema of Larynx Edema of Pharynx Severe Wheezing Shortness of Breath |
| iv im sq time | 15-30 sec |
| 6 rights of med admin | right medicine right dose right patient right time right route right documentation |
| chart on documentation | name date of order meds given route and frequency dose given time given pt response complaints or ADR |
| what should medication order include | Patient Surname First Name Medical Record # Ward/Clinic Drug Name Drug Dose Drug Route Dr’s Printed Name Dr’s Signature Date of Order |
| verbal orders | EMERGENCY situations only RN writes order on MAR & repeats back to Dr Enter into medical record BOTH Dr & RN names are signed |
| telephone order | given via phone usually after you update the Dr about the condition Transcribe the same way as a verbal order Requires a read-back by person receiving the order |
| if med error occurs | RN assesses & examines Patient RN Contacts Dr ASAP Once Patient is stable, notify the supervisor RN fills out a written incident report w/in 24 hrs |
| included in incident report | Patient Info Location Time of Incident Description RN Response Patient Outcome Signature of RN |
| meds that cant be crushed | Capsules Enteric coated Long acting release Slow acting release |
| meds that can be crushed | pre-scored use pillating device |
| eye ointment | bedtime |
| nose drops for infants | 20-30 min before feeding |
| renal suppositorys | 2 Inches |
| intradermal in childen | only up to 0.1ml |
| subcutaneous in children | 26-30 gauge needle 1/2 in inserted 90 degrees |
| intramuscular for children gauge | 25-30 gauge |
| intramuscular needle toddlers | 1 - 1 1/4 inch |
| intramuscular needle for infants | 1 in |
| preferred sites for children | first vastus lateralis 2nd deltoid |
| inches of IM needles usually | 1 - 1 1/2 in |
| inches subcut or intradermal needle usually | 3/8 - 5/8 |
| IM syringe | 1-3 mL |
| subcut syringe | 1-3 mL |
| tb syringe for | intradermal or other subcut injections or for small doses for children |
| intradermal injection syringe | TB syringe |
| intradermal injection gauge | 25-27 |
| intradermal injection needle length | 3/8 -5/8 in |
| intradermal insert angle | 15 degrees |
| subcut injections syringe | Insulin for insulin tb for others |
| subcut gauge | 25 (26-30 for children) |
| subcut needle length | 5/8 at 45 degree angle 1/2 in at 90 degree angle |
| intramuscular injections syringe | 3 mL |
| intramuscular gauge for aqueous solution | 20-25 |
| intramuscular gauge for viscous solution | 18-25 |
| intramuscular gauge for children | 25-30 |
| intramuscular needle length for obese pt | 1 1/2 + |
| intramuscular needle length thinner pt | 1/2 - 1 in |
| intramuscular needle for infants | 1 inch |
| intramuscular needle for toddlers | 1 - 1 1/4 |
| intramuscular angle admin | 90 degrees if possible |
| intramuscular ventrogluteal | 1/2 - 2 inch |
| intramuscular lateris | 1/2 - 2 inch |
| intramuscular deltoid | 1/2- 1 1/2 inch |
| ampule | glass container 1 time use snap off top use filter needle |
| vial | glass or plastic rubber top for multi use must inject air to get it out |
| ampule + vial | use vial first |
| insulin measured in | units |
| Lypoatrophy | Small depressions in the subcutaneous fat |
| Lypohypertrophy | Lump under the skin caused by accumulation of extra fat |
| lovenox injection admin what route? | subcutaneous |
| lovenox injection site | between the left or right anterolateral & left or right posterolateral abdominal wall |
| lovenox injection angle | 90 degrees |
| OD | Right eye |
| OS | left eye |
| OU | both eyes |
| nasoenteric or ng tube what position | high fowlers |
| flush nasoenteric or ng tube | before and after each med (15-30) mL |
| pt gastric ph | 4 or less |
| elevate head ng tube | 1hr after admin |
| check ng tubes | every 4-6 hours |
| meds that require double check | insulin anticoagulant (heparin) |
| count narcotics | during opening of drawer during shift changes |
| admin narcotic document | pt name date time of admin name of med dose rn signature |
| if give only part of narcotic | another nurse has to watch you dispose not in sharps container both have to sign |
| absorption | passage of meds into blood from site of admin |
| distribution | passage of meds to tissue and organs |
| metabolism | metabolized med into inactive form |
| excretion | meds leaving body depends on med chem makeup |
| therapeutic effect | desired / expected |
| side effect | predictable / unavoidable N/V, dry mouth, constipation, dizziness, drowsiness |
| adverse side effect | not predictable unintended undesirable take weeks-months to develop |
| toxic effect | after prolong intake of med builds up in blood system due to not excreting or metabolizing high dose certain antidotes available to fix |
| idiosyncratic reactions | unpredictable reactions over/ under/ diff than normal |
| allergic reactions | unpredictable meds act as amtigen --> antibodies being produced -->allergic reaction *antibiotics high risk |
| always record pt allergies where | MAR |
| Buccal route | by mouth |
| sublingual route | under tongue |
| topical route | on skin |
| suppository route | rectal vaginal |
| non parental routes | buccal sublingual topical suppository |
| parental routes | intramuscular subcutaneous intradermal epidural intravenous |
| peak level of meds | when admin med just before body absorbs last bit of med after peak.. serum falls quickly drawn when drug is expected to reach peak |
| trough level of meds | pt at which lowest amount of drug in serum drawn 30 min before next dose |
| check label of meds with MAR... | 3 times |
| when do you check the label of meds with MAR | before preparing meds, when pulling out, check expiration date while preparing med before giving med to pt |
| giving med that you didnt prepare yourself | NEVER |
| preparing med not labeled | NEVER |
| medication order requires for what drugs? | every drug |
| compare med order with.. | MAR |
| verify med info when | new MARs written PT transfer |
| preparing right dose nursing should | check admin record and physicians orders |
| check label on container of med for what? | concentration of med |
| calculations for med | verified with another nurse esp. narcotics heparin tovenox |
| assess appropriate dose with pt | age, diagnoses, gender |
| check patient for identification... | twice bring MAR with you to room pt name birthdate allergies |
| medications administered to routes.... | ONLY from route indicated in order |
| meds can be given in what time frame | 30 min before or 30 min after |
| documentation should be done when? | ASAP after meds given |
| legal med order given by | physician, NP, Pa |
| verbal and telephone orders must be sign within | 24 hours |
| medication error rn... | assess and examine pt call doctor asap tell supervisor once pt is stable fills out incident report DO NOT PUT IN MAR |
| standing order | specific orders for various situations routine orders |
| NOW orders | within 30 min to hour |
| liquid med less than 10 ml | draw in calibrated oral syringe |
| using inhalers | spacer device recommended for small children watch for ADR of brochidialaters: tremors restlessness dizziness |
| turn ampule or vial upside down to draw? | ampule |
| z track injection purpose | to decrease skin irritation by sealing off meds in muscle tissue |
| z track injection technique | inject med deep into muscle pull skin tightt over laterally over skin 1- 1 1/2 insert & inject slowly leave needle in place 10 sec withdraw needle and release skin |
| clear insulin | Regular & Humalog (Lispro); Novolog (Aspart) |
| cloudy insulin | NPH; Lente |
| mixing cloudy and clear insulin | roll cloudy until mixed take cloudy bottle fill with air DONT w/draw liquid take clear bottle fill with air withdraw liquid take syringe insert into cloudy bottle and withdraw liquid |
| prevention of lypoatrophy and lypohypertrophy | rotate injection sites |
| Ventrogluteal Site | place heal of hand over greater trochanter of patient’s hip point thumb toward patients groin, index finger points the anterior superior iliac spine, extend middle finger along iliac crest toward buttock the center of the triangle the pinch skin |
| Vastus Lateralis site | muscle located on anterior lateral aspect of the thighfrom a hand above the knee to a hand below the greater trochanter of the femur, use the middle one third of the muscle for injection can use other portions for multiply injections patient lie flat |
| deltoid site | located by fully exposing the patients arm and shoulder and relax arm lower edge of acromion process 2.5 - 5 cm below acromion process apex-4 fingers across deltoid muscle. top finger along acromion procress then I.S. 3 fingers below acromion process |
| dorso site | lateral aspect of upper arm subcutanous- lower portion of upper arm, later side-3 finger up form elbow 3 finger down from deltoid insertion. |
| forearm intradermal site | 4 fingers from end or elbow, and 4 fingers up from wrist, 15 degree angle, just upper dermis see bubble of med |
| Abdomen (subcutaneous) | repeated injections -2 in around belly button, not above costal margin or below pubic area and not going past the anterior/superior iliac spine. -multiple sites |
Created by:
ksarichburg
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