Ch 32 Medication Administration

Principles when administering eye meds

1. Avoid instilling any form of eye meds directly onto the cornea. It is very sensitive 2. Avoid touching the eyelids or other eye structures with eydroppers or ointment tubes. The risk of transmitting infection is high 3. Use eye mediation only for the patient's affected eye 4. Never allow a patient to use another patient's eye meds

Safety in medication administration for older adults

1. Frequently review a patient's medication history & consult with a health care provider to simplify 2. Keep instruction clear & simple, provide memory aids, & ensure that print is large 3. Assess functional status to detriment if patient will require assistance in taking meds 4. Some older adults have a greater sensitivity to drugs 5. If difficulty in swallowing ask health care provider to substitute a liquid medication 6. Teach alternatives to meds such as proper diet vs vitamins & exercise vs laxatives

A toddler is to receive 2.5 mL of an antipyretic by mouth. Which equipment is the most appropriate for medication administration for this child? A. A medication cup B. A teaspoon C. A 5-mL syringe D. An oral-dosing syringe

4. An oral-dosing syringe

The health care provider orders 500mg of amoxicillin to be administered in a gastric tube every 8 hours. The bottle of amoxicillin is labeled 400mg/5mL. How much amoxicillin do you give

400mg/5mL=500mg/xmL 400x=2500 x=6.25

Medication allergy

Adverse reaction such as rash, chills, or gastrointestinal disturbances to a medication. Once a drug allergy occurs, the patient can no longer receive that particular medication.

Latin prefixes designates Subdivision of basic units

Deci-(1/10 or 0.1) Cents-(1/100 or 0.01) Milli-(1/1000 or 0.001)

Practice Acts(NPAs)

Define the scope of nurses' professional functions & responsibilities

Formula method

Dose ordered/dose on hand*amount on hand=amount to administer

Ophthalmic

Drugs given into the eye in the form of either eye drops or ointments

Designation of basic units

Gram=g or Gm Liter=l or L Milligram=mg Milliliter=mL

Infusions

Introduction of fluid into the vein, giving intravenous fluid over time

Parenteral administration

Involves injecting a medication in body tissues

Needle length for immunizations male-female-length

Less than 130-less than 130-5/8 to 1 inch 130 to 152-130 to 152-1 inch 153 to 260-153 to 200-1 to 1.5 inches 260+-200+-1.5 inches

Prescriptions

Medication to be taken outside of the hospital

Buccal

Placing the solid medication in the mouth against the mucous membranes of the cheek until it dissolves

Needle length for site & ages site-child-adult

Ventrogluteal-1/2 to 1 inch-1/12 inch vastus lateralis-5/8 to 1 inch-5/8 to 1 inch deltoid-1/2 to 1 inch-1 to 1 1/2 inch

Idiosyncratic reaction

an unexpected reaction to a drug that is peculiar to the individual

Equivalents of measurement

1 mL=15-16 minims=15 drops(gtt) 5 mL=1 dram=1 teaspoon(tsp) 15 mL=4 drams=1 tablespoon(tbsp) 30 mL=1 fluid oz=2 tablespoons(tbsp) 240 mL=8 fluid oz=1 cup(c) 480 mL=1 pint(pt)=1 pint(pt) 960 mL=1 quart(qt)=1quart(qt) 3840 mL=1 gallon(gal)=1 gallon(gal)

Protecting a patient from aspiration

1. Allow patients to self-administer meds if possible 2. Know signs of dysphagia; cough, change in voice tonite or quality after swallowing, delayed swallowing, incomplete oral clearance or pocketing of food, regurgitation 3. Asses patient's ability to swallow & cough 4. Prepare oral meds in form that is easiest to swallow 5. Position patient in an upright, seated position 6. If patient has unilateral weakness, place the medication in the stronger side of mouth 7. Administer pills one at a time 8. Thicken regular liquids or offer fruit nectars 9. Some meds can be crushed & mixed with puréed foods 10. Avoid straws because they decrease the control patient has over volume intake 11. Have patient hold & drink form a cup 12. Time meds to coincide with mealtimes or when patient is well rested & awake 13. Administer meds using another route if risk of aspiration is severe

Nursing diagnoses may apply during medication administration

1. Anxiety 2. Ineffective health maintenance 3. Deficient knowledge(medication self-administration) 4. Noncomplinace(medications) 5. Impaired swallowing 6. Impaired memory 7. Caregiver role strain(caregiving activities)

Nurses administer meds intravenously by the following methods

1. As mixtures within large volumes of IV fluids 2. By injection of a bonus or small volume of medication through an existing IV infusion line or intermittent venous access 3. By "piggyback" infusion of a solution containing the prescribed medication & a small volume of IV fluid through and existing IV line

A pediatric nurse takes a medication to a 12-year-old female patient. The patient tells the nurse to take it away because she is not going to take it. What is the nurse's next action? 1. Ask the patient's reason for refusal 2. Consult with the patient's parents for advice 3. Take the medication away & chart the patient's refusal 4. Tell the patient that her health care provider knows what is best for her

1. Ask the patient's reason for refusal

After receiving an intramuscular injection in the deltoid, a patient states, "My arm really hurts. It's burning & tingling where i got my injection. What should the nurse do next? 1. Assess the injection site 2. Administer an oral medication for pain 3. Notify the patient's health care provider of assessment findings 4. Document assessment findings & related intervention in the patient's medical record 5. This is a normal finding so nothing needs to be done 6. Apply ice to the site for relief of burning pain

1. Assess the injection site 3. Notify the patient's health care provider of assessment findings 4. Document assessment finding & related intervention in the patient's medical record

Recommendations for prevention of needle stick injuries

1. Avoid using needles when effective needle less systems or sharps with engineered sharps injury protection safety devices are available 2. Dont recap any needle after medication administration 3. Plan safe handling & disposal of needles before beginning a procedure 4. Immediately dispose of needles, needleless systems, & SESIP into puncture-proof, leak-proof sharps disposal containers 5. Maintain a sharps injury log that includes the following: type & brand of device involved in incident, location of incident, description of incident, & privacy of employees who have had sharps injuries 6. Attend education offerings on blood borne pathogens & follow recommendations for infection prevention, including receiving the hep B vaccine 7. Participate in the selection & evaluation of SESIP devices with safety features within your agency

Compare the label of the medication container with the medication administration record(MAR) 3 times

1. Before removing the container from the drawer or shelf 2. As the amount of medication orders is removed form the container 3. At the patient's bedside before administering the medication to the patient

You are a new graduate nurse completing your orientation on a very busy intensive care unit. You cannot read a health care provider's order for one of your patient's medications. You have heard from more experienced nurses that this health care provider does not like to be called, and you know that another of the health care provider's patients is very unstable. What is the most appropriate next step for you to take? A. Call the health care provider to clarify the order B. Talk with your preceptor to help you interpret the order C. Refer to a medication manual before giving the medication D. Use your best judgment and critical thinking and administer the dose you think the health care provider ordered

1. Call the health care provider to clarify the order

Medication errors involving children frequently happen for the following reason

1. Confusion between formulations for adults & children 2. Availability of multiple pediatric concentrations of oral liquid meds 3. Inaccurate preparation of meds that need to be diluted 4. Similar packaging of meds & names of meds that look alike & sound alike 5. Parents who dont understand how to prepare & administer meds correctly 6. Errors in calculation & use of inaccurate measuring devices as opposed to devices made to measure small-volume doses

Advantages to intermittent venous access include the following

1. Cost savings resulting from the omission of continuous IV therapy 2. Effectiveness of nurse's time enhanced by eliminating constant monitoring of flow rates 3. Increased mobility, safety, & comfort for the patient

Application of topical medications

1. Direct application of a liquid or ointment(e.g., eye drops, gargling, or swabbing the throat) 2. Insertion of a medication into a body cavity(e.g., placing a suppository in rectum or vagina or inserting medicated packing into vagina) 3. Instillation of fluid into a body cavity(e.g., eardrops, nose drops, or bladder & rectal instillation) 4. Irrigation of a body cavity (e.g., flushing eye, ear, vagina, bladder or rectum with medicated fluid) 5. Spraying a medication into a body cavity(e.g., instillation into nose & throat)

Principles when mixing meds from 2 vials

1. Dont contaminate one medication with another 2. Ensure that the final dose is accurate 3. Maintain aseptic technique

dimensional analysis

1. Identify the unit of measure that you need to administer. For example if you are giving a pill, you usually give a tablet or a capsule; for parenteral liquid oral medication, the unit is milliliters 2. Estimate the answer 3. Place the name or appropriate abbreviation for x on the left side of the equation(e.g., x tab, x mL) 4. Place available info from the problem in a fraction format on the right side of the equation. Place the abbreviation or unit that matches what you are going to administer in the numerator 5. Look at the medication order & add other factors into the problem. Set up the numerator so it matches the unit in the previous denominator 6. Cancel out like units of measurement on the right side of the equation. You should end up with only one unit left in the equation, & it should match the unit on the left side of the equation 7. Reduce to the lowest terms if possible & solve the problem or solve for x. Label answer 8. Compare your estimate from step 1 with answer form step 2

Using volume-controlled infusions have the following advantages

1. It reduces risk of rapid-dose infusion by IV push. Meds are diluted & infused over longer time intervals 2. It allows for administration of meds that are stable for a limited time in solution 3. It allows for control of IV fluid intake

Guidelines when calculating pediatric doses

1. Most pediatric meds are ordered in milligrams per kilogram(mg/kg). Therefore weigh the patient in kilograms before administering meds. Avoid converting the patient's weight from pound to kilograms to prevent errors 2. Pediatric doses are usually a lot smaller than adult doses for the same medication. You frequently use micrograms & small syringes 3. IM doses are very small & usually dont exceed 1 mL in small children or 0.5mL in infants 4. Subcutaneous dosages are also very small & dont usually exceed 0.5mL 5. Most meds are not rounded off to the nearest tenth. Instead they are rounded to the nearest thousandth 6. Measure dosages that are less than 1mL in syringes that are marked in tenths of a milliliter if the dosage calculation comes out even & doesn't need to be rounded. Use a tuberculin syringe for medications preparation when the medication needs to be rounded to the nearest thousandth 7. Estimate the patient's dose before beginning the calculation; label & compare the answer with the estimate before preparing the medication 8. To determine if a dose is safe before giving the medication compare & evaluate the amount of medication ordered over 24 hours with the recommended dosage

Process for medication reconciliation

1. Obtain, verify, document: obtain a comprehensive & current list of a patient's medications whenever he or she experiences a change in health care setting. Include all current prescriptions & over-the-counter(OTC) meds 2. Consider & compare-review what the patient was taking at home or preadmission & make sure that the list of meds, dosages, & frequencies is accurate. Compare this list to the current ordered meds & treatment plan to ensure accuracy. Include family caregiver in this discussion 3. Reconcile-compare new medication orders with the current list; investigate any discrepancies with the patient's health care provider & document changes 4. Communicate-ensure that all the patient's health care providers have the most updated list of meds. Communicate & verify changes in meds as with the patient

Guidelines for telephone & verbal orders

1. Only authorized staff receive & record telephone or verbal orders. Agency identifies in writing the staff who authorized. 2. Clearly identify patient's name, room number, & diagnosis 3. Red back all orders to health care provider 4. Use clarification questions to avoid misunderstandings 5. Write "TO"(telephone order) or "VO"(verbal order), including date & time, name of patient, & complete order; sign the name of the health care provider & nurse 6. Follow agency policies; some agencies require documentation of the "read-back" or require two nurses to review & sign telephone or verbal orders. 7. Health care provider co-signs the order within the time frame required by the agency

IV piggyback medication with label following ISMP safe-labeling guidelines

1. Patient name 2. Location 3. Second identifier 4. Generic name 5. BRAND name 6. Patient dose 7. Diluent 8. Route 9. Tidal volume 10. Bar code 11. Initials as needed 12. Expiration date as needed in a MM/DD?YYYY format 13. Pharmacy info if required 14. Comments 15. Other info as required by state or federal law

Medication order needs to have the following parts

1. Patient's full name 2. Date & time that the order is written 3. Medication name 4. Dosage 5. Route of administration 6. Time & frequency of administration 7. Signature of health care provider

Principles when mixing insulin's

1. Patients whose blood glucose levels are well controlled on a mixed-insulin dose need to maintain their individual routine when preparing & administering their insulin 2. Dont mix insulin with any other meds or dilute to unless approved by the health care provider 3. Never mix insulin glargine(Lotus) or insulin detemir(Levemir) with other types of insulin 4. Inject rapid-acting Insulins mixed with NPH insulin within 15 mins before a meal 5. Verify insulin does with another nurse while you are preparing the injection

Steps to take to prevent medication errors

1. Prepare medications for only one patient at a time 2. Follow the six rights of medication administration 3. Be sure to read labels at least 3 times(comparing medication administration record[MAR] with label) before administering the medication 4. Use at least 2 patient identifiers & review the patient's allergies whenever administering a medication 5. Dont allow any other activity to interrupt administration of medication to a patient 6. Double-check all calculations & other high-risk medication administration processes & verify with another nurse 7. Dont interpret illegible handwriting; clarify with health care provider 8. Question unusually large or small doses 9. Document all medications as soon as they are given 10. When you have made an error, reflect on what went wrong & ask how you could have prevented the error. Complete an occurrence report per agency policy 11. Evaluate the context or situation in which a medication error occurred 12. Attend in-service programs that focus on medications commonly administered 13. Ensure that you are well rested when caring for patients 14. Involve & educate patients when administering medications 15. Follow established agency policies & procedures when using technology to administer medications

Six Rights of Medication Administration

1. Right medication 2. Right dose 3. Right patient 4. Right route 5. Right time 6. Right documentation

Guidelines for safe narcotic administration & control

1. Store all narcotics in a locked, secure cabinet or container 2. Maintain a running count of narcotics by counting them whenever dispensing them 3. Use a special inventory record each time a narcotic is dispensed 4. Use the record to document the patient's name, date, time of medication administration, name of medication, & dosage 5. A 2nd nurse witnesses disposal of the unused part if a nurse gives only part of a dose of a controlled substance

A patient has the following rights

1. To be informed of the name, purpose, action, & potential undesired effects of a medication 2. To refuse a medication regardless of the consequences 3. To have qualified nurses or physicians assess a medication history, including allergies & use of herbals 4. To be properly advised of the experimental nature of medication therapy & give written consent for its use 5. To receive labeled meds safely without discomfort in accordance with the 6 rights of medication administration 6. To receive appropriate supportive therapy in relation to medication therapy 7. To not receive unnecessary meds 8. To be informed if meds are a part of a research study

Preventing infection during an injection

1. To prevent contaminating the solution, draw up medication quickly. Dont allow ampules to stand open 2. To prevent needle contamination, avoid letting a needle touch contaminated surfaces 3. To prevent syringe contamination, avoid touching length of plunger or inner part of barrel. Keep tip of syringe covered with cap or needle 4. To prepare skin, wash with soap & water if soiled with dirt, drainage, or feces & dry

TJC recommendations for new enteral tube connectors

1. Trace tubing or catheter from the patient to the point of origin: A. Before connecting or reconnecting any device or infusion B. At any transition such as to a new setting or service C. As part of the hand-off process 2. Route tubes & catheters with different purposes in standard directions & label the tubes at both the proximal & distal ends 3. Use tubing & related equipment only for their intended use A. Never use standard Luer syringes for oral meds or enteral feedings B. Dont use IV tubing or IV pumps for enteral feedings C. Use distinctly different pumps for IV applications D. Eliminate the use of temporary adapters as soon as possible E. Dont force connections & avoid workarounds 4. Use safe practices for high-aller meds A. Label the tubing or catheter B. Dont use tubing or catheter with injection ports C. Use an independent double-check procedure 5. Educate staff A. Provide adequate staff education for anyone using this new equipment B. Provide a reference manual 6. Create a culture of safety & reporting of adverse events

Minimize injection discomfort in the following ways

1. Use a sharp-beveled needle in the smallest suitable length & gauge 2. Position a patient as comfortably as possible to reduce muscular tension 3. Select the proper injection site, using anatomical landmarks 4. Apply a vapocoolant spray or topical anesthetic to the injection site before giving the medication 5. Divert the patient's attention from the injection through conversation using open-ended questioning 6. Insert the needle quickly & smoothly to minimize tissue pulling 7. Hold the syringe steady while the needle remains in tissues 8. Inject the medication slowly & steadily

guidelines to ensure safe administration of transdermal or topical medications

1. When taking a medication history or reconciling meds, specifically ask patients if they take any meds in the forms of patches, topical creams or any route other than oral 2. When applying a transdermal patch, ask the patient if they have an existing patch 3. Wear gloves when removing & applying patches 4. If dressing or patch is difficult to see, apply a noticeable label 5. Document location on body wehre medicaiton was placed 6. Document removal of patch or medicaiton

Nursing Assessment Questions

1. Which prescription & nonprescription meds & herbal & nutritional supplements do you take 2. Why do you take these meds 3. Which side effects do you experience? Which effects bother you or affect you negatively 4. What have you been told to do if a side effect develops 5. Have you ever stopped taking your meds & why 6. What do you do to help remember to take your meds 7. Do you have any allergies to meds or foods? If so which ones? Describe what happens 8. Described your normal eating patterns 9. How do you pay fo your meds? Do you have to stretch your budget 10. What questions do you have about your meds?

A health care provider ordered enalapril (Vasotec) 2mg IV push for a patient with hypertension. The pharmacy sent vials marked 1.25 mg enalapril/mL. How many mL does the nurse administer?

1.6mL

Converting measurements within one system

1000mg=1g 350mg=0.35g 1L=1000mL 0.25L=250mL 32oz=1 quart

What statement made by a 4-year-old patient's mother indicates that she understands how to administer her son's eardrops? 1. To straighten his ear canal, i need to pull the outside part of his ear down & back 2. I need to straighten his ear canal before administering the medication by pulling his ear upward & outward 3. I need to put my son in a chair & make sure that he's sitting up with his head tilted back before i give him the eardrops 4. After i'm Done giving him his eardrops, i need to make sure that my son remains sitting straight up for at least 10 mins

2. I need to straighten his ear canal before administering the medication by pulling his ear upward & outward

A nursing student is administering ampicillin PO. The expiration date on the medication wrapper was yesterday. What is the appropriate action for the nursing student to take next? 1. Ask the nursing professor for advice 2. Return the medication to pharmacy & get another tablet 3. Call the health care provider after discussing this situation with the charge nurse 4. Administer the medication since meds are good for 30 days after their expiration date

2. Return the medication to pharmacy & get another tablet

A nurse admits a 72-year-old patient with a medical history of hypertension, heart failure, renal failure, & depression to a general medical patient care unit. The nurse reviews the patient's medication orders & notes that the patient has three health care providers who have ordered a total of 13 meds. What is the most appropriate action for the nurse to take next? 1. Give the meds after identifying the patient using 2 patient identifiers 2. Provide medication education to the patient to help with adherence to the medical plan 3. Review the list of meds with the health care providers to ensure that the patient needs all 13 4. Set up a medication schedule for the patient that is least disruptive to the expected treatment schedule in the hospital

3. Review the list of meds with the health care providers to ensure that the patient needs all 13

A nurse accidentally gives a patient the meds that were ordered for the patient's roommate. What is the nurse's first priority? 1. Complete an occurrence report 2. Notify the health care provider 3. Inform the charge nurse of the error 4. Assess the patient for adverse effects

4. Assess the patient for adverse effects

A nursing student is administering meds to a patient through a gastric tube (G-tube). Which of the following actions taken by the nursing student requires the nursing instructor to intervene? 1. The nursing student places all the patient's meds in different medicine cups 2. The nursing student evaluates each medication & holds the tube feeding before administering a medication that needs to be administered on an empty stomach 3. The nursing student flushes the tube with 30mL of water between each medication 4. The nursing student crushes a nifedipine extended-release tablet & mixes it with water before administering it

4. The nursing student crushes a nifedipine extended-release tablet & mixes it with water before administering it

A child is taking albuterol through a pressurized metered-dose inhaler (pMDI) that contains a total of 64 puffs. The dose is 2 puffs every 6 hours. How many days will the pMDI last?

8

After seeing a patient, the health care provider starts to give a nursing student a verbal order for a new medication. The nursing student first needs to: A. Follow ISMP guidelines for safe medication abbreviations. B. Explain to the health care provider that the order needs to be given to a registered nurse. C. Write down the order on the patient's order sheet and read it back to the health care provider. D. Ensure that the six rights of medication administration are followed when giving the medication.

B. Explain to the health care provider that the order needs to be given to a RN

The nurse is administering an intravenous push medication to a patient who has a compatible IV fluid running through intravenous tubing. Place the following steps in appropriate order A. Release tubing & inject medication within amount of time recommended by agency policy, pharmacist, or medication reference manual. B. Select injection port of intravenous tubing closest to patient. Whenever possible, injection port should accept a needleless syringe. Use IV filter if required by medication reference or agency policy C. After injecting medication, release tubing, withdraw syringe, & recheck fluid infusion rate D. Connect syringe to port of intravenous line. Insert needleless tip or small-gauge needle of syringe containing prepared drug through center of injection port E. Clean injection port with antiseptic swab. Allow to dry F. Occlude intravenous line by pinching tubing just above injection port. Pull back gently on syringe plunger to aspirate blood return

B. Select injection port of intravenous tubing closest to patient. Whenever possible, injection port should accept a needleless syringe. Use IV filter if required by medication reference or agency policy E. Clean injection port with antiseptic swab. Allow to dry D. Connect syringe to port of intravenous line. Insert needleless tip or small-gauge needle of syringe containing prepared drug through center of injection port F. Occlude intravenous line by pinching tubing just above injection port. Pull back gently on syringe plunger to aspirate blood return A. Release tubing & inject medication within amount of time recommended by agency policy, pharmacist, or medication reference manual C. After injecting medication, release tubing, withdraw syringe, & recheck fluid infusion rate

Common dosage administration schedules

Before meals-AC, ac As desired-ad lib Twice each day-BID, bid After meals-PC,pc Whenever their is a need-prn Every morning, AM-qam Every hour-qh Every day-Daily Every 4 hours-Q4h 4 times per day-QID, qid Give immediately-STAT, stat 3 times per day-TID, tid

Pressurized metered—dose inhalers (pMDIs)

Breath-actuated metered inhaler, and dry powder inhalers delivering medications that produce local effects such as bronchodilation.

Greek prefixes designates multiples of the basic units

Deka-(10) Hecto-(100) Kilo-(1000)

The health care provider orders morphine sulfate 2mg IV. The medication is available in a vial containing 10mg/mL.

Dose ordered/dose on hand*amount on hand=amount to administer 2mg/10mg*1mL=? .2mL

Solution

Given mass of solid substance dissolved in a known volume of fluid or a given volume of liquid dissolved in a known volume of another liquid

Medication error

Inappropriate use of a medication that could lead to patient harm.

Intradermal(ID)

Injection into the dermis just under the epidermis

Anaphylactic reactions

Life threatening, are characterized by sudden constriction of bronchiolar muscles, edema of the pharynx & larynx & severe wheezing & sortness of breath

Transdermal disk

Medication delivery device in which the medication is saturated on a waferlike disk, which is affixed to the patient's skin. This method ensures that the patient receives a continuous level of medication.

Basic units of measurement in metric system

Meter(length) Liter(volume) Gram(weight)

Absorption

Occurs when medicaiton molecules pass into the blood form site of medication administration

Terms associated with medication actions

Onset-time it takes after a medication is administered for it to produce a response Peak-time it takes for a medication to reach its highest effective concentration Trough-minimum blood serum concentration of medication reached just before the next scheduled dose Duration-time during which medication is present in concentration great enough to produce a response Plateau-blood serum concentration of medication reached & maintained after repeated fixed doses

Tips for administering meds to kids

Oral meds 1. Liquids are safer to swallow than pills to avoid aspiration 2. Use droppers for administering liquids to infants; straws often help older kids swallow pills 3. Offer juice, a soda, or frozen juice bar, if allowed, after the child swallows a drug 4. When mixing meds in other foods or liquids, use only a small amount. The child may refuse to take all of a larger mix 5. Avoid mixing a medication in a child's favorite foods or liquids because the child may later refuse them 6. A plastic, disposable oral syringe is the most accurate device for preparing liquid doses, especially those less than 10 mL Injections 1. Use caution when selecting intramuscular injection sites 2. Children are sometimes unpredictable & uncooperative 3. Always awaken a sleeping child before giving an injection 4. Distracting a child with conversation, bubbles, or a toy reduces pain perception 5. If time allows, apply a lidocaine ointment to an injection site before the injection to reduce pain perception during the injection

Irrigation

Process of washing out a body cavity or wounded area with a stream of fluid

Intravenous(IV) injection

Produces the most rapid absorption because medications are available immediately when they enter the systemic circulation

Poly pharmacy

Refers to a situation in which elderly people are prescribed several medications. The various side effects and interactions of those medications can result in dementia symptoms.

Parts of a prescription

Rx-means "take thou" & per inscription Inscription-contains the drug name, strength, & dose Signature-info to be written on the label such as directions to the patient Superscription-Patient's name, address, & age & date are given for identification purposes DEA-practitioners who wish to prescribe controlled substances must register with the Federal Drug Enforcement Agency

Instillation

To cause to enter drop by drop or very slowly

Detoxify

To remove the toxic quality of a substance. The liver acts to detoxify chemical in drug compounds

Prohibited & error-prone abbreviations

Ug-microgram-mcg AD, AS, AU-right ear, left ear each ear-use right ear OD, OS, OU-right eye, left eye, each eye, use right eye BT-bedtime-use bedtime HS-half-strength use half—strength or bedtime hs-at bedtime hours-use bedtime or half-strength IU-international unit-use units o.d. OD-once daily-use daily Per os-by mouth, orally-use PO, by mouth or orally q.d. Or QD-every day-use daily qhs-nightly at bedtime-usenightly SC, SQ, sub q-subcutaneous-use subcut or subcutaneously TIW or tiw-3 times a week-use 3 times weekly U or u-unit-use unit do not use trailing zeros .5-0.5-use zero before decimal Abbreviations such as mg or mL with a period-mg/mL-do not use period after HCl-hydrochloride acid or hydrochloride-use full name HCT-hydrocortisone-use ful name HCTZ-hydrochlorothiazide-use full name MgS04-magnesium sulfate-use full name MS, MS04-morphine sulfate-use full name PCA-procainamide-use full name "Nitro" drip-nitroglycerin infusion-use full name 3-Dram-use metric system x3d-for 3 days-use for three days > & <-greater or less than-use greater or less than @-at-use at &-and-use & +-plus or and-use and circle-hour-use hr, h, or hour

Mild allergic reactions

Urticaria(hives)-raised, irregularly shaped skin eruptions with varying sizes & shapes; eruptions have reddened margins & pale centers Rash-Small, raised vesicles that are usually reddened; often distributed over entire body Pruritus-itching of skin; accompanies most rashes Rhinitis-inflammation of mucous membranes lining nose; causes swelling & clear, watery discharge

You are working in a health clinic on a college campus. You need to administer medroxyprogesterone acetate intramuscularly to a female patient for birth control. You look up this medication in. A reference manual & determine that it is viscous & injections can be painful. On the basis of this info, you plan which of the following when administering this medication? 1. Inject the medication over 3 mins to reduce pain associated with the injection 2. Administer the medication in the ventral gluteal site 3. Use the Z-track method when administering the medication 4. Use the deltoid site for medication administration 5. Ask the patient questions about her major & which classes she is taking during the injection to provide distraction

W. Administer the medication in the ventral gluteal site 3. Use the Z-track method when administering the medication 5. Ask the patient questions about her major & which classes she is taking during the injection to provide distraction

Health care provider orders 0.45 g penicillin V potassium through a gastric tube. The vial label read: penicillin V potassium 125mg/5mL

X mL=5mL/125mg*1000mg/1g*.45g/1 xmL=5*1000*.45/125 x=2250/125 x=18mL

Side effect

a predictable and often unavoidable adverse effect produced at a usual therapeutic dose

Metric system

decimal system of measurement based on certain physical standards and scaled on multiples of 10

peak concentration

highest serum level concentration

Intramuscular(IM)

injection into a muscle

Intravenous(IV)

injection into a vein

Subcutaneous

injection into tissues just below the dermis of the skin

Intracardiac

injection of a medication directly into cardiac tissue

Intraarticular

injection of a medication into a joint

Intraocular

inserting a medication similar to a contact lens into the patient's eye.

Synergistic effect

interaction of two or more medicines that results in a greater effect than when the medicines are taken alone

trough concentration

lowest serum level concentration

Medication reconciliation

nurses, pharmacists, and other health care providers compare the medication that a patient is taking currently with what the patient should be taking and any newly ordered medications

Toxic effects

often develop after prolonged intake of a medication or when a medication accumulates in the blood because of impaired metabolism or excretion

Therapeutic effect

the expected or predicted physiological response caused by a medication

minimum effective concentration

the plasma drug level below which therapeutic effects will not occur

Biotransformation

the process in which enzymes convert a drug into a metabolite that is itself active, possibly in ways that are substantially different from the actions of the original substance

Pharmacokinetics

the study of how medications enter the body, reach their site of action, metabolize, and exit the body

Biological half-life

the time it takes for excretion processes to lower the amount of unchanged medication by half

Sublingual

under the tongue

Adverse effects

undesired, unintended, and often unpredictable responses to medication

Z-track method

used to minimize local skin irritation by sealing the medication in muscle tissue pull overlying sking and sub Q tissue laterally to the side 1 -1.5 inches, inject the needle into the muscle leaving in for 10 seconds after injection, then release the skin.

Medication interaction

when one medication modifies the action of another