MAPE- 1
temp
(°F) = (°C) × 1.8 + 32 (°C) = (°F) -32 / 1.8
2.2 lbs
1 kg
Aerosol
Aqueous medication sprayed and absorbed in mouth and upper airway; not meant for ingestion
UD
As directed ("ut dictum")
hs
At bedtime, hour of sleep
HS
Half-strength
pre admin safety
Read the label on the medication container and compare it with the MAR at least 3 times: before removing the container from the supply drawer when placing the medication in an administration syringe just before administering the medication to the patient.
Liniment
Usually contains alcohol, oil, or soapy emollient applied to skin
vaginal instillation
a. Remove suppository from foil wrapper and apply liberal amount of sterile, water-based lubricating jelly to smooth or rounded end. Lubricate gloved index finger of dominant hand. b. With nondominant gloved hand expose vaginal orifice by gently retracting labial folds. c. With dominant gloved hand gently insert rounded end of suppository along posterior wall of vaginal canal entire length of finger [3 to 4 inches] to ensure equal distribution of medication along walls of vaginal cavity cream/foam applicator [2-3 inches]
patient and family teaching
use instructional materials written no higher than a sixth-grade reading level. Provide instructions written in the patient's language if available. have the patient or family caregiver repeat the name and use for each medication plus the dosing instructions. use teach-back as a method to confirm patient learning and improve health care provider education Determine if the patient requires a compliance aid or memory cue. Do not use a family member as an interpreter Medication dose containers organized by the hours and days of the week are very useful If the patient correctly identifies the name of the medication, ask him or her the following questions: • Why are you taking this medication? • How often do you take this medication and at what time of day? • What side effects can occur with this medication? • If this side effect occurs, what are you going to do about it? assess the patient's sensory, motor, and cognitive functions. Impairments may affect the patient's ability to safely self-administer medications.
Drug Distrubution
(1)The first check is the health care provider ordering the right drug for the right purpose. (2)The pharmacist is the second check to ensure that the drug is appropriate and ordered correctly and then provided to the unit correctly. (3)Finally, the nurse verifies the drug before administration with the three checks for accuracy to be sure that it is appropriate and ordered correctly.
Apply these principles when mixing medications from two vials
1. Do not contaminate one medication with another. 2. Ensure that the final dose is accurate. 3. Maintain aseptic technique. 4. After mixing multidose vials label the vial -the date and time of mixing -concentration of medication per milliliter. -Some multidose vials require refrigeration after the contents are reconstituted.
admin
1. Follow the six rights of medication administration. 2. Inform the patient of the name, purpose, action, and common side effects of each medication. Evaluate his or her knowledge of the medication and provide appropriate teaching using teach-back technique. 3. Stay with the patient until the medication is taken. Provide help as necessary. Do not leave medication at the bedside without a health care provider's order. For example, some patients may take their own vitamins while in the hospital. 4. Respect the patient's right to refuse a medication. If the medication wrapper remains intact, return the medication to the patient's unit-dose drawer. When medication is refused, determine the reason and take action accordingly.
Evaluation
1. Monitor for evidence of therapeutic effects, side effects, and adverse reactions. This includes monitoring physical response (e.g., heart rhythm, blood pressure, urine output, or laboratory results). 2. When a medication is given for relief of symptoms, ask the patient to report if symptoms have diminished or been relieved. In addition, reassess the patient after medication is administered (e.g., 30 minutes after medicating for pain). 3. Observe injection sites for bruises, inflammation, localized pain, numbness, or bleeding. 4. Evaluate that patient and family caregiver understand purpose of medication therapy, dose regimens, and ability to self-administer medication by using teach-back techniques.
Postadministration Activities
1. Record medications immediately after administration (see agency policy). Include the drug name, dose, route, time, and your signature. 2. Document preassessment as required (e.g., blood pressure measurement before antihypertensives). 3. Document postassessment data pertinent to patient's response. This is especially important when giving prn drugs. 4. If a patient refuses a medication, document that it was not given, the reason for refusal, and when you notified the health care provider.
6 rights of medication administration
1. Right medication 2. Right dose 3. Right patient 4. Right route 5. Right time 6. Right documentation
legal document
1.Do not erase, apply correction fluid or scratch out errors while charting -Draw a single line through error, write error and initial above it. 2.Do not be critical or express personal opinions about the client or other care providers -only objective data should be recorded; client's comments should be quoted. 3.Correct all errors promptly -be sure information is accurate. 4.Record all facts -do not speculate or guess, be specific with your information. 5.Use non erasable ink and make entries legible. 6.Do not leave any blank spaces -draw a line to the end of the line. 7.Do not chart for anyone else -only chart what activities you have performed. 8.If an order is questioned, record that you sought clarification -you are responsible for your actions. 9.Begin eachentry with the date, time, and end each entry with your signature and title. 10.Late Entry -Document as soon as possible and identify new entry as a "late entry." a)Enter current date/time -do not attempt to give the appearance that the entry was made on a previous date or an earlier time. The entry must be signed.
6 rights
1.The right Client/Person-the nurse must identify the client by checking the medication order and the client's identification bracelet to ensure that the right client is receiving the right medication. 2.The right Dose-to ensure that the right dose is given, the nurse must triple check any calculations and have another team member check the calculation. 3.The right Medication-comparison of the medication to the medication order is imperative. The nurse must only give medication they have prepared and be present when it is taken. 4.The right Route-the nurse must give the medication via the right route. In preparing the medication, the triple check will identify the route to be given on the medication order. 5.The right Time-the nurse will check the medication order to ensure that the medication is given at the right time. The prescriber will identify the times that the medication is to be given. 6.The right Documentation-the nurse will record the client's status prior to the medication administration as well as the medication given, the time it was given, the dose given, and the route it was given in. Then the nurse will follow up and record the client's response to the medication given.
1 tbsp
15ml
1 in
2.54 cm
1 oz
30 ml
1 gallon
3840 ml
1 pint
480 ml
1 tsp
5ml
other 4 rights of medications administration
7. right to education 8. right to refuse 9. right assessment 10. right evaluation
other 4 rights
7.The right Assessment-the nurse will assess client for specific needs prior to administration (heart rate, blood pressure, blood glucose, pain, and agitation/anxiety). 8.The right to Education-the nurse will provide patient education concerning medications given. 9.The right Evaluation-the nurse will evaluate for effectiveness of medication, as well as any side or adverse effects, both objectively and per client report. 10.The right of Refusal-the nurse will listen to client concerns regarding receiving any medications. Education as to the importance of prescribed medications should be provided, and physician notification must be made to alert him/her to client request of refusal. Documentation of refusal must also be made.
1 cup
8 oz 240 ml
1 quart
960 mL
medication adherence
A patient's level of education, prior experience with medication therapy, and the family's influence on actions significantly influence__________________
Sub Q
Abdomen, triceps, anterior thigh, posterior hip or shoulder blade 3/8-5/8 inch 23-27 g(may be even smaller for insulin syringes) 90 degrees (adult) 45 degrees (thin adult or child) 1 mL * at least 2 inches from belly button *at least 1 inch away from the previous site
Percutaneous/topical medication administration
Aerosol Powders or Liquids- Used in nebulizers and inhalers Powders- Applied to the skin Creams- Semisolids for internal and external use Ointments- Semisolids in petroleum or lanolin base Pastes- Thick ointments Suppositories- Molded with firm base for insertion into the rectum/vagina Transdermal Medications - Patches Topical Drops- Generally for eyes, nose/ears
Oral, buccal
By mouth/mucous membrane
The Three Checks( GPA)
Check 1: Gathering/Collecting medications. Verify against order/MAR. Check 2: Preparing medications. Check 3: Administration at the client's bedside.
Elixir
Clear fluid containing water and alcohol; often sweetened May be contraindicated in diabetic/alcoholic patient
Extract
Concentrated medication form made by removing the active part of the medication from its components. Extracts are prepared as a syrup or dried form of pharmacologically active medication, usually made by evaporating solution
IM
Deltoid(immunizations) 1-1.5 inch(adult) 5/8-1 inch(child or thin adult) 20-25 g 90degrees 1 mL Vastus lateralis(infants) 20-25 g 90 degrees 3 mL Ventrogluteal(preferred) 20-25 g 90 degrees 3 mL Not Recommended Dorsogluteal -----------(may need 18 gauge for very viscous solution)
med errors
Errors include: inaccurate prescribing administering the wrong medication the wrong route the wrong time interval administering extra doses failing to administer a medication. When an error occurs, the patient's safety and well-being become the top priority. A nurse assesses and examines the patient's condition and notifies the health care provider of the incident as soon as possible. Once the patient is stable, the nurse reports the incident to the appropriate person in the agency.
peds
Evidence shows that children are at risk for experiencing an ADE as a result of their metabolic rate. Factors contributing to errors include workload, distractions, and lack of knowledge. The child's age, weight, and maturity of body systems all affect the ability to metabolize and excrete medication. Other factors that influence medication dosages in children include the difficulty in evaluating the desired effect and the hydration status of the child.
Aqueous suspension
Finely dissolved drug particles in liquid medium must be shaken; when left standing, particles settle to bottom of container Always shake the bottle well
Troche (lozenge)
Flat, round tablet that dissolves in mouth to release medication; not meant for ingestion
medication by inhalations
Floating an MDI in water to determine how much medication is left is not recommended because extra propellant causes the container to float even if no medication remains in the inhaler. Devices that count down the number of remaining doses are available for MDIs. Some DPIs have mechanisms that indicate how many doses are left. However, these mechanisms are not always accurate. to calculate how long medication in an inhaler will last, divide the number of doses in the container by the number of doses the patient takes per day. face shields for children 4 and under Instruct the patient to rinse his or her mouth with water after inhaling a corticosteroid medication to prevent the develop-ment of an oral fungal infection. If a second dose of the same medication is ordered, wait 20 to 30 seconds between inhalations. • If a second type of inhaled medication is ordered, wait 2 to 5 minutes between medication inhalation bronchodilator then corticosteroid
ID
Forearm (ventral) or upper back 3/8-5/8 inch 25-29g 5-15 degrees 0.1 mL
Intramuscular (IM)
Into a muscle
Intravenous (IV)
Into a vein
Intradermal (ID)
Into the dermis of the skin
Epidural
Into the epidural space
Suppository
Into the rectum or vagina
Subcutaneous (Sub Q)
Into the subcutaneous tissue of the skin
Parenteral administration
Intradermal subcutaneous intramuscular intravenous routes.
Transdermal patch or disk
Medicated disk or patch embedded with medication that is applied to skin Drug absorbed through skin over a designated period of time (e.g., 24 hours)
Paste
Medication preparation that is thicker than ointment; absorbed through skin more slowly than ointment; often used for skin protection
Topical
On the skin (as a cream or patch) and eyedrops/eardrops
rectal suppositories
Position the patient on his or her left side(sims) Insert suppository gently through anus, past internal sphincter and against rectal wall (4 inches) in adults (2 inches) in children and infants Have the patient remain lying on his or her left side for 15 to 20 minutes contraindications: active rectal bleeding or diarrhea Retention enemas need to be held for 30 minutes to 1 hour before expulsion
AD AS AU
Right ear left ear each ear
OD OS OU
Right eye left eye each eye
Lotion
Semiliquid suspension that usually protects, cools, or cleans skin
Ointment (salve or cream)
Semisolid, externally applied preparation, usually containing one or more medications
Intraocular disk
Small, flexible oval (similar to a contact lens) consisting of two soft outer layers and a middle layer containing medication; slowly releases medication when moistened by ocular fluid.
Suppository
Solid dosage form mixed with gelatin and shaped in form of a pellet for insertion into body cavity (rectum or vagina) (Suppository melts when it reaches body temperature and is then absorbed.)
aqueous solution
Substance dissolved in water and syrups
Sustained release
Tablet or capsule that contains small particles of a medication coated with material that requires a varying amount of time to dissolve
Sublingual
Under the tongue
hand hygiene
Use good hand-hygiene technique. Avoid touching tablets and capsules. Use sterile technique for parenteral medications. Wear clean gloves when administering parenteral medications and certain topical medications. • Before direct contact with patients • After contact with blood, body fluids, excretions, mucous membranes, wound dressings, or nonintact skin • After contact with a patient's skin • After removing gloves
check med
When preparing medications, be sure that the label is clear and legible and that the drug is mixed properly; has not changed in color, clarity, or consistency; and has not expired.
introcular
You place the medication into the conjunctival sac where it remains for up to 1 week.(disk)
Culturally
a patient's values and beliefs affect medication response.
ear medication administration
a.Apply clean gloves and gently clean outer ear with washcloth if drainage is present b. Place patient in side-lying position If eardrops are a cloudy suspension, shake them for about 10 seconds. c. Straighten ear canal by pulling auricle down and back (children younger than 3 years) upward and outward (children 3+) d. Instill prescribed drops holding dropper 1 cm ( inch) above ear canal. e. Ask patient to remain in side-lying position 2 to 3 minutes. Apply gentle massage or pressure to tragus of ear with finger unless contraindicated because of pain. f. If cotton ball is needed, place it into outermost part of canal. Do not press cotton deep into canal. Remove it after 15 minutes. If medication is needed in the other ear, wait 5 to 10 minutes after instillation of the first eardrops before administering.
tincture
alcohol extract from plant or vegetable
Allergic reactions
also are adverse unpredictable responses to a medication. RXNS Urticaria (hives)- Raised, irregularly shaped skin eruptions with varying sizes and shapes; reddened margins and pale centers Rash -Small, raised vesicles that are usually reddened; often distributed over the entire body Pruritus- Itching of the skin; accompanies most rashes Rhinitis- Inflammation of mucous membranes lining the nose, causing swelling and a clear watery discharge
Side effects
are predictable and often unavoidable secondary effects produced at a usual therapeutic drug dose.
Bar-code labels
are required on all medications, vaccines, and over-the-counter (OTC) drugs used in health care agencies
Adverse drug events or effects (ADEs)
are unintended, undesirable, and often unpredictable
abbreviations
cap, caps. Capsule susp Suspension el, elix Elixir tab,tabs. Tablet sup, supp. Suppository
drug names
chemical name- describes the drug composition and molecular structure generic name- is the name that is listed in official publications such as the United States Pharmacopeia (USP). A manufacturer who first develops a medication provides the generic name trade name or brand name- is used to market the medication. The trade name has the symbol™ at the upper right of the name, indicating a manufacturer trademark of the name
sharps
do not recap needles away from carrier and toward floor replace sharps at 2/3 full orientation: types of needles and syringes needle-less equip where sharps container are
polypharmacy
five or more concurrent drugs or the mixing of nutritional or herbal supplements with medications Safety precautions include: -assessing a patient's health status, -current medication regimen (including OTC drugs and herbal products), -the reason for existing and proposed medications -any environmental factors that influence accurate and safe medication administration by the patient and family caregiver(s).
idiosyncratic reaction
is an unpredictable effect in which a patient overreacts or underreacts to a medication or has a reaction different from normal.
the metric system
is the most logically organized of the measurement systems. Metric units are easy to convert and compute through simple multiplication and division. Each basic unit of measure is organized into units of 10. Multiplying or dividing by 10 forms secondary units.
labeling
labeling syringes, including before a procedure labeling all medicines that are not labeled
syrup
medication dissolved in a concentrated sugar solution
always leading zero
never trailing zero
Medications known to produce tolerance
opium alkaloids (e.g., morphine), nitrates, and ethyl alcohol.
Enteral administration
oral administration through aNG Tube PEG Tube rectal suppositories enemas
nasal drops
posterior pharynx- tilt patient's head backward. ethmoid or sphenoid sinus-tilt head back over edge of bed or place small pillow under patient's shoulder and tilt head back frontal and maxillary sinus- tilt head back over edge of bed or pillow with head turned toward side to be treated
When mixing medication from both a vial and ampule
prepare medication from the vial first. Using the same syringe and filter needle, next withdraw medication from the ampule. (it is not necessary to add air to withdraw medication from an ampule)
Two types of medication dependence exist:
psychological dependence: a patient desires the medication for benefit other than the intended effect. Physical dependence: is a physiological adaptation to a medication that manifests itself by intense physical disturbance when the medication is withdrawn.
All aspects of the client's care are recorded such as:
subjective data client's behavior objective data treatments medication administration client teaching discharge planning
Medication labels include:
the trade name of the drug in large letters, the generic name in smaller letters, the form of the drug, the dosage, the expiration date, the lot number, and the name of the manufacturer .
Guidelines for Safe Opioid Administration and Control
• All controlled substances are stored in a securely locked, substantially constructed cabinet (i.e., automated medication dispensing system [AMDS]) or a locked room. • Authorized nurses carry a set of keys or an individual computer entry code for the AMDS. • An inventory record is used each time a controlled substance is dispensed. Records are often kept electronically and provide an accurate ongoing account of the medications used, wasted, and remaining. If you find a discrepancy, correct and report it immediately. • Use a special inventory record to document a patient's name, date, name of medication, dose, time of medication administration, and signature of nurse dispensing the medication. • A second nurse witnesses disposal of the unused part if a nurse gives only part of a dose of a controlled substance. Computerized systems record the nurses' names electronically. If paper records are kept, both nurses sign their names on the form. Follow agency policy for appropriate waste of opioids. Do not place wasted part of medications in sharps containers.
Protecting a Patient from Aspiration
• Allow patients to self-administer medications if possible. • Know signs of dysphagia (difficulty swallowing): cough, change in voice tone or quality after swallowing, delayed swallowing, incomplete oral clearance or pocketing of food, regurgitation. • Assess patient's ability to swallow and cough by checking for presence of gag reflex and then offering 50 mL of water in 5-mL allotments. Stop if patient begins to cough. • Prepare oral medications in the form that is easiest to swallow. • Position patient in an upright, seated position with feet on the floor, hips and knees at 90 degrees, head midline, and back erect if possible. • If patient has unilateral weakness, place the medication in the stronger side of the mouth. Turning the head toward the weaker side helps the medication move down the stronger side of the esophagus. • Administer pills one at a time, ensuring that each medication is swallowed properly before the next one is introduced. • Thicken regular liquids or offer fruit nectars if patient cannot tolerate thin liquids. • Some medications can be crushed and mixed with pureed foods if necessary. Refer to a medication reference to verify which medications are safe to crush. • Avoid straws because they decrease the control patient has over volume intake, which increases the risk of aspiration. • Have patient hold and drink from a cup if possible. • Time medications to coincide with mealtimes or when patient is well rested and awake if possible. • Administer medications using another route if risk of aspiration is severe.
eye medications
• Avoid instilling any form of eye medications directly onto the cornea. • Avoid touching the eyelids or other eye structures with eyedroppers or ointment tubes. • Use eye medication only for the patient's affected eye. • Never allow a patient to use another patient's eye medications.
safe med admin in older adults
• Consult with the health care provider to keep the medication plan as simple as possible • Keep instructions clear and simple and provide written materials in large print • Minimize distractions and make sure that older adult is comfortable • Teach the complications and interactions of all over-the counter medications • Teach the older adult to set up a daily or weekly schedule for medications using memory aids such as a calendar . Have a family caregiver help with medication administration as needed. • Monitor patient's response to medications to assess for overuse or underuse of the medication and anticipate possible dosage modifications • Reduce the chance of errors by color coding or labeling medication bottles • Include patient's family caregiver or key support person in any type of instruction. • Evaluate teaching by having patient repeat back instructions.
preventing med errors
• Follow the six rights of medication administration. • Only prepare medications for one patient at a time. • Be sure to read labels at least 3 times (comparing MAR with label): When removing medication from storage, before taking to patient's room, before giving medication. • Use at least two patient identifiers every time you administer medications (e.g., patient name, birthday, hospital number) whenever administering a medication. • Do not allow any other activity to interrupt administration of medication to a patient. • Double-check all calculations and other high-risk medication administration processes (e.g., patient-controlled analgesia) and verify with another nurse. • Do not interpret illegible handwriting; clarify with the health care provider. • Question unusually large or small doses. • Document all medications as soon as they are given. • When you have made or discovered an error, reflect on what went wrong and ask how you could have prevented it. Complete an occurrence report per agency policy. • Evaluate the context or situation in which a medication error occurred. This helps to determine if nurses have the necessary resources for safe medication administration. • When repeated medication errors occur within a work area, identify and analyze the factors that may have caused the errors and take corrective action. • Attend in-service programs on the medications you commonly administer. • Ensure that you are well rested when caring for patients. Nurses make more errors when they are tired. • Involve and educate patients when administering medications. Address patients' concerns about medications before administering them • Follow established agency policies and procedures when using technology to administer medications Medication errors occur when nurses "work around" the technology.
NPSG
• Identify patient correctly. Use at least two patient identifiers (neither can be patient's room number) when providing care, treatment (e.g., medications), or services. • Improve the effectiveness of communication among caregivers. • Verbal or telephone orders require a verification "read-back" of the complete order or test result by the person receiving the order/test result. • Standardize a list of abbreviations, acronyms, symbols, and dose designations that are not to be used throughout an organization. • Improve the safety of using medications. • Identify and at a minimum annually review a list of look-alike/sound-alike drugs used by the organization. • Before a procedure, label all medications and medication containers (e.g., syringes) that are not labeled. Do this in areas where medicines and supplies are set up, such as on and off the sterile field in perioperative and other procedural settings. Labels include drug name, strength, amount, expiration date when not used within 24 hours, and expiration time when expiration occurs in less than 24 hours. • Take extra care with patients who take anticoagulants. Use only oral unit-dose products and premixed infusions. When heparin is administered intravenously and continuously, use programmable infusion pumps. • Maintain and communicate accurate patient medication information. • Accurately and completely reconcile medications across the continuum of care. • There is a process for comparing the patient's current medications with those ordered for the patient while under the care of the health care organization. • Communicate a complete list of the patient's medications to the next provider of service when a patient is referred or transferred to another setting, service, or level of care. Also provide the complete list to the patient on discharge from the agency. • Encourage patients' active involvement in their own care as a patient safety strategy.
Verbal/telephone orders
• Only authorized staff receive and record verbal or telephone orders. Agency identifies in writing the staff who are authorized. • Clearly identify patient's name, room number, and diagnosis. • Read back all orders to health care provider (TJC, 2015). • Use clarification questions to avoid misunderstandings. • Write "VO" (verbal order) or "TO" (telephone order), including date and time, name of patient, and complete order; sign the name of the health care provider and nurse. • Follow agency policies; some agencies require documentation of the "read-back" or two nurses to review and sign telephone or verbal orders. • Health care provider co-signs the order within the time frame required by the agency (usually 24 hours; verify agency policy).
medication action times
• Onset of medication action: Time it takes after a medication is administered for it to produce a response • Peak action: Time it takes for a medication to reach its highest effective peak concentration • Trough: Minimum blood serum concentration of medication reached just before the next scheduled dose • Duration of action: Length of time during which a medication is present in a concentration great enough to produce a therapeutic effect • Plateau: Blood serum concentration reached and maintained after repeated, fixed doses
mixing insulin
• Patients whose blood glucose levels are well controlled on a mixed-insulin dose need to maintain their individual routine when preparing and administering their insulin. • Do not mix insulin with any other medications or diluents unless approved by the health care provider. • Never mix insulin glargine (Lantus) or insulin detemir (Levemir) with other types of insulin. • Inject rapid-acting insulins mixed with NPH insulin within 15 minutes before a meal. • Verify insulin doses with another nurse while you are preparing the injection. 1. hand hygiene 2. roll NPH in hands 3. clean tops with alcohol 4. inject air into NPH, inject air into reg insulin 5. draw up insulin 6. draw up NPH
preventing infection during injection
• To prevent contaminating the solution, draw up medication quickly. Do not allow ampules to stand open. • To prevent needle contamination, avoid letting a needle touch contaminated surfaces • To prevent syringe contamination, avoid touching length of plunger or inner part of barrel. Keep tip of syringe covered with cap or needle. • To prepare skin, wash with soap and water if soiled with dirt, drainage, or feces and dry. Use friction and a circular motion while cleaning with an antiseptic swab. Swab from center of site and move outward in a 5-cm (2-inch) radius.
systems in place to avoid distractions
• Wearing a medication safety vest, sash or red apron. • Using visible medication preparation signs. • Medication administration checklists. • Staff and patient education. • Establishing no-interruption zones
Topical or transdermal medications
• When taking a medication history or reconciling medications, specifically ask patients if they take any medications in the forms of patches, topical creams, or any route other than the oral route. • When applying a transdermal patch, ask the patient if he or she has an existing patch. • Wear disposable gloves when removing and applying transdermal patches. • If the dressing or patch is difficult to see (e.g., clear), apply a noticeable label to the patch. • Document the location on the patient's body where the medication was placed on the MAR. • Document removal of the patch or medication on the MAR. Fold sticky sides of the patch together and dispose of the patch in a child-proof contain
