Exam 5 Module 9 & 10

Sublingual administration

involves placing a drug under your tongue to dissolve and absorb into your blood through the tissue there.

Types of data

Subjective Objective

SA

Sustained action

Generic Name

Chemical name of the medication. The most official drug system to list drugs.

XL

Extended length

Poor glycemic control leads to

Multi body system damages

True or False: Extended-release capsules and enteric coated tablets should not be crushed.

True

The major site of drug metabolism

liver

Problem Solving: Intuitive

(Working with an expert able to pick up cues that you are not able to see yet)

The physician writes an order for intravenous fluids to infuse at 150 mL per hour. If the drop factor of the tubing is 10, at how many drops per minute should the fluid infuse? drops

25 drops

KSA

Knowledge Skills Attitudes QSEN attributes to safety

SR

Slow release

A nurse is conducting an interview with a patient to collect a medication history. Which of the following questions would be used to ensure safe medication administration? "Have you noticed any change in your bowel habits?" "Do you have any allergies to medications?" "How do you feel about taking medications?" "At what times do you take your medications?"

"Do you have any allergies to medications?"

Clinical reasoning

(applying clinical thinking to

Problem Solving: Trial-and-error

(involves killing people)

Problem Solving: Scientific

(nursing process...orderly, dynamic (it changes)

Clinical judgment

(outcome of clinical thinking and clinical reasoning)

Clinical thinking

(systematic)

3 basic routes of medication

*Enteral (sublingual and buccal routes) *Parenteral (subcutaneous, intradermal, and intramuscular routes) *Topical (skin-transdermal) eyes, ears, nose. (lungs-inhalers) rectum, or vagina.

Also called symptoms Perceived only by infected individual Not measurable Not verifiable Examples: Pain, nausea, "nervous", dizziness

Subjective data

What are the factors that affect drug action?

- developmental considerations - weight - gender - cultural and genetic factors - psychological factors - pathology - environment - timing of administration

Which of the following medication dosages is properly written? .8 mg 0.25 mg 00.125 mg .125 mcg

0.25 mg

A physician orders Cipro 500 mg, PO q12h for a patient with bronchial pneumonia. The nurse has Cipro 250 mg on hand. How many tablets would the nurse dispense?

2 tablets

Most drugs take about how many half-lives to be eliminated from the body?

5 half-lives

A client admitted with Hodgkin disease has a handwritten prescription for vinblastine 3.7 mg intravenously (IV) weekly. The nurse interprets the prescription as vincristine 3.7 mg and administers the wrong medication. The client becomes neurovascularly compromised and has a fatal reaction to the medication. The client's family begins a litigious suit against the facility and the nurse's license is suspended by the board of nursing. In preparation for the lawsuit, the nurse meets with the nurse attorney to review the events. Which appropriate statement, if given by the nurse, indicates he has an understanding of the lawsuit? "I checked the medication before giving it and literature states it is for Hodgkin disease.? ?I had a duty and it was my responsibility to get clarification before administering the medication, which I did not.? ?I had a duty and it was my responsibility to double check the medication, which I did, yet this still happened.? ?I could not read the health care provider?s handwriting, so I am not at fault.?

?I had a duty and it was my responsibility to get clarification before administering the medication, which I did not.?

DM (Diabetes Mellitus)

A disease resulting from the body's inability to produce and or utilize insulin.

Characteristics of the nursing process: Universally applicable

A framework for all nursing activities in any practice setting. ex:

Who has the highest incidence if Type 2 DM?

African Americans, Hispanics, Native Americans

Goal

An aim or endpoint (time limited, client focused, specific, measurable.)

Drug

Any chemical that effects the physiological functions of a living organism.

The first step of the nursing process

Assessment (collecting data)

A nursing student reports to the instructor that a medication due at 9 a.m. was omitted. Which of the following principles is the student demonstrating? Altruism Social justice Autonomy Integrity

Integrity

A nurse is caring for a client with typhoid at a health care facility. The nurse checks the medication order in the client's chart for the drugs prescribed to the client. Which of the following is a required component of the medication order? Client's age Client's signature Client's diagnosis Client's name

Client's name

You are reviewing a patient's newly written medication order and are unable to read the prescriber's handwriting. Which of the following actions by is most appropriate? Send the order to the pharmacy for accurate interpretation. Disregard the order until the prescriber returns to the unit. Confer with another nurse who is more familiar with the prescriber's handwriting. Contact the prescriber to clarify the order.

Contact the prescriber to clarify the order.

CR

Controlled release

A multisystem disease An insidious, silent killer Affects all major organs of the body A major public heath problem 7th leading cause of death by disease

DM Diabetes Mellitus

Chemical name

Describes the drug's chemical and molecular structure.

Second step of the nursing process

Diagnosis

Gordon's functional health patterns: Value-belief pattern

Do they practice an organized religion? If so, what is it?

Which of the following clients is likely to have altered metabolism of medications? Elderly Adolescents Middle adults School-age children

Elderly Metabolism is the process of chemically changing the drug in the body. Metabolism takes place in the liver. Alterations in liver function, including decreased functions that occurs with aging or disease, affect the rate at which drugs are metabolized.

XT

Extended time

A hospitalized patient asks the nurse for "some aspirin for my headache." There is no order for aspirin for this patient. What will the nurse do? Ask the patient's family to bring some aspirin from home. Go ahead and give the patient aspirin, a common self-prescribed drug. State that an order from the doctor is legally required and check with the doctor. Ask the patient's visitors if they have any aspirin for the patient. SUBMIT ANSWER Exit quiz

Go ahead and give the patient aspirin, a common self-prescribed drug.

Characteristics of the nursing process: Dynamic

Great interaction and overlapping of the 5 steps. ex:

Drug Classifications: Anticoagulants

Heparin Lovenox Coumadin

Characteristics of the nursing process: Interpersonal

Human being is always at the heart of nursing. ex:

In which way does a nurse play a key role in error prevention? Never questioning a physician's order because the physician is ultimately responsible for the client outcome Notifying the Occupational Safety and Health Administration (OSHA) of workplace violations Informing the client of the Patient's Bill of Rights Identifying incorrect dosages or potential interactions of ordered medications

Identifying incorrect dosages or potential interactions of ordered medications

A nurse is caring for a client with severe lower back pain. The doctor orders administration of an analgesic as a stat dose. When should the nurse administer the medication? Immediately As needed Once For a specified number of days

Immediately

A nurse is ordered to administer epinephrine to a child who was stung by a bee and is allergic to insect bites. Which means of drug administration would the nurse use to achieve rapid absorption and quicker results in this emergency situation? Patch Injection Oral Inhalation

Injection

You are caring for a patient who just returned from the postanesthesia care unit (PACU) and rates current pain as "9 out of 10." Which of the following prescribed medications will provide the fastest relief from pain? Oral acetaminophen with codeine (Tylenol #3) Intravenous morphine sulfate Oral acetaminophen and oxycodone (Percocet) Intramuscular ketorolac tromethamine (Toradol)

Intravenous morphine sulfate

Trade name

Is the drug's registered trademark ex: Tylenol, Ibuprofen

A nurse is preparing a prescribed dosage of an inhalant medication for a client with asthma. Which of the following explains why inhalation is a good route for medication administration? It prevents unpleasant aftertastes associated with oral medications. It eliminates the potential of suffocation and asphyxia. It eliminates bad breath. It allows the lungs to quickly absorb the medication.

It allows the lungs to quickly absorb the medication. Explanation:The inhalant route is effective because the lungs provide an extensive area from which the circulatory system can quickly absorb the medication. The inhalant method distributes medication to distal areas of the airways, but some clients find that the inhaled drugs leave an unpleasant aftertaste. Inhalants carry some risk of suffocation and asphyxia. Inhalants may cause bad breath

A nurse is caring for a client with scabies. The client has been prescribed a drug that has a topical route of administration. Which of the following should the nurse tell the client regarding the administration of the drug? It has to be swallowed. It has to be inhaled. It has to be applied on the skin. It has to be injected.

It has to be applied on the skin.

Health promotion nursing diagnosis has two parts

Label Defining characteristics ex: Desire to enhance selfcare

Short-term outcomes (how long)

Less than a week

Long-term outcomes (how long)

Longer than a week

Risk diagnosis has 2 parts

Potential problem (label) Etiology (risk factors) There are NO signs and symptoms (defining no characteristics)

Drug Classifications: Antihyperglycemic Agents

Metformin Glucophage Glyburide Glipizide Glibenclamide Tolbutamide Chlorpropamide

Drug Classifications: Insulin

Novolin R Novolin N Novolin 70-30 Levemir

A client newly diagnosed with congestive heart failure has a prescription for digoxin (Lanoxin). The nurse counts the heart rate before administration of the medication and obtains a heart rate of 51 beats per minute. Which action by the nurse demonstrates adherence to the standards of nursing care? Nurse administered the medication and reassessed the client in 30 minutes Nurse administered the medication after reviewing the client?s serum potassium level Nurse withheld the medication and notified the health care practitioner Nurse withheld the medication, retook the heart rate, and gave it at a later time

Nurse withheld the medication and notified the health care practitioner

Characteristics of the nursing process: Outcome oriented

Nurses and patients work together to identify outcomes. ex:

Also called signs Observable by others Measurable Verifiable Examples: Vital signs, vomiting, bleeding, refusing to eat.

Objective data

Which of the following routes of medication administration is most commonly prescribed? Topical Intravenous Subcutaneous Oral

Oral

Characteristics of the nursing process: Systematic

Part of an ordered sequence of activities. ex:

Benefits of the nursing process benefits who?

Patient and nurse.

QSEN Competencies:

Patient-centered care Teamwork and collaboration Evidence-based practice Quality improvement Safety Informatics

QSEN competencies

Patient-centered care Teamwork and collaboration Evidence-based practice Quality improvement Safety Informatics

Setting Priorities:

Physiological needs-basic needs Safety needs-basic needs Belongingness and feeling love needs-psychological needs Esteem needs-psychological needs Self-actualization-Self-fulfillment needs

Third step in the nursing process:

Planning

Problem-focused nursing diagnosis has 3 parts

Problem (label) Etiology (cause) Signs & Symptoms (defining characteristics)

2 Diagnosis

Problem focused (actual) Risk

A physician writes an order for ampicillin 1 gram every 6 hours for Mr. Jameson Owens. What is missing in this order? Frequency Route Time Amount

Route

A nurse in a long-term care facility consistently administers clients' medications 60 to 90 minutes after the scheduled administration time. The nurse also leaves scheduled treatment procedures for nurses to complete on the next shift. Which of the following would be an appropriate strategy for this nurse to pursue? Seek input and direction on time management and priority setting Reschedule treatment procedures for the next shift Ask the nurse manager for a lighter workload Pre-pour medications for the shift to expedite the process

Seek input and direction on time management and priority setting

Drugs with short half-lives are given how often?

Several times daily

Outcomes: SMART

Specific Measurable Attainable Realistic Time-bound

Outcome

Specific, measurable criteria used to evaluate whether the patient's goal has been met.

Pharmacodynamics

The study of what the drug does to the body

Pharmacokinetics

The study of what the drug does to the body

Pharmacology

The study or science of drugs

Onset of action

The time required for a drug to elicit a therapeutic response after dosing.

What is the term used for the concentration of drug in the blood serum that produces the desired effect without causing toxicity? Peak level Half-life Therapeutic range Trough level

Therapeutic range

Factors affecting kidney's ability

Tissue perfusion rate Presence of disease

Drug Classifications: Nonsteroidal Anti-Inflammatory Agents

Tylenol Aspirin Motrin

The nurse is preparing to administer digoxin to a client with heart failure. The nurse obtains an apical pulse rate for 1 minute and determines a rate of 52 beats/minute. What is the first action by the nurse? Administer the medication and inform the charge nurse about the rate. Administer atropine to speed the heart rate and then administer the digoxin. Withhold the medication and notify the physician of the heart rate. Administer the medications and then notify the physician.

Withhold the medication and notify the physician of the heart rate.

Buccal administration

involves placing a drug between your gums and cheek, where it also dissolves and is absorbed into your blood.

Gordon's functional health patterns: Cognitive/Perceptual pattern

ex: Do they wear glasses?

Gordon's functional health patterns: Health perception/management

ex: What are their allergies?

Gordon's functional health patterns: Sleep/rest pattern

ex: What's your usual pattern of sleep?

Areas of rapid distribution

heart, liver, kidneys, brain

Areas of slower distribution

muscle, skin, fat

Peak effect

the time required for a drug to reach its maximum therapeutic response in the body

To be excreted via kidney the drug must be

water-soluble