test 2 intro

blood sugar over ... is high

110

•A client has an order for chloramphenicol, 500 mg every 6 hours. The drug comes in 250 mg capsules. How many capsules would the nurse administer per dose?

2 capsules •Cap/250mg x 500mg/1= 2

medication reconciliation

A procedure to maintain an accurate and up-to-date list of medications for all patients between all phases of health care delivery.

Liquids, suspensions & elixirs:

Determine if meds need to be shaken or diluted. especially with PEG tube

trade name

brand name. selected by the pharmaceutical company that sells the drug. a medication can have several trade names when produced by different manufacturers

prescription

hospitals order the medication prescription is taken outside of the hospital

examples of allergic reaction

swollen face bumps rashes

nasal drops

•Patient should be supine. Head up. •Hold dropper 1 cm (1 inch) above nares. •Instruct patient to breathe through mouth, stay supine, and do not blow nose for 5 minutes after putting in drops.

excretion

process of removing a drug or its metabolites from the body. kidneys excrete most drugs through urine the lungs are a primary route for the excretion of gaseous substances such as inhalation anesthetics

vaginal

- Position pt. supine with knees bent and feet flat on bed. (dorsal recumbent) •Usually comes with an applicator. •Have pt. remain in this position as directed on package. •Document procedure and outcome in nurse's notes and MAR. put blue pad under

ears (ear drop)

-Can be administered with patient sitting or in side-lying position. -Straighten the ear canal by pulling the auricle upward and outward for adults; or down and back for children under 3. Hold dropper 1 cm (1/2 inch) above ear canal. (put on side)

nasogastric tube and gastric tube

-Do not give sublingual medication Do not crush: extended/time release enteral feeding through ng tube only use ng tube if problem will be fixed within 14 days, not for permanent use flush tube before and after giving medication with 30 ml water. mix meds with 15 mL and then use another 15 mL to get it all the way down

Routes of Parenteral Administration

-Intradermal (ID) : under skin -Subcutaneous (SQ) : in fatty part of tissue -Intramuscular (IM) : inner muscle -Intravenous (IV) : inner vain

elderly adults

-No child proof containers - flip top to the other side (upside down) so they can open it -Containers for the week -Income limitations -Multiple physicians and pharmacies (polypharmacy)

ensuring correct administration

-right reason - if the reason doesn't make sense then clarify the meds -right assessment data - check bp when giving bp meds -right education -right response - therapeutic response .. is it working?

A nurse is caring for an adolescent client who has pneumonia and a prescription for cefpodoxime 5 mg/kg PO every 12 hr for 5 days. The client weighs 88 lb. How many mg should the nurse administer per dose? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.) ___________________Mg

200 mg

subcutaneous injections have a ...

Absorption is slower - adipose tissue just below the epidermis and dermis

A nurse preparing medication for a client is called away to an emergency. What should the nurse do? A. Have another nurse guard the preparations. B. Put the medications back in the containers. C. Have another nurse finish preparing and administering the medications. D. Lock the medications in a cart and finish them upon return

D. Lock the medications in a cart and finish them upon return

Nursing History

OTC meds - over the counter medication Bronchodilators - inhalers Coumadin - blood thinners

Six Rights of Medication Administration

Right patient Right medication Right dose Right route Right time Right documentation

sublingual route of administration

Sublingual (under tongue): Warn patient not to chew or swallow the med or drink any liquids with it.

multi-dose vial

a container that has several doses of a medication in it. usually insulin always label when opened with initials and date it was opened

allergic effect / allergic reaction

an immune system response that occurs when the body interprets the administered drug as a foreign substance and forms antibodies against the drug. symptoms may become more severe each time the drug is introduced into the body can be mild or severe unpredictable response to medication

topical medication (creams)

apply with glove on, tongue blade or applicator, cotton-tip applicator -Dressing change/medication application is painful, administer pain medication ½ hour before starting procedure.

PRN order

as needed order patient has to ask for it

when giving an infant liquid medicine you place it

between gum and cheek to prevent aspiration

formula for how much insulin to give

blood sugar minus 100 divided by 20

drug tolerance

body is accustomed to the medication might have to up the dosage to get the desired effect

which order would the nurse need to contact the primary healthcare provider to clarify? A. Furosemide 20mg PO every morning before breakfast. B. Diltiazem 120mg PO every day. C. Ampicillin 500mg by mouth D. Nitroglycerin 0.4mg PO Stat

c. ampicillin 500 mg by mouth no frequency is listed

the nurse is administering the first dose of an intravenous infusion of an antibiotic. which statement made by the client is a cause for concern? a. i feel hungry b. i feel like i need to urinate c. i feel like my back and my arms are itching d. i feel very tired

c. i feel like my back and my arms are itching this is not a normal for an antibiotic

factors affecting drug action

certain variable can influence the action or effect of a medication developmental consideration, weight, biologic sex, genetic and cultural factors, psychological factors, pathology, environment, and timing of medication administration

chemical name

chemical that makes up the drug

how to help patient swallow medication

chin tucked to chest and stroking underside of chin and throat.

STAT or now order

do it now

trof

drop in medication toxic drugs

drug interactions

drugs interact with other medications or herbs ALWAYS get a complete list that is inclusive to ALL medications that the patient takes including over the counter medication like ibuprofen or advil

oral route of administration

easiest and most commonly used slower onset of action -The patient should be sitting in semi-fowler's position. Give med with 60 -100 ml of fluid (usually water) if allowed. -Monitor pt. for vomiting, absence of gag reflex, difficulty swallowing, & decreased LOC. if this is happening don't give meds by mouth -Do not mix with large amt. food or drink. -Enteric-coated or time-released must be swallowed whole. -Need to know if medication can be taken with food or on empty stomach.

tetrogenic effect

effects fetus and they do not develop correctly

therapeutic effect

expected response or expected effect

abdomen has the .... absorption rate of insulin

fastest

allergies

first thing to inspect before giving meds hypersensitivity to something

if you draw medication up you MUST

give the medication. no one else can give your medication and do not gie anyone else's medication

ampule

glass that holds medication break the glass away from you draw up medicine with filter needle, change the needle, then give meds

drug classification or drug classes refer to ...

group of drugs that share similar characteristics.

diameter decreases with ..

higher number needle

peak

highest the medication hits toxic drugs

inhalation

if you are using different medication wait 1-2 minutes between puffs •Can use spacer. goes on end of inhaler for easier use •DPI (Dry power inhalers): Do not shake. Place mouth piece between lips. really strong inhalation. have to rinse mouth after or you can get a yeast infection. used for corticosteroids shake inhaler, pt blow out normally, then inhale and hold for 8-10 seconds with an MDI •Have patient exhale and then inhale medication deeply through mouth for 3-5 sec., then hold breathe for 5-10 sec. with DPI

one-time order

is given one time and then medication is done

transdermal route of administration

medication in a skin patch and absorbed through the skin. wear gloves so you don't give medication to yourself cannot place on hairy sites rotate sites do not put on raw area of skin do not throw away in trash can - put in biohazard container

Handling controlled substances

must be locked, medication is counted every shift, and if there is any waste needed another nurse must watch

distribution

occurs after the drug has been injected or absorbed into the bloodstream the drug molecules are transported throughout the body to where they take action

generic name

official name identifies the drugs active ingredient and is the name assigned by the manufacturer that first develops the drug

DO NOT leave meds ..

out. you must lock them up

parts of the order

patients name and secondary identifier (date of birth) date and time the order is written name of drug to be administered dosage route to be administered (oral, buccal, iv) frequency (every 4 hours, every 6) signature of prescribing provider

drugs are classified in two primary ways ....

pharmaceutical class and therapeutic class

how does psychological factors affect drug action?

placebo effect giving a placebo is unethical without approvement

side effect

predictable and often unavoidable ... NOT ADVERSE REACTIONS and NOT ALLERGIES ex: diarrhea when on antibiotics or pain medication causes nausea and constipation

therapeutic classification

refers to the clinical indication for the drug of therapeutic action ex: antibiotics or antihypertensive

pharmaceutical classification

refers to the mechanisms of action, physiologic effect, and chemical structure ex: beta blockers or calcium channel blockers

absorption is influenced by ..

route .. ex: oral meds will take longer than iv liquid solubility : drugs that are more lipid soluble can be absorbed more readilt and pass more easily through cell membrane pH .. ex: acidic meds work better in an acidic environment blood flow dosage .. ex: loading dose gets it at therapeutic level then maintenace level

thighs have a .... absorption rate

slower

vial

small bottle containing medicine or other liquids •Keep the needle below the level of the fluid •Maintain sterility of the plunger. if you open the bottle for the first time and do not touch the rubber stopper then it is sterile, if it already open you have to clean it

diameter increases with ...

smaller number needle

how does cultural and genetic factors affect drug action?

some cultures do not believe in taking medication some cultures believe in herbal medication

toxic effect

specific groups of symptoms related to drug therapy that carry risk for permeant damage the organ or system affected by the toxicity is used to name the toxicity ex : ototoxic : harmful to ears

if you are inserting a needle subcutaneously you insert in ...

the back of the arm, abdomen, or anywhere where there is at least 2 inches of fat

metabolism

the change of an active drug from its original form to an inactivated or new form most drugs are inactivated by the liver and transformed to inactive substances for excretion

Pharmacokinetics

the effect the body has on the drug. movement of drug molecules in the body in relation to the drug's absorption, distribution, metabolism, and excretion

Absorption

the process by which the drug is transferred from its site of entry into the body to the blood stream

types of medication action

therapeutic effect and side effect

thicker viscosity of medicine needs a

thicker needle

sublingual meds

under the tongue and a little faster working than oral

adverse reaction

unexpected reaction to a drug can be severe and may require discontinuation of the drug ex: morphine causes a sudden drop in blood pressure

idiosyncratic effect

unusual or peculiar response to a drug may be the exact opposite of the expected response

suppositories

use when pt can't swallow, is on NPO, or throwing up -Lubricate suppository. water based Rectal •Place pt. on left side. put blue pad under them •Insert just beyond the internal sphincter. •Instruct pt. to retain med. 20-30 minutes.

single dose vial

vial that contains one dose of medication to be used and then discarded .. do not have to label

how does weight affect drug action?

weigh more then more meds need to be used and vice versa sometimes body surface area is used

verbal orders (VORB)

written order or telephone order repeat back to physician usually in a emergency situation direct admission will have verbal orders

subcutaneous injections

•45 to 90 degree angle - depends on size of the needle •Pinching or bunching the skin for thinner clients. Do not aspirate. •Do not massage site after the injection •3/8" to 5/8" needle •Insulin syringe ONLY for administering insulin

special considerations

•Ask client/family how the client best takes their medication •When mixing drugs, use only a small amount of liquid or food •Enteric-coated and formulated slow-release medications should not be crushed •Remain with client until medication is swallowed

administering insulin

•Insulin: hormone to treat diabetes •Administered by injection because it breaks down in GI •Concentration of 100 units/ml (others exist) •Use correct syringe •Must be checked by another nurse sliding scale

MAR

•MAR - Medication Administration Record •Times for doses Documentation

before preparing the drug the nurse must know

•Maximum drug dosage •Minimum drug dosage •Drug actions - how the drug acts in the body •Drug contraindications •Patient allergies Nursing actions

routes to give medication

•Oral - one of the slowest •Sublingual - faster than oral •Buccal - faster than oral •Parenteral -Subcutaneous -Intramuscular -Intravenous -Intradermal •Topical -Vaginal -Rectal -Skin/Transdermal

older adults

•Polypharmacy - go to diff doctors and end up with diff meds. pt might end up with same meds •Self-Prescribing - ibuprofen (causes GI bleeds) and Tylenol (liver issues) and constipation meds •Over-the-counter Meds same as self prescribing Noncompliance - make sure pt actually is before you document

eye medication

•Right eye= O.D. (Latin: Oculus Dexter) •Left eye= O.S. (Oculus Sinister) •Both= O.U. (Oculus Uterque) no longer use those abbreviations, but still learn Patient should be sitting or supine with head tilted slightly back, looking up at the ceiling. Hold the dropper 1-2 cm ( ½ in to ¾ in) above conjunctival sac Have the client close the eye(s) for 1-3 minutes

maintain clients rights

•Right to be informed of medication, purpose, action and side effects. •Right to refuse med - tell patient what it is for and then document •Right to be informed of experimental nature of med - placebo •Right to receive labeled med

symbols and abbreviations

•bid - twice a day •tid - three times a day •qid - four times a day •hs - hours of sleep •ac - before meals •pc - after meals •with, without •i, ii, iii, iv

subcutaneous

•inject into tissue. -Used for small doses (0.5 to 1 ml) of nonirritating, water soluble medications. -Insulin, Heparin, Lovenox (ALWAYS given in abdomen) (NEVER massage, can increase bleeding) -Use 3/8 to 5/8 in, 25-27 gauge needle. Insulin syringes can be 26-31 gauge. -If you can pull up 2 inches of skin, go in at 90 degree, if not go in at 45 degree angle.

intradermal

•usually used for allergy and tb testing Into the dermis (below the epidermis) •Common sites: forearm, upper back •Tuberculin (TB) syringe •¼" to ½" 25 or 27 gauge needle •Small dose - less than 0.5 mL angle 5 to 15 degrees - usually 15 degrees clean site in circular motion always insert 0.1 under the skin. never more than 0.5

standing orders

routine orders

insertion of needle

•Wipe area with alcohol prep •90 degree IM -Z-Track -Dart •45 to 90 degree SQ : depends on size of the needle •15 degree intradermal