D1 TLU Fundamentals - Chapter 31 Medication Administration
What are the routes for topical medication administration?
1. Direct application of liquid or ointment 2. insertion into a body cavity 3. Installation of fluid into a body cavity 4. Irrigation of a body cavity 5. Spraying a medication into a body cavity
What are the steps of the Medication Reconciliation process
1. Obtain patients list of medications 2. Verify the list is correct 3. Document any findings 4. Review past medications with current medications 5. Communicate and verify changes or issues
What are the time intervals of medication action?
1. Onset of medication action 2. Peak action 3. Trough 4. Duration of action 5. Plateau
What is a No-interruption zone (NIZ)?
A space created by placing signs, red type, or some type of border on the floor around medications carts or areas, these zones signify not to interrupt the nurse in that area
How many drops are in 1 mL
About 15 drops (gtt)
when do anaphylactic reactions occur?
After being sensitized to an allergen and coming into contact with that allergen afterwards
Where should all narcotics be stored?
All narcotics should be stored in a locked, secure container
Why do highly lipid-soluble drugs cross the cell membrane so easily?
Because a cell membrane has a lipid layer
Why should you make sure a pill crusher is clean of remnants?
Because remnants of previously crushed medications increase the concentration of a medication that a patient was not prescribed
What is the easiest and most desirable route for medication administration?
By mouth
Why should insulin detemir not be mixed with insulin?
Can make it ineffective
What happens if an oral use liquid is injected through IV?
Can result in local complications, such as sterile skin abscess, or systemic effects, such as a fatality
What determines a medications organ of excretion?
The medications chemical makeup
What increases when a patient experiences polypharmacy?
The risk of adverse reactions and medication interaction with other medications and food
What happens when a medication exits through a swat gland?
The skin often becomes irritated
What is true of Basic medications in regards to their ability to be absorbed?
They are not absorbed before reaching the small intestine
Why is the risk for drug-drug interaction high during enteral feeding?
They can interact together as soon as they are administered
What is true of Acidic medications in regards to their ability to be absorbed?
They pass through the gastric mucosa rapidly
What is the Z track method?
This is used for IM injections. Use nondominant hand to pull skin laterally and hold it in position while giving injection. Release skin immediately after withdrawing needle to seal off the injection site. This prevents the medication from leaking through the more sensitive subcutaneous tissue from the muscle. Done at the ventrogluteal or dorsogluteal sites.
How are medications absorbed?
When blood comes into to contact with the site of administration; the richer the blood supply at the site of administration, the faster a medication is absorbed
Which agency publishes a list of medication names that are a common cause of medical errors due to their simillarities?
the Institute for Safe Medication Practices (ISMP)
Which international organization has developed tubing connecter standards for the enteral connecter and what is the name of the new enteral-only connector?
the International Organization for Standardization (ISO); ENfit connector
What must happen for a medication to be distributed to an organ?
the medication must pass through all tissues and biological membranes of the organ
What should a special inventory record contain?
the patients name, date, time of medication administration, name of medication, and dosage
How are intrathecal medications administered?
though a catheter surgically placed in the subarachnoid space or one of the ventricles of the brain
Why do health care providers often combine medications?
to create an interaction that has a beneficial effect
How do healthcare providers report adverse effects to the FDA
using the MedWatch program
What is medication reconciliation?
where you are supposed to compare the meds they should be on (and actually using) to new meds that are ordered to resolve any discrepancies
What is a standing order?
written in advance of a situation that is to be carried out under specific circumstances; is usually carried out until another provider cancels it or a specific period of time has elapsed
What is biotransformation?
Changing a compound into something more usable by the body
What do patients who receive medication by inhalation usually suffer from?
Chronic asthma, emphysema, or bronchitis
What does accurate medication reconciliation require?
Consulting with the patient, family caregivers, other clinicians, pharmacists, and other members of the health care team
You are caring for a patient who has diabetes complicated by kidney disease. You need to make a detailed assessment when administering medications because this patient may experience problems with: A. absorption. B. biotransformation. C. distribution. D. excretion.
D. excretion
A postoperative patient is receiving morphine sulfate via patient-controlled analgesia (PCA). The nurse assesses that the patient'srespirations are depressed. The effects of the morphine sulfate can be classified as: A. allergic. B. idiosyncratic. C. therapeutic. D. toxic.
D. toxic
Why should IM sites be rotated?
Decrease the risk for tissue hypertrophy
What can be used by a patient to help eliminate anesthetic gases more rapidly after surgery?
Deep breathing and coughing
What should you do if a patient refuses medication or is undergoing tests or procedures that result in a missed dose?
Explain the reason that the medication was not given in the nurses' notes
Overreaction or underreaction or different reaction from normal
Idiosyncratic reaction
What happens when a medication comes in contact with a large surface area?
It is absorbed at a faster rate
What types of medication do exocrine gland exrete?
Lipid-soluble medications
Where does most biotransformation occur?
Liver, Lungs, kidneys, blood, and intestines
What is the Intrathecal route of medication administration commonly used for?
Long-term treatment
What kinds of medications might be used for a STAT order?
Medications with acute effects and target critical conditions
What is the Epidural route of medication administration commonly used for?
Regional analgesia for surgical procedures
Why are most Nurse Practice Acts (NPAs) broad?
So that nurses' professional responsibilities are not limited
What is the risk when a medication is excreted through the mammary glands?
That a nursing infant will ingest the chemicals
What is the ISMP's stance of splitting tablets?
That it has questionable accuracy even if the pill is scored and that medication errors can occur here
What does the Needlestick Safety and Prevention Act mandate?
The use of special needle safety devices to reduce the frequency of needlestick injuries
What is the primary purpose of a Nurse Practice Act (NPA)
To protect the public from unskilled, undereducated, and unlicensed personnel
What can happen if a nurse fails to follow EBP recommendations from the American Society for Parenteral and Enteral Nutrition (ASPEN) regarding tube feeding?
Tube obstruction, reduced medication effectiveness, and increased risk of medication toxicity
What is it called when a healthcare provider orders medical treatment or medication verabally?
Verbal ordder
How are sever nosebleeds usually treated?
With packing or nasal tampons, which are treated with epinephrine to reduce blood flow
What is the recommended time lime on non-time-sensitive medication?
Within 1 hour of scheduled dose
Should a DEA number be on a patients prescription
Yes
What should be done to the container of a narcotic if a partial dose of a is given?
a second nurse should witnesses the disposal of the unused part
How are intraperitoneal medications administered?
administered into the peritoneal cavity
Which class of medications has a high incidence of allergic reactions?
antibiotics
What does current evidence show regarding children and medication errors?
children are at a much higher risk for experiencing a medication error than adults, an medication errors in children have a much greater chance of causing serious and even fatal consequences
What is urticaria?
commonly referred to as "hives"; a kind of skin rash notable for pale red, raised, itchy bumps
What is a single (one-time) order?
given one time for a specific reason, common for preoperative medications or medications given before diagnostic examinations
How are Epidural medications administered?
in the epidural space via a catheter
Where is an epidural given?
in the spine via catheter
How are intraosseous medications administered?
infusion of medication directly into the bone marrow
What is pruritus?
itching
More people die from _________ than from chronic lower respiratory diseases, accidents, stroke, Alzheimer's disease, and diabetes mellitus
medical errors
What increases the risk for medication toxicity?
renal function impairment
What route should insulin be given?
subcutaneous
What does the Institute for Safe Medication Practices (ISMP) recommend be used when writing the name of commonly confused drugs?
tall-man or mixed-case lettering
What was the first American law to regulate medications?
the Pure Food and Drug Act
What are the components of a medication order?
1) Patient's full name 2) Date and time that order is written 3) Medication name 4) Dosage 5) Route of administration 6) Time and frequency of administration 7) Signature of health care provider
Which groups of patients are most at risk for adverse medication reactions?
1. the very young 2. Older adults 3. pregnant woman 4. Patients taking multiple medications 5. patients who are under- or over- weight 6. patients with renal or liver disease
What is 1 cup in mL?
240 mL
At what angle is an intradermal needle inserted?
5-15 degrees
What should be done to monitor the dispensing of opioids?
A special inventory record should be used to record each time an opioid is dispensed; A running count of opioids should be maintained and any discrepancy reported
how are intrapleural medications administered?
A syringe and needle or a chest tube is used to administer medications directly into the pleural space
What is the FDA's MedWatch program?
A voluntary program that encourages nurses and other health care professionals to report when a medication, product, or medical event causes serious harm to a patient by completing the MedWatch form
Toxic effect, side effect, and idiosyncratic reactions are all examples of
Adverse effects
What happens if excess decongestant solution is swallowed?
Can cause serious systemic effects, especially in children
Why should insulin not be mixed with other medications?
Can hamper its effectiveness
What is a PRN order?
Given as needed for symptom management
How should heparin be administered?
IV or SubQ 2 inches from the umbilicus Verified with another RN
What is insulin detemir and glargine?
Insulin detemir is a long-acting, man-made version of human insulin
What is the Intraarterial route of medication administration commonly used for?
Patients who have arterial clots and receive clot-dissolving agents
What should you not assume when a medication is ordered for a patinet?
That it is the correct medication or the correct dose
Which agency enforces medication laws which ensure that all medication on the market undergo vigorous testing before they are sold to the public?
The Food and Drug Administration (FDA)
What determines how fast a medication is distributed throughout the body?
The vascularity of the various tissues and organs
Why are pediatric patients medication dosages rounded to the nearest thousandth?
To prevent overdose
What is a 1% solution?
1 gram dissolved in 100 mL
A 1:1000 dilution represent what?
1 gram in 1000 mL of solution
What does the ISMP recommend as best practice for oral liquids?
1. All oral liquids should be dispensed by the pharmacy in an oral syringe using metric measurements 2. Family or caregivers purchase oral liquid dosing devices that display only the metric scale
What can you do to protect a patient from Aspiration?
1. Allow patient to self-administer medications if possible 2. Know signs of dysphagia 3. Assess patient's ability to swallow and cough 4. Prepare oral medication in form that is easiest to swallow 5. Position the patient in an upright seated position at a 90-degree angle 6. suggest the patient flex the head in a chin down position before swallowing 7. If patient has unilateral weakness, place medication in stronger side of mouth 8. administer pills one at a time
What are contraindications for ear irrigation?
1. History of middle ear infection in the last 6 weeks 2. if the patient has undergone any form of ear surgery 3. if the patient has a perforation 4. if their is any history of a mucous discharge in the last year
What must occur for a medication to be useful therapeutically?
1. Must enter the patient body 2. Must be absorbed 3. Must be distributed to cells, tissues, or a specific organ 4. Must alter physiological functions
What must be done when a nurse receives a verbal or telephone order
1. Nurse must write the complete order 2. Read it back to the prescribing provider 3. Receive confirmation as to the accuracy of what you read back 4. Make sure the order is countersigned by the health care provider, usually within 24 hours
What should be done to ensure safe administration of transdermal or topical medications?
1. Reconcile medications 2. Ask patient if they have an existing patch 3. Wear clean gloves 4. Apply a noticeable label to hard to see patches 5. Document patch placement location in MAR 6. Document patch removal in MAR
What three phases of medication administration are nurses commonly distracted during?
1. The acquisition of the medication 2. Transportation to the bedside 3. Actual administration
What should the patients position be when administering a medication into the ethmoid sinus?
1. The head should be tilted back over the edge of the bed 2. A pillow should be placed under the shoulder
What are a patients rights regarding medication administration?
1. To be informed of the name, purpose, and action of a medication and its side effects 2. To refuse a medication 3. To have their medication history assessed by a nurse or physician 4. to be advised of the experimental nature of medication therapy 5. To receive labeled medications safely and without discomfort 6. To receive appropriate supportive therapy relating to medication therapy 7. To receive no unnecessary medications 8. To be informed if medications are part of a research study
What are the steps following a medication administration error?
1. assess patient 2. notify health care provider 3. report incident to appropriate person 4. file an incident report
Which agency's set standards for medication strength, quality, purity, packaging, safety, labeling, and dose form?
1. the United States Pharmacopeia (USP) 2. the National Formulary
What is the recommended time limit on time-sensitive medication?
30 minutes before or after scheduled dose
What do the deeper passages of the respiratory tract provide in regards to the inhalation route of medication administration?
A large surface area
What did the book "To Err is Human: Building a Safer Health System" published by the Institute of Medicine (IOM) in 1999 help create?
A national awareness about the effect of medical errors within the health care system
What is the difference between a rescue medication and a maintenance medication in regards to inhalers?
A rescue medication is taken for immediate relief of acute respiratory distress; Maintenance medications are used on a daily schedule to prevent acute respiratory distress
What is the Right Indication?
A seventh right of medication administration that is being considered; narrows medication choices, dosage forms, and dosing regimens, which reduce the risk of a wrong medication being chosen
What is the controlled substance act?
Act (passed in 1970) to regulate the distribution of drugs that may result in dependency
What is the Intraperitoneal route of medication administration commonly used for?
Chemotherapeutic agents, insulin, and antibiotics
What is the Intrapleural route of medication administration commonly used for?
Chemotherapeutics, medications that help resolve persistent pleural effusion
What is the Intraosseous route of medication administration commonly used for?
In infant and toddlers who have poor access to their intravascular space or when an emergency arises, and IV access is impossible
What is a unit dose system?
Multiple drugs placed in unit dose packaging dispensed in a single container (such as a medication bin) labeled with a patient's name. Directions for administration are NOT provided by the pharmacy and are obtained from the order or medication administration record.
Should you round up when calculating Puffs in an inhaler?
No, you would round down because you can't have more than the calculated value