Nur 155 Exam 4 (Galen) questions and answers

drug any substance that positively or negatively alters physiologic function medication drug specifically administered for its therapeutic effect on psychological function 6 rights of medication administration patient, time, dose, route, medication, documentation Routes of medication administration -Oral administration -Swallowed -Sublingual -Buccal -Nasogastric -gastric -intestinal -jejunal tubes oral medications (PO) precautions always test the patients ability to swallow, level of consciousness, and if they are experiencing nausea and vomiting medication route: swallowing safest, most convenient, and least expensive (liquid or pill) medication route: sublingual allows rapid absorption, placed under the tongue to dissolve medication route: buccal allows rapid absorption, placed against the mucous membrane of the inner cheek until dissolved completely medication route: NG Tube check tube placement before med administration, crush med and mix with water, flush before and after, if NG tube is hooked to suction, stop suction, give med, don't start for 30 mins topical medications lotions, creams, powders, and aerosol sprays topical medication administration cleanse the skin before applying med, use gloves when applying to avoid absorption through your skin transdermal medications designed to be absorbed through the skin (usually a patch) transdermal medications administration cleanse before placing, remove old patch, place in new spot from before inhaled medication inhaler and nebulizer Inhaled medication administration very rapid, administered through the respiratory tract nasal medications nose drops, spray Nose drop administration have pt blow nose and tilt head back (or to affected side), don't touch tip of applicator, have pt leave head back for 5 mins nose spray administration have patient tilt head down, looking at their feet with spray tip aimed in the direction of the eye otic medications (ear) should be room temp, if taking out the fridge, gently roll in hands Otic medication administration pull ear up and outward for adults, down and back for children if pt has a tympanic membrane that has been damaged, you want to be very careful, ensure ear drops are room temp, use sterile technique -have the pt lie with the ear to be treated in the uppermost position, wait 5 mins before administering in another ear (if needed) ophthalmic medications (eye) drops, oitments Eyedrop Administration gently pull down skin below the eye to expose the conjunctival sac, administer drops in center of sac, have pt blink several times, instruct patient to keep eyes closed for 1-2 mins Eye ointment administration squeeze a 1⁄2-inch-wide strip of ointment onto the conjunctival sac, instruct pt to close eyes for 2-3 mins, and inform them the med may temporarily blur vision suppositories Rectal and vaginal Rectal Suppositories administration can be local or systemic, often store in fridge, HAVE TO GO FROM FRIDGE TO RECTUM, DONT PUT IN POCKET, position the pt on the left side with upper knee flexed (left lateral position), to insert push pass the internal sphincter (3-4 in) instruct pt to lay in same position with buttocks together for 5-10 mins, if its a laxative pt should remain supine for 35-45 mins vaginal suppositories administration have pt lie on back with knees flexed (dorsal recumbent position), fully insert using a rolling motion, going downward and backward, instruct pt to lie on back for 5-10 mins parenteral medications -administer by injection into tissue, muscle, or vein -can be ampules, vials, powered, prefilled, or mixed -includes intradermal, subcutaneous, and intramuscular medications intradermal injection is located where in the dermis common sites of intradermal injection inner forearm, upper arm, and scapular area, intradermal injection only used for small amounts of meds (0.01-0.1 mL) a 1 mL tuberculin syringe is used, it is inserted at a 5-15 degree angle with the bevel up subcutaneous injection absorption is slow, volume of med should not exceed 1 mL, injection site should be rotated, a 0.5-3 mL syringe is used. the needle is inserted at a 45-90 degree angle (45 if less tissue is available) subcutaneous injection is located where layer of fat located below the dermis and above muscle tissue common sites of subcutaneous injections common sites include, the abdomen, lateral aspects of the upper arm and thigh, scapular area of the back, and upper ventrodorsal gluteal area what size needle is used for a subcu injection a 25-31 gauge needle What size needle is used for intradermal injections? a 25-27 gauge needle common sites for a intramuscular injection ventrogluteal, vastus lateralis, and deltoid intramuscular injection injection volume varies from 1-5 mL depending on the site and body muscle mass, should be administered using the Z-track method, needle is inserted at a 90 degree angle location of IM in an infant vastus lateralis location of IM in children vastus lateralis / deltoid location of IM in adults ventrogluteal or deltoid examples of locked narcotics morphine, methamphetamine what to do if a controlled substance has to be wasted two licensed clinical staff members must witness the disposal what color are liquid medications should you not use cloudy if you have a medication error what should your priority be assess and determine the effect on the patient and intervene any adverse effects. make assessment, notify the PCP, and DOCUMENT the event what to do if a nurse hands you a med and asks you to bring it to their pt do not give it to the pt, instead waste the medication and draw it up again, yourself whose medications should you administer only draw up your own allergic reactions unpredictable immune responses to medications anaphylactic reaction a medical emergency, this is a severe allergic reaction what is on a prescription which is dispensed by a pharmacist -patients name -date and time -drug name -dosage -route -frequency -signature of the person writing the order 5 common types of medication orders -routine: specific times -PRN: as needed -one time/on call: usually right before surgery -stat: immediately -now: not immediate but give it no acute pain pain lasting less than 3-6 months, has rapid onset chronic pain postoperative pain that persists more than 3 months and longer than 6 months, pain is on a daily basis and causes distress, interferes with daily functioning, can be a complaint or disease Types of pain scales -scorates -PQRST -OLDCARTS -numeric scale (verbal descriptor) -wrong baker faces scale -activity tolerance scale Socrates site, onset, character, radiation, association, time, exacerbation, severity PQRST provocation, quality, severity, temporality OLDCARTS onset, location, duration, character, aggravating factors, reliving factors, timing, severity numeric scale (verbal descriptor) 1-10 (1-3 mild, 4-7 moderate, 8-10 severe) 1-3 give things like Tylenol, 4-7 things like codeine, 8-10 things like oxycodone wrong baker faces scale used on kids, uses faces from smiling to crying activity tolerance scale no pain to bed rest required physiologic alterations caused by pain -endocrine -cardiovascular -respiratory -musculoskeletal -genitourinary -gastrointestinal -immune system physiologic: endocrine release of excessive hormones, results in carbohydrate, protein, and fat breakdown, along with poor use of glucose physiologic: cardiovascular increases cardiac workload and oxygen demand, can lead to increased heart rate, blood pressure and possible blood clot formation physiologic: respiratory reduces air exchange and increase inspiratory and expiratory pressures, respiratory rate becomes irregular physiologic: musculoskeletal impairs muscle function and capacity to preform daily activities physiologic: genitourinary decreases gastric emptying and motility, results in slow movement of food physiologic: immune system inflammatory response is initiated, inflammatory mediators are release to prevent further tissue injury, fight infection, and reduce pain Multimodal Pain Management use of more than one means for controlling pain, combines a variety of treatment Multimodal Pain Management examples can be two medications like Tylenol and codeine or a medication with a complementary therapy like massage therapy clinical manifestations of pain: cardiovascular increased HR and systolic BP, decreased systolic BP and pulse, can lead to chest pain and hypercoagulation clinical manifestations of pain: respiratory increased RR and bronchospasms, pneumonia, and atelectasis clinical manifestations of pain: gastrointestinal delayed gastric emptying, constipation, weight loss clinical manifestations of pain: musculoskeletal muscle spasms, impaired mobility, weakness, fatigue Why do we not crush or break an extended release or coated pill? If its extended release or has a coating it is used to be released over an extended amount of time clinical manifestations of pain: endocrine fever, shock clinical manifestations of pain: genitourinary decreased urine output, urinary retention, fluid overload clinical manifestations of pain: sensory dilated pupils, rapid speech, slow speech, pallor clinical manifestations of pain: immune impaired immune function, infection opioid analgesics used for relief of moderate or severe pain, things like morphine, oxycodone, fentanyl, pentazocine, dezocine, etc. What are the barriers to adequate pain management -patients personal barriers -healthcare provider barriers patients personal barriers fear of addiction, cost, no access to healthcare healthcare provider barriers poor pain assessment skills, inaccurate beliefs, prejudicial attitudes reevaluation of pain: nonpharmacological 30 to 60 mins after reevaluation of pain: intramuscular, subcutaneous, oral 30 to 60 mins after reevaluation of pain: transdermal 12 to 16 hours after reevaluation of pain: IV, sublingual 15 to 30 mins after health literacy a person's capacity to learn about and understand basic health information and services, and to use these resources to promote one's health and wellness domains of learning cognitive, psychomotor, affective cognitive learning compromises knowledge and material that is remembered, memorization and recall of information (thinking, reading, learning) psychomotor learning physical movement and the use of motor skills in learning affective learning emotional component of integrating new knowledge (emotions, behaviors, attitudes, beliefs) factors affecting health literacy and patient teaching - age and developmental stage - role - environment - timing - availability of resources - evidence based practice