Medication administration Questions and Answers Certified solutions

Medication administration Questions and Answers Certified solutions 1970 Controlled Substances Law - drug schedule - ANS- Schedule of drugs - I, II, III, IV, V Lower is more addictive (Schedule I is illegal) Pre-requisites for safe and effective medication administration - ANS- Pharmacokinetics Growth and development Nutrition Mathematics skills Teratogenic - ANS- causes birth defects Albumen's interaction with drugs - ANS- Binds to drugs → low albumen = increased toxicity Doseage is important How are meds classified? - ANS- Meds with similar characteristics are grouped into classifications Ways of classification - ANS- The effect of the med on the body system The symptoms the medication relieves - ANS- The med's desired effect 5 medication forms - ANS- Tablet Capsules Elixirs Suppositories Troches Medication legislation and standards - ANS- Governmental regulation Health care institutions and medication laws Medication regulations and nursing practice Non-therapeutic medication use "Off-label" indications Pharmicokinetics - ANS- The study of how medications enter the body, reach their site of action, are metabolized, and exit the body Types of medication action - ANS- Therapeutic effects Side effects Adverse effects Toxic effects Idiosyncratic reactions Allergic reactions Medication interactions Medication dose responses Adverse effects - ANS- Effects of a med that are not intended and are more serious Toxic effects - ANS- Too high a dose of the med Idiosyncratic reactions - ANS- Effect of med that is opposite of expected effect Allergic reactions - ANS- Adverse effect that triggers allergic response (hives, swelling, anaphylactic shock) Medication interactions - ANS- 2 or more meds interact with each other. Sometimes it is good and/or intended (synergistic), but sometimes it is a bad thing Medication dose responses - ANS- Medication doses are patient specific Angioedema - ANS- Swelling of lips, tongue, mucous membranes that can occlude throat Pharmacokinetics - ANS- Absorption Distribution Circulation Membrane permeability Protein binding Metabolism Excretion Main organ of Metabolism - ANS- Liver Main organ of Excretion - ANS- Kidney Circulation - ANS- Consider cardiac function in relation to medication Membrane permeability - ANS- Lipophilic meds are more easily absorbed than hydrophilic, but it should be hydrophilic after it is metabolized so that it is easier to excrete (think of hand lotion - greasy hydrates better, but can't be too greasy or it will be hard to wash off...or something like that) Protein binding - ANS- Many meds bind to albumen Inactive part binds and active part is free -- Low albumen = higher med toxicity Medication routes - ANS- Oral Parenteral Topical Oral medication route - ANS- Sublingual Buccal Parenteral route - ANS- Subcutaneous (SQ) Intramuscular (IM) Intravenous (IV) Intradermal (ID) Subcutaneous (SQ) - ANS- Shorter, fine gauge needle Intramuscular (IM) - ANS- 23 or 21 gauge Length depends on size of person Volume - no more than 2 mL Must make 'Z track' Intravenous (IV) - ANS- Into vein Infiltration - if needle slips out of vein into surrounding tissue If we give wrong med by IV, we must give something to counteract it immediately Can give larger volumes by IV Intradermal - ANS- Very fine gauge needle PPD, allergy testing Topical administration - ANS- Skin Mucous membranes Inhalation Intraocular route Otic Nasal Pediatric dosages - ANS- Calculate based on surface area of child Chart of height and weight on pg 698, but I don't think we need to know that Types of Orders - ANS- Standing orders (prewritten but must get a Rx afterward) PRN orders (as needed) Single (one-time) orders Stat orders (one time, give it immediately) Distribution systems - ANS- Unit dose Computer-controlled dispensing systems (Pixis) Medication error - ANS- Any event that could cause or lead to a patient receiving inappropriate medication therapy or failing to receive appropriate medication therapy Most occur when routine procedures are not followed 6 Patient Rights - ANS- -Right medication -Right dose -Right client (need 2 unique patient identifiers: name & DOB) -Right route -Right time -Right documentation (be sure to doc patient response before and after administration) Components of Drug Orders (7) - ANS- -Patient's full name -Date that the order is written (and sometimes a stop date too) -Drug name (generic name is best) -Dosage -Route of administration -Time and frequency of administration -Signature of prescriber (pg 701) Maintaining patient's rights - ANS- -Be informed of medication name, purpose, action and potential undesired effects -Refuse a medication (explore reasons for refusal, explain why it is important, and notify prescriber) -Have qualified nurses or physicians assess a medication hx -Be properly advised of the experimental nature of medication -Receive labeled medications safely without discomfort -Receive appropriate supportive therapy -Not receive unnecessary medications Assessment for medication administration - ANS- • History • Patient's perceptual or coordination problems • Patient's current condition • Patient's attitude about medication use • Patient's learning needs Medication Reconciliation - ANS- Any time a patient changes facilities or units within a facility, must have all medications reconciled Implementation - ANS- • Health promotion activities • Acute care activities • Restorative care activities • Special considerations for administering medications to specific age-groups • (I have not the foggiest clue how this fits in...) Parenteral Administration of Medication - ANS- • Administered by injection • Invasive • Must use aseptic technique • Rapid effects Syringes - parts - ANS- • Cylindrical barrel with close-fitting plunger • A tip designed to fit the hub of a hypodermic needle Syringes - 2 classifications - ANS- • Leur-lok • Non luer-lok Syringes - sizes - ANS- • Various sizes • Large syringes are used to administer certain types of medications, add medications to IV solutions, and irrigate wounds or drainage tubes Syringes - tuberculin syringe - ANS- • Has a long, thin barrel with a pre-attached thin needle • The syringe is calibrated in sixteenths of a mL and has a capacity of 1 mL • Used for ID and SQ injections Syringes - insulin syringe - ANS- • Hold 0.3 to 1 mL and are calibrated in units • Most are U 100s and each mL of solution contains 100 units of insulin Needles - ANS- • Parts: hub, shaft, and bevel • Vary in length from ¼ to 3 inches • The needle length chosen depends on the client's size and weight and the route of administration • As the needle gauge gets smaller, the needle diameter becomes larger • The viscosity of the liquid determines the gauge selected Disposable injection units - ANS- • Disposable, single dose, prefilled syringes are available • Tubex and Carpoject injection systems Preparing an injection from an ampule - ANS- • An ampule contain single doses of medication in a liquid • An ampule is made of glass with a constricted, pre-scored neck that must be snapped off to allow access to the medicine Preparing and injection from a vial - ANS- • A vial is a single-dose or multidose container that has a rubber seal at the top • A metal cap protects the seal • Contain liquid or dry forms of medications • Vial label specifies solvent or diluent needed • Closed system requiring air to remove contents • After mixing multidose vials, place a label that includes the date and time of mixing and the concentration of medication per mL on the vial Can you mix medications? - ANS- If two medications are compatible, it is possible to mix them in one injection Insulin - the basics - ANS- • A hormone used to treat diabetes mellitus • Must be injected • Available in 100 units per mL in US • 100-unit scaled syringe is used to prepare 100-unit insulin • A client may receive more than one type of insulin Insulin classifications - three rates of action - ANS- • Short acting (ultra rapid-acting, rapid acting, and slower acting) • Intermediate acting • Long acting (not used much) Lispro and aspart insulin - ANS- • Acts within 15-30 and 10-20 minutes respectively • Given almost always subcutaneously • Can be given IV but rare Regular insulin - ANS- • Acts within 30-60 minutes • Given SQ or IV Intermediate-acting insulin - ANS- • Acts more slowly than regular • Given SQ • Cloudy or clear • Examples: NPH, glargine insulin How is insulin ordered? - ANS- • Insulin is ordered by specific dosage at select times or by a sliding scale • Sliding scale: blood sugar is checked after a meal (post prandial) and then insulin amount is adjusted based on results 3 parts of insulin cycle - ANS- • Onset • Peak • Duration When is hyperglycemia most likely in the insulin cycle? - ANS- At peak Normal fasting blood sugar level - ANS- 70-100 mg/dL Administering insulin - ANS- • Rotate - don't shake! (can create air bubble and denature proteins) • When giving two in one injection - regular before intermediate -- NRRN (air in NPH, air in regular, draw out regular, draw our NPH)