med administration

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jword2
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137061
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med administration
Updated:
2012-02-26 18:54:10
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danny
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nursing
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  1. what are the three different type names a medication can have?
    chemical

    generic

    trade
  2. what is the chemical name of a medication?
    provides an exact description of the medication composition (ex. acetlysalicylic acid)
  3. wht is the generic name of a medication?
    name given by the manufactuerer who first developed the medication (ex. aspirin)
  4. what is the trade name of a medication?
    yhe name under which a manufactuer markets a medication

    has the symbol TM at the upper right of the name

    can be several trade or brand names (ex. excedrin, bufferin, anacin)
  5. what do medication classifications indicate?
    effect the med has on a body system

    symtoms that the med relieves

    medications desired effect
  6. can a medication be classified in more then one group?
    yes
  7. medications with simular characteristics are grouped into ?
    classifications
  8. the form of the medication determines what?
    which route you give the med
  9. list the solid forms of medication and descibe them
    caplet - shaped like a capsule and coated for ease of swallowing

    capsule - medication encased in a gelatin shell

    tablet- powdered medication compressed into hard disk or cylinder

    enteric-coated tablet- dissolves in intestines where med is absorbed

    pill- contains one or more meds, rarely used because it has been repaced by tablets
  10. list liquid forms of mediation and describe them
    elixer- clear fluid containig water and/or mixed with alcohol. often sweetened

    extract- syrup or dried form of pharmacologically active meds

    aqueous solution- substance dissolved in water and syrups

    aqueous suspension- finely devided drug particles dispersed in liquid mediums

    syrup- medication dissolved in a consintrated sugar solution

    tincture- alcohol extract from a plant or vegetable
  11. list medication forms commonly prepared fpr administration by topicalroute and describe them
    ointment (salve or cream)- semisolid, externally applied preperation, usually containing one or more meds

    liniment- usually contains alcohol, oil, or soapy emollient applied to skin

    lotion- liquid suspension that usually protects, cools, or cleanes skin

    paste- thick ointment; absorbed through skin more slowly than ointment, often used for skin protection

    transdermal disk or patch - medicated disk or patch obsorbed through skin over a period of time ( usually 24hrs to 1 wk)
  12. the study of how a medication enters the body is what?
    pharmacokinetics
  13. what are the four phases of pharmacokenetics (how meds enter the body)?
    absorption

    distribution

    metabolism

    excretion
  14. the first phase of pharmacokenetics, it is the passage of medication molecules into the bloodstream from the site of medication
    absorption
  15. what factors influence absorption of medication into the body?
    route

    ability to dissolve

    blood flow to the site

    body surface

    lipid solubility of the med

    food
  16. what are the four routes that meds are absorbed and describe them?
    skin- slower due to the make up of the skin

    oral- slow because of the passage through the GI tract

    mucous membrane & respiratory airways- quicker due to vascularity of tissue

    IV (intravenous)- most rapid d/t immediate access to the systemic
  17. the second phase of pharmacokenetics. The medication is distibuted to organs and tissues and to its specific site of action, this is called what?
    distribution
  18. what are some factors that affect the distribution of medications through the body?
    circulation

    membrane permability

    protein binding
  19. how does body surface area affect the asorption rate of a medication?
    the larger the area, the faster the absorption rate

    (ex. small intestines- its absorption and effects are quicker d/t larger BSA than absorption in the stomach)
  20. how does blood supply affect the absortion rate of a medication?
    sites with increased blood supply will absorb much quicker than sites with less blood supply


    (ex. muscle tissue vs. skin)
  21. during absorption, the ability for a med to dissolve depends largely on its form of?
    preparation
  22. the rate of absorption is faster if the meds are givin on ?
    an empty stomach
  23. you may have to give meds on a full stomach if?
    GI symptoms present
  24. how does circulation affect distribution of medications
    limited blood flow or poor blood supply equals poor distribution
  25. how fast a med gets circulated through the blood stream to a specific area depends on the medication's ?
    vascularity
  26. what are some ways membrane permeability affects the distribution of meds
    some membranes serve as barriers to the passage of meds

    in older adults, changes in permeability of the blood-brain barrier often cause adverse effects

    some membranes are nonselective (ex. placental membrane allows fat and non-fat soluble agents to cross, causing fetal deformities
  27. how does protein binding affect distribution
    The degree to which medication bind to serum proteins e.g. albumin affects medication distribution
  28. Medications bound to albumin do not exert any pharmacological activity
  29. Unbound or free drug molecules are considered the active form of the medication
  30. Older adults, patients with liver disease or malnutrition have decreased albumin—>more unbound medication—> Risk for toxicity. this is an example of what?
    protein binding during distribution
  31. when does metabolism occur?
    after reaching the site of action
  32. Occurs under the influence of enzymes that detoxifies and transforms toxic substances. what is this?
    biotransformation
  33. where does metabolism take place?
    liver (most often)

    kidneys

    lungs

    bloods

    intestines
  34. If there is a decrease in liver function, the body eliminates medication more slowly. Therefore there is a risk of?
    medication toxicity
  35. the process of the drug exiting the body is ?
    excretion
  36. what determines which organ excretes the medication?
    chemical makeup of the drug
  37. what are the modes of excretion?
    • Kidneys (most common)
    • Liver
    • Lungs
    • Bowel
    • Sweat, salivary glands, milk
  38. renal function is essential for ?
    excretion of medications
  39. renal impairment = ?
    risk for drug toxicity
  40. if their is a decline in renal function, what must be done to the medication?
    dose must be reduced
  41. what amount of fluid intake is adequate to premote proper elimination of medication ?
    50 mL/kg/day
  42. what type of medication action is "intended or a desired physiological response of a medication" ?
    therapeutic effect
  43. each medication has a desired ?
    therapeutic effect
  44. what is Nitroglycerin's therapeutic effect?
    works to lower cardiac workload and raise myocardial oxygen supply, thus eliminating chest pain
  45. why is it important to know the expected therapeutic effect of medication the pt receives?
    allows for proper teaching about the intended effect and evaluation of the effectiveness of the drug
  46. what type of medication action is "a predictable and often unavoidable secondary effect produced at a therapeutic dose" ?
    side effect
  47. when are side effects of drugs usually discovered?
    during clinical drug testing
  48. what are some common side effects you'll usually find with medications?
    GI upset (N/V, constipation, diarrhea)
  49. what type of medication action is "undesired, unpredictable, unintended responses to medication" ?
    adverse effects
  50. "a pt becomes comatose after taking a medication" is an example of what type of medication action?
    adverse affect
  51. what must happen if a pt has an adverse affect to a medication?
    Medication must be discontinued

    you are obligated to report the adverse affect
  52. "overdose, prolonged intake of a drug, medication accumulates in the blood d/t impaired metabolism or excretion" can cause what type of medication action?
    toxic effect
  53. "morphine can cause respiratory distress if to much is giving" is an example of what type of med action?
    toxic effect
  54. Narcan can reverse the toxic effects of what drug?
    morphine
  55. "Unpredictable response, Any abnormal or peculiar response, May manifest itself in a number of ways, Overresponse,Underresponse,Response different from the expected outcome", these are what kind of medication actions?
    diosyncratic reactions
  56. Unpredictable reaction in which the patient becomes immunologically sensitized to a medication after taking the first dose. this is what type of med action?
    allergic reaction
  57. if a pt has a known history of allergic reactions to a med, the pt needs to have what?
    allergy bracelet
  58. Anaphylatic Reaction is what type of med action?
    severe allergic reaction
  59. "Sudden constriction of bronchiolar muscles, Edema of the pharynx and larynx, Severe wheezing" are symtoms of what?
    anaphylatic reaction
  60. "Antihistamines, Epinephrine, Bronchodilators" are treatments for what?
    Anaphylatic Reaction
  61. "When one medication modifies the action of another medication" this is known as what?
    medication interactions
  62. "An effect resulting from two drugs—the effect of the two drugs combined is greater than the effects of the medications when given separately" this is what type of medication interaction?
    synergistic interactions
  63. Alcohol is a CNS depressant that has a synergistic effect on antihistamines, antidepressants, barbiturates, and narcotic analgesics. this is an example of what type of medical interaction?
    synergistic interactions
  64. Antihypertensives with diuretics act together to control moderate HTN. this is an example of what type of interaction?
    synergistic interaction with a therapeutic effect
  65. An effect resulting from two drugs—the effect of one drug reduces or abolishes the effect of the other drug. this is an example of what type interaction?
    antagonistic interaction
  66. Lorazepam can decrease the antiparkinson effects of levodopa. this is an example of what type of interaction?
    antagonistic
  67. Narcan reverses the respiratory depression associated with morphine toxicity. this is an example of what type of interaction?
    antagonistic results with therapeutic affects
  68. Time it takes after you administer a drug to produce a response
    onset
  69. Time it takes for a drug to reach its highest effective concentration
    peak
  70. Time during which the drug is present in a concentration great enough to produce a response
    duration
  71. Blood serum concentration of a drug reached and maintained after repeated fixed doses
    plateau
  72. Time it takes for excretion processes to lower the serum medication concentration by half
    serum half life
  73. To maintain a therapeutic plateau, patient needs to ?
    receive regular fixed doses
  74. for serum half-life; If a drug’s half-life is 8 hours, then the amount of drug in the body is as follows:
    • Initially: 100%
    • After 8 hours: 50%
    • After16 hours: 25%
    • After 24 hours: 12.5%
  75. who prescribes a med for the pt ?
    health care provider
  76. what kind of medication orders are given when electronic or written communications are not possible?
    telephone or verbal orders
  77. what must the nurse do when receiving verbal or telephone orders?
    write the name of the prescriber and sign the nurses name
  78. you never give a med without first reiving a?
    order
  79. what are the 5 common types of med orders givin in an acute care setting?
    standing

    PRN

    single

    stat

    now
  80. orders carried out until the health care provider cancels it by another order or until a prescribed number of days elapse. the order may indicate a final date or number of dosages. this is what kind of order?
    standing or routine order
  81. Medications given only when the patient requires it
    Usually has set time intervals to be given. This is what kind of order?
    PRN
  82. when giving PRN meds, you the nurse need to document what?
    Assessment data you used to determine the need of the medication

    Evaluate the effectiveness of the medication
  83. Given only once at a specified time
    Common for preoperative medications or diagnostic examinations


    this is what kind of order?
    single order
  84. Medication given immediately & only once
    Usually written in emergency situation when there is a sudden change in patient’s condition


    this is what kind of order?
    stat order
  85. More specific than a stat order
    Administered quickly, but not immediately
    Up to 90 minutes to administer the medication
    Only administer now medications one time
    Ex: Vancomycin 1 gram IVPB now

    this is what kind of order?
    now order
  86. when a patient goes to surgery, the surgery automatically cancels ?
    all patient preoperative medications
  87. when the patient returns from surgery, the patient’s condition changes after surgery and the MD or the health care provider must ?
    write new orders
  88. When the patient is transferred to another health care agency or to a different unit within a hospital or is discharged the prescriber?
    reviews the medications and writes new orders as indicated
  89. Special areas used for stocking and dispensing medications (carts, rooms, cabinets, storage units in patient’s rooms)
    distribution systems
  90. Portable carts w/drawerslKeep a 24-hour supply of meds for each patient
    Each tablet or capsule is individually wrapped
    Also contains limited amounts of PRN medication
    Designed to reduce number of medication errors and saves steps in dispensing medications
    unit dose system
  91. Useful for the control of narcotics
    Individual security code for access
    Select pt’s name, desired drug, and route
    System dispenses desired med, records it, and charges it
    computer-controlled dispensing system
  92. Assess the pt’s ability to self-administer meds & determine if a med should be given at a specific time
    Administering meds correctly and monitoring effects
    Educating the patient about proper and correct administration

    these are roles and responsibilities of who?
    the nurse
  93. most common of medical errors
    1.5 million patients harmed each year
    Costs= $3.5 billion (medical cost treating drug related injuries in hospitals each year)
    400,000 PREVENTABLE related injuries in hospitals
    530,000 PREVENTABLE related injuries in OP clinics
    800,000 PREVENTABLE related injuries in long term care facilities
    med errors
  94. possible causes for med errors are?
    • Inaccurate prescribing
    • Administering the wrong medication
    • Administering extra doses
    • Failing to administer a dose
    • Giving the medication at the wrong time
    • Wrong amount (too much/too little)
  95. When an error occurs, client safety and well-being are top priority
    If an error occurs:
    • Assess well-being of patient
    • Notify MD or prescriber of the incident as soon as possible
    • Report to manager or supervisor
    • Complete incident report---usually filled out within 24 hours
  96. Process recommended by TJC that exists for comparing current medications with those ordered for the patient.
    Medication Reconciliation
  97. obtaining a current list of medications from the pt is what step in the process of reconciliation
    verify
  98. making sure the list of current meds is accurate and involving as many people as necessary to do so, is what part of the process of reconciliation
    clarfying
  99. comparing the new med orders with the current list of medications and investigating any discrepancies with the HCP is what step in the process of reconciliation
    reconcile
  100. communicating the updated list to caregivers and clients as needed is what step in the process of reconciliation
    transmitting
  101. what critical thinking skills are extremely important when dispensing meds to a pt
    knowledge

    experience

    attitude

    standards
  102. The Six Rights of Medication Administration
    • RIGHT MEDICATION
    • RIGHT DOSE
    • RIGHT PATIENT
    • RIGHT ROUTE
    • RIGHT TIME
    • RIGHT DOCUMENTATION
  103. Order required before giving any medication
    ALWAYS compare order in chart with MAR
    Meds from Bottles or Containers-Compare the label of the medication container with the medication administration order three (3) times

    these are way to make sure the nurse has?
    the right med
  104. when getting meds from bottles or containers, when are the three times you check the med?
    • Before removing the container from the drawer/shelf
    • As you remove the medication ordered from the container Before returning it to storage
  105. how do you make sure you have the right medication when using unit-dose packaged meds
    • Check medication label and dosage when taking it out of the medication dispensing system
    • Verify ALL medications at the patient’s bedside with the MAR
    • Administer ONLY the medications that YOU prepare
  106. how do you ensure the right dose when crushing tablets
    • Clean crushing device before using
    • Use small amounts of food or liquid when mixing medications
    • Not all medications can be crushed
  107. what are ways to verify that you have the right pt
    • Ask them to state their name
    • ID number on bracelet assigned by health care agency
    • Telephone number
  108. If the specified route is not the recommended route, what do you do?
    notify the prescriber immediately
  109. what do you do when the route is not specified on an order?
    Always consult with prescriber
  110. with injections, use only what?
    • Use only preparations designed for parenteral use
    • Label reads “For injectable use only”
  111. ALL routine ordered meds should be given within 60 minutes of the prescribed time
    30 minutes before or 30 minutes after prescribed time
  112. After administration of medication what do you document?
    • Document on MAR according to policy
    • Document any other needed information on the MAR
    • Record in nursing notes how patient responds to the medication (positive or negative)—if negative, inform MD NEVER document giving a medication prior to giving
    • Document any refusal or withholding of medication.
  113. Obtain/review a medical history before giving medications
    Provides indications/contraindications for drug therapy
    May also discover medications patient may need


    what part of the nursing process is this for administering meds?
    assessment
  114. All allergies and types of reactions should be noted on patient’s ?
    admission notes, H&P, and medication records
  115. Assess ALL medications
    Prescription
    Nonprescription
    Herbal supplements
    Length of time patient has been on medication
    Current dose schedule


    what part of the nursing process is this for administering meds
    medication history
  116. what type of references can you use when getting a medication history
    • PDR (Physician’s Desk Reference)
    • Nursing drug handbook
    • Medication insert
  117. what are things you need to assess about Patient’s Perceptual or Coordination Problems
    • Assess patient’s ability to prepare doses and administer medication
    • May need to assess whether family or friends are willing and able to assist
  118. how can a pts attitude affect medication use
    • Affects compliance of medication
    • May reveal dependence or avoidance
    • Observe behavior for evidence of medication dependence or avoidance
    • Assess patient’s cultural beliefs
  119. how does knowledge and understanding of a medication affect the pt
    • Affects the patient’s ability to comply or adhere
    • If patient understands reason of taking a drug, likelihood of compliance is enhanced.
    • Teach medication purpose, proper administration techniques, and possible side effects
    • If patient cannot afford medications, discuss financial resources.
  120. To assess learning needs of pts, ask patients the ?
    purpose of the meds, expected side effects, correct administration techniques, etc. of their meds
  121. The failure of a patient to take their medication as prescribed is known as
    Noncompliance/Nonadherence
  122. what can cause a pt to be Noncompliance/Nonadherence
    • Poor education
    • Perception that medication is not needed
  123. In older adults…
    • Depression
    • Do not like side effects
    • Too busy
  124. what are some things yo can give to pt and family to provide info about a med?
    • Easy to read pamphlets
    • Handouts
  125. what are some things you need to teach pt and family about giving daily injections
    • Must learn to prepare and administer injection correctly using aseptic technique
    • Good to teach family/caregiver if patient becomes ill or physically unable
  126. what do you need to teach pt and family about side effects and toxicity
    • Family/caregiver also needs to be aware of symptoms of medication side effects or toxicity esp. if they are cognitive or behavioral in nature.
    • Learning the basic guidelines for medication safety can ensure proper use and storage of medications in the home
  127. what are the components of a med order
    • Patient’s full name
    • Date and time the order is written
    • Name of the medication
    • Dosage of the medication
    • Route of administration
    • Time and frequency of administration
    • Signature of the prescriber
  128. Once you receive and process a medication order, what do you do?
    place the order on the MAR - Includes Pt’s name,Room/bed number, Names, dosages, routes and frequencies of me
  129. what are things that need to be known about recording medications
    • Record immediately after administration.
    • Never chart before administering.
    • If a dose is missed, explain the reason in the nurses’ notes, e.g.
    • If refuses, investigate WHY?
    • Follow any other protocol regarding missed dose.
  130. Special Considerations for Administering Medications to Special Age Groups
    • Older Adults
    • Physiological changes-Sensory or functional changes
    • Behavioral changes-Mental or emotional changes
    • Economic factors
  131. The use of two or more medications from the same chemical class or similar action to treat an illness

    Mixing of herbal products or nutritional supplements with medications

    this is known as ?
    polypharmacy
  132. happens when patients need to take several medications to treat their illnesses, e.g. multiple meds to lower B/P.
    rational polypharmacy
  133. happens when patients take more medications than needed, e.g. more than one healthcare provider or self-prescribing
    irrational polypharmacy

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