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Who is legally responsible for the safe and therapeutic effects of drugs?
What do you need to know in preparation for medication administration?
- 1. be able to locate the information about each drug
- 2. consistently caclculate drug dosages accurately
- 3. use the 5 rights
- 4. recognize the nursing implications for each drug given
According to the FDA, which 5 standards must be met before a drug can be marketed?
who prescribes drugs?
- physicians' assistants
- nurse practitioners
- advanced practice nurses
Drugs usually have 3 names
- chemical name
- generic name
- trade name
- *nurses usually know the generic and trade
- substances used as medicine
- drugs = medicine
What are the uses for drugs?
The responsibility for the security of controlled drugs in a hospital is shared by?
nurse and pharmacist
Which information is included in the nurses notes after medication is given?
- patients name
- patients room #
Before you administer a drug you must know the 5 rights, which are...
- 1. right drug
- 2. right dose
- 3. rigth route
- 4. right time
- 5. right patient
what are the 5 rules?
- 1. teach the patient about the drug
- 2. take a complet drug history
- 3. assess the patient for drug allergies
- 4. be aware of potential drug interactions from other drugs or foods
- 5. document each drug you administer after giving it
What is pharmacokinetics?
study of how drugs enter the body and reach their site of action and how they are metabolized and excreted
The rate of drug absorption is affected by which factors?
- disease condition
- immune mechanisms
- emotional state
What kind of drug penetrates the blood-brain barrier?
What kind of drug crosses the placental barrier and affects the fetus?
medication errors account for a great number of occurence reports, during which steps does these errors occur?
- order interpretation
- patient identification
- administration route
- documentation errors
- drug is broken down to active ingredient
- occurs in liver (most common site), lungs, blood, intestines and kidneys
What must the nurse be knowledgeable about regarding the patients medicine?
- appropriate dosage
- generic and trade names for drugs
- desired effect
- possible adverse reactions
- expected side effects
- drug-drug interactions
- drug-food interactions
- preparation of the drug for administration
What information is required for a complet drug order?
- patients full name
- drug name and how often it should be given
- dosage and route of administration
- date, time and signature of the prescribing physician
- kidneys (main route)
- exocrine glands
study of a drug's effect on cellular physiology and biochemistry and its mechanism of action
when the highest blood or plasma concentration of the drug is achieved
duration of action
length of time the drug exerts a pharmacological effect
- time it takes for excretion to lower the drug concentration by half
- in order to maintain a therapeutic level, doses are given when the previous dose should reach its half life
Ethnopharmacologic research shows that...
different ethnic groups metabolize drugs differently
What is the difference between agonists and antagonists?
- agonists produce a response
- antagonists block a response
When identifying a patient 2 of the 4 common patient identifiers are used, what are they?
- patient states name
- patient's arm band
- patient's birthdate
- patient states birthdate
What are the 4 types of drug action?
- stimulation or depression
- inhibition or killing
*the less specific the drug action, the more side effects the drug may have
severe allergic reaction
What are the principles of medication administration?
- medications are given by the person who prepped them
- don't leave medication at the bedside
- lock up narcotics
- check orders before giving drugs
- avoid distractions when prepping drugs
- know the drug being given, its action, the dosage and precautions
- follow 5 rights and 5 rules
- observe aseptic technique
- review pt medical history
- look for drug interactions
- check for pt allergies
- teach the pt about his drugs
How is a childs dosage calculated?
- based on age, size and weight
- parents will advise on least traumatic route of administration
Recommendation for older patients on long term anti-inflammatory medication...
monitor for GI bleeding and anemia
Fastest and slowest rates of absorption when admnistering medicine
- intravenous - fastest
- oral - slowest
What are the 4 common types medication orders
- standing order: given til cancelled or dosage limit reached
- PRN: given as needed
- one time: order for a drug to be given just once; usually for a diagnostic test
- stat: order for a single dose to be given immediately
If a medication error is found, who reports it?
- the nurse who found it
- all med errors must be reported
drugs packaged in single individual doses
unit dose system
- pharmacy delivers 24 hr supply of drugs for each patient
- reduces med errors and is time efficient
- keeps minium amount of drugs required
- packages must not be opened until after the 3rd medicine check
computer controlled dispensing system
useful for accounting for scheduled drugs
when alternative methods of alleviating a pt health problem can be found, should they be used?
yes, some people don't want to depend on a chemical
what is medication reconciliation
identifying all of the pt meds and informing the pt and staff
What is the medication administration record (MAR)
sheet listing medications prescribed and times to be given
proper method of adminstering pills
- pour pills into the bottle cover and transfer to medicine cup
- never touch the pills
how often should MAR entries be checked with the original order?
every 24 hours
What should be documented after a drug is given?
- site (if pertinent)
- info about side effects from previous doses
- any patient teaching
To prevent medication errors it is best to check the medication how many times?
- third check is doneat bedside
Why are the elderly at great risk for drug toxicity
- decreased albumin allows more ubound drug circulation
- drug becomes more potent
computerized physician order entry (CPOE)
- prescriber enters med order in the computer; reduces transcription error
- can include pt info such as allergies, vital signs and lab results
Name the 3 types of medication administration systems
- unit dose; most common
- individual prescription system
- stock supply of medicine; least common
- several days worth of meds are supplied
- used in outpatient clinics and community pharmacies
When topical treatments are applied the nurse must assess the patient for the following effets..
What is a spansule
- time released pellets placed in a capsule)
- do not crush
if a pt is given water along with his medication, should it be entered in teh I&O sheet?
placed under tongue
placed in the pocket between the teeth and cheek
ophthalmic (eye) medication
- drops, ointment or eye disk
- must be kept sterile
- if eye dropper tip is contaminated, replace the med wtih a new bottle
otic (ear) medication
- kids younger than 3: pull ear lobe down
- over 3 y/o: pull the top of the pinna out and up
- place patient supine and in the later position to give medicine
- pt must remain later for 5 - 10 minutes to allow for absorption
positioning for nose drops
pt lies down face up and the neck hyperextened
how does food in the GI tract affect drug compatiblity
- may speed up, reduce, prevent absorption
- delays emptying of stomach
- stomach acid may break down medications
- suppositories, ointments, creams and irrigation
- cleanses vagina in prep for surgery
- supply antiseptics
- remove odors or foul discharge
- apply heat or cold to soothe inflamed tissues
- irrigations are clean procedures unless pt gave birth or is postop
- vaginal irrigation = douche
pt position for insertion of rectal suppository
place the pt in the left sims' position
administering meds through a feeding tube
- most oral medications that aren't time release or enteric can be administered
- do not combine meds
- mix med with 30 mL of warm water
- place pt in high fowler's
- flush with 15 - 30 mL of water
- document liquids in I&O chart