Nursing Fundamentals Vol 2: Chapter 23
General Medication Guidelines.
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. What would you like to do?
As the RN, you are always responsible for evaluating client _____ to medications. What does this include?
- both therapeutic effects and side effects
What are the preprocedure assessments of clients performed prior to medication administration? (8)
- 1) Assess knowledge of medication
- 2) Determine whether the prescribed dosage is appropriate for the patient's age and weight.
- 3) Check for any history of allergies to medications or food
- 4) at least on the the first administration, assess the patients knowledge about the medications being given
- 5) Assess for any factors that would interfere with drug absorption (diarrhea, foods, other medications, inadequate circulation).
- 6) Before administering the medication, assess vital signs and check lab studies specific to the medication to detmine whether the medication safely administered.
- 7) Assess for any patient findings that might affect absorption and/or metabolism of the medication (impaired liver function, inflammatin, age-related changes).
- 8)Assess for any situations in which adminstering the medication would not be responsible (i.e. patient is NPO and order is for oral medication).
When performing pre-procedure assessments related to medication administration and you are assessing your knowledge of of the medication, what shoud you be expected to know? (9)
- 1) Drug action
- 2) Purpose
- 3) Recommended dosage
- 4) Time of onset
- 5) Peak Action
- 6) Common Side Effects
- 7) Contraindication
- 8) Drug interactions
- 9) Nursing Implications
Why are drug doses typically lower for children?
Because of both age and weight.
Dosing for elderly patients is based on _____. Why?
- Renal function (NOT weight)
- The elderly tend to have less efficient liver and renal function, increasing the length of time a drug stays in the body before being excreted.
True or false: Children have less efficient renal function.
True: Both children and the elderly have less efficient renal and liver function.
True or False: A patient with a pencicillin allergy is at a low risk for also being allergic to cephalosporin.
False: A patient with a penicillin allergy is at a high risk for being allergic to cephalosporin.
The patient will be more likely to take the medication correctly if he/she understands what?
Why the medication must be taken.
Medications are metabolized more _____ in a patient wth decreased liver function.
What situations would it be unreasonable to administer oral medications? (5)
- The patient is NPO for a surgery or test
- The patient is vomitting
- The patient has difficulty swallowing
- The patient is too sedated
What are the six rights of medication administration?
- Many Doctors Cant Read Their Drivel
What general steps should you follow when adminstering medications regardless of type or route? (12( 19)
- 1) Check the MAR for the patient's name and ID number, as well as medication, dose, route, rime, and drug allergies. (1ST CHECK)
- 2) Check to see if the prescription matches the MAR and includes the patient's name, patient's identifier, medication name, dose, route, time, and patients allergies.
- 3) Follow agency policies for administering medication, including time frame for administration.
- 4) Wash your hands
- 5) Access the patient's medication drawer; unlock the medication cart, or log onto the medication dispensing computer.
- 6) If administering narcotic or barbituate, obtain narcotic cabinet key and sign out medication, including patient's name, drug dose, and other info per agency policy (also note the drug count when removing a narcotic).
- 7) Select the ordered medication and compare medication with the MAR for the first five rights (patient dose drug route time); check for drug allergies, An inpatient should be wearing an identification band with the drug allergies identified; allergies should be clearly marked in the chart and on the MAR or in the electronic health record (EHR). Quesion the patient about allergies before giving the newly ordered medication.
- 8) Calculate the medication dosage. Double check it. If you are unable to measure the dose exactly, contact the pharmacist.
- 9) Check the expiratin date (on the label or on the box) of all medications.
- 10) After preparing the medications, do a second check to verigy the correct medication, dose, route, and time (2ND CHECK)
- 11) Lock the medication cart. Never leave an unlocked medication cart unattended.
- 12) Administer the medications.
- a) Take the medication and the MAR or hand-held portable device with the electronic health record (EHR) into the patient's room (for final check)
- b) Identify the patient using two forms of identification according to agency policy.
- c) Do a check of the rights of medication, right dose, right route, right time (3RD CHECK).
- d) perform any assessments needed, such as checking pulse or blood pressure.
- e) explain to the patient that you are there to administer the medication and teach him about the medication.
- f) administer the medication using appropriate technique.
- g) Remain with patient until you are sure she has taken the medication.
- h) Document the medication given in the patient's record.
What do you do if a patient tells you the pill you are ready to give him is a different color than what he normally takes of a certain prescribed medication?
Determine why the tablet is different from what the patient is used to taking. Always verify the identity of the drug, especially when it is called into question by the patient who is familiar with what he normally takes.
What do you do if the label on the medication shows an expiration date that has passed? Why?
- Do not give medication. Send it back to the pharmacy for reconstituition or replacement.
- Expired medication can lose its potency.
The patient refuses to take the prescribed medication. What should you do?
Hold the dose and notify the prescriber. The patient has a right to refuse therapy.
What do you do if you cannot decipher the prescriber's handwritten medication order?
Hold the dose and notify the prescriber for clarification. Bever administer medication if you are not completely sure what is intended.
Your patient's medication is not available from the pharmacy at the time the next dose is due. What should you do?
Do not borrow the medication from another patient's supply. Administer only medication prescribed for that particular patient. Notify the pharmacy of the need to immediately dispense the medication.
All narcotics must be accounted for and _____ for every shift.
Most agencies allow medications to be given __a__ before or _a__ after the time indicated on the MAR.
Why is it necessary to never leave an unlocked medication cart unattended?
Locking the cart guards against pilferage and protects, children, older adults with dementia, or anyone wanting to open the cart.
What are some of the ways in which a patient can be identified?
- Checking the ID bracelet
- Having the patient state his or her name
- Comparing the patient to a picture
- Checking the patients date of birth against the MAR
How many forms of identifcation does the Joint Commission require before medication may be adminstered to a patient?
True or False: Althou an error does not actually occur until the patient has taken a medication, you may be required to file a report for an averted error.
When a nurse administers digoxin, she/he must assess the _____. What assessment findings would result in the nurse witholding the dose?
- apical pulse
- an apical pulse below 60 bpm
What takes place during the evaluation performed after medication administration?
- Evaluate the therapeutic effects of the medication.
- Be alert for any adverse reactions, side effects or allergic reactions. If present, notify the appropriate care provider.
What steps are involved in patient teaching as it pertains to medication administration? (8)
- 1) Describe how the drug is prescribed and when the patient should take the medication.
- 2) Discuss the importance of taking the medication as prescribed.
- 3) Explain the need for any laboratory tests for monitoring the medication, such as tests to measure drug level in the blood, if appropriate.
- 4) Explain the purpose, common side effects, and drug interactions of the medications the patient is taking.
- 5) Teach the patient to observe for side effects that signal the need to contact the prescriber
- 6) Discuss ways to minimize side effects of a medication.
- 7) Discuss potential cultural issues related to taking the medication.
- 8) Teach the patient to self administer medications as apprpriate.
What steps are involved in home care as it pertains to medication administration?
- 1) Assess the client's ability to self administer medications safely
- 2) Determine the client's financial ability to obtain medications
- 3) Instruct the client about safe storage of medications
- 4) Provide instructions for use of each medication
- 5) Determine whether the client or caregiver has had past problems or present concerns about taking the medication prescribed.
- 6) If problems have occured in the past or there are present concerns, discuss possible remedies.
What steps are involved in documenting medication administration?
- 1. Chart the medication, time, dosage, and route given,
- 2. preadministration assessments, and your signature.
- 3. DO NOT:
- a. document before giving the medication
- b. document for anyone else
- c. ask another nurse to document a drug you have given.
- 4. Document only after administering the medication.
- 5. Chart all therapeutic and adverse effects of the medication. Chart your nursing interventions and teaching of potential adverse effects.
- 6. Record the scheduled medications on the MAR.
- 7. If the patient is unable to or refuses to take the medication, document it on the MAR that the medication was not administered and the readon, and inform the physician.
- 8. For parenteral medications, chart the site of injection.
When recording scheduled medications on the MAR, you should record the PRN medications where? What should you include?
- In the nursing notes and in the MAR
- The reason the medication was given and the patient's response to the medication
When administering a liquid medication that contains powder, when should you prepare it? Why?
- Mix with liquid at bedside and then give mixture to the patient to drink immediately.
- Some powders thicken very quickly so they need to be mixed immediately before administration.
What would you like to do?
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