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The route of absorption is chosen according to ____________
Speed of absorption, site of action, desired effect (local vs. systemic), patient's physical and mental well-being
Types of Non-Parenteral Medications
Oral, Enteral, Nasal, Eye, Ear, Buccal, Sublingual, Bronchioles (inhalation), Vaginal, Rectal, Topical and Trasndermal
AVOID the oral route of medication (PO) if the patient:
is nauseated, vomiting, has decreased GI motility, is on restricted oral intake, or cannot swallow
- at the patient's bedside...
- This allows the nurse to review them with the patient and if they refuse one or do not need one you will know which one not to give
Only medications that are _____ should be broken. And the unused medication should be discarded
DO NOT crush __________
enteric-coated or sustained release medications
(if crushing pills, clean mortar between uses. and add medication to a small amount of food that the patient will FINISH)
When pouring liquid medication make sure the label is ______
in the palm of your hand (so the label doesn't get ruined)
When measuring liquid medication place the medication cup ________
On flat surface and bend down to read at eye level
Most common types of enteral feeding:
GI tube, NG tube, PEG tube, J-tube
When administering enteral feeding place the patient:
in high fowlers with HOB elevated for at least 1 HOUR after medication administration
The first thing that needs to be done when administering enteral feeding:
verify the placement of the tube
If a patient has too much gastric residual (greater than 2 hours worth of feeding)....
medication should be held (sign of delayed gastric emptying)
After administering enteral medication (if the tube is connected to suction)...
disconnect the tube and leave it clamped for 20-30 minutes after administering the medicaition
If a patient on enteral feeding is on continuous tube feeding....
clamp for 30 minutes, give medication, flush, resume feeding 30 minutes to 1 hour after.
When giving medication through a tube, administer each medication _____
separately (some medications may interact with each other or become less effective if mixed with other drugs)
How are sublingual drugs absorbed?
through the abundant number of superficial blood vessels of the undersurface of the tongue (there is relatively rapid absorption for quick systemic effects)
Do not allow patient to ______ when administering sublingual medications
swallow or chew
Most common sublingual medication and how often can it be given?
Nitroglycerin (can give up to 3 over 15 min period)
How are buccal medications administered?
between patient's cheek and gums toward the back of the mouth....
DO NOT ALLOW PATIENT TO SWALLOW OR CHEW
For bot buccal and sublingual, do NOT allow patient:
- -to swallow or chew
- -to drink water AFTER
When administering spray medication, tell the patient:
- -not to swallow right away
- -do NOT spit or rinse mouth for 5-10 min after
Opthalmic medications are considered:
How do you administer opthalmic medication?
- -gently wipe away drainage/discharge going from the inner canthus towards the outer canthus
- -hold clean tissue in non-dominant hand just below the eyelid
- -pull downward to expose the conjunctival sac
- -ask patient to look up at ceiling and/or hyperextend head
- -administer drops about 1/2 to 3/4 inches above the conjunctival sac...do not put on cornea
- -apply gentle pressure on the duct to prevent medication from flowing into the tear duct
- (if ointment, apply on inside of lower lid and have patient blink or roll eyeball around)
Ear drops should be administered at:
body temperature (prevents dizziness and nausea)
How do you administer otic medications
- -position pt on side
- -remove any cerum or drainage blocking outermost portion of the ear canal
- -straighten ear canal (pull UP and BACK for adult, DOWN and BACK for a younger child)
- -have patient remain in a side-lying position for 5-10 minutes
- -insert cotton ball in outermost portion of ear
- -wait 5 minutes before administering in second ear
When administering nasal medications, have patient breath _____ while remaining supine for _____
through mouth; 5 minutes without blowing nose
Shake inhaler for:
How would you teach your pt to use an inhaler?
- -take a deep breath and exhale completely
- -inhale slowly and deeply while depressing the medication canister
- -breath in for 2-3 seconds
- -hold breath if possible for about 5-10 seconds
- ***repeat after 1 minute or 2-5 minutes if a second medication is being given
For ALL inhalers (especially steroidal ones), be sure to have the patient:
rinse their mouth and gargle after treatment to decrease the risk of getting thrush
Do not give rectal/vaginal medications if the patient has:
had rectal surgery or has active bleeding
Administration of rectal medications:
- -have pt take slow, deep breaths through their mouth to relax the anal sphincter
- -go past internal sphincter (4in. in adult, 2 in. in child
- -have patient remain supine/left side for 5 minutes
Administration of vaginal med:
- -have pt void before inserting
- -have pt remain supine for 10 minutes
- -offer pt peri pad
Types of topical medications:
lotions, pastes, ointments, creams, and patches
Administration of topical medications:
- -wear gloves
- -skin should be cleaned with soap and water prior to applying
- -do NOT put over skin that is non-intact and for some medications preferably areas free of hair
- -assess previous sites and rotate application sites when possible
Measure nitroglycerine cream:
in inches...DO NOT MASSAGE OR RUB IN
Always put ________ on patch or ointment paper
Date, Time, and Initials
Types of transdermal medications:
Hormones, Narcotic analgesics, cardiac medications, and nicotine
Administration of transdermal patch:
- -always wear gloves
- -remove old patch before new one
- -fold patch in half with adhesive side together when disposing of them
- -try to apply patch at the same time each day
- -after applying, press firmly for 10 seconds
5 Rights of Medication Adminstraion
- ***CHECK AT LEAST 3 TIMES****
- Patient- minimum of 2 identifiers
- (Some places include right documentation)
As a nurse, it's important to think...
DEFENSIVELY.... "what if" "why" "what will happen if I don't do something"
All medications need to have a complete _____ which consists of _____:
doctor's order; name of the drug, dose, route, frequency, special instructions, and doctor's signature
Chart any medication ordered but NOT given by:
circling it and recording on the MAR (and/or nurses notes) why the patient's medication was not given
When the physiological response of a medication decreases after repeated administration....It takes higher doses to produce desired effects.
When a patient needs a drug to function
physical drug dependence
When a patient takes a drug for another reason other than its therapeutic effects
psychological drug dependence