N200 Medication

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N200 Medication
2010-11-06 19:48:09

Medication administration
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  1. Federal government roles in the regulation of medications
    is to protect the health of the people by ensuring that medications are safe and effective. Currently the FDA ensures that all medications undergo vigorous testing before they are sold.
  2. State government roles in the regulation of medications
    conform to federal legislation but also have additional controls such as alcohol and tobacco.
  3. Health care institutions and the roles in the regulation of medications
    individual policies to meet federal and state regulations.
  4. Nurse Practice Act
    define the scope of a nurse’s professional functions and responsibilities.
  5. Chemical name
    provides an exact description of the medication’s composition and molecular structure
  6. Generic name
    manufacturer who first develops the medication, which becomes the official name
  7. Brand/ Trade name
    the manufacturer has trademarked the medication’s name
  8. A medication classification indicates
    indicates the effect of the medication on a body system, the symptoms the medication relieves, or the medication’s desired effect
  9. The form of the medication determines its
    determines its route of administration
  10. Pharmacokinetics
    is the study of how medications enter the body, reach their site of action, metabolize, and exit the body
  11. Absorption is
    refers to the passage of medication molecules into the blood from the site of administration
  12. What factors influence drug absorption
    • a. route of administration
    • b. ability of the medication to dissolve
    • c. blood flow to the site of administration
    • d. body surface area
    • e. lipid solubility
  13. Factors that affect the rate and extent of medication distribution
    • a. circulation
    • b. membrane permeability
    • c. protein binding
  14. The role of metabolism
    occurs under the influence of enzymes that detoxify, degrade, and remove biologically active chemicals, mostly in the liver
  15. What is the primary organ for drug excretion
    the kidneys; when renal function declines, a client is at risk for medication toxicity
  16. Therapeutic effects
    is the expected or predictable physiological response to a medication
  17. Side effects
    are the unintended, secondary effects a medication predictably will cause
  18. Adverse effects
    are severe responses to medication
  19. Toxic effects
    develop after prolonged intake of a medication or when a medication accumulates in the blood because of impaired metabolism or excretion
  20. Idiosyncratic reactions
    unpredictable effects in which a client overreacts or underreacts to a medication or has a reaction different from normal
  21. Allergic reactions
    are predictable responses to a medication
  22. Anaphylactic reactions
    allergic reactions that are life-threatening and characterized by sudden constriction of bronchiolar muscles, edema of the pharynx and larynx, and severe wheezing and shortness of breath
  23. A medication interaction is:
    when one medication modifies the action of another medication
  24. A synergistic effect is:
    The combined effect of the 2 medications is greater than the effect of the medications when given separately
  25. Serum concentration
    constant blood level within a safe therapeutic range
  26. Peak concentration
    highest serum concentration
  27. Serum half-life
    is the time it takes for excretion processes to lower the serum medication concentration by half
  28. Onset of drug action
    time it takes after a medication is administered for it to produce a response
  29. Peak action
    time it takes for a medication to reach its highest effective concentration
  30. Trough
    minimum blood serum concentration of medication reached just before the next scheduled dose
  31. Duration of action
    time during which the medication is present in concentration great enough to produce a response
  32. Pateau
    blood serum concentration of a medication reached and maintained after repeated fixed doses
  33. 3 types of oral routes
    • a. oral
    • b. buccal
    • c. sublingual
  34. 4 major sites for parenteral injections
    • a. intradermal
    • b. subcutaneous
    • c. intramuscular
    • d. intravenous
  35. Epidural
    administered in the epidural space via a catheter, usually used for post-op analgesia
  36. Intrathecal
    a catheter that is in the subarachnoid space or one of the ventricles of the brain
  37. Intraosseous
    infusion of medication directly into the bone marrow, commonly used in infants and toddlers
  38. Intraperitoneal
    into the peritoneal cavity such as chemotherapeutic agents, insulin, and antibiotics
  39. Intrapleural
    directly into the pleural space, commonly chemotherapeutics
  40. Intraarterial
    directly into the arteries
  41. Intraarticular
    injection of a medication into a joint
  42. 5 methods for applying medication to mucous membranes
    • a. directly applying a liquid or ointment
    • b. inserting a medication into a body cavity
    • c. instilling fluid into a body cavity
    • d. irrigating a body cavity e. spraying
  43. Intracardiac
    injection directly into the cardiac tissue
  44. What is the benefit of the inhalation route
    They are readily absorbed and work rapidly because of the rich vascular alveolar capillary network present in the pulmonary tissue
  45. 3 types of measurement used in medication therapy
    • a. metric
    • b. apothecary
    • c. household
  46. A solution is :
    given mass of solid substance dissolved in a known volume of fluid or a given volume of liquid dissolved in a known volume of another fluid
  47. Verbal medication order
    if the order is given verbally to the nurse by the provider
  48. Standing or routine medication order
    is carried out until the prescriber cancels it by another order or until a prescribed number of days elapse
  49. prn
    a medication that is given only when a client requires it
  50. single (one-time)
    a medication that is given only once at a specified time
  51. STAT
    single dose of a medication to be given immediately and only once
  52. Now:
    is used when a client needs a medication quickly but not right away; nurse has up to 90 minutes to administer
  53. What are the medication distribution systems
    • a. unit dose
    • b. automated medication dispensing systems (AMDS)
  54. What are the common medication errors that can cause client harm
    inaccurate prescribing, administration of the wrong medicine, giving the medication using the wrong route or time interval, and administering extra doses or failing to administer a medication
  55. What is the process for medication reconciliation
    • a. verify
    • b. clarify
    • c. reconcile
    • d. transmit
  56. What are the 6 rights of medication administration
    • a. the right medication
    • b. the right dose
    • c. the right client
    • d. the right route
    • e. the right time
    • f. the right documentation
  57. What are the Patient Care Partnership related to medication administration
    • a. be informed of the medication’s name, purpose, action, and potential undesired effects
    • b. refuse a medication regardless of the consequences
    • c. have qualified nurses or physicians assess a medication history
    • d. be properly advised of the experimental nature of medication therapy and give written consent
    • e. receive labeled medications safely without discomfort
    • f. receive appropriate supportive therapy g. not receive unnecessary medications h. be informed if medications are a part of a research study
  58. What areas does the nurse need to assess to determine the need for and potential response to medication therapy
    • a. history
    • b. history of allergies
    • c. medication data
    • d. diet history
    • e. client’s perceptual coordination problems
    • f. client’s current condition
    • g. client’s attitude about medication use
    • h. client’s knowledge and understanding of medication therapy
    • i. client’s learning needs
  59. What are some nursing diagnoses used during the administration of meications
    1. anxiety

    2. health maintenance, ineffective

    3. health-seeking behaviors

    4. deficient knowledge

    5. noncompliance

    6. disturbed visual sensory perception

    7. impaired swallowing

    8. effective therapeutic regimen management

    9. ineffective therapeutic regimen management
  60. Identify factors that can influence the client's compliance with medication regimen
    health beliefs, personal motivations, socioeconomic factors, and habits
  61. What are the outcomes for a client with newly diagnosed type 2 diabetes
    • a. will verbalize understanding of desired effects and adverse effects of medications
    • b. will state signs, symptoms, and treatment of hypoglycemia
    • c. to monitor blood sugar to determine if medication is appropriate to take
    • d. establish a daily routine that will coordinate timing of medication with meal times
  62. What are the components of medication orders
    • a. client’s full name
    • b. date and time that the order is written
    • c. medication name
    • d. dose
    • e. route of administration
    • f. time and frequency of administration
    • g, signature of provider
  63. The recording of medications incluedes
    the name of the medication, dose, route, and the exact time of administration and site
  64. What are the precautions to take when administering any oral preparaion
    1. a. Determine the client’s ability to swallow.

    b. Assess the client’s cough.

    c. Determine the presence of a gag reflex.

    d. Prepare oral medications in the form that is easiest to swallow.

    e. Allow the client to self-administer medications if possible.

    f. If the client has unilateral weakness, place the medication in the stronger side of the mouth.

    g. Administer pills one at a time, ensuring that each medication is properly swallowed before the next one is introduced.

    h. Thicken regular liquids or offer fruit nectars if the client cannot tolerate thin liquids.

    i. Avoid straws because they decrease the control the client has over volume intake, which increases the risk of aspiration.

    j. Have client hold cup and drink from cup if possible.

    k. Time medications to coincide with mealtimes or when the client is well-rested and awake if possible.

    l. Administer medications using another route if risk of aspiration is severe.
  65. What is the most common form of nasal instillation
    decongestant spray or drops
  66. 4 principles for administering eye instillations
    • a. avoid instilling any eye medication directly onto the cornea
    • b. avoid touching the eyelids or other eye structures with eye droppers or ointment tubes
    • c. use medication only for the client’s affected eye
    • d. never allow a client to use another client’s eye medications
  67. Failure to instill ear drops at room temp causes:
    vertigo, dizziness, nausea
  68. Vaginal medications are available as:
    suppositories, foam, jellies, or creams
  69. Rectal suppositories are used for:
    exerting local effects (promoting defecation) or systemic effects (reducing nausea)
  70. Metered-dose inhalers (MDIs):
    delivers a measured dose of medication with each push of a canister often used with a spacer
  71. Dry power inhalers (DPIs)
    hold dry, powdered medication and create an aerosol when the client inhales through a reservoir that contains the medication
  72. What are the aseptic techniques to use to prevent an infection during an injection:
    1. Draw medication from ampule quickly; do not allow to stand open.

    2. Avoid letting needle touch contaminated surface.

    3. Avoid touching length of plunger or inner part of barrel.

    4. Prepare skin, use friction and a circular motion while cleaning with an antiseptic swab, and start from the center and move outward.
  73. What are the factors that must be considered when selecting a needle for an injection:
    • a. the client’s size and weight
    • b. type of tissue into which the medication is to be injected
  74. Ampule
    contain single doses of medications in a liquid
  75. Vial
    is a single dose or multidose container with a rubber seal at the top (closed system)
  76. What are the 3 principles to follow when mixing medications from two vials:
    • a. do not contaminate one medication with another
    • b. ensure that the final dose is accurate
    • c. maintain aseptic technique
  77. Insulin is classified by:
    rate of action (rapid, short, intermediate, and long-acting); each has a different onset, peak, and duration of action
  78. What are the principles when mixing two kinds of insulin in the same syringe
    • a. need to maintain their individual routine when preparing and administering their insulin
    • b. do not mix insulin with any other medication or diluents
    • c. never mix insulin glargine or insulin detemir with other types of insulin
    • d. inject rapid-acting insulin mixed with NPH within 15 minutes before a meal
    • e. do not mix short-acting and lente insulins unless the blood glucose levels are currently under control with this mixture
    • f. do not mix phosphate-buffered insulins with lente insulins
  79. What are the techniques to minimize client discomfort that is associated with injections
    • a. use a sharp beveled needle in the smallest suitable length and gauge
    • b. position the client as comfortably as possible to reduce muscle tension
    • c. select the proper injection site
    • d. divert the client’s attention from the injection
    • e. insert the needle quickly and smoothly
    • f. hold the syringe while the needle remains in tissues
    • g. inject the medication slowly and steadily
  80. What are the best sites for subcutaneous (sub-Q) injections
    the outer posterior aspect of the upper arms, the abdomen (below the costal margins to the iliac crests), and the anterior aspects of the thighs
  81. What is the maximum amount of water-soluble medication given by the Sub-Q route?
    0.5 to 1 ml
  82. What angles should be utilized when administering a Sub-Q injection
    • 25-gauge, 5/8 inch needle inserted at a 45-degree angle
    • or a ½ inch needle inserted at a 90-degree angle
  83. What is the angle of insertion for an intramuscular (IM) injection
    90 degrees
  84. What is the maximum volume of medication for IM injections for a Well-developed adult:
    3 ml into a large muscle
  85. What is the maximum volume of medication for IM injections for Older children, older adults or thin adults:
    2 ml
  86. What is the maximum volume of medication for IM injections for Older infants and small children:
    1 ml
  87. Vastus lateralis
    lacks major nerves and blood vessels; rapid absorption; frequently used in infants, older children, and toddlers (immunizations)
  88. Ventrogluteal
    deep site away from nerves and blood vessels, less chance of contamination, easily identified landmarks, preferred site for medications
  89. Deltoid
    easily accessible but muscle not well developed, use small amounts, not used in infants or children, potential for injury to radial and ulnar nerves, immunizations for children, recommended site for hepatitis B and rabies injections
  90. What is the rationale for the Z-track method in IM injections
    minimizes local skin irritation by sealing the medication in muscle tissue
  91. What is the rationale for intradermal injections
    skin testing, injected into the dermis where medication is absorbed slowly
  92. What are the methods a nurse can use to administer medications intravenously
    • a. as mixtures within large volumes of IV fluids
    • b. injection of a bolus or small volume of medication
    • c. piggyback infusion
  93. What are the advantages of the intravenous route of administration
    • a. fast-acting medications must be delivered quickly
    • b. constant therapeutic blood levels
  94. What are the disadvantages of IV bolus medications
    • a. most dangerous method because there is not time to correct errors
    • b. a bolus may cause direct irritation to the lining of blood vessels
  95. What are the advantages of using volume controlled infusions
    • a. it reduces risk for rapid-infusion by IV push
    • b. allows for administration of medications that are stable for a limited time in solution
    • c. it allows for control of IV fluid intake
  96. Piggyback set
    a small (25-250 ml) IV bag connected to short tubing lines that connects to the upper Y port of a primary infusion line
  97. Tandem setup
    small (25-100 ml) IV bag connected to a short tubing line to the lower Y port of a primary infusion
  98. Volume-control administration set
    small (50-150 ml) containers that attach below the primary infusion bag
  99. miniinfusion pump
    battery-operated and allows medications to be given in very small amounts of fluid (5-60 ml)
  100. 3 advantages of using intermittent venous access devices
    cost-saving, convenience, increased mobility, safety, and comfort for the client
  101. The study of how drugs enter the body, reach their sites of action, are metabolize, and exit from the body is called:
  102. What statement correctly characterizes drug absorption
    • Most drugs must enter the systemic circulation to have a therapeutic effect
    • ** absorption refers to the passage of medication molecules into the blood from the site of administration
  103. the onset of drug action is the time it takes for a drug to :
    Produce a response
  104. Which is not a parental route of administration,
    a. Buccal
    b. Intradermal
    c. Intramuscular
    d. Subcutaneous
    Buccal is wrong, this is an oral route
  105. The nurse is preparing an insulin injection in which both regular and NPH will be mixed. Into which vial should the nurse inject air first?
    a. the vial of regular insulin
    b. the vial of NPH
    c. Either vial, as long as modified insulin is drawn up first
    d. Neither viral; it is not necessary to put air into vials before withdrawing medication
    • B-the vial of NPH
    • **if mixing rapid- or short-acting insulin with intermediate or long-acting insulin, take insulin syringe and aspirate volume of air equivalent to the dose of insulin to be withdrawn from the long-acting insulin first