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222 Cards in this Set
- Front
- Back
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In order to perform safe medication administration, the nurse should assess the patient when?
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before and after administering the medication
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Safe medication administration includes 8 things:
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-assessing the patient
-interpreting the order -calculating medication dosages -the 5 rights -the 3 safety checks -Accounting for medications -evaluation -documentation |
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During the initial assessment the nurse should note the following about the patient:
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-medication history
-allergies -medical history -physical assessment -pregnancy and lactation status |
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What should a nurse know about a patient's medication history?
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what meds the patient is on, what the meds are for, who prescribed the meds, and whether the patient takes any over the counter or herbal medications
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In regards to a patients medication history, allergies should also be discussed. The nurse should find out...
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what the patient is allergic to and what kind of reaction occurs with exposure to that food or med.
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An allergy to ____ can be a contraindication for having CAT scans.
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shellfish
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An allergy to ____ can be a contraindication for getting the flu vaccine.
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eggs
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Prior to medication administration the nurse should check 4 things:
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-Medication record (MAR)
-Diet and Fluid orders -Laboratory values -Physical assessment |
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All medications and when they are coming due can be found on the _____.
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MAR
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It is important to look at the patient's diet and fluid orders so that...
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you will know the type of diet and whether the pt is NPO.
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When looking a a patient's lab values it is important to...
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be sure that the lab values justify giving medications.
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You should always assess ____ before and after giving the patient medications.
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vital signs
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Listen to breath sounds before and after giving a patient ______.
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bronchodilaters
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Always assess a patient's _____ before giving HTN meds.
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blood pressure
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Types of medication orders include:
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-routine/standing
-PRN -one-time/single dose -STAT -telephone/verbal |
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A medication order that is carried out for a specified number of days or until it is cancelled by another order is a _____.
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routine/standing order
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A medication order that is to give medications as needed and when in the nurse's judgement the patient needs it is a _____.
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PRN
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PRN stands for ____.
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pro re nata
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When a _____ medication order is written it is for the medication to be given once. An example is with preoperative medications.
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one-time/single dose
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_____ is an order for a medication to be given immediately.
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STAT
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If a medication order is illegible, the nurse should...
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call the person who wrote the order and ask them to clarify for you.
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When interpreting medication orders the nurse should do what 3 things?
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-clarify illegible orders
-evaluate the route and dose -have knowledge of contraindications and side effects. |
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Components of a medication order include:
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-Client name
-date and time written -medication name -medication dosage -route of administration -frequency of administration -signature |
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The five rights are:
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Right CLIENT
Right MEDICATION Right DOSAGE Right ROUTE Right TIME |
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The three safety (label) checks are done when?
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1-Take meds out of drawer and check against MAR
2-Check meds against MAR again in the patient's room 3-Scan patient bracelet and scan each medication PRIOR to giving it. |
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There is a ____ minute time window on each side of the time that the medication is written to be given.
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30
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Upon oral assessment of a medication the nurse should assess the patient for...
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nausea, ability to swallow, gag reflex, vomiting
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The appropriate position for a client taking oral medications is ______.
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sitting upright
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Medications that are administered orally come in many different preparations:
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tablets
capsules caplets solutions suspensions emulsions |
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Tablets, capsules and caplets may be _____ coated.
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enteric
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______ is a special coating designed to dissolve at a more alkaline pH in the small intestine therefore reducing the chance of stomach upset.
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Enteric coating
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A medication that has an enteric coating should not be given with _____ or _____. They also should not be crushed.
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antacids or milk
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A tablet should not be broken unless it is _____.
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scored
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Liquid medications may come in the form of
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solutions
suspensions emulsions |
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When administering liquid medications it is important to remember:
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-pour the liquids label up
-measure at eye level and the bottom of the meniscus |
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_____ are clear liquids that contain some mixture of alcohol and liquid. They can be called elixirs.
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Solutions
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_____ are liquid medications that have small particles of solids dispersed in liquid.
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Suspensions
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_____ are a mixture of 2 liquids; often one is oil-based and the other is water.
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Emulsions
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____ and ____ should always be shaken before administration.
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Suspensions and Emulsions
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If you have a prescription for an odd amount or less that 5cc, use a _____ to administer the medication.
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syringe
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_____ are solid tablets that exert some kind of anesthetic or antiseptic effect in the tissues of the mouth.
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Troche/lozenge
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____ medications are given under the tongue.
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Sublingual
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_____ medications are placed in the cheek to dissolve.
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Buccal
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Before giving sublingual or buccal medications, the nurse should assess the
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integrity of the mucous membranes of the mouth
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Patients who have taken sublingual or buccal medications should avoid
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chewing or swallowing the medication and avoid smoking or drinking liquids for 30 minutes.
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____ medications are given through a GI tube into the stomach or jejunum.
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Enteral
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Different types of GI tubes are:
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-NG
-NI/NJ -Gastrostomy |
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A _____ goes thru the nose into the stomach.
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NG
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A ______ goes thru the nose into the small intestine.
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NI/NJ
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A _____ goes straight into the stomach and is accessed through a place on the abdomen.
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gastrostomy
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Before administering medications via an enteral route, the nurse should assess for
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proper placement of the tube; make sure it is where it is supposed to be
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The appropriate position for a client receiving enteral medications is _____.
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with the HOB elevated.
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It is best to give patients _____ if via an enteral route.
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liquids
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If giving tablets via an enteral route, the nurse should
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check for liquid preparation or crush tablet and mix with water then give at room temp.
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When giving enteral medications it is important to flush with ______ before and after each medication.
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water
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If a person has an NG tube for suction, clamp and hold suction for _____ after giving medications.
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20-30 minutes
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A _____ medication is applied to the skin.
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topical
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A topical medication that is greasy and non-soluble in water is ________.
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ointment
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A topical medication that is non-greasy and easier to wash off is ______.
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cream
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Topical medications should be applied...
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in the direction of the hair follicle.
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The goal of a topical medication is a ____ effect.
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local
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Important things to remember when applying topical medication is...
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-it will give local effect
-assess skin integrity -wear gloves -cleanse area |
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Medication that is applied with a patch is ______.
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transdermal
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Transdermal medications provide a _____ effect.
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systemic
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When administering transdermal medications, it is important to remember...
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-to rotate sites
-put date, time, and initials on the patch |
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When applying opthalmic medications to the eye it is important to remember...
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-avoid contaminating the tip
-apply in lower conjunctival sac -apply gentle pressure over inner canthus of eye to prevent entering tear duct. |
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When applying opthalmic medications, it is important to first assess...
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the eye for lesions, exudate, redness, swelling, burning, itching, and blurred vision.
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When administering an otic medication it is important to remember...
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-warm the solution to room temp.
-straighten the ear canal -maintain position 3-5 minutes |
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Things to remember when administering nasal medications include:
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-have client blow nose
-use medical asepsis -avoid touching nares with dropper |
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Important things to remember when administering inhalation medications is it causes _____ effects, you should _____ prior to use, create an _____ around device, ____ slowly, _____ about 10 seconds, avoid ____, exhale thru ______, and point towards _____.
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local and systemic
shake airtight seal inhale hold breath overuse pursed lips back of throat |
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A spacer is used with inhalation medications to...
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keep medications contained.
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Inhalation medications are mostly administered by _____.
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respiratory therapy
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_____ medication administration is contraindicated for cardiac patients.
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Rectal
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Important things to remember when administering rectal medications include:
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-put patient in Sims' position
-use lubricant -insert beyond internal sphincter -remain in bed 5 minutes |
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A consideration for administering rectal medications kids is...
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check about 30 minutes later to be sure it hasn't been expelled.
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Important things to remember when administering vaginal medications is...
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-put patient in supine position
-use lubricant -direct downward and backward -remain supine for 5-10 minutes -give a panty liner |
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______ administration is the administration of medications by any route other than the oral or gastrointestinal routes.
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Parenteral
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4 routes of parenteral medication administration are:
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IV
IM SQ Intradermal |
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The syringe has 3 basic parts:
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hub, barrel, and plunger
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The sterile parts of a syringe are:
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hub, inside of barrel, shaft and plunger tip
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The 3 basic parts of a needle are:
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hub
cannula (shaft) bevel |
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The diameter of the shaft of a needle is called the ______.
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gauge
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A 16 gauge needle is _____ than an 24 gauge needle.
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larger
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Needle gauges range from ____.
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16-30
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Needle lengths range from ____.
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1/4-2 inches
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The larger the needle gauge, the _____ the shaft of the needle.
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smaller
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A tuberculin syringe is ___cc.
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1
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The insulin syringe is measured in _____.
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units
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Never put a _____ in a Sharp's container.
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capped syringe
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Choosing injection equipment is dependent upon...
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-route of administration
-viscosity of the solution -quantity to administer -body size of patient -type of medication |
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SQ injection needles are ____ than IM injection needles.
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shorter
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Viscosity is _____.
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thickness
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A glass container of single dose drugs is an _____.
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ampule
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When opening an ampule, use a _____ swab and break _____.
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gauze/alcohol
away from your body |
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When drawing up medication from an ampule you should use a ____ needle.
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filter
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A _____ is a glass/plastic rubber-capped container that may contain a single or multiple dose.
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vial
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____ are self-sealing.
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Vials
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Before drawing medication from a vial you should
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inject air into the space above the solution.
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Always clean the top of a vial with _____.
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alcohol
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What are the steps when mixing medications in one syringe from two vials?
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-Draw air equal to volume withdrawn from both vials
-inject air into 1st then 2nd -withdraw meds from 2nd -change needles -withdraw meds from 1st |
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When drawing meds from a vial and ampule, withdraw from the _____ first.
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vial
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The purposes for intradermal injections include:
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diagnostic, allergy and TB testing
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Intradermal injections are absorbed _____.
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slowly.
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Sites for intradermal injections are:
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-inner aspect of forearm (TB test)
-upper chest -upper back |
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The needle angle for intradermal injections is _____.
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10-15 degrees
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The needle length for intradermal injections is
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1/4-1/2"
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Do you aspirate intradermal injections?
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no
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The maximum amount of medication to be given intradermal is _____.
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0.5cc
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With an intradermal injection the needle should be inserted bevel ____.
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up
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Subcutaneous injections are absorbed more _____ than IM injections and produce a sustained effect.
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slowly
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Sites for subcutaneous injections are:
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-abdomen, back of upper arm
-thigh, scapular area -upper dorsogluteal area |
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The angle used for subcutaneous injections is _____.
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45 degrees
except heparin and insulin are 90 degrees |
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The gauge for subcutaneous needles is _____.
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25-30
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The needle length for subcutaneous injections is
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3/8 to 1 inch
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Always aspirate when giving subcutaneous injections except...
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when administering heparin and insulin.
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The maximum amount of medication per site for subcutaneous injections is ___cc.
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1
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When giving subcutaneous injections you should ____ sites and document on the MAR where you gave it.
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rotate
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Always give Lovanox in the _____.
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abdomen
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Intramuscular injections absorb _____.
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rapidly
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The angle for giving intramuscular injections is ______.
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90 degrees
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When giving intramuscular injections a ____ gauge needle should be used.
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21-23
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The appropriate needle length for intramuscular injections is ____.
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1-1and1/2 inches
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When giving intramuscular injections you should aspirate except when giving _____.
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immunizations
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The maximum amount of medication to be injected intramuscularly is _____.
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4cc
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The maximum amount of medication to be injected in the deltoid is _____.
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1cc
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The maximum amount of intramuscular medication that can be injected with children is _____.
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1-2cc
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The purpose of using the Z track technique is to...
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prevent backflow of medication into the subcutaneous tissue therefore reducing the chance of irritation.
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4 injection sites for intramuscular injections are:
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-ventrogluteal
-dorsogluteal -vastus lateralis -deltoid muscle |
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The recommended site for IM injections for anyone over 7 months is the _____ site.
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ventrogluteal
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The landmarks of the ventrogluteal injection site are:
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greater trochanter and anterior superior iliac spine
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The ____ is a wel developed muscle that is free of major nerves and vessels.
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ventrogluteal
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The _____ is near the sciatic nerve has many major blood vessels and should not be used in children younger than 3 years.
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dorsogluteal site
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The IM site that is not recommended is the _____ site.
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dorsogluteal
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The landmarks of the dorsogluteal IM injection site are:
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greater trochanter and posterior superior iliac spine
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The IM injection site used most often in children is the _____ because it has no large nerves or vessels in proximity.
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vastus lateralis
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Landmarks used to locate the vastus lateralis IM site are:
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-greater trochanter
-femoral condyle (knee) -middle 3rd of anterior lateral aspect |
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The IM site that is not well developed in children is the _____.
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deltoid
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The IM site that is a small muscle and is near the radial nerve and artery is the ______.
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deltoid muscle
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Landmarks of the deltoid IM site are:
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acromion process (2-3 fingerwidths below) and in line with axilla
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Ways to decrease discomfort in administering injections are:
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-small gauge needle
-change needle -relax muscle (on back- knees flexed, or prone- toes pointed inward) -use quick, dart-like motion -inject slowly -never exceed recommended amounts -avoid hard or tender areas -rotate sites -use Z-track |
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When documenting medication administration be sure to do 5 things:
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-document after giving meds
-explain why meds omitted -document patients refusal to take meds -the site of injections -client teaching (provide written instructions) |
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Things you should not do with medications are:
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-leave meds sitting on top of med cart unattended
-leave med cart unlocked when not in use -leave meds in a patient's room -give meds prepared by another nurse |
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Goals of IV therapy are:
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-achieve normal fluid and electrolyte balance
-achieve optimal nutritional status -maintain hemostasis thru blood and blood component administration -administration of medications |
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When administering IV therapy the nurse should know 3 things:
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-IV solution
-rate -what site looks like |
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The IV order must include:
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-type of fluid
-rate of administration -type and amount of any additives (medications, K, etc...) |
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3 types of IV solutions are:
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-Nutrient
-Electrolyte -Blood and Blood Components |
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An IV solution of CHO and water can't maintain _____ for an extended amount of time.
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nutrition
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A person that needs total bowel rest will get ____.
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TPN
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Parenteral nutrition (TPN) consists of (5):
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dextrose, proteins, lipids, vitamins and minerals
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An ____ IV solution consists of cations and anions.
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electrolyte
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IV solutions of blood and blood components may consist of
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-volume expanders (RBC's and albumin)
-platelets and WBC's -Fresh, frozen plasma (FFP), clotting factors |
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Volume expanders for blood and blood components are:
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RBCs and albumin
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3 types of peripheral venous access devices are:
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-over-the-needle catheter (angiocath)
-winged-tipped (butterfly) -intermittent infusion devices (heparin well/lock, prn adaptor) |
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An _____ has a flexible teflon catheter that is left in the vein.
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angiocath
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PIV stands for
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peripheral IV
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IVs are always inserted bevel ____.
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up
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_____ provide IV access even when IV fluids are not going.
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Intermittent infusion devices
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Intermittent infusion devices must be flushed with NS ____.
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Q12h
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Intermittent infusion devices are:
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heparin lock/well
prn adaptor |
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Venipuncture sites include:
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dorsal venous networks in the hand and arm and the scalp and foot of infants.
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Don't use the ____ as a venipuncture site in adults because it can lead to increased risk of developing DVTs.
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feet
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____ is extremely irritating to the tissue and should therefore only be given via Central lines.
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TPN
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Central Venous Catheters are used with patients who get ____.
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TPN
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In a non-tunneled central line the line goes right into the _____ and then the tip goes down and rests in the _____.
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subclavian or jugular vein
superior vena cava |
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With a tunneled central line the catheter...
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enters through the chest cavity and is threaded subcutaneously along the chest into the subclavian vein and the the SVC to the right atrial opening of the heart.
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Purposes for central lines include:
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-long term IV therapy
-TPN -meds that are damaging to vessels |
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Complications of central lines are:
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-infections
-pneumothorax (air in chest cavity) -air embolist |
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After insertion of central line, assess for symptoms of...
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respiratory distress
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Always flush a central line before giving meds with _____ and after the meds with _____.
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normal saline
normal saline and heparin |
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If nothing is running thru a central line, it should be flushed with ____ every _____.
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normal saline and heparin
12 hours |
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A PICC is...
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a peripherally inserted central catheter
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The purpose of a PICC line is
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long term IV access (home therapy)
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An advantage of using a PICC line is
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it decreases the risk of pneumothorax and has less risk of embolist and infection.
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PICC lines are inserted in the
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anticubital area (basilic and cephalic veins) of the arm and then goes the same route as the central line.
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When you assess a PICC line, assess the ____ and ____.
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insertion site and the chest area.
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____ is an implanted subcutaneous injection port that provides long term IV access and has the same uses and complications as other central lines.
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Implanted venous access device
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A ____ is an implanted venous access device.
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port
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Ports are often seen with
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people who are getting chemo.
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The type of needle used with a port is called a _____.
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uber needle
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When there is a problem between the patient and the IV pump it is called a ______.
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distal occlusion
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When there is a problem between the IV pump and IV bag it is called a ______.
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proximal occlusion
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Always check IV bags and medications for _____.
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expiration dates
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When monitoring an IV infusion, note the following:
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-solution
-infusion rate -patency (open line) -drip chamber should be 1/2 full -assess insertion site -PICC line -Avoid BP -Assess for other complications -Document |
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When assessing the IV insertion site, it is important to assess for:
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-pain
-infiltration, phlebitis -bleeding, leaking -integrity of dressing (is it intact) |
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When monitoring a PICC line, assess the ____ and ____.
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extremity and upper chest
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Avoid ____ on the side of an IV because it can cause _____.
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BP
infiltration |
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When monitoring an IV infusion, monitor for complications such as
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-fluid overload
-infiltration -phlebitis |
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When discontinuing an IV Infusion:
|
-Check MD order
-don gloves -use roller clamp to stop flow -lift opposite sides of dressing -pull laterally while stabilizing catheter -withdraw catheter -cover puncture site with dry gauze (no alcohol) -apply pressure when removing catheter |
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When monitoring an IV infusion site document...
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-type of access
-type of fluid and additives -location of site -rate -condition of site |
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When discontinuing an IV infusion site document:
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-amount infused
-time discontinued -condition of site -complications and measures taken |
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Complications of IV therapy include:
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-infiltration
-extravasation -phlebitis -infection -ecchymosis/hematoma -fluid overload -air embolism |
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____ is the leakage of a nonvesicant solution into the SQ tissue.
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Infiltration
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Infiltration may be caused by
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taking blood pressure in that area or a catheter puncturing the vein.
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_____ is the leakage of a vesicant solution.
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Extravasation
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S/Sx of infiltration include:
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pain (burning, tenderness), swelling, coolness, pallor, leaking
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If infiltration occurs you should...
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discontinue infusion, apply cool compresses and restart somewhere else if needed.
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A ____ is a solution that can cause tissue necrosis or death.
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vesicant
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If extravasation occurs, tissue sloughing will occur in _____.
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1-4 weeks
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If extravasation occurs...
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discontinue infusion and follow agency policy.
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_____ is a complication of IV therapy that is seen as pain, redness, swelling, warmth, and vein that is hard and warm.
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Phlebitis
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If phlebitis occurs...
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discontinue IV infusion and apply compresses
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Infection of IV site could be ____ or _____.
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local or systemic
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S/Sx of infection include:
|
-redness
-swelling -warmth -exudate -fever, chills and malaise |
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If IV infection occurs...
|
discontinue IV infusion and administer antibiotics
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____ is infiltration of blood into the tissue.
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Ecchymosis/hematoma
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S/Sx of ecchymosis/hematoma are:
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bruising, swelling, pain and tenderness.
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If ecchymosis/hematoma occurs...
|
discontinue IV, apply light pressure and compresses
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The primary symptom of fluid overload is _____. Other S/Sx include:
|
edema
respiratory distress, dyspnea |
|
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If fluid overload occurs...
|
decrease rate and notify physician and increase HOB, oxygen and diuretics.
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____ is an entry of air into the circulatory system.
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Air embolism
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Symptoms of an air embolism are:
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chest pain and respiratory distress
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If an air embolism occurs...
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stop IV and notify physician
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Prevention of IV therapy complications can be done by...
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-stabilize catheters
-use largest vein & smallest cath. -avoid veins not easily palpated -avoid areas of flexion -use aseptic technique -label IV soln, bag, and tubing -change IV tubing q96h -change IV soln q24h -monitor rate -assess site -intake and output -know vesicant potential beforehand |
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A grain measures ____.
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weight
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A minim measures _____.
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volume
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A dram measures _____ and _____.
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weight and volume
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An ounce measures ____ and ______.
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weight and volume
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The ______ system uses ratios and proportions.
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apothecary
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The household measurement system uses:
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drop (gtt)
teaspoon tablespoon |
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____ is the addition of a diluent to a drug in powdered form in order to restore in to a solution.
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Reconstitution
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Drugs are stored in powdered form to maintain ____ and increase _____.
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stability
storage time |
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When labeling a medication after reconstitution include...
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date, time, initials
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