Term
| What are the four types of drug orders? |
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Definition
| Types of orders – prn, single/one time, stat/now, standing orders |
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Term
| What are the seven parts of a drug order? |
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Definition
| name of pt, date/time order written, name of drug, dose, route, frequency, signature of prescriber |
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Term
| WHat are the types of drug schedules? |
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Definition
Drug schedules –
bid
tid
qid
every other day
every day
ac
pc
hs |
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Term
| When do you check the medication you are administering? |
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Definition
Three checks:
1. COmpare to the MAR as you remove the medicine from the dispenser
2. Compare to the MAR as you prepare the medicine for administration
3. Compare the MAR to the medication bedside as you administer the drug |
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Term
| What are the nurse's responsibilities in drug administration? |
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Definition
Assessing the patient and understanding need for medication
Ensuring the rights of medication administration
Preparing the medication to be administered using accurate dosage calculations
Administering medication safely and documenting it is given
Monitoring patient response
Educating patient regarding his medication regimen |
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Term
| How is the route of medicine decided? |
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Definition
1. Properties of medicine
2. Desired effects
3. Patient's physical and mental capabilities |
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Term
| Describe the oral route of medicine administration. What are the advantages and disadvantages? |
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Definition
Most commonly used
“po” route, given by mouth and swallowed, either alone or with liquid
Liquid, tablet, capsule, etc.
Advantages
Most convenient, easiest, safest
Slower onset of action, more prolonged effect
Preferred route by patients, less stress
Most economical
Disadvantages
Absorption is dependent on the pH, motility, and presence of food in the GI system
Drugs can irritate stomach mucosa
Unpleasant taste
Contraindicated for patients with swallowing difficulties (aspiration), nausea, vomiting, unconscious
Restrictions before diagnostic tests, surgery (NPO), and when gastric suctioning in place |
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Term
| When should you remove the medicine from its packaging? |
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Definition
| At the bedside with the patient and the MAR. |
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Term
| What are some steps to ensure safety while administering medicine? |
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Definition
Always have the patient’s MAR at administration
Give partial doses accurately (scored)
Never touch medications with ungloved hands
Check expiration dates on all medications
Assess aspiration risk |
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Term
| What is the sublingual route? How is is adminstered? |
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Definition
Placing a medication under the tongue where it dissolves with the patient’s saliva and is absorbed
Tablet (ex: Nitroglycerin)
Absorption rate is more rapid than oral route – abundant vasculature
Higher concentration to blood (bypass digestive system)
Do not swallow but hold in place
Avoid drinking or eating until drug dissolved |
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Term
| WHat is the buccal route? |
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Definition
Placing a medication in the mouth next to the mucous membranes of the cheek and gum
Tablet |
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Term
| How should you administer oral medications? |
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Definition
Assess for risk of aspiration, other contraindications?
Assess medical history, allergies, physical findings, lab data
Determine accuracy/completeness of the MAR
Obtain medication from cart or dispensing system
Calculate proper dosage – pill crushing, cutting
Offer water or other fluids with oral drugs
Ask whether the patient prefers to take the medications by hand or in a cup, one at a time or all at once
Discard any medication that is contaminated
Never leave medications at bedside |
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Term
| How should you measure liquid medications? |
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Definition
| Eye level at the base of the meniscus |
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Term
| What should the patient know about medicine administration? |
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Definition
Keep in original container, legible label
Discard outdated medications
Always finish a prescribed medication
Never save a medication for future use
Dispose of medications in sink/toilet, not trash
Never give someone a drug prescribed for another person
Read labels carefully and follow instructions |
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Term
| What is the parental route? |
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Definition
“outside the intestines”
Injecting a drug into the body
Intradermal (ID)
Subcutaneous (SC, SQ)
Intramuscular (IM)
Intravenous (IV)
Must be performed using asepsis
Requires the use of syringes and needles |
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Term
| What are the four part of the needle? |
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Definition
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Term
| What are the sizes of needles and how are they measured? |
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Definition
Available in various gauges and lengths
Gauge = diameter of the needle
18-30g
↑gauge → ↓diameter of the needle
Needle length – ¼” to 2”
Choice of gauge and length depends on
Route of administration, viscosity, quantity delivered, body size, type of medication |
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Term
| What are the three parts of a syringe? |
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Definition
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Term
| What are some ways to avoid needle stick injuries? |
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Definition
Needle stick injuries are a major risk for nurses
Risk of HIV, Hepatitis B and C, others
Precautions
Never recap a used needle
One-handed scoop method
Dispose of used, uncapped needles and sharps in puncture-proof containers
Never bend or break needles before disposal |
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Term
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Definition
Glass container usually designed to hold a single dose of a drug
Clear glass, prescored/constricted neck
Range from 1cc to 10cc or more
Ampule must be carefully broken at the neck
Filter needle required
Do not touch rim of ampule when using needle to remove medication |
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Term
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Definition
Small glass bottle with a sealed rubber cap
Single dose to multiple dose
Metal or plastic cap protects
the rubber seal
Rubber cap must be wiped with
alcohol before use
Cap is pierced with a needle
Air must be injected to displace the drug removed due to closed system
Expires in 24 hours if opened |
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Term
| How would you reconstitute a medication? |
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Definition
A liquid (solvent or diluent) must be added to a powdered drug before it can be injected
Actovials
Must be reconstituted according to manufacturer instructions
Common solvents: sterile water, sterile saline
Single-dose and multi-dose vials
Attention to dosage calculations! |
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Term
| What are the recommended angles of different injection types? |
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Definition
Intradermal: 15 degrees
Subcutaneous: 45 or 90
Intramuscular: 72 to 90 degrees |
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Term
| Describe an intradermal injection: |
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Definition
Delivers small amount of medication or antigen into tissues just below the epidermis – longest absorption time
Commonly given for allergy testing, TB testing, and vaccinations
Wheal produced – small volume only (0.1cc)
Absorption is slow
Evaluate local effect |
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Term
| How is an intradermal injection administered? |
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Definition
Sites: inner surface of the forearm, upper back under shoulder blades
Tuberculin syringe (1cc)
26-27G, 1/4”-1/2” needle
Stretch skin taut
15 degree angle, bevel up
Insert 1/8” into dermis
Do not massage area |
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Term
| Describe a subcutaneous injections |
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Definition
Sites: inner surface of the forearm, upper back under shoulder blades
Tuberculin syringe (1cc)
26-27G, 1/4”-1/2” needle
Stretch skin taut
15 degree angle, bevel up
Insert 1/8” into dermis
Do not massage area |
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Term
| What are the advantages to a subcutaneous injection? |
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Definition
Advantages
Slower, more sustained drug absorption than IM
Minimal tissue injury
Little risk of injuring large blood vessels and nerves
Easy to self administer |
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Term
| What is the technique for a subcutaneous injection? |
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Definition
Sites: upper arms, thighs, abdomen, upper back, ventrogluteal/dorsogluteal areas
Rotate sites for diabetics (1 month)
Amount of injectate: 0.5-1cc
Syringe: 1-3cc, insulin syringe
Needle: 25G, 3/8-1” (3/8 to 5/8” is most common)
Angle: 45 degree angle (1 inch of tissue), 90 degree angle (2 inches of tissue)
Do not aspirate |
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Term
| What is the technique for insulin administration? |
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Definition
Use smallest gauge necessary
26-29G
Specific sites have different absorption rates
Abdomen has the fastest absorption rate
Assess for complications at sites
Mixing of 2 different insulins (lab) |
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Term
| Describe intramuscular injections: |
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Definition
Faster medication absorption than SQ due to muscle’s greater vascularity
Deposited deep into the muscle tissue – slow, sustained release over hours, days, weeks
Few sensory nerves – less painful when giving irritating drugs
Anatomic landmarks and site boundaries must be identified
Patient’s weight and amount of medication influence needle size
Angle of insertion: 90 degrees
Maximum amount of injectate: depends on muscle used
1cc (small children, older infants)
2cc (thin adults, children, elderly)
3cc (well-developed adult) |
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Term
| What type of needle and syringe is best for intramuscular injections |
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Definition
Syringe - size
Depends on the amount of medication being given
Usually 3-5cc syringe
Needle – length, gauge
Depends on patient’s age and weight, muscle injected, amount of adipose tissue covering the muscle, type of solution (viscosity)
Usually 1½ inches and #21 or #22 gauge BUT . .
Criteria
Signs of infection or injury
Presence of bruising or abrasions
Location of nerves, blood vessels, and bones
Volume of drug to be injected
Sites of previous injections
Muscle mass available
Use nursing judgment to assess client needs |
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Term
| What are some possible complications of IMs? |
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Definition
Abscesses
Cellulitis
Injury to blood vessels, bones, and nerves
Lingering pain
Tissue necrosis
Periostitis |
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Term
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Definition
The nurse should aspirate before IM injections EXCEPT for vaccinations.
Why?
To determine that the tip of the needle is not in a blood vessel
Clear aspiration → inject
Bloody aspiration → remove needle immediately, discard syringe |
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Term
| What are the three IM sites? |
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Definition
Gluteus medius and minimus
Safe site for all clients
Away from major nerves, blood vessels
Greatest thickness of muscle
Sealed off by bone
Less fat to penetrate than buttock area
Preferred injection site for adults
Ventrogluteal: Position supine, prone, or side-lying
Inject in V shaped area between iliac crest and anterior superior iliac spine, palm on greater trochanter
Needle length=1½”
Dorsogluteal:
Gluteal muscle of the buttocks
Injected above a line from the posterior superior iliac spine to the greater trochanter of the femur
Risks
Striking the sciatic nerve, bone
Injecting into blood vessels
Not recommended by the literature, do not use
Vastus Lateralis:
Muscle is thick and well-developed
Located on the anterior lateral aspect of thigh
Injectable area limited – trochanter to knee
Needle length
5/8-1”
Deltoid:
Supine position with knee slightly flexed, sitting
Often used in infants as well as children
May have to bunch the muscle
Lateral aspect of the upper arm
Not often used
Small muscle development in most adults
Close to radial nerve and brachial artery
Indicated only for small injection volumes, when giving immunizations, or if other sites are no accessible
No more than 1cc
Needle length = 5/8-11/4” children, 1-11/2” adults
Rapid absorption, easy access
Recommended site for toddlers, children, adults
Remove restrictive clothing
Relax arm at side and flex elbow
Palpate acromion process
Inject into imaginary triangle area on muscle
1-2 inches or 2-3 finger-widths below process |
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Term
| What is the Z track method? |
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Definition
Z-track method
Minimize irritation by sealing medication in muscle tissue, staggering the needle pathway
Z-track technique
Use non-dominant hand to pull the skin laterally and downward approximately 1-1½ inches
Inject the medication deep into the muscle, wait 10 seconds
Release the skin after withdrawing the needle
Medication cannot escape from the injection site
Never massage the site |
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Term
| Describe topical administration: |
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Definition
Directly applied to skin
Creams, pastes, ointments, shampoos, lotions, sprays, powders, medicated dressings, baths
Local effect with few side effects
Absorption dependent on area’s vascularity
Avoid applying to breaks in skin
Systemic effects possible
Don’t apply a topical dose without first removing the residue from previous applications
Wear gloves, use tongue blade
Apply less to mucous membranes than skin
Never apply to eyelids or ear canal (occlusion)
Not too much |
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Term
| Describe transdermal application: |
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Definition
Ointment, adhesive patch (layered)
Medication reservoir is secured on the skin
Avoids GI absorption
Few side effects
Prolonged systemic effects (constant, controlled)
Hours to days in place
Examples: nitroglycerin, estrogen, nicotine, fentanyl
Nursing considerations
Wear gloves
Apply at regular intervals to maintain effects
Asses for skin allergies, broken/irritated skin
Avoid scarred, calloused skin; hairy areas
Remove residue, cleanse skin thoroughly
Change sites
Label patches when applied
Warn of side effects of medications |
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Term
| Describe rectal application: |
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Definition
Most unpredictable route of administration – poor absorption
Must be placed past the internal anal sphincter and against rectal mucosa
Used primarily for local action
Laxatives
Fecal softeners
Enemas
Ointments
Indications: unconscious, vomiting, unable to swallow, enema
Bypasses the GI system
Local and systemic effects
Side-lying or Sims’ position
Lubricate rounded end of suppository, finger
Insert tapered end first into anus, past internal sphincter (toward umbilicus)
Adult: insert 3-4 inches
Children: insert 2 inches
Remain in side-lying position at least 5 minutes
Determine if medication was retained |
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Term
| Describe Vaginal Application: |
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Definition
Creams, foams, tablets, and suppositories melted by body heat can be applied intravaginally
Indication – infection
Uses a narrow tubular applicator with an attached plunger or use lubricant on suppository
Administration should be timed to allow patient to sit down afterward to retain medicine
Evaluate effectiveness of interventions |
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Term
| Describe Ophthalmic Application: |
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Definition
Drop, ointment, disk, lens
Local effect but may have systemic effects
Anesthetize the eye, dilate the pupil, diagnostic exams, lubricate the eye, treat disorders
Systemic effect
Contamination precautions – ½ inch above conjunctival sac
Assess ability to self-administer
Verify the correct eye administration |
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Term
| Describe Otic Application: |
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Definition
Indications: infection, inflammation of inner ear, pain, cerumen removal, local anesthesia, removal of foreign bodies
Drops, irrigations
Usually not used when ruptured eardrum (sterile aseptic technique)
Assess hearing, drainage, pain, patency (TM)
Side-lying positioning
Adults: pull auricle upward, outward
Children: pull auricle downward, backward
Apply gentle massage unless contraindicated
Evaluate effectiveness |
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Term
| Describe Nasal Application |
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Definition
Drops, sprays, aerosols, packing
Indications: congestion, colds, allergies, anesthesia, infections, polyps, nosebleeds
Local and systemic effects
Abuse precautions
Position of the client depends on target site
Nose: tilt head back, apply to nasal mucosa
Sinus: ethmoid, sphenoid or frontal, maxillary
Avoid contamination of dropper
Remain in position at least 5 minutes |
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Term
| Describe Metered dose Inhalers |
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Definition
Aerosol spray, mist, powder
Local and systemic effects
Indications: respiratory disease (such as bronchitis, emphysema, asthma)
Precautions
Equipment options
Client education necessary
Shake inhaler well (3-5 seconds)
Take deep breath and exhale
Determine proper position of canister for medication administration (in mouth, in front of mouth, spacer)
Hold inhaler properly
Inhale slowly and deeply through mouth + depress canister fully (only one time)
Hold breath for 5-10 seconds, longer if possible
Remove inhaler from or away from mouth
Exhale slowly through pursed lips
Wait 5 minutes before use of another inhaler
Rinse mouth with water, clean inhaler mouthpiece after each use
Evaluate effectiveness of intervention |
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Term
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Definition
Benefits
Rapid onset
Control
Infuse large amount of fluids |
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Term
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Definition
| Administration of nutrition through a nasogastric tube or gastric tube |
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Term
| What is a PICC? What are the risks? |
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Definition
PICC
Peripherally inserted central catheter
Non-tunneled external catheter
Small (20-24” long) flexible catheter inserted in a peripheral vein then threaded so that the tip is positioned in the heart
Indications
To draw blood
To administer fluids such as blood, chemotherapy, drugs, nutrition
Catheter movement from the site, damage to the tube, or malfunction
Infection
Pain or spasms in the shoulder, neck, arm, or where the line enters the body
Numbness and/or tingling in arm or hand |
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Term
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Definition
Inserted directly into the subclavian or the internal jugular veins for short-term use
Can be tunneled through the subcutaneous skin to the subclavian vein for long-term placement
The type of CVAD catheter used depends on
The length of therapy
The patient’s condition
The type of solution or medication needed |
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