patient vomits after oral pill –> assess vomit for pill or fragments –> notify doctor to see if another dose is necessary
meds clogged and won’t move through tube –> tell doctor –> may request to replace the tube
draw up needed amount of liquid into the syringe –> stick needle into top of powdered med vial –> inject liquid portion into the powder –> remove needle & recap –> agitate vial to completely mix
giving the dose:
draw up prescribed amount of meds while holding syringe vertically @ eye level
single/one time=only once at time specified by prescriber
stat=single order carried out immediately
standing order/routine order=carried out until cancelled by another order
ask patient to state name
compare dose needed to the amount of meds you have
and dispose correctly of what is not needed (don’t need to notify anyone or get re-prescribed)
air into NPH insulin vial –> air into regular insulin –> take out correct amount of insulin –> go back to NPH insulin and withdrawn 40 units
placing air in the NPH insulin and don’t touching the needle to the insulin makes sure that the needle is contaminated and therefore there is no chance to contaminate the regular (short acting) insulin
The nurse is responsible for any medications he or she gives and must contact the doctor to inform her of the patient’s allergy to the drug. The nurse should not give the medication and might speak with the supervisor only if uncomfortable with the physician’s answer once she is notified. The nurse is legally unable to order a replacement medication, as is the pharmacist.
max intramuscular injection=3mL
max intradermal injections=0.01-0.05mL
individual supply=container with enough meds for multiple doses; long term car; nursing homes
stock supply=emergency use that stays on nursing unit
automate medication systems=have frequently used meds for that unit, PRN meds, controlled meds, emergency meds
fowlers position helps with gastric reflux
sublingual application is when something is put under the tongue that is then supposed to be dissolved into the body and SHOULD NOT be swallowed
sublingual application –> don’t chew, swallow, eat, smoke
doesn’t matter if you take the meds on empty stomach, are talking, or performing physical activities
2-After retrieval from the drawer and compared with the CMAR
3-When replacing the container to the drawer or shelf (or before giving the unit dose medication to the patient)
use abdomen area –> bc less painful
forearm, back, upper chest
stop IV flow, stop med administration –> clamp the IV at site nearest to the patient –> change administration tubing –> restart infusion
BEFORE ALL ADMINISTRATIONS
check compatibility of meds with IV fluid
standing order=carried out as specified until cancelled by a new order
10-15 angle of entry
90 angle (most typical)
15 angle only if no venous access port is in place
intramusclar injection locations:
vastus lateralis muscle
DONT USE DORSOGLUTEAL MUSCLE
based on body surface and weight
intramuscular injection irritate upper levels of tissue –> z track method causes less pain to this tissue
z track isn’t used for any other type of injection
good bc the area is free of major blood vessels and fat
don’t use dosogluteal bc near sciatic nerves and you could also inject into subcutaneous fat
could use deltoid region for intramuscular since there is only a little bit of fat but it lies close to radial nerve (don’t want to hit this nerve)
nurse must stay with medications once they have been prepared OR lock them in med cart
DO NOT leave meds unattended or placed back in their containers
once you prepare meds, you have to be the one to administer
eutectic mixture –> pain relief for only 2 hrs
ice pack to numb skin –> before injection NOT after
massaging –> DONT DO bc could lead to discomfort and complications
The nurse should not massage the site following an injection because in some clients it could lead to further complications and discomfort
The larger the gauge, the smaller the needle.
#1 –> gauge/diameter of needle
#2 –> length in inches
viscosity –> directs the choice of gauge when giving an injection
size of syringe –> based on amount of meds you’re administering
don’t need to inform physician or head nurse about patient’s absence
the smaller the number, the larger the diameter
18 gauge > 27 gauge in diameter
gauge/diamete/width (all synonyms)
@ risk for cumulative effect bc…..
decreased rate of drug metabolism
higher drug plasma concentrations–> prolonged action and increased possibility of drug toxicity (if liver function and production of enzymes for metabolism is decreased
decreased # of protein binding sites –> toxicity
decreased (not increased) kidney function –> toxicity (bc amount of secretion is decreased)
the needle hub
The outside of the cap and barrel do not need to be kept sterile.
3 yrs old –> pulled straight back
< 3 yrs old --> down and back
> 3 yrs old –> up and back
swollen ear canal –> wick can be inserted for med delivery
dropper should NOT touch the ear
turbo-inhaler=propelled driven device that spins and suspends ad finely powdered medication
An aerosol results after a liquid drug is forced through a narrow channel using pressurized air or an inert gas.
-client has disorders that affect the absorption of medications (burns as an example)
-quick response is needed
-when client was to avoid the discomfort of REPEATED intramuscular injections
transdermal medications=absorbed through the skin
After application, the drug migrates through the skin and eventually is absorbed into the blood stream.
Pastes are drugs within a thick base that are applied, but not rubbed, into the skin. Sublingual applications are drugs that are placed under the tongue and left to dissolve slowly. Buccal applications are drugs that are placed against the mucous membrane of the inner cheek.
pastes=drugs in thick base that are applied but not rubbed into the skin
Healthcare facility personnel perform a count of controlled medications at specified times (each shift or when removed from an automated dispensing machine).
To convert a larger unit into a smaller unit, move the decimal point to the right (the new number is larger than the original). 1000 milligrams (mg) is equal to 1 gram (g); therefore 0.8 g is multiplied by 1000 (which is equivalent to moving the decimal point 3 places to the right) to determine how many mg it is equivalent to
After instilling the prescribed number of drops in the client’s ear, the nurse should ask the client to maintain the position briefly until the solution travels toward the eardrum. When instilling the medication in the client’s ear, the nurse first manipulates the client’s ear to straighten the auditory canal. Tilting the client’s head away, the nurse then administers the prescribed number of drops of medication. The client remains in this position briefly as the solution travels toward the eardrum. The nurse then places a cotton ball loosely in the ear to absorb the excess medication. The nurse then waits for at least 15 minutes before administering the medication in the opposite ear if prescribed. Briefly postponing the application within the second ear avoids displacing the initially instilled medication when repositioning the client.
When medication becomes clogged in the tube, you should attach a 10-mL syringe onto the end of the tube, pull back, and then lightly apply pressure to the plunger in a repetitive motion. This may dislodge the medication. If the medication does not move through the tube, the physician should be notified.
To avoid any potential complications, the nurse should review the client’s medication, allergy, and medical history. The nurse should read and compare the label on the medication with the medical record at least three timesbefore, during, and after preparing the medicationto ensure that the right medication is given at the right time by the right route. Administering the medication within 30 to 60 minutes of the scheduled time demonstrates timely administration and compliance with the medical order. Allowing sufficient time to prepare the medication with minimal distraction promotes the safe preparation of medications
If an elderly client is having difficulty comprehending the discharge instruction, the nurse should involve a second responsible person in the instruction in order to ensure client safety. A referral for skilled nurse visits is appropriate for homebound older adults who need additional instructions about medication routines after discharge. However, the nurse would not ask a second nurse to simply repeat the instructions or delegate the teaching to somebody else. The nurse will also not write all the discharge instructions on the various medication containers, but instead will write all the instructions in detail on the discharge sheet for the client’s convenience.
When administering medications through an enteral tube for a tube-fed client, the nurse must avoid crushing sustained-release pellets because keeping them whole ensures their sequential rate of absorption. The nurse should not add medications to the formula because some medications may interact with the components in the formula, causing it to curdle or change its consistency. Additionally, a slow infusion would alter the medication’s dose and rate of absorption. The nurse should mix each medication separately, not together, with at least 15 to 30 mL of water. The nurse should use warm water when mixing powdered medications to promote dissolving the solid form.
therapeutic range is the concentration of drug in the blood serum that produces the desired effect without causing toxicity. peak level is the highest plasma concentration. Trough level is the point when the drug is at its lowest concentration. half life is the amount of time it takes for 50% of the blood concentration of a drug to be eliminated from the body
allergic reactions from an immunologic response to a substance to which the client is sensitized
Metabolism is the process of chemically changing the drug in the body. Metabolism takes place in the liver. Alterations in liver function, including decreased functions that occurs with aging or disease, affect the rate at which drugs are metabolized.
A spacer would help maximize the absorption of the drug in a client who is having problems coordinating his breathing with the inhaler use. A spacer provides a reservoir for the aerosol medication. As the client takes additional breaths, he continues to inhale the medication held in the reservoir. This tends to maximize the drug’s absorption because it prevents drug loss. A metered-dose inhaler is a canister that contains medication under pressure; the aerosolized drug is released when the container is compressed. A turbo-inhaler is a propeller-driven device that spins and suspends a finely powdered medication. Nasal drops are liquid medication sprayed or dropped into the client’s nose. These, however, would not help in maximizing the absorption of the medication.
Medication can be added to small amounts of food, but should not be added to liquids. If it is questionable whether the medication was swallowed, check the patient’s mouth and cheeks. If a pill is dropped, it should be discarded, and if a patient vomits, notify the physician to see if the medication should be readministered.
A complaint of “breakthrough” pain, especially postsurgery, would likely require the nurse to administer a PRN analgesic. A new onset of chest pain would likely require a stat order, while longstanding treatment of hypertension and asthma would likely include standing orders for relevant medications
A rectal suppository must make contact with the rectal mucosa for absorption to occur so it should be inserted about 3 to 4 inches.
A meter-dose inhaler has a canister that contains medication under pressure. It is much more commonly used than the turbo-inhaler, which is a propeller-driven device that spins and suspends a finely powdered medication. A turbo-inhaler, not a meter-dose inhaler, has propellers that get activated during inhalation.
Intravenous is the fastest route of administration because the medication goes into the bloodstream immediately. The second fastest route is an injection because they are quickly absorbed into vessels. Oral medication is a slow route and should not be used in an emergency situation. Medication via patches would not administer the medication quickly enough in an emergency situation. Inhalation medications are specifically given for respiratory issues.
The ventrogluteal site involves the gluteus medius and gluteus minimus muscles in the hip area. This site is recommended for adults because there are no large nerves or blood vessels, it is removed from bone tissue, it is clean, and the patient may lie on the back, abdomen, or side for the injection.
The vastus lateralis site is most desirable for administering injections to infants and small children, as well as clients who are thin or debilitated with poorly developed gluteal muscles. The dorsogluteal site is avoided in clients younger than 3 years because their gluteus maximus muscle is not sufficiently developed; whereas, the ventrogluteal site is safe for children. The deltoid site is the least-used intramuscular injection site because it is a smaller muscle than the others. It is used only for adults because the muscle is not sufficiently developed in infants and children.
125 mcg = 0.125 mg. 0.0625 mg 0.125 mg = 0.5 tablets
A wheal or blister indicates that the medication has been injected into the dermis. If the wheal or blister does not appear, the medication has most likely been given into the subcutaneous tissue and must be re-injected into another site. The primary care provider needs to be notified that the skin test needs to be administered again so that an order can be obtained.
• Numb the skin with an ice pack before the injection
• Insert and withdraw the needle without hesitation
• Instill the medication slowly but steadily
The nurse can reduce discomfort associated with injections by using alternative techniques such as numbing the skin with an ice pack before the injection, inserting and withdrawing the needle without hesitation, and instilling the medication slowly and steadily. Nurses use the Z-track method for intramuscular injections, not for any other injection. Supporting the tissue during withdrawal reduces discomfort.
Attach the infusion tubing to the medication container by inserting the tubing spike into the port with a firm push and twisting motion, taking care to avoid contaminating either end. The IV piggyback delivery system requires the intermittent or additive solution to be placed higher than the primary solution container. The nurse is responsible for calculating and regulating the infusion with an infusion pump. Using aseptic technique, remove the cap on the tubing spike and the cap on the port of the medication container.
The process by which the medication is delivered to the target cells and tissues is called distribution. Absorption is the process by which a medication enters the bloodstream. Synergism is a drug interaction that increases the drug effect. The process of chemically changing the drug in the body is called metabolism; it takes place mainly in the liver.
A client with acute diabetic ketoacidosis requires intravenous access for the administration of insulin.