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Who is legally responsible for the safe and therapeutic effects of drugs?
- nurses
- physicians
- pharmacists
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What do you need to know in preparation for medication administration?
- 1. be able to locate the information about each drug
- 2. consistently caclculate drug dosages accurately
- 3. use the 5 rights
- 4. recognize the nursing implications for each drug given
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According to the FDA, which 5 standards must be met before a drug can be marketed?
- purity
- potency
- bioavailability
- efficacy
- safety
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who prescribes drugs?
- physicians
- dentists
- osteopaths
- veterinarians
- physicians' assistants
- nurse practitioners
- advanced practice nurses
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Drugs usually have 3 names
- chemical name
- generic name
- trade name
- *nurses usually know the generic and trade
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Define drugs
- substances used as medicine
- drugs = medicine
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What are the uses for drugs?
- treatment
- palliation
- diagnosis
- cure
- prevention
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The responsibility for the security of controlled drugs in a hospital is shared by?
nurse and pharmacist
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Which information is included in the nurses notes after medication is given?
- patients name
- time
- patients room #
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Before you administer a drug you must know the 5 rights, which are...
- 1. right drug
- 2. right dose
- 3. rigth route
- 4. right time
- 5. right patient
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what are the 5 rules?
- 1. teach the patient about the drug
- 2. take a complet drug history
- 3. assess the patient for drug allergies
- 4. be aware of potential drug interactions from other drugs or foods
- 5. document each drug you administer after giving it
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What is pharmacokinetics?
study of how drugs enter the body and reach their site of action and how they are metabolized and excreted
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The rate of drug absorption is affected by which factors?
- weight
- afe
- sex
- disease condition
- genetics
- immune mechanisms
- physiology
- emotional state
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What kind of drug penetrates the blood-brain barrier?
fat-soluble drugs
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What kind of drug crosses the placental barrier and affects the fetus?
most drugs
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medication errors account for a great number of occurence reports, during which steps does these errors occur?
- order interpretation
- patient identification
- administration route
- dosage
- documentation errors
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drug metabolism
- drug is broken down to active ingredient
- occurs in liver (most common site), lungs, blood, intestines and kidneys
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What must the nurse be knowledgeable about regarding the patients medicine?
- appropriate dosage
- generic and trade names for drugs
- desired effect
- possible adverse reactions
- expected side effects
- drug-drug interactions
- drug-food interactions
- preparation of the drug for administration
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What information is required for a complet drug order?
- patients full name
- drug name and how often it should be given
- dosage and route of administration
- date, time and signature of the prescribing physician
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drug excretion
- kidneys (main route)
- bowel
- liver
- lungs
- exocrine glands
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pharmacodynamics
study of a drug's effect on cellular physiology and biochemistry and its mechanism of action
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peak action
when the highest blood or plasma concentration of the drug is achieved
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duration of action
length of time the drug exerts a pharmacological effect
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half life
- time it takes for excretion to lower the drug concentration by half
- in order to maintain a therapeutic level, doses are given when the previous dose should reach its half life
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Ethnopharmacologic research shows that...
different ethnic groups metabolize drugs differently
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What is the difference between agonists and antagonists?
- agonists produce a response
- antagonists block a response
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When identifying a patient 2 of the 4 common patient identifiers are used, what are they?
- patient states name
- patient's arm band
- patient's birthdate
- patient states birthdate
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What are the 4 types of drug action?
- stimulation or depression
- replacement
- inhibition or killing
- irritation
*the less specific the drug action, the more side effects the drug may have
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anaphylaxis
severe allergic reaction
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What are the principles of medication administration?
- medications are given by the person who prepped them
- don't leave medication at the bedside
- lock up narcotics
- check orders before giving drugs
- avoid distractions when prepping drugs
- know the drug being given, its action, the dosage and precautions
- follow 5 rights and 5 rules
- observe aseptic technique
- review pt medical history
- look for drug interactions
- check for pt allergies
- teach the pt about his drugs
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How is a childs dosage calculated?
- based on age, size and weight
- parents will advise on least traumatic route of administration
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Recommendation for older patients on long term anti-inflammatory medication...
monitor for GI bleeding and anemia
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Fastest and slowest rates of absorption when admnistering medicine
- intravenous - fastest
- oral - slowest
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What are the 4 common types medication orders
- standing order: given til cancelled or dosage limit reached
- PRN: given as needed
- one time: order for a drug to be given just once; usually for a diagnostic test
- stat: order for a single dose to be given immediately
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If a medication error is found, who reports it?
- the nurse who found it
- all med errors must be reported
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unit dose
drugs packaged in single individual doses
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unit dose system
- pharmacy delivers 24 hr supply of drugs for each patient
- reduces med errors and is time efficient
- keeps minium amount of drugs required
- packages must not be opened until after the 3rd medicine check
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computer controlled dispensing system
useful for accounting for scheduled drugs
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when alternative methods of alleviating a pt health problem can be found, should they be used?
yes, some people don't want to depend on a chemical
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what is medication reconciliation
identifying all of the pt meds and informing the pt and staff
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What is the medication administration record (MAR)
sheet listing medications prescribed and times to be given
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proper method of adminstering pills
- pour pills into the bottle cover and transfer to medicine cup
- never touch the pills
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how often should MAR entries be checked with the original order?
every 24 hours
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What should be documented after a drug is given?
- route
- time
- site (if pertinent)
- info about side effects from previous doses
- any patient teaching
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To prevent medication errors it is best to check the medication how many times?
- 3
- third check is doneat bedside
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Why are the elderly at great risk for drug toxicity
- decreased albumin allows more ubound drug circulation
- drug becomes more potent
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computerized physician order entry (CPOE)
- prescriber enters med order in the computer; reduces transcription error
- can include pt info such as allergies, vital signs and lab results
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Name the 3 types of medication administration systems
- unit dose; most common
- individual prescription system
- stock supply of medicine; least common
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prescription system
- several days worth of meds are supplied
- used in outpatient clinics and community pharmacies
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When topical treatments are applied the nurse must assess the patient for the following effets..
- inflammation
- swelling
- redness
- discharge
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What is a spansule
- time released pellets placed in a capsule)
- do not crush
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if a pt is given water along with his medication, should it be entered in teh I&O sheet?
yes
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sublingual medication
placed under tongue
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buccal medication
placed in the pocket between the teeth and cheek
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ophthalmic (eye) medication
- drops, ointment or eye disk
- must be kept sterile
- if eye dropper tip is contaminated, replace the med wtih a new bottle
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otic (ear) medication
- kids younger than 3: pull ear lobe down
- over 3 y/o: pull the top of the pinna out and up
- place patient supine and in the later position to give medicine
- pt must remain later for 5 - 10 minutes to allow for absorption
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positioning for nose drops
pt lies down face up and the neck hyperextened
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how does food in the GI tract affect drug compatiblity
- may speed up, reduce, prevent absorption
- delays emptying of stomach
- stomach acid may break down medications
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vaginal medication
- suppositories, ointments, creams and irrigation
- cleanses vagina in prep for surgery
- supply antiseptics
- remove odors or foul discharge
- apply heat or cold to soothe inflamed tissues
- irrigations are clean procedures unless pt gave birth or is postop
- vaginal irrigation = douche
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pt position for insertion of rectal suppository
place the pt in the left sims' position
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administering meds through a feeding tube
- most oral medications that aren't time release or enteric can be administered
- do not combine meds
- mix med with 30 mL of warm water
- place pt in high fowler's
- flush with 15 - 30 mL of water
- document liquids in I&O chart
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