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IVPB
intravenous piggyback
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ml,mL
milliliter (equivalent to cc)
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NPO, npo
nothing by mouth
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NS, N/S
normal saline (sodium chloride, 0.9%)
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PCA
patient controlled analgesia
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PRN, prn
whenever necessary
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QNS
quantity not sufficient
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stat
immediately and once only
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ISMP
Institute for Safe Medication Practice
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monitors medication administration and identifies practices that have contributed to medication errors
ISMP
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JCAHO
Joint Commission on Accreditation of Healthcare Organizations
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has approved a list of dangerous abbreviations that have been prohibited effective 1/1/04
JCAHO
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medication orders contain 6 parts
- 1. date
- 2. patient's name
- 3. Medication name
- 4. dosage or amount of medication
- 5. route or manner of administration (if no route is specified, the oral route is usually the appropriate one)
- 6. Time to be administered, or frequency
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when taking a telephone order, always obtain:
the name of the person calling in the order & write the name of that person & the time the call was made next to the medication ordered
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all phone orders must be followed by:
a read back statement
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it's the responsibility of the health care practitioner to check:
medication order for completeness by noting the 6 items
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the physician must sign all verbal and telephone orders within:
24 hours
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the prescription blank contains 2 additional items:
physcian's Drug Enforcement Administration registration # if it's controlled substance & the # of times that the prescription can be refilled
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on a prescription blank, check for:
completeness, legibility & accuracy, including date, patient's name, medication name, dosage, router, frequency or time, # of refills and DEA # for controlled substances
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some states have passed legislation requiring:
name of the medication to be legibly printed or typed & may require the quantity of the drug prescribed to be in both textual & numerical formats. the prescriber must also print his or her name under the signature
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example of legislation passed:
Legible Prescription Law, which became effective in FL on 7/1/03
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original system of weights & measure for writing med orders
apothecary system
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Is a pharmacist or druggist
Apothecary
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the preferred system of measurement & is used at the present
metric system
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the lease accurate system of measurement
household system
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medication orders are concerned with only 2 types of measurement:
- 1. measuring fluids, or liquid measure
- 2. measuring solids, or solid weight
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includes the minim, fluid dram, fluid ounce, pint, quart and gallon - liquid
- grain, dram, ounce & pound - solid
- apothecary
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a ___ is approx equivalent to 1 minim of water, but the type of solution may cause variation
drop
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invented by the French in the late 18th century & is the international standard for weights & measures
metric system
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includes liter and the milliliter, which is approx equivalent to the cubic cm-liquid
- gram & the milligram - solid
- metric
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equipment most commonly used for measuring meds include:
medicine cup & various syringes calibrated in millilters and/or minims
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5 mL (metric converted to household)
1 tsp
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15 mL (metric converted to household)
1 tbsp
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30 mL (metric converted to household)
2 tbsp
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240 mL (metric converted to household)
1 measuring cup (240 mL)
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500 mL (metric converted to household)
1 pt
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1,000 mL (metric converted to household)
1 qt
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1g (metric-grams converted to metric-milligrams)
1,000 mg
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0.6g (metric-grams converted to metric-milligrams)
600 mg
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0.5g (metric-grams converted to metric-milligrams)
500 mg
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0.3g (metric-grams converted to metric-milligrams)
300 mg
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0.2g (metric-grams converted to metric-milligrams)
200 mg
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0.1g (metric-grams converted to metric-milligrams)
100 mg
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0.06g (metric-grams converted to metric-milligrams)
60 mg
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0.05g (metric-grams converted to metric-milligrams)
50 mg
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0.03g (metric-grams converted to metric-milligrams)
30 mg
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1 lb (pounds converted to kilograms)
0.453592 kg
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1 kg (kilograms converted to pounds)
2.2 pounds (lb)
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to convert pounds to kilograms:
divide # of pounds by 2.2
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be careful in calculating the weight in kg because:
the slightest error, especially in pediatric doses could result in serious or fatal consequences
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many meds are dispensed by the pharmacist in:
unit-dose form (which each individual dose of med is prepackaged in a seperate packet, vial or prefilled syringe)
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when the dosage ordered differs from the dosage on hand, the problem can be solved simply by completing 3 basic steps:
- 1. check whether all measure are in the same system; convert if necessary
- 2. write the problem in equation form using the appropriate formula & labeling all parts & complete the necessary calculations
- 3. check the accuracy of your answer for reasonableness & have someone else verify your calculations
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basic calculation:
- desired dose
- ______________ X quantity of on-hand dose
- on-hand dose
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cautions for the basic calculation method:
- 1. label all parts of the formula
- 2. use the same label for desired and on-hand doses
- 3. use the same label for the quantity & the answer (the amount to be given)
- 4. reduce fractions to lowest terms before dividing
- 5. mulitply by the quantity after dividing
- 6. take extra care with decimals
- 7. convert fractions to decimals
- 8. round off decimals to one decimal place after computations complete
- 9. verify the accuracy of calculations w/an instructor
- 10. question the answer if not within normal limits
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describes the relationship between 2 #'S
ratio ex( 1 g: 15 gr)
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consists of 2 ratios that are equal:
proportion ex(1 g: 15gr = 2 g: 30 gr)
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known unit of : known = desired unit : unknown
measure equivalent of measure equivalent
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to solve the problem:
multiply the 2 outer terms or extrems & then multiply the 2 inner terms or means
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cautions for the ratio & proportion method:
- 1. label all parts of the equation
- 2. the ratio on left contains the known quantity & the ratio on right contains desired and unknown quantities
- 3. terms of the 2nd ratio must be in the same sequence as those in the 1st ratio
- 4. multiply the extremes 1st and then the means
- 5. take extra care w/decimals
- 6. convert fractions to decimals. round off decimals to 1 decimal place
- 7. label the answer
- 8. verify the accuracy of calculations w/instructor
- 9. question any unusual dosage not w/i normal limits
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in neonates, ___ & ____ needed for drug absorption & metabolism are not fully develped.
renal function & some enzyme systems
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is more permeble
neonates blood-brain barrier
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contributes a greater percentage of the neonates body weight, also affecting drug aborption
total body water
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appropriate dosage for children, as well as adults, must take into consideration variables such as:
age, weight, sex & metabolic, pathological or psychological conditions
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recommended pediatric drug dosages are derived from:
data obtained in clinical trials utilizing sick children
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when preparing drug dosages for children, always refer to:
PDR or AHFS Drug Information (AHFS DI)
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recommended dosages of drugs are often expressed:
in the references as a # of milligrams per unit of body weight, per unit of time
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factors leading to possible dangerous cumulative effects for geriatric:
slower metabolism, poor circulation, or impairment of liver, kidneys, lungs or central nervous system.
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can affect assimilation of drugs & interfere with therapeutic effect:
any chronic disease, debility, dehydration or electrolyte imbalance
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prevention of medication errors:
- 1. never lease the decimal point naked. always place a zero before a decimal point
- 2. never place a decimal point & zero after a whole #
- 3. avoid using decimals whenever whole #'s can be used as alternatives ex(0.5 g can be expressed as 500 mg)
- 4. have a 2nd qualified person double-check any calculations for accuracy
- 5. always question the order if you have any difficulty interpreting the spelling of a drug name or the # used for the dosage, or the dosage seems inappropriate
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