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what are the ten rights of medication administration?
- Right Medication
- Right Dose
- Right Time
- Right Route
- Right Client
- Right Documentation
- Right Education
- Right to Refuse
- Right Assessment
- Right Evaluation
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first 5 rights of medication administeration
- Right Medication
- Right Dose
- Right Time
- Right Route
- Right Client
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2nd 5 rights of med administration
- Right Documentation
- Right Education
- Right to Refuse
- Right Assessment
- Right Evaluation
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What are the 3 medication preparation checks
- compare label on med to MAR
- check expiration date
- 1 when you get med out
- 2 when placing into cup(pouring, drawing up, placing package in cup)
- 3 when putting the medication away
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you should leave medication ______ until ______
- in package
- until you hand it to client
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Medication Preparation
- Know the Drug (if don't look it up)
- Check medical administration record (MAR)
- Verify Route
- Organize self and supplies
- only prepare meds for 1 client at a time
- check expiration date
- never leave meds unattended
- always lock the lock box
- check ID Bracelet (have client state name/DOB)
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what physiological changes occur in the elderly
- Altered memory
- Decreased Visual acuity
- Decreased renal function
- Less complete and slower absorption from CGI tract
- increased proportion of fat to lean Body mass
- decreased liver function
- decreased organ sensitivity
- decreased manual dexterity
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altered memory in elderly causes
- did they remember to take meds
- did they take too many times
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decreased renal function in elderly
resulting in slower elimination of drugs and higher concentrations of drugs in the bloodstream for longer periods of time
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when preparing to give a medication you should always know ______
- why they are getting the med
- always ask about allergies
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3 checks for injection meds
- 1 when it is taken from med cart
- 2 before withdrawing the medication
- 3 after drawing medication (putting med away or throwing away package)
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steps for preparing med from ampule
- 3 check
- hand hygiene
- make sure med is out of top, open ampule (opener or gauze)
- top goes in sharps container
- attach filter needle-draw out dose
- replace needle with reg needle needed for type or injection you are giving
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steps for mixing insulin
using 1 syringe
- draw up the amount of air that u are removing from both vials
- inject air into NPH withdraw needle (do not touch liquid)
- inject air into reg insulin and withdraw amount needed
- reinsert needle in NPH and withdraw amount needed
- be careful to only get amount ordered
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steps for intradermal injection
- prepare med & prepare client explain wheal
- select site and clean/let dry
- remove cap, expel air
- Hold Almost PARALLEL (15*or less) to skin BEVEL UP
- nondom hand hold and pull taught
- insert tip, bevel should be visible under the skin
- inject slowly so wheal appears
- withdraw at same angle
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things that you should never do after intradermal injection
- DO NOT MASSAGE
- DO NOT RECAP
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sites for intradermal injections
- inner lower arm
- upper chest
- back beneath scapulae
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what is intradermal route most commonly used for
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Sub Q injections
sites and angle
- outer aspects of upper arm
- anterior aspects of thighs
- abdomen
- scapular areas of upper back
- upper ventrogluteal
- dorsogluteal areas
- ONLY SMALL DOSES
- 45* angle with palm facing to the side or upward
- 90* palm downward
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what are the essential parts of an order
- client's full name
- Date, month and year
- Drug Name, dosage, frequency and route of administration
- Signature of person writing the order
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do not crush meds that are......
- time released
- sublingual
- enteric coated
- sustained release
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when giving med through NG or g-tube or j-tube what precautions should be made before giving
- if poss have pharmacy switch to liquid
- if no liquid form check to see if it can be crushed
- crush and dissolve into at least 30mL warm water
- check tube placement
- aspirate stomach contents and measure
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when giving meds through NG, Gtube or j-tube
steps of administer after dissolved in 30mL warm water
- remove plunger and connect to a pinched tube
- put 15-30mL of water in syringe barrel to flush
- raise or lower to adjust the flow
- pinch or clamp before all water is instilled
- pour liquid or dissolved med into barrel
- if giving more than one med give each separately with 15 to 30mL water between each to flush
- disconnect from suction and keep tubing clamped for 20 to 30 mins to enhance absorption
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when giving heparin
- abdomen at least 2 inches away from umbilical
- and above iliac crest
- 90* angle
- DO NOT ASPIRATE
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what types of medications are given Sub Q
- vaccines
- pre-op meds
- narcotics
- insulin
- heparin
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what kinds of medications are given intramuscular
- vaccines
- hep B
- pneumonia
- flu
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landmarks for deltoid IM
- four fingers across deltoid starting at acromion process
- axillary is lower border line
- give injection in triangle
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landmarks for vastus lateralis
- divide area between greater trochanter and lateral femoral condyle into thirds give injection in middle third of thigh
- RECOMMENDED FOR CHILDREN 7 months AND YOUNGER
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Landmarks for ventrogluteal
- pt lays on side knee bent pulled up slightly towards chest
- nurse uses opposite hand
- palm over greater trochanter index finger points toward client's head middle finger drops dorsally towards buttocks inject inside triangle
- Not as much risk, sealed off from the bone contains less fat than Butt, suitable for infants over 7 months
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dorsogluteal
- not recommended because sciatic nerve, major blood vessels and bone
- if has to be used
- children over 3 or that have been walking for more than 1 year
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what is Z-Track
- injection given IM
- use nondominant hand to push subQ away give injection at 90* into the muscle hold needle in for 10 seconds then withdraw and release skin
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