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NurseFaith
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The route of absorption is chosen according to ____________
Speed of absorption, site of action, desired effect (local vs. systemic), patient's physical and mental well-being
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Types of Non-Parenteral Medications
Oral, Enteral, Nasal, Eye, Ear, Buccal, Sublingual, Bronchioles (inhalation), Vaginal, Rectal, Topical and Trasndermal
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AVOID the oral route of medication (PO) if the patient:
is nauseated, vomiting, has decreased GI motility, is on restricted oral intake, or cannot swallow
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Open tablets/capsules:
- at the patient's bedside...
- This allows the nurse to review them with the patient and if they refuse one or do not need one you will know which one not to give
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Only medications that are _____ should be broken. And the unused medication should be discarded
scored
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DO NOT crush __________
enteric-coated or sustained release medications
(if crushing pills, clean mortar between uses. and add medication to a small amount of food that the patient will FINISH)
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When pouring liquid medication make sure the label is ______
in the palm of your hand (so the label doesn't get ruined)
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When measuring liquid medication place the medication cup ________
On flat surface and bend down to read at eye level
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Most common types of enteral feeding:
GI tube, NG tube, PEG tube, J-tube
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When administering enteral feeding place the patient:
in high fowlers with HOB elevated for at least 1 HOUR after medication administration
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The first thing that needs to be done when administering enteral feeding:
verify the placement of the tube
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If a patient has too much gastric residual (greater than 2 hours worth of feeding)....
medication should be held (sign of delayed gastric emptying)
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After administering enteral medication (if the tube is connected to suction)...
disconnect the tube and leave it clamped for 20-30 minutes after administering the medicaition
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If a patient on enteral feeding is on continuous tube feeding....
clamp for 30 minutes, give medication, flush, resume feeding 30 minutes to 1 hour after.
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When giving medication through a tube, administer each medication _____
separately (some medications may interact with each other or become less effective if mixed with other drugs)
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How are sublingual drugs absorbed?
through the abundant number of superficial blood vessels of the undersurface of the tongue (there is relatively rapid absorption for quick systemic effects)
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Do not allow patient to ______ when administering sublingual medications
swallow or chew
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Most common sublingual medication and how often can it be given?
Nitroglycerin (can give up to 3 over 15 min period)
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How are buccal medications administered?
between patient's cheek and gums toward the back of the mouth....
DO NOT ALLOW PATIENT TO SWALLOW OR CHEW
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For bot buccal and sublingual, do NOT allow patient:
- -to swallow or chew
- -to drink water AFTER
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When administering spray medication, tell the patient:
- -not to swallow right away
- -do NOT spit or rinse mouth for 5-10 min after
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Opthalmic medications are considered:
STERILE
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How do you administer opthalmic medication?
- -gently wipe away drainage/discharge going from the inner canthus towards the outer canthus
- -hold clean tissue in non-dominant hand just below the eyelid
- -pull downward to expose the conjunctival sac
- -ask patient to look up at ceiling and/or hyperextend head
- -administer drops about 1/2 to 3/4 inches above the conjunctival sac...do not put on cornea
- -apply gentle pressure on the duct to prevent medication from flowing into the tear duct
- (if ointment, apply on inside of lower lid and have patient blink or roll eyeball around)
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Ear drops should be administered at:
body temperature (prevents dizziness and nausea)
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How do you administer otic medications
- -position pt on side
- -remove any cerum or drainage blocking outermost portion of the ear canal
- -straighten ear canal (pull UP and BACK for adult, DOWN and BACK for a younger child)
- -have patient remain in a side-lying position for 5-10 minutes
- -insert cotton ball in outermost portion of ear
- -wait 5 minutes before administering in second ear
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When administering nasal medications, have patient breath _____ while remaining supine for _____
through mouth; 5 minutes without blowing nose
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Shake inhaler for:
5-10 seconds
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How would you teach your pt to use an inhaler?
- -take a deep breath and exhale completely
- -inhale slowly and deeply while depressing the medication canister
- -breath in for 2-3 seconds
- -hold breath if possible for about 5-10 seconds
- ***repeat after 1 minute or 2-5 minutes if a second medication is being given
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For ALL inhalers (especially steroidal ones), be sure to have the patient:
rinse their mouth and gargle after treatment to decrease the risk of getting thrush
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Do not give rectal/vaginal medications if the patient has:
had rectal surgery or has active bleeding
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Administration of rectal medications:
- -have pt take slow, deep breaths through their mouth to relax the anal sphincter
- -go past internal sphincter (4in. in adult, 2 in. in child
- -have patient remain supine/left side for 5 minutes
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Administration of vaginal med:
- -have pt void before inserting
- -have pt remain supine for 10 minutes
- -offer pt peri pad
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Types of topical medications:
lotions, pastes, ointments, creams, and patches
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Administration of topical medications:
- -wear gloves
- -skin should be cleaned with soap and water prior to applying
- -do NOT put over skin that is non-intact and for some medications preferably areas free of hair
- -assess previous sites and rotate application sites when possible
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Measure nitroglycerine cream:
in inches...DO NOT MASSAGE OR RUB IN
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Always put ________ on patch or ointment paper
Date, Time, and Initials
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Types of transdermal medications:
Hormones, Narcotic analgesics, cardiac medications, and nicotine
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Administration of transdermal patch:
- -always wear gloves
- -remove old patch before new one
- -fold patch in half with adhesive side together when disposing of them
- -try to apply patch at the same time each day
- -after applying, press firmly for 10 seconds
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5 Rights of Medication Adminstraion
- ***CHECK AT LEAST 3 TIMES****
- Patient- minimum of 2 identifiers
- Drug
- Dose
- Route
- Time
- (Some places include right documentation)
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As a nurse, it's important to think...
DEFENSIVELY.... "what if" "why" "what will happen if I don't do something"
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All medications need to have a complete _____ which consists of _____:
doctor's order; name of the drug, dose, route, frequency, special instructions, and doctor's signature
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Chart any medication ordered but NOT given by:
circling it and recording on the MAR (and/or nurses notes) why the patient's medication was not given
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When the physiological response of a medication decreases after repeated administration....It takes higher doses to produce desired effects.
Drug Tolerance
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When a patient needs a drug to function
physical drug dependence
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When a patient takes a drug for another reason other than its therapeutic effects
psychological drug dependence
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