1. Additional parenteral routes
    Intrathecal/intraspinal, intracardiac, intra-arteriole, intra-articular, intra-peritoneal
  2. Intrathecal/intraspinal
    injecting between the vertebrae (steroid medication). done most often to decrease inflammation and pain
  3. Intracardiac
    doctor injects directly into the heart (epinephrine to start heart or other cardiac medications)
  4. Intrapleural
    pleural space around the lungs. antibiotics or anti-inflammatory medications
  5. Intra-arteriole
    injecting into an artery
  6. TPA (intra-arteriole injection)
    tissue plasminogen activator ("clot buster"). natural enzyme that frees plasmin from plasminogen. plasmin breaks down fibrin (formation of blood clots
  7. Intra-articular
    injecting between joints
  8. Intra-peritoneal
    injecting into peritoneal cavity of the abdomen
  9. Topical: painting or spreading
    Nitropaste (nitroglycerine like a toothpaste, squeeze out ointment, apply to paper patch. put on right or left should er or right/left chst and tape in place. skin C&D. rotate sites to decrease skin irritation
  10. Soaks or dressings
    submerge the body part (better if hand or foot) or soak materials (larger body part)
  11. Medicated baths
    apply more to the whole body
  12. Patches with medication inside
    transdermal: going through skin Applied locally but have systemic affects (exception: lidoderm anesthetic for pain in one area. lidocaine). 24-72 hours
  13. Duragesic
    pain med left for 72 hours (CA pt who has difficulty taking PO meds)
  14. Some transdermal patches only put on for 12 hours
    usually Catapres for BP. old adult doesn't need it when sleeping. might cause their BP to lower too much if left on at night Shoulders, upper chest, and upper back. check doctors order and MAR for specific instructions
  15. Application to mucous membranes
    Eye, Ear, or through the rectum
  16. Creams and suppositories
    antibiotic, laxative, stool softeners, nausea, anti-emetics
  17. Yeast infections
    water soluble lubricant for area and finger. sterile
  18. 3 Determining Factors
    Condition of the skin: thick, thin, or intact. concentration of the drug. prolonged skin contact (amount of time application is left in place, more opportunity for it have affects
  19. Inhaled
    large surface area in the respiratory tract. allows medication to reach deeply into the lungs. easy absorption of mists and gases occurring through the alveoli. oxygen and general anesthetics have systemic affects (Albuterol helps with shakiness & the rest of the body). some inhalations are designed to go only to the lungs. others are designed to have systemic affects
  20. Preliminatry steps for inhalers
    Shake to mix properly. hand position (2 point or 3 point). Inhaler position: held one to two inches from mouth or use a spacer (chamber in between medication and application site. may used a spacer: to get full affect of the medication
  21. Use
    Shake, hand position, tip head slightly back, dispense puff of medication while inhaling for 2-3 seconds
  22. Inhale/exhale
    2-3 seconds. hold breath up to 10 seconds. exhale slowly through pursed lips
  23. Wait
    at least 1 minute between puffs of an inhaler. wait 2-5 minutes between 2 inhalers
  24. Intra-ocular route
    med is on disk like a contact in between layer. inner and outer layer. kept in eye for up to a week Example: Pilocarpine (tx of Glaucoma)
  25. Roles in med administration
    Physicians role, Pharmacist role, Nurse's role, S.N. role
  26. Physicians role
    8 types of medication orders. controlled substances: double locked. counted at the end of every shift. needs to be signed out: electronic signature. RN needs to witness the waste (sometimes you don't give the entire dose). RN signs out the medication
  27. Pharmacists role
    sometimes suggest d/c (sometimes pt takes drug too long) Fill the prescription Distributes them to appropriate location
  28. Nurse's role
    Knowledge: medications re repetitive in some floors. maintaining 8 rights
  29. S.N. role
    Get ready to check your medications. get lab values. knowledge. don't get too comfortable (don't do it robotically)
  30. Analysis/Nursing Diagnosis
    Impaired swallowing (CVA), Sensory-perceptual alteration, Impaired physical mobility. Knowledge deficit. Diagnosis of noncompliance. Anxiety
  31. Impaired swallowing
    risk for aspiration
  32. Sensory-perceptual alteration
    for area of vision
  33. Impaired physical mobility
    especially in the hands
  34. Knowledge deficit
    specify what the deficit is (related to: what is going on with the pt. confusion, impaired LOC, problem with concentration, short attention span)
  35. Diagnosis of noncompliance
    find out why
  36. Anxiety
    fear of future. cost
  37. Planning
    Organization (first 30 minutes make or break. know times and frequencies divide up. one pt at at time). Knowledge (med information. good working knowledge of history & physical. concentration). and Attention
  38. Implementation
    Correct communication (legible drug order. no questions in your mind about that medication when you go to give it). Accuracy (CALCULATE CAREFULLY)I
  39. Implementation
    Correct administration (asepsis. surgical asepsis - sterile. clean vial/clean site/fresh alcohol pad. assess that route is appropriate)
  40. Implementation
    Correct recording of medications (document when medication is given. ask if you have questions regarding how to document)
  41. Implementation
    Patient/family teaching (teach the family members. maintain patient rights)
  42. Evaluation
    assess for any complications and for effectiveness of nursing interventions Complications: adverse affects. trauma at the injection site
  43. 5 rights
    right patient (organization sheet/comp), right medication, right dosage, right route (regular insulin may be given intravenously), right time/frequency
  44. Additional
    Right documentation. right to refuse (find out why. informed refusal). right to be educated (know what they are refusing. complications of not taking. benefits of taking)
  45. AVOIDING Medication Errors
    use correct procedure (follow MAG). honesty with errors (potentially life-threatening). incidence report
  46. Errors of omission
    not given
  47. Errors of commission
    shouldn't have done that you did
  48. Do not
    document incidence report on chart. could be pt didn't get medication on time, but is ok
  49. Nursing Process related to Medications
    Medical history, allergy history, Medication information, Diet, pt current condition, assess whether they are NPO, Perceptual or coordination problems, Pt attitude, Pt knowledge, address pt learning needs
  50. Medical history
    past illnesses and any chronic health problems
  51. EBL
    estimated blood loss. indicates whether or not you pt is at risk for dehydration
  52. Allergy history
    food allergies, cleaning solution, tape
  53. Medication information
    prescribed, OTC, herbal preparations, supplements
  54. Diet
    eating pattern, protein is especially important, ABCD, copper
  55. Pt current condition
    don't give PO meds while vomiting
  56. Assess whether or not they are NPO
    does not mean no medications. may be just medications that are allowed
  57. Perceptual or coordination problems
    visual, hearing, finger movement
  58. Pt attitude
    sometimes noncompliant
  59. Pt knowledge
    don't assume. ask questions. get subjective data. have them explain their medications to you
  60. Address pt leaning needs
    assess knowledge first (if it takes 4-6 weeks to reach it's effectiveness, teach them about that!)
  61. Considerations for infants/children
    age. weight. body surface area. ability to metabolize, absorb, and excrete meds (it will stay in their blood longer if retained)
  62. Considerations for older adults
    Aging Process: decreased organ effectiveness (liver/kidneys). Additional factors: behavioral, economic (cost)
  63. Sliding Scale (SS) Insulin
    standing orders for the giving of additional insulin according to accu checks ac & hs (before meals or at bedtime). q6h. q3h
  64. Insulin Concentration
    0.3 ml, 0.5 ml, or 1 ml U 100/ml (do not draw up insulin in regular hypodermic syringe)
  65. Insulin Administration
    checked by another RN Syringe is not detachable Needle gauge: 26-30 (needle is very thin) Insulin pens: prefilled cartridge goes into that pen (helpful for vision impaired - loud clicks. manual dexterity - can't move well with their fingers)
  66. Rapid acting
    Lispro, Aspart: 5-15 minutes, 1-2 hours, and 4-6 hours. give food right away because of rapid onset. Less likely to see hypoglycemia with rapid acting
  67. Short Acting
    Regular, Humulin R, Novolin R: 30-60 minutes, 2-4 hours, 6-8 hours. mid-morning hypoglycemia
  68. Intermediate Acting
    NPH, Humulin N, Lispro Protamine: 1-2 hours, 4-8 hours, 10-18 hours
  69. Long Acting
    Lantus, Ultralente: 3-4 hours, 8-14 hours, 12-24 hours. usually given at bedtime to DECREASE early am hypoglycemia. sometimes given at early morning medication
  70. Combining insulin
    Humalog 75/25 75% Lispro Protamine 25% Lispro Benefite of faster onset, but have duration Humulin 70/30 Humulin 50/50
  71. Insulin Differs
    Onset, Peak (predict hypoglycemia. important). Duration (length of action). Clarity. Route. Most subcutaneous, 90, no aspiration or massage. some is given IV by IVP or by bag. pill for inhalation, nasal inhalation or inhalation
  72. Insulin site rotation
    prevents unpredictable absorption. Lipodystrophy - lipoatraphy (wasting away of fatty tissue - little dips)
  73. Guidelines for rotation
    1 inch apart in a given location. absorption is more consistent in the same area. map out injection sites (small X)
  74. Insulin storage
    Kept out of the refrigerator short term. 10 ml usually good for a month in a cool place. Initials, date, and time when opened/multi-used
  75. Preliminary knowledge
    dosage volume (amt of medication. sometimes you have to dilute medication). drug viscosity (thickness) - does it need: diluent. Lower gauge number needed for thick medication
  76. Correct technique
    If incorrect, possible infection for poor asepsis (need sterile technique). could cause increased trauma or introduce pathogens Poor insertion: trauma (stabilize hand. careful how you pull out)
  77. Minimizing discomfort
    Use sharp needle (change needle with IM injection. sharp as possible. don't want medication to be outside of needle while giving medication - only want it going into muscle). Appropriate gauge/length needle (18-22, occasionally 23 depending on viscosity)
  78. Correct site
    away from bones, away from blood vessels and nerves (dorsogluteal/deltoid)
  79. Diversion Techniques
    want them to be relaxed. be relaxed yourself. follow guidelines:) Get pt mind off. don't be afraid to talk to your pt
  80. Insertion/Removal
    remove quickly on your insertion. get movement out as quickly as you can. don't jerk out at a bad angle!
  81. Subcutaneous injections
    Slower absorption. advantage for insulin. don't massage don't speed up absorption of medication (not as vascular as muscle tissue. has blood vessels)
  82. Sites
    Lateral upper arms. Abd. Anterior thighs
  83. selection
    site without infection
  84. Later upper arms
    insulin and other subcutaneous injections. can fold arm across chest to access area more easily
  85. Abd
    two inches away from umbilicus & any scars. base of ribcage and out to sides. not into love handles
  86. Anterior thighs
    mid to lateral. upper back (below the scapula). upper dorsal/ventral gluteal areas
Card Set
Medication Administration