Medications.txt

Intrathecal/intraspinal, intracardiac, intra-arteriole, intra-articular, intra-peritoneal

injecting between the vertebrae (steroid medication). done most often to decrease inflammation and pain

doctor injects directly into the heart (epinephrine to start heart or other cardiac medications)

pleural space around the lungs. antibiotics or anti-inflammatory medications

injecting into an artery

tissue plasminogen activator ("clot buster"). natural enzyme that frees plasmin from plasminogen. plasmin breaks down fibrin (formation of blood clots

injecting between joints

injecting into peritoneal cavity of the abdomen

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

submerge the body part (better if hand or foot) or soak materials (larger body part)

apply more to the whole body

transdermal: going through skin Applied locally but have systemic affects (exception: lidoderm anesthetic for pain in one area. lidocaine). 24-72 hours

pain med left for 72 hours (CA pt who has difficulty taking PO meds)

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

Eye, Ear, or through the rectum

antibiotic, laxative, stool softeners, nausea, anti-emetics

water soluble lubricant for area and finger. sterile

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

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

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

Shake, hand position, tip head slightly back, dispense puff of medication while inhaling for 2-3 seconds

2-3 seconds. hold breath up to 10 seconds. exhale slowly through pursed lips

at least 1 minute between puffs of an inhaler. wait 2-5 minutes between 2 inhalers

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)

Physicians role, Pharmacist role, Nurse's role, S.N. 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

sometimes suggest d/c (sometimes pt takes drug too long) Fill the prescription Distributes them to appropriate location

Knowledge: medications re repetitive in some floors. maintaining 8 rights

Get ready to check your medications. get lab values. knowledge. don't get too comfortable (don't do it robotically)

Impaired swallowing (CVA), Sensory-perceptual alteration, Impaired physical mobility. Knowledge deficit. Diagnosis of noncompliance. Anxiety

risk for aspiration

for area of vision

especially in the hands

specify what the deficit is (related to: what is going on with the pt. confusion, impaired LOC, problem with concentration, short attention span)

find out why

fear of future. cost

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

Correct communication (legible drug order. no questions in your mind about that medication when you go to give it). Accuracy (CALCULATE CAREFULLY)I

Correct administration (asepsis. surgical asepsis - sterile. clean vial/clean site/fresh alcohol pad. assess that route is appropriate)

Correct recording of medications (document when medication is given. ask if you have questions regarding how to document)

Patient/family teaching (teach the family members. maintain patient rights)

assess for any complications and for effectiveness of nursing interventions Complications: adverse affects. trauma at the injection site

right patient (organization sheet/comp), right medication, right dosage, right route (regular insulin may be given intravenously), right time/frequency

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)

use correct procedure (follow MAG). honesty with errors (potentially life-threatening). incidence report

not given

shouldn't have done that you did

document incidence report on chart. could be pt didn't get medication on time, but is ok

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

past illnesses and any chronic health problems

estimated blood loss. indicates whether or not you pt is at risk for dehydration

food allergies, cleaning solution, tape

prescribed, OTC, herbal preparations, supplements

eating pattern, protein is especially important, ABCD, copper

don't give PO meds while vomiting

does not mean no medications. may be just medications that are allowed

visual, hearing, finger movement

sometimes noncompliant

don't assume. ask questions. get subjective data. have them explain their medications to you

assess knowledge first (if it takes 4-6 weeks to reach it's effectiveness, teach them about that!)

age. weight. body surface area. ability to metabolize, absorb, and excrete meds (it will stay in their blood longer if retained)

Aging Process: decreased organ effectiveness (liver/kidneys). Additional factors: behavioral, economic (cost)

standing orders for the giving of additional insulin according to accu checks ac & hs (before meals or at bedtime). q6h. q3h

0.3 ml, 0.5 ml, or 1 ml U 100/ml (do not draw up insulin in regular hypodermic syringe)

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)

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

Regular, Humulin R, Novolin R: 30-60 minutes, 2-4 hours, 6-8 hours. mid-morning hypoglycemia

NPH, Humulin N, Lispro Protamine: 1-2 hours, 4-8 hours, 10-18 hours

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

Humalog 75/25 75% Lispro Protamine 25% Lispro Benefite of faster onset, but have duration Humulin 70/30 Humulin 50/50

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

prevents unpredictable absorption. Lipodystrophy - lipoatraphy (wasting away of fatty tissue - little dips)

1 inch apart in a given location. absorption is more consistent in the same area. map out injection sites (small X)

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

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

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)

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)

away from bones, away from blood vessels and nerves (dorsogluteal/deltoid)

want them to be relaxed. be relaxed yourself. follow guidelines:) Get pt mind off. don't be afraid to talk to your pt

remove quickly on your insertion. get movement out as quickly as you can. don't jerk out at a bad angle!

Slower absorption. advantage for insulin. don't massage don't speed up absorption of medication (not as vascular as muscle tissue. has blood vessels)

Lateral upper arms. Abd. Anterior thighs

site without infection

insulin and other subcutaneous injections. can fold arm across chest to access area more easily

two inches away from umbilicus & any scars. base of ribcage and out to sides. not into love handles

mid to lateral. upper back (below the scapula). upper dorsal/ventral gluteal areas