What ensures that all medications undergo vigorous testing before being sold?
The Food and Drug Administration
What conforms to federal legislation but also has additional control such as alcohol and tobacco?
What defines the scope of a nurse's professional functions and responsibilities?
The Nurse Practice Act
What provides an exact description of a medication's composition and molecular structure?
The chemical name
What is created by the manufacturer who first develops a medication and becomes its official name?
The generic name
What is trademarked by the manufacturer to identify the particular version of the drug they have manufactured?
The trade name
What indicates the effect of a medication on the body system, the symptoms the medication relieves, or the medications desired effects?
What determines a medication's route of administration?
What is the study of how medications enter the body, reach their site of action, metabolize, and exit the body?
What refers to the passage of medication molecules into the blood from the site of administration?
Route of administration
Ability of the medication to dissolve
Blood flow to the site of administration
Body surface area
Factors that influence drug absorption
Factors that affect the rate and extent of medication distribution
After a medication reaches its site of action, it becomes ____________ into a less active or inactive form that is easier to excrete.
When renal function declines, a patient is at risk for medication ___________.
The ________ are the primary organ for drug excretion.
____________ effects are the expected or predictable physiological response to a medication.
_________ effects are predictable and often unavoidable secondary effects a medication will cause.
___________ effects are unintended, undesirable, and often unpredictable severe responses to medication.
__________ effects develop after prolonged intake of a medication or when a medication accumulates in the blood because of impaired metabolism or excretion.
___________ reactions are unpredictable effects in which a patient overreacts or underreacts to a medication or has a reaction that is different from normal.
____________ reactions are unpredictable responses to a medication.
___________ reactions are allergic reactions that are life threatening and characterized by sudden constriction of bronchiolar muscles, edema of the pharynx and larynx, and severe wheezing and shortness of breath.
____________ occurs when one medication modifies the action of another medication; it may alter the way another medication is absorbed.
A ___________ effect is when the combined effect of the two medications is greater than the effect of the medications when given separately.
The plasma level of medication below which the medication's effect will not occur is called the ________.
MEC (Minimum effective concentration)
What is highest serum level concentration of a medication called?
What is the lowest serum level concentration of a medication called?
The time it takes for the excretion process to lower the serum medication concentration by half is called what?
The biological half-life
The 3 types of oral routes
The 4 major sites for parenteral injections
What are administered in the epidural space via a catheter, and is usually used for postoperative analgesia?
What type of medication is administered via a catheter that is in the subarachnoid space or one of the ventricles of the brain?
What type of medication is administered directly into the bone marrow and is commonly used in infants and toddlers?
What type of medication, such a chemptherepeutic agents, insulin, and antibiotics, are administered into the peritoneal cavity?
What type of medication, commonly chemotherpeutics, are administered directly into the pleural space?
What type of medications are administered directly into the arteries?
What type of medications are administered directly into cardiac tissue?
What type of medications are injected into a joint?
What is readily absorbed and work rapidly because of the rich vascular alveolar capillary network present in the pulmonary tissue?
What is a given mass of solid substances dissolved in a known volume of fluid or a given volume of liquid dissolved in a know volume of another fluid?
3 measurements used in medication administration
What is the formula used to determine the correct dose when preparing solid or liquid forms of medications?
Dose ordered/Dose on hand x Amount on hand = Amount to administer
What kind of order is carried out until the prescriber cancels it by another order or until a prescribed number of days elapse?
Standing or routine order
What kind of order is a medication that is given only when a patient requires it?
What kind of order is given only once at a specific time?
Single or one-time order
What kind of order describes a single dose of a medication to be given immediately and only once?
How long does a nurse have to administer a medication that is ordered "now"?
What are the medication distribution systems?
Unit dose and Automated medication dispensing systems (AMDS)
Administration of the wrong medication
Giving the medication using the wrong route or time interval
Administering extra doses
Failing to administer a medication
Common medication errors that can cause a patient harm
Process of medication reconciliation
The 6 rights of medication administration
A patient may:
-be informed of a medication's name, purpose, action, and potential undesired effects
-refuse a medication regardless of the consequences
-have qualified nurses or physicians assess a medication history
-be properly advised of the experimental nature of medication therapy and give written consent
-receive labeled medications safely without discomfort
-receive appropriate supportive therapy
-not receive unnecessary medications
-be informed if medications are a part of a research study
Patient Care Partnership
History of allergies
Patient's perceptual coordination problems
Patient's current condition
Patient's attitude about medication use
Patient's knowledge and understanding of medication therapy
Patient's learning needs
Areas a nurse needs to assess to determine the need for and potential response to medication therapy
Ineffective Health Maintenance
Readiness for Enhanced Immunization Status
Effective Therapeutic Regimen Management
7 potential nursing diagnoses used during the administration of medications
Will verbalize understanding of desired effects and adverse effects of medications
Will state signs, symptoms, and treatment of hypoglycemia
Will monitor blood sugar to determine if medication is appropriate to take
Will establish a daily routine that will coordinate timing of medications with meal times
Outcomes for a patient with newly diagnosed type 2 diabetes
Factors that can influence a patient's compliance with medications regimen.
1. Patient's full name
2. Date and time that order is written
3. Medication name
5. Route of administration
6. Time and frequency of administration
7. Signature of provider
Components of medication orders
1. The name of medication
What needs to be on the medication record
Patient responds to therapy
Patient has the ability to assume responsibility for self-care
The goals for safe and effective medication administration
1. Determine the patient's ability to swallow and cough and check for gag reflex
2. Prepare oral medications in the form that is easiest to swallow
3. Allow the patient to self-administer medications if possible
4. If the patient has unilateral weakness, place the medication in the stronger side of the mouth
5. Administer pills one at a time, ensuring that each medication is properly swallowed before the next one is introduced
6. Thicken regular liquids or offer fruit nectars if the patient cannot tolerate thin liquids
7. Avoid straws because they decrease the control the patient has over volume intake, which increases the risk of aspiration
8. Have the patient hold the cup and drink it if possible
9. Time medications to coincide with meal times or when the patient is well rested and awake if possible
10. Administer medications using a different route if risk of aspiration is severe
Precautions to take when administering any oral preparation to prevent aspiration
1. Document where the medication was placed in the MAR
2. Assess if patient has an existing patch before application
3. Apply a noticeable label to the patch
4. Document removal of medications on the MAR
Guidelines to ensure safe administration of transdermal or topical medications
Decongestant spray or drops is the most common form of __________ instillation.
1. Avoid instilling any eye medication directly onto the cornea
2. Avoid touching the eyelids or other eye structures with the eye dropper or ointment tube
3. Use medication only for the patient's affected eye
4. Never allow a patient to use another patient's eye medication
4 principles for administering eye instillations
Vertigo, dizziness, and nausea are symptoms a patient can experience ear drops are not instilled at _________ temperature.
____________ medications come in suppositories, foam, jellies, and creams.
____________ suppositories are used to exert local effects (promoting defecation) or systemic effects (reducing nausea).
What type of inhaler delivers a measured dose of medication with each push of a canister and is often used with a spacer?
Pressurized metered-dose inhaler (pMDIs)
What type of inhaler releases medication when a patient raises a level and then inhales?
Breath-actuated metered-dose inhaler (BAIs)
What type of inhaler holds dry, powdered medication and creates an aerosol when the patient inhales through a reservoir that contains the medication?
Dry powder inhaler (DPI)
1. Draw medication from ampule quickly; do not allow it to stand open
2. Avoid letting the needle touch contaminated surface
3. Avoid touching the length of the plunger or inner part of the barrel
4. Prepare the skin, use friction and a circular motion while cleaning with an antiseptic swab, and start from the center and move outward
Aseptic techniques to prevent an infection during injection
Patient size and weight
Type of tissue into which the medication is to be injected
Factors to consider when selecting a needle for an injection
What contains a single dose of medication in a liquid?
What is a single dose or multidose container with a rubber seal at the top (closed system)?
1. Do not contaminate one medication with another
2. Ensure that the final dose is accurate
3. Maintain aseptic technique
3 principles to follow when mixing medications from two vials
_______ is classified the rate of action (rapid, short, intermediate, and long acting); each has a different onset, peak, and duration of action.
1. Maintain patient individual routine when preparing and administering their medication
2. Do not mix insulin with any other medication or dilutes
3. Never mix insulin glargine or insulin detemir with other types of insulin
4. Inject rapid-acting insulin mixed with NPH within 15 minutes of a meal
5. Verify insulin dosages with another nurse while preparing them
Principles to follow when mixing two types of insulin in the same syringe
1. Use a sharp beveled needle in the smallest suitable length and gauge
2. Position the patient as comfortably as possible to reduce muscle tension
3. Select the proper injection site
4. Apply a vapocoolant spray or topical anesthetic to the site if possible
5. Divert the patient's attention from the injection
6. Insert the needle quickly and smoothly
7. Hold the syringe while the needle remains in the tissue
8. Inject the medication slowly and steadily
Techniques used to minimize patient discomfort that is associated with injections
The outer posterior of the upper arm
The abdomen (below the costal margins to the iliac crest)
The anterior aspects of the thigh
Best sites for subcutaneous injections
What is the maximum amount of water-soluble medication given by the subcutaneous route?
0.5 to 1 mL
What angles should be used when administering a subcutaneous injection, and what needle should be used?
25-gauge, 5/8-inch needle inserted at a 45-degree angle, or a 1/2-inch needle inserted at a 90-degree angle
What is the angle of insertion for an intramuscular (IM) injection?
What is the maximum volume of medication for an IM injection for a well-developed adult?
What is the maximum volume of medication for an IM injection for older children, older adults, and thin adults?
What is the maximum volume of medication for an IM injection for older infants and small children?
What site of administration of injections is deep and away from nerves and blood vessels and is the preferred site for large volumes for adults, children, and infants, viscous and irritating solutions?
What site of administration of injections for adults and children due to well developed thick muscle; it is the lateral aspect of the thigh?
What site of administration of injections is easily accessible, is used for small volumes, not used in infants or children, and has a potential for radial and ulnar nerve damage?
What type of injection minimizes local skin irritation by sealing the medication in muscle tissue?
___________ injections are used in skin testing and is injected into the dermal layer where the medication is absorbed slowly.
Mixtures within large volumes of IV fluids
Injection of a bolus or small volume of medication
Methods of IV administration
Fast-acting medications must be administered quickly
It provides constant therapeutic blood levels
It can be used when medications are highly alkaline and irritating to the muscle and subcutaneous tissue
Advantages of IV administration of medication
It is the most dangerous method because there is no time to correct errors
A bolus may cause direct irritation to the lining of blood vessels
Disadvantages of IV bolus medications
What reduces the risk of rapid infusion by IV pust, allow for administration of medications that are stable for a limited time in a solution, and allow for control of IV fluid intake?
What is a small (35-250 mL) IV bag connected to short tubing lines that connects to the upper Y port of a primary infusion line?
What is a batter-operated machine that allows medications to be given in a very small amounts of fluid (5-60mL)?
A mini-infusion pump
What is a small (50-150 mL) container that attaches below the primary infusion bag?
A volume-control administration set
1. Cost saving
3. Increased mobility
5. Patient comfort
5 advantages of using intermittent venous access devises
A nurse preparing an insulin injection in which both regular and NPH will be mixed, which vial should the nurse inject air into first?
Into the vial from the long-acting insulin