Drug Administration: The Six Rights
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Questions and Answers

Which of the following is NOT one of the six rights of drug administration?

  • Right route
  • Right insurance (correct)
  • Right patient
  • Right time

    • What is the purpose of using two identifiers when verifying the right patient?

  • To ensure accurate documentation
  • To confirm patient identity accurately (correct)
  • To speed up the administration process
  • To verify the medication type

    • Which medication type best exemplifies PRN administration?

  • Blood pressure medication for hypertension
  • Antibiotics for infection treatment
  • Insulin for diabetes management
  • Pain medication for acute pain relief (correct)

    • What should a nurse do if they encounter an unclear order from a physician?

    <p>Clarify the order with the physician and document the clarification</p> Signup and view all the answers

    What is a medication error?

    <p>An event leading to incorrect medication administration</p> Signup and view all the answers

    To prevent errors, what should a nurse verify regarding drug calculations?

    <p>Double-check calculations with a colleague</p> Signup and view all the answers

    What is a major responsibility of nurses in medication management?

    <p>Final verification of medication before administration</p> Signup and view all the answers

    Which of the following actions will best help minimize medication errors?

    <p>Focusing on one task while administering medications</p> Signup and view all the answers

    What is the primary characteristic of transdermal medications?

    <p>They are absorbed through the skin.</p> Signup and view all the answers

    Which site is commonly used for subcutaneous injections?

    <p>Upper outer arm</p> Signup and view all the answers

    What is the angle of administration for intramuscular injections?

    <p>90 degrees</p> Signup and view all the answers

    What is the maximum volume allowed for an injection into the deltoid muscle?

    <p>2 milliliters</p> Signup and view all the answers

    Which part of the syringe connects the needle to the barrel?

    <p>Hub</p> Signup and view all the answers

    What is a characteristic of intravenous (IV) injections?

    <p>They provide the quickest absorption</p> Signup and view all the answers

    In the nursing process, which phase involves gathering data about the patient's medication needs?

    <p>Assessment</p> Signup and view all the answers

    Which type of injection is reserved for sensitivity testing?

    <p>Intradermal (ID) injection</p> Signup and view all the answers

    What is the expected action after injecting with a Z-track method?

    <p>Wait 10 seconds before releasing the tissue</p> Signup and view all the answers

    Which type of syringe is described as coming pre-filled with medication?

    <p>Pre-loaded syringe</p> Signup and view all the answers

    Which statement is true regarding essential components of medication orders?

    <p>The order must include the physician's signature to be valid.</p> Signup and view all the answers

    What is a key characteristic of unit dose dispensing systems?

    <p>They provide single-dose medications that are opened at the bedside.</p> Signup and view all the answers

    Which type of medication order requires administration within 30 minutes?

    <p>Now Order</p> Signup and view all the answers

    What is the primary purpose of pharmacy automation systems?

    <p>To improve the accuracy and efficiency of medication dispensing.</p> Signup and view all the answers

    Which practice is NOT recommended when handling medications?

    <p>Touching capsules or tablets with bare hands.</p> Signup and view all the answers

    What is a critical step before administering medications to a patient?

    <p>Always verify the patient's ability to swallow.</p> Signup and view all the answers

    When injecting medications intramuscularly (IM), what is a necessary step to ensure safety?

    <p>Aspirate before giving IM injections.</p> Signup and view all the answers

    How should ear drops be administered to avoid discomfort?

    <p>At room temperature to ensure comfort.</p> Signup and view all the answers

    What is NOT a requirement when preparing to administer parenteral medications?

    <p>Recapping dirty needles immediately after use.</p> Signup and view all the answers

    Why is it important to observe a patient taking their medication?

    <p>To confirm the patient is swallowing the medication correctly.</p> Signup and view all the answers

    What is a significant risk associated with medications that have similar names?

    <p>They may cause confusion leading to medication errors.</p> Signup and view all the answers

    What storage condition is necessary for some medications?

    <p>Certain medications require protection from light or refrigeration.</p> Signup and view all the answers

    What must be done before administering eye drops?

    <p>Clean the eye area of any discharge or drainage.</p> Signup and view all the answers

    What is a crucial practice when disposing of sharps containers?

    <p>They must be disposed of according to hospital policy.</p> Signup and view all the answers

    What technique should be used when administering a Z-track injection?

    <p>Change the needle before injecting.</p> Signup and view all the answers

    Which of the following actions is essential when administering intradermal injections?

    <p>Use a 25 to 27 gauge needle.</p> Signup and view all the answers

    What is a key requirement for applying transdermal patches?

    <p>Rotate sites to minimize skin irritation.</p> Signup and view all the answers

    What is the correct procedure for administering ear drops to a child under three years old?

    <p>Pull the ear lobe down and back.</p> Signup and view all the answers

    After administering medication, what should be done to ensure proper post-administration responsibilities?

    <p>Document the administration in the patient's chart immediately.</p> Signup and view all the answers

    What is the main purpose of using two methods of identification for verifying the right patient?

    <p>To prevent medication errors by confirming identity</p> Signup and view all the answers

    What does PRN stand for in relation to medication administration?

    <p>Pro Re Nata</p> Signup and view all the answers

    Which of the following is a key element of the right documentation process?

    <p>Documenting medication administration immediately after giving the medication</p> Signup and view all the answers

    What is a characteristic of multi-dose vials when used in medication administration?

    <p>They require special handling when opened</p> Signup and view all the answers

    How do automated dispensing systems contribute to medication management?

    <p>They track medications accessed and provide a log of transactions</p> Signup and view all the answers

    What should a nurse do immediately if they notice an error in a patient's medication administration?

    <p>Notify the physician, correct the mistake, and document the incident</p> Signup and view all the answers

    Why is it important for nurses to listen to patients regarding their medications?

    <p>Patients can provide information that may prevent medication errors</p> Signup and view all the answers

    What is the primary difference between a stat order and a now order?

    <p>A stat order must be administered within 15 minutes, while a now order should be given within 30 minutes.</p> Signup and view all the answers

    Why is it important to check the medication order against the patient's profile?

    <p>To confirm that the medication prescribed is safe for the patient.</p> Signup and view all the answers

    What should be done when drawing up medication from a vial?

    <p>Insert air into the vial equal to the air volume to be drawn up.</p> Signup and view all the answers

    What is the best practice regarding the administration of capsules?

    <p>Verify with a pharmacist if a capsule can be opened if needed.</p> Signup and view all the answers

    Which step is essential before administering medication via a tube?

    <p>Verify the placement of the tube.</p> Signup and view all the answers

    What should be done if blood is aspirated while giving an intramuscular injection?

    <p>Remove the needle, discard it, and redraw the medication.</p> Signup and view all the answers

    What should be done immediately after drawing up medication from an ampule?

    <p>Discard the ampule and needle in the sharps container.</p> Signup and view all the answers

    During which type of injection should the needle be inserted at a 90-degree angle?

    <p>Intramuscular injections.</p> Signup and view all the answers

    What is the primary reason for rotating injection sites for subcutaneous injections?

    <p>To avoid the formation of scar tissue.</p> Signup and view all the answers

    What is a key characteristic of enteric-coated medications?

    <p>They are designed to protect the stomach and dissolve in the intestine.</p> Signup and view all the answers

    Study Notes

    Drug Administration: The Six Rights

    • Six Rights: Right patient, right drug, right dose, right route, right time, right documentation
    • Right Patient: Verify using ID bracelet, medication administration record (MAR), and a second identifier (usually the date of birth).
    • Right Drug: Ensure the drug label matches the MAR and the drug in hand.
    • Right Dose: Confirm the correct dosage in milligrams, micrograms, or other units.
    • Right Route: Verify the intended route of administration (e.g., oral, intravenous, intramuscular).
    • Right Time: Administer medication consistently as per the MAR schedule.
    • Right Documentation: Record medication administration on the MAR; PRN medications should be documented in the nurse's notes as well.

    PRN Medications

    • PRN (Pro re nata) medications are given "as needed."
    • Examples: Pain medication, medications for nausea, constipation.
    • Documentation: Document pain level using a pain scale (0-10) before and after administering PRN medication.
    • Therapeutic Response: Monitor for desired effects (e.g., pain reduction), documenting in the nurse's notes.

    Patient Safety Goals

    • Accurate Patient Identification: Use at least two methods, such as ICN, full name, and date of birth.
    • Do Not Use List: Abide by the facility's "do not use" list of abbreviations, symbols, and acronyms to prevent errors.
    • Medication Errors: Any event leading to the wrong medication, dose, time, or route is a medication error.
    • Transcription Errors: Occur when physician orders are incorrectly transcribed onto the MAR or computerized system.
    • Dispensing Errors: Result from failure to check the six rights during medication retrieval and dispensing.
    • Administration Errors: Occur when the nurse fails to verify the six rights before administering medication.

    Preventing Medication Errors

    • Clarify Ambiguous Orders: If unable to read an order, contact the physician for clarification and document the clarification.
    • Drug Calculation Verification: Double-check drug calculations with another nurse.
    • Medication Appearance: If a patient questions the appearance of a medication, verify with the pharmacy.
    • Focus on One Task: Avoid multitasking while administering medications to minimize errors.

    Nurse's Role in Preventing Medication Errors

    • Nurses are the final line of defense in preventing medication errors.
    • Verify all medications using the six rights and appropriate technology (e.g., scanners).
    • Monitor for both therapeutic and non-therapeutic responses to medication.

    Medication Orders

    • Essential Components: Drug name, dose, route, time/schedule, and physician signature.
    • Clarification Orders: Document any order clarifications with the physician, indicating the date, time, and doctor's telephone number.

    Different Types of Medication Dispensing Systems

    • Unit Dose: Single-dose medications dispensed in sealed containers, opened only at the bedside.
    • Multi-Dose Vials: Contain multiple doses, requiring date and initialing upon opening.
    • Nursing Home Pill Packs: Pre-packaged medications for multiple days, requiring removal of pills as needed.
    • Stock Medications: Medications for common use, stored in large bottles, requiring sterile pouring techniques.
    • Automated Dispensing Systems: (e.g., Pyxis, Microcell): Technology-based system requiring user authentication and dispensing medications based on patient orders.

    Pharmacy Automation: A Giant Leap

    • Computerized systems in pharmacy can be used for dispensing medications, enhancing efficiency and accuracy.
    • Modern pharmacy automation systems can track the usage of narcotics, monitoring who accessed what drawers, ensuring accountability and potentially aiding investigations in case of missing medication.

    Orders and Their Types

    • Standing Order: Medications administered on a routine basis, like daily heart medications.
    • Single Order: A one-time medication order.
    • Stat Order: A one-time order requiring immediate administration, usually within 15 minutes.
    • Now Order: A one-time order requiring administration within 30 minutes.
    • Time Limit on Orders: Some medications, like pain medication and antibiotics, have time limits on their orders, needing to be reordered periodically.

    Medicine Handling Practices

    • Three checks are crucial when dispensing medication:
      • Check the order against the medication label.
      • Check the medication when retrieved from storage.
      • Check the medication before returning it to storage.
    • Never touch capsules or tablets.
    • Medications should be handled with clean hands, and gloves should be worn when manual manipulation like opening capsules or cutting tablets is necessary.
    • Never give medications that were prepared by someone else.
    • Avoid pouring liquid medication directly onto the label as it can render it illegible.

    Medication Safety

    • Double-check medications with similar names, like diphenhydramine and diphenhydramine. Even though a minor difference, it is crucial to avoid mistakenly giving Benadryl (diphenhydramine) instead of Dramamine (diphenhydramine).

    Medication Administration

    • Never give medication that you have not personally verified: This includes verifying the medication name, dosage, route, and time.
    • Never give medication that was not prepared by you: You must personally verify the contents and the medication before administering it.
    • Store medications properly: Some medications require special storage conditions, such as refrigeration or protection from light. Always store medications correctly to maintain their effectiveness.
    • Never crush tablets or open capsules without consulting a pharmacist: This is important to ensure that the medication is given in its intended form and that it does not become ineffective.
    • Verify the patient's ability to swallow: Before giving medication, make sure the patient can swallow safely.
    • Assess the need for assistance: Determine if the patient needs help taking their medication.
    • Provide a full glass of water: Ensure the patient has water available before administering medication.
    • Always observe the patient taking medication: Never leave medication at the bedside without observing the patient taking it.
    • Flush tubes before and after administering medication: This helps ensure the medication is delivered correctly and prevents clogging.
    • Always wear gloves when administering parenteral medications: This helps maintain cleanliness and reduces the risk of infection.
    • Cleanse the injection site properly: Use circular motions from the inside to the outside when cleaning the injection site.
    • Aspirate before giving IM injections: Aspirate (pull back) the plunger to check for blood return. If blood returns, the needle is in a blood vessel, and you need to remove the needle and start over.
    • Never recap dirty needles: Recap only needles that have not been used on a patient. Use the scoop method for recapping dirty needles.
    • Dispose of sharps containers properly: Sharps containers must be disposed of according to hospital policy.
    • Administer ear drops at room temperature: Avoid giving ear drops that are too cold or too hot to prevent discomfort, ringing in the ears (tinnitus), and dizziness.
    • Use one bottle of ear drops per person: Ear drops are for individual use only.
    • Never touch the tip of the ear drop applicator to the ear: This can contaminate the medication.
    • Pull the earlobe back and up for adults and children over three: Pull the earlobe down and back for children under three.
    • Keep patients in a reclined position for five to ten minutes after administering ear drops: This allows the medication to absorb properly.
    • Clean the eye area before administering eye drops: Remove any discharge or drainage from the eye before giving eye drops.
    • Never touch the tip of the medication container to the eye: This can contaminate the medication.
    • Apply pressure to the tear duct after instilling eye drops: This helps prevent systemic absorption of the medication.
    • Use lubricant when administering suppositories: Lubricants make the administration of suppositories more comfortable for the patient.

    Types of Medications

    • Parenteral medications: These are injectable medications.
    • Oral medications: These are taken by mouth.
    • Percutaneous medications: These are absorbed through the skin and mucous membranes.
    • Transdermal medications: These are absorbed through the skin and provide a more consistent blood level of the drug.

    Types of Syringes

    • Ampules: These are small glass vials that contain medication.
    • Vials: These are glass bottles that contain medication.
    • Pre-loaded syringes: These are syringes that come pre-filled with medication.
    • Insulin pens: These are devices that contain insulin and have a small needle for injection.

    Medication Routes

    • Subcutaneous (SQ) injections:
      • Given in the fatty tissue under the skin.
      • Sites:
      • Upper outer arm
      • Abdomen (two inches away from the umbilicus)
      • Anterior thighs
      • Back between the shoulder blades (usually reserved for allergy testing)
      • Angle for administration:
      • 45 degrees for average-sized adults
      • 90 degrees for obese patients
      • Volume: 0.5 to 1 milliliter
    • Intramuscular (IM) injections:
      • Given into a muscle.
      • Sites:
      • Deltoid (maximum 2 milliliters)
      • Vastus lateralis (maximum 3 milliliters, preferred site for children under three)
      • Ventrogluteal (maximum 3 milliliters)
      • Angle for administration: 90 degrees
    • Z-track injections:
      • A method of intramuscular injection used for irritating or staining medications.
      • Pull the skin and subcutaneous tissues laterally to the side before injecting the medication.
      • Wait 10 seconds after injecting before releasing the tissue.
    • Intravenous (IV) injections:
      • Given directly into a vein.
      • Absorbed most rapidly.
    • Intradermal (ID) injections:
      • Given into the upper layer of the skin.
      • Slow absorption for sensitivity testing.
      • Sites:
      • Forearm
      • Upper back (usually reserved for allergy testing)
      • Angle for administration: 15 degrees
      • Volume: Usually less than 0.1 milliliter

    Parts of a Syringe

    • Barrel: Holds the medication.
    • Plunger: Fits inside the barrel and helps draw up and inject the medication.
    • Tip: Holds the needle.
    • Hub: Connects to the syringe.
    • Shaft: The passageway for medication.
    • Bevel: The slanted, sharp end of the needle.

    Nursing Process and Medication Administration

    • Assessment: Gathering data about the patient's medication needs, allergies, and any factors that may affect their medication administration.
    • Diagnosis: Identifying nursing diagnoses related to medication administration and any problems that may arise (e.g., non-compliance, anxiety, knowledge deficit).
    • Planning: Developing a plan of care that includes goals for medication administration, teaching, and monitoring.
    • Implementation: Carrying out the plan of care, including administering medication, providing teaching, and monitoring for effects.
    • Evaluation: Assessing the effectiveness of the medication administration plan and adjusting as needed.

    Remember to always be cautious and practice safe medication administration!

    Drug Administration: The Six Rights

    • The six rights are: right patient, right drug, right dose, right route, right time, right documentation
    • Verify patient identity with ID bracelet, medication administration record (MAR), and a second identifier (usually date of birth)
    • Ensure drug label matches MAR and the drug in hand
    • Confirm dosage in milligrams, micrograms, or other units
    • Verify intended route of administration (e.g., oral, intravenous, intramuscular)
    • Administer medications consistently as per the MAR schedule
    • Record medication administration on the MAR; PRN medications should be documented in the nurse's notes as well.

    PRN Medications

    • Given "as needed"
    • Examples: pain medications, medications for nausea, constipation
    • Document pain level using a pain scale (0-10) before and after administering PRN medication
    • Monitor for desired effects (e.g., pain reduction)

    Patient Safety Goals

    • Use at least two methods for accurate patient identification (e.g., ICN, full name, date of birth)
    • Abide by the facility's "do not use" list of abbreviations, symbols, and acronyms
    • Any event leading to the wrong medication, dose, time, or route is a medication error
    • Transcription errors occur when physician orders are incorrectly transcribed onto the MAR or computerized system
    • Dispensing errors result from failure to check the six rights during medication retrieval and dispensing
    • Administration errors occur when the nurse fails to verify the six rights before administering medication

    Preventing Medication Errors

    • Clarify ambiguous orders with the physician and document the clarification
    • Double-check drug calculations with another nurse
    • Verify medication appearance with the pharmacy if questioned by the patient
    • Avoid multitasking while administering medications

    Nurse's Role in Preventing Medication Errors

    • Nurses are the final line of defense in preventing medication errors
    • Verify all medications using the six rights and appropriate technology (e.g., scanners)
    • Monitor for both therapeutic and non-therapeutic responses to medication

    Medication Orders

    • Essential components include drug name, dose, route, time/schedule, and physician signature
    • Document order clarifications with the physician, indicating the date, time, and doctor's telephone number

    Different Types of Medication Dispensing Systems

    • Unit Dose: Single-dose medications dispensed in sealed containers, opened only at the bedside.
    • Multi-Dose Vials: Contain multiple doses, requiring date and initialing upon opening.
    • Nursing Home Pill Packs: Pre-packaged medications for multiple days, requiring removal of pills as needed.
    • Stock Medications: Medications for common use, stored in large bottles, requiring sterile pouring techniques.
    • Automated Dispensing Systems: (e.g., Pyxis, Microcell): Technology-based system requiring user authentication and dispensing medications based on patient orders.

    Pharmacy Automation: A Giant Leap

    • Computerized systems can be used for dispensing medications, enhancing efficiency and accuracy.
    • Modern pharmacy automation systems can track the usage of narcotics, monitoring who accessed what drawers, ensuring accountability and potentially aiding investigations in case of missing medication.

    Orders and Their Types

    • Standing Order: Medications administered on a routine basis, like daily heart medications.
    • Single Order: A one-time medication order.
    • Stat Order: A one-time order requiring immediate administration, usually within 15 minutes.
    • Now Order: A one-time order requiring administration within 30 minutes.
    • Time Limit on Orders: Some medications, like pain medication and antibiotics, have time limits on their orders, needing to be reordered periodically.

    Medicine Handling Practices

    • Three checks are crucial when dispensing medication:
      • Check the order against the medication label.
      • Check the medication when retrieved from storage.
      • Check the medication before returning it to storage.
    • Never touch capsules or tablets.
    • Medications should be handled with clean hands, and gloves should be worn when manual manipulation like opening capsules or cutting tablets is necessary.
    • Never give medications that were prepared by someone else.
    • Avoid pouring liquid medication directly onto the label as it can render it illegible.

    Medication Safety

    • Double-check medications with similar names, like diphenhydramine and diphenhydramine.

    Medication Administration

    • Never give medication that you have not personally verified: This includes verifying the medication name, dosage, route, and time.
    • Never give medication that was not prepared by you: You must personally verify the contents and the medication before administering it.
    • Store medications properly: Some medications require special storage conditions, such as refrigeration or protection from light. Always store medications correctly to maintain their effectiveness.
    • Never crush tablets or open capsules without consulting a pharmacist: This is important to ensure that the medication is given in its intended form and that it does not become ineffective.
    • Verify the patient's ability to swallow: Before giving medication, make sure the patient can swallow safely.
    • Assess the need for assistance: Determine if the patient needs help taking their medication.
    • Provide a full glass of water: Ensure the patient has water available before administering medication.
    • Always observe the patient taking medication: Never leave medication at the bedside without observing the patient taking it.
    • Flush tubes before and after administering medication: This helps ensure the medication is delivered correctly and prevents clogging.
    • Always wear gloves when administering parenteral medications: This helps maintain cleanliness and reduces the risk of infection.
    • Cleanse the injection site properly: Use circular motions from the inside to the outside when cleaning the injection site.
    • Aspirate before giving IM injections: Aspirate (pull back) the plunger to check for blood return. If blood returns, the needle is in a blood vessel, and you need to remove the needle and start over.
    • Never recap dirty needles: Recap only needles that have not been used on a patient. Use the scoop method for recapping dirty needles.
    • Dispose of sharps containers properly: Sharps containers must be disposed of according to hospital policy.
    • Administer ear drops at room temperature: Avoid giving ear drops that are too cold or too hot to prevent discomfort, ringing in the ears (tinnitus), and dizziness.
    • Use one bottle of ear drops per person: Ear drops are for individual use only.
    • Never touch the tip of the ear drop applicator to the ear: This can contaminate the medication.
    • Pull the earlobe back and up for adults and children over three: Pull the earlobe down and back for children under three.
    • Keep patients in a reclined position for five to ten minutes after administering ear drops: This allows the medication to absorb properly.
    • Clean the eye area before administering eye drops: Remove any discharge or drainage from the eye before giving eye drops.
    • Never touch the tip of the medication container to the eye: This can contaminate the medication.
    • Apply pressure to the tear duct after instilling eye drops: This helps prevent systemic absorption of the medication.
    • Use lubricant when administering suppositories: Lubricants make the administration of suppositories more comfortable for the patient.

    Types of Medications

    • Parenteral medications: These are injectable medications.
    • Oral medications: These are taken by mouth.
    • Percutaneous medications: These are absorbed through the skin and mucous membranes.
    • Transdermal medications: These are absorbed through the skin and provide a more consistent blood level of the drug.

    Types of Syringes

    • Ampules: These are small glass vials that contain medication.
    • Vials: These are glass bottles that contain medication.
    • Pre-loaded syringes: These are syringes that come pre-filled with medication.
    • Insulin pens: These are devices that contain insulin and have a small needle for injection.

    Medication Routes

    • Subcutaneous (SQ) injections:
    • Given in the fatty tissue under the skin.
    • Sites: - Upper outer arm
      - Abdomen (two inches away from the umbilicus) - Anterior thighs - Back between the shoulder blades (usually reserved for allergy testing)
    • Angle for administration: - 45 degrees for average-sized adults - 90 degrees for obese patients
    • Volume: 0.5 to 1 milliliter
    • Intramuscular (IM) injections:
      • Given into a muscle.
      • Sites:
      • Deltoid (maximum 2 milliliters)
      • Vastus lateralis (maximum 3 milliliters, preferred site for children under three)
      • Ventrogluteal (maximum 3 milliliters)
      • Angle for administration: 90 degrees
    • Z-track injections:
      • A method of intramuscular injection used for irritating or staining medications.
      • Pull the skin and subcutaneous tissues laterally to the side before injecting the medication.
      • Wait 10 seconds after injecting before releasing the tissue.
    • Intravenous (IV) injections:
      • Given directly into a vein.
      • Absorbed most rapidly.
    • Intradermal (ID) injections:
      • Given into the upper layer of the skin.
      • Slow absorption for sensitivity testing.
      • Sites:
      • Forearm
      • Upper back (usually reserved for allergy testing)
      • Angle for administration: 15 degrees
      • Volume: Usually less than 0.1 milliliter

    Parts of a Syringe

    • Barrel: Holds the medication.
    • Plunger: Fits inside the barrel and helps draw up and inject the medication.
    • Tip: Holds the needle.
    • Hub: Connects to the syringe.
    • Shaft: The passageway for medication.
    • Bevel: The slanted, sharp end of the needle.

    Nursing Process and Medication Administration

    • Assessment: Gathering data about the patient's medication needs, allergies, and any factors that may affect their medication administration.
    • Diagnosis: Identifying nursing diagnoses related to medication administration and any problems that may arise (e.g., non-compliance, anxiety, knowledge deficit).
    • Planning: Developing a plan of care that includes goals for medication administration, teaching, and monitoring.
    • Implementation: Carrying out the plan of care, including administering medication, providing teaching, and monitoring for effects.
    • Evaluation: Assessing the effectiveness of the medication administration plan and adjusting as needed.

    Remember to always be cautious and practice safe medication administration!

    Six Rights of Drug Administration

    • Right Patient - Verify patient identity with two identifiers - ID bracelet and MAR (medication administration record) or ask for second identifier like date of birth.
    • Right Drug - Ensure the drug on the MAR and the drug in hand match.
    • Right Dose - Administer the correct dosage in milligrams, micrograms, etc.
    • Right Route - Choose the appropriate route - PO (oral), IV (intravenous), IM (intramuscular).
    • Right Time - Administer medication at consistent time as the MAR dictates.
    • Right Documentation - Record each medication administration on the MAR. Include details in the nurse's notes for PRN medications.

    PRN Medications

    • PRN stands for "pro re nata," meaning "as needed."
    • PRN medications are commonly prescribed for pain, nausea, constipation, etc.
    • PRN medications require documentation in both the MAR and the nurse's notes.
    • Monitor for therapeutic and non-therapeutic responses to medications to ensure effectiveness.

    Patient Safety Goals

    • Accurate client identification is crucial. Use at least two identifiers like ICN, name, and date of birth.
    • Avoid using abbreviations, symbols, and acronyms from the "do not use list" to prevent errors.
    • Nurses are the last line of defense against medication errors.

    Medication Error Prevention

    • Clarification Orders: Call the physician to clarify any unclear orders and document changes in the nurse's notes.
    • Double-Check Calculations: Always have another nurse verify drug calculations to ensure accuracy.
    • Listen to the Patient: If a patient questions a medication, always check it even if it appears correct.

    Types of Medications

    • Unit Dose: Individually packaged doses, typically opened at the bedside.
    • Multi-Dose Vial: Contains multiple doses. Requires dating and initials when opened.
    • Nursing Home Pill Packs: Pre-packaged medications with individual pills.
    • Stock: Large bottles of medications, typically used in long-term care facilities.
    • Computerized Dispensing Systems (Pyxis, Microcell): Automated dispensing systems that require a login and fingerprint verification.

    Automated Dispensing Systems

    • Automated dispensing systems function as electronic pharmacies offering quick and easy medication access.
    • These systems track medications in use and prevent potential theft.
    • Automated dispensing systems also keep a log of who accessed which medication and when.

    Types of Medication Orders

    • Standing Order: Routine medication given until a physician discontinues it or the time limit expires.
    • Single Order: A one-time only medication order
    • Stat Order: A one-time order to be given as soon as possible, typically within 15 minutes.
    • Now Order: A one-time order to be given within 30 minutes.

    Medication Administration Steps

    • Always check the medication order against the patient's profile.
    • Wash hands before handling medication.
    • Handle medication three times: when removing from storage, when removing from the container, and before returning to storage.
    • Never remove a medication if the label is illegible
    • Never touch capsules or tablets with bare hands
    • Use gloves when medication handling requires direct contact such as opening a capsule or crushing a tablet.
    • Be extra cautious when dispensing medications with similar names to prevent errors.
    • Never administer drugs prepared by anyone else.

    Medication Administration

    • Never give medication that you have not personally verified.
    • Never give medication that someone else has drawn up, even if you trust them.
    • Return drugs requiring special storage to the storage area immediately after preparation.
    • Never crush tablets or open capsules without consulting the pharmacist.
    • Always verify a patient’s ability to swallow before giving medications.
    • Assess the need for assistance before administering medication.
    • Give a full glass of water with each dose.
    • Never leave medication at the bedside unless there is a specific order to do so.
    • Always observe patients taking medication and ensure they swallow it.
    • Always check the placement of a tube before administering medication through it.
    • Flush the tube before and after administering medication through it.
    • Avoid food or drink when using buccal or sublingual medicatons.

    Types of Oral Medications

    • Powder medications need to be mixed with a liquid, usually water.
    • Tablets are round, solid drug forms.
    • Scored tablets have a line in the center making it easier to break in half.
    • Enteric-coated medicines are coated to protect the stomach and dissolve in the intestine.
    • Capsules contain powder or pellets and may need to be crushed for tube feeding.
    • Lozenges or troches are medications that you put in your mouth and suck on until they dissolve.
    • Liquids and suspensions need to be shaken before administration to ensure a consistent dose.

    Administration of Parenteral Medications

    • Always wear gloves before giving an injection.
    • Cleanse the skin properly using a circular motion from inner to outer and wait for it to dry before injecting.
    • Aspirate (pull back on the plunger) when giving IM injections to ensure you are not in a blood vessel.
    • If blood is aspirated, remove the needle, discard it, and redraw the medication.
    • Apply pressure to the injection site after withdrawing the needle to minimize bleeding.
    • Never recap dirty needles.
    • Use the scoop method to recap needles if a sharps container is not immediately available.
    • Dispose of sharps in an approved sharps container.

    Ampules

    • Tap the ampule to ensure all medication has gone to the bottom.
    • Use an alcohol prep to break the ampule, snapping away from you and the patient.
    • Tighten the needle on the syringe only once to avoid it unscrewing.
    • Hold the ampule upside down and insert the needle into the neck.
    • Slowly pull back on the plunger to draw up the medication.
    • Recap the needle after drawing up the medication, as it has not yet been in a patient's body.

    Vials

    • Cleanse the rubber stopper of the vial in a circular motion.
    • Inject an equal amount of air into the vial as the medication you are going to withdraw.
    • Turn the vial upright and withdraw the medication, leaving a slight excess.
    • Tap the syringe to remove any air bubbles.
    • Do not reinsert the needle into the vial after withdrawing medication.

    Pre-Loaded Syringes

    • Two-bags systems: insert the needle into the syringe, tighten needle's connection, push the little piece into the syringe, and screw it in.
    • Carpuject systems: insert the cartridge into the syringe, twist the end to tighten it, push the medication, and dispose of the cartridge.
    • Always dispose of the pre-loaded syringe into the sharps container.

    Subcutaneous Injections

    • Administered in fatty tissue.
    • Common sites: upper arms, abdomen (two inches away from the umbilicus), anterior thighs, upper back (between shoulder blades).
    • Volume: 0.5 to 1 milliliter.
    • Angle: 45 degrees (90 degrees for obese patients)
    • Needle size: 23 to 25 gauge, 3/8 to 5/8 inch.
    • Do not aspirate
    • Rotate injection sites to avoid lipodystrophy.

    Intramuscular Injections

    • Administered deeper into muscles for more rapid absorption than subcutaneous injections.
    • Common sites: deltoid, vastus lateralis, ventrogluteal.
    • Deltoid: Maximum 2 milliliters, below the acromion process, above the top of the armpit.
    • Vastus lateralis: Preferred site for children under three, up to 3 milliliters, midpoint on the outer side of the thigh.
    • Ventrogluteal: Up to 3 milliliters, use landmarks on the buttocks: greater trochanter, anterior iliac spine, and crest. Can be painful.
    • Angle: 90 degrees.
    • Needle size: 22 gauge, 1 to 1.5 inches (thicker medications may require a larger needle).
    • Aspirate unless giving anticoagulants like heparin or Lovenox, as it can cause tissue damage and increase the risk of bleeding

    Z-Track Injections

    • Used for medications that are irritating to the tissues.
    • Change the needle after drawing up the medication.
    • Draw 0.1 to 0.2 milliliters of air into the syringe to create an air bubble at the end and seal the medication in the muscle.
    • Pull the skin and subcutaneous tissue laterally to the side about one inch and inject.
    • Wait 10 seconds before releasing the tissue.

    Intravenous Medications

    • Administered directly into the bloodstream for the most immediate effect.
    • Will be covered in detail in a future semester.

    Intradermal Injections

    • Used for sensitivity testing.
    • Slow absorption allows for good results.
    • Common sites: anterior forearm, upper back.
    • Volume: 0.1 milliliter.
    • Needle size: 25 to 27 gauge, 1/4 to 5/8 inch.
    • Use a TB syringe.
    • Angle: 15 degrees, bevel up.
    • Wheel should form if administered correctly.
    • Do not aspirate or massage after injection.

    Parts of a Syringe

    • Barrel: Contains the medication, measured in milliliters or units (for insulin syringes).
    • Plunger: Fits inside the barrel, draws up and injects the medication.
    • Tip: Holds the needle.
    • Hub: Connects to the syringe, color-coded.
    • Shaft: passageway for medication.
    • Bevel: Slanted, sharp edge of the needle, eases insertion.

    Percutaneous Medications

    • Absorbed across the skin and mucous membranes.
    • Always wear gloves when administering percutaneous medications.
    • Monitor for skin irritations.

    Patches

    • Apply a new patch to a new site.
    • Clean the old patch site with soap and water before applying a new one.
    • Fold used patches in on themselves and dispose of them properly, including in a sharps container for narcotic patches.

    Transdermal Medications

    • Absorbed across the skin, providing a more consistent blood level of medication.
    • Apply to a non-hairy area.
    • Date, time, and initial the application site.
    • Rotate application sites.

    Ear Drops

    • Use room temperature drops.
    • Never touch the tip of the applicator to the ear.
    • Adults and children over three: pull the ear lobe back and up.
    • Children under three: pull the ear lobe down and back.
    • Have the patient remain in the position for five to ten minutes after administration to allow absorption.

    Ophthalmic Medications

    • Should say "ophthalmic" for eye use only.
    • Apply pressure to the tear duct to prevent systemic absorption.
    • Drops should be placed in the lower conjunctival sac, not directly on the eyeball.
    • Ointments should be applied along the inner lower eyelid from inner to outer.
    • Clean the eyes with any exudate or drainage before administering medication.
    • Do not touch the tip of the medication container to the eye.

    Suppositories

    • Use lubricant to facilitate insertion.
    • Position the patient on their left side with their lower leg pulled up.
    • Insert the suppository all the way into the rectum or vagina.
    • Ensure it is adequately lubricated before insertion to minimize discomfort.

    Inhalation Medications

    • Administer with slow, deep breaths.
    • Have the patient depress the delivery mechanism while inhaling.
    • Wash the mouthpiece after each use.
    • Shake the inhaler before administration.
    • Administer the full number of puffs as prescribed by holding the breath for as long as possible between puffs.
    • Spacers can be used to increase medication delivery and reduce side effects.

    Insulin Pens

    • Dial the desired dose.
    • Inject the medication with a small needle.
    • Retract the needle and dispose of it in a sharps container.
    • Insulin pens are multi-dose and can be used multiple times.

    Post-Administration Responsibilities

    • Record the medication administration in the patient's chart as soon as possible.
    • Document the need for any assistance with medication in the nursing record.
    • Evaluate the patient's response to the medication.

    Nursing Process

    • Assessment
    • Gather baseline data (initial) and ongoing data (while medication is being taken).
    • Diagnosis
    • ** Identify potential nursing diagnoses related to medication administration, such as knowledge deficit, noncompliance, or anxiety.**
    • Planning
    • Develop goals and expected outcomes for the medication.
    • Identify appropriate nursing interventions.
    • Create a teaching plan.
    • Implementation
    • Administer medication following the six rights.
    • Implement nursing interventions.
    • Educate the patient about the medication
    • Evaluation
    • Monitor the patient for adverse effects.
    • Assess the effectiveness of the medication.

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    Description

    This quiz covers the critical aspects of medication administration known as the Six Rights. These include verifying the right patient, drug, dose, route, time, and documentation. Additionally, it touches on PRN medications and their appropriate use and documentation.

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