Medication Administration Practices: Flushing and Transdermal Applications
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Questions and Answers

What is pharmacokinetics primarily concerned with?

  • Administering medication to patients
  • The manufacturing process of medication
  • Medication production in the laboratory
  • The study of medication absorption, distribution, metabolism, and excretion in the human body (correct)

    • Which factor affects the absorption route of medication based on the text?

  • Patient's age
  • Blood type of the patient
  • Ionization (pH of medication and site of absorption) (correct)
  • The color of the medication

    • Why does oral or enteral route have a lower rate of absorption compared to other routes?

  • The specific blood type of the patient
  • The medication being highly ionized
  • The presence of mucus in the gastrointestinal tract that delays medication movement (correct)
  • The color of the medication

    • What is a characteristic that makes intramuscular injection faster in absorption compared to subcutaneous injection?

    <p>Fat layer thickness in subcutaneous tissue</p> Signup and view all the answers

    Why is IV administration considered the fastest route for medication delivery?

    <p>Medication directly enters the circulatory system</p> Signup and view all the answers

    How can vomiting or diarrhea affect the absorption of medication in the body?

    <p>They may hinder or prevent proper absorption of medication</p> Signup and view all the answers

    What is a key reason for administering medication either 30 minutes before or after the scheduled time?

    <p>To prevent harm or substandard effects</p> Signup and view all the answers

    According to CMS regulations, what must healthcare facilities have in place regarding medication timing?

    <p>Policies and procedures for addressing medication timing</p> Signup and view all the answers

    What is an essential step for nurses to take before administering medication to a patient?

    <p>Review the client's MAR (Medication Administration Record)</p> Signup and view all the answers

    Why is it important for patients to know why a medication has been prescribed to them?

    <p>To improve patient compliance with the treatment</p> Signup and view all the answers

    What type of medications are considered 'time critical' and require immediate administration?

    <p>Medications with a narrow therapeutic window that must be given on time</p> Signup and view all the answers

    What is a crucial aspect of maintaining client safety concerning medication administration?

    <p>Maintaining an accurate list of every client's medication, including over-the-counter drugs</p> Signup and view all the answers

    What is the primary organ responsible for the removal of medication from the body?

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

    In medication metabolism, which enzyme in the liver plays a significant role?

    <p>Cytochrome P550</p> Signup and view all the answers

    Which medication is transformed into morphine during metabolism?

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

    What does Therapeutic Drug Monitoring help healthcare providers to monitor?

    <p>Medication concentration in blood</p> Signup and view all the answers

    What characterizes the through blood level of medication?

    <p>Lowest concentration correlating with elimination rate</p> Signup and view all the answers

    Which organ receives high vascular supply according to the text?

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

    What is meant by a 'blackbox warning' on a medication label?

    <p>The medication may produce serious adverse effects</p> Signup and view all the answers

    In medication metabolism, what influences metabolism related to age?

    <p>'Liver function and size' blood flow</p> Signup and view all the answers

    'Pharmacodynamics' studies how medication works concerning what two factors?

    <p>'Medication concentration and body response'</p> Signup and view all the answers

    'Adverse Drug Reactions' can range from tolerable to potentially causing what?

    <p>'Reversible damage or death'</p> Signup and view all the answers

    What is considered a medication error?

    <p>Any event that results in client injury during medication administration</p> Signup and view all the answers

    What technology helps reduce medication errors according to the text?

    <p>Automated medication dispensing systems</p> Signup and view all the answers

    What should nurses not resort to when problems arise during medication administration?

    <p>Using workarounds like overriding the system</p> Signup and view all the answers

    What should nurses do if an error occurs during medication administration?

    <p>Assess the client for any medical condition changes and notify the healthcare provider</p> Signup and view all the answers

    Which of the following is a strategy to reduce medication administration errors?

    <p>Recognize the client's right to refuse medications</p> Signup and view all the answers

    What is a potential complication associated with nasogastric, gastrostomy, or jejunostomy tubes?

    <p>Clogging of the tube due to medication administration</p> Signup and view all the answers

    How should tablets be handled to ensure proper administration?

    <p>Make sure they are not broken down before reaching the small intestine</p> Signup and view all the answers

    What is a characteristic of liquid medications according to the text?

    <p>Easier to swallow than solid medications</p> Signup and view all the answers

    What is the recommended volume of water for flushing before and after medication administration?

    <p>30 to 60 ML</p> Signup and view all the answers

    Where are ophthalmic medications typically placed?

    <p>On the mucus membrane of the eye</p> Signup and view all the answers

    What is the purpose of Punto occlusion or nasolacrimal inclusion during medication administration?

    <p>To prevent medication from entering the nasal lacrimal duct</p> Signup and view all the answers

    How should a nurse administer otic medications?

    <p>On the outer ear at room temperature</p> Signup and view all the answers

    What is the purpose of engaging in safe device disposal immediately after use?

    <p>To prevent needlestick injuries</p> Signup and view all the answers

    How should nasal medications be administered?

    <p>Within the nostrils</p> Signup and view all the answers

    What does a tuberculin syringe specifically measure?

    <p>'Under the skin' medication doses</p> Signup and view all the answers

    Why is it important for patients not to go to the bathroom within 20 minutes after receiving topical medications through rectal route?

    <p>To avoid accidental loss of medication</p> Signup and view all the answers

    What should a patient do after receiving a transdermal medication patch?

    <p>'Old patch should be removed - new patch supplied and rotated to different sites'</p> Signup and view all the answers

    What is the main consideration when selecting a site for medication administration?

    <p>Condition of the anticipated site</p> Signup and view all the answers

    Which route of medication administration involves delivering medication into large skeletal muscles?

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

    What is a common sign of inflammation of the vein when infusing intravenous fluid or medication?

    <p>Redness and heat around the vein</p> Signup and view all the answers

    Why are infants not administered intramuscular injections in the deltoid and gluteus maximus?

    <p>The muscles are not fully developed</p> Signup and view all the answers

    Why is transdermal medication administration in infants considered high risk?

    <p>Thin skin and rich blood supply</p> Signup and view all the answers

    What should a nurse inform clients about regarding their medication?

    <p>Potential side effects</p> Signup and view all the answers

    At what reading level should client education materials be ideally written according to literacy in medication administration?

    <p>6th grade level</p> Signup and view all the answers

    What is the severe life-threatening reaction with immune response that can cause respiratory distress, fever, and blisters?

    <p>Stephen Johnson syndrome</p> Signup and view all the answers

    Which substance is categorically teratogenic, causing fetal defects, pregnancy loss, and developmental disabilities?

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

    Why are iron preparations better absorbed with orange juice?

    <p>Vitamin C in orange juice enhances absorption</p> Signup and view all the answers

    What is the key factor influencing individual response to medication mentioned in the text?

    <p>Genetic factors</p> Signup and view all the answers

    What do children's dosages of medications typically consider in terms of metabolism and excretion?

    <p>Lack of metabolizing enzymes</p> Signup and view all the answers

    Why are older adults often challenged when it comes to absorbing, metabolizing, and excreting medications?

    <p>Less muscle mass</p> Signup and view all the answers

    What is polypharmacy as mentioned in the text?

    <p>&quot;Taking five or more medications&quot; situation</p> Signup and view all the answers

    What should nurses confirm before administering medication to ensure it's correct according to the text?

    <p>&quot;Right patient&quot; identification</p> Signup and view all the answers

    What must be administered within 30 minutes from placing the order according to the text?

    <p>&quot;Urgent or ASAP&quot;</p> Signup and view all the answers

    Study Notes

    Pharmacokinetics

    • Study of the absorption, distribution, metabolism, and excretion of medication in the human body
    • Factors affecting absorption:
    • Route of administration
    • Ionization (pH of medication and site of absorption)
    • Dissolution (medication must be dissolved before absorption)
    • Blood flow (medication absorbs rapidly when blood flow is high)
    • Lipid solubility (medication formation can have high or low lipids)
    • Surface area of the absorptive site
    • Client-specific factors (e.g. vomiting, diarrhea)

    Distribution

    • Process of delivering medication to the target organ or tissue
    • Factors affecting distribution:
    • Circulatory status (blood flow, medication solubility, and protein binding ability)
    • High vascular areas (heart, brain, liver, and kidney receive the greatest blood supply)
    • Low vascular areas (bone, skin, and adipose tissue receive less blood supply)

    Metabolism

    • Chemical process of converting medication structure
    • Factors affecting metabolism:
    • Liver enzyme (cytochrome P450) transformation
    • Age (e.g. infant, child, adult)
    • Genetic characteristics (e.g. race, ethnicity)
    • Disease states (e.g. liver, kidney, or heart failure)

    Excretion

    • Process of removing medication from the body
    • Factors affecting excretion:
    • Kidney function
    • Liver function
    • Heart function

    Pharmacodynamics

    • Study of how medication works in relation to medication concentration and body response
    • Therapeutic drug monitoring:
    • Used by healthcare providers to monitor medication levels
    • Important to ensure accurate medication administration and avoid adverse reactions

    Adverse Drug Reactions (ADR)

    • Unintended and undesired effects of medication
    • Types of ADR:
    • Allergic reactions
    • Hypersensitivity reactions
    • Anaphylaxis
    • Medication interactions

    Medication Administration

    • Right client:
    • Verify client identity
    • Check medical record number
    • Right medication:
    • Verify medication order
    • Check brand name or generic name
    • Right dose:
    • Calculate correct dosage
    • Check concentration and dosage form
    • Right route:
    • Verify administration route (e.g. oral, IV, topical)
    • Right time:
    • Check administration schedule
    • Verify timing of medication administration

    Medication Errors

    • Any avoidable event that results in incorrect medication use or client injury
    • Factors contributing to medication errors:
    • Interruptions during medication administration
    • Distractions (e.g. phone calls, conversations)
    • Lack of knowledge or education
    • Similar medication names or packaging

    Medication Reconciliation

    • Process of reviewing and verifying client medication lists
    • Important to ensure client safety and accurate medication administration

    Route of Administration

    • Three major categories: enteral, topical, and parenteral
    • Factors affecting route of administration:
    • Medication attributes (e.g. solid, liquid, gas)
    • Location of desired action (e.g. local, systemic)
    • Client conditions and adherence

    Medication Forms

    • Tablet:

    • Pressing and making sure of substance

    • Can be chewable or half-scored

    • Can be quick release, delayed release, or extended release

    • Capsule:

    • Soft and hard gelatin

    • Can be enteric-coated

    • Liquid:

    • Can be difficult to swallow

    • May be used for oral or enteral administration

    • Transdermal:

    • Allows for slow, sustained release of medication

    • Patches can be rotated to different sites

    • Ophthalmic:

    • Used for local infection or inflammation

    • Administered to the eye or conjunctiva

    • Otic:

    • Used for local infection or inflammation

    • Administered to the outer ear

    • Nasal:

    • Used for local infection or inflammation

    • Administered to the nostrils

    • Intravaginal:

    • Used for infections or to administer estrogen

    • Rectal:

    • Used for infections or inflammation

    • Administered to the rectum

    • Parenteral:

    • Includes intradermal, intramuscular, subcutaneous, and IV administration

    • Factors affecting parenteral administration:

    • Needle size and type

    • Viscosity of medication

    • Client's age, size, and condition### Selecting an Injection Site

    • Avoid inflamed areas to prevent false positive results

    • Deliver medication into adipose tissue due to abundant capillaries

    • Medications include insulin and low molecular weight heparin

    Factors to Consider for Medication Administration

    • Condition of the skin
    • Presence of lipohypertrophy
    • Amount of audible tissue
    • Age and size of the client
    • Amount of medication to be given (older adults: maximum of 1 ML)
    • Condition of the anticipated site (pain, mobility, edema, inflamed, bruises)

    Routes of Medication Administration

    • Intradermal
    • Subcutaneous
    • Intramuscular
    • IV (deliver fluid, nutrients, blood, and blood products)

    IV Infusion

    • Administer via an IV infusion set with 0.9% sodium chloride or dextrose 5% in water
    • Volume: 50-250 mg
    • Administer over a specific period of time: 30-90 minutes

    Central Access Devices

    • CBD (central access device) inserted into a large central vein
    • Directly delivers into central blood circulation
    • Examples: PIC, central catheter, and CVC (central venous catheter)

    Assessing for Complications

    • Flavis (inflammation of the vein): redness, pain, heat, and swelling
    • Infiltration: pain, swelling, redness, cool skin temperature around the insertion site
    • signs of IV fluid or medication leakage around the insertion site

    Administering Medication to Infants and Children

    • Infants: use a syringe without a needle or a dropper, held in a semi-reclining position to prevent aspiration
    • Toddlers and early school-age children: use a syringe or medicine cup
    • School-age children: able to swallow pills, tablets, and capsules

    Injection Sites for Infants and Children

    • Infants: deltoid and gluteus maximus muscles not fully developed, use vastus lateralis muscle instead
    • Use small gauge (25-30 G) needle to reduce pain
    • Inject 0.5-1 ML at a 90° angle, 1 inch deep
    • Toddlers: use deltoid muscle starting at 18 months, injecting 0.5-2 ML

    Transdermal Medication in Infants

    • High risk of toxicity due to thin skin and rich blood supply
    • Client education is crucial to ensure active role in medication regimen

    Medication Literacy

    • Average reading level of adult medication instructions: 8-9th grade level
    • 1/5 of Americans read at a 5th-grade level or lower
    • Recommended client education material: written at a 6th-grade level

    Role of the Nurse

    • Educate clients about medications and encourage active role in regimen

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    Description

    Learn about the importance of flushing before giving medication and between administering multiple medications. Understand the recommended flushing volumes and techniques for different routes of administration. Explore the benefits and considerations of transdermal applications for slow, long-lasting medication release.

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