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Questions and Answers
What step in the nursing process is used to gather comprehensive data about a patient's health condition and medications?
What step in the nursing process is used to gather comprehensive data about a patient's health condition and medications?
What is a critical action a nurse must take after receiving a medication order?
What is a critical action a nurse must take after receiving a medication order?
Which factor is essential for planning medication administration?
Which factor is essential for planning medication administration?
In medication administration, what should a nursing care plan include to ensure comprehensive care?
In medication administration, what should a nursing care plan include to ensure comprehensive care?
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What is the primary purpose of the 9 Rights of Drug Administration?
What is the primary purpose of the 9 Rights of Drug Administration?
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Which of the following best describes contraindications?
Which of the following best describes contraindications?
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What is a black box warning?
What is a black box warning?
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What is the primary effect of digoxin on the heart's activity?
What is the primary effect of digoxin on the heart's activity?
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In what organ does the majority of drug metabolism occur?
In what organ does the majority of drug metabolism occur?
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If a drug has a long half-life, what implication does this have for dosing frequency?
If a drug has a long half-life, what implication does this have for dosing frequency?
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What should a nurse do if a patient shows signs of a rash and has been scheduled to receive penicillin?
What should a nurse do if a patient shows signs of a rash and has been scheduled to receive penicillin?
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Which is correct regarding the right patient verification process before medication administration?
Which is correct regarding the right patient verification process before medication administration?
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What is a critical factor to consider when administering medications to patients with altered body weight or liver function?
What is a critical factor to consider when administering medications to patients with altered body weight or liver function?
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What should a nurse remember regarding the route of administration of medications?
What should a nurse remember regarding the route of administration of medications?
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Which action should be taken to ensure the right time for administering medication?
Which action should be taken to ensure the right time for administering medication?
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What practice should be employed to prevent errors in drug administration?
What practice should be employed to prevent errors in drug administration?
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Which of the following describes the right dose in medication administration?
Which of the following describes the right dose in medication administration?
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What is a key consideration when administering high-alert medications like insulin or heparin?
What is a key consideration when administering high-alert medications like insulin or heparin?
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What is the main purpose of medication reconciliation in healthcare?
What is the main purpose of medication reconciliation in healthcare?
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What does a high-alert drug indicate?
What does a high-alert drug indicate?
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Which order type requires immediate administration without delay?
Which order type requires immediate administration without delay?
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What is the effect of an antagonist drug at a receptor site?
What is the effect of an antagonist drug at a receptor site?
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Which of the following is a common cause of medication errors?
Which of the following is a common cause of medication errors?
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What does pharmacodynamics study?
What does pharmacodynamics study?
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What is the purpose of a black box designation for a drug?
What is the purpose of a black box designation for a drug?
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Which process involves the conversion of a drug into its active form in the body?
Which process involves the conversion of a drug into its active form in the body?
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What type of prescription details the administration of a medication until it is discontinued or for a set number of doses?
What type of prescription details the administration of a medication until it is discontinued or for a set number of doses?
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Why is it important to evaluate the therapeutic effects of a drug?
Why is it important to evaluate the therapeutic effects of a drug?
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What should a nurse do if a patient refuses a medication?
What should a nurse do if a patient refuses a medication?
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Which of the following actions must be followed when administering controlled substances?
Which of the following actions must be followed when administering controlled substances?
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Which describes expected side effects of medication?
Which describes expected side effects of medication?
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What is considered a serious adverse effect of medication?
What is considered a serious adverse effect of medication?
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What does the principle of autonomy imply for patient medication?
What does the principle of autonomy imply for patient medication?
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What should be included on a legal prescription for medication?
What should be included on a legal prescription for medication?
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What must a nurse do if a medication error occurs?
What must a nurse do if a medication error occurs?
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The 9 Rights of Drug Administration serve primarily to enhance hospital revenue.
The 9 Rights of Drug Administration serve primarily to enhance hospital revenue.
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Clinical judgment is solely based on subjective data collected from patient reports.
Clinical judgment is solely based on subjective data collected from patient reports.
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Legal responsibility in nursing varies across states as defined by the Nurse Practice Act.
Legal responsibility in nursing varies across states as defined by the Nurse Practice Act.
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Subjective data refers to observable information that can be measured by any healthcare provider.
Subjective data refers to observable information that can be measured by any healthcare provider.
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A black box warning indicates that a medication poses no risk to patients.
A black box warning indicates that a medication poses no risk to patients.
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Study Notes
Key Terms
- 9 Rights of Drug Administration: A set of nursing actions to minimize medication errors and protect the patient.
- Assessment: The first step in the nursing process, gathering information about the patient to plan care.
- Clinical Judgement: A combination of critical thinking and decision-making, resulting in an observed outcome.
- Contraindication: A medical reason why a specific drug should not be given to a patient.
- Evaluation: Assessing the effectiveness of treatment by observing the patient's response to the nursing care plan.
- Identifiers: Information used to positively confirm a patient's identity for medication administration.
- Nursing Process: A methodical system for nurses to guide their work including assessment, diagnosis, planning, implementation, and evaluation.
- Objective Data: Information that can be directly observed by others, such as vital signs or physical examinations.
- Planning: Utilizing information gathered in the assessment to set short- and long-term goals for patient care.
- Subjective Data: Information reported by the patient, such as feelings or thoughts about their condition.
- PRN Drug Order: An order for medication to be given as needed based on a nurse's clinical judgement.
- Black Box Warning: An FDA designation indicating a drug carries a higher-than-normal risk of serious or life-threatening problems.
- Emergency or Stat Drug Order: A one-time order for immediate administration of a drug.
- Legal Responsibility: The nurse's authority defined by state Nurse Practice Acts, guiding their actions and judgments during professional duties.
- Nurse Practice Act: State law that licenses nurses, setting educational and professional requirements for safe practice.
- Professional Responsibility: The nurse's obligation to act ethically and competently as healthcare providers.
The Role of the LPN/LVN
- Provide nursing care for patients of all ages.
- Work in various settings including hospitals, nursing homes, assisted living, outpatient clinics, home health, psychiatric facilities, hospices, and rehabilitation centers.
- Focus on safe, high-quality, and cost-effective care.
- Safely administer and monitor medications before and after administration.
The Nursing Process for Medication Administration
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Assessment:
- Gather information about the patient's health condition.
- Collect subjective and objective data.
- Obtain a complete medication history, including prescription, over-the-counter, herbal, and dietary supplements.
- Consider factors affecting drug therapy, such as allergies, disease conditions, and previous drug experiences.
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Diagnosis:
- Identify the patient's disease or condition.
- Use knowledge of the diagnosis to contribute to the plan of care.
- Address key questions, including:
- Patient's major health problems
- Likely necessary drugs
- Special knowledge or equipment required
- Patient's concerns and cultural beliefs
- Patient's understanding of their treatment and medications
- Factors affecting self-care abilities
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Planning:
- Collaborate with nurses, patients, and caregivers.
- Set short- and long-term goals for patient care.
- Ensure accurate medication orders by:
- Verifying the drug administration record against the original order.
- Checking the medication prior to administration to the patient.
- Understanding the provider's order and the reason for medication administration.
- Addressing any questions about medication safety before administration.
- Hold the medication if any part of the order is unclear, the patient's condition might worsen, or if there are concerns regarding the provider's information or the patient's condition.
- Notify the charge nurse and nursing supervisor immediately if the provider cannot be contacted or does not address concerns.
- Develop a teaching plan for the patient, including information about the drug's action, side effects, and correct administration.
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Implementation:
- Implement the care plan by safely administering medications to the patient.
- Apply knowledge of the drug's expected action.
- Document medication administration in the patient's medical record after giving the medication.
- Employ the "Nine Rights of Drug Administration" to ensure patient safety.
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Nine Rights of Drug Administration:
- Right Patient: Use at least two identifiers to confirm the correct patient (full name, medical record number, date of birth, telephone number).
- Right Drug: Check the drug label at least three times to ensure accurate medication.
- Right Dose: Verify the correct amount of medication based on the healthcare provider's order.
- Right Route: Ensure the medication is in the prescribed form and administer via the intended route.
- Right Time: Administer the medication at the correct time according to the order, agency guidelines, and drug-specific considerations.
- Right Reason: Understand the rationale for administering the medication to the patient.
- Right Documentation: Record medication administration in the patient's medical record accurately and promptly.
- Right to Refuse: Respect the patient's right to refuse medications, clarify reasons, provide patient teaching, and document the refusal.
- Right Response: Evaluate the patient's response to the drug, including therapeutic effects, expected side effects, and adverse effects.
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Evaluation:
- Evaluate the patient's response to the medication.
- Assess expected and unexpected findings.
- Observe for signs of improvement, side effects, adverse effects, or allergic responses.
- Monitor for therapeutic effects, expected side effects, and adverse effects.
- Document any side effects or adverse effects.
Legal and Ethical Considerations
- Nurses must understand the impact medication administration has on patient health and safety.
- Mixing medications, crushing pills, or opening capsules require careful consideration and may have legal and ethical consequences.
Regulation of Drug Administration
- Nurses follow federal, state, and agency rules regarding medication administration.
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Federal Laws:
- Ensure drug safety and effectiveness.
- Regulate drugs that may be abused and dangerous.
- Classify drugs into three categories:
- Controlled Substances: Highly regulated due to potential for abuse.
- Prescription Drugs: Require a healthcare provider's order.
- Over-the-Counter Drugs: Available without prescription.
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State Laws:
- Define the legal scope of practice for nurses, including medication administration.
- Specify requirements for LPN/LVN licensing.
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Hospital or Agency Rules:
- Provide specific guidelines for medication administration within the healthcare setting.
Controlled Substances
- Controlled substances require regular inventory to prevent diversion.
### Legal Prescriptions
- Legal prescriptions are required for all drugs administered in hospitals and long-term care facilities.
- Prescriptions must include patient's full name, date, drug name, route of administration, dose, frequency, duration, and prescriber's signature.
- Additional details can be added to the prescription, such as "Take with meals" or "Do not refill".
Types of Medication Orders
- Standing order: Indicates drug administration until discontinued or for a specific number of doses.
- Emergency/STAT order: One-time order for immediate administration.
- Single drug order: One-time order for administration at a designated time.
- As-needed/PRN order: Administration based on the nurse's judgment of patient need.
Medication Errors
- Medication errors can be costly and potentially fatal.
- Errors can occur during drug preparation, transportation to the patient, or administration.
- Fast pace, low staffing, multitasking, and interruptions can contribute to medication errors.
- All medication errors must be reported.
- Patient monitoring is essential following a medication error (e.g., vital signs, labs, frequent assessments).
- Investigations are conducted to prevent future errors.
- Nurses may be held liable for negligence or carelessness.
- Agency policies should be followed to minimize interruptions and prevent errors.
- Abbreviations should be avoided to reduce confusion.
High-Alert Drugs
- High-alert drugs have a high risk of harm if an error occurs.
- Errors can happen when the wrong patient receives the drug, an incorrect dose is administered, or the prescribed dose is omitted.
- Common high-alert drug categories include potassium (cardiac indications), insulin (hyper- or hypoglycemia), narcotics (opioids), chemotherapy drugs, and heparin (increased bleeding risk).
Black Box Designation
- Assigned by the FDA to drugs with a higher-than-normal risk of serious or life-threatening problems.
- Prescribers consider risk vs benefit when prescribing these drugs.
- Patients taking these medications are closely monitored.
Medication Reconciliation
- Practice of comparing patient's medication orders with all medications they are currently taking.
- Helps prevent medication errors like wrong dosages, duplication, or missing medications.
- The nurse compares the prescribed medication list with the patient's existing medications.
Protection of Healthcare Workers
- Unsafe clinical practices (e.g., recapping syringes) can lead to injury and exposure to bloodborne pathogens.
- Hospitals must have a written plan for reducing needlestick injuries.
- Equipment to prevent needlesticks includes sharps containers and needless devices.
- Exposure control plans are reviewed annually.
Pharmacokinetics & Pharmacodynamics
- Pharmacokinetics: What the body does to the drug.
- Pharmacodynamics: What the drug does to the body.
- Pharmacotherapeutics: The use of drugs in disease treatment.
Drug Names
- Important to know both generic and trade names of drugs to prevent errors.
- Generic name: Not capitalized, most commonly used.
- Trade (brand) name: Name used by the drug manufacturer.
- Chemical name: Describes the drug's atomic/molecular structure (rarely used).
Drug Attachment
- Drugs interact with receptor sites on body cells.
- Receptor sites control substance entry and cell activity.
- Drugs that activate receptors are known as receptor agonists.
- Partial agonists have a partial activating effect.
- Antagonists bind to receptor sites but do not activate them, blocking the action of agonists.
Basic Drug Processes
- Drugs undergo chemical changes in the body to become usable.
- Absorption: How the drug enters the body and reaches circulation.
- Distribution: Drug travels through the body to the target organ or tissue.
- Metabolism (Biotransformation): Breakdown of drugs by enzymes in the liver, lungs, kidneys, blood, and intestines.
- Excretion: Elimination of drug metabolites from the body.
Timing of Medication Dose Responses
- Half-life: Time required for 50% of the drug to be removed from the body.
- Onset of action: Time taken for a drug to produce a therapeutic effect.
- Peak action: Time for a drug to reach its highest effective concentration.
- Trough: Minimum blood serum concentration of a medication before the next dose.
- Duration of action: Time period during which the drug is effective.
- Plateau: Blood serum concentration maintained after repeated doses.
Drug Responses
- Desired action: Expected therapeutic effect of the drug.
- Side effects: Predictable and unavoidable adverse effects.
- Adverse effects: Unintended, undesired, and unpredictable responses.
- Idiosyncratic responses: Strange, unique, or unpredictable reactions.
- Paradoxical response: Opposite effect from the expected drug action.
-
Hypersensitivity: Increased reaction to a drug.
- Allergy: Sensitivity caused by an antibody response.
- Anaphylactic reaction: Life-threatening allergic reaction.
Drug Interactions
- One drug can alter the action of another.
- Interactions often occur during liver metabolism.
- Additive effect: Combined drugs produce a greater therapeutic effect than individually.
- Antagonistic effect: One drug interferes with the action of another.
- Synergistic effect: Combined drugs have a greater effect than the sum of their individual effects.
Personal Factors Influencing Drug Therapy
- Medication tolerance: Patients need higher doses for the same therapeutic effect over time.
- Dehydration, overhydration, low blood pressure, shock, heart failure, and reduced blood flow: Can affect drug distribution.
- Alcohol or illicit drug use: Can increase metabolic enzyme activity.
- Liver or kidney problems: Can lead to drug retention and increased risk of toxicity.
- Body size and lean-to-fat ratios: Affect drug dosage requirements.
- Ethnicity and genetic makeup: Can influence drug responses.
Medication Administration Considerations
- Special populations require careful medication administration due to physiological differences.
- Pediatric patients experience growth, body fat, and body water changes impacting drug responses.
- Pregnant or breastfeeding patients require careful consideration of drug risks to both mother and fetus.
- Older adults may experience altered drug processing due to aging, leading to a higher risk of adverse effects.
- Polypharmacy (use of multiple medications) is common in older adults, increasing the complexity of medication management.
Medication Administration Best Practices
- Nurses must understand patient conditions and prescribed medications.
- Drug cards are useful for learning and remembering frequently prescribed medications.
- Never administer unfamiliar medications without understanding their purpose.
Essential Components of a Drug Card
- Trade and generic name
- Dosage range (individual patient dosage should be specific)
- Desired action
- Expected side effects (minimum of 3)
- Adverse effects
- Classification (helps group medications and understand their mechanisms)
- Nursing implications (minimum of 3)
- Contraindications
Practical Medication Administration Activities
- Students should create drug cards for a variety of medications.
- Examples:
- Intravenous (IVPB): Vancomycin
- Oral: Warfarin, Metoprolol
- Inhaled: Albuterol
- Injectable (subcutaneous): Novolin R
Drug Card Content
- Drug classification
- Trade and generic name
- Desired action
- Expected side effects
- Adverse effects
- Nursing implications
- Contraindications
Medication Evaluation Tool
- Students should be able to provide a drug profile for all medications administered.
- Key elements:
- Generic and trade name
- Drug classification
- Expected action
- Reason for administration
- Safe dose range
- Contraindications
- Side effects (3)
- Nursing implications (3)
- Patient teaching (3)
Medication Administration Skills Lab
- Students will practice providing drug knowledge and administer medications to simulated patients.
- Example medications used in the lab:
- Metoprolol succinate ER
- Coumadin
- Novolin R
- Vancomycin
- Albuterol sulfate
- Dextrose 50%
Controlled Substances
- Controlled substances are regularly counted to prevent drug diversion.
- Legal prescriptions must include patient's full name, date, drug name, route of administration, dose, frequency, duration, and prescriber's signature.
Medication Orders
- Standing orders are for drugs given until discontinued or for a certain number of doses.
- Emergency or STAT orders indicate immediate administration once.
- Single drug orders are for one-time administration at a specified time.
- As needed (PRN) orders are for drugs given based on patient need and nurse's judgment.
Medication Errors
- Medication errors are costly and can lead to patient deaths.
- Errors can occur during drug preparation, transport, and administration.
- Fast pace, low staffing, multitasking, and interruptions increase the risk of errors.
- All medication errors must be reported.
- Nurses may be held professionally and/or legally liable for negligence or carelessness.
- Agency policies and minimizing interruptions help prevent errors.
- Abbreviations are discouraged due to confusion, use "Do Not Use" lists for high-alert medications.
High-Alert Drugs
- High-alert drugs pose a high risk of harm when medication errors occur.
- Errors can occur when incorrect patients receive the drug, or incorrect doses are administered.
- Common high-alert drug categories include potassium, insulin, narcotics, chemotherapy drugs, and heparin.
Black Box Designation
- The FDA assigns Black Box Designation to drugs with a higher risk of serious or life-threatening problems.
- Prescription considers the risks versus benefits when prescribing these drugs.
- Patients taking these medications are closely monitored by the prescriber.
Medication Reconciliation
- Medication reconciliation compares patient's medication orders with their current medications.
- This helps prevent medication errors like wrong dosages, duplication, or omissions.
- The nurse compares the prescribed medication list with the patient's actual medications.
- The list should include OTC drugs, herbal supplements, vitamins, and prescription medications.
Protection of Healthcare Workers
- Unsafe clinical practices, such as recapping syringes, can increase exposure to bloodborne pathogens (Hepatitis B, Hepatitis C, HIV).
- Hospitals must have plans to reduce needlestick injuries.
- Use equipment such as sharps containers and needless devices to prevent needle sticks.
Drug Processes
- Pharmacokinetics is what the body does to the drug.
- Pharmacodynamics is what the drug does to the body.
- Pharmacotherapeutics is the use of drugs in treating diseases.
- Drug Names are crucial for avoiding medication errors.
- Generic Names are not capitalized, while Trade Names are specific to manufacturers.
- Chemical Names describe the drug's structure and are rarely used by nurses or providers.
Drug Attachment
- Drugs bind to receptor sites on body cells, influencing their activity.
- Receptor agonists activate receptors, while partial agonists have a partial effect.
- Antagonists bind to receptor sites without activating them, blocking agonist action.
Basic Drug Processes
- Absorption: The way the drug enters the body and reaches circulation.
- Distribution: Drug movement through the body, reaching target organs or tissues.
- Metabolism: Drug breakdown in the liver, lungs, kidneys, blood, and intestines.
- Excretion: Elimination of drug metabolites from the body (through urine, feces, lungs, skin).
Timing of Medication Dose Responses
- Half-life: Time for 50% of the drug to be eliminated from the body, influencing dosing frequency.
- Onset: Time for a drug to produce a therapeutic effect.
- Peak: Time for a drug to reach its maximum effect.
- Trough: Minimum drug concentration before the next dose.
- Duration: Length of time a drug produces a therapeutic effect.
- Plateau: Constant drug concentration achieved after repeated doses.
Drug Responses
- Desired Action: Expected therapeutic effect of a drug.
- Side Effects: Predictable, unavoidable adverse effects at therapeutic doses.
- Adverse Effects: Unintended, undesired, and unpredictable responses to drugs.
- Idiosyncratic Responses: Strange, unique, or unpredicted responses to drugs.
- Paradoxical Response: Opposite of the expected drug action.
- Hypersensitivity: Increased drug reaction, including allergies.
- Anaphylactic Reaction: Life-threatening allergic response requiring immediate medical attention.
Generic Equivalents
- Drugs from different companies with the same active ingredient are considered generic equivalents.
- Slight differences in processing may lead to variations in absorption, distribution, or metabolism.
- Bioequivalence refers to the generic equivalent being the same as the brand name product.
Drug Interactions
- One drug can alter the action of another.
- Interactions often occur during liver metabolism.
- Additive Effect: Drugs work together to enhance their effect.
- Antagonistic Effect: One drug interferes with the action of another.
- Synergistic Effect: Combined effect of two drugs is greater than the sum of their individual effects.
Food, Alcohol, and Drug Interactions
- Food and alcohol can affect drug metabolism in the liver.
- Cigarette smoking and caffeine can also affect drug action.
- Pregnant women should not take drugs without consulting their healthcare provider.
Personal Factors Influencing Drug Therapy
- Medication tolerance: Requires higher doses over time to achieve the same effect.
- Hydration status, blood pressure, and blood flow affect drug distribution.
- Alcohol and illicit drug use affect drug metabolism.
- Liver and kidney function impact drug clearance.
- Body size and fat-to-lean ratio influence drug dosage.
- Ethnicity and genetics can influence drug response.
Drug Response Across Lifespan
- Drug responses vary across different stages of life.
Medication Administration - Key Considerations
- Patient Differences: Factors such as body size, water content, organ maturity, and overall organ health can significantly affect how a patient responds to medications.
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Special Populations:
- Pediatrics: Growth, body fat, and body water content change as children develop. These changes influence how medications are absorbed, distributed, metabolized, and eliminated.
- Pregnant/Breastfeeding: Medications affect both the mother and the developing fetus or infant. Healthcare providers consider the risks versus benefits for both parties. Teratogenicity, the potential for a drug to cause birth defects, is a major concern.
- Older Adults: Individuals over 65 are at higher risk for drug-related problems due to changes in drug processing within the aging body. Polypharmacy (taking multiple medications) is common in this population, increasing the chance of drug interactions and side effects.
Principles for Safe Medication Administration
- Thorough Patient Understanding: Nurses should understand the patient's medical history, current medications, and reasons for the medications being prescribed.
- Drug Cards: Creating and using drug cards for frequently prescribed medications can help nurses learn and recall important drug information.
- Familiarization: Never administer an unfamiliar medication without understanding its purpose and intended use for the patient.
Essential Components of a Drug Card
- Trade and Generic Names
- Dosage Range (Specific dosage for the patient should be known)
- Desired Action
- Expected Side Effects (Minimum of 3 listed)
- Adverse Effects
-
Classification
- Helps to group medications and understand their mechanisms of action.
- Example: Beta Blockers
-
Nursing Implications (Minimum of 3 listed)
-
Examples:
- Do not crush extended-release medications.
- Take blood pressure before administering antihypertensives.
- Monitor peak and trough levels when administering vancomycin.
- Provide medication-specific patient teaching (e.g., warfarin requires regular blood draws, keep sublingual nitroglycerin readily available, when to call emergency services).
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Examples:
- Contraindications
Practical Application: Drug Card Creation
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Medication Assignments: Assign 5-7 medications to students and instruct them to write drug cards.
-
Sample Medications:
- Intravenous: Vancomycin (IVPB)
- Oral: Warfarin, Metoprolol
- Inhaled: Albuterol
- Subcutaneous Injection: Novolin R
-
Sample Medications:
Drug Card Content
- Classification
- Trade and Generic Names
- Desired Action (e.g., decrease blood pressure for antihypertensives)
- Expected Side Effects
- Adverse Effects
- Nursing Implications
- Contraindications
Medication Administration Skills Lab: Drug Knowledge Review
-
Drug Profile Evaluation: Students should be able to provide a detailed drug profile, including:
- Generic and Trade Name
- Classification
- Expected Action
- Reason for Prescribing
- Safe Dosage Range
- Contraindications
- Side Effects (3)
- Nursing Implications (3)
- Patient Teaching (3)
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Sample Medications: Students practice providing drug knowledge for medications used in simulated patient scenarios.
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Example Meds:
- Metoprolol succinate ER 50 mg
- Coumadin 2mg
- Novolin R
- Vancomycin 500 mg/100 mL
- Albuterol sulfate
- Dextrose 50%
-
Example Meds:
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Test your knowledge on medication administration within nursing practices. This quiz covers various aspects such as the nursing process, medication orders, and the rights of drug administration. Perfect for nursing students and professionals looking to refresh their understanding of critical medication administration principles.
