Advanced Nursing Skills Module I Exam PDF

Advanced Nursing Skills Module I Exam Chapter 33: Pharmacology & Preparation for Drug Administration- Williams (11 questions) ❖ Children considerations o Dosages are based on age, size, and weight o Never refer to medication as candy o Involve parents ❖ Older adul...

Advanced Nursing Skills Module I Exam Chapter 33: Pharmacology & Preparation for Drug Administration- Williams (11 questions) ❖ Children considerations o Dosages are based on age, size, and weight o Never refer to medication as candy o Involve parents ❖ Older adult considerations o Watch for drug interactions o Metabolism is slowed (why they often require lower doses) o Watch for GI bleeding or anemia if on long-term anti-inflammatory drugs for arthritis o Blood pressure will fluctuate o Fall precautions o May become easily dehydrated and have electrolyte imbalances (diuretics) o Color code mediations due to limited vision o Always assess swallowing ability and monitor for pocketing o Due to previous strokes, place med of strong side of mouth o Non-compliance- not able to buy meds, can’t open bottles, may not understand, may not like side effects (males may stop due to sexual dysfunction or urinary retention) ▪ Education is so important!!! ❖ Med errors o Nurse must report it immediately o Whoever conducts or discovers incident must report it immediately o 4th leading cause of death in the U.S. ❖ Overall general rules of medication administration o Kidneys and liver: breakdown medications o Be aware of adverse reactions (especially with first dose of new medication) o Question order if Mutiple drugs have the same action o Always have one double check an order if it’s a high-risk drug o Check medication 3 times before administering it o Be aware of LASA drugs (look alike, sound alike) o Always stop and investigate if pt has questions o Narcotics must have 2 licensed nurses verify and witness wastes o Aseptic technique, hand hygiene, never touch meds o Always document after giving the medication ❖ Schedule of narcotics o Schedule I: not accepted for medical use; high abuse potential (heroin, marijuana, methamphetamine)  o Schedule II: high potential of abuse, severe psychological or physical dependence (cocaine, oxycodone) o Schedule III: potential for abuse but less than Schedules I and II (Ketamine, anabolic, steroids) o Schedule IV: low potential for abuse relative to Schedule II (midazolam, diazepam) o Schedule V: mixtures contain limited quantities of other schedules material (codeine preparations; 200mg/100ml; motofen) ❖ 6 rights of administration: right drug, dose, route, time, patient, documentation o 2 methods of identification: name and DOB (visual and verbal) o Lookup unfamiliar drugs o Compare dose to MAR and label on medication o Document dosage (mg or mL), location, and never forget to reassess pain levels (20-30 minutes) o Avoid distractions, never rush o Never give a medication that someone else prepared for you o Never crush anything without checking with pharmacy ❖ Verbal orders o Emergencies: provider must write and sign after emergency is over o Telephone verbal order: must perform a read back to assure info is correct Chapter 34: Administering Oral, Topical, and Inhalant Medications (21 questions) ❖ Oral (PO): most convenient and least expensive route o Sublingual: under tongue o Buccal: in between cheek and teeth o Either solid or liquid form ▪ If liquid, cover label when pouring and read meniscus at the base o Always assess swallowing ability previously ▪ Never crush pills unless it’s okay to ▪ Never crush enteric coated, sublingual or sustain release medications o Oral syringes are orange ❖ Transdermal: either a patch or a paste o Apply to a clean, hairless area o Always wear gloves even when removing old patch o Ex: nitroglycerin, scopolamine, estrogen, fentanyl, nicotine ❖ Drops o Ophthalmic (eyes): pull lower eyelid sown then place drug in the center o Otic (ear): for adults pull up and back; for children pull down and back o Nasal (nose): dropper or atomizer bottles; block one nostril and inhale through the nose as atomizer is squeezed; have client lie on back with neck hyperextended  ❖ Topical: ointments, pastes, and lotions o Follow directions when applying ❖ Rectal suppositories: inserted into body orifices o Sim’s position is best o Can help prevent vomiting, soothe hemorrhoids, prevent bladder spasms, promote bowel movement, and reduce fever ❖ Vaginal suppositories: helps to cleanse vagina for surgery, reduce bacterial growth, remove odors and discharge o Apply heat or cold to inflamed tissues ❖ Inhalation: nebulizers, sprays, atomizers, face mask o Metered dose inhalers: specific amount of medication with each spray; held at front of mouth and med is inhaled as inhaler is triggered ❖ Feeding tube: with liquids or suspensions o Small bore tubes can become easily clogged o Dissolve meds well in warm water (30 mL) o Flush with 15-30 mL of water in between meds o Make sure HOB is at 30 degrees at least because gravity helps move meds o Clamp or plug tube for 30 minutes before returning suction and leave HOB at 30 o Prepare in aseptic technique o If medication ordered is a liquid or gel capsule, aspirate the liquid with a syringe and needle Chapter 35: Administering Intradermal, Subcutaneous, and Intramuscular Injections (15 questions) ❖ Parental injections: NOT via GI tract, use of a syringe and needle or IV o Introduces medication into body tissue or fluids o May cause pain and patient discomfort o Select patients: NPO, digestion issues, those who need quick relief (action is hastened/will hit faster) o Always: ensure accurate dose, select correct site, use sterile technique o Use: sterile needles and syringes, appropriate length of needles ▪ 3 mL is most common used ▪ Orange syringes are for units (insulin only) o Select: injection sites carefully, rotate sites ▪ Make sure site is free of lesions, tattoos, freckles, moles, rashes, inflammation, relatively free of hair o Needle gauges: larger the number the smaller the diameter ▪ 25-27, 29: Intradermal ▪ 25-27: subcutaneous ▪ 21-23: intramuscular o Needle length  ▪ 5/8- ½ inch: intradermal and subcutaneous ▪ 1-3 inches: intramuscular o Always have BEVEL UP ❖ Needle sticks and safety o Report all needle sticks o Immediately dispose of needle in sharps after use o Use the one-handed recapping technique ❖ Cleaning injection site: o Use alcohol swab and go in a circular motion until 2 inches in diameter around chosen area is clean o Allow skin to fully fry ❖ Pulling mediations up through vial o Take off rubber topper and cleanse with alcohol swab still o Always inject the amount of air into the vial = to the medication being drawn up o Reconstitute if in powder form (bottle will have instructions) ▪ Solute: powder, mixed with dilutant, is then drawn up in a syringe ▪ Dilutant: liquid, sterile water, saline, lidocaine o Before mixing 2 medications in a single syringe, check for compatibility ❖ Ampules: made of glass; use protection and a filter needle when drawing up, then place a new needle of injection ❖ Drawing up insulins (cloudy clear clear cloudy) o Step 1: inject air into longer acting insulin (cloudy) o Step 2: inject air into short acting insulin (clear) o Step 3: withdraw amount of short acting insulin (clear) o Step 4: withdraw amount of long acting insulin (cloudy) ❖ Intradermal: medication is deposited into dermal layer; “bleb” will be formed o DO NOT ASPIRATE OR MASSAGE o Small wheal will form (raised area) o Volume: 0.1-0.5 mL (if >0.5, question dose) o Sites: inner part of forearm, upper back o Syringe: 1 mL, 25 or 27 gauge, ¼-5/8 inch length o Angle: 5-15 degree between upper layers of the skin ▪ You should feel resistance when administering; if no resistance is felt, medication may be too deep ❖ Subcutaneous o Volume: 0.5-1.0 mL o Sites: upper outer arm, anterior surface of thigh, 2 inches away from umbilicus on abdomen (will do umbilicus for med admin checkoff) o Gauges: 25 gauge, 5/8 inch; 27 gauge, 3/8-½ inch o Syringe: 1 mL (tuberculin); 3 mL (can use but will only give up to 1 mL) o Angle: 45-90 degrees (depends on size of needle)  o Administration: pinch a little, rotate sites, DO NOT ASPIRATE, DO NOT MASSAGE ❖ Intramuscular o Volume: 0.5-3 mL o Sites: deltoid (for med admin checkoff, ventrogluteal (most comfy), vastus lateralis (best for infants) o Needle gauges: 22-23 gauge; 1-3 inches (most common is 1-2 inches) o Syringe: 3-5 mL o Angle: 90 degrees o Administration: z-track method, ASPIRATE BEFORE ADMINISTERING ❖ Anaphylactic shock: caused when meds are given to a patient who may be allergic o Why it’s important to check patient 30 minutes after administering a medication o Symptoms: urticaria, bronchial constriction, edema, circulatory collapse ***2 dosage calc questions***