Foundations In Nursing Exam 3 Review PDF

Foundations In Nursing: Exam 3 Review Medication Administration: ○ Safety Measures: Institute of Medicine (IOM), JCAHO National Pt Safety Goals Medication Distribution: unit-dose systems, pre-packaged, pre-labeled, individual doses S...

Foundations In Nursing: Exam 3 Review Medication Administration: ○ Safety Measures: Institute of Medicine (IOM), JCAHO National Pt Safety Goals Medication Distribution: unit-dose systems, pre-packaged, pre-labeled, individual doses Systems of Medication: Automated medication-dispensing: ex: pyxis (fingerprint/password) Barcode medication administration: pt wears bracelet, nurse scans barcode to ensure correct pt, drug, dose, time, route and documentation ○ Types of Medications: Non-prescription/Over the counter (OTC): FDA approved and controlled ex:Tylenol Prescription meds: meds that require supervision to safely determine therapeutic vs toxic Herbs/botanicals: natural=safe? Potency? Drug interactions? Ex: echinacea ○ Medication Orders: Name: brand/trade name, look/sound alike meds Tall man lettering: emphasizes commonly mistaken portions of med name Dosage: frequency and strength – metric, apothecary, household NO trailing zeros (0.3 NOT 0.300) Zero BEFORE decimal (0.3 NOT.3) Route: how does it get in the patient PO: oral or by mouth ID: intradermal a.c=before meals IM: intramuscular SC: subcutaneously p.c=after meals IV: intravenously SL: sublingual Inhaled, rectal/vaginal, topical, otic, ophthalmic, transderma Purpose: pain, fever, nausea, disease, etc. Signature: Of prescribing physician Types: electronic (EPIC) Routine/standing order single/one-time order PRN order titration order (heparin) Standing protocols Verbal order (none/rare) ○ Patient Controlled Analgesia (PCA): morphine, sulfate, dilaudid Basal rate: continuous infusion for pain control Bolus rate: pt dose as needed but lock out time for safety Child PCA with narcan drip (reduces side effects, itching and nausea) **Pain team manages per protocol and from nursing data (how many times does pt push button?) ○ Drug Action: Pharmacokinetics: absorption, distribution, metabolism, excretion (what body does to drug) Pharmacodynamics: therapeutic effects, adverse effects, side effects, tolerance, allergic rxn, toxicity and drug interactions (what drug does to body) ○ Medication Assessment: medical hx, allergies, intolerances, medication hx, medication orders/records, diet and fluid orders, laboratory values ○ Physical Assessment: ability to swallow, GI motility, adequate muscle mass, venous access, VS, body system assessment, pt knowledge and compliance ○ Safe Med Administration: interpret order, calculate adult/child dosage, inform pt what they are taking, assess pt understanding of med, assess pt allergies and hx, admin med with 5 rights ○ Administration Errors: Discrepancy between the drug received by pt and the drug therapy intended by prescriber Errors of omission– drug is not administered Incorrect administration technique and admin of incorrect or expired meds  Deliberate violation of guidelines ○ Preventing Medication Errors: Redesigning delivery systems, creating safety cultures, maximizing communication, barcode scanning, simulation High risk meds→increased risk to cause harm (narcotics, insulin, heparin, potassium) Risk increases in pediatric population and in elderly due to varying size/weight and polypharmacy Reporting errors: QI (quality improvement) ○ FIVE RIGHTS OF MEDICATION ADMINISTRATION: Right Patient: always use 2 pt identifiers *match with bracelet* First and last name, med record #/history #, SSN, birthdate If no pt bracelet→STOP→get bracelet→then continue with meds Right Medication: check the label 3x before admin, check expiration date Some meds require 2 person to check independently (heparin, insulin) Check when med is removed from storage, when pouring/preparing, and about to give Right Dose: check the order, check usual dose ranges, check mg/kg for children QUESTION: if the pt does, if you are concerned about accuracy, pt tolerance, route, or the med dispensed does not match the dose Right Route: make sure med is given by ordered route, is route safe/appropriate for pt? DO NOT interchange routes (ordered IV, you give IM=WRONG) Right Time: check correct frequency and time, follow routine med times for institution ON TIME: 30 min-1H before or after scheduled admin time Check the MAR to see when the med was given last, check PRN interval Any food interactions (on empty stomach, with meals, after meals) Right Documentation: time, route, dose, site, date/time, initials/signature If med is not given– document WHY Document therapeutic effects and side effects (vomit, pain levels) NEVER record a med before giving it, ONLY record what YOU give Record administration of meds ASAP Use only acceptable abbreviations Record any positive or negative or allergic effects of med Right to Refuse: document as such ○ Special Circumstances: *CAN THEY SWALLOW??* Parents may need to help administer meds to children. Child should help if possible Dilute in small amounts (juice/pudding) Offer assistance to elderly pt Use liquids, crush pills, allow ample time ○ Pre-Administration Assessments: BP meds/HR (digoxin, HOLD if