Exam 3 Study Guide Fundamentals PDF

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µÉ°÷ * *☒☒*"* " "" "☒☒***%% § Ch. 31 g. j Drug Names Notes by Morgan Payne ⑧ ☒ Chemical Provides the exact description of medication's composition ⑧ on Generic The manufacturer who first develops the drug assigns the name, and it is ③ then listed in the U.S pharmacopeia. Trade Also known as brand or proprietary name. This is the name under which a ☒ manufacturer markets the medication ¥ Trade Name: Tylenol Generic Name: Acetaminophen "" Drug Information ' Classification Medication Forms Effect of medication on body systems Solid, liquid, sublingual, buccal Symptoms the medication relives Topical; on skin Medication's desired effect Parenteral; anything outside the GI system; IV, injection, eye drops Forms for instillation into body cavities > Eye drops, ear drops, rectal depository Pharmacokinetics The study of medications traveling through the body % ÷ §: k ③ se Four Processess Greek Origin iii. i. iii.. ☒ Absorption 'Pharmakon' is drug ⑧ ¥ Distribution 'Kinetikos' is moving, putting into motion. Metabolism ☒ Excretion ⑤ Go % ¥ 0 % I A ⑧ ☒ §÷¥É ** * * * ☒ ** * * """ Ch. 31 ⑨ or Notes by Morgan Payne & Pharmacokinetics ⑧ Absorption ☒ ⑧ Passage of medication molecules into the blood from the site of administration ☒ Rate of absorption determines how soon the medication takes effect ⑤ on > Topical, on the skin, medication is the slowest absorption rate. > Medication given through the IV is the fastest absorption rate As Amount of medication the body absorbs determines the intensity ☒ The route of administration affects the rate and amount of absorption * Distribution The transportation of medications to site of action by bodily fluids Factors Influencing Distribution: Circulation , If pt has cardiac disease, their circulatory status is comprised, so med could take longer for effects to happen Membrane permeability Protein binding Metabolism Is the process where once reach target site of action it is broken down to less active, less potent, or inactive form Primarily occurs in Liver, but can take place in kidneys, lungs, intestines, and blood ,If pt has liver or kidney failure, medication is going to hang out in bloodstream >These pt will be given lower doses of medication Factors Influencing Metabolism: Age Increased medication metabolizing enzyme First pass effect Similar metabolic pathway Nutritional Status ÷ %. : * Excretion § 9 The process of getting rid of medications from the body ☒ ⑧ ¥ Medications exit the body through the: ③ > Kidney Primarily ⑨ y If pt has renal failure, meds build in the bloodstream and could get to toxic levels ☒ ÷ as > Liver, intestines, lungs, exocrine glands; breast milk for example ☒ Go * Extent of kidney function can increase duration and intensity of medication response * ☒ ⑥ % →☒In ⑥% I A A ☒ I A µg.Éjo ⑥ ** ☒☒ ☒ ** ☒ * * ** * Ch. 31 ⑨ Types of Medication Actions Notes by Morgan Payne & ③ ' Therapeutic Effect Expected or predicted physiological response ☒ What we want to see after medication is given ⑧ If we give a pt with HTN a med to lower the BP, the therapeutic effect ☒ on would be lower BP ③ a.. Adverse Effect Unintended, undesirable, often unpredictable ☒. Side Effect Predictable, unavoidable secondary effect % \ Toxic Effect Accumulation of medication in the bloodstream 1 Idiosyncratic Reaction Overreaction or under reaction or different reaction from normal ex; Ambien is given to help sleep, can cause pt to be hyperactive I Allergic Reaction unpredictable response to a medication < Medication Interactions One medication modifies the action of another Medication Tolerance More medication is required to achieve the same therapeutic effect : Medication Dependence Physical, Psychological - Nursing Considerations for P.O Meds For Liquids, suspensions, and elixirs follow directions on medication packaging in regard to dilution and shaking > Contraindications for administering P.O Meds: > Vomiting > Decreased GI motility Absence of gag reflex > Dysphagia > > Decreased level of consciousness; LOC \ To facilitate swallowing have clients sit at at least a 90 degree angle and use liquid form when possible - Administer irritating medications, like analgesics, with small amount of food / Administer oral medications as prescribed, follow directions if medication is to be taken before meals or on empty stomach; ex, 30 min to 1 hr before meals > Example, thyroid medication for low levels of thyroid hormone has to be given on empty stomach : Do not mix meds large amount of food or beverages incase pt cannot consume entire quantity Avoid administration with interacting foods or beverages > Ex: grapefruit juice : Follow manufacturer directions for crushing, cutting, and diluting medications Only scored medications should be broken or cut - Ensure patients swallow enteric coated or time release medications whole  " " " - - " - - , , , , ,... - my Routes of Medication '.. , i Ch. 31.. i , Notes by Morgan Payne Oral: Enteral \ Most Common Route - Tablets, Capsules, Suspensions, Elixirs, Lozenges. Sublingual Administration I Under the tongue \ Buccal Administration - Between cheek and gum Parenteral Routes Routes of Medication / Four Major Sites of injection > Intradermal never give up What we get when we get a TB test u Subcutaneous > Ex: Insulin injection it Intramuscular > Intravenous > J Other routes Epidural, intrathecal, intraosseous, intraperitoneal, intrapleural, and intraarterial > Intraosseous is used in military when someone goes into cardiac arrest or has been u injured and in a coma; they drill a hole in part of the bone in the leg and give meds in the bone marrow - Routes limited to physicians Intracardiac and intraarticular > Topical Administration - Skin - Mucous Membranes - Transdermal / Instillation; drops, ointment, sprays I Inhalation and Intraocular route ⑤ % ! ☒ ☒ LEE ☒ ☒ON a ☒ ☒ ☒www.o ☒ WOW ⑨ - Types of Orders in Acute care Ch. 31 Notes by Morgan Payne ⑧ ÷ ::. Standing orders or routine medication orders ☒ PRN orders ☒. Single, one time, orders RN Role: ALWAYS read back the order E. on STAT orders to the provider ③ Now Orders Prescriptions Parts of a prescription ☒ A % - Nurse's Roles Determines medications ordered are correct Assesses patient's ability to self administer - : Determines medication timing Administers medications correctly : Closely monitors effects Provided patient teaching Does not delegate medication administration to AP / you're Amazing ° Medication Errors Any preventable event that may cause inappropriate medication use or jeopardize patient safety % Steps: ÷. ' First assess the patient's condition, then notify the health care provider When patient is stable, report the incident § Prepare and file an occurrence or incident report ☒ ÷. : ⑧. Report near misses and incidents that cause no harm ③ ' During transitions in care, reconcile medications ☒ ☒ § 3 ☒ * ☒ % → % A →% A A  ☒ * ☒ ☒ LEE ☒ ☒ % ☒ ☒ www.o ☒ 8 ÷ Ch. 31 ⑨ - Notes by Morgan Payne : Safety Guidelines For Medication Administration ⑧ ☒ Be vigilant during medication administration. Verify that medications have not expired by checking labels. ② Use at least two identifiers before administering medications, and check against the MAR. ⑤ Before administering medication, check for accuracy THREE times § Clarify unclear medication orders and ask for help if needed. p Use strict aseptic technique during Parenteral medication preparation and administration - ☒ * 3 Checks of Medication Administration - 1st Check: > In the Med room while preparing medication, check it against the MAR e 2nd Check: > After preparation, re check medication against the MAR ensuring right drug, right does, right route, and right time V 3rd Check: > At patient's bedside, re check medication and comparing to MAR at bedside ensuring right drug, right dose, right route, right time, and right patient; with 2 patient identifiers Never use room number as identifier you got this 7 Rights of Medication Administration± ? ¥ Right Patient nor Right Mediation * ③ ¥ ÷ ☐ N Right Dose ☒ § ⑤ and Right Time A ☐ not Right Route ☒ Go * ☒ Right Documentation Er % →☒In % nor Right Indication, or reason I A I A I A ☒ ☒  ☒☒ *%ᵗ☒☒""" ☒"" """"" """☒""""ʳ ☒ ʰ & ⑨ & Ch. 31 : NURSING DIAGNOSIS Notes by Morgan Payne ☒ Impaired health maintenance Lack of knowledge; medication ☒ Non adherence; medication regimen ⑨ Adverse medication interaction ¥ Oral Medication Administration or Complex Medication Regimen; polypharmacy ② r. % Easiest and most desirable route Food can affect absorption % Protect patients from aspiration Follow special precautions when administering medications to patients with enteral or small bore feeding tubes Follow tubing connection standards " Verify tube is compatible with medication absorption Use liquid medications when possible Flush between each medication, do not mix the medications Before giving med, make sure tube is in right spot, patent, and look for residual What happens when a medication drops on the floor? Throw it away, do not use ÷ Can you crush an extended release or enteric Coated pill? NO If someone has no problem swallowing what position should the bed be in when giving medications? At least 30 degrees, does not matter if they have no problem swallowing You crush a pill to administer through a feeding tube, what do you mix it with? Sterile water You are checking the residual on a feeding tube prior to giving meds, and there is a lot of gastric content. What does this mean and what do you do? % This means that things are not being digested. You should call the provider and get the I. order decreased for the dosage. ☒ % ☒ You have 2 medications prepared to administer through a feeding tube. What is % Sg ⑤ the correct order? Flush tube with sterile water I ⑤ so 2 Administer first med go ☆ 3 Flush with sterile water § 4 Administer second med 8 ÷ % Is % 5 Finish by flushing with sterile water % ☒ I. ☒% ⑧ % % ☒ % ☒ ☒  ☒☒ *%ᵗ☒ """☒☒"" """"" """☒"""""" """"" """ & ⑤ TOPICAL MEDICATION ADMINISTRATION & Ch. 31 Notes by Morgan Payne : Ointments, creams, and transdermal patches ☒ Ask if they have existing patch, remove before applying the new one ☒ Rotate sites of patch, do not put new patch in same spot as old spot ⑨ Sites you can apply patches: ¥ or > ✗ Trunk, lower abdomen, upper arm, lower back ② Not lower forearm. r Before new patch make sure skin is clean and dry Wear gloves when applying patch Label a patch that is hard to see, like a transparent patch % Document patch and location, and removal % NASAL INSTILLATION Methods Spray, drops, nasal packing : Decongestant spray or drops are most common For spray, guide tip away from the septum Caution patient to avoid the rebound affect The longer they use the spray, it will cause nasal congestion 8 EYE INSTILLATION → f- & E Avoid the cornea E- Avoid touching eye or eyelid with droppers or tubes E- Use only on affected eye Intraocular instillation ¥ > disk resembles a contact lens 5 Assess if patient can administer eye drops themselves EAR INSTILLATION won Ear drops ← I Instill at room temperature Use sterile solutions % A * > Check for eardrum rupture prior to administering Adults; pull up pinna ÷ : * Kids; pull down pinna Irrigation ☒ ⑤ > To remove excessive cerumen g. > Only when it causes hearing deficit, ear discomfort, or to visualize the tympanic membrane ⑤ § so ⑤ go ÷ % ☒ I. ☒% ⑧ % % ☒ % E. § ,÷¥" ☒☒ ☒%ᵗʰ ☒° ☒☒☒ ☒☒ °" & ☒ & & VAGINAL INSTILLATION ③ Vaginal medication Inserted with a gloved hand ☒ so For yeast infections ⑤ For low hormones or Assess if patient can do own vaginal instillation ②. & Rectal Instillation a ☒. Can be given to decrease fever if patient can not swallow 8- ' Can be given as a laxative, decrease pain, decrease spasms § ⑨. Positioning * left side lying posting with right leg bent up; Sim's position. Enema may be given prior to inserting suppository INHALATION MEDICATION I Patient needs to have hand strength, and hand breath coordination / Steps: : 1; First pt will take a deep breath in and out 2; Then put inhaler in mouth - 3; squeeze canister as they take a slow deep breath in : 4; Then hold breath for 1o seconds 5; then exhale slowly If patient can not do that, they will use a spacer :PARENTERAL MEDICATION ADMINISTRATION Need the correct size syringe, and correct type : Need the correct size needle The smaller the number, the larger the diameter - Preparing an injection from a vial > If dry, use solvent or diluent as needed > Injected air into vial, then draw up mediation > Label multi dose vial after mixing > Refrigerate remaining doses if needed ' Preparing an injection from an ampule > Snap off ampule neck % > Aspirate medication into syringe using filter needed > Replace filter needle with appropriate size needless device As § > Administer injection ☒ %. > Filter needle is to filter if any glass was in medication Mixing medications From a vial and an ampule i% so ' > > prepare med from the vial first; use same syringe and filter needle to withdraw med from ampule& Mixing medications from two vials do not contaminate one medication with another ⑨ ☒. Both ways of mixing; maintain aseptic technique § ÷☒ % % % ☒ % %% ⑧ % % Ch. 31 Notes by Morgan Payne ☒ % ☒ ☒ @  ☒ % ☒% ☒% ☒ ☒ ☒ ☒ ☒☒☒ ☒ ☒ ☒% & ⑨ & Ch. 31 : Mixing Insulins Notes by Morgan Payne ☒ q§ ☆ Inject rapid acting insulins mixed with NPH insulin within 15 minutes before a meal. ☒. Technique ÷ > Draw up the air of the dosage for the long acting insulin; instill the air ☒ > Draw up the air of the dosage for the regular insulin; instill the air ② § or > Leave syringe in the fast acting one after instilling air, draw up dosage > Then go to long acting insulin and draw up the dosage As Long acting insulin is called NPH ☒. Regular insulin is clear; NPH insulin is cloudy. Draw up regular insulin first ¥. Must have another nurse check your dosage ⑧ NEEDLE ANGLES : Subcutaneous; 45 or 90 degrees Intramuscular; 90 degrees : Intradermal; 15 degrees For subcutaneous make sure you pinch tissue first Subcutaneous Injections Medications places into loose connected tissue : under dermis Exercise and hot or cold compresses influence rate of absorption - Most common site is abdomen and back of arm Tell pt to rotate injection sites INTRAMUSCULAR INJECTION - : Faster absorption than subQ Administer at a 90 degree angle % A Z TRACK METHOD ÷. This ensures medication stays in the muscle ☒ ☒ ⑤ ' For meds like iron and B12 ¥ ' With one hand push the skin over, the other hand ⑤ inject the needle ⑤ ' Then pull the needle out, then let go of the skin µ & ÷ % Is % ☒ I. ☒% ⑧ % ☒ ☒ % ☒ ☒ ,÷!É ☒ ☒ ☒☒ ☒%ᵗʰ ☒% ☒☒ ☒ ☒☒ °" " & ☒ & LANDMARKS FOR IM MEDICATIONS BB ☒ Ventrogluteal Site _ ☒ > Gluteus medius so Preferred and safest site for all adults, children, and infants ② V Method : ② D ' Vastus Lateralis Used for adults and children ☒ often used for infants, toddlers, and children receiving immunizations ☒ > Use middle third of muscle for injection ii. Deltoid : Not well developed in many adults : Many nerves and brachial artery in this area ÷ site is 3 finger widths below the acromion process Injections less than 2 ml Not preferred but commonly used for vaccines Intradermal Used for skin testing; TB, allergies Angle of insertion is 5 to 15 degrees Band > A small bleb will form INTRAVENOUS ADMINISTRATION , Administered by the following methods: > Infusion of large volumes of IV fluid > Injection of a bolus or small volume mediation; IV push medications > 'piggyback' infusion LARGE VOLUME INFUSIONS - Safest and easiest method of IV administration We will not mix any medication into an IV bag ÷BOLUS DOSES; IV PUSH MEDICATIONS - Medication in a syringe; attach to IV tubing; push into patient Introduces a concentrated dose of a med directly into the systemic circulation % A ⑨. !Most dangerous method for medication administration! As § ' Know how fast or how slow to push the medication ☒ § p ⑤ ⑤ PIGGYBACK A ☒ ⑤ ' Instill a smaller amount of fluid connected to the primary line ⑤. The small amount, secondary line, is hung higher than the primary line ☒ ' The primary line is hung lower § ' Secondary tubing is connected to the Y site § Ch. 31 ☒ Notes by Morgan Payne ☒ & % % % % % ☒ % ☒% ⑧ % % % @ ¥÷ ☒☒ *⇐ʰ☒ ° °"°ʰ ☒ʰ " " """" ° & ② & Ch. 31 & Notes by Morgan Payne ② IV MEDICATION LABEL ☒ so ② or ②. r & A % % SALINE LOCK; AKA HEP LOCK : For patients that don't need continuous IV fluids Make sure it remains patent I Flush saline lock every 8 hours > unclamps it > clean port > flush with saline - After medication is administered flush again ¥ % ③ " ÷ : § ☒ ⑤ § Sg so ☒ ⑨ & ☒ & ☒% % % % % ☒% ⑧ % ☒ ☒ % ¥÷ ☒☒ °*%ʰ☒%""% %ᵗʰ☒ʰ * ☒ʰ ☒ "" ° & ☒ & Ch. 47 & BOWEL ELIMINATION Notes by Morgan Payne ② ☒ > ☒ or ②. r & a FACTORS THAT INFLUENCE ELIMINATION % % After putting a bedpan under a pt, what position do you put the bed in? Sitting position hmm COMMON BOWEL ISSUES / Constipation > Excessive straining > Bowel movements that are infrequent or hard to pass I Diarrhea > Causes dehydration, check fluid and electrolyte levels / Incontinence Your client is going to be receiving > Short term, like from diarrhea feeding via NG tube. What is the correct > Long term because pt lost control of the sphincter sequence the nurse should follow to initiate the feeding? > protect skin; clean asap; use protective barrier on skin ✓ Flatulence A. Check residual feeding contents > passing gas B. Verify Tube placement C. Evaluate tolerance of feeding - Hemorrhoids D. Administer the feeding > Caused by increased venous pressure from straining Answer: B, A, D, C > Can also be caused by pregnancy % A BOWEL DIVERSIONS As § ☒. Ostomies ☒ § > > Ileostomy; more liquid stool ⑤ Colostomy; more formed stool ↳ ÷ & so ⑨. go What test is used to look for blood in the stool? Guaiac Stool Test mmmm ☒ ☒ ☒ % Is % % ☒% ⑧ % % ☒ % @  " " " """"" " ☒"" ""☒☒"" """☒☒"""☒"""""" """"" """ & ⑤ & Ch. 47 & NURSING DIAGNOSIS RT BOWEL ELIMINATION Notes by Morgan Payne ☒ § ' Bowel incontinence * ' Constipation ☒ §. Risk for constipation ⑨ - Diarrhea ¥ or ' Lack of knowledge of dietary regimen ② r ACTUE CARE ☒ ' Cathartics and laxatives 8 > Cathartics have a stronger and more rapid effect than laxatives > Suppositories may act more quickly than oral medications I Antidiarrheal agents ENEMAS - Cleansing enemas > Tap water, normal saline, hypertonic solutions, soapsuds / Pt needs to be positioned on their left side with their right leg bent - The enema bag needs to be on an IV pole to be pulled by gravity > If pt has cramping, we can lower bag so that the rate is slower : Otherpttypes Tell to hold it as long as possible of enemas > Oil retention > Carminative; helps reduce gas > Kayexalate; bring down potassium levels < NOT a sterile a technique If patient has cramping while receiving an enema what are you going to do? Lower the bag to lower the rate 7 NASOGASTRIC TUBE OSTOMIES " Clean technique , Stoma should look pink; like inside your mouth Get Xray to ensure its in correct spot should never look purple or black i Maintain patency of tube Check provider order before removing tube Clean with ONLY warm water; no soap Educate pt to empty bag when its half full. RESTORATIVE CARE ☐ &% -. Bowel training > Have pt go to restroom 1 hour after they eat a meal Maintenance of proper fluid and food intake % ☒ ⑤ A > high fiber; oatmeal and bran ☒ & ☐. Promoting of regular exercise ' Management of skin integrity for pt with fecal incontinence or diarrhea ⑨ ☒ & ÷ % ☒ I. ☒% ⑧ % % ☒ % ☒ ☒ @  ☒ lÑ%☒ ☒☒☒☒☒☒☒ ☒% & 3 & & : ☒ Finals Week ! ÷ § ⑨ 8 or ② this ! you got r § ☒ Trust God & 8- Stay positive aw go Morgan Payne - % } 8 § § ☒ ÷ ⑤ ☒ & % go & ¥ ÷ Is ☒%%%☒☒% ☒ ☒ ☒ ☒ @