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72 Cards in this Set
- Front
- Back
What information should you know about each medication you will be administering to your patients?
|
-Names
-Desired therapeutic effects -Actions on body -Forms & Dosages -Appropriate routes -Side effects -Precautions |
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What are appropriate resources for medication information?
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-Drug guide book
-Internet drug reference -Pharmacist |
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Which medications can be delegated to CNA?
to LPN? |
CNA- no medication administration can be delegated
LPN- can be delegated to give all medications except IV push, certain critical care IV piggy back meds, and chemotherapy |
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Can you delegate a CNA to give an enema?
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Yes as long as it doesn't have meds in it
|
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What should the RN do when administering a new med to the patient for the first time?
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Educate the patient and/or family on the medication
|
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What is an example of a drug's generic and trade name?
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Tylenol and acetaminophen
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What should the RN know about the pharmacokinetics of each medication they will be administering?
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Absorption
Distribution & metabolism of drugs by body |
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What should the RN know about each drug action and response?
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Therapeutic effects
Side effects Adverse effects Interactions |
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How is the therapeutic drug classification categorized?
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by disease state
ex: anti-hypertensive |
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How is the pharmacologic drug classification categorized?
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by its action on the body
ex: ACE inhibitors, Beta Blockers, Vasodilators |
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What information should you know about each medication you will be administering to your patients?
|
-Names
-Desired therapeutic effects -Actions on body -Forms & Dosages -Appropriate routes -Side effects -Precautions |
|
What are appropriate resources for medication information?
|
-Drug guide book
-Internet drug reference -Pharmacist |
|
Which medications can be delegated to CNA?
to LPN? |
CNA- no medication administration can be delegated
LPN- can be delegated to give all medications except IV push, certain critical care IV piggy back meds, and chemotherapy |
|
Can you delegate a CNA to give an enema?
|
Yes as long as it doesn't have meds in it
|
|
What should the RN do when administering a new med to the patient for the first time?
|
Educate the patient and/or family on the medication
|
|
What is an example of a drug's generic and trade name?
|
Tylenol and acetaminophen
|
|
What should the RN know about the pharmacokinetics of each medication they will be administering?
|
Absorption
Distribution & metabolism of drugs by body |
|
What should the RN know about each drug action and response?
|
Therapeutic effects
Side effects Adverse effects Interactions |
|
How is the therapeutic drug classification categorized?
|
by disease state
ex: anti-hypertensive |
|
What information should you know about each medication you will be administering to your patients?
|
-Names
-Desired therapeutic effects -Actions on body -Forms & Dosages -Appropriate routes -Side effects -Precautions |
|
How is the pharmacologic drug classification categorized?
|
by its action on the body
ex: ACE inhibitors, Beta Blockers, Vasodilators |
|
What are appropriate resources for medication information?
|
-Drug guide book
-Internet drug reference -Pharmacist |
|
Which medications can be delegated to CNA?
to LPN? |
CNA- no medication administration can be delegated
LPN- can be delegated to give all medications except IV push, certain critical care IV piggy back meds, and chemotherapy |
|
Can you delegate a CNA to give an enema?
|
Yes as long as it doesn't have meds in it
|
|
What should the RN do when administering a new med to the patient for the first time?
|
Educate the patient and/or family on the medication
|
|
What is an example of a drug's generic and trade name?
|
Tylenol and acetaminophen
|
|
What should the RN know about the pharmacokinetics of each medication they will be administering?
|
Absorption
Distribution & metabolism of drugs by body |
|
What should the RN know about each drug action and response?
|
Therapeutic effects
Side effects Adverse effects Interactions |
|
How is the therapeutic drug classification categorized?
|
by disease state
ex: anti-hypertensive |
|
How is the pharmacologic drug classification categorized?
|
by its action on the body
ex: ACE inhibitors, Beta Blockers, Vasodilators |
|
What is a therapeutic effect?
|
what is the expected expect of the drug
|
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What are side effects?
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Predictable symptoms that occur as a consequence of normal dosage. Can be mild such as postural hypotension or severe/life threatening such as liver or renal toxicity or teratogenic fetal harm
|
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What are adverse effects?
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unexpected events
-allergic reaction: mild versus anaphylactic -idiosyncratic reaction -Toxic |
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What population are more responsive to calcium channel blocker anti-hypertensives?
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older adults & african americans
|
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What population are Beta Blockers & ACE inhibitor anti-hypertensives more effective in?
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caucasians
|
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What did the Controlled Substances Act of 1970 focus on?
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Strict controls on distribution
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What is an idiosyncratic reaction?
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Results in the opposite effect of what it should have
|
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What is a control schedule?
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Drugs with a significant potential for abuseare classified into 5 categories or schedules
Schedule I: highest potential for abuse- illicit drugs (heroin,LSD, Marijuana) Schedule II: (Morphine, Dilaudid) Schedule III: (Vicodin, Meperidine) Schedule IV: (valium, xanax) Schedule V: lowest potential for abuse (OTC cough suppressant with codeine) |
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What are the nurses responsibilities of controlled substances according to the controlled substances act of 1970?
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-Nurses must keep an accurate record of every controlled substance in stock on their unit
-All controlled substances are stored using a double locked system -Keys to medication areas are under the control of nurses on the unit at all times -Discarding of controlled substances must be witnessed & co-signed by another nurse -(2) Two nurses reconcile the count of all controlled substances at every shift change -Written renewal orders are required q 72 h for all schedule II & III drugs |
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What are the 4 ways medications travel through the body?
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Absorption
occuring at site of administration Distribution transport of medication in bloodstream and into cells Metabolism biotransformation (mostly by liver Excretion Removal from body (mostly by kidneys) |
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What factors affect absorption of medications?
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-Surface area and contact time
-Blood flow at site of administration -Solubility (water versus lipid soluble) lipid soluble molecules more easily absorbed -Drug form -Route of administration -Age: older adults-gastric emptying time slower, peristalsis slower |
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What are some factors that affect distribution of medications throughout the body?
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-Systemic circulatory status
-Protein-binding properties of drug -Membrane permeability properties : blood brain barrier-selective to highly lipid-soluble substances such as antidepressants, dilantin, nicotine, caffeine, and alcohol -Age: older adult- less muscle and total body water increases concentration of water-soluble drugs, lower serum protein increases amounts of free drug in circulationand risk for toxicity, blood-brain barrier effectiveness diminishes |
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What does protein-binding have to do with medications?
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-Most drugs bind to serum proteins (like albumin) in varying degrees
-When bound to a protein the drug cannot enter the cell -Only unbound "free" can enter cell and create effect -(2) drugs given concurrently & highly bound to the same site on a plasma protein will compete for the binding site resulting in a greater proportion of free drug and potential for toxicity |
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What is an agonist?
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Medication that has the ability to bind & mimic receptor activity and create and/or increase an endogenous effect
|
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What is an antagonist?
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Medication that has ability to bind & block receptor activity and prevent and/or decrease an endogenous effect
|
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What is a bronchodilator?
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ex: albuterol
Used for asthma attacks, classified as beta-agonists They attach to adrenergic receptors in the sympathetic nervous system (SNS) and mimic the action of norepinephrine |
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What are Beta-blockers?
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ex: atenolol
used to decrease blood pressure, classified as alpha-antagonists They attach to the adrenergic receptors in the SNS and block the action of norepinephrine |
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What is saturability and when does it occur?
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Drug receptor binding is saturable.
This occurs when all available receptors are occupied. Once all available receptors are saturated, increasing the drug concentration will not increase the risk of adverse side effects. |
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What factors affect metabolism of medications?
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-Bioavailability properties of the medication after biotransformation through liver (called "first-pass" effect)
-Hepatic dysfunction and disease -Change in amount of liver enzymes used in the biotransformation process : decreased in malnutrition and in older adults, fast vs. slow acetylator |
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What factors affect excretion of medications?
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-Renal function capacity : older adult has decreased glomerular filtration rate
-Plasma half-life properties of the drug -Physiological drug effects of onset/peak/duration and therapeutic index (TI) |
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What happens when drugs stay in the system for a long period of time (because they have a long half life)?
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Toxicity builds up
|
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What is the therapeutic index (TI)?
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Margin between therapeutic level and toxic level
Therapeutic drug monitoring is required for medications with low TI (narrow margin) -Peak and trough levels measured in blood -ex: aminoglycoside antibiotics (mysins) |
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What should the RN assess related to patient medications?
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-Patient history and diagnoses
-Allergies -Medication reconciliation -Swallowing ability -Patient knowledge and attitude -Current health status: ex nausea? -Lab values, BP, HR parameters -Diet and fluid restrictions -Use of herbals, caffeine, alcohol, street drugs |
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What should the RN know about medication administration regarding lab values?
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-Medications may be prescribed based on lab results
-Medications may alter body functioning and lab values may denote this -Nursing responsibility includes incorporating lab data with medication administration |
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What should the RN know about medication administration regarding parameters?
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-Many medication orders are dependent on specific parameters such as:
*vital signs: hold for SBP <100 *Lab values: hold for INR >3 *Sliding scale: administer certain amount of insulin based on blood glucose level |
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What is the normal blood glucose serum value?
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70-105 mg/100mL
|
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What is the normal Blood Urea Nitrogen (BUN) serum value?
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10-20 mg/100mL
|
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What is the normal creatinine serum value?
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0.5-1.2 mg/100mL
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What is the normal Potassium (K) serum value?
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3.5-5.0 mEq/L
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What is the normal Albumin serum level?
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3.5-5 g/dl
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What are the nursing responsibilities regarding medication reconciliation as stated in NPSG 8
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Accurately and completely reconcile medications across the continuum of care
-a process exists for comparing the patient's current medications with those ordered while under the care of the health facility of HCP -a complete and reconciled list of medications is communicated & documented upon transfer of a patient to another health facility or HCP -upon discharge a complete and reconciled list of medications is provided and explained to the patient or patient's family |
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What are creatinine levels significant of?
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kidney function
|
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What are BUN levels significant of?
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liver function
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What must be on a complete drug order in order for the RN to be authorized to administer the medication?
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-Patient name
-Drug name -Dose -Route -Frequency -Date -Signature |
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In order for a drug order to be accurate and legible, what should be considered?
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-Clearly written
-No use of inappropriate abbreviations -Safe dosage and appropriate route -Indicated for patient dx -Correct transcription -Use of "read back" for verbal or telephone orders |
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What does STAT mean on a drug order?
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given immediately & only once
|
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What does NOW mean on a drug order?
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given within 90 minutes
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What is a unit dose?
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individual patient supply loaded by pharmacy into med cart drawers
|
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What is stock?
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kept on the floor for frequent use
ex: tylenol, ASA, insulin |
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What are controlled substances?
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not on med cart, locked in narcotic cabinet
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How many identifiers must the RN use when providing care, treatment, and services?
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2 identifiers
-Patient name -Patient medical record number -Patient date of birth |
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What are some nursing strategies to implement safe medication administration?
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-Follow six rights and three checks
-Utilize best practice standards for administration -Question unusually lage or small doses -Use 2 nurse procedure for high-alert medications -Check before crushing or splitting medications -Avoid being interrupted or distracted -Do not leave medications at bedside or unattended -Never sign for a medication you did not give yourself -Calculate drug dosages accurately & double check, verify with another nurse when necessary |