exam 1 med admin, pain, infection/isolation, safety/mobility

• 10 Rights of Med Admin?

  right patient, right medication, right dose, right route, right time, right documentation, right assessment, right to refuse, right education, right evaluation/response
• 8 components of a medication order?

  patient name

  medication

  dose

  route

  frequency

  indication for use

  time and date written

  providers signature
• Intramuscular injections:

  needle length: 5/8- 1 1/2 inches

  20-25 gauge

  90 degrees

  sites: deltoid, ventrogluteal, vastus lateralis
• subcutaneous injections:

  needle length: 3/8 - 5/8 inches

  25-30 gauge

  sites: 2 inches from umbilicus, thigh, back of arm

  45-90 degree angle
• absorption: movement of medication from where it was administered to circulation
• metabolism: also biotransformation, process of converting a medication to a form that is easily excreted
• first past effect: results in lower concentration of the medicine in systemic circulation; because oral meds pass from small intestine to hepatic circulation via mesenteric vein and portal vein flowing into liver
• most drugs metabolized by liver
• kidneys most responsible for excretion
• distribution: the process of drug delivery to the target organ or tissues that occurs before metabolism and excretion
• excretion: process of removing drugs from the body
• peak plasma level: when a drug is at its highest concentration; not necessarily at its most therapeutic level
• trough serum level: lowest concentration of a medication that correlates to the rate of elimination
• half life: time it takes for medication to fall to half its strength through excretion (half its concentration)
• onset of action: time the medication takes to produce a therapeutic affect after its administration
• duration of action: time for which the med maintains its therapeutic action
• reporting med error:

  monitor patient for changes in condition

  notify nurse supervisor

  complete incident report after notifying physician

  -incident report includes situation, what happened, actions taken, people involved, circumstances, erroneous med administered, scheduled med omitted, client assessment, interventions provided
• teretogenic: known to cause fetal defects
• allergic or hypersensitivity reaction develops when the body perceives a foreign substances (medication) as an allergen, producing the antibodies to counteract the allergen; produces histamines in response to tissue injury
• anaphylaxis: severe life-threatening reaction resulting from histamine producing dyspnea, hypotension, and tachycardia
• stevens-johnson syndrome (SJS) that develops 1-15 days following drug administration. Manifested by respiratory distress, fever, chills, a diffuse fine rash, and then blisters
• prodrugs: inactive chemicals that are transformed through metabolism to become active before they have therapeutic effect
• high alert meds?

  insulin, opiates, narcotics, iv heparin, injectable potassium chloride
• z-track method: stretching skin to promote muscle stretch to reduce risk of medication being deposited into subcutaneous tissue
• what is pain?

  An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage.
• acute pain: from injury, anticipated or predictable ends; goes away within 6 months
• chronic pain: constant or recurring pains; longer than 6 months
• pain threshold: point when client begins experiencing pain
• pain tolerance: how much pain client is willing to take
• cancer pain: tumor pain, bone pain, and treatment-associated pains (chemo or radiation)
• nociceptive pain: skin, organs, bones, referred pain
• neuropathic pain: nerve pain; shooting, burning, tingling
• localization- where is the pain happening
• etiology- what is causing the pain
• signs of acute pain-

  fear, pallor, nausea, vomiting, grimacing, guarding, crying, tachycardia, dilated pupils, hypertension, tachypnea, diaphoresis, vasovagal response (decreased HR)
• chronic pain- depression and anxiety, increased disability, suppression of immune function
• NSAIDS- non steroidal anti-inflammatory drugs; impact kidneys, GI irritation (GI bleeds)
• acetaminophen- impacts liver, in cold medicine (taking acetaminophen and cold meds = BAD)
• opioids- depress central nervous system (worry about respiratory depression) not breathing effectively; CO2 levels climb; pay attention to how sleepy pt is
• adjuvant meds (used in conjuction w other meds)

  anticonvulsants/membrane stabilizers: gabapentin (for neuropathic pain too)

  antidepressants

  corticosteroids