study for test 2 kenz

Principles of Medication Administration

• Right Patient: Verify the patient’s identity using at least two identifiers (e.g., full name and date of birth) and cross-check their wristband. [1, 2]

• Right Drug: Double-check the medication label against the physician’s order at least three times (when retrieving, preparing, and putting the drug away). [1, 2]

• Right Dose: Confirm that the dosage amount is appropriate for the patient, paying special attention to calculations and high-alert medications (like insulin or heparin) which require an independent double-check by another professional. [1, 2]

• Right Route: Ensure the medication is delivered via the specified path (e.g., oral, intravenous, intramuscular, subcutaneous, or topical) as different routes alter absorption and onset speeds. [1, 2]

• Right Time:

Nurse responsibility with medications

The nurse must know all aspects of the drug being administered and appropriate nursing parameters.

Right to Refuse

The patient has the right to refuse any medication.

Nursing action when a patient refuses medication

Explain risks of refusing, reinforce why it is prescribed, notify the HCP, and document.

Patient's Right to Education

The patient has the right to accurate and thorough information about medications.

Medication education should include

Medication name, purpose, action, side effects, dietary restrictions, and labs requiring monitoring.

Drug information resources

USP-NF, PDR, pharmacology texts, nursing drug references, journals, electronic formularies, and pharmacists.

FDA

Food and Drug Administration; involved in establishing and regulating drug standards.

ISMP

Institute for Safe Medication Practices.

DEA

Drug Enforcement Administration; regulates controlled substances.

U.S. drug legislation

Sets official drug standards and defines prescription drugs.

Nurse Practice Acts

Laws that regulate nursing practice, including medication administration.

Institutional Policies

Facility-specific rules and procedures nurses must follow when administering medications.

Drug Research

A complex process that follows ethical principles and informed consent.

Informed Consent

Required ethical component of drug research.

Drug Trials

Research trials must be conducted with integrity.

New Drug Development

Occurs through four phases according to the pharmacology lecture.

Over-the-Counter Medication (OTC)

Medication that can be obtained without a prescription.

Prescription Medication

Medication that requires an authorized prescription.

Herbs/Botanicals

Plant-based substances that may be used for health purposes.

Pharmaceutical Classification

Classifies drugs by mechanism of action, physiologic effect, and chemical structure.

Therapeutic Classification

Classifies drugs according to clinical indication or therapeutic action.

Examples of Therapeutic Classes

Analgesic, antibiotic, and antihypertensive.

Chemical Name

Identifies a drug's atomic and molecular structure.

Generic Name

Name assigned by the manufacturer that first develops the drug and derived from its chemical name.

Trade Name

Brand name copyrighted by the company selling the drug.

Medication Prescription: Patient Information

Must include the patient's full name; some locations also require an address.

Medication Prescription: Date and Time

Must include the date and time the order was written.

Medication Prescription: Medication

Must identify the medication being prescribed.

Medication Prescription: Dosage

Must state how much medication is to be administered.

Medication Prescription: Frequency

Must state how often the medication should be administered.

Medication Prescription: Route

Must state how the medication is administered.

Medication Prescription: Prescriber

Must include the prescriber's printed name, signature, credentials, and required registration information.

Controlled Substance

A medication regulated by the DEA.

Controlled Substance Nursing Responsibility

Account for all narcotics on the unit.

Medication Waste

Narcotic medication that is discarded or wasted must be countersigned according to policy.

Narcotic Counts

Nurses perform narcotic counts according to facility policy.

Controlled Medication Security

Only authorized individuals should have access to controlled-substance systems.

Medication Error Contributing Factors

Poor communication, poor medication storage, heavy workload, interruptions, and distractions.

Incident/Occurrence Report

A report associated with medication errors and safety events.

Preventing Medication Errors

Arrive rested and undistracted and follow medication-administration rights.

Preventing Dose Errors

Calculate doses carefully and double-check when required with another RN.

Look-Alike/Sound-Alike Drug Safety

Watch for medications with similar names.

Patient Identification Safety

Be cautious when patients have the same last name.

Unfamiliar Medication Orders

Clarify unfamiliar medication names and dosages.

Illegible Medication Orders

Clarify illegible orders before administering the medication.

Medication Abbreviations

Avoid unsafe abbreviations when communicating medication orders.

Medication Resources

Know and use available medication-information resources.

Medication Order Changes

Keep up with changes in medication orders.

Pharmaceutic Phase

The phase in which a medication must dissolve into solution before it can be absorbed.

Tablets

Tablets are not 100% active drug.

Drug Dissolution

Drugs generally need to be in solution before they can be absorbed.

GI Fluids

Most medications disintegrate and absorb faster in acidic fluids.

Food and Drug Absorption

Food in the GI tract may interfere with or enhance drug dissolution and absorption.

Pharmacokinetics

The effect the body has on a drug.

Four Pharmacokinetic Processes

Absorption, distribution, metabolism, and excretion.

Pharmacodynamics

The effect a drug has on the body.

Absorption

Movement of a drug into the bloodstream.

Critical Concentration

Amount of medication needed to produce a therapeutic effect.

Loading Dose

A dose given when a medication effect is needed quickly.

Factors Affecting Absorption

Route, lipid solubility, pH, blood flow, administration site conditions, and dosage.

Distribution

Transport of a drug to body tissues and organs.

Factors Affecting Distribution

Local blood flow, membrane permeability, protein binding, blood-brain barrier, placenta, and breast milk.

Metabolism/Biotransformation

Chemical conversion of a drug in the body.

Factors Affecting Metabolism

Liver function, health or disease status, first-pass effect, and drug half-life.

First-Pass Effect

A medication may pass through the liver before reaching systemic circulation.

Excretion

Removal of a drug from the body.

Factors Affecting Excretion

Function of the kidneys, liver, lungs, exocrine glands, and creatinine clearance/GFR.

Creatinine Clearance/Glomerular Filtration Rate

Measurements related to kidney function that influence medication excretion.

Lifespan Factors Affecting Medications

Age, weight, gender, pregnancy, genetics, and cultural factors.

Therapeutic Range

the blood concentration or dosage of a medicine that treats a condition safely without causing harm

Trough Level

the lowest concentration of a medication in a patient's bloodstream, measured right before the next scheduled dose

Half-Life

the time it takes for the concentration of that medication in your bloodstream or body to reduce by 50%

Receptor Theory

Explains drug activity through interaction with receptor sites.

Agonist

Interacts with receptor sites to cause activity similar to naturally occurring chemicals.

Agonist Example

The lecture uses insulin replacement as an example.

Antagonist/Inhibitor

Drug interaction concept involving blocking or inhibiting activity at receptor sites.

Antagonistic Interaction

happens when two or more drugs combine and the total effect is less than the sum of their individual effects

Synergistic Interaction

occurs when two or more substances, agents, or factors combine to produce an overall effect that is greater than the sum of their individual effects working alone

Drug Incompatibility

a physical or chemical reaction that happens in vitro (outside the body) when two or more drugs or solutions are mixed together in a syringe, IV bag, or tubing before administration

Adverse Drug Effects Include

Primary actions, secondary actions, hypersensitivity, allergic reactions, and toxic effects.

Side Effects

unintended secondary reactions that happen along with the main therapeutic benefits of a drug

Medication Indications

Preventative, diagnostic, or treatment purposes.

Factors Influencing Drug Choice

Age, disease, condition, medical history, side effects, expected results, allergies, and availability.

Medication Teaching: Administration

Teach the patient proper techniques for administering the medication.

Medication Teaching: Frequency

Teach how frequently and for how long the medication should be taken.

Medication Teaching: Dose Changes

Patients should not change medication doses without consulting the healthcare provider.

Medication Sharing

Patients should not share medications.

Medication Storage

Teach patients how medications should be stored.

Therapeutic Communication

Purposeful professional communication used within the nurse-patient relationship.

Forms of Communication

Verbal and nonverbal communication.

Verbal Communication

One major form of communication identified in the lecture.

Nonverbal Communication

Communication through nonverbal cues such as posture, facial expression, and gestures.

Communication Methods Used by Nurses

Auditory, visual, and kinesthetic methods.

Communication Technologies

Electronic communication, social media, email, text messaging, telehealth, and telemedicine.

Factors Influencing Communication

Developmental level, culture, roles, space, health state, values, and environment.

Developmental Level

Factor that can influence how a person communicates.

Sociocultural Differences

Cultural and social differences can influence communication.

Roles and Responsibilities

A person's role and responsibilities can influence communication.

Space and Territoriality

Personal space and territorial needs can influence communication.