MEDICATION ADMINISTRATION + PRIORITY SETTING FRAMEWORKS

two hearts in 3/4 time-the avalanches

adverse drug reaction (ADR)

an unintended and non therapeutic effect, ranging from tolerable to harmful and sometimes irreversible or death

adverse drug event (ADE)

life threatening reaction that requires medical intervention to prevent death or disability, or congenital anomaly. must be reported to the FDA to improve safety outcomes, revise drug labels/warnings, and withdraw drugs from the market when needed.

black box warning

issued on medications that may produce lethal and iatrogenic (medical induced harm) results.

hypersensitivity reaction

when the body perceives a medication as a foreign substance, stimulating an immune response. be sure to review the MAR and to ask the client if they have any allergies before administering medications.

anaphylaxis

severe, life threatening reaction resulting from histamine release producing dyspnea, hypotension, and tachycardia. epi-pens are the antidote for this.

steven-johnson syndrome (SJS)

potentially fatal drug reaction that develops 1-14 days after drug administration. s/s include respiratory distress, fever, chills, a diffuse fine rash, then blisters (soulo)

therapeutic drug monitoring (TDM)

method used by health care providers to monitor medication concentrations in a client’s blood. used for those medications that have a narrow therapeutic window, as a means of providing adequate and safe medication administration without causing an adverse medication reaction

rapid acting insulin

rapid onset of 15-30 min and peaks in 30 min to 2.5 hours. ex include aspart and lispro.

short acting insulin

onset of 30-60 min, peaks in 1-5 hours. ex is regular insulin.

intermediate acting insulin

onset of 60-120 min and peaks in 6 to 14 hours. ex is NPH. can be mixed with regular or rapid acting.

long acting insulin

onset of 70 min, does not have a peak. ex is lantus. can never be mixed with any other insulin.

drug interactions

food, supplements, medical conditions, and even other drugs can interact with medications and cause effects such as decreasing action, increasing action, or other ADRs.

age considerations

pediatric clients are going to have a lower dose of medications and a high rate of metabolism, so meds may have to be given more often. older adults often have comorbidities and are more prone to ADEs; the number of medications taken also increases with age.

medication checks

done when obtaining medications from drawer or dispensing machine, during preparation, and immediately prior to administration. be sure to examine expiration date.

client education

inform clients on indications, expected side effects, what to report to provider, and when the client should notice the medication is working before administering medications.

medication reconciliation

medications prescribed are reviewed to confirm they correspond with the existing list of prescriptions the patient is taking. done during admission, on discharge, and during transfer.

narcotic wasting

if a portion of the med is unused, the nurse must waste the medication with another nurse present. entire process should be done in front of the verifying nurse including pulling the med, drawing it up, and wasting it. will be recored in the pyxis. applies to all controlled substances

priority

indicates importance. a task in nursing that you should complete FIRST above everything else

maslow’s hierarchy of needs (maslow’s)

theory that suggests there are five categories of needs that motivate human beings. includes psychological, safety, love and belonging, esteem, and self-actuallization.

ABCDE bundle

a systemic method that can be utilized in any health care setting to evaluate and treat a client. involves airway, breathing, circulation, disability, and exposure.

airway (A)

being sure that there is nothing blocking or restricting the flow of air. the #1 priority; requires immediate intervention to prevent hypoxia and death. examples include partial or complete obstructions, respiratory depression (via drugs), inflammation, facial trauma, and foreign objects.

breathing (B)

assess after patients airway has been established. involves auscultation, obtaining respiratory rate and observing depth and pattern, monitoring for cyanosis, presence of chest wall symmetry, and use of accessory muscles.

circulation (C)

assess after breathing and airway have been established. involves examining skin tone, temperature, capillary refill, hypotension, changes in pulse rate/regularity/volume, and decreased urine output (sign of hypovolemia).

disability (D)

assess after patient’s breathing, airway, and circulation has been established. involves determining a patient’s neurological status. assess levels of consciousness, response to verbal or painful stimulations, and level of orientation. can not be properly assessed if the other ABCs have not been established.

exposure (E)

final component of ABCDE. examining what caused the cascade of events. check for the presence of internal or external bleeding, rashes or other indications of allergic reactions, and edema. also check for manifestations of DVT, which can include warmth, pain, and edema of the calf. temperature readings can also help determine the presence of potential infectious or other inflammatory processes.

unstable

ex: acute changes in conditions. uncontrolled bleeding, severe respiratory distress, and frequently changing blood pressure readings.

stable

ex: vital signs remain unchanged and within expected reference range, mildly elevated BP and a history of hypertension

urgent

factors or situations that have a considerable probability of causing harm or discomfort if interventions are not implemented quickly (ex: answering a bed alarm).

non-urgent

low risk needs that do not require immediate intervention. MSK conditions, non-allergic itching and reports of pain with urination fall within this category. although they do not require immediate attention, the nurse should still address them all in a timely manner.