Pharm Lab Exam

Identify the components of a medication order

Patient name, MCP, date, time, medication, concentration, dose, route, prescriber, date ordered

Identify the components of the medication administration record (MAR).

Patient name, MCP, date, time, medication, concentration, dose, frequency, route

10 rights of med administration

1. right patient

2. right medication

3. right dose

4. right route

5. right time

6. right education

7. right assessment

8. right evaluation

9. right documentation

10. right to refuse

3 checks of medication administration

1. when you take the med out of the cupboard

2. before you draw up the med

3. before administering med to patient

Patient position for oral med administration

Sitting or fowlers. Stay there for 30 mins after the med is given

Patient position for eye medication administration

lying supine, or sitting back in a chair with the head hyperextended, looking up

Patient position for ear medication administration

On side, with ear to be treated facing up

Patient position for rectal medication administration

left side lying sims with upper leg flexed upward

Patient position for nasal medication administration

Upright position with head slightly tilted forward

Methods of naloxone administration

Nasal spray and injection

Needle size for intradermal injection

25- or 27- gauge needle, ⅛ inch to ⅝ inch

Intradermal injection site

3 to 4 finger widths below antecubital space, one hand above the wrist.

Upper back

Needle size for subcutaneous injection

25- gauge, ⅛ to ⅝ inch needle

Subcutaneous injection sites

Backs of arms, back, glutes, abdomen, thighs.

Must be free of skin lesions, bony prominences, large muscles, and large nerves. Palpate sites first.

How long does heparin have to be injected for?

Over 30 seconds

Needle size intramuscular

if aqueous med, 20-25 gauge

if viscous med, 18-21 gauge

generally, 22 gauge for adults

1-1.5 inch needle, generally 1 inch

Intramuscular injection sites

• Ventrogluteal (recommended)

• Vastus lateralis

• Deltoid

Ventrogluteal mapping

• Place patient supine or lateral

• Have patient flex knee and hip

• Use left hand for right side, right hand for left side

• point thumb toward patient’s groin, index towards anteriosuperior iliac spine, middle extends along iliac crest

• index, middle, and liliac crest form v shape

• inject in middle of the v shape

Vastus lateralis mapping

• place one hand above the knee and one hand below greater trochanter

• locate middle third of vastus lateralis by drawing imaginary line along midline of anterior and lateral thigh

Deltoid mapping

• Have patient flex and place lower arm across their abdomen or back

• Palpate lower edge of acromion process

• place 4 fingers across deltoid muscle with top finger touching acromion process

• inject 3 finger widths below acromion process

Intradermal injection angle

5-15 degrees

Subcutaneous injection angle

45-90 degree angle

Intramuscular injection angle

90 degree angle

Intramuscular injection special steps

Z track and aspirate. If blood is aspirated, discard and draw up med with new needle

How often do IV lines have to be changed if the infusion is continuous?

Every 96 hours

How often do IV lines have to be changed if infusion is intermittent?

Every 24 hours

How to label a IV line?

Time, date, what is infusing. All lines must be labelled

Signs of fluids overload:

• edema

• crackles

• ascites

• low BP

• distended jugular veins

• low LOC

• confusion

Things we DONT want to see at IV site

• warmth

• redness

• drainage

Characteristics of infiltration

Cold and puffy

Characteristics of phlebitis

Painful, red, warm to the touch

How often does IV bag and pump have to be assessed?

Every hour

How often does the IV lock (port) have to be flushed?

Once a shift, and anytime you go to hook it up

How many mL do we use to flush an IV port?

3mL. Aspirate before flushing. Ensure there is no resistance when you flush

How often does gauze at the IV site need to be changed?

Every 2 days

How often does tegaderm need to be changed at the IV site?

Every 3-5 days

What is a piggyback

Regular bag with smaller bag behind it

What type of med set line is used for a piggyback?

Secondary line

What to do if air bubbles are present in secondary line

Flick air bubbles back to the drip chamber

Does a piggy back always have to be connected to a primary line?

YES

Does the piggyback bag go higher or lower than primary bag?

HIGHER

Does the med and fluids run at the same time with a piggyback set?

No. the pump starts fluids once the med runs out

How do you adjust the drip rate of a piggyback?

Adjust the drip rate with the roller clamp on the primary line. The roller clamp on the secondary line must be completely open

On a med chart, what do the different symbols indicate?

C = compatible, X = not compatible, | = conflicting data

If there are multiple compatible fluids for a med, what would be the first choice?

Normal saline, because it is the most readily available

What is the SAS method?

S- Saline flush

A- Administer med

S- Saline flush

Can you recap used needles?

No. Go straight to the sharps container after use

How do you document narcotics?

Update total narcotic count for the med you are using. Witness must sign for you if you are wasting any narcotic drugs. Draw line through what you did not withdraw. Sign the sheet.

How many mL can you inject IM?

2-5mL, although over 3mL is unusual because it does not absorb properly

How fast should a IM injection be administered?

10 seconds per mL