nurse exam - safe medication administration

5 rights of medication administration

Right Patient

Right Drug

Right Dose

Right Route

Right Time

routine prescription

a medication order which continues until the prescriber has changed
or discontinued the medication

standing prescription

a protocol-based order to be administered in specific circumstances

Single prescription

medication is given one-time as directed by the prescriber

Stat prescription

medication is given once immediately

PRN (as needed) prescription

in addition to the five rights, the circumstance for administration is part of the order.

NOW prescription

like a stat order but not as urgent; medication should be given within 90
minutes.

Assessment - medication administration

objective and subjective data, determine if medication and dose is appropriate

Planning - medication administration

avoid distractions, calculate and measure dose precisely, check strength of medication on hand. Verify and prioritize.

Implementation - medication administration

the five rights, provide the patient instructions and information about the
medication.

Evaluation - medication administration

identify and document the patients response to the medication

The Nursing Process and Medication Administration

ADPIE

Weight is measured in

pounds (lbs. English/household) or kilograms (kg metric).

Height is measured in

inches and feet or cm/meter

intake and output are measured in

ounces or cups (English/household) or milliliters or liters (mL/L metric)

Medication dosages are usually in

teaspoons/tablespoons (tsp./tbsp. English/household) or milliliters

1 tsp= ?

5 mL

1 tbsp =

15 mL

1 oz =

30 mL

1 cup =

8 oz = 240 mL

2.2 lbs =

1 kg

dosages for pills are measured in

milligrams or micrograms (mg/mcg).

1 mg =

1,000 mcg

1 g =

1000 mg

Dosages for liquid medications/injections are measured in

mL

Volume for IV fluids is expressed in

L

1 L =

1,000 mL

Time is measured either with a

12-hour clock (AM & PM) or 24-hour clock

In a 24-hour clock, the day begins at

12:01 am (0001)

In a 24-hour clock, the day ends at

midnight (2400)

Temperature is measured in

degrees (98.6 F/37 C)

CD

Controlled dose

CR

Controlled release

CRT

Controlled-release tablet

LA

Long-acting

SA

sustained action

SR

Sustained release

TR

Time-release

TD

Time-delay

XL or XR

Extended release

AC

before meals

PC

after meals

PRN

as needed

STAT

immediately

PO

by mouth

SL

sublingually

ID

intradermal

IM

intramuscular

SC

subcutaneous

IV

intravenous

TID

three times a day

QID

four times a day

BID

twice a day

h (R)

hour

q

every

gtt

drop

OD

right eye

OS

left eye

OU

both eyes

AD

right ear

AS

left ear

AU

both ears

Weights for infants and children need to be converted to

kilograms for the purposes of medication dosage calculation.

Young children and infants’ weights are expressed in

pounds and ounces

how many oz in a 1 pound

16

what is the total amount of a drug to be taken over the course of 24
hours. Total dosages for medication in infants and children are usually expressed in

mg/kg per day

dosage reference ranges which will vary depending upon

age, indication, route of administration, and renal/liver function.

Facilities that use EMRs benefit from

computer aided order entry for medications

Most acute care settings, especially those in large, urban areas in the US, have

electronic medical records (EMR)

All medication administration records will contain the following

patient ID, current date, name of medication, dose, route, frequency, order date, expiration date, time of administration, and administration instructions

Medication orders are written by

prescribers and sent to the pharmacy

pharmacist role

prepares and distributes the medication within acute care settings

nurse role in medication administration

administer medications to patients once the medications are available from the pharmacy

Medications are distributed in acute settings in the following ways:

Unit dose

Pharmacy bulk

unit dose

from a manufacturer

pharmacy bulk

the pharmacist dispenses the appropriate amount from supplies on hand

Medications are stored on the unit in either

medication carts, medication rooms, a locked cabinet in each patient’s room, or an automated dispensing system.

what has to be locked and accounted for every shift

controlled substances

types of solid medications

tablets

enteric-coated tablet

troche or lozenge

capsule

caplet

tablets

if scored, can be broken, or split

troche or lozenge

designed to dissolve in the mouth and should not be swallowed

capsule

the medication is encased in a gelatin container. if the medication is time-released, the capsule with contain beads. otherwise, the capsule will contain power. capsules should not be crushed but may be open

caplet

a tablet shaped like a capsule. some people find caplets easier to swallow

safety of oral medications depends upon the

patients ability to swallow

most solid medications are

swallowed whole

liquids should be used for patients who have

feeding tubes or those who cannot swallow pills (children & infants)

some oral medications are placed

under the togue to dissolve (sublingual/SL), between the cheek and the gums to dissolve (buccal), or in the mouth to dissolve (troche, lozenge)

types of liquid medications

elixir

syrup

suspension

solution

elixir

contains water, alcohol, sweetener, and medication

syrup

contains water, concentrated sugar, and medication

suspension

contain fine particles of medication which do not dissolve completely in water. these must be shaken prior to administration

what are the most accurate ways to draw up the correct amount of liquid medications

Calibrated measuring cups or syringes

why are some medication in powdered form

Usually this is because the reconstituted form (liquid) does not have a long shelf life. In other words, it is not stable in the formulation in which it is to be administered

Diluent

term used for the liquid that reconstitutes a powdered medication.

what are used as diluents for injectable medication

Normal (0.9%) saline, 5% dextrose
in water (D5W), sterile water, and even lidocaine

what is used to reconstitute oral medication

potable water

Use an oral syringe for medications that should be given

orally

Use a parenteral syringe for medications given

IV or by injection

what can be screwed onto a parenteral syringe (Luer-Lok

needles, not an oral syringe

Once reconstituted, a multi dose vial must be

labeled