Nursing Quiz #2

"rights of medication administration

• Right drug

• Right dose

• • Right route

• • Right patient

• • Right time

• • Right documentation — always document immediately after giving medication."

"the 3 medication checks

Before pouring/drawing up • After preparing • At bedside • Always be sure to explain the medication at bedside."

"medication administration sequence

• Hand hygiene/gloves

• checks/rights

• Inform/educate patient about medication

• clean vial

• draw up air

• remove needle cap

• draw up med

• replace cap

• clean insertion site

• administer

• deposit needle in sharps

• Document IMMEDIATELY

• Follow up and evaluate effects

"medication classifications

Usage — how it works • Body system — where it works • Chemical pharmacological class"

"pharmacokinetics (ADME)

Absorption: process by which drug is transported from site of entry → bloodstream; influenced by route"

"drug onset vs peak

Onset: concentration at which drug effects appear.

• Peak: medication reaches highest blood concentration.

• Affected by age"

"secondary effects of medications

anaphylactic: severe allergic reaction; immediate and life threatening

• symptoms: palpitations; obstructed airway

• treat with: steroids, antihistamine, epi

• cumulative: drug builds up

ex) patient in kidney failure -> drug builds up due to inability to excrete -> becomes toxic

• idiosyncratic: drug does opposite of intended effect

• synergistic: drugs that promote action of another

• antagonistic: inhibiting effect

ex) birth control inhibits antibiotics

• placebo: an effect that occurs due to patient believing treatment will work

"legal/safety considerations when giving meds

• Scope/limitations of practice

• Know what nurses can/cannot administer

• Some medications require 2-RN verification

• Never leave medications unattended"

"what should you do in each scenario?

1) unfamiliar medication?

2) medication error?

3) patient reports that they usually receive a different looking pill at this time?

4) patient refuses

5) patient asks what medication is for?

6) what to do before administering a PRN med?

1. Unfamiliar medication? → Look it up before administration.

2. Medication error? → Notify provider and be honest.

3. Patient reports they usually receive a different-looking pill at this time? → Stop and check before administering.

4. Patient refuses → Educate about risks/benefits and document

5. Patient asks what medication is for? → Understand the medication and explain.

6. What to do before administering a PRN med? → Assess pain first."

"exercise

Activity that is greater than one's baseline

. • Requires muscle contraction."

"immobility

No movement or absence of muscle contractions."

5 types of exercise and examples of each

1. Aerobic: exercise requiring increased oxygen — e.g. running/walking

2. anaerobic: high intensity short duration; does not require much oxygen — e.g. sprinting

3. isotonic: muscle contraction & joint movement; muscle changes length while producing force against constant resistance — e.g. weigthlifting

4. isometric: muscle contraction w/o joint movement; muscle length does not change — e.g. plank/wall sit

5. resistance: muscles work against resistance to build strength — e.g. resistance band exercises

"factors that affect mobility

Weight • Lifestyle • Age • Environment — don't move as much in winter or extreme heat • Socioeconomic status • Disability/disease — CNS events (stroke"

"types of ROM exercises

• Passive: nurse moves joint through ROM since patient is unable to move independently

• Active: patient independently moves joints through full ROM; nurse provides little assistance."

"benefits of ROM exercises

Improve joint mobility

• Increase circulation

• Active ROM specifically: increased muscle mass"

"how does regular exercise affect physiologic function?

Cardiovascular: maintain cardiac health; improve circulation. • Respiratory: expanded lung function; avoid fluid in lungs (atelectasis). • Neurological: improved mood; increased endorphins. • Psychosocial: increased alertness. • Musculoskeletal: prevention of atrophy (muscle/tissue shrinkage). • GI: promotes motility and peristalsis; prevents constipation."

"what are the effects of immobility?

All negative! • Cardiovascular: decreased venous circulation; increased risk of DVT/edema. • Respiratory: shallow breathing; risk of aspiration"

"why are immobile patients at higher risk of developing pressure injuries?

Prolonged pressure • Decreased blood flow to area • Inability to reposition"

"examples of important nursing intervention to prevent pressure injuries

• Reposition — 2hrs

• Regular skin assessment

• Keep skin clean and dry

• Monitor for incontinence

• Elevation devices/compression if needed

• Encourage mobility and ambulation if possible

"risks associated with exercise

Cardiac injury

• Tear associated with past injury

• Dehydration influenced by environment

• Temperature regulation issues — e.g. hypothermia or heat exhaustion

"Braden scale

Evaluates risk of developing pressure ulcers.

• Lower # = higher risk of ulcer development."

"stages of pressure injuries

• Stage 1: non-blanchable redness (erythema) of intact skin.

• Stage 2: partial-thickness skin loss with exposed dermis; may present as a blister.

• Stage 3: full-thickness skin loss; fat may be visible.

• Stage 4: full-thickness skin and tissue loss; structures underneath may be visible.

• Unstageable pressure injury: full-thickness skin and tissue loss obscured by slough (necrotic tissue).

• Deep tissue pressure injury: persistent non-blanchable deep red maroon or purple area

"common pressure injury sites

Any areas with bony prominences or consistently under pressure:

• Sacrum

• Elbows

• Heels

• Back of head

• Back of knees & thighs

"routes for injecting medications

Intramuscular (IM)

• Subcutaneous

• Intravenous

• Intradermal

• Intrathecal — spinal

• Intra-articular — into joint"

"why are medications given by injection?

Emergencies — if we don't have another way

• Diagnostic tests

• NPO orders

• Gastrointestinal issues

• Absorption — some medications can't be absorbed when given orally"

"what equipment is needed when giving an injection

• Alcohol prep pads (2)

• Gloves (to wear during administration)

• Syringe

• Needle

• Actual medication"

"where can the syringe be touched? / what parts of the syringe must be kept sterile?

1. Barrel & top of plunger. • 2. Anything that will touch the inside of the barrel"

"how to label a syringe?

Insulin

• med name

• # of units

Other

• med name

• dose in Xmg/XmL

"what does it mean to give a medication in a parenteral route?

Given by injection rather than through the GI tract."

"needle length & gauge

Length:

• Smaller needles (5/8 in) → subcutaneous & intradermal

• Larger needles (1–1½ in) → IM.

Gauge:

• Varies to match the viscosity of the medication or other bodily substances.

• Higher viscosity → smaller gauge

"3 commonly used types of syringes

1 mL (TB) syringe: • • Holds small volumes • • mL scale • • Calibrated in hundredths & tenths of a mL • 3 mL syringe: • • Holds volumes up to 3 mL • • mL scale • • Calibrated in tenths of a mL & whole mLs • Insulin syringe: • • Holds volumes up to 100 units • • Units scale • • INSULIN SYRINGES CAN ONLY BE USED FOR INSULIN ADMINISTRATION!"

"minimizing patient discomfort

Use smallest needle size

• Administer proper amount based on site

• Steady the syringe

• Inject slowly (5–10 seconds if possible)

• Distract the patient

• Pull skin tight to cut through tissue quickly"

sites for IM injections & how to locate

Ventrogluteal:

• Hand on greater trochanter; thumb facing toward front of body • Middle finger on iliac spine

• Pointer finger on iliac crest

• Inject between fingers •

Vastus lateralis:

• One hand on greater trochanter

•One hand on lateral femoral condyle

• Divide area into thirds

• Inject on lateral aspect of the middle

Deltoid:

• Find acromion process

• 2–3 fingers down

• Make a peace sign

• Inject between fingers

Other sites:

•Rectus femoris

•Dorsogluteal — DON'T USE! → too close to bones

"z-track method

ONLY FOR IM INJECTIONS.

Purpose:

• prevent leakage of medication

• more comfortable for patients.

Steps:

1. Displace skin

2. Insert needle 90 degrees

3. Inject

4. Remove needle

5. Release skin"

"aspirating

ONLY FOR IM INJECTIONS.

• What is it? Pulling back on syringe for 5–10 seconds before administering.

• Purpose: check for blood at site of injection.

• What to do if I see blood? Remove needle dispose med and start over

deltoid

• site, volume, gauge, needle length

Site: deltoid

• Volume: 0.5–1 mL

• Gauge: 22–25

• Needle length: 5/8–1 in (children); 5/8–1½ in (adults)"

"vastus lateralis

Site: vastus lateralis • Volume: • • 1 mL — infants • • 1–2 mL — children 1–12 yrs • • 3–5 mL — adults (depending on muscle size) • Gauge: 22–25 • Needle length: 5/8–1 in (all ages)"

"ventrogluteal

Site: ventrogluteal • Volume: 2.5–3 mL • Gauge: 20–25 • Needle length: 1–1½ in depending on client"

"rectus femoris (not recommended)

Site: rectus femoris • Volume: 2 mL • Gauge: 22–25 • Needle length: 1½–3 in"

"sites for subcutaneous injections

Back of arms • Abdomen (2 in from umbilicus) • Back of thighs • Upper thighs"

"what is done when administering heparin and enoxaparin via subcutaneous injection?

• site & why

• angle

• should i pinch if so when?

• massage or not?

• Site & why: abdomen — allows for better absorption.

• Angle of administration: 90 degrees.

• When to pinch: pinch prior to inserting → insert → release pinch → administer.

• Massage or no massage? NO MASSAGE because it is an anticoagulant (could cause bleeding/bruising)."

"what is diabetes?

Metabolic disorder where the body either:

• Cannot produce insulin

• Cannot use insulin that the body already has"

"type 1 vs. type 2 diabetes

Type 1: body does not make insulin. • Type 2: body cells cannot respond to the insulin that it produces."

"what is insulin?

Hormone produced by the pancreas that helps the body transport glucose into cells."

"hypoglycemia

• What is it? Blood glucose <70.

• Can quickly progress to a coma.

• Signs: Cool & clammy skin, Shaking ,Tachycardia (can be masked if taking beta blockers)

• Intervening: Give fast-acting carbohydrates — recheck glucose in 15 min

"intradermal injections

What is it? Administering a drug into the dermal layer of skin. • Common sites: lower arm"

insulin administration

• site, volume (mL), gauge, needle length

site: back of arms, abdomen, thigh

volume: 0.5-1 mL

gauge: 28-30

needle length:

• max 5/8 for arm

• anywhere else 3/16 - 1

"ampule & special considerations when using

Ampule: special type of vial (glass!) with breakable neck.

• Special considerations:

• Need ampule opening device

• Use filter-tip needle when drawing up

• No air allowed in container"

"what should documentation include?

• direct quotes from patient, family or visitors

• data that has been gathered

• actions taken

• individuals notified of concerns/issues

• evaluation

"legal aspects of charting

CORRECT CHART! • Writing neatly in blue or black ink • Signing & dating every entry • Use proper spelling"

"ADPIE

Steps of the nursing process: • Assess: pull information. • Diagnose: where a nursing diagnosis is made (prioritized based on Maslow's hierarchy). • Plan: make it a SMART goal — specific"

"difference between nursing and medical diagnoses

Nursing diagnosis: patient-specific. • Medical diagnosis: generalized."

"two types of nursing diagnoses

Actual nursing diagnosis (three-part):

• problem is present + have evidence.

• • Problem → related to → as evidenced by

Risk nursing diagnosis (two-part): problem may occur but no evidence yet.

• Potential problem → related to."

"prioritization

WHAT COULD KILL PATIENT FIRST? • Anything impacting ABCs should be FIRST PRIORITY."

acetaminophen

• class, use, contraindications, interactions, adverse effects

class: non opioid antipyretic/ analgesic

therapeutic use: fever reducer & pain reliever

contraindications: pregnancy/lactation; liver disease

interactions: alcohol; warfarin (increased risk of bleeding)

adverse effects: acute toxicity, GI upset

heparin

• class, use, contraindications, interactions, adverse effects, interventions

class: anticoagulant

use: prevent blood clotting; treat/prevent DVT, stroke & PE

contraindications: pregnancy/lactation; history of uncontrolled bleeding or hemophilia

interactions: aspirin & NSAIDs increase bleeding risk

adverse effects: low platelet count, toxicity, hemorrhage

interventions: monitor platelet count; avoid concurrent use of NSAIDs

enoxaparin

• class, use, contraindications, interactions, adverse effects, interventions

class: anticoagulant

use: treatment/prevention of DVT, PE & stroke

contraindications: pregnancy/lactation; history of uncontrolled bleeding & hemophilia

interactions: aspirin & NSAIDs increase bleeding risk

adverse effects: low platelets, hemorrhage, toxicity

interventions: monitor platelet counts; avoid concurrent use of NSAIDs

rivaroxaban

• class, use, contraindications, interactions, adverse effects, interventions

class: anticoagulant

use: stroke prevention; treatment/prevention of DVT or PE

contraindications: pregnancy/lactation; renal or hepatic impairment; known allergy

adverse effects: risk of bleeding; increased liver enzymes

interventions: monitor bleeding/bruising; monitor liver enzyme levels

docusate sodium

• class, use, contraindications, interactions, adverse effects, interventions

class: surfactant laxative (decreases surface tension of stool to allow it to pass through)

use: temporary treatment of constipation

contraindications: pregnancy/lactation; bowel obstruction

adverse effects: dehydration; rectal inflammation; GI irritation; fluid retention

interventions: monitor for fluid retention; increase water intake

lisinopril

• class, use, contraindications, interactions, adverse effects, interventions

class: ACE inhibitor

use: treatment of hypertension; heart failure & heart attack

contraindications: known allergy; pregnancy/lactation

interactions: antihypertensive medications increase hypotensive effect; NSAIDs decrease therapeutic effect

adverse effects: cough, hyperkalemia; orthostatic hypotension

interventions: avoid use of NSAIDs; monitor potassium levels

metoprolol

• class, use, contraindications, interactions, adverse effects, interventions

class: beta blocker

use: treatment of hypertension, angina & heart attack

contraindications: arrythmias; pregnancy/lactation

interactions: calcium channel blockers intensify effects; antihypertensive meds intensify hypotensive effect

adverse effects: bradycardia; decreased cardiac output; hypotension; AV node block; orthostatic hypotension

interventions: monitor pulse & BP; monitor if taking calcium channel blockers concurrently

insulin aspart

• class, use, contraindications, interactions, adverse effects, interventions

class: rapid acting antidiabetic

use: treatment of diabetes

contraindications: pregnancy/lactation

interactions: beta blockers and other meds can have added hypoglycemic effects; diuretics inhibit effects of insulin

adverse effects: hypoglycemia; lipohypertrophy

interventions: monitor for hypoglycemia; regularly rotate injection sites

senna

• class, use, contraindications, interactions, adverse effects, interventions

class: stimulant laxative

use; temporary treatment of constipation

contraindications: bowel obstruction; pregnancy/lactation

interactions: milk & antacids interfere with enteric coating of capsules

adverse effects: fluid retention; Gi irritation; dehydration; rectal inflammation

interventions: monitor for fluid retention; only to be used short term → long term use can result in electrolye imbalances

diltiazem

• class, use, contraindications, interactions, adverse effects, interventions

class: calcium channel blocker

use; treatment of hypertension, angina & cardiac arrythmias

contraindications: pregnancy/lactation; heart block/heart failure

interactions: grapefruit juice; use of beta blockers can lead to heart failure

adverse effects: orthostatic hypotension, peripheral edema; acute toxicity; suppressed cardiac function

interventions: monitor BP and EKG; monitor for signs of bradycardia

amlodipine

• class, use, contraindications, interactions, adverse effects, interventions

class: calcium channel blocker

use: treatment of angina & hypertension

contraindications: pregnancy/lactation; allergy; kidney/liver dysfunction

interactions: antihypertensives & grapefruit juice

adverse effects: orthostatic hypotension, peripheral edema

interventions: monitor BP and for signs of peripheral edema

glargine

• class, use, contraindications, interactions, adverse effects, interventions

class: long acting antidiabetic

use: treatment of diabetes

contraindications: pregnancy/lactation

interactions: alcohol & beta blockers have added hypoglycemic effect; diuretics counteract effects of insulin

adverse effects; hypotension; hypokalemia; lipohypertrophy

interventions: monitor for hypotension & hypokalemia; rotate injection sites

metformin

• class, use, contraindications, interactions, adverse effects, interventions

class: oral antidiabetic

use: treatment of diabetes

contraindications: pregnancy/lactation; kidney impairment

interactions: use of iodine contrast media can cause kidney failure

adverse effects: GI effects; lactic acidosis (blood becomes acidic)

interventions: discontinue medication 24-48 hours before imaging procedures using contrast media

regular insulin

• class, use, contraindications, interactions, adverse effects, interventions

class: short acting antidiabetic

use: treatment of diabetes

contraindications: pregnancy/lactation

interactions: additive hypoglycemic effects with alcohol & beta blockers; diuretics inhibit the effects of insulin

adverse effects: hypoglycemia; hypokalemia; lipohypertrophy

interventions: monitor for hypoglycemia/hypokalemia; rotate injection sites

glipizide

• class, use, contraindications, interactions, adverse effects, interventions

class: oral antidiabetic

use: treatment of TYPE 2 diabetes

contraindications: patients with TYPE 1 diabetes

interactions: NSAIDs & SSRIs have added hypoglycemic effect

adverse effects: hypoglycemia

interventions: monitor for hypoglycemia

gabapentin

• class, use, contraindications, interactions, adverse effects, interventions

class: anticonvulsant/ antiepileptic

use: adjunct to treatment of partial onset seizures; treatment of nerve pain

contraindications: pregnancy

interactions: meds or substances that promote CNS depression (opioids, sleep aids, sedatives)

adverse effects: drowsiness, poor coordination; peripheral edema

interventions: advise patient to avoid activities requiring alertness, monitor for peripheral edema

monitor renal function

rapid acting insulin

• example

• onset, peak & duration

• ex) aspart

• onset: 15-20min

• peak: 0.5-3 hours

• duration 3-5 hours

short acting insulin

• example

• onset, peak & duration

(ex. regular insulin)

• onset: 30-60 min

• peak: 2-4 hours

• duration: 4-12 hours

intermediate acting insulin

• onset, peak & duration

• onset: 1-2hours

• peak: 4-12 hours

• duration: 14-24 hours

long acting insulin

• example

• onset, peak & duration

(ex. glargine)

• onset: 2-4 hours

• peak: minimal

• duration: up to 24 hours

ultra long acting insulin

• onset peak & duration

• onset: 1 hour

• peak: 12 hours

• duration: 24-42 hours