Nursing Techniques 1

responsibilities of the nurse during med admin

interpret, transcribe, prepare, administer, teach, document, and evaluate

3 names of a medication

1. chemical

2. generic

3. brand

drug classification

the effects of medication on the body, relieving symptoms, or desired effect

4 processes of pharmacokinetics

1. Absorption

2. Distribution

3. Metabolism

4. Excretion

How are pharmacokinetics influenced

route of administration, the function of each body organ

first pass effect in absorption

medications are extensively metabolized at a specific location (usually the liver)

other places the first pass effect can occur in

lungs, vascular system, gi tract

what is bioavailability

the amount of med able to reach the target cells to produce its intended effect

distribution

the transportation of medications in the bloodstream to the site of blood action

metabolism

breakdown of medication into an inactive form

which patients are at risk for medication toxicity

older adults, chronically ill individuals

what is excretion and list examples

1. where meds exit the body

2. lungs, kidneys, bowel, exocrine glands

Half-life of a medication

the amount of time it takes for half of the drug to be eliminated. Liver and kidney disease, aging, absence of food, and slowed metabolic rate prolong half-life because of their effects on metabolism and excretion.

therapeutic effect

intended or desired response of a medication

T or F: can a medication have more than one therapeutic effect. If so list an example

True

Example: aspirin-platelets, fever, and pain relief

side effect

any effect that is caused by a drug and that is different from the drug's intended effect. can be harmless or slightly harmful

adverse effect

a severe negative response to a drug, requires immediate stoppage

example: IV iron in certain pts

toxic effects:

development of toxicity in the blood after prolonged use of a medication

example of an antidote used to reverse toxic effects of drugs

narcan - used to reverse opioid overdose

idiosyncratic reaction

an unexpected reaction to a drug that is peculiar to the individual

Which age group does idiosyncratic reactions affect the most

older adults

allergic reactions

immune response to a medication

medication interactions

occur when one med modifies the action of another medication. Meds may increase or diminish the action of other meds and alter the meds absorption, metabolism, or elimination from the body.

polypharmacy

the use of multiple drugs that are more than medically necessary

synergistic/greater effect

when the combined effect of two medications or a medication and a substance is greater than the effects of the medications given

examples of synergistic effects

-alcohol and antidepressants

-grapefruit juice and birth control

what is the effect of a synergistic effect gone wrong

potentially high levels of drugs in the bloodstream

example of a synergistic effect used to help control a medical condition

iron and vitamin d

onset

when med starts to produce therapeutic response

peak

med reaches max therapeutic response, highest serum concentration, after peaking the serum med concentration falls progressively

trough

point at which lowest amount of drug is detected in serum

duration

length of time drug exhibits therapeutic response

types of medication orders

routine, stat, single, standing, and prn

routine order

Administered until the health care provider discontinues the order or until a prescribed number of doses or days have occurred.

stat order

single order carried out immediately. most common in urgent situations

single/one-time order

one dose given at a specific time

examples of single orders

-valium before surgery

-oxytocin in labour

standing order

Is an order conditioned upon the occurrence of certain events (e.g., low BG, angina). It authorizes a medical professional such as a nurse to institute certain treatments or medications. All patients who meet the same criteria receive the same treatment

example of a standing order

maternity ward has a standing order for pain medications and vital signs

prn order

an as needed order, requires nurse to use their judgement before client recieves it

7 essential parts to a drug order

1. Patient name

2. Date and time order written

3. Drug name

4. Drug dose

5. Frequency of administration

6. Route of administration

7. Signature of prescriber

goal of med reconciliation

to increase client safety by providing the correct meds the client uses. helps prevent adverse reactions

Nurse's role in med admin

1. The drug, reason, effects + nursing implications

2. perform assessment to determine safety and client education

3. administration, monitoring the effects, documentation, respond+report reactions

10 rights of med admin

1. *Right client

2. *Right medication

3. *Right dose

4. *Right route

5. *Right time/frequency

6. *Right documentation

7. *Right reason

8. Right to refuse

9. Right to client education

10. Right evaluation

4 things to do if client refuses medication

1. ask why they are refusing

2. ensure they are informed + consequences

3. notify precriber

4. document reason why

4 things client should know when being educated

1. reason for med

2. med actions

3. possible side effects

4. effectiveness of the med

Med prep checks

First Check

When removing med from drawer (also check expiry date of med)

Second Check

After preparing the med (after dosage calculation, pouring, splitting, etc.)

Third Check

Before returning any bottle to drawer or placing med in med cup to take to client

what are the 3 A's to bedside med admin

allergies, armband, assessment

T or F: nurse should do medications in order from top-bottom on the MAR

true

What should you consider while pt is taking meds

have pt in sitting position to prevent aspiration, do not leave meds unattended, stay with client until medications are swallowed

when should you not give oral meds to a pt

If they have nausea/vomiting, gi alterations, gastric suctioning, decreased LOC or unconscious, increased RR

how do medications affect vital signs

meds such as acetaminophen can decrease T, RR, and O2 saturation

how does illness, infections, and diseases affect vital signs

fever causes increased P, RR, and BP. infection increases P, and sepsis. causes a decrease in BP

how does exercise and stress affect vital signs

increases T, P, RR, and BP

PO intake affects vital signs by

altering T, BP

What are the most common medication errors

omission, improper dose, wrong time, extra dose, wrong patients

What is a medication error

Any preventable event that could cause or lead to a client either receiving inappropriate med therapy or failing to get it

What makes PRN medications different

they are dependent on the nurse's judgement. Decisions about PRN medication administration are dependent on thorough accurate assessments and critical thinking

What are some common examples of PRN meds

Analgesics

GI meds

MDI's (multidose inhalers)

Nitro

Sedatives

Anti-anxiety meds

When should a nurse document a PRN med

When assessment and rationale for a drug is needed, reason why med was given, when it was given

Requirements of narcotics and controlled substances

dispensed with prescription, be stored in a locked cabinet, documented, wastage is witnessed

What are some example of topical medications

• Transdermal

• Opthalmic

• Otic

• Nasal

• Vaginal

• Inhaled

• Rectal

Examples of transdermal meds

ointments, pastes, creams, lotions, powders, sprays, patches

Should you wear gloves while applying transdermal medications

Yes otherwise you will expose yourself to the medication

Where should you NOT apply a patch

on open skin, lesions, distal extremities, breast tissue, areas with rashes/erythema/scar tissue

What should you do before applying a patch medication

Sign your name and date the patch, also record in the MAR

What must the container say when using ophthalmic meds

Must be sterile and say for ophthalmic use

How do you administer ophthalmic medications

Ask client to look up and with non-dominant hand expose lower conjunctival sac by gently pulling down on skin just below eye. Next rest dominant hand with dropper or tube on client's forehead and instill eye gtt 1-2 cm above eye into outer third of the lower conjunctival sac. Ask client to close eyelid not to squeeze shut and press firmly on nasolacrimal duct

How do you install otic meds

You straighten the ear canal i(based on age). Once gtt instilled press on tragus a few times to assist the flow of med in ear canal. Instruct client to remain in lateral position 5 min following med admin to prevent drops from escaping and to allow med to reach all sides of ear canal.

What effect is common with nasal meds

the rebound effect

How do you install nasal meds

Client is generally in a seated position, head tilted back, and inhale as med enters nare.

What can influence drug action youth

• Immature liver & kidneys

• Immature blood-brain barrier

• Larger percent of body surface area (BSA) for their weight - thinner epidermal layer

• Drug ordering different (weight based)

What factors influence drug action in older adults

• Absorption

• Protein binding sites

• Metabolism

• Nephrons; GFR

-drug receptor interaction

-circulation

-distribution

What effects posture

• Disease

• Pregnancy

• Atrophy

• Obesity

• Fractures

• Ligament/soft tissue injury

• Static posture

What can decrease joint flexibility

Age, Injury, Certain musculoskeletal injuries

What is mobility

Ability to move freely, easily and independently requires intact functioning of both the musculoskeletal and the nervous systems.

What is immobility

Inability to move freely can lead to deconditioning Prolonged immobility can lead to: Deconditioning: clinical syndrome that results in reduced functioning of multiple body systems, especially the musculoskeletal system.

effects of immobility on the musculoskeletal system

decreased muscle mass, atrophy, strength, endurance, and impaired joint mobility

nursing interventions to prevent musculoskeletal immobility

ROM, isotonic, isometric exercises

frequent ambulation

splints to prevent contractures

proper body alignment

effects of immobility on the integumentary system

decreased O2 and nutrients to tissues, inflammation, ischemia

effects of immobility on the respiratory system

decreased lung expansion, hypoventilation, impaired gas exchange, pooling of secretions

effects of immobility on the circulatory system

Decreased cardiac output, venous pooling, peripheral edema

effects of immobility on the gastrointestinal system

Decreased peristalsis, fluid intake, and appetite

nursing interventions to prevent integumentary immobility

frequent skin assessment, reposition q2h, proper hygiene to keep skin clean and dry

nursing interventions to prevent respiratory immobility

frequent respiratory assessment, positioning to promote lung expansion, DB&C exercises etc., frequent ambulation

nursing interventions to prevent cardiovascular immobility

frequent circulatory assessment, compression stocking application+assessment, exercise (ROM), BP assessment prior to ambulation

nursing interventions to prevent gastrointestinal immobility

frequent GI assessment including I & O, bowel activity, frequent ambulation, diet considerations including protein, fibre, and fluid

what are some pathological influences on mobility

congenital+postural anomalies, CNS damage and conditions, abnormalities or trauma of the muscloskeletal system, disease and illness

factors that affect mobility

medication, motivation, age, pain, surgery, amputation, restraints, bed rest

What are some benefits of the activities of daily living

work, play, maintaining independence, relationships, communication (nonverbal)

Consequences of impaired mobility on metabolism

-decreased metabolic rate

-negative nitrogen balance

-decreased production of stress hormones

-slowing of all systems

-decreased food intake

-decline nutritional intake

-impaired healing

-electrolyte imbalance

-decreased physical and emotional coping capacity

Consequences of impaired mobility on the respiratory system

Decreased mobility places clients at risk of atelectasis which can then lead to hypostatic pneumonia. Both conditions cause decrease oxygenation, prolong recovery, and add to a patient's discomfort

Consequences of impaired mobility on the cardiovascular system

patients at risk for orthostatic hypotension, increased cardiac workload, and thrombus formation. During immobility there is decreased circulating blood volume, pooling of the blood in the lower extremities, and decreased autonomic response. Oxygen consumption increases as the workload of the heart increases.

Consequences of impaired mobility on the musculoskeletal system

Decreased mobility often leads to loss of endurance, strength, muscle mass, and decreased stability and balance. Also impacted with impaired calcium metabolism, disuse osteoporosis

Consequences of impaired mobility on the urinary system

urinary retention, stasis, UTI, and renal calculi

Consequences of impaired mobility on the skin

pressure injuries, friction and shearing injuries, deep tissue damage

Prior to transport or ambulations what assessment should you do

ACES assessment

what should you consider prior to repositioning a patient

• Degree of exertion permitted

• Activity tolerance

• Ability to assist with move (muscle strength, flexibility, paralysis, pain-may need analgesic)

• Weight

what should the nurse consider before repositioning a pt

• Their own strength and ability to safely move the client

• The need for any assistive devices (must be used for weights over 35 lbs) and if they are necessary ensuring they are present and in safe working order (cannot leave to run and grab something)

• Any tubes, medical devices such as IV's, urinary catheters to ensure they are kept safe

• The effects of meds that may impair alertness, balance, strength, and mobility

High Fowler's position

•HOB 60-90° angle

• Used if client having severe difficulty breathing or eating