Nursing Theory Exam 3

med outside of the GI tract

parenteral

things commonly experienced with a medication

side effects

unusual and potentially life-threatening reactions to a medication

adverse effects

meds that can’t be taken together

contradictions

nurses role in med admin 

verify order

assessments 

education

documentation

check rights

double check dosage calculations

6 rights of med admin (Patients Do Drugs Round The Day)

person, dosage, drug, route, time, documentation 

three checks

before you prepare, after you prepare, at the bedside

parts of an order

medication name

route

frequency

time

reason (if PRN)

dose

special instructions

length of time

prescription date

types of oral meds

tablet, capsule, liquid

buccal/sublingual 

enteral 

enteral

nasogastric tube or gastrostomy

oral med considerations

must be able to swallow and conscious

aspiration risk

should be sitting up or side laying

remain until fully swallowed

types of topical medications 

lotions, ointments, creams, transdermal 

topical med considerations

wear gloves

assess skin

place new patch in different area after removing old patch

irrigation

wash out body cavity i

installation 

insert into body cavity 

ophthalmic med

eye drops - put into conjunctival sac

otic med

ear drops - side laying n

nasal med 

blow nose first 

quick deep breath while spraying 

vaginal med position

in dorsal recumbent position

rectal med position

sims

types of inhalation meds

metered dose inhalers

dry powder inhalers

types of parenteral meds

IM, SQ, ID, IV

site and angle of intra dermal 

right under skin 15

subq site and angle

into fatty layer 90-45

intra muscular site and angle  

muscle 90

needle gauges 

14-30 (bigger the # the smaller the needle)

blunt needle

used to draw up from vial only

filter needle 

used to draw up from ampule 

IM Sites 

ventrogluteal 

deltoid 

vastus lateralis

ID injection sites

chest

shoulder blade

forearm

SQ sites

lower stomach

front of thigh

tricep

hip

below shoulder blades

ID injection requirements 

max volume: ~0.1 mL

syringe:1mL or TB syringe 

needle length: 3/8-3/4

gauge: 26-28 G

angle: 5-15 

SQ injection requirements

max volume: tricep (0.3mL) abdomen (0.5mL) anterior thigh (1mL)

needle length: 3/8-1

gauge: 25-27 G

angle: 45-90

IM injection requirements

max volume: large muscles (up to 3mL) smaller (0.5-1mL)

syringe: 1-3mL

needle length: 1-1 ½

gauge: 22-25 G

angle: 90

directly into blood stream

IV injections 

pay most attention to side effects dealing with (ABC)

Airways, Brain, Cardiovascular,

describe chemical structure

chemical names

simple (common) name 

generic name 

created by drug companies

brand name

group with similar properties

drug class 

could cause harm if used in error 

high alert drugs

meds from plants that can interact with others and are not always FDA approved

herbal

chemicals the body makes

intrinsic

chemicals that the body does not make (must be taken in) 

extrinsic  

reason drug is prescribed

indication

types of adverse effects

allergic reactions and angioedema

adverse effects of the airway 

anaphylaxis 

adverse effect that involves two or more systems

anaphylactic shock

an immune response to medications that causes swelling to the face and has no cure (NOT an allergy)

angioedema

A rare reaction to medication that causes flu like symptoms and rash on less than 10% of skin commonly on mucus membranes

Steven-Johnson syndrome

reaction to meds that cause burn like patches and skin to peel off on over 30% of the body that has no cure 

Toxic epidermal necrolysis (TENS)

drug movement through the body

pharmacokinetics

movement of meds across mucosal lining of small intestine

absorption

factors affecting absorption

blood flow, stomach ph, pace of GI movement

meds binding to plasma proteins and albumin in the blood stream

distribution

factors affecting distribution

blood flow, protein availability, vascular permeability

specialized endothelial lining where cells are tightly pressed together to protect the brain that 98% of meds can’t pass

blood brain barrier

to cross the blood brain barrier

-must be highly lipid soluble and low molecular weight or bind to transport proteins

process where drug is chemically changed by the body for excretion that primarily takes place in the liver 

metabolism 

metabolized into active pharmacological substance

pro drug

factors affecting metabolism

liver function, first pass effect, drug competition, nutrition

the process of mads going from SI through hepatic portal vein into the liver where some is metabolized to an inactive form and excreted reducing the amount of active drug available

first pass

percent of administered drug available for activity in systematic circulation

bioavailability

first and second fastest drug admin route 

IV and intraosseous (30-60 seconds)

slowest drug admin route

oral (30mins-1hr)

after __ half lives 99% has been eliminated

7

larger first dose to achieve therapeutic effect while steady state is being achieved 

loading dose 

the process of all drugs being filtered in the kidneys and exiting the body

excretion

factors affecting excretion

age, kidney or liver impairment, and urine pH

what a drug does to the body 

pharmacodynamics 

smallest amount of a drug that will still cause a reaction

minimum effective concentration

how long it takes to reach the minimum

onset

meds are scheduled to be administered at (what pharmodynamic point?)

trough 

what do agonists do

activate receptors

what do antagonists do

block receptors

type of drug effect that causes substantially greater reaction

synergist 

type of drug effect where two cancel each other out

antagonist

Full lab panel

Comprehensive metabolic panel

shortened lab panel 

Basic metabolic panel 

Labs that are high if liver is impaired

AST and ALT

labs that indicated binding and absorption

total protein and albumin

labs that indicate kidney function 

Creatnine, BUN, and GFR 

low GFR indicates

kidney disease

Full panel for blood

Complete Blood Panel

blood lab panel that show different types of WBCs and can be used to identify infection 

CBC with diff 

panel used when on blood thinners

coagulation panel

fluid balance labs (2)

hematocrit and electrolytes