NURM-102 Medication Administration Exam Review

Standing order

Repeated daily

Medication Order elements

• Name, DOB

• Drug name, dose, route, frequency

• Provider name and special instructions

3 checks

1. Taking it out

2. Comparing with MAR

3. At bedside

Confused patients…

cannot refuse meds

If oriented patients refuse meds…

Educate and document if they refuse again

10 Rights

1. Patient

2. Drug

3. Dose

4. Route

5. Time

6. Documentation

7. Education

8. Reason

9. Response

10. To refuse

3 patient identifiers

1. Name

2. DOB

3. Medical record number

How should medication be handled?

Aseptically, do not touch with bare hands

Oral drug forms

Liquid, tablets, capsules, powders, elixirs, suspension

Contraindications for Oral Meds

• Nausea/Vomiting

• Altered LOC

• Impaired/absent gag reflex

Topical

Ointment or cream for skin

Transdermal

Patches

Nebulizer

For patients who can’t breathe on their own

• Converts liquid into a fine mist

Ophthalmic ointment

Applied on conjunctiva from inner to outer canthus without touching conjunctiva

• Apply pressure on inner canthus afterwards

• Keep eyes closed for 2-3 minutes after

• DO NOT LET TUBE TOUCH EYES DIRECTLY

Eye drops

Administer drops to lower, central conjunctiva

• Gentle pressure to inner canthus for 2-3 minutes to keep it from going systemic

• Eyes closed for those 2-3 minutes

Nose spray

• Blow nose beforehand

• Tilt head back

• Occlude one nostril

• Squeeze while breathing

• Hold position for 5 minutes

Subcut needle dimensions

• Max 1mL

• 3-5/8 of an inch needle

• 25-27 gauge

IM needle dimensions

• Max 3mL

• 1-1.5 inch needle

• 20-22 gauge

• Slight firm pressure afterwards

Mixing meds/insulin

Cloudy clear clear cloudy

ID injection

• Causes bubble, use on hairless site

• Pull skin taut

• 5-15 degree angle, only inserted 1/8 of an inch

• NO pressure afterwards

• Ventrogluteal, deltoid, vastus lateralis

• Z-track to move skin so drug doesn’t leak into subcut

Subcut injections

• Between skin and muscle

• Rotate sites

• 90 degree heavier, 45 degrees for thinner

• ½ to 5/8 inch needle, 25-27 gauge, 1-3 mL syringe

• Needle in, release pinched skin

• Wait 5-10 seconds before withdrawing

If med can’t be crushed but needs to be given by tube?

Call pharmacy

Before giving meds, ask pt…

Name, DOB, MRN, and allergies

N/V

Nausea and vomiting

Do not crush/open

EC/TR

After giving oral meds…

Check their mouth

Rectal route is used for…

N/V or unconscious patients

Rectal route

Lie on left side

• Lubricate rounded end, melts in body cavity

• Insert in direction of umbilicus (you will feel resistance from sphincter)

Pastes

Stiffer topical med that doesn’t melt at body temp

Lotion

Liquid topical med that cools, soothes and reduces inflammation

Inhaler procedure

• Sit upright, shake inhaler for 10 seconds

• Press down inhaler as they inhale deeply, hold for 5-10 seconds

• 1-2 min between puffs

Bevel

Opening at the end of the needle,

Subcut sites

• Outer posterior upper arm

• Abdomen (2+ inches from umbilicus)

• Anterior thigh

• Upper ventrogluteal area

• Scapular area of upper back

IM sites

• Ventrogluteal

• Deltoid

• Vastus lateralis

Post med administration…

• Monitor response

• Side effects

• Toxic effects

• Pain relief

• Reduced bp or hr?

Narcotic orders

Must be renewed every 48 hours

• Wastage requires a witness to cosign

MDI

Metered Dose Inhaler

• Each press delivers measured dose

• Requires coordination and strength

• Spacer can be used if needed

DPI

Dry Powder Inhaler

• Dry powder that creates aerosol as it travels through reservoir

• Easier than MDI, fast deep breath