Pharmo - Ch. 3

Adverse effect

any undesirable sign or symptom associated with the use of a medical product

Serious adverse effect

used to define threat of permanent disability or immediate risk of death

side effect

used to define threat of permanent disability or immediate risk of death

toxic epidermal necrolysis (TEN)

occurs when liver fails to properly break down drug, severe and deadly allergic reaction

widespread epidermal sloughing caused by disintegration of top layer of skin and mucous membranes

associated with anticonvulsants or any OTC drug like ibuprofen

stevens-johnson syndrome (SJS)

same or similar drugs as TEN but occurs withing 1-14 days

nonspecific upper respiratory infection with chills, fever, and malaise

generalized blister-like lesions within a few days and skin sloughing up to to 10% of the body

anaphylaxis

severe type of allergic reaction that involves the massive, systemic release of histamine and other chemical mediators of inflammation that can lead to life-threatening shock

5 rights of drug administration

1. right patient

2. right medication

3. right dose

4. right route of administration

5. right time of delivery

3 checks of drug administration

1. checking the drug with the medication information system before taking it out

2. checking how to prepare the drug

3. checking the drug before administering it to the patient

Adherence

taking a medication in the manner prescribed by the provider or OTC instructions

metric system of measurement

Liters (L) or milliliters (mL)

cubic centimeter (cc) = 1 mL of fluid

kilograms (kg), grams (g), milligrams (mg), or micrograms (mcg)

enteral route

orally, nasogastric or gastrostomy tubes

tablets, capsules, and liquid forms

enteric-coated tablets

dissolve in alkaline environment of the small intestine and should not be crushed

sublingual route

rapid onset of action, under the tongue

buccal route

tablet or capsule in the cheek oral cavity

less permeable to most medications with slower absorption

orally disintegrating tablets (ODTs)

quick dissolving of medications

Nasogastric (NG) tube route

short-term treatment in the NG tube inserted from the nasopharynx to the stomach

Gastrostomy (G) tube

surgically placed into the stomach and is for long-term drug administration

Topical Drug Administration

skin (dermatologic preparations) or membranous linings of the eye, nose, respiratory tract, urinary trach, vagina, and rectum (instillations and irrigations)

Inhalations through the respiratory tract

ophthalmic route

used to treat local conditions of the eye and surrounding structures

available in the form of eye irrigations, drops, ointments, and medicated disks

Otic route

used to treat local conditions of the ear, including infections and soft blockages of the auditory canal

include eardrops and irrigations

nasal route

local and systemic drug administration

ease of use and avoidance of the first-pass effect and digestive enzymes

astringent effect

drops or sprays used to shrink swollen mucous membranes or loosen secretions and facilitate drainage

vaginal route

deliver medications for treating local infections and to relieve vaginal pain and itching

suppositories, creams, jellies, or foams

rectal route

local or systemic drug administration

suppository form, few laxatives and others via enema

parenteral route

delivers drugs via a needle into the skin layers, subcutaneous tissue, muscles, or veins

intradermal (ID) injection

dermis layer of the skin

allergy and disease screening or for local anesthetic delivery prior to venous cannulation

only 0.1 to 0.2 mL

upper back, over the scapulae, the high upper chest, and the inner forearm

subcutaneous injection

delivered to the deeper tissue layers associated with the skin

Insulin, heparin, vitamins, some vaccines, and other medications are given in this area

provides rapid absorption

• Outer aspect of the upper arms, in the area above the triceps muscle

• Middle two-thirds of the anterior thigh area

• Subscapular areas of the upper back

• Upper dorsogluteal and ventrogluteal areas

• Abdominal areas, above the iliac crest and below the diaphragm, 1.5 to 2 inches out from the umbilicus.

0.5 to 1 mL

intramuscular (IM) injection

into the muscle

rich blood supply → moves quickly into blood → more rapid onset of action than oral, ID, or subQ injections

up to 3 mL but only max of 1mL in the deltoid and triceps

intravenous (IV) injection

administered directly into the bloodstream and immediately available for use by the body

large-volume infusion

intermittent infusion

IV bolus (push)

fastest onset of drug action and most dangerous

What is the role of the nurse in medication administration? (Select all that apply.)

1. Ensure that medications are administered and delivered in a safe manner.

2. Be certain that healthcare provider orders are accurate.

3. Inform the patient that prescribed medications need to be taken only if the patient agrees with the treatment plan.

4. Ensure that the patient understands the use and administration technique for all prescribed medications.

5. Prevent adverse drug reactions by properly administering all medications.

6. All of the above

All of the above

Before administering drugs by the enteral route, the nurse should evaluate which of the following?

1. Ability of the patient to lie supine

2. Compatibility of the drug with intravenous fluid

3. Ability of the patient to swallow

4. Patency of the injection port

3

While the nurse takes the patient’s admission history, the patient describes having a severe allergy to an antibiotic. What is the nurse’s responsibility to prevent an allergic reaction? (Select all that apply.)

1. Instruct the patient to alert all providers about the allergy.

2. Document the allergy in the medical record.

3. Notify the provider and the pharmacy of the allergy and type of allergic reaction.

4. Place an allergy bracelet on the patient.

5. Instruct the patient not to allow anyone to give the antibiotic.

6. All of the above

6

The order reads, “Lasix 40 mg IV STAT.” Which action should the nurse take?

1. Administer the medication within 30 minutes of the order.

2. Administer the medication within 5 minutes of the order.

3. Administer the medication as required by the patient’s condition.

4. Assess the patient’s ability to tolerate the medication before giving.

2

Which medications would not be administered through a nasogastric tube? (Select all that apply.)

1. Liquids

2. Enteric-coated tablets

3. Sustained-release tablets

4. Finely crushed tablets

5. IV medications

2-5

A patient with diabetes has been NPO (nothing by mouth) since midnight for surgery in the morning. He usually takes an oral type 2 antidiabetic drug to control his diabetes. What would be the best action for the nurse to take concerning the administration of his medication?

1. Hold all medications as ordered.

2. Give him the medication with a sip of water.

3. Give him half the original dose.

4. Contact the provider for further orders.

4

Why do errors continue to occur despite nurses’ following the five rights and three checks of drug administration?

What strategies can the nurse use to ensure adherence to drug therapy for a patient who is refusing to take medication?

Compare the oral, topical, IM, subcutaneous, and IV routes. Which has the fastest onset of drug action? Which routes avoid the hepatic first-pass effect? Which require strict aseptic technique?

What are the differences among a STAT order, an ASAP order, a PRN order, and a standing order?