Untitled Flashcards Set

1. Medication route and Pharmacokinetics
• Pharmacokinetics refers to how medications ______Travel_ through the body.
• Medications undergo a variety of biochemical processes that result in absorption, distribution,
metabolism, and excretion.
• Phases of pharmacokinetics
• Absorption The transmission of medications from the location of administration (gastrointestinal
[GI] tract, muscle, skin, or subcutaneous tissue) to the ______bloodstream_____________.
• The most common routes of administration are enteral (through the GI tract) and parenteral (by
injection).
• Each of these routes has a unique pattern of absorption.
• The rate of medication absorption determines how soon the medication takes effect.
• The amount of medication the body absorbs determines its intensity.
• The route of administration affects the rate and amount of absorption.
2. Route: Oral
• Barriers to absorption:
• Medications must pass through the layer of epithelial cells that line the GI tract.
• Absorption pattern
• varies greatly due to
• Stability and solubility of the medication
• Gastrointestinal pH and emptying time
• Presence of food in the stomach or intestines
• Concurrent medications
• Forms of medications (enteric-coated pills, liquids) Route:
• Subcutaneous and intramuscular
• Barriers to absorption: The capillary walls have large spaces between cells. Therefore, there is no
significant barrier.
• Absorption pattern: factors determining the rate of absorption
• Solubility of the medication in water
• Highly soluble medications have rapid absorption (10 to 30 min).
• Poorly soluble medications have slow absorption.
• Blood perfusion at the site of injection
• Sites with high blood perfusion have rapid absorption.
• Sites with low blood perfusion have slow absorption.
• Route: Intravenous
• Barriers to absorption: No barriers
• Absorption pattern
• Immediate: enters directly into the blood
• Complete: reaches the blood in its entirety
• Distribution The transportation of medications to sites of action by bodily fluids.
• Factors influencing distribution
• Circulation: Conditions that inhibit blood flow or perfusion (peripheral vascular or cardiac disease)
can delay medication distribution.

WEEK 5 N100 GUIDED NOTES
• Permeability of the cell membrane: The medication must be able to pass through tissues and
membranes to reach its target area. Medications that are lipid-soluble or have a transport system can
cross the blood-brain barrier and the placenta.
• Plasma protein binding: Medications compete for protein binding sites within the bloodstream,
primarily albumin.
• The ability of a medication to bind to a protein can affect how much of the medication will leave
and travel to target tissues.
• Two medications can compete for the same binding sites, resulting in toxicity.
• Metabolism (biotransformation) Changes medications into less active forms or inactive forms by
the action of enzymes.
• This occurs primarily in the liver, but also takes place in the kidneys, lungs, intestines, and blood.
3. Factors influencing medication metabolism rate
• Age: Infants have a limited medication-metabolizing capacity.
• The aging process also can influence medication metabolism but varies with the individual.
• In general, hepatic medication metabolism tends to decline with age. Older adults require smaller
doses of medications due to the possibility of accumulation in the body.
• An increase in some medication-metabolizing enzymes: This can metabolize a particular
medication sooner, requiring an increase in dosage of that medication to maintain a therapeutic level.
It can also cause an increase in the metabolism of other concurrent-use medications.
• First-pass effect: The liver inactivates some medications on their first pass through the liver. Thus,
they require a nonenteral route (sublingual, IV) because of their high first-pass effect.
• Similar metabolic pathways: When the same pathway metabolizes two medications, it can alter the
metabolism of one or both of them. In this way, the rate of metabolism can decrease for one or both
of the medications, leading to medication accumulation.
• Nutritional status: Clients who are malnourished can be deficient in the factors that are necessary to
produce specific medication-metabolizing enzymes, thus impairing medication metabolism.
• Excretion The elimination of medications from the body, primarily through the
____kidney____________. Elimination also takes place through the liver, lungs, intestines, and
exocrine glands (in breast milk). Kidney ______failure/decreased function____ can lead to an
increase in the duration and intensity of a medication’s response
4. MEDICATION RESPONSES
• Medication dosing attempts to regulate medication responses to maintain plasma levels between the
minimum effective concentration (MEC) and the toxic concentration.
• A plasma medication level is in the therapeutic range when it is effective and not toxic. Nurses use
therapeutic levels of many medications to monitor clients’ responses.
• THERAPEUTIC INDEX (TI) Medications with a high TI have a wide safety margin; therefore,
there is no need for routine blood medication-level monitoring. Medications with a low TI require
close monitoring of medication levels. Nurses should consider the route of administration when
monitoring for peak levels (highest plasma level when elimination = absorption).
• For example, an oral medication can peak from 1 to 3 hr after administration.
• If the route is IV, the peak time might occur within 10 min.
• Refer to a medication reference or a pharmacist for specific medication peak times.
• For trough levels, obtain a blood sample immediately before the next medication dose, regardless
of the route of administration.
• A plateau is a medication concentration in plasma during a series of doses. HALF-LIFE (t1/2)
The time for the medication in the body to drop by 50%.

WEEK 5 N100 GUIDED NOTES
• Liver and kidney function affect half-life. It usually takes four half-lives to achieve a steady blood
concentration (medication intake = medication metabolism and excretion).
• Short half-life: Medications leave the body quickly: 4 to 8 hr.
• _______Long______half-life Medications leave the body more slowly: over more than 24 hr,
with a greater risk for medication accumulation and toxicity.
• Short-dosing interval or MEC drops between doses. Can give medications at longer intervals
without a loss of therapeutic effects. Medications take a longer time to reach a steady state.
• Pharmacodynamics (mechanism of action)
• The interactions between medications and target cells, body systems, and organs to produce
effects. These interactions result in functional changes that are the mechanism of action of the
medication.
• Agonist: Medication that can mimic the receptor activity that endogenous compounds regulate.
For example, morphine is an agonist because it activates the receptors that produce analgesia,
sedation, constipation, and other effects. (Receptors are the medication’s target sites on or within
the cells.)
• Antagonist: Medication that can block the usual receptor activity that endogenous compounds
regulate or the receptor activity of other medications. For example, losartan, an angiotensin II
receptor blocker, is an antagonist. It works by blocking angiotensin II receptors on blood vessels,
which prevents vasoconstriction.
• Partial agonists: Medication that acts as an agonist and an antagonist, with limited affinity to
receptor sites. For example, nalbuphine acts as an antagonist at mu receptors and an agonist at
kappa receptors, causing analgesia at low doses with minimal respiratory depression.
5. Routes of administration
• ORAL OR ENTERAL Tablets, capsules, liquids, suspensions, elixirs, lozenges
• Most common route
• Least expensive
• Convenient
• NURSING ACTIONS
• For liquids, suspension, and elixirs, follow directions for dilution and shaking. To prepare the
medication, place a medicine cup on a flat surface before pouring, and ensure the base of the
meniscus (lowest fluid line) is at the level of the dose.
• Contraindications for oral medication administration include vomiting, decreased GI motility,
absence of a gag reflex, difficulty swallowing, and a decreased level of consciousness.
• Have clients sit upright at a 90° angle to facilitate swallowing.
• Administer irritating medications (analgesics) with small amounts of food.
• Do not mix with large amounts of food or beverages in case clients cannot consume the entire
quantity.
• Avoid administration with interacting foods or beverages (grapefruit juice).
• Administer oral medications as prescribed, and follow directions for whether medication is to be
taken on an empty stomach (30 min to 1 hr before meals, 2 hr after meals) or with food.
• Follow the manufacturer’s directions for crushing, cutting, and diluting medications. Break or cut
scored tablets only.
• Make sure clients swallow enteric-coated or time-release medications _____whole______.
• Use a liquid form of the medication to facilitate swallowing whenever possible
• Sublingual and buccal Directly enters the bloodstream and bypasses the liver
• Sublingual: under the tongue

WEEK 5 N100 GUIDED NOTES
• Buccal: between the cheek and the gum
• CLIENT EDUCATION
• Keep the medication in place until complete absorption occurs.
• Do not eat or drink while the tablet is in place or until it has completely dissolved.
• TOPICAL Medications directly applied to the mucous membranes or skin. Includes powders,
sprays, creams, ointments, pastes, oil-and suspension-based lotions.
• Painless
• Limited adverse effects
• NURSING ACTIONS
• Apply with a glove, tongue blade, or cotton-tipped applicator.
• Do not apply with a bare hand.
• For skin applications, wash the skin with soap and water. Pat dry before application.
• Use surgical asepsis to apply topical medications to open wounds.
• Transdermal Medication in a skin patch for absorption through the skin, producing systemic effects
• CLIENT EDUCATION
• Apply patches as prescribed to ensure proper dosing.
• Wash the skin with soap and water and dry it thoroughly before applying a new patch.
• Place the patch on a hairless__________ area and rotate sites to prevent skin irritation.
• Instillation (drops, ointments, sprays) Generally used for eyes, ears, and nose
• Eye
• NURSING ACTIONS
• Use medical aseptic technique when instilling medications in eyes
• Have clients sit upright or lie supine, tilt their head slightly, and look up at the ceiling.
• Rest your dominant hand on the clients’ forehead, hold the dropper above the conjunctival sac
about 1 to 2 cm, drop the medication into the sac, avoid placing it directly on the cornea, and have
them close the eye gently. If they blink during installation, repeat the procedure.
• Apply gentle ____pressure_________ with your finger and a clean facial tissue on the
nasolacrimal duct for 30 to 60 seconds to prevent systemic absorption of the medication.
• If instilling more than one medication in the same eye, _____wait______ at least 5 min between
them.
• For eye ointment, apply a thin ribbon to the edge of the lower eyelid from the inner to the outer
canthus.
• Never touch the eye with the tip of the dropper
• Ear
• NURSING ACTIONS
• Use medical aseptic technique when administering medications into the ears.
• Have clients sit upright or lie on their side.
• Straighten the ear canal by pulling the auricle upward and outward for adults or down and back
for children less than 3 years of age. Hold the dropper 1 cm above the ear canal, instill the
medication, and then gently apply ______pressure____________ with your finger to the tragus
of the ear unless it is too painful.
• Do not press a cotton ball deep into the ear canal. If necessary, gently place it into the outermost
part of the ear canal.
• Have clients _____lay__________ in the side-lying position if possible for 2 to 3 min after
installation of ear drops.

WEEK 5 N100 GUIDED NOTES
Nasal
• NURSING ACTIONS
• Use medical aseptic technique when administering medications into the nose.
• Have clients lie supine with their head positioned to allow the medication to enter the appropriate
nasal passage.
• Use your dominant hand to instill the drops, supporting the head with your nondominant hand.
• Instruct clients to breathe through the ___nose_____________, stay in a supine position, and not
to blow the nose for 5 min after drop instillation.
• For nasal spray, prime the spray if indicated, insert tip into nares, and point nozzle away from
the center of the nose.
• Spray into nose while the client inhales and instruct the client not to blow their nose for several
minutes.
• Rectal suppositories
• NURSING ACTIONS
• Position clients in the left lateral or ____Sims_______________ position.
• Insert the suppository just beyond the internal sphincter.
• Instruct clients to remain flat or in the left lateral position for at least 5 min after insertion to
retain the suppository. Absorption times vary with the medication.
• Vaginal
• NURSING ACTIONS
• Position clients supine with their knees bent and their feet flat on the bed and close to their hips
(modified lithotomy or dorsal recumbent position).
• Provide perineal care, if needed.
• _______________ the suppository or fill the applicator, depending on the formulation.
• Insert the medication along the posterior wall of the vagina (7.5 to 10 cm [3 to 4 in] for
suppositories; 5 to 7.6 cm [2 to 3 in] for creams, jellies or foams) or instill irrigation as indicated.
• Instruct clients to remain supine for at least 5 min after insertion to retain the suppository.
• If using a reusable applicator, wash it with soap and water. (If it is disposable, discard it.)
• INHALATION Administered through metered-dose inhalers (MDI) or dry-powder inhalers (DPI)
• MDI (Can be delegated to LPN/LVN)
• CLIENT EDUCATION
• Remove the cap from the inhaler’s mouthpiece.
• Shake the inhaler vigorously five or six times.
• Hold the inhaler with the mouthpiece at the bottom.
• Hold the inhaler with your thumb near the mouthpiece and your index and middle fingers at the
top.
• Hold the inhaler about 2 to 4 cm (1 to 2 in) away from the front of your mouth or close your
mouth around the mouthpiece of the inhaler with the opening pointing toward the back of your
throat.
• Take a deep breath, and then exhale.
• Tilt your head back slightly, press the inhaler, and, at the same time, begin a slow, deep inhalation
breath. Continue to breathe slowly and deeply for 3 to 5 seconds to facilitate delivery to the air
passages.
• Hold your breath for 10 seconds to allow the medication to deposit in your airways.
• Take the inhaler out of your mouth and slowly exhale through pursed lips.

WEEK 5 N100 GUIDED NOTES
• Resume normal breathing.
• A spacer keeps the medication in the device longer, thereby increasing the amount of medication
the device delivers to the lungs and decreasing the amount of medication in the oropharynx.
• For clients who use a spacer
• Remove the covers from the mouthpieces of the inhaler and of the spacer.
• Insert the MDI into the end of the spacer.
• Shake the inhaler five or six times.
• Exhale completely, and then close your mouth around the spacer’s mouthpiece. Continue as with
an MDI.
• DPI
• CLIENT EDUCATION
• Do not shake the device.
• Take the cover off the mouthpiece.
• Follow the manufacturer’s directions for preparing the medication (turning the wheel of the
inhaler or loading a medication pellet).
• Exhale completely.
• Place the mouthpiece between your lips and take a deep inhalation breath through your mouth.
• Hold your breath for 5 to 10 seconds.
• Take the inhaler out of your mouth and slowly exhale through pursed lips.
• Resume normal breathing.
• clients who need more than one puff should wait the length of time the provider specifies before
self-administering the second puff.
• Rinse your mouth out with water or brush your teeth if using a corticosteroid inhaler to reduce
the risk of fungal infections of the mouth.
• Remove the canister and rinse the inhaler, cap, and spacer once a day with warm running water
and dry them completely before using the inhaler again.
• NASOGASTRIC AND GASTROSTOMY TUBES
• NURSING ACTIONS
• Verify proper tube placement.
• Use a syringe and allow the medication to flow in by gravity or push it in with the plunger of the
syringe.
• GENERAL GUIDELINES
• Use liquid forms of medications; if not available, consider crushing medications if appropriate
guidelines allow.
• Do not administer sublingual medications.
• Do not crush specially prepared oral medications (extended/time-release, fluid-filled,
enteric-coated).
• Administer each medication separately.
• Do not mix medications with enteral feedings.
• Completely dissolve crushed tablets and capsule contents in 15 to 30 mL of sterile water prior to
administration.
• To prevent clogging, flush the tubing before and after each medication with 15_to
___30____ mL water.
• Flush with another 15 to 30 mL sterile water after instilling all the medications.
• PARENTERAL

WEEK 5 N100 GUIDED NOTES
• NURSING ACTIONS
• The vastus lateralis is best for infants 1 year and younger.
• The ventrogluteal site is preferable for IM injections and for injecting volumes exceeding 2 mL.
• The deltoid site has a smaller muscle mass and can only accommodate up to 1 mL of fluid.
• Use a needle size and length appropriate for the type of injection and the client’s size. Syringe
size should approximate the volume of medication.
• Use a tuberculin syringe for solution volumes less than 0.5 mL.
• Rotate injection sites to enhance medication absorption and document each site.
• Do not use injection sites that are edematous, inflamed, or have moles, birthmarks, or scars.
• For IV administration, immediately monitor clients for therapeutic and adverse effects.
• Discard all sharps (broken ampule bottles, needles) in leak- and puncture-proof containers.
• Intradermal
• NURSING ACTIONS
• Use for tuberculin testing or checking for medication or allergy sensitivities.
• Use small amounts of solution (0.01 to 0.1 mL) in a tuberculin syringe with a fine-gauge needle
(26- to 27-gauge) in lightly pigmented, thin-skinned, hairless sites (the inner surface of the mid-
forearm or scapular area of the back) at a 10° to 15° angle.
• Insert the needle with the bevel up. A small bleb should appear.
• Do not massage the site after injection.
• Subcutaneous
• NURSING ACTIONS
• Use for small doses of nonirritating, water-soluble medications (insulin and heparin).
• Use a 3⁄8- to 5⁄8-inch, 25- to 27-gauge needle or a 28- to 31-gauge insulin syringe. Inject no more
than 1.5 mL of solution.
• Select sites that have an adequate fat-pad size (abdomen, upper hips, lateral upper arms, thighs).
• For average-size clients, pinch up the skin and inject at a 45° to 90° angle. For clients who are
obese, use a 90° angle.
• Mixing drugs in one syringe
• Golden rule-check for compatibility before mixing
• Always inject air into the vial to prevent contamination before drawing
• Mixing insulin
• A patient may be prescribed more than one type of insulin depending on insulin body needs.
• Basal insulin such as glargine, Demir or NPH and prandial or short/immediate acting insulin such
as regular insulin.
• Never mix glargine or Demir with any other insulin
• Steps for mixing insulin NPH (N) and regular insulin (R)
• Step 1: Roll gently and clean. The vial stoper with alcohol wipe
• Step 2: Add air to cloudy (intermediate-acting) insulin (NPH)
• Step 3: Add air to clear (short-acting) insulin (Regular)
• Step 4: Withdraw clear (short-acting) insulin first, then cloudy (intermediate-acting) insulin.
• Always use and recommend pre-mixed insulin to the client and unit.

WEEK 5 N100 GUIDED NOTES
•
• Intramuscular
• NURSING ACTIONS
• Use for irritating medications, solutions in oils, and aqueous suspensions.
• The most common sites are ventrogluteal, deltoid, and vastus lateralis (pediatric). The
dorsogluteal is no longer recommended as a common injection site due to its close proximity to
the sciatic nerve_______.
• Use a needle size 18- to 27-gauge (usually 22- to 25-gauge), 1- to 1.5-inch long, and inject at a
90° angle. Solution volume is usually 1 to 3 mL.
• Divide larger volumes into two syringes and use two different sites. Use the Z-track technique for
IM injections of irritating fluids or fluids that can ___stain____________the skin (iron
preparations). This method prevents medication from leaking back into subcutaneous tissue.
Reference guidelines to determine whether this technique is recommended for a given medication
• Intravenous
• NURSING ACTIONS
• Use for administering medications, fluid, and blood products.
• Vascular access devices can be for short-term use (catheters) or long-term use (infusion ports).
• Use 16-gauge devices for clients who have trauma.
• Use 18-gauge during surgery and blood administration.
• Use 22- to 24-gauge for children, older adults, and clients who have medical issues or are stable
postoperatively.
• Peripheral veins in the arm or hand are preferable. Ask clients which site they prefer. For
newborns, use veins in the head, lower legs, and feet. After administration, immediately monitor
for therapeutic and adverse effects. (Infiltrations-erythema, tenderness, swelling, streak fomation)
• Oral
• ADVANTAGES
• Safe
• Inexpensive

WEEK 5 N100 GUIDED NOTES
• Easy and convenient
• Disadvantage
• Oral medications have highly variable absorption. Inactivation can occur by the GI tract or
first-pass effect. Clients must be cooperative and conscious. Contraindications include nausea and
vomiting.
• Subcutaneous and intramuscular (IM)
• ADVANTAGES
• Use for poorly soluble medications.
• Use for administering medications that have slow absorption for an extended period of time
(depot preparations).
• Disadvantage
• Injections are more costly.
• Injections are inconvenient.
• There can be pain with the risk for local tissue damage and nerve damage.
• There is a risk for infection at the injection site
• Intravenous
• Advantages
• Onset is rapid, and absorption into the blood is immediate, which provides an immediate
response.
• This route allows control over the precise amount of medication to administer.
• It allows for administration of large volumes of fluid.
• It dilutes irritating medications in free-flowing IV fluid.
• Disadvantages
• IV injections are even more costly.
• IV injections are inconvenient.
• Absorption of the medication into the blood is immediate.
• This is potentially dangerous if giving the wrong dosage or the wrong medication.
• There is an increased risk for infection or embolism with IV injections.
• Poor circulation can inhibit the medication’s distribution.

WEEK 5 N100 GUIDED NOTES
Safe Medication Administration and Error Reduction
6. Nurse responsibilities
• Having knowledge of federal, state (nurse practice acts), and local laws, and facilities’ policies that
govern the prescribing, dispensing, and administration of medications
• Preparing and _____administering_________________ medications, and evaluating clients’
responses to medications
• Developing and maintaining an up-to-date knowledge base of medications they administer, including
uses, mechanisms of action, routes of administration, safe dosage range, adverse effects, precautions,
contraindications, and interactions
• Maintaining knowledge of acceptable practice and skills competency
• Determining the accuracy of medication prescriptions
• ________report___________ all medication errors
• Safeguarding and storing medications
7. KNOWLEDGE REQUIRED PRIOR TO MEDICATION ADMINISTRATION
• Medication category: Medications have a pharmacological action, therapeutic use, body system
target, chemical makeup, and classification for use during pregnancy. For example, lisinopril is an
angiotensin-converting enzyme inhibitor (pharmacological action) and an antihypertensive
(therapeutic use).
• Mechanism of action: This is how the medication produces its therapeutic effect. For example,
glipizide is an oral hypoglycemic agent that lowers blood glucose levels primarily by stimulating
pancreatic islet cells to release insulin.
• Therapeutic effect: is the expected effect (physiological response) for which the nurse administers
the medication to a specific client. One medication can have more than one therapeutic effect. For
example, one client might take diphenhydramine to relieve allergies while another takes it to induce
sleep.
• Adverse effects: These are undesirable and potentially dangerous responses to a medication. Adverse
effects can be inadvertent or predictable. Some are immediate; others take weeks or months to
develop. For example, the antibiotic gentamicin can cause hearing loss.
• Toxic effects: Medications can have specific risks and manifestations of toxicity. For example, nurses
monitor clients taking digoxin for dysrhythmias, a manifestation of cardiotoxicity. Hypokalemia
places these clients at greater risk for digoxin toxicity.
• Interactions: Medications can interact with each other, resulting in beneficial or harmful effects. For
example, giving the beta-blocker atenolol concurrently with the calcium channel blocker nifedipine
helps prevent reflex tachycardia. Medications can also increase or decrease the actions of other
medications, and food can interact beneficially or harmfully with medications.
• Precautions, contraindications: These are conditions (diseases, age, pregnancy, lactation) that make
it risky or completely unsafe for clients to take specific medications. For example, tetracyclines can
stain developing teeth; therefore, children younger than 8 years should ___not_____ take these
medications. Another example is that heart failure is a contraindication for labetalol, an
antihypertensive medication.
• Preparation, dosage, administration: It is important to know any specific considerations for
preparation, safe dosages, and how to administer the medication. For example, morphine is available
in many different formulations. Oral doses of morphine are generally higher than parenteral doses due
to extensive first-pass effect. Clients who have chronic severe pain (with cancer) generally take oral
doses of morphine.
8. MEDICATION PRESCRIPTIONS

WEEK 5 N100 GUIDED NOTES
Each facility has written policies for medication prescriptions, including which providers can write,
receive, and transcribe medication prescriptions.
• TYPES OF MEDICATION PRESCRIPTIONS
• Routine or standing prescriptions
• A routine or standing prescription identifies medications nurses give on a regular schedule with or
without a termination date. Without a termination date, the prescription will be in effect until the
provider discontinues it or discharges the client.
• Providers must re-prescribe some medications (opioids and antibiotics) within a specific amount
of time or they will automatically discontinue.
• Single or one-time prescriptions: A single or one-time prescription is for administration once at a
specific time or as soon as possible. These prescriptions are common for preoperative or
preprocedural medications. For example, a one-time prescription instructs the nurse to administer
warfarin 5 mg PO at 1700.
• Stat prescriptions: A stat prescription is only for administration once and immediately. For example,
a stat prescription instructs the nurse to administer digoxin 0.125 mg IV bolus stat. Now prescriptions
A now prescription is only for administration once, but up to 90 min from when the nurse received
the prescription. For example, a now prescription instructs the nurse to administer vancomycin 1 g
intermittent IV bolus now.
• PRN prescriptions: A PRN (pro re nata) prescription specifies at what dosage, what frequency, and
under _____which__________conditions a nurse can administer the medication.
• The nurse uses clinical judgment to determine the client’s need for the medication. For example,
a PRN prescription instructs the nurse to administer morphine 2 mg IV bolus every hour PRN for
chest pain.
• Other prescriptions Providers might write prescriptions for specific circumstances or for specific
units. For example, a critical care unit has standing prescriptions for treating clients who have
asystole.
• COMPONENTS OF A MEDICATION PRESCRIPTION
• The client’s full name
• The date and time of the prescription
• The name of the medication (generic or brand)
• The strength and dosage of the medication
• The route of administration
• The time and frequency of administration: exact times or number of times per day (according to
the facility’s policy or the specific qualities of the medication)
• The quantity to dispense and the number of refills
• The signature of the prescribing provider
9. COMMUNICATING MEDICATION PRESCRIPTIONS
• Origin of medication prescriptions: Providers or nurses who take verbal or telephone prescriptions
from a provider write medication prescriptions on the client’s medical record.
• If the nurse writes a medication prescription on the client’s medical record, the facility’s policy
specifies how much time the provider has to sign the prescription. Nurses transcribe medication
prescriptions onto the medication administration record (MAR)
• Taking a telephone prescription
• Only when absolutely necessary

WEEK 5 N100 GUIDED NOTES
• Ensure that the prescription is complete and correct by reading it ___back___________to the
provider: the client’s name, the name of the medication, the dosage, the time to give it, the
frequency, and the route.
• To ensure correct spelling, use aids (“b as in boy”). State numbers separately (“one, seven”for
17).
• Remind the provider to verify the prescription and sign it within the amount of time the facility’s
policy specifies.
• Write or enter the prescription in the client’s medical record.
• If possible, have a second nurse listen on an extension or on a speaker in a private area (to ensure
confidentiality).
10. MEDICATION RECONCILIATION
The Joint Commission requires policies and procedures for medication reconciliation. Nurses compile
a list of each client’s current medications, including all medications with correct dosages and
frequency. They compare the list with new medication prescriptions and reconcile it to resolve any
discrepancies. This process takes place at admission, when transferring clients between units or
facilities, and at discharge.
11. PRE-ASSESSMENT FOR MEDICATION THERAPY
• Nurses obtain the following information before initiating medication therapy and update it as
necessary. Health history
• Age
• Health problems and the current reason for seeking care
• All medications clients currently take (prescription and nonprescription): the name, dose, route, and
frequency of each
• Any unexpected findings possibly from medication therapy
• Use of herbal or “natural” products for medicinal purposes
• Use of caffeine, tobacco, alcohol, or illicit drugs
• Clients’ understanding of the purpose of the medications
• All medication and food allergies
• Physical examination A systematic physical examination provides a baseline for evaluating the
therapeutic effects of medication therapy and for detecting possible adverse effects.
12. RIGHTS OF SAFE MEDICATION ADMINISTRATION
• Right client
• Verify clients’ identification before each medication administration.
• The Joint Commission requires two client identifiers.
• Acceptable identifiers include the client’s name, an assigned identification number, telephone
number, birth date, or other person-specific identifier (a photo identification card).
• Nurses also use bar-code scanners to identify clients.
• Check for allergies by asking clients, checking for an allergy bracelet or medal, and checking the
MAR.
• Right medication
• Correctly interpret medication prescriptions, verifying completeness and clarity.
• Read medication labels and compare them with the MAR three times: before removing the
container, when removing the amount of medication from the container, and in the presence of
the client before administering the medication.
• Leave unit-dose medication in its package until administration.
• Right dose

WEEK 5 N100 GUIDED NOTES
• Use a unit-dose system to decrease errors. If not available, calculate the correct medication dose;
check a drug reference to make sure the dose is within the usual range.
• Ask another nurse to verify the dose if uncertain of the calculation.
• Prepare medication dosages using standard measurement devices (graduated cups or syringes).
• Some medication dosages require a second verifier or witness (some cytotoxic medications).
• Automated medication dispensing systems use a machine to control the dispensing of
medications.
• Right time
• Administer medication on time to maintain a consistent therapeutic blood level.
• Refer to the drug reference or the facility’s policy for exceptions; general recommendations
follow.
• Administer time-critical medications within 30 min of the prescribed time.
• Facilities define which medications are time-critical; usually this includes medications that
require a consistent blood level (antibiotics).
• Administer non-time-critical medications prescribed once daily, weekly, or monthly within 2 hr
of the prescribed time.
• Administer non-time-critical medications prescribed more than once daily (but not more than
every 4 hr) within 1 hr of the prescribed time.
• Right route
• The most common routes of administration are oral, topical, subcutaneous, intramuscular (IM),
and intravenous (IV).
• Additional administration routes include sublingual, buccal, intradermal, transdermal, epidural,
inhalation, nasal, ophthalmic, otic, rectal, vaginal, intraosseous, and via enteral tubes.
• Select the correct preparation for the route the provider prescribed (otic vs. ophthalmic topical
ointment or drops).
• Right ___documentation___________________
• Immediately record pertinent information, including the client’s response to the medication.
Document the medication after administration, not before.
• Right client
• Inform clients about the medication: its purpose, what to expect, how to take it, and what to
report.
• To individualize the teaching, determine what the clients already know about the medication,
need to know about the medication, and want to know about the medication.
• Right to __________refuse____________
• Respect clients’ right to refuse any medication.
• the consequences, inform the provider, and document the refusal.
• Right assessment
• Collect any essential data before and after administering any medication.
• For example, measure apical heart rate before giving digoxin.
• Right ________evaluation______________
• Follow up with clients to verify therapeutic effects as well as adverse effects.
13. RESOURCES FOR MEDICATION INFORMATION
• Nursing drug handbooks
• Pharmacology textbooks
• Professional journals

WEEK 5 N100 GUIDED NOTES
• Physicians’ Desk Reference (PDR)
• Professional websites
• Pharmacists
14. MEDICATION ERROR PREVENTION COMMON MEDICATION ERRORS
• Wrong medication or IV fluid
• Incorrect dose or IV infusion rate
• Wrong client, route, or time
• Administration of a medication to which the client is allergic
• Omission of a dose or extra doses
• Incorrect discontinuation of medication or IV fluid
• Inaccurate prescribing The Institute for Safe Medication Practices (ISMP) is a nonprofit
organization working to educate health care providers and consumers about safe medication
practices. The ISMP and the FDA identify the most common medical abbreviations that result in
misinterpretation, mistakes, and injury. For a complete list, go to the ISMP website
15. Controlled substances
• Drugs that have potential for abuse or dependance
• Two nurses must witness any wasting of narcotics
• Ensure that it is “wasted” in the pyxis system, documented, and done in a timely manner
• Once it has been documented, it should be wasted in the appropriate receptacle
• Anytime suspicious activity is a concern, it should be reported immediately. There should be no
“further investigation” done on the nurses part, the hospital will do that
• Narcotics are locked in a pyxis system and should NEVER be left out

WEEK 5 N100 GUIDED NOTES
COMPLEMENTARY AND ALTERNATIVE THERAPIES
• Integrative therapies are combination of complementary and alternative therapies and western
medicine which focuses on optimal health of the whole person.
Complementary and alternative therapies are based on Eastern medical systems
• Alternative therapies are treatment approaches that become the primary treatment and replace
western medicine.
• Complementary therapies are treatment approaches used in addition to or to enhance conventional
medical care
• Clients’ choice for complimentary therapies
• _____________ for natural treatment options to add or replace modern treatment
• Client desire to take more role in their care
• The main component of complimentary therapy is client acceptance and involvement in the treatment
therapy.
16. CATEGORIES OF CAM
• Whole medical systems: Complete medical systems outside of allopathic medicinal beliefs
(traditional Chinese medicine, ayurveda, homeopathy)
• Biological and botanical therapies: Involve the use of _____natural____________ products to
affect health (diets, vitamins, minerals, herbal preparations, probiotics)
• Body-based and manipulative methods: Involve external touch to affect body systems (massage,
touch, chiropractic therapy, acupressure)
• Mind-body therapies: Connect the physiological function to the mind and emotions (acupuncture,
breath work, biofeedback, art therapy, meditation, guided imagery, yoga, psychotherapy, tai chi)
• Energy therapies: Involve use of the body’s energy fields (reiki, therapeutic touch, magnet therapy)
Movement therapies: Use exercise or activity to promote physical and emotional well-being (Pilates,
dance therapy)
17. CAM PRACTITIONERS Referrals for nurses
Specialized licensed or certified practitioners can provide complementary or alternative therapies.
• Acupuncture/acupressure: Needles or digital pressure along meridians to alter body function or
produce analgesia
• Homeopathic medicine: Administering doses of substances (remedies) that would produce
manifestations of the disease state in a well person to ill clients to bring about healing
• Naturopathic medicine: Diet, exercise, environment, and herbal remedies to promote natural healing
Chiropractic medicine: Spinal manipulation for healing
• Massage therapy: Stretching and loosening muscles and connective tissue for relaxation and
circulation
• Biofeedback: Using technology to increase control_____________ of various neurologic body
responses to minimize extremes
• Therapeutic touch: Using hands to help bring energy fields into balance
18. NATURAL PRODUCTS AND HERBAL REMEDIES
• Natural products include herbal medicines, minerals and vitamins, essential oils, and dietary
_______supplements_______________. Clients use nonvitamin, nonmineral natural products to
prevent disease and illness, and to promote health.
• Herbal remedies are derived from plant sources and are the oldest form of medicine.
• The FDA does not regulate many of these products.

WEEK 5 N100 GUIDED NOTES
• Some herbal agents have been deemed safe or effective by nongovernment agencies. However, even
safe or commonly used substances can have adverse effects and interfere with prescription medication
efficacy.
• Examples of herbal medicines:
• Aloe: Wound healing
• Chamomile: Anti-inflammatory, calming
• Echinacea: Enhances immunity
• ___Garlic__________________: Inhibits platelet aggregation
• ________Ginger______________: Antiemetic
• Ginkgo biloba: Improves memory
• Ginseng: Increases physical endurance
• Valerian: Promotes sleep, reduces anxiety
19. NURSING AND CAM
• Understand the varieties of therapies available and any safety precautions associated with their use.
• Be receptive to learning about clients’ alternative health choices_____________and practices
(home remedies, cultural practices, vitamin use, modification of prescriptions).
• Identify clients’ needs for complementary or alternative therapies, along with the client’s values and
treatment preferences.
• Incorporate complementary or alternative therapies into clients’ care plans.
• Evaluate client’s responses to CAM interventions.
• Assist with evaluating the safety of herbal and natural products the client can be using.
• Provide the client with reliable information and determine possible interactions with prescription
medicines and therapies.
20. Nursing initiated therapies
• Nursing interventions can provide some aspects of complementary alternative therapies, including the
following:
• Guided imagery/visualization therapy: Encourages healing and relaxation of the body by having
the mind focus on images
• Healing intention: Uses caring, compassion, and empathy in the context of prayer to facilitate
healing
• Breath work: Reduces stress and increases relaxation through various breathing patterns Humor:
Reduces tension and improves mood to foster coping
• Meditation: Focuses attention to a single or unchanging stimulus to become more mindful or aware
of self
• Simple _____touch_________________: Communicates presence, appreciation, and acceptance
• Music or art therapy: Provides distraction from pain and allows the client to express emotions;
earphones improve concentration
• Therapeutic ___communication___________________: Allows clients to verbalize and become
aware of emotions and fears in a safe, nonjudgmental environment
• Relaxation techniques: Promotes relaxation using breathing techniques while thinking peaceful
thoughts (passive relaxation) or while tensing and relaxing specific muscle groups (progressive
relaxation)