MAPE
DO NOT USE LIST
MS
QD
QOD
IU
U
MSO4
MgSO4
MEDICATIONS (WHAT TO CHECK BEFORE ADMINISTERING):
Digoxin: HR
Vancomycin: Trough level, creatinine
Metoprolol: BP
Heparin: aPTT, Hct, hemoglobin
Warfarin: INR/PT
Lisinopril: HR
Losartan: BP
CONVERSIONS
WEIGHT/MASS:
1000 mcg = 1 mg
1,000,000 mcg = 1 g
1000 mg = 1 g
1000 g = 1 kg
2.2 lbs = 1 kg
16 oz = 1 lb
VOLUME:
1000 mL = 1 L
30 mL = fl. oz
5 mL = 1 tsp
15 mL = 1 tbsp
8 oz = 1 cup
240 mL = 1 cup
2 cups = 1 pint
4 cups = 1 quart
MEASUREMENT:
2.54 cm = 1 in
10 mm = 1 cm
100 cm = 1 m
TEMPERATURE:
1.8(C) + 32 = F
Normal temperatures: Celsius is 36-38 and Fahrenheit 98.6-100.4
TEN RIGHTS
Right patient
Right drug
Right time
Right route
Right documentation
Right dose
Added 4
Right assessment
Right evaluation
Right education
Right to refuse
NEEDLE STUFF
Intradermal (ID)
Location: Forearm and upper back
Angle: 5-15 degrees
Gauge: 25-29 G
Max Volume Input: 0.1 mL
Insertion Inches: 3/8 - 5/8
Intramuscular (IM):
Location: Deltoid (vaccines) & Vastus lateralis (infants)
Angle: 90 degrees
Gauge: 20-25 G
Insertion inches: 1-1.5 (adults) & 5/8 - 1 (thin adults and children)
Max Volume input: 1 mL (deltoid) 3 mL (vastus lateralis & ventrogluteal)
Subcutaneous (subcut):
Location: Abdomen, triceps, anterior thigh, posterior hip, shoulder blade
Angle: 45-90 degrees
Gauge: 23-27 G
Max Volume Input: 1 mL
Insertion Inches: 3/8 - 5/8
LAB SAFE MED ADMIN
Oral:
Gather: Check each med & calculate dosage
Prepare:
Unit dose: Packaged med in cup without unwrapping.
Multi-dose bottle medication: Pour tablet into bottle lid and transfer to med cup. Extra tablets returned to bottle without being touched
Crushing: Crush each separately and until smooth. Mix in small amount of applesauce or pudding if client diet allows after scanning med.
Liquid: Remove cap and place on table upside down. Hold med cup at eye level and fill; measure at the bottom of the meniscus.
Sublingual: Under the tongue.
Buccal: inside jaw (alternate sides)
Administer: 6 rights and scan each med prior.
Assist patient to sitting
Rectal:
Contraindications: Do not give to client with recent rectal surgery and active rectal bleeding.
Position patient on left side with upper leg flexed (L lateral recumbent or sims)
Instruct client to exhale while inserting suppository with finger against rectal wall, 4 inches through in adult
Client must remain on left side for at least 5 minutes.
Vaginal:
Pt must empty bladder first. Position client in dorsal recumbent position.
Spread labia with non-dominant hand.
Insert suppository in 2-3 inches.
Client remains supine for 10 minutes
Transdermal:
Remove previous patch, FOLD adhesive side together, and DISCARD per facility policy (not regular trash).
Clear remaining adhesive from skin.
DATE, TIME, INITIAL patch prior to application.
Apply to new site with clean, non-hairy skin.
Inhaled:
Metered-dose inhaler without spacer (MDI):
Shake gently, client takes deep breath and inhales. Hold canister 1-2inches from mouth (or close mouth around it).
Client hold breath for 10 seconds then exhale slowly thru pursed lips.
With spacer:
Shake gently, client takes deep breath and exhales, spacer placed over mouthpiece in clients mouth.
Depress canister while client inhales slowly and deeply for 2-3 seconds
Hold breath for 5-10 seconds
Wait 1 minute in between puff
Second med?: wait 5 minutes between inhaled meds
Dry-powder inhaler (DPI)
Do not shake
Load capsule into inhaler nd puncture capsule with piercing button to allow release of powder into inhaler.
Deep breath & exhale. Client wraps lips around mouthpiece and inhales fast and deeply.
Hold breath 5-10 seconds
Wait 30-60 seconds between inhalations of same med.
Wait 5 minutes between inhalation of different meds.
Rinse mouth after.
Otic:
Remove drainage or debris.
Turn client head opposite side of administration.
Pull pinna up and back (adult)
Gentle massage of tragus after dropping along ear canal.
(If ordered) Moistened cotton ball into ear canal o prevent med leaking. Leave no longer than 15 minutes.
Nasal:
Blow nose first.
Tilt head back or place in reclined/supine position.
Drops: Hold ½ inch above nostril. Stay in position for 5 minutes.
Spray: Pt sits upright, occlude opposite nostril. Insert tip of spray container into nostril and inhale through open nostril. Stay in position for 5 minutes.
Don’t blow nose for 5 minutes.
Ophthalmic:
Clean
Lay supine or sit back with head hyperextended.
Drops: Look up toward ceiling and administer drops 1-2 cm above conjunctival sac.
Pt applies pressure to nasolacrimal duct for 1 minute.
Ointment: Place ½ inch strip in lower conjunctival sac moving inner to outer.
Pt closes eyes 1-2 minutes and rub circular motion
Wait 3-5 minutes before second medication.
Expect blurred vision 10-30 minutes
SHARPS SAFETY
Sharps container should be replaced when 2/3 full.
2 RNs must waste when gathering meds; NOT after administering.
Never recap a USED needle.
CHARTING AND DOCUMENTATION
Do not erase, apply correction fluid or scratch out errors while charting – Draw a single line through the error, write “error”, and initial above it.
Do not leave any blank spaces – draw a line to the end of the line.
DO NOT document in the patient chart that an occurrence report was completed.
MEDICATION ROUTES AND ABBREVIATIONS (OTIC AND OPHTHALMIC)
Otic: Pertaining to the ear. (AD, AS, AU)
AD = Right ear
AS = Left ear
AU = Both ears
Ophthalmic: Pertaining to the eye. (OD, OS, OU)
OD = Right eye
OS = Left eye
OU = Both eyes
COMPLETE ORDERS
Drug, dose, route, time → If PRN, need indication.
• Ex.Zofran 4mg PO Q8hrs, PRN n/v.
Zocor 10mg PO nightly.
Carvedilol 25mg IVP q5min PRN Heart Rate greater than 165