µÉ°÷ * *☒☒*"* • § g. j • " " "☒☒***%% " Ch. 31 Notes by Morgan Payne Drug Names ⑧ ☒ Chemical Provides the exact description of medication's composition • • Generic on • Trade ⑧ The manufacturer who first develops the drug assigns the name, and it is then listed in the U.S pharmacopeia ③ . Also known as brand or proprietary name. This is the name under which a manufacturer markets the medication ☒ ¥ Trade Name: Tylenol Generic Name: Acetaminophen •"" Drug Information Classification • • • Effect of medication on body systems Symptoms the medication relives Medication's desired effect ' Medication Forms • • • • Solid, liquid, sublingual, buccal Topical; on skin Parenteral; anything outside the GI system; IV, injection, eye drops Forms for instillation into body cavities > Eye drops, ear drops, rectal depository Pharmacokinetics The study of medications traveling through the body ÷ §: k Four Processess se Absorption Distribution Metabolism Excretion ¥ • ¥ 0 % ③ Greek Origin iii. i. iii. ☒ . is drug •• 'Pharmakon' 'Kinetikos' is moving, putting into motion ⑧ . ☒ ⑤ Go % % I A • ⑧ ☒ §÷¥É • ** * * or Absorption • • on ** * ☒ " "" * Ch. 31 Notes by Morgan Payne Pharmacokinetics & • • * ⑧ ☒ ⑧ Passage of medication molecules into the blood from the site of administration Rate of absorption determines how soon the medication takes effect > Topical, on the skin, medication is the slowest absorption rate Medication given through the IV is the fastest absorption rate Amount of medication the body absorbs determines the intensity The route of administration affects the rate and amount of absorption ☒ ⑤ . > • • • ⑨ As ☒ * Distribution The transportation of medications to site of action by bodily fluids Factors Influencing Distribution: • Circulation , If pt has cardiac disease, their circulatory status is comprised, so med could take longer for effects to happen Membrane permeability • Protein binding • • Metabolism Is the process where once reach target site of action it is broken down to less active, less potent, or inactive form • Primarily occurs in Liver, but can take place in kidneys, lungs, intestines, and blood ,If pt has liver or kidney failure, medication is going to hang out in bloodstream >These pt will be given lower doses of medication Factors Influencing Metabolism: Age Increased medication metabolizing enzyme First pass effect Similar metabolic pathway • Nutritional Status • • • • • ÷ : § 9 ¥ % . • • y ÷ as * * Excretion • • ☒ The process of getting rid of medications from the body Medications exit the body through the: > Kidney Primarily If pt has renal failure, meds build in the bloodstream and could get to toxic levels > Liver, intestines, lungs, exocrine glands; breast milk for example Extent of kidney function can increase duration and intensity of medication response ⑥ % →☒In ⑥% I A A ☒ I ⑧ ③ ⑨ ☒ ☒ Go * A ☒ µg.Éjo • ** ⑥ ☒☒ • ' Therapeutic Effect • on Adverse Effect . ** * Ch. 31 Notes by Morgan Payne ⑨ ③ Expected or predicted physiological response ☒ ⑧ What we want to see after medication is given If we give a pt with HTN a med to lower the BP, the therapeutic effect ☒ would be lower BP ③ Unintended, undesirable, often unpredictable ☒ Side Effect Toxic Effect Accumulation of medication in the bloodstream Allergic Reaction % Overreaction or under reaction or different reaction from normal ex; Ambien is given to help sleep, can cause pt to be hyperactive unpredictable response to a medication Medication Interactions One medication modifies the action of another Medication Tolerance More medication is required to achieve the same therapeutic effect : Medication Dependence - * Predictable, unavoidable secondary effect Idiosyncratic Reaction I < ☒ * a. . \ 1 ** Types of Medication Actions & • • ☒ Physical, Psychological Nursing Considerations for P.O Meds For Liquids, suspensions, and elixirs follow directions on medication packaging in regard to dilution and shaking Contraindications for administering P.O Meds: > Vomiting > Decreased GI motility Absence of gag reflex Dysphagia > Decreased level of consciousness; LOC To facilitate swallowing have clients sit at at least a 90 degree angle and use liquid form when possible Administer irritating medications, like analgesics, with small amount of food Administer oral medications as prescribed, follow directions if medication is to be taken before meals or on empty stomach; ex, 30 min to 1 hr before meals > Example, thyroid medication for low levels of thyroid hormone has to be given on empty stomach Do not mix meds large amount of food or beverages incase pt cannot consume entire quantity : Avoid administration with interacting foods or beverages > Ex: grapefruit juice Follow manufacturer directions for crushing, cutting, and diluting medications : Only scored medications should be broken or cut Ensure patients swallow enteric coated or time release medications whole > > > \ - / - • - , , , . . . " " - Routes of Medication " - " i ' m y , , - - , . \ . Most Common Route Tablets, Capsules, Suspensions, Elixirs, Lozenges Sublingual Administration I \ Under the tongue Buccal Administration - Between cheek and gum Parenteral Routes / Routes of Medication Four Major Sites of injection > Intradermal What we get when we get a TB test Subcutaneous Ex: Insulin injection Intramuscular Intravenous Other routes Epidural, intrathecal, intraosseous, intraperitoneal, intrapleural, and intraarterial Intraosseous is used in military when someone goes into cardiac arrest or has been injured and in a coma; they drill a hole in part of the bone in the leg and give meds in the bone marrow Routes limited to physicians Intracardiac and intraarticular never u > it > > J > u - > Topical Administration - - / I Skin Mucous Membranes Transdermal Instillation; drops, ointment, sprays Inhalation and Intraocular route . i , Ch. 31 Notes by Morgan Payne Oral: Enteral - . . give up ⑤ • - ÷ % ! :: . E. on ☒ LEE ☒ ☒ON a ☒ ☒ ☒www.o Types of Orders in Acute care • . ☒ Standing orders or routine medication orders PRN orders Single, one time, orders STAT orders Now Orders Prescriptions ☒ WOW Ch. 31 Notes by Morgan Payne ⑨ ⑧ ☒ ☒ • RN Role: ALWAYS read back the order to the provider ③ • Parts of a prescription ☒ A % Nurse's Roles Determines medications ordered are correct - Assesses patient's ability to self administer : Determines medication timing Administers medications correctly : Closely monitors effects Provided patient teaching Does not delegate medication administration to AP - / ° ÷ § ÷ : § you're Amazing Medication Errors Any preventable event that may cause inappropriate medication use or jeopardize patient safety % Steps: • First assess the patient's condition, then notify the health care provider When patient is stable, report the incident ☒ Prepare and file an occurrence or incident report ⑧ Report near misses and incidents that cause no harm ③ ☒ During transitions in care, reconcile medications . ' . . ' ☒ • ☒ 3 * % → % A →% A A ☒ * ☒ ÷ • - : ☒ ☒ LEE ☒ ☒ % ☒ ☒ www.o ☒ 8 Ch. 31 Notes by Morgan Payne ⑧ Safety Guidelines For Medication Administration • ⑨ ☒ Be vigilant during medication administration Verify that medications have not expired by checking labels ② Use at least two identifiers before administering medications, and check against the MAR Before administering medication, check for accuracy THREE times § Clarify unclear medication orders and ask for help if needed Use strict aseptic technique during Parenteral medication preparation and administration p . . ⑤ . • . ☒ - - e V * 3 Checks of Medication Administration 1st Check: > In the Med room while preparing medication, check it against the MAR 2nd Check: > After preparation, re check medication against the MAR ensuring right drug, right does, right route, and right time 3rd Check: > At patient's bedside, re check medication and comparing to MAR at bedside ensuring right drug, right dose, right route, right time, and right patient; with 2 patient identifiers Never use room number as identifier you got this 7 Rights of Medication Administration± ? ¥ ÷ ☐ § * ③ ¥ ☒ ⑤ and ☐ * Er Right Patient nor Right Mediation N Right Dose Right Time not Right Route ☒ Right Documentation nor Right Indication, or reason • % →☒In % I A I A A ☒ Go ☒ I A ☒ ☒☒ & & " " *%ᵗ☒☒""" ☒" " """☒"" " "" " "ʳ ☒ ʰ ⑨ Ch. 31 Notes by Morgan Payne DIAGNOSIS : NURSING Impaired health maintenance • Lack of knowledge; medication Non adherence; medication regimen Adverse medication interaction Complex Medication Regimen; polypharmacy • ☒ ⑨ ¥ Oral Medication Administration or ☒ ② . r % Easiest and most desirable route % Food can affect absorption Protect patients from aspiration Follow special precautions when administering medications to patients with enteral or small bore feeding tubes Follow tubing connection standards Verify tube is compatible with medication absorption Use liquid medications when possible Flush between each medication, do not mix the medications Before giving med, make sure tube is in right spot, patent, and look for residual " What happens when a medication drops on the floor? Throw it away, do not use ÷ Can you crush an extended release or enteric Coated pill? NO If someone has no problem swallowing what position should the bed be in when giving medications? At least 30 degrees, does not matter if they have no problem swallowing You crush a pill to administer through a feeding tube, what do you mix it with? Sterile water You are checking the residual on a feeding tube prior to giving meds, and there is a lot of gastric content. What does this mean and what do you do? % Sg so . ☒ ☒ You have 2 medications prepared to administer through a feeding tube. What is the correct order? Flush tube with sterile water I Administer first med Flush with sterile water 4 Administer second med 5 Finish by flushing with sterile water 2 3 ☆ ÷ % This means that things are not being digested. You should call the provider and get the I order decreased for the dosage. % Is % % ☒ I. ☒% % ⑤ ⑤ go § 8 ☒ ⑧ % % ☒ % ☒ ☒☒ & & : • • ¥ or r *%ᵗ☒ " """☒☒" "" " "" " " " """☒"" " "" " "" TOPICAL MEDICATION ADMINISTRATION " "" Ch. 31 Notes by Morgan Payne Ointments, creams, and transdermal patches Ask if they have existing patch, remove before applying the new one Rotate sites of patch, do not put new patch in same spot as old spot Sites you can apply patches: Trunk, lower abdomen, upper arm, lower back ✗ Not lower forearm Before new patch make sure skin is clean and dry Wear gloves when applying patch Label a patch that is hard to see, like a transparent patch Document patch and location, and removal ⑤ ☒ ☒ ⑨ > ② . % % NASAL INSTILLATION Methods Spray, drops, nasal packing Decongestant spray or drops are most common For spray, guide tip away from the septum Caution patient to avoid the rebound affect The longer they use the spray, it will cause nasal congestion : EYE INSTILLATION 8 f- → & E Avoid the cornea Avoid touching eye or eyelid with droppers or tubes Use only on affected eye Intraocular instillation disk resembles a contact lens Assess if patient can administer eye drops themselves EE- ¥ 5 > EAR INSTILLATION won Ear drops ← at room temperature I Instill Use sterile solutions Check for eardrum rupture prior to administering Adults; pull up pinna * Kids; pull down pinna Irrigation To remove excessive cerumen Only when it causes hearing deficit, ear discomfort, or to visualize the tympanic membrane > A ÷ : § * > > • ☒ ⑤ g. ⑤ ⑤ go so ÷ % E. § % ☒ I. ☒% ⑧ % % ☒ % ,÷¥" ☒☒ ☒%ᵗʰ ☒° & & ☒☒☒ °" ☒☒ • VAGINAL INSTILLATION & • ③ Vaginal medication Inserted with a gloved hand For yeast infections For low hormones Assess if patient can do own vaginal instillation • so or . ' . . ☒ ☒ ⑤ ② . & Rectal Instillation a ☒ Can be given to decrease fever if patient can not swallow Can be given as a laxative, decrease pain, decrease spasms Positioning * left side lying posting with right leg bent up; Sim's position Enema may be given prior to inserting suppository 8- § ⑨ INHALATION MEDICATION Patient needs to have hand strength, and hand breath coordination Steps: : 1; First pt will take a deep breath in and out 2; Then put inhaler in mouth 3; squeeze canister as they take a slow deep breath in : 4; Then hold breath for 1o seconds 5; then exhale slowly If patient can not do that, they will use a spacer I / - :PARENTERAL MEDICATION ADMINISTRATION Need the correct size syringe, and correct type the correct size needle : Need The smaller the number, the larger the diameter Preparing an injection from a vial > If dry, use solvent or diluent as needed > Injected air into vial, then draw up mediation > Label multi dose vial after mixing > Refrigerate remaining doses if needed Preparing an injection from an ampule > Snap off ampule neck % > Aspirate medication into syringe using filter needed > Replace filter needle with appropriate size needless device As > Administer injection ☒ > Filter needle is to filter if any glass was in medication • Mixing medications From a vial and an ampule > prepare med from the vial first; use same syringe and filter needle to withdraw med from ampule& • Mixing medications from two vials ⑨ > ☒ do not contaminate one medication with another § Both ways of mixing; maintain aseptic technique - ' § % i% so . ' . ÷ ☒ Ch. 31 Notes by Morgan Payne % % % ☒ % %% ⑧ % % ☒ % ☒ ☒ @ % ☒ & & ☒% ☒% ☒ ☒ ☒ ☒ ☒☒☒ ☒ ☒ Insulins : Mixing Inject rapid acting insulins mixed with NPH insulin within 15 minutes before a meal • . ☆ Technique > Draw up the air of the dosage for the long acting insulin; instill the air > Draw up the air of the dosage for the regular insulin; instill the air > Leave syringe in the fast acting one after instilling air, draw up dosage > Then go to long acting insulin and draw up the dosage Long acting insulin is called NPH Regular insulin is clear; NPH insulin is cloudy Draw up regular insulin first Must have another nurse check your dosage . ÷ • § or • . . . ☒% Ch. 31 Notes by Morgan Payne q§ ⑨ ☒ ☒ ☒ • ② As • ☒ ¥ ⑧ NEEDLE ANGLES : Subcutaneous; 45 or 90 degrees Intramuscular; 90 degrees 15 degrees : Intradermal; For subcutaneous make sure you pinch tissue first Subcutaneous Injections Medications places into loose connected tissue dermis : under Exercise and hot or cold compresses influence - INTRAMUSCULAR INJECTION - rate of absorption Most common site is abdomen and back of arm Tell pt to rotate injection sites absorption than subQ : Faster Administer at a 90 degree angle • % A ÷ ¥ ÷ Z TRACK METHOD . ' ' ' • ☒ ☒ This ensures medication stays in the muscle For meds like iron and B12 With one hand push the skin over, the other hand inject the needle Then pull the needle out, then let go of the skin ⑤ ⑤ • ⑤ µ & ☒ % Is % ☒ I. ☒% ⑧ % ☒ ☒ % ☒ ,÷!É & ☒ ☒☒ ☒ & ☒%ᵗʰ ☒% ☒☒ °" ☒ ☒☒ LANDMARKS FOR IM MEDICATIONS • • so ' D " ☒ BB Ventrogluteal Site _ > Gluteus medius Preferred and safest site for all adults, children, and infants V Method Vastus Lateralis Used for adults and children often used for infants, toddlers, and children receiving immunizations > Use middle third of muscle for injection Deltoid Not well developed in many adults Many nerves and brachial artery in this area site is 3 finger widths below the acromion process Injections less than 2 ml Not preferred but commonly used for vaccines Intradermal Used for skin testing; TB, allergies Band Angle of insertion is 5 to 15 degrees > A small bleb will form ☒ ② : : ÷ ☒ ② ☒ ☒ ii. : INTRAVENOUS ADMINISTRATION , Administered by the following methods: > Infusion of large volumes of IV fluid > Injection of a bolus or small volume mediation; IV push medications 'piggyback' infusion > - LARGE VOLUME INFUSIONS Safest and easiest method of IV administration We will not mix any medication into an IV bag ÷BOLUS DOSES; IV PUSH MEDICATIONS - A . ' § Medication in a syringe; attach to IV tubing; push into patient Introduces a concentrated dose of a med directly into the systemic circulation !Most dangerous method for medication administration! Know how fast or how slow to push the medication § p ⑤ ⑤ ' . ' ' As ☒ ⑤ PIGGYBACK A ☒ Instill a smaller amount of fluid connected to the primary line The small amount, secondary line, is hung higher than the primary line The primary line is hung lower Secondary tubing is connected to the Y site % % ⑨ % % % % ☒ % ☒% ⑧ ⑤ ☒ § § ☒ Ch. 31 Notes by Morgan Payne ☒ % % % & @ ¥÷ ☒☒ *⇐ʰ☒ ° & °"°ʰ ☒ʰ " """" • ° " ② & & • • Ch. 31 Notes by Morgan Payne IV MEDICATION LABEL ② ☒ so ② or ② r & . A % % SALINE LOCK; AKA HEP LOCK patients that don't need continuous IV fluids : For Make sure it remains patent Flush saline lock every 8 hours > unclamps it > clean port > flush with saline After medication is administered flush again I - ¥ ÷ % ③ " : § ☒ ⑤ § Sg ☒ so ⑨ ☒% • & ☒ % % % % ☒% ⑧ % ☒ ☒ % & ¥÷ ☒☒ °*%ʰ☒%""% & & %ᵗʰ☒ʰ * ☒ʰ ☒ "" BOWEL ELIMINATION & • •° ☒ Ch. 47 Notes by Morgan Payne ☒ • • ② > ☒ or ② r & . a FACTORS THAT INFLUENCE ELIMINATION % % After putting a bedpan under a pt, what position do you put the bed in? Sitting position hmm / I / ✓ COMMON BOWEL ISSUES Constipation > Excessive straining > Bowel movements that are infrequent or hard to pass Diarrhea > Causes dehydration, check fluid and electrolyte levels Incontinence > Short term, like from diarrhea > Long term because pt lost control of the sphincter > protect skin; clean asap; use protective barrier on skin Flatulence passing gas Hemorrhoids Caused by increased venous pressure from straining > Can also be caused by pregnancy Your client is going to be receiving feeding via NG tube. What is the correct sequence the nurse should follow to initiate the feeding? A. Check residual feeding contents B. Verify Tube placement C. Evaluate tolerance of feeding D. Administer the feeding > - > Answer: B, A, D, C • A § § ÷ % BOWEL DIVERSIONS . As ☒ Ostomies > Ileostomy; more liquid stool > Colostomy; more formed stool ☒ ⑤ ↳ & ⑨ go so . What test is used to look for blood in the stool? Guaiac Stool Test ☒ mmmm ☒ % Is % % ☒% ⑧ % % ☒ % ☒ @ & " " " ""☒☒" "" " " " """ "" ☒" " "" " " " "☒☒"""☒"" " "" & • ' § ' * . § ¥ or ' ⑤ Ch. 47 Notes by Morgan Payne NURSING DIAGNOSIS RT BOWEL ELIMINATION & " "" Bowel incontinence Constipation Risk for constipation Diarrhea Lack of knowledge of dietary regimen r ' ☒ ☒ ⑨ ② ACTUE CARE ☒ Cathartics and laxatives Cathartics have a stronger and more rapid effect than laxatives Suppositories may act more quickly than oral medications Antidiarrheal agents 8 > > I ENEMAS Cleansing enemas > Tap water, normal saline, hypertonic solutions, soapsuds Pt needs to be positioned on their left side with their right leg bent The enema bag needs to be on an IV pole to be pulled by gravity > If pt has cramping, we can lower bag so that the rate is slower Tell to hold it as long as possible : Otherpttypes of enemas > Oil retention > Carminative; helps reduce gas > Kayexalate; bring down potassium levels NOT a sterile a technique - / - < If patient has cramping while receiving an enema what are you going to do? Lower the bag to lower the rate NASOGASTRIC TUBE " i &% Stoma should look pink; like inside your mouth should never look purple or black Clean with ONLY warm water; no soap Educate pt to empty bag when its half full . ☐ RESTORATIVE CARE . - • . & ☐ 7 Clean technique Get Xray to ensure its in correct spot Maintain patency of tube Check provider order before removing tube OSTOMIES , ' % Bowel training > Have pt go to restroom 1 hour after they eat a meal Maintenance of proper fluid and food intake > high fiber; oatmeal and bran Promoting of regular exercise Management of skin integrity for pt with fecal incontinence or diarrhea ☒ ⑤ A ☒ ⑨ ☒ & ÷ ☒ % ☒ I. ☒% ⑧ % % ☒ % ☒ @ ☒ • & lÑ%☒ : Finals • ÷ § or r § ☒% you got 3 ☒ Week ! • ⑨ ② this ! • ☒ Trust God & - Stay positive aw Morgan Payne % 8- • go • } 8 • § § ☒ ÷ ⑤ ☒ & % ÷ & & • 8 ☒☒☒☒☒☒☒ • go & ¥ ☒ Is ☒%%%☒☒% ☒ ☒ ☒ @
