week 2

Question 1

The 8 Rights of Med Administration

Answer 1

1. Right Medication
2. Right Dose
3. Right Time
4. Right Route
5. Right Client
   – Always check the Pt’s ID band
6. Right Documentation
7. Right Reason
8. Right Frequency
9. For refusal

Question 2

right time

Answer 2

In most instances, the medication can be considered given “on time” if administered within ½ hour prior to or ½ hour after the time ordered.

Question 3

The right documentation

Answer 3

• The right documentation refers to the charting of the time when the medication was given.
• This needs to be charted immediately after the client has taken his/her medication
• The nurse needs to witness the client taking the medication before she can sign off
• This documentation should be placed on the medication record under the correct date and time.

Question 4

The Right Reason

Answer 4

• refers to the nurses’ knowledge as to why the patient is on the medication
• The nurse verifies that the medication ordered is correct for the clients illness or diagnosis
• The nurse can refer to the CPS under “drug uses” to determine that this is an appropriate medication for the reason in which this patient is being treated

Question 5

The Right Frequency

Answer 5

• The nurse must know why a medication is ordered for certain times of the day and whether the time schedule can be altered
• Medications that must act at certain times are given priority (ie. Insulin should be given at a precise interval before a meal)
• Give medications according to their action: ie. Sleeping pills are given at bedtime whereas as diuretics are given in the morning

Question 6

Medication errors (MEs)

Answer 6

failure to complete or use the correct planned action for pnt when providing meds

Question 7

Adverse drug events (ADEs)

Answer 7

injury that is cb a med or failure to admin a med. May or may not cause harm to pnt

Question 8

Adverse drug reactions (ADRs)

Answer 8

injury occurring at the time a drug is used.

Question 9

idiosyncratic

Answer 9

is a rxn that is specific to the pnt

Question 10

Two types of Adverse Drug Reactions (ADRs)

Answer 10

Allergic reactions

Idiosyncratic reactions

Question 11

Parenteral Drugs

Answer 11

IM (intramuscular)
SubQ (subcutaneous)
ID (intradermal)
IV (intravenous)
you need to be certified to do IVpush

Question 12

Parenteral Drugs x2

Answer 12

Never recap a used needle!

May recap an unused needle with the “scoop method”

Question 13

Filtered Needle

Answer 13

ampules

Question 14

for narcotics

Answer 14

you need to double count them on your shift

Question 15

DONT MASSAGE HEPARIN

Answer 15

.

Question 16

HOLD Z TRACK FOR

Answer 16

10 SECONDS

Question 17

AIR LOCK

Answer 17

0.2mL of air IN THE NEEDLE AND IT LOCKS THE MEDICATION INSIDE.

Question 18

Ventrogluteal site

Answer 18

preferred site for adults and children over 18 months

Question 19

Vastus lateralis site

Answer 19

(preferred site for infants)

Question 20

First trimester

Answer 20

is the period of greatest danger for drug-induced developmental defects
Nausea medications

Question 21

During the last trimester

Answer 21

the greatest percentage of maternally absorbed drug gets to the fetus

Question 22

FDA classifies drugs for pregnancy according to their safety

Answer 22

Pain meds, any opioids, can cause respiratory depression. Look for apneic spaz on baby.

Question 23

Absorption

peds

Answer 23

Gastric pH less acidic (-increase abrop rate)

Gastric emptying is slowed (-peristalsis is slower)

Topical absorption faster through the skin (thin and more permeable)

Intramuscular absorption faster (-because there is more fluid) and irregular (-developing muscle)

More drug enters the brain because of the immature blood-brain barrier (-watch baby for neurological e

Question 24

Distribution

peds

Answer 24

TBW (total body water) is 70% to 80% in full-term infants, 85% in premature newborns, 64% in children 1 to 12 years of age

Greater TBW means fat content is lower

Decreased level of protein binding (more free drug in the tissues)

Immature blood-brain barrier

Question 25

Metabolism | peds

Answer 25

Liver immature, does not produce enough microsomal enzymes Less Cytochrome P-450 enzyme is produced (necessary for metabolism of drugs) ( –the drug becomes more potent) Older children may have increased metabolism, requiring higher doses

Question 26

Excretion | peds

Answer 26

Kidney immaturity affects glomerular filtration rate and tubular secretion (drugs not readily excreted) Decreased perfusion rate of the kidneys Increased susceptibility to drug overdoses and side effects as metabolites (by-products of the drugs) are not excreted

Question 27

NEVER GIVE ASPRIN TO CHILDREN IT LINKS TO RYES SYNDROME

Answer 27

YOU CAN GIVE TYLONOL AND ADVIL

Question 28

NEVER GIVE 2 Y/O A PILL

Answer 28

. FOR THE POTENTIAL OF ASPRIATON.

Question 29

. The child receives a dose of 1 teaspoon per directions according to his weight of 28 lb. Later, when his 5 yr-old sister needs a dose, she receives 1.5 teaspoons because her weight is 45 lb. If the concentration of the drug contains 160 mg per teaspoon, then how much medication (mg) did the 5 year-old receive with her dose? Change all weights to kilograms. 25/2.2=11.36* 160

Answer 29

?

Question 30

5. What should the parents look for when evaluating the children’s response to a dose of acetaminophen

Answer 30

DECREASE FEVER

Question 31

Polypharmacy

Answer 31

(the use of many different medications from various physicians or OTC for the same illness. They doctor shop)

Question 32

Decreased albumin: | geriatrics

Answer 32

Reduced protein, therefore higher unbound drugs resulting in enhanced symptoms (-DRUG-DRUG INTERCTIONS) Increased leakage into the tissues (therefore poorly excreted) Protein bound drugs are too large to pass through the vessel walls therefore, they cannot pass into the tissues to illicit a drug response only unbound drugs are “free” to attach to the receptor sites

Question 33

excretion in geriatrics

Answer 33

LOOK FOR HIGH SERUM CREATINE (LOW KIDNEY FUNC LOOK FOR ENZYMES IN LIVER (AST AND ALT) HIGH LEVELS INDICATE LIVER IS IN POOR FUNCTION.

Question 34

7. Injections given in the outer layers of the dermis in very small amounts

Answer 34

- id

Question 35

9. Another term for IV push medications-

Answer 35

bolus

Question 36

10. Injections that deposit drugs deep into muscle tissue-

Answer 36

im

Question 37

11. This route allows for rapid absorption of drugs into the bloodstream through oral mucous membranes.- c

Answer 37

sublingiual

Question 38

2. The IM site that is not preferred for use due to the proximity of the sciatic nerve and major blood vessels-

Answer 38

dorsal gluteal

Question 39

3. The preferred IM site for adults and children older than age 18 months

Answer 39

ventrogluteal

Question 40

4. The IM site located in the upper arm

Answer 40

deltoid

Question 41

5. Topical medications may be administered via these patches to the skin

Answer 41

.transdermal

Question 42

6. This type of needle should be used when withdrawing medications from a glass ampule.

Answer 42

filter

Question 43

8. Topical medications for asthma may be administered through a metered-

Answer 43

dose inhaler.

Question 44

10. Abbreviation for small-volume IV medication admixtures –

Answer 44

iv piggyback

Question 45

Vitamins

Answer 45

Essential for normal physiological and metabolic function Available from natural sources from both plants and animals (fruits, veggies, meat and fish) Also available synthetically Insufficient amounts result in various deficiencies, can be due to: Poor diet intake Swallowing disorders Digestive disorders Absorption disorders Financial difficulties leading to poor nutritional intake

Question 46

Vitamin K and Vitamin B

Answer 46

complex vitamins are obtained by synthesis in the small intestine by normal bacterial flora

Question 47

Vitamin D

Answer 47

can be synthesized by the skin when exposed to sunlight

Question 48

Water-Soluble Vitamins

Answer 48

B-complex group and vitamin C Can be dissolved in water Excreted via the kidneys Cannot be stored by the body in large amounts Daily intake required to prevent deficiencies

Question 49

Fat-Soluble Vitamins

Answer 49

``` Vitamins A, D, E, K Present in both plant and animal foods Stored in the liver and fatty tissues in large amounts Most excreted via feces Daily intake not required ``` Deficiency occurs only after prolonged deprivation Can become toxic if excessive amounts are consumed resulting in hypervitaminosis

Question 50

Vitamin A

Answer 50

Fat soluble obtained from plants and animals Vitamin A (retinol) derived from animal fats (butter and milk), eggs, meat, liver, fish liver oils The vitamin A in animal tissues is derived from carotene, which are found in plants (green and yellow vegetables and yellow fruits) Required for growth and development of bones and teeth Necessary for other processes Reproduction Integrity of mucosal and epithelial surfaces Cholesterol and steroid synthesis Essential for night vision ``` Dietary supplement Infants and pregnant and nursing women Deficiency states Hyperkeratosis of the skin Night blindness Other eye disorders Skin conditions Acne and psoriasis ``` Ingestion of excessive amounts causes toxicity Irritability, drowsiness, vertigo and delirium Increased intracranial pressure in infants Generalized peeling of the skin and erythema over several weeks Brittle nails, hair loss Symptoms resolve once the vitamin is discontinued Decreased absorption with lubricating laxatives

Question 51

Vitamin D

Answer 51

Fat soluble “Sunshine vitamin” Responsible for proper utilization of calcium and phosphorus Essential for calcification of bone Regulation of serum calcium via the parathyroid hormones ``` Vitamin D-containing foods Fish oils, salmon, sardines, herring Fortified milk, breads, cereals Animal livers, tuna fish, eggs, butter Endogenous synthesis in the skin from the sun ``` Regulates absorption of and use of calcium and phosphorus Necessary for normal calcification of bone and teeth Dietary supplement Treatment of vitamin D deficiency Treatment and correction of conditions related to long-term deficiency: Rickets, Tetany (muscular contractions), osteomalacia (softening of the bones) Prevention of osteoporosis Hypertension Arrhythmia (when combined with Digoxin) Fatigue, muscle weakness and pain, ataxia and gi distress Decreased absorption with lubricating laxatives Risk of cardiac arrhythmia with Digoxin preparations

Question 52

Vitamin E

Answer 52

``` Fat soluble Dietary plant sources Fruits, grains, cereals, vegetables, oils, wheat germ Animal sources Eggs, chicken, meats, fish ``` Exact biologic function of vitamin E is unknown Believed to act as an antioxidant Dietary supplement Antioxidant, prevents formation of toxic chemicals in the body Treatment of deficiency Highest risk of deficiency in premature infants Nausea Vomiting Headache Fatigue

Question 53

Vitamin K

Answer 53

Fat soluble Three types: K1, K2, K3 Dietary sources of K1 Green leafy vegetables (cabbage, spinach), meats, milk Vitamin K2 synthesized by the intestinal flora Essential for synthesis of blood coagulation factors in the liver Vitamin K–dependent clotting factors II VII IX X Vitamin K1 deficiency results in coagulation disorders Dietary supplementation Treatment of deficiency (rare as the intestinal flora synthesizes sufficient amounts) Antibiotic therapy (wipes out the normal flora) Newborn infants (due to mal-absorption from decreased bile, therefore newborns are given a dose of Vitamin K1 injectable after birth) Mal-absorption Reverse the effects of certain anticoagulants (warfarin) Adverse Effects: Headache Anemia Rash

Question 54

Water-Soluble Vitamins

Answer 54

``` Vitamin B complex thiamine (B1) – pyridoxine (B6) riboflavin (B2) – folic acid (B9) niacin (B3) – cyanocobalamin (B12) pantothenic acid (B5) Vitamin C ascorbic acid ``` Can dissolve in water Not stored in the body Body excretes what it doesn’t use via the kidney Intake must be adequate and regular or deficiency may develop Toxic reactions are very rare

Question 55

Vitamin B1 (Thiamine)

Answer 55

Essential for carbohydrate metabolism Integrity of the peripheral nervous system Integrity of the cardiovascular system Integrity of the gastrointestinal tract Used as a dietary supplement for mal-absorption due to alcoholism Available in: whole grains, liver and beans

Question 56

Vitamin B2 (Riboflavin)

Answer 56

``` Water soluble vitamin Essential for tissue respiration Generally safe, no reports of toxicity May discolor urine to yellow-orange Deficiency is rare and does not usually occur in healthy people ``` ``` If present: Alcoholism is a major cause Deficiency also caused by: Intestinal malabsorption Long-term infections Liver disease Malignancy ``` ``` Food sources Leafy green vegetables Eggs Nuts Meats Yeast ```

Question 57

Vitamin B3 (Niacin)

Answer 57

Water soluble Food sources Meats, beans, liver, yeast, wheat Works as an antihyperlipidemic agent (lowers cholesterol and triglyceride levels) Essential for carbohydrate, protein and lipid metabolism and tissue respiration ``` Adverse Effects Flushing (most frequently reported effect) Pruritus Gi distress Generally subside with continued use ```

Question 58

Vitamin B6 (Pyridoxine)

Answer 58

Deficiency results in anemia and peripheral neuropathy (paraesthesia) Available in whole grains, nuts, yeast, fish and organ meats

Question 59

Vitamin B9 (Folic Acid)

Answer 59

Essential for the production of nucleoproteins (DNA and RNA) Prevention of fetal neural tube defects (ie spina bifida) Folic Acid deficiency leads to anemia Available: dried beans, peas, oranges and green vegetables

Question 60

Vitamin B12 (Cyanocobalamin)

Answer 60

Essential for the metabolism of fat, carbohydrates and protein synthesis Required for growth, cell replication and CNS (myelin synthesis) Available in: organ meats, liver, kidney, fish, shell fish, meat and dairy Deficiency leads to anemia, degeneration of the CNS and nerve atrophy

Question 61

Vitamin C (Ascorbic Acid)

Answer 61

``` Water soluble Natural sources Citrus fruits and juices Tomatoes Cabbage Cherries Liver ``` ``` Deficiency: Prolonged deficiency results in scurvy Gingivitis and bleeding gums Loss of teeth Anemia Subcutaneous hemorrhage Bone lesions Delayed healing of soft tissues and bones ``` ``` Indications: Dietary supplement Prevention and treatment of scurvy Urinary acidifier Prophylactic for the common cold (not proven) ``` Megadoses: Nausea, vomiting, headache, abdominal cramps Acidified urine, with possible stone formation Discontinuing megadoses may result in scurvy-like symptoms

Question 62

Minerals

Answer 62

Are inorganic elements or salts Bind with enzymes or other organic molecules Help to regulate many body functions Act as building blocks Needed for intracellular and extracellular electrolytes

Question 63

Calcium

Answer 63

Most abundant mineral element in the body Accounts for 2% of body weight Highest concentration in bones and teeth Efficient absorption requires adequate amounts of vitamin D ``` Calcium Deficiency: Calcium deficiency: hypocalcemia Infantile rickets Adult osteomalacia Osteoporosis Calcium requirements high for Growing children Women who are pregnant or breast-feeding ```

Question 64

Magnesium

Answer 64

One of the principal cations of intracellular fluid Essential for enzyme systems associated with energy metabolism Required for: Nerve physiology Muscle contraction ``` Causes of Deficiency: Hypomagnesemia Malabsorption Alcoholism Long-term IV feedings Diuretics Metabolic disorders (hyperthyroidism, diabetic ketoacidosis) ```

Question 65

Zinc

Answer 65

Trace element Essential in metabolic reactions of proteins and carbohydrates Important for normal tissue growth and repair, especially wound repair

Question 66

Vitamins and Minerals:Nursing Implications

Answer 66

Assess nutritional status Assess baseline lab values (WBC, RBC, protein, albumin levels) Assess history and medication history Assess for contraindications