What some some responsibilities of the provider?
-history and physical-diagnosing-prescribing medications-monitoring response to therapy-modifying prescriptions as needed
What are some of the responsibilities of the pharmacist?
-ensure prescriptions are valid-prepares and distributes medications-works with the health team to evaluate the effectiveness-provides instructions for administration-Resource to the medical team on side effects, toxicities, interactions, and incompatibilities of drugs
What are some responsibilities of the nurse?
prepare, administer, and evaluate patient response
UTD knowledge is based on what?
- use- mechanisms of action- routes- safe dosage range- adverse reactions and side effects- precautions- contradictions- interactions
what type of medication order does not require provider approval and consists of typical OTC drugs like Tylenol?
standing/protocol order
What is a routine/scheduled order?
a routine med. order such as giving daily vitamins or normal BP medication
What is a PRN order?
-medication order administered AS NEEDED-nurse must assess for pain and administer based on pain response but does not have to wait until very painful response
A one time booster shot is what type of medication order?
One-Time Order
What is a STAT order?
drugs administered for an emergency situation
What is a NOW order?
not the same as a STAT order, EX: give this antibiotic now before surgery, not necessarily emergency
What are phone/verbal orders?
-order given by phone or verbal-READ BACK ALL ORDERS-HAVE SECOND RN LISTEN-WRITE DOWN ORDER-ASSISTANTS CANT TAKE THESE ORDERS
What are the components of medication orders?
-Patient full name-age and weight-date and time-medication name (brand or generic)-dosage (amount or strength)-route of administration-time and frequencysignature of HCP
If a drug order is incorrect what should the nurse do?
call the prescriber
Adverse medication effects occur in what % of older adults?
22%
What are some key points of commandment 1 right drug?
- Compare the Electronic record with med order chart- Compare 3 TIMES- Do not give meds from unmarked container or drugs mixed by another person
When should the EMAR label be compared to the med order chart?
- when removing from storage - before taking to patients room- before giving medication
What are some key points of commandment 2 right dose?
-ask peer to check calculations- ALWAYS double check INSULIN
For commandment 3 right route, when should you consult the provider who wrote the order?
- route not specified- med not available via ordered route- unable to access specified route (no IV, unconscious) provider has to change route
What are the main components of commandment 4 right assessment?
labs and vital signs
What does TID stand for?
three times a day
What are some components of commandment 5 right time?
-some meds have priority -some meds can be given within 30 min to 1 hour before/after time drug is scheduled- EMAR will have times assigned but these can be changed using clinical judgement
What type of insulin is fast acting (within 30 minutes)?
regular insulin
What type of insulin acts over 12-24 hours?
long acting insulin (NPH)
True or False: food must be available when giving insulin?
True
What does AC stand for?
before meals
When is BG checked for normal insulin?
AC and HS per sliding scale
if BG <70 what should you do?
follow hypoglycemic protocol and give 0 units
if BG 71-120 how many units should be given?
0
if BG 121-180 how many units should be given?
2
if BG 181-250 how many units should be given?
4
if BG 251-325 how many units should be given?
6
if BG 326-400 how many units should be given?
8
if BG is > 400 how many units should be given?
10 and draw blood and send to lab and notify HCP
At what hours should you check BG?
0600, 1100, 1600, 2100
What are some components of commandment 6 right patient?
-MUST check at least 2 patient identifiers- check clients id bracelet- ask client to state name- scan armband
What are some components of commandment 7 right documentation?
- chart things such as PRN's: follow up assessments- meds held on purpose- any missed meds- refused meds- preassessment data required for certain drugs such as HR and BP-Chart medication administration AFTER the med is given
What is the easiest and most preferred route of administration?
oral
What are some disadvantages of oral administration?
slower onset, many contraindications
What are some advantages of the buccal and sublingual routes of administration?
- rapid absorption: sublingual faster than buccal- not digested (avoids gi tract and liver)- easier than swallowing
What are some disadvantages of the buccal and sublingual routes of administration?
-eating/drinking can decrease absorption-cant use for extended-release meds-mouth irritation
What are some advantages of PEG tubes/Enteral meds?
great for patients who are NPO or cant Swallow
What are some disadvantages of PEG tubes/Enteral meds?
-must prep meds-not all meds can be crushed-time-consuming to administer-potential for fluid overload-high risk for aspiration-potential to clog tubes
What are some advantages of topical/skin treatments?
-painless and easy-local effects
What are some disadvantages of topical/skin treatments?
-can be messy-absorption impacted by clothing or edma-cant apply to broken/open/irritated skin unless designed to heal open wounds
What are some advantages of nasal administration?
easy and local effects
What are some disadvantages of nasal administration?
require proper positioning and can be difficult with children
What are some advantages of optic administration?
local effects
What are some disadvantages of optic administration?
- can be difficult for some patients such as children- confusion with OD, OS, OU- temporary blurred vision
What are some advantages of otic administration?
local effects
What are some disadvantages of otic administration?
-confusion with AD, AS, AU-can cause vertigo or nausea if not room temp - never give cold- cerumen inhibits absorption
What are some advantages of vaginal administration?
local effects and patient may self administer
What are some dis advantages of vaginal administration?
-uncomfortable or embarrassing-messy and discharge may be odorous-requires dorsal recumbent position-sometimes refrigeration requiredUSUALLY administered AT NIGHT
What are some advantages of rectal administration?
-option when oral or parenteral routes not available-patient may self administer-suppository is an easy route for infants
What are some dis advantages of rectal administration?
-uncomfortable or embarrassing for patient-may require a cleansing enema first for suppository-refrigeration may be required
What are some advantages of inhalation administration?
-covers a large surface area of the respiratory tract-rapid action and effects
What are some dis advantages of inhalation administration?
-local and systematic effects-inhalers require patient participation
What is the name of the method used to recap unused needles?
one-handed scoop method