Capusule

Powder or gel form of an active drug enclosed in a gelatinous container

Elixir

Medication in a clear liquid containing water, alcohol, sweeteners, and flavorings

Liniment

Medication mixed with alcohol, oil, or soap, which is rubbed on the skin

Lotion

Drug particles in a solution for topical use

Ointment

Semisolid preparation containing a drug to be applied externally; also called an unction

Tablet

Small, solid dose of medication; compressed or molded; may be any size or shape, or enteric coated

Pill

Mixture of a powdered drug with a cohesive material; may be ound or oval

Powder

Single drug or mixture of finely ground drugs

Solution

A drug dissolved in another substance

Suppository

An easily melted medication preparation in a firm base, such as gelatin, that is inserted into the body

Suspension

Finely divided, undissolved particles in a liquid medium; should be shaken before use

syrup

Medication combined with water and sugar solution

Enteric Coated

A tab or pill coated to prevent stomach irritation

AC/PC

before/after meal

QD/BID/TID/QID

1x/day

2x/day

3x/day

4x/day

CR/XR/LA/XL

extended release/long-acting

NGT

nasogastric tube

PO/NPO

by mouth/NOTHING by mouth

STAT

immediate

PRN

as needed

Legal Aspects of Administering Medications

Failure to ensure pt safety

Failure to follow policies and procedures

Failure to properly delegate and supervise

Failure to notify health care provider of problems

Failure to follow orders

Contributing to med errors

Failure to convey discharge orders

Failure to document properly

Failure to accurately assess and monitor pt's condition

5 Rights of Med Administration

Right Medication

   Patient

 Dose

  Route

Time

Physiological Factors and Individual Variables

Affecting Drug Action

1) Developmental considerations

2) Weight

3) Gender

4) Genetic & Cultural Factors

5) Pathology

6) Environment

7) Timing of Med. Admin.

Pharmacokinetics

Effect of the body on the drug

Movement of drug molecules in the body in relation to the drug's absorption, distribution, metabolism, and excretion

Drug Absorption

process by which a drug is transferred from its site of entry into the body to the bloodstream, affected by ROUTE, LIPID solubility, pH, BlOOD FLOW, SITE of admin., DOSE

Distribution

depends on blood flow to the tissues, drug's ability to leave the bloodstream, & drug's ability to enter the cells

Drug Metabolism

aka BIOtransformation

the change of a drug from its original form to a new form

*LIVER* is the primary site for metabolism

Drug Excretion

removing a drug, or its metabolites from the body

*KIDNEYS* excrete most drugs.

*LUNGS* excrete gaseous substances like inhaled anesthetics

Pharmacodynamics

process by which drugs alter cell physiology and affect the body

i.e. drug receptor interaction altering cell function

i.e. drug enzyme interaction

Factors in Assessing Pt's need for/response to

drug therapy

Previous/Current drug use

Medication Schedule

Response to Medications

Attitude toward drugs and use of drugs

Compliance with regimen

Storage

Essential Components of a 

Drug Order

Patient Name

Date & Time Drug Ordered

Name of Drug

Dose of Drug

Route of Admin.

Frequency of Admin.

Signature of Orderer

Benefits of Various Routes of Admin.

Oral-take longest to be absorbed

Injection-take less time than oral to be absorbed

IV-directly placed in bloodstream NOT absorbed

(take effect quickly)

Safety Checks in Med Prep

Check label 3x...

...when you reach for the container/unit dose package

...after retrieval & compared with MAR, BEFORE pouring

....when replacing container OR BEFORE giving to PT

Nursing Process in 

Med Admin

Assessment: health status, current/past illnesses, lab                                   results, KDA, meds

Diagnosis: i.e. constipation r/t use of narcotics

Outcomes/Goals: i.e. pt will pass bowel movement by 7:00pm, 03/15/2013

Interventions: medication administration i.e. suppository

Evaluations: was goal met? 

Correct Procedure for Administering

Oral Med

DO NOT crush enteric-coated or CR drugs

Mix with food or drink if compatible

Allow pt to suck on ice first

Correct Procedure for Administering

a Subcutaneous Injection

Admin. into adipose just below epidermis & dermis

i.e. insulin & heparin

Slow rate of absorption into capillaries

Sites: Outer upper arm, Abdomen, Anterior thigh,

Upper back, Upper Ventral/Dorsogluteal area

Needle: 25-30 Gauge, 3/8" or 5/8"

<1ml

45 to 90 degree angle

Correct Procedure for Administering

an Intramuscular Injection

i.e. antibiotics, hormones, vaccines

Sites: Vastus Lateralis, Deltoid, Ventrogluteal

Needles: 20 to 25 Gauge (aqueous solution),

18 to 25 Gauge (oil-based solution)VL 5/8" to 1", Del 5/8" to 1 1/4" (kids), 5/8" to

1 1/2" (adults), Vent 1 1/2"

Correct Procedure for Administering

a Topical Application

Applied to skin/mucous membranes, including eyes, ears, nose, rectum, vagina, lungs

Clean hands. 

Rub in med.

Apply heat if indicated to increase absorption

Correct Procedure for Administering

Eye Application

Exert pressure on bony prominence beneath conjunctival sac.

Tilt back pt's head

Exert pressure on lacrimal duct to prevent systemic absoprtion

DO NOT touch tip of med container on eye

Correct Procedure for Administering

Ear Application

Clean external ear (Pinna)

Pull ear up and back in an adult

Pull ear straight back for a school-aged child

Pull ear down and back for infant/child under 3yrs.

Correct Procedure for Administering

Nose Drops

Tilt head back

Correct Procedure for Administering

Rectal Preparations

Assist pt to SIMS position. Drape.

Apply lubricant to the rounded end of suppository and index finger or dominant hand

Insert 3" to 4" 

Pt remains on side for 5 minutes

Correct Procedure for Administering

Vaginal Preparations

Lubricate sup. with water or water-soluble gel

Use lithotomy position and drape

Clean vaginal orrifice with warm water

Admin gently in a rolling manner

Have pt remain in supine position for 5 to 10 min

Correct Procedure for Administering

Buccal & Sublingual applications

Between cheek and gum

Under tongue

Correct Procedure for Administering

Inhalations

i.e. bronchodilators

nebulizers, MDIs, DPIs

Give bronchodilators before corticosteroids

Drug Allergies 

Immune System response

i.e. rash, urticaria, fever, diarrhea, nausea, vomiting

*Anaphylactic Reaction* results in respiratory distress, sudden severe bronchospasm, cardiovascular collapse. Treat with vasopressors, bronchodilatros, corticosteriods, o2, IV fluids, antihistamines

Drug Tolerance

Body becomes used to the effects of a drug

Drug Toxic Effects

specific groups of symptoms r/t drug therapy that carry risk for permanent damage or death

i.e. hepatotoxicity-damage to liver

Cummulative effect-body can't metabolize 1st dose before 2nd dose given>toxic levels

Idiosyncratic effect

(paradoxical effect)

unusual response to drug

Drug Interactions

One drug is affected by another or food or something

Antagonist effect-counteraction

Synergistic effect-compounded action

Aspirin

AKA Bufferin, Ecotrin, St. Joseph, Halfprin

(magnesium salicylate)

ACTION: COX 1, COX 2 inhibitor

Reduces Pain, Inflammation, Fever

*nausea, vomitting, diarrhea, diaphoresis*

Narcan

(opioid antagonist)

(naloxone)

ACTIONS: blocks opioid receptors

SIDE EFFECTS: ^RR, PR, BP

PT ED: 

Tylenol

(acetaminophen)

ACTIONS: COX inhibitor in CNS only, NOT anti-inflam or anti-coag. Analgesia, Antipyresis

SIDE EFFECTS: liver damage (overdose) HT in QD use in women, abdominal pain, nausea, vomiting, diarrhea, sweating (overdose)

PT ED: 

Percocet

(generic name is endocet) 

ACTION: Opioid Agonist for pain

SIDE EFFECTS: lower BP, low RR, nausea, dizziness, constipation, potential for abuse

PT ED: Avoid alcohol, Avoid driving, rise slowly, take only PRN, ^fiber&water, take w/ food/milk

Morphine

ACTION: OPIOID AGONIST for severe pain

SIDE EFFCTS: lower BP, low RR, nausea, dizziness, constipation, potential for abuse

PT ED: Avoid alcohol, Avoid driving, rise slowly, take only PRN, ^fiber&water, take w/ food/milk

Codiene

ACTION: OPIOID AGONIST for mild to moderate pain

SIDE EFFCTS: lower BP, low RR, nausea, dizziness, constipation, potential for abuse

PT ED: Avoid alcohol, Avoid driving, rise slowly, take only PRN, ^fiber&water, take w/ food/milk

Celebrex

(celecoxib)

ACTION: COX2 inhibitor

SIDE EFFECTS: GI bleeding, renal dysfunction, cardiovascular events, cerebrovascular events

PT ED: report GI toxicity (abdominal pain, dark stools),wt gain, edema, chest pain 

NSAIDS 

in general

Interfere w/ prostaglandin production

Inhibit COX1, COX2 enzymes

1. suppress inflamation 2. treat pain 3. reduce fever 4.dysmenorrhea5. anticoagulation

SIDE EFFECTS: GI upset, bleeding, renal dysfunction, thromboembolic events (non-aspirin)

PT ED: take w. food or milk, Avoid alcohol, Report GI irritation, prolonged bleeding, wt gain, edema

Bronchodilators

Medication administered by inhalation.

Decrease resistance to airflow by enlarging air passageways.

Promote relaxation of musculature in the tacheobronchial tree

SIDE EFFECTS: Headache, Dizziness, Drowsiness, Nausea, Vomiting, Constipation, Palpitations, Tachycardia, HT, Nervousness 

Principles of

Therapuetic Communication 

Be Objective

Be Focused

Be Caring

Be Supportive 

Components of a Med Order

Patient Name

Date & Time Order Written

Drug

Dose

Route

Times of Administration

Signature of Orderer

Needle Sizes & Syringes

Intradermal Injections- 1/4" to 1/2" 26 or 27 Gauge

Subcutaneous-3/8" to 1" 25 to 30 Gauge

Intramuscular-1 1/2" 22 Gauge

Insulin-5/16" & 1/2" 28 to 30 Gauge

Principles of 

Med Administration

3x Safety Check:

When retrieved, Prior to Pouring, When Returning

7 Rights:

Right drug

Right route

Right dose

Right time

Right PT

Right documentation

Right to refuse

Child Dose Calculations

mg/kg/day

or

mg/kg/dose

1kg=2.2lb

i.e. 50lb child= 22.73kg

Factors of

Communication 

Gender

Environment

Physical, mental & emotional status

Values

Forms of 

Communication

Verbal

Nonverbal

Helping Relationship

Phases:  

Orientation-Getting to know pt/Establish trust

Working-"How do you feel about this new diagnosis?"/Establish goals

Termination-Wrap things up, Discharge readiness

Blocks to 

Therapeutic Communication

Preconceived Ideas

Disconnected nurse

Talking in Med Terminology

Lack of Trust/Respect

Giving Advice instead of Offering Options

Not paying attention

Not helping them talk

SBAR

Situation

Background

Assessment

Recommendation

SBAR 

hands-off

Transfer of care (info, responsibility, authority) between providers

Communicate Interactively (questions)

Communicate Up-to-Date Info

Limit Interruptions

Allow Sufficient Time

Require Verification

Ensure Receiver has opportunity to review data & treatment

Function & Role of

Cardiovascular System 

&

Transport of Respiratory Gases 

pumps blood carrying O2 and CO2 to and away from tissues. Gas exchange takes place in the lungs with the alveoli and capillaries. 

Care for Pts Undergoing Diagnostic Procedure r/t 

Respiratory Function

 Aterial Blood Gas & pH Analysis

 preparation:  Explain procedure inc. puncture of radial, brachial, or femoral artery. Allen's test

Aftercare:  Record sup. O2/Resp. Settings on lab slip

Place specimen on ice and take to lab.

Apply pressure 5-10 min

Cytologic Study

Prep:  Collect sputum 3 consec. days in a.m.

Instruct Pt deep cough, expel sputum into sterile cont. Cap w/ tight-fitting lid

After:  Label & send cont. to lab

Age-Related Differences

in pts w/ 

respiratory problems

Older Adults have decreased elastic recoil of lungs, need to use accessory muscles for expiration, fewer functional capillaries & more fibrous tissue in alveoli, decreased skeletal muscle strength in thorax, reduced vital capacity , increased residual volume.

Less air exchange, more secretions remain in lungs, drier mucous membranes, altered pain sensation, diff. norms for body temp., pos. atypical fever, greater risk for aspiration due to slower gastric motility, impaired mobility & inactivity

Respiratory Assessment

Respiratory Assessment: assess usual patterns of respiration, medications that are taken daily, health history, recent changes in breathing, lifestyle and environment, cough, sputum, chest pain, dyspnea, fever, fatigue

Nursing Interventions

for

Maintaining & Promoting O2

Teach Pt about pollution-free environments

Reduce anxiety, Good nutrition, High Fowler's Position, Adequate fluid intake, Humidified air, Deep breathing, Use of incentive spirometer, pursed-lip breathing, promote and control coughing, perform chest pt, suction airway, Administer meds, Provide sup. o2, 

Artificial Airways

Oropharyngeal-used to keep tongue out of the way. Goes in back of pharynx. For post-op pts while unconscious

Nasopharyngeal-used for frequent nasotracheal suctioning

Endotracheal Tube-used to oxygenate pt via mechanical vent

Tracheostomy-

Meds for Oxygenation

Inhaled meds via nebulizer, MDI, DPI, PO, inhalation, IV, Rectally

Accolate, Singulair, Albuterol, Theophylline, Corticosteroids, Diphenhydramine, Cetrizine (Zyrtec), Fexofenadine (Allegra), Cromolyn Sodium (Intal)

O2 Therapy

Flow Rate:  L/min

ordered by physician

humidify

no smoking when in use

Avoid synthetic fabrics & oil & open flames

Delivered by nasal cannula, nasopharyngeal cath, face mask, O2 tent

Inhalation Therapy

used to open airways, to liquefy or loosen thick secretions or reduce inflammation.

Via nebulizer, MDI, PDI

Suctioning

used when pt is unable to remove secretions with coughing

via canula through oropharynx, nasopharynx, or trache.

Chest Percussion

.use a cupped palm to loosen pulmonary secretions for 30 to 60 seconds several times/day

Vibration

uses manual compression and tremor on pt's chest wall to loosen secretions.

rhythmic contractions and relaxation of arm & shoulder muscles while holding the hands flat on chest wall as pt exhales.

Postural Drainage

uses gravity to drain secretions 2 to 4x/day for 20 to 30 minutes

High Fowler's do drain apical sections of upper lobes

Lying position, half on ab, half on side, R & L to dain post. section of upper lobes

Lying position on L side to drain R lobe

Trendelenburg position to drain lower lobes