STUDY GUIDE FOR EXAM #1

MEDICAL CALCULATIONS
• 6 RIGHTS OF MEDICATION ADMINISTRATION:
o RIGHT PATIENT
• Check id bracelet
• Ask pt name and birthdate
• Check name on pts medication label
o RIGHT MEDICATION
• Make sure drug order is complete and legible
• Check drug label 3 times
• Check expiration date
• Know the drug action
o RIGHT DOSE
• Calculate drug dose
• Know recommended dose for the drug
• Recalculate dose with another nurse when in doubt
o RIGHT ROUTE
• Know proper route of administration
• Use aseptic techniques
• Document injection site on patients chart
o RIGHT TIME
• Administer drug at specified time
• Document any delay or omitted drug dose
• Administer with food if it irritates gastric mucosa
• Administer ATB in even intervals q6h, q8h
o DOCUMENTATION
• Place initials on MAR and eMAR
• Document that pt refused or drug was omitted by circling
initials
• Indicate on the MAR if drug was delayed and time it was
given
• TYPES OF DRUG ORDERS:
o Standing or Routine: Carried out until Dr cancels or prescribed
number of days has passed.
o PRN: Given at patient’s request or nurses’ discretion.
o Single (One Time): Given once at a specific time.
o STAT: Given immediately and given once.
o NOW: Client needs meds quickly but not right away, has 90 min.
to administer.
o Prescription: To be taken outside of hospital.

• TWO IDENTIFIERS:
o PT’S ID BAND
o HAVE PT STATE NAME AND DOB
o PT FAMILY MEMBER
o MARS

• PHARMACIST ROLE:
o Prepare and distribute
o Mixing solutions
o Fill RX accurately
o Dispensing correct medication, proper dosage and amount with
accurate labels.

• DISTRIBUTION SYSTEM:
o Pharmacy gets orders, prepares orders, and delivers.
o Medication rooms, pixys.

• NURSES ROLE:
o Admin medication to client
o Verify 6 rights

• MEDICATION ERROR:
o Notify supervisor, physician, patient
o Document on variance form
 o Fill out incident report

• THE MAXIMUM AMOUT OF MEDICATION THAT CAN BE

GIVEN IM: 3ML

• PHARMACOKINETICS: The study of how medications enter the body,

reaches their site of action, metabolize, and exit the body.
o Absorption: passage of medication molecules into the blood from
site of administration.
 Factors that influence absorption:
• Route of admin.
• Ability to dissolve
• Blood flow to site of admin
• Body surface area
• Liquid solubility
o Distribution: after absorption, medication is distributed within the
body tissues, organs and specific site of action.
 Distribution depends on:
• Circulation
• Membrane permeability
• Protein binding
o Metabolism: after medication reaches its site of action, it becomes
metabolized into an inactive form that is easier to excrete.
o Excretion: after medication is metabolized, they exit the body
through the kidneys, liver, bowel, lungs, and exocrine glands.
• TYPES OF MEDICATION ACTION:
o Therapeutic Effects: The expected or predictable physiological
response a medication causes.
o Side Effects: predictable & unavoidable secondary effect
produced at a therapeutic dose.
o Adverse Effects: unintended, undesirable, unpredictable severe
responses to medications.

• MEDICATION INTERACTIONS: when one medication modifies the

action of another.

• SYNERGISTIC EFFECT: the combined effect of two medications is

greater than when the meds are given separately.

• TERMS ASSOCIATED WITH MEDICATION ACTIONS:

o Onset: Time it takes for medication to prod. response
o Peak: time it take for med. to reach highest effect concentration
o Trough: min blood serum concentration of medication reached
before next scheduled dose
o Duration: time which medication is present in concentration great
enough to produce a response
o Plateau: blood serum concentration of a medication reached and
maintained after repeated fixed doses.
 • ROUTES OF ADMINISTRATION:
o Oral: Medications given by mouth.
 Sublingual
 Buccal
o Parenteral: Medications injected into the body.
 Intradermal: 15 degrees-into dermis
 Subcutaneous: 45 degrees- below dermis
 Intramuscular: 90 degrees-into muscle tissue
 Intravenous: into vein
 Epidural: epidural space via catheter
 Intrathecal: subarachnoid space/brain ventricle
 Intraosseous: into bone
 Intra peritoneal: into abdomen
 Intrapleural: inject/or chest tube into pleural space
 Intraarterial: into artery
o Topical: Medications applied by the skin.
o Inhalation:
o Intraocular:

• ALTERNITE METHODS OF DRUG ADMINISTRATION

o Patch: slow systemic absorption
o Inhalation: delivers prescribed dose to be absorbed by mucosal
lining of respiratory tract
o Nasal spray: relieves nasal congestion, shrinks polyps
o Eye drops and ointment: eye disorders, infections, allergies,
examinations and surgeries
o Ear drops: soften or loosen cerumen, anesthetic effect,
immobilize insects, infections
o Pharyngeal sprays, mouthwash, lozenges: reduce throat
irritation, antiseptic effect, anesthetic effects
o Topical: protect skin areas, prevent and treat dryness and itching,
relieve pain
 o Rectal: relieve vomiting, relieve pain or anxiety, promote
defecation, administer drugs that could be destroyed by gastric
enzymes
o Vaginal: infections and inflammation

• NURSING PROCESS AND MEDICATION ADMIN

o ASSESSMENT
o History
o Allergies
o Medications
o Diet
o Coordination / perceptual problems
o Current condition
o Attitude about med. use
o Knowledge and understanding about medication
therapy
o Learning needs
o DIAGNOSIS
o Based on information given the nurse will
determine diagnosis
o PLANNING
o Goals and outcomes
o Setting priorities
o Collaborative care
o IMPLEMENTATION
o Health promotion
 Family and pt teaching
o Acute care
 Receiving medication orders
 Correct transcription and communication
of orders
 Accurate dose calculation and
measurement
  Correct administration
 Recording medication administration
o Restorative Care
o EVALUATION
o Nurse make sure all outcomes met

• REDUCING DISTRACTIONS DURING MEDICATION

ADMINISTRATION
o Consistently follow nursing protocols for medication admin
decreases errors
o Nurses who experience fewer distractions during medication
admin prevent medication errors
o Placing “Do Not Disturb” signs in medication prep areas reduce
distractions and errors
o Nurses need to investigate strategies that will decrease distractions
and enhance their ability to follow nursing protocols and improve
their focus during medication administration

• Q 8h is not the same as 3 times a day.

• Q 12h is not the same as twice a day.

• COMPONENTS ON A DRUG ORDER

o Date and Time order written
o Drug name
o Dosage
o Route of administration
 o Frequency and times of administration
o Physicians signature
o Patients full name

1 GRAM = 1000 MG 1 MG = 1000 MCG

1 GM = 15 GR 1 GR = 60 MG

1 IN = 0.0254 M 1 IN = 2.54 CM

1 L = 32 OZ 1 OZ = 30 ML

1 KG = 2.2 LBS

30 ML = 1 OZ = 8 DR = 2 T = 6t
STEPS IN DRAWING UP INSULIN, HUMULIN R & N:
• Cleanse stoppers with alcohol, roll between palm of hands to mix
the insulin
• Draw up air for amount of humulin n and inject into bottle, make
no contact with medication, pull needle out
• Draw up amount of air for humulin R, inject in bottle and
withdraw same amount of medication
• Inject needle in humulin n and withdraw medication
• Administer immediately.
• Always draw up insulin R before N!!!!!!!!

WHERE MEDS ARE ADMINISTERED IN THE EYE:

• EYE DROPS
o Lye or sit with head tilted back
o Have pt look up towards ceiling and away from dropper.
o Pull down on lower lid, place one drop of med into the lower
conjunctival sac. Prevents drug from dropping on cornea.
o Press on medial nasolacrimal canthus with tissue to prevent
systemic drug absorption.
o Repeat for other eye if infected.
o Have pt to blink one or two times and then keep the eyes
closed for several minutes. Use tissue to blot away extra
fluids.
• EYE OINTMENT:
o Lye or sit with head tilted back.
o Pull down on lower lid to expose conjunctival sac of affected
eye.
o Squeeze a strip of ointment onto the conjunctival sac ¼ in.
 o Repeat on other eye if infected
o Have pt close eye for 2-3 minutes. Vision may be blurred for
a short time.

POSITION PATIENT TO ADMINISTER EAR DROPS:

• Have patient lie on unaffected side or sit upright with head tilted to
unaffected side.
• Straighten the external ear canal
o Adults: pull up and back
o Children: pull down and back
• Instill prescribed number of drops. Avoid contamination dropper
• Instruct patient to remain in position for 2 to 5 minutes to prevent
med from leaking out of ear

RECONSTITUTION OF POWERED DRUGS:

Read label carefully. It will instruct you on how much liquid
to add for a certain amount of injectable.

PUNISHMENT FOR NARCOTIC ABUSE FOR HEALTHCARE

WORKER:
• Fines
• Imprisonment
• Loss of license

Z-TRAC INJECTION:
• Used to minimize local skin irritation by sealing meds in muscle
tissue.
• Select site and prepare with alcohol
• Pull overlying skin and subcutaneous muscle 1 to 1 ½ inches
laterally to side.
 • Hold skin taut with non dominant hand, inject med deep into
muscle
• Needle stays in for 10 seconds to allow meds to disperse
• Release skin after withdrawing needle

HEPARIN

NURSING IMPLICATIONS AND RESPONSIBILITIES FOR

ADMINISTERING DRUG:
 Assess for signs of bleeding and hemorrhage (gums, nosebleeds,
unusual bruising, black tarry stool, hematuria, decrease in
hematocrit and blood pressure, guaiac positive stools) notify
physician if these occur.
 Assess for additional or increased blood clots.
 Monitor for hypersensitivity reactions (chills, fever, and urticaria)
report to physician.
 Monitor PTT and hematocrit prior to and periodically throughout
therapy
 Monitor platelet count every 2-3 days
 Observe injection site for hematomas, ecchymosis, or
inflammation.

MORPHINE

USUAL DOSAGE: 4-10 mg every 3-4hours starting dose 50 years and older
MI 8-15 mg q3-4h, <50 years old .05-.2 mg/kg q3-4h
Neonates .05mg/kg q4-8 h

CLASSIFICATION: Therapeutic: opioid analgesics

Pharmacologic: opioid agonists

SIDE EFFECTS/ADVERSE REACTIONS:

 CNS: may cause confusion, sedation, dizziness, dysphoria, euphoria
floating feeling, hallucinations, headache, and unusual dreams.
ENT: blurred vision, diplopia, and miosis.
CV: hypotension, bradycardia,
GI: constipation, nausea, vomiting
GU: urinary retention
DERM: flushing, itching, sweating
MISC: physical dependence, psychological dependence, tolerance.

NITROGLYCERIN

ROUTE OF ADMINISTRATION:
 Sublingual
 Buccal
 By mouth
 IV
 Transdermal

SIDE EFFECTS/ADVERSE REACTIONS:

CNS: dizziness, headache, apprehension, restlessness, weakness
EENT: blurred vision
CV: hypotension, tachycardia, syncope
GI: abdominal pain, nausea, vomiting
DERM: contact dermatitis
MISC: alcohol intoxication from IV, cross tolerance, flushing tolerance

SPECIAL CONSIDERATIONS:

» Anemia, severe
» Cerebral hemorrhage or
» Head trauma, recent (nitrates may increase cerebrospinal fluid pressure)
» Glaucoma (nitrates may increase intraocular pressure)
Hepatic function impairment, severe (increased risk of methemoglobinemia)
» Hyperthyroidism
Hypertrophic cardiomyopathy (angina may be aggravated)
Hypotension, with low systolic pressure (may be aggravated, accompanied
by paradoxical bradycardia and increased angina pectoris)
» Myocardial infarction, recent (risk of hypotension and tachycardia, which
may aggravate ischemia)

SITES FOR GIVING INJECTIONS:

• SUBCUTANEOUS INJECTIONS:
o Outer posterior aspect of the arm
o Abdomen below the costal margins to the iliac crest
o Anterior aspect of the thighs

• INTRAMUSCULAR INJECTIONS:
o Vastus Lateralis: anteral lateral aspect of the thigh
o Ventrogluteal: locate by placing heel of hand over greater
trochanter of hip using index finger and thumb to create triangle.
o Deltoid

• ANATOMICAL LANDMARKS: Select site for injections.

• SERUM HALF-LIFE: the time it takes for excretion process to lower

the serum/medication concentration by half.