day 2 medication aide
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Medication Aide Chapters 6-9
Generic
Universal name based on chemical ingredients Name starts with a small letter-is longer in
length & is more difficult to pronounce Trade Name
Name is given by Co. that develops it Name starts with a capitol letter-is shorter in
length & is easier to pronounce
Drug Names
Body system Therapeutic use or clinical indication Physiological or chemical action Prescription or non-prescription Illegal drugs
Drug Classification
Drugs act in the human body in the following ways:
Change physiological activity within the body Drugs form a chemical bond within specific sites Drugs that interact with a receptor to cause a response
are agonists Drugs that attach to a receptor but do not cause a
response are antagonists Drugs that interact with a receptor to cause a response
but prevent other responses are partial agonists Once given, all drugs go through stages
Absorption, distribution, metabolism, and excretion
Basic Principles
Factors that affect drug absorption
Absorption Age and weight of consumer Dry or wrinkled skin Decreased number of hair follicles Condition of consumer i.e. decreased cardiac
output, pain, fever Inability to chew tablets for chewable drugs Less saliva production GI absorption affected by disease processes,
presence of other drugs
Cont….
Distribution Amount of body water Decreased levels of plasma proteins
Metabolism Decreased liver function Genetics, smoking, diet, gender, liver disease,
other drugs Excretion
Decreased kidney function
Is the process by which a drug is transferred
from its site of body entry to circulating body fluids for distribution. The rate depends on: The route Blood flow through the tissue where the drugs
was given How well the drug can dissolve
Absorption
Give oral drugs with enough fluid Reconstitute and dilute drugs as
recommended by the manufacturer Give drugs into the correct tissue
To promote absorption
Enteral (oral, rectal, or naso-gastric) Parenteral (bypass GI tract)
Subcutaneous Intramuscular Intravenous percutaneous
Drugs are given
Refers to the ways drugs are transported by
circulating body fluids to the sites of action. Once absorbed into the blood, a drug’s
distribution is determined by: Chemical properties How it is affected by the blood and tissues it
contacts
Distribution
Is the process by which the body in-activates
drugs. The liver is the primary site for drug
metabolism.
Metabolism
Is the elimination of a drug from the body. Urine and feces are the primary routes of
excretion.
Excretion
No drug has a single action. When a drug is absorbed and distributed, the
desired action (expected response) usually occurs.
All drugs can affect more than one body system, therefore side effects and adverse drug reactions can occur.
Drug Action
An unintended reaction to a drug given in a
normal dosage. Nausea Dry mouth Dizziness Blurred vision Ringing in ears
Side effects
Unintended effect on the body from using a
legal drug, illegal drug, or two or more drugs. Rash, itching, high blood sugar
(hyperglycemia) and a reduced number of platelets (thrombocytopenia) are common ADRs.
Drug reactions/adverse
drug reaction
Is an unfavorable response to a substance that
causes a hyper-sensitivity reaction. Most common reaction is
Uticaria (hives) Most severe reaction is
Anaphylaxis Severe, life threatening. Sweating, SOB, hypotension, irregular pulse,
respiratory distress, and swelling of larynx First exposure- mild reaction Second exposure- severe reaction
Allergic reaction
Is something unusual or abnormal that
happens when a drug is first given. Can be considered an over –reaction to a drug Related to the body’s inability to metabolize the
drug
Idiosyncratic Reaction
Age Body weight Metabolic rate Illness Willingness to take drugs Placebo effect Tolerance Dependence Cumulative effect
Factors Influencing Drug Action
Occurs when the action of one drug is altered
by the action of another drug Increase the action of the other (potentiation) Decrease the action of the other (antagonist)
Drug Interactions
American Hospital Formulary Service Drug
Information Drug Interaction Facts Drug Facts and Comparison Handbook of Nonprescription Drugs Natural Medicines Comprehensive Database Physician’s Desk Reference Package Inserts Drugs.com
Drug Information
Classification Brand Name Generic Name Therapeutic Use Dose Side Effects Anything unusual Any Nsg. Precautions
Drug Activity
Physician Physician’s assistant/ nurse practitioner Pharmacist Director of nurses Supervisory nurse Medication aide
Health Professionals
Person’s full name Date Drug name Route of administration Dose Frequency of use Duration of order Doctor’s (prescriber’s) signature
Drug order
STAT order Single order Standing order PRN order Ordering methods
Written order Verbal order Telephone order Faxed order Electronic order
Drug orders
All have to be approved by
Joint Commission Institute for safe Medication Practice Facility
Commonly used Abbreviations
Weights
Metric system (microgram, milligram, centigram, gram, kilogram)
Apothecary system (grain, seldom used) Household system (pound)
Volume Metric (milliliter, centiliter, deciliter, liter) Apothecary (minim) Household system (tablespoon, teaspoon, cup,
ounce)
Measurements in drug orders
Addiction Adverse reaction Allergic reaction Anaphylactic shock Antagonist Contraindication Cumulative effect Drug abuse Habituation Idiosyncrasy Initial dose Maintenance dose Nursing precautions, interventions
Terms for describing drug interactions
Placebo Potentiate Side effect Therapeutic effect, desired effect Tolerance Toxic effect
Cont…
Person’s name, address, phone number Pharmacy’s name, address, phone number Prescription number Date prescription filled Original date of prescription Doctor’s name Brand name of drug Generic name of drug Manufacture’s name Drug dosage Amount in container How often to take Warnings Number of refills allowed Expiration date or when to discard
Information on the label
Person’s name, room number, identifying information Admission form Health history Physical examination results Doctor’s order form Doctor’s progress notes Nursing team progress notes (describes care given,
person’s response & progress) Graphic sheet (records, measurements/observations
made daily, every shift, or 3 or 4 times a day Flow sheet Laboratory & x-ray reports IV therapy record
Medical record
Respiratory therapy record Consultation reports Surgery & anesthesia reports Assessments/reports from social services,
dietary service, and physical, occupational, speech and recreational therapy
Consent forms PRN/unscheduled medication record
Continue
Medication administration record (MAR)
Scheduled medications Parental medications STAT medications Pre-operative medications PRN medications (date, time, drug given, dose
given, route, reason for giving, person’s response)
Time drug given and by whom
Cont….
Summarizes information in medical record Quick, easy source of information Updated regularly (usually in pencil) Not formal, legal part of medical record Destroyed when person leaves facility
Purpose of a Kardex
Nurse verifies and transcribes order Nurse decides is drug safe to give Nurse contacts physician if order deemed unsafe, physician may
cancel or rewrite order Transcribe (copied)
Copied to Kardex and MAR (secretary may copy) Nurse signs, dates, times transcription on original order Nurse sends order to pharmacy to fill
Order may New drug Discontinued drug Change an order STAT or one-time-only order
Transcribing drugs orders
Report
Person’s name, room number Time of observation Only what observed or did Changes from normal
Record What observed What you did Person’s response Record administration of medication as soon as given Sign per facility policy, date & time medication given Report medications refused, not given; not of medication record; discard
drug Record PRN medication immediately with reason given and results Report unusual reaction
How to accurately report and record
Four drug distribution systems
Floor or ward stock system Frequently used Avoids waiting or lag time Pros and cons
Individual prescription order system 3-5 day ordered drug Stored in patient bin Safe system Pharmacist/nurse review order before drug given Pharmacy monitors drug expiration date Fewer drugs for drug diversion (taking person’s drug for your
own use) STAT, PRN drugs available
Cont…
Computer-controlled dispensing system Pharmacy stocks drug cart for patients/residents on unit Accessed by security code/password Drug bar coded, patient ID bracelet also bar coded Patient’s ID scanned and drug scanned (provides check of
correct drug and automatically documents drug administration)
Unit dose system Single-unit dose package dispensed for each dose ordered 24 hour supply (refilled every day) in nursing centers may be
for week or month at a time Safe, cost, and time efficient Reduces risk of drug diversion May be color coded for different times of day
Cont…
Computer-controlled dispensing system Pharmacy stocks drug cart for patients/residents on unit Accessed by security code/password Drug bar coded, patient ID bracelet also coded Patient’s ID scanned and drug scanned (provides check of
correct drug and automatically documents drug administration)
Narcotic control systems Regulation of controlled substances Single-unit packages kept in locked cabinet in medication
room; or in a special container in the med cart- charge nurse has the key which cannot be given to anyone except the person giving the narcotic
Inventoried at the end of each shift Must be counted by 2 qualified individuals If the count is not correct- MUST investigate Each narcotic has its own inventory sheet
which must match the count of that narcotic
Narcotic count
Drug storage
Drug cart (locked) as is the room that they’re stored in Drugs stored in original container or unit dose package in
person’s individual bin Some drugs may need to be stored in refrigerator; tight
containers- moisture & heat can destroy drug Assisted living residents may store own drugs if able to self
medicate-otherwise are stored in a locked room Controlled substances (narcotics) double locked –may be on
drug cart or separate cabinet Emergency medications may be stored in floor or stock system Medications for external use stored separate from those for
internal use
Disposal of drugs
Disposed of because Person refuses to take drug Drug dropped on the floor or bed You are to give only part of drug dispensed Drug becomes contaminated Person discharged Person died Doctor discontinued drug
Follow facility disposal policy Do not return to stock supply Document according to facility policy
Six rights
Right drug Read the label before removing from unit dose cart or shelf Read label before preparing or measuring prescribed dose Read label before returning drug to shelf or opening unit
dose packet Right time
By drug order Standard administration times Blood level Best drug absorption time Diagnostic tests One-time-only, PRN, STAT
Six rights cont…
Right dose Compare dose on label to MAR Use appropriate measuring devise Report nausea & vomiting Correct drug calculation (may need to be nurse)
Right person Compare person’s ID to MAR Two identifiers
Name Birthdate ID number
Check for allergies
Six rights cont…
Right route Drug order gives route Never change route Only give as allowed to give by prescribed route Routes
IV (most rapid onset action) IM (next fastest onset action) Sub-Q (probably next fastest) Intradermal (absorption slow)
What you can give Inhalation(fastest) Sublingual(next fastest) Suppository(next) Oral (slowest onset)
Right documentation Record as quickly as possible Follow documentation standards Right documentation
Drug errors
Prescribing errors Wrong drug for person’s diagnosis Drug person allergic to Wrong dose for person’s diagnosis
Transcription errors Misinterpreting/misunderstanding drug ordered or directions Interpreting hand-writing, not legible Using unapproved abbreviations Omitting a drug order Using wrong spelling Writing wrong dates or times
Drug errors cont….
Dispensing Sending wrong drug or dose to facility Using wrong formulation Using wrong dosage form
Giving drugs Giving wrong drug Giving wrong dose Giving an extra dose Giving drug not ordered for person Missing or skipping a dose Giving a drug at wrong time Giving drug in wrong way
Safety rules for drug
administration Follow the six rights of drug administration Store drugs properly Have good lighting to read Kardex, MAR Stay focused, don’t get distracted Keep working area clean, neat, orderly Check container label for drug name, dose, route Check person’s chart, Kardex, MAR, ID for allergies Check person’s chart, Kardex, MAR for rotation schedules for drugs applied
to skin Know why drug ordered, side effects, adverse reactions Calculate drug dosages accurately Identify person before giving drug Position person for route of administration Have correct fluids ready for person to swallow oral drugs Stay with person to make sure drugs have been swallowed Follow facility policy for self-administered drugs
Cont…
Never leave a drug in person’s room to take later Never leave a drug unattended Refer questions about person’s drug or treatment plan to nurse Do not prepare or give drug if container not properly labeled or unreadable Give only drugs you are allowed to administer Give drugs only prepared by pharmacist Check drug name, dose, frequency, route, against order Do not return unused drug to stock supply Do not mix liquid drug with water or other fluid unless directed to Ask nurse if you have any questions, concerns Practice good hand hygiene Never touch actual drug Check drug carefully (may look alike) Listen to patient – knows drugs best Observe for side effects Make sure drug cabinet/cart is locked
Infection is a disease state resulting from the
invasion and growth of microbes (pathogens)
Bacteria & viruses Medical asepsis (clean technique)
Hand washing!
Preventing Infection
Guidelines set by the CDC Prevent the transmission of infectious agents Blood borne Pathogen Standard
Isolation Precautions
Hand hygiene Gloves Gowns Masks
Standard Precautions
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