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PHARM - EXAM 1
6 Rights of Medication Administration
Right Patient
Right Medication
Right Dose
Right Time
Right Route
Right Documentation
Nursing Considerations
Three Checks
Check for Allergies
Assess the Patient
Education
2 mins
Needle Sizes and Uses
Adjust Size Based on Height/Weight
Subcutaneous Injections
3/8 or 5/8 inch
Intramuscular (IM)
1-1.5 inches
1 min
Peak and Trough
Peak
Highest Concentration
Trough
Lowest Level of Therapeutic Range
Obtain Before Next Dose
Half-Life
2 mins
Conversions: Pounds and Kilograms
2.2 lb (pounds)
1 kg (kilogram)
Know Your Own Weight
37 secs
Routes of Administration Part One
Enteral Administration
Oral
Sublingual
Buccal
Rectal
Tubes
Topical or Mucous Membrane Administration
Transdermal
Drops/Spray
Vaginal
Inhalation Administration
Inhalation
2 mins
Routes of Administration Part Two (Parenteral)
Parenteral Administration
Intradermal
Subcutaneous
Intramuscular (IM)
Intravenous
Epidural
Intrathecal
Intraosseous
Intraperitoneal
2 mins
Eye Medication Administration
Procedure
Supine with Neck Hyperextended
Wash Away Crusts
Cotton Ball on Cheekbone
For Ophthalmic Drops
Instill Drops into Conjunctival Sac
Repeat if Missed or Patient Blinks
5 Minutes Before 2nd Medication
For Ophthalmic Ointment
Thin Stream Along Inner Edge
Inner Canthus to Outer Canthus
2 mins
Ear Drops Medication Administration
Indications
Earwax Buildup
Ear Infections
Pulling The Pinna
Child - Back and Downward
Adult - Back and Upward
Procedure
Side-Lying with Ear Up
Instill Medication
Stay for 2-3 Minutes
Nursing Considerations
Room Temperature
May Massage Tragus
Perforated Eardrum
2 mins
Parenteral Medications
Intravenous (IV)
Fast-Acting
Greatest Risk
Intramuscular (IM)
Common Injections Sites: Deltoid, Vastus Lateralis, Ventrogluteal, and Dorsogluteal Muscles
Absorbed Fast
Vaccines and Epinephrine
3 mL Limit
Subcutaneous (SC)
Common Injections Sites: Abdomen, Arm, and Thigh
Absorbed Slower
Insulin and Hormones
Small Volumes
Intradermal (ID)
Common Injection Sites: Back of Forearm and Upper Back
Longest to Absorb
Tuberculosis and Allergy Testing
Under 0.5 mL
5 mins
Intramuscular Medication (IM) Administration
Risks
Injury to Nerves, Bone, and Blood Vessels
Sites
Deltoid
Vastus Lateralis
Ventrogluteal
Nursing Considerations
Selection of Needle Length
Aseptic Technique for Drawing Up
Z-Track
90 Degree Angle
Max Amount (2-5 mL Adult, 1 mL Child)
Techniques to Reduce Pain
2 mins
Intradermal Medication Administration
SKIN TESTING
Tuberculin Screening
Allergy Testing
INTRADERMAL SITES
Dermis
Inner Forearm or Upper Back
INTRADERMAL Injection
1mL Syringe (26 or 27 Gauge Needle)
5 to 15 Degrees
Small Bleb
2 mins
Transdermal Medication Administration
Application
Patch or Disc
Directly on Skin of Arms, Chest, Upper Back
Benefits
Avoids First Pass Metabolism
Sustained Administration of Medication
Nursing Considerations
Clean Skin After Removal
Rotate Sites of Patches
Apply to Dry Skin
Avoid Shaved Skin
Avoid Heat
Nitro Effects Lost After 24 Hours
2 mins
Morphine
Mechanism
Opioid Receptor Agonist
Indications
Pain
Myocardial Infarction
Side Effects
Nausea and Vomiting
CNS Depression
Biliary Colic
Constipation
Increased Intracranial Pressure (ICP)
Pupillary Constriction
Hypotension
2 mins
Codeine
Mechanism
Opioid Receptor Agonist
Indications
Mild to Moderate Pain
Cough Suppressant
Side Effects
Sedation
Constipation
Miosis
Considerations
Close Monitoring When Breast Feeding
Often Combined with Non-Opioids
2 mins
Metric System
Weight
Kilogram (kg)
Gram (g/gm)
Milligram (mg)
Microgram (mcg)
Volume
Liter (L)
Milliliter (mL)
Length
Meter (m)
Converting
Larger to Smaller: Multiply
Smaller to Larger: Divide
3 mins
Documentation Guidelines
Factual
Objective Information
Subjective Information from Patient
Objective Supports Subjective
Accurate
Avoid Unnecessary Words and Details
Exact Measurements
Current
Assessments
Document ASAP
Treatment and Response
Change in Status
Admission, Transfer, Discharge or Death
Organized
Document in a Logical Order
Ensure Information Recorded is Complete
4 mins
NSAIDs
Indications
Anti-inflammatory
Analgesic
Fever
Closure of Patent Ductus Arteriosus
Mechanism of Action
Reversible Inhibition of COX-1 and COX-2
Block Prostaglandin Synthesis
Side Effects
Interstitial Nephritis
Gastric Ulcer
Renal Ischemia
1 min
Naloxone (Narcan)
Mechanism
Competitive Opioid Receptor Antagonist
Indications
Opioid Induced CNS Depression
Side Effects
Severe Nausea and Vomiting
Excitable State
Opioid Withdrawal Symptoms
Considerations
Repeated Dosing Often Required
1 min
Opioid Use Disorder and Withdrawal Assessment (Formerly Opioid Abuse and Withdrawal Assessment)
Abuse Assessment
Euphoria
Miosis
CNS Depression
Abuse Withdrawal
Yawning
Gooseflesh
Sweating
Rhinorrhea
Kicking Movements
Consideration
Naloxone
1 min
Acetaminophen
Indications
Fever
Pain
Mechanism of Action
Reversibly Inhibits COX
Acts Primarily in CNS
Side Effect
Hepatic Necrosis
N-acetylcysteine Antidote
51 secs
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