Fundamental Nursing Skills and Concepts

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Fundamental Nursing Skills and Concepts

• ORAL MEDICATIONS
• Chapter 32

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CHAPTER 32

• MEDICATIONS
• One of the most important responsibilities of a
  nurse
• Chemical substance
• Medications and Drugs used interchangeably
• Information found in pharmacology texts or drug
  reference manuals
• Medication order
• Physicians, dentists write orders and nurse
  practitioners and advanced practice nurses can if
  state laws allow

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CHAPTER 32

• MEDICATION ORDERS
• Components of order
• Pt.s name
• Date and time
• Drug name
• Dose
• Route
• Frequency
• Signature of physician

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CHAPTER 32

• MEDICATION ORDERS
• Drug Name
• Trade name
• Generic name
• Drug Dose
• Amount to be administered
• Metric
• Apothecary
• Household
• Route of Administration
• The way the medication will be given
• Oral, topical, inhalant, parenteral
• Frequency of Administration

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CHAPTER 32

• MEDICATION ORDERS
• Route of Administration
• The way the medication will be given
• Oral
• Swallow or Enteral Tube
• Most common route
• Solid
• Scored
• Enteric coated
• Sustained Release
• Liquid forms
• Syrups
• Elixirs
• Suspensions
• Topical
• Inhalant
• Parenteral

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CHAPTER 32

• MEDICATION ORDERS
• Frequency of Administration
• How often and/or how regular administered
• Stat
• q.d.
• q.o.d
• b.i.d.
• t.i.d.
• q.i.d.
• q.h.
• q4h or q6h or q8h or q24h
• Scheduled according to predetermined schedule of
  the health agency

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CHAPTER 32

• MEDICATION ORDERS
• Verbal orders
• Face to face
• Telephone orders
• If not physically present
• Nursing guidelines for telephone orders
• THESE ORDERS ARE MORE LIKELY TO BE MISINTERPRETED
  THAN ANY OTHERS WHEN POSSIBLE ASK TACTFULLY IF
  THE ORDER CAN BE WRITTEN.

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CHAPTER 32

• DOCUMENTATION IN THE MEDICATION ADMINISTRATION
  RECORD (MAR)
• Ensures timely and safe administration
• Signature, Title (credentials), and Initials
• Sometimes kept separate eventually becomes part
  of the record
• Always in black ink

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CHAPTER 32

• METHODS OF SUPPLYING MEDICATIONS
• Individual supply
• Unit dose supply
• Stock supply
• Automated medication dispensing machines

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CHAPTER 32
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CHAPTER 32

• STORING MEDICATIONS
• Med carts
• Separate room
• Regardless of location kept under lock and key
• ACCOUNTING FOR NARCOTICS
• Controlled substances
• Kept under double lock and key
• Federal laws regulating possession and
  administration
• Nurse responsible for accurate count
• Counted at each change of shift
• One counts the medication the other checks the
  count on the record, both must match.
  Inconsistencies are taken care of immediately.

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CHAPTER 32

• Medication Administration
• Applying the five rights
• RIGHT DRUG
• RIGHT DOSE
• RIGHT ROUTE
• RIGHT TIME
• RIGHT PATIENT
• Calculating dosages
• Prepare accurately
• Sometimes having to do conversion

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CHAPTER 32

• Guidelines for preparing medications safely
• 1. Under well lighted area
• 2. Work without interruptions/distractions
• 3. Check label THREE TIMES
• a. When reaching for the medication
• b. Just before placing medication in cups
• c. When returning the medication to the
  place of keeping (med drawer, shelf, etc.)000
• 4. Avoid unlabeled containers
• 5. Return containers without clear labels to
  pharmacy
• 6. Never transfer medications from one
  container to another
• 7. Check expiration dates
• 8. Inspect medication return if appears as if
  decomposed.

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CHAPTER 32

• Administering Oral Medications by Enteral Tube

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CHAPTER 32

• Administering Oral Medications by Enteral Tube
• Smaller than esophagus special techniques
  required to avoid obstruction
• Need to make sure that you check for placement
  when giving medications
• Gastric tubes used for decompression
• Make sure to clamp the tube for 30 minutes after
  medications given
• Instill medications separate from feeding
• First medications may react with feeding
• Feeding may be infusing to slow alters dose and
  absorption

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CHAPTER 32

• Nursing Guidelines for Preparing Medications for
  Enteral Administration
• Use liquid if available
• Add 15 to 60 ml to thick liquids
• Crush tablets if not enteric coated
• Open capsules
• Do not crush sustained released capsules
• Mix each drug separately with 15-30 ml of water
• Use warm water (never ice water)
• Pierce gelatin capsules squeeze liquid out
• May soak gelatin tablets in warm water
• Avoid bulk forming laxatives
• Stop feeding 15 to 30 minutes before and after
  giving meds with meds to be given on empty stomach

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CHAPTER 32

• DOCUMENTATION
• Document on MAR if scheduled drug
• Document on MAR and in chart if a prn medication
  is given
• Document in timely manner
• If medication withheld need to document on MAR
  and maybe on chart as to why
• When medication is not given that is scheduled
  need to CIRCLE THE TIME and initial it
• When documenting med was given may need to draw a
  line through it (example hospital MAR) or just
  initial it was given (example Long Term Care
  facility)

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CHAPTER 32

• MEDICATION ERRORS
• Nurse has a responsibility to report as soon as
  discovered
• Assess the patient and condition
• Fill out form if agency policy states to do so
  called incident report or accident report (do not
  make reference to report in charting in the
  chart, it is not part of medical chart)

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CHAPTER 32

• Nursing Implications
• NANDA Nursing diagnosis
• Deficient Knowledge
• Risk for Aspiration
• Ineffective Therapeutic Regimen Management
• Ineffective Health Maintenance
• Noncompliance

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CHAPTER 32

• Gerontologic Considerations
• Age related changes influence how geriatric
  patient may react to meds
• Polypharmacy increases risk of drug interactions
  and adverse reactions
• Possible impaired ability to swallow
• Mixing medications with small amount of soft
  foods might help
• Include a second person if patient has problems
  understanding medication regimen upon discharge
• Make sure person is using assistive devices such
  as glasses or hearing aid to understand
  instructions
• Evaluate understanding of medication regimen
• Check about ability to pay possibly 3 month
  supply better
• Generic forms to help with cost
• May need childproof caps
• Use ways to help person identify containers of
  medications

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REVIEW

• TABLETS THAT ARE ABLE TO BE BROKEN IN HALF ARE
  CALLED?

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REVIEW

• WHAT ARE THE THREE TIMES THAT YOU CHECK
  MEDICATIONS?

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REVIEW

• WHEN MANY MEDICATIONS ARE GIVEN AT ONE TIME TO A
  PATIENT THIS IS CALLED?

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REVIEW

• WHY DO YOU NOT CRUSH A SUSTAINED RELEASE
  MEDICATION?

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REVIEW

• HOW DOES THE WAY THAT YOU STORE NARCOTICS DIFFER
  FROM OTHER MEDICATIONS?

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REVIEW

• HOW DO YOU SIGNIFY THAT A MEDICAITON WAS NOT
  GIVEN?

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REVIEW

• NAME THE FIVE RIGHTS
• __________________
• __________________
• __________________
• __________________
• __________________

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REVIEW

• WHAT IS THE REPORT CALLED THAT A NURSE FILLS WHEN
  A MEDICATION ERROR HAS OCCURRED? IS IT PART OF
  THE CHART?

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REVIEW

• HOW MANY mls OF WATER DO YOU USE TO MIX CRUSHED
  MEDICATIONS?

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REVIEW

• BEFORE GIVING ENTERAL MEDICATIONS YOU SHOULD DO
  WHAT?