NURSE-3101 Lecture Notes - Lecture 4: Nph Insulin, Regular Insulin, Diluent

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9 Sep 2016
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Chapter 28 Medications
Drug Names
Chemical Name
oPrecise description of the drug’s chemical composition.
N-acetyl-para-aminophenol
Generic Name
oIdentifies the drug’s active ingredient; assigned by the manufacturer that first
develops the drug.
acetaminophen
Trade Name (brand name; proprietary name)
oSelected by the pharmaceutical company that sells the drug; protected by
trademark.
Tylenol
oA common mild analgesic is acetaminophen (Tylenol).
oHospital medication administration records commonly list drugs by generic name.
Drug Preparations
Pill
oMixture of powdered drug with cohesive material; round or oval.
Tablet
oSmall, solid dose of medication; compressed or molded.
Capsule
oPowder/gel form of active drug enclosed in gelatinous container.
Enteric Coated
oPill/tablet coated to prevent stomach irritation.
Don’t crush!
Extended Release
oAllows for slow, continuous release over predetermined period.
oOther names: CR (controlled release); SR (sustained release); LA (long-acting).
Don’t crush!
Same drug may be available in different form; get order for most appropriate form.
oPatient can’t swallow pill; get liquid form if available
Medication Orders
No medication may be given to a patient without a medication order from a licensed
practitioner.
Follow only written orders or orders entered in computer system.
Verbal orders
oFrom physician to nurse given only in emergency situations.
oUpon admission, physician must write orders for all medications to be given.
Medication reconciliation
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oWhat patient took at home vs. new orders vs. orders after surgery vs. orders in
critical care area vs. transfer orders vs. discharge orders. Process of specifying
medications and maintaining current, accurate list of medications patient is
receiving.
Types of Medication Orders
Routine
oCarried out as specified until canceled by another order.
oCan also write routine orders for specified time period.
Example: prednisone 60 mg p.o. once daily for 3 days.
Standing
oSpecified set of orders for particular situation.
Example: orthopedic surgeon has standing orders for all total hip
replacement patients.
PRN (as needed)
oPatient receives med when requested/required. Orders for pain medications or
nausea relief written this way. Follow time limits
Example: morphine 2 mg IV q 2 hours p.r.n. severe pain; give only if 2
hours after last dose
One-Time Order
oDrug given only once.
Stat Order
oOne-time order but given immediately.
Parts of a Medication Order
Name
oPatient name.
oAll order sheets labeled; careful if patient with same name on division.
Date/Time
oDate and time order written.
oBe clear as to start/stop time; e.g., narcotic orders expire in 3 days.
Drug Name
oName of drug to be administered.
oGeneric name most common.
Dosage
oDosage of drug.
oMetric system; should be specific. (furosemide 40 mg, not furosemide 20 mg 2
tablets).
Route
oRoute by which drug to be administered.
oMust be clearly stated; some drugs can be given in more than one way; others
may be used safely through only one route.
Frequency
oFrequency of administration.
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oStandardized times; military time; administer within 30 minutes before or after
ordered time; pre-operative meds must be given on time.
Signature of health care provider writing order.
Legal Issues Arising from Drug Administration
Is the correct preparation, dose, and route ordered?
Do the patient’s condition, symptoms, and health status warrant receiving this
medication?
Does it make sense for the patient to have this medication?
NURSES ARE LEGALLY RESPONSIBLE FOR THE DRUGS THEY
ADMINISTER.
YOU ARE THE LAST SAFEGUARD PROTECTING THE PATIENT FROM HARM.
Firmly and with respect, question orders you are unsure of.
o“I am concerned about this order because. . .”
6 Rights of Drug Administration
Right MEDICATION
oCompare drug label with medication administration record 3 times.
When removing drug from drawer. Read the label!
When placing drug next medication administration record (MAR). Read
the label!
When placing drug in medicine cup. Read the label!
Right DOSE
oIs amount you are about to give correct?
oIf you’re not sure about a drug calculation, have someone double-check it for you.
oMust double-check heparin and insulin with another RN.
Right PATIENT
oIdentify using 2 patient identifiers.
Most common is name and birth date.
Never use room number or physical complaint.
Check MAR against ID bracelet. Ask patient to state full name and birth
date.
Bar code system requires sign-in to computer, scan patient ID, and scan
drug package.
Right ROUTE
oOrder must designate route of administration.
Call prescriber if route missing or inappropriate.
Right TIME
oRoutinely scheduled: t.i.d. (0900, 1300, 1800).
oAt intervals: q. 8 hrs.
oAs needed (p.r.n.): q. 4 hrs. p.r.n. pain.
oMust check to see if time to give drug again.
All routinely ordered meds to be given within 30 minutes before or
after scheduled time.
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