MODULE 12: RLE

Nurse Practice Acts: define the scope of nurse’s professional

functions and responsibilities
• The primary intent of NPAs is to protect the public from
undereducated personnel
• Violations of the Controlled Substances Act are punishable by loss
of nurse license
GUIDELINES FOR SAFE NARCOTIC ADMINISTRATION AND CONTROL
• Store all narcotics in a locked container
• Maintain a running count of narcotics by counting them
• Use inventory record each time a narcotic is dispensed
• Use the record to document the patient’s name
• A second nurse witnesses disposal of the unused part
FORMS OF MEDICATION
• ORAL
1. Solid
° Caplet: solid dosage for oral use
° Capsule: encased in gelatin shell
° Tablet: powdered medication compressed into cylinder
° Enteric-coated tablet: tablet that does not dissolve in stomach
2. Liquid
° Elixir: contain water or alcohol
° Extract: medication made by removing the active part of
medication
° Aqueous solution: dissolved in water and syrups
° Aqueous suspension: dissolved drug particles diapered in liquid
medium
° Syrup: dissolved in a concentrated sugar solution
2. Other forms
° Troche: dissolve in mouth to release medication
° Aerosol: sprayed and absorbed in mouth
° Sustained release: contains small particles of medication which
requires a time to dissolve
• TOPICAL
° Ointment: externally applied preparation
° Liniment: soapy emollient applied to skin
° Lotion: protects, cools, or cleans the skin
° Paste: thick ointment
° Transdermal disk: medicated disk absorbed through skin
• PARENTERAL
° Solution: sterile preparation that contains one or more dissolved
compounds
° Powder: medication that are dissolved in a sterile liquid
• BODY ACTIVITIES
° Intraocular outer layer containing medication
° Suppository: dosage mixed with gelatin
Anaphylactic reactions: constriction of bronchiolar muscles
MILD ALLERGIC REACTIONS
• Urticaria: irregularly shaped skin eruptions
• Rash: raised vesicles that are usually red
• Pruritus: itching of skin
• Rhinitis: inflammation of mucous membrane lining nose
Minimum Effective Concentration: plasma level of a medication
below
Toxic concentration: level at which the toxic effects occur
Peak concentration: highest level
Trough concentration: lowest level
Biological half-life: time it takes for excretion processes to lower the
amount of unchanged medication
Time-critical medication: result in harm responses in patient
Non-time-critical medications: not affect the desired effect of the
medication
COMMON DOSAGE SCHEDULE
• Before meals
• As desired
• Twice each day
• After meals
• Whenever there is a need
• Every morning
• Every hour
• Every day
• Every 4 hours
• 4 times per day
• Give immediately
• 3 times per day
• TERMS ASSOCIATED WITH MEDICATION ACTIONS
• Onset: time it takes after a medication is administered for it to
produce a response
• Peak: time it takes for a medication to reached highest effective
concentration
• Trough: medication reached just before the next schedule dose
• Duration: medication is present in concentration that is great
enough to produce a response
• Plateau: medication reached and maintained after repeated fixed
doses
 MOD 13

Oral administration: commonly used route of medication

administration
Sublingual administration: instruct patients not to swallow
medication given by sublingual route
Buccal administration: involves placing the solid medication in the
mouth
Parenteral administration: injecting medication into body tissues
FOUR MAJOR SITES OF INJECTION
1. Intradermal: injection into the dermis
2. Subcutaneous: injection into tissues
4. Intramuscular: injection into muscle
5. Intravenous: injection into vein
OTHER ROUTES
• Epidural: administered in the epidural space
• Intrathecal: administer directly into the subarachnoid space
• Intraosseous: administer directly into the bone marrow
• Intraperitoneal: absorbed into the circulation
• Intrapleural: administer directly into the pleural space
• Intraarterial: administered directly into the arteries
° Intracardiac: medication administration that are limited to
physician
° Intraarticular: injection of medication into joint
Topical Administration: painting or spreading the medication over
an area
Transdermal disk: patch that has systemic effects
WAYS TO APPLY TOPICAL MEDICATION
1. Direct application of liquid
2. Insertion of medication into body activity
3. Instillation of fluid into body cavity
4. Irrigation of body cavity
5. Spraying medication into body activity
Inhalation route: administer through nasal and oral passage
Intraocular route: administer through inserting medication similar
to contact lens into a patient’s eye
Apothecary system: used infrequently today
Metric system: most logically organized
BASIC UNITS OF MEASUREMENT IN METRIC SYSTEM
• Length, volume, and weight
Solution: given mass of solid substance
Note: To convert milligrams to grams and liters to milliliters, just
divide the given to 1,000
 MODULE 14: RLE

Standing or Routine Order: carried out until the health care

provider cancel it

Rx: means take thou

Inscription: contains the drug name, strength, and dose
Signature: directions to the patient
Superscription: patient’s name, address, age and date
DEA: practitioner who wish to prescribe controlled substances
Unit-dose System: storage system that varies by health care agency
Automated Medication Dispensing System: control the dispensing
of all medication
Bar-Code Medication Administration: requires the nurse to scan bar
code to identify the patient
Medication error: can cause inappropriate medication
COMPONENTS OF INCIDENT REPORT
• Patient’s information
• Location and time of the incident
• Factual description of what occurred
• Signature
Report all medication errors that reach the patient, including those
that do not cause harm
COMPONENTS OF MEDICATION ORDER
• Patient’s full name: distinguishes the patient from other people
with the same last name
• Date and time that the order: the day, month, year, and time
• Medication name: a health care provider order a medication by its
generic name
• Dosage: amount of the medication
• Route of administration: health care provider only uses accepted
abbreviations for medication routes
• Time and frequency of administration: nurse needs to know what
time and how frequently to administer medications
• Signature of health care provider: the signature makes an order a
legal request
Standards: actions that ensure safe nursing practice
Medication order: required for every medication that you
administer to a patient
CPOE: allows a health care provider to order medications
electronically
COMPARE MEDICATION LABEL WITH MAR 3 TIMES
1. Before removing the container from the drawer
2. As the amount of medication ordered is removed from the
container
3. At the patient’s bedside before administering the medication
Right dose: the unit-dose system is designed to minimize errors
Right patient : medication errors occur because a patient gets a
drug intended for another patient
Right route: always consult the health care provider if an order does
not include a route of administration
Right time: you need to know why a medication is ordered for
certain times of the day
Right documentation: nurses use accurate documentation to
communicate with one another
 MOD 15

° Important precaution when administering oral medication is

protect the patient from aspiration
° Aspiration occurs when medication, food or fluid intended for GI
administration enters the respiratory tract
° Position the patient in 90° angle when administering oral
medication
° Slightly flex the patient’s head in a chin-down position
TECHNIQUES THAT PROTECT THE PATIENT FROM ASPIRATION
(KAPAPACOHATAI)
• Know the signs of dysphagia, regurgitation, incomplete oral
clearance, cough, change in voice, and delayed swallowing
• Assess the patient’s ability to swallow and cough
• Prepare the medication in the form that it easiest to swallow
• Allow patients to self-administer medications if possible
• Position the patient in an upright, seated position
• Administer pills one at a time
• Crushed medications and mixed with pureed foods if necessary
• Offer fruit nectars if the patient cannot tolerate thin liquids
• Have the patient drink from a cup if possible
• Avoid straws
• Time medications to coincide with mealtimes
• Administer medications using another route if risk is severe
• If the patient has unilateral weakness, place the medication in the
stronger side of mouth
Tubing connector standards: the enteral connector will no longer be
leur compatible
 MOD 16

Transdermal patch: patch that remains in place for an extended

amount of time
GUIDELINES THAT ENSURE SAFE ADMINISTRATION OF
TRANSDERMAL MEDICATION (DADAWA)
• Document the location on the patient’s body
• Apply a noticeable label to patch
• Document the removal of the patch on the MAR
• Ask the patients if they take any medications in the forms of
patches
• Wear disposable gloves when removing and applying transdermal
patch
• Ask the patient if they have existing patch
Nasal instillation: patients with nasal sinus alterations sometimes
receive medications by spray
Eye instillation: some patients use eye drops such as artificial tears
(ophthalmic: medications for eye conditions)
PRINCIPLES WHEN ADMINISTERING EYE MEDICATION (ANUA)
• Avoid instilling any form of eye medications directly onto the
cornea
• Never allow a patient to use another patient’s eye medications
• Use eye medication only for the patient’s affected eye
• Avoid touching the eyelids with eyedroppers
Intraocular instillation:
Ear instillation: you need to instill eardrops at room temperature
Vaginal instillation: available in suppositories, foam, jellies, or
creams
Rectal instillation: rectal suppositories are thinner and more bullet
shaped
Pressurized metered-dose inhalers (pMDIs), breath-actuated
metered-dose inhalers (BAIs), and dry powder inhalers (DPIs):
medications that produce local effects
Inhaled medications are described as “rescue” or “maintenance”
Rescue medication: taken for immediate relief of acute respiratory
distress
Maintenance medication: used on a daily schedule to prevent acute
respiratory distress
FORMULA FOR INHALER
EX. A patient take Albuterol 2 puffs 4 times a day. The canister has
200 puffs. How long the MDI will last?
2 puffs × 4 times a day = 8 puffs per day
200 puffs ÷ 8 puffs per day = 25 days
Teach Back: used to determine patients and family’s understanding
about eye medication
 MOD 18

Intravenous Therapy: used to sustain clients who are unable to take

substances orally
TYPES OF SOLUTIONS
• Isotonic solutions: have the same osmolality as body fluids
• Hypotonic solutions: have a lower osmolality than body fluids
• Hypertonic solutions: have a higher osmolality than body fluids
• Colloids: also called plasma expanders
INTRAVENOUS DEVICES (IV CANNULAS)
1. Butterfly sets: wing-tip needle with a metal cannula
2. Plastic cannulas: over-the-needle device
IV GAUGES
• Gauge: diameter of the lumen of the needle
• The smaller the gauge number, the larger the diameter of the
lumen; the larger the gauge number, the smaller the diameter of
the lumen
• For rapid emergency fluid administration: 14-, 16-, 18-, or 19-
gauge
• For peripheral fat emulsion infusions: 20- or 21- gauge
• For standard IV fluid: 22- or 24- gauge
• For client with very small veins: 24- to 25- gauge
IV CONTAINER
• Container: may be glass or plastic
IV CHAMBER
• Macrodrip chamber: used if the solution is thick (drop factor
varies from 10 to 20 drops (gtt/mL)
• Microdrip chamber: has a short vertical metal piece (60 gtt/mL)
COMMON INTRAVENOUS SITES
• Inner surface of hand
• Dorsal surface of hand