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Pharmacology Remediation: Medication Administration and Nursing Considerations, Exams of Nursing

Nightingale Medical InstituteNursing

A comprehensive overview of medication administration principles and nursing considerations in various clinical settings. It covers topics such as enteric coated medication administration, medication administration via ng tubes and enteral feeding tubes, client identification procedures, adverse effects of various medications, and nursing interventions for specific drug classes. The document also includes information on medication contraindications, monitoring lab values, and identifying idiosyncratic reactions. It is a valuable resource for nursing students and professionals seeking to enhance their knowledge and skills in medication administration.

Typology: Exams

2024/2025

Available from 04/13/2025

Dr.HellenSteves
Dr.HellenSteves ๐Ÿ‡บ๐Ÿ‡ธ

263 documents

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Pharmacology Remediation
approved latest Version
Admin. Enteric Coated Med
- Have client sit upright to faciliate swallowing
- Admin. Irritating med, analgesics, w/ small amount of food
- Avoid admin. w/ interacting food or beverages, such as grapefruite juice
- In general, admin. oral med on an empty stomach (30 - 60 min before, 2hr after
meals)
- Make sure client swallow enteric coated or time-release med whole
Admin. Med via NG Tube
- Verify proper tube placement
- Prevent clogging, flush tube BEFORE & AFTER each med w/ 15 - 30 mL warm
sterile water
- Flush w/ another 15 - 30 mL warm sterile water AFTER instilling all the med
- Use liquid form of med (if not available, crush med if allowed)
- DO NOT admin. sublingual med through NG Tube
- Admin. med separately
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Download Pharmacology Remediation: Medication Administration and Nursing Considerations and more Exams Nursing in PDF only on Docsity!

Pharmacology Remediation

approved latest Version

Admin. Enteric Coated Med

  • Have client sit upright to faciliate swallowing
  • Admin. Irritating med, analgesics, w/ small amount of food
  • Avoid admin. w/ interacting food or beverages, such as grapefruite juice
  • In general, admin. oral med on an empty stomach (30 - 60 min before, 2hr after meals)
  • Make sure client swallow enteric coated or time-release med whole

Admin. Med via NG Tube

  • Verify proper tube placement
  • Prevent clogging, flush tube BEFORE & AFTER each med w/ 15 - 30 mL warm sterile water
  • Flush w/ another 15 - 30 mL warm sterile water AFTER instilling all the med
  • Use liquid form of med (if not available, crush med if allowed)
  • DO NOT admin. sublingual med through NG Tube
  • Admin. med separately
  • Completely dissolve crushed tablet & capsule contents in 15 - 30 mL sterile water prior to admin.

Admin. Med through Enternal Feeding Tube

  • Use a liquid form of the med to facilitate swallowing whenever possible
  • DO NOT admin. sublingual med through NG Tube
  • Completely dissolve crushed tablet & capsule contents in 15 - 30 mL sterile water prior to admin.
  • DO NOT mix med. w/ enternal feedings

Identifying a Client prior to med admin.

  • Check ID bands for names & ID number
  • Check for allergies by asking clients, looking for an allergy bracelet or medal, & reviewing the MAR (3x)
  • *Use barcode scanners to ID clients Responding to AE of Ramipril Reinforcing Teaching about Prednisone Suppression of adrenal gland function
  • Admin. oral glucocorticoid on alternate-day

Disturbances of Fluid & Electrolytes

  • Observe manifestation & report to provider

Interactions

  • Monitor K+ level & admin. supplement
  • Avoid use of NSAIDs. If GI distress occurs, notify provider
  • Notify if hyperglycemia occurs. INCREASE dosage of insulin/oral hypoglycemics might be needed

Nursing Admin.

  • Advise to inhale the beta2 agonist BEFORE inhaling glucocorticoid. The beta agonist promotes bronchodilator & enhances absorption of the glucocorticoid
  • Inform parents that glucocorticoids can slow the rate of growth in children; however, it does not affect the adult height Therapeutic Effect of Donepezil Treatment of Alzheimer's & Parkinson's disease Reinforcing Teaching about Fexofenadine Sedation
  • Take med @ night to minimize daytime sedation
  • Avoid driving, activities that require alertness, consumption of alcohol, & other CNS depressant meds (barbiturates, benzodiazepines, opioids)

Anticholinergic Effects

  • Take sips of water, suck on candy, & maintain 2 - 3L of water /day from food & beverage sources GI Discomfort
  • Take antihistamine w/ meals Acute toxicity, excitation, hallucinations, incoordination, & seizure in children
  • Advise to notify provider if occurs
  • Admin. activated charcoal & cathartic to DECREASE absorption of antihistamine
  • Admin. acetaminophen for fever
  • Apply ice packs or admin. sponge baths Respiratory depression, local tissue injury @ IV site
  • Monitor respiratory distress, & have resuscitation equipment available
  • Monitor extravasation, & advise to report any pain/burning sensation Identify an Idiosyncratic Reaction to Diphenhydramine There is some potential for misuse, as the med can instill euphoria in INCREASED doses Med Contraindications for a Client who has Hypertension

When using automated med dispensing system, perform the same checks & adapt as necessary Resources for med info

  • Providers (nurses, physicians, pharmacists)
  • Poison control centers
  • Sales Rep. from Drug Companies
  • Nursing Pharm. textbooks & med handbooks
  • *Physician's Desk Reference
  • Professional journals & websites Identifying manifestations of an Allergic Reaction
  • Treat mild rashes & hives w/ Diphenhydramine
  • Before admin. any med, obtain a complete med history AE of Lorazepam IV Toxicity = Can lead to respiratory depression, severe hypertension, or cardiac/respiratory arrest Priority Finding for Antipsychotic med Neuroleptic Malignant Syndrome (*Life-threatening medical emergency)
  • Manifestations include:

Sudden INCREASE grade fever BP fluctuations Dysrhythmias Muscle rigidity Diaphoresis Drooling Change in LOC developing into Coma Nursing Action

  • Stop antipsychotic med
  • Monitor VS
  • Apply cooling blankets
  • Admin. antipyretic (Aspirin, Acetaminophen)
  • INCREASE fluid intake
  • Diazepam is admin. to control anxiety as well as reduce BP & Heart Rate
  • Dantrolene & bromocriptine are admin. to induce muscle relaxation
  • Wait 2 weeks BEFORE resuming therapy. Consider lowering the dosage or switching to an atypical agent Admin. Beta Blocker
  • Use sterile technique when handing the applicator portion of the container. Avoid touching any part of the applicator, & keep the lid in place when not in use
  • Remove prior does BEFORE applying new dose. Measure the specific dosage w/ applicator paper & spread the med over 6.4 - 8.9cm (2.5 - 3.5in) of the paper
  • Apply to clean, hairless area of body, & cover w/ clear plastic wrap (Same guidelines as Transdermal Patch)
  • Avoid touching ointment w/ hands Evaluating Teaching about Sublingual Nitroglycerin
  • *Stop activity. Sit or lie down.
  • Immediately put 1 sublingual tab under tongue & let dissolve. Rest for 5 min.
  • If 1st tab DOES NOT relieve pain, CALL 911, then take 2nd tab.
  • After another 5 min, take a 3rd tab if still in pain. DO NOT TAKE MORE THAN 3 sublingual tab Technique for admin. Enoxaparin SubQ SubQ w/out Prefilled Syringe
  • Use 20 - 22-gauge needle to withdraw med from vial
  • Replace needle w/ smaller one (25 - 26-gauge, 1/2 - 5/8 in long)
  • Admin. deep SubQ injection to abdomen, ensure distance of 5cm (2in) from umbilicus
  • DO NOT ASPIRATE Prefilled syringe in various dose SubQ
  • Rotate sites between right & left anterior arterial & post lateral abdominal wall @ least 5 cm (2 in) from umbilicus
  • DO NOT EXPEL the air bubble in the syringe unless adjustments to the dosage are necessary
  • Pinch up area of skin, inject @ a 90* angle, & insert needle completely
  • DO NOT ASPIRATE
  • Inject entire content Identifying Findings of Aspiring Toxicity Bleeding disorders & thrombocytopenia are contraindications. Clients who have peptic ulcer disease or severe kidney or hepatic disorders require caution when taking Aspirin โ€”> (DO NOT GIVE Aspirin to children or adolescent who have influenza or chickenpox due to the risk for Reye's Syndrome) Urine acidifiers (ammonium chloride) can INCREASE aspirin level โ€”> Monitor for Aspirin toxicity (hearing loss, tinnitus) > w/hold med & notify provider

Notes

  • Stops platelet from clumping together
  • Prevent MI, previous stroke
  • *Complication Med causing Urinary Retention Diphenoxylate; difenoxin

Depression History of Severe Allergies Older Adult require caution when receiving Beta Adrenergic Blockers Identifying an AE of Lisinopril 1st dose Orthostatic Hypotension

  • Monitor BP for 2hr AFTER treatment
  • Change positions slowly & lie down if feeling dizzy Cough
  • Notify provider & stop taking med if Dry Cough occurs Hyperkalemia
  • Avoid use of salt substitutes containing K+ Rash, dysgeusia (taste alterations)
  • Inform provider if effect occur
  • AE will stop w/ discontinuation of med Angioedema
  • Treat severe effects w/ SubQ injections of Epinephrine
  • DO NOT admin. further doses of any ACE inhibitors

Neutropenia

  • Monitor WBC every 2 weeks for 3 months, then periodically
  • STOP taking med & notify provider @ 1st indication of infection (fever, sore throat) Withhold Antihypertensive med Beta Blocker = Metoprolol, Propranolol

Complication

  • Bradycardia (monitor pulse. If < than 50/min withhold the med & notify provider) Reinforcing Teaching about Atenolol IV admin. of atenolol, metoprolol, labetalol, or propranolol is an option for some clients Monitoring a Client receiving Propranolol
  • Bradycardia

Monitor pulse. If < than 50/min, withhold & notify provider

  • Hypoglycemia

Monitor BG to detect hypoglycemia

Admin. Antibiotics Hand hygiene *Give oral prophylactic penicillin Admin. pneumococcal conjugate vaccine, meningococcal vaccine, & Haemophilus influenza type B vaccine Tuberculin Skin Test result

  • Read w/in 48 - 72 hr
  • An induration (palpable, raised, harden area) of 10 mm or > in diameter indicates a POSITIVE skin test (5 mm is considered POSITIVE for immune compromised clients)
  • *A POSITIVE Mantoux test indicates that the client has developed an immune response to TB. It DOES NOT confirm that active disease is present. Clients who have been treated for TB can have a POSITIVE reaction Evaluate understanding of Transdermal Nitroglycerin
  • Place patch on hairless area of skin (chest, back, abdomen, thigh) & rotate sites to prevent skin irritation
  • Remove old patch. Wash the new application site w/ soap & water & dry it throughly BEFORE applying new patch
  • *Remove the patch @ night to reduce risk of developing tolerance to nitroglycerin (Clients should be MED FREE between 10 - 12 hr/day)

Client Ed

  • Self - admin. the correct dosage, DO NOT CUT patches Identifying an Unexpected Response to Atrovastatin
  • DO NOT take atrovastatin, lovastatin, & simvastatin concurrently w/ meds that suppress CYP3A
  • Atrovastatin & fluvastatin are preferable choices for clients who have impaired kidney function. For other statins, providers reduce the dosage Report Priority Finding of Simvastatin Myopathy
  • Report muscle aches, pain, & tenderness Reversing the Effects of Heparin Hemorrhage due to Heparin overdose
  • Withhold Heparin. The client needs Protamine IV & should avoid other anticoagulants, including aspirin Monitor aPTT. Usual result is 40 seconds, but therapeutic 1.5 - 2 times (60 - 80 seconds) โ€”> Check aPTT every 4 - 6 hrs

Reinforcing Teaching about Omeprazole Short-term Treatment

  • Minor AE include

Headache Diarrhea Nausea/Vomiting Long-term Treatment

  • Pneumonia

Monitor & report of Respiratory Infection

  • Osteoporosis, fractures

INCREASE vitamin D & calcium intake

  • Rebound acid Hypersecretion

Take low dose & taper slowly to discontinue

  • Hypomagnesemia

Monitor & report of hypomagnesemia (tremors, muscle cramps, seizures) Med admin. to a Client who is experiencing Nausea & Vomiting

Antiemetics prevent or treat nausea & vomiting from various causes. Try to identify the underlying related factors & verify the clients receive the appropriate med Caring for a Client who is Experiencing PostOp Pain

  • Ketorolac is for short-term treatment of moderate to severe pain, such as during PostOp recovery
  • Concurrent use w/ opioids allow for lower dosages of opioid & thus minimize AE (constipation, respiratory depression)
  • Clients receive ketorolac parenterally @ 1st then PO. Use SHOULD NOT be longer than 5 days because of the risk of kidney damage Monitoring for AE of Acetaminophen Acute toxicity
  • Results in liver damage w/ early manifestations of

Nausea / Vomiting Diarrhea Sweating Abdominal discomfort (progressing to hepatic failure, coma, & death) Interactions

  • Acetaminophen slows the metabolism of Warfarin, leading to INCREASE levels of Warfarin (Monitor PT & INR level, & report them to provider for dosage adjustment of Warfarin)