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Medications by Mind Map: Medications

1. Controlled

1.1. C1

1.1.1. Heroin, Hashish, LSD, GHB

1.1.2. No accepted medical use, lack of safety

1.1.3. High Abuse Potential, Dependence Liability: Severe

1.2. C2

1.2.1. Amphetamines, Opioid narcotic(morphine, meperidine), dronabinol, short acting barbs(pentobarbital, secobarbital

1.2.2. Tamper proof prescription,

1.2.3. No tele orders

1.2.4. Refills not allowed

1.3. C3

1.3.1. Some opioid narcotics: codeine, hydrocodone, some CNS, anabolic steroids

1.3.2. Written or telephone order

1.3.3. 5 refills within six months

1.4. C4

1.4.1. Benzos, anxiolytic, anticonvuls, muscle relax, sedatives, nonbenzo hypnotic, intermediate acting barbs, opioid narcs like propoxyphene, pentazocine

1.4.2. Rules same as C3

1.5. C5

1.5.1. Antidiarhheal prep with diphenoxylate and loperamide, small amounts of narcs like codeine used as antitussives

1.5.2. No script for many

1.6. Nurse management

1.6.1. Waste

1.6.1.1. 2 people

1.6.1.2. When?

2. Disposal

3. Forms

3.1. Capsule, Caplet

3.2. Tablet

3.3. Enteric Coated

3.4. Elixir

3.5. Suspension

3.6. Ointment

3.7. Suppository

3.8. Transdermal patch

3.9. Topical

3.9.1. Meidcated Cream/Lotions/Ointments

4. Six Rights

4.1. Right Medication

4.1.1. Before removing medication

4.1.2. When you remove the medication and prepare

4.1.3. At bedside before admin

4.2. Right Patient

4.2.1. 2 Patient Identifiers

4.2.2. Barcode scanning if setting every time

4.3. Right Dose

4.3.1. Calculation correct?

4.3.2. Strength right?

4.3.3. Dose appropriate?

4.3.4. 2RN

4.3.5. Cup level liquid pour, scored tablets, crush meds into small amount of food

4.4. Right Route

4.4.1. Did Pt tolerate, Where exactly, Any complications, which IV, any fluid/med infusing

4.5. Right Time

4.5.1. How many minutes before/after can administer?

4.5.2. Frequency correct

4.5.3. Stat meds

4.6. Right Documentation

4.6.1. Med given/not given/refused

4.6.2. Dose

4.6.3. Route

4.6.4. Response of patient

4.6.5. Time

4.7. Other issues

4.7.1. Not expired!

4.7.2. No extra or omitted doses

4.8. Errors

4.8.1. Errors injure 1.5 million and KILL 7000

4.8.2. If error occurs

4.8.2.1. Assess patient

4.8.2.2. Call prescribing provider

4.8.2.3. Incident report f

4.8.2.3.1. Patient ID info

4.8.2.3.2. Time + Location

4.8.2.3.3. Description of event with follow up

5. Orders

5.1. Parts

5.1.1. Patients Name

5.1.2. Date/Time

5.1.3. Name of drug

5.1.4. Dose

5.1.5. Strength

5.1.6. Route

5.1.7. Frequency

5.1.8. Signature

5.2. Rules

5.2.1. No trailing zeros

5.2.2. Always zero before decimal

5.3. Questioning

5.3.1. Warranted

5.3.2. Sensible

5.3.3. PT confusion?

5.3.4. Correct dose and prep order

6. RS

7. Routes

7.1. Enteral

7.1.1. PO, NG, SL, Buccal,

7.1.2. First Pass Effect

7.2. Parenteral

7.2.1. IM, SQ, ID, IV, Intraosseous, Epidural, Intrathecal

7.2.2. Administration

7.2.2.1. Needles

7.2.2.1.1. Parts

7.2.2.1.2. Types: Tuberculin 3ml, 10ml, insulin pens

7.2.2.1.3. Gauges:

7.2.2.1.4. Insertion angle

7.2.2.1.5. Inject from vial

7.2.2.1.6. Inject from ampule

7.2.2.1.7. Insulin Injection

7.2.2.1.8. Intradermal Injection

7.2.2.1.9. Subcutaneous Injection

7.2.2.1.10. Intramuscular Injections

7.2.2.2. How can we prevent needle sticks?

7.2.2.2.1. Don't cap by hand put in sharps bin

7.3. Topical

7.3.1. Local Effect

7.3.2. Lotions, Creams, Liquids, Ointments

7.3.3. Steps

7.3.3.1. Skin integriy

7.3.3.1.1. What if skin breakdown- how does it affect absobrtion

7.3.3.2. Gloves

7.3.3.3. Even and thin layer over skin

7.3.4. Nitroglycerin

7.3.4.1. Desired number of inches onto measuring guide

7.3.4.2. Remove previous paper from patient and fold used sides together

7.3.4.3. Sites

7.3.4.3.1. Arms

7.3.4.3.2. Chest

7.3.4.3.3. Back

7.3.4.3.4. Legs

7.3.4.3.5. No broken skin, no hair surface, no scar tissue

7.3.4.3.6. No massage in

7.3.4.4. Secure with transparent dressing(tegaderm)

7.3.4.5. Date, time, initial

7.3.5. Transdermal Pouch

7.3.5.1. Steps

7.3.5.1.1. Remove old patch

7.3.5.1.2. Dispose of old patch with sticky sides together

7.3.5.1.3. Clean and dry area

7.3.5.1.4. Select hairless location not over bony prominence

7.3.5.1.5. Apply firmly to skin and hold for ten second

7.3.5.1.6. Date, time, initial patch

7.3.5.1.7. Redness or irritation?

7.3.5.1.8. When do you change patch

7.3.6. Ophthalmic Med

7.3.6.1. Eye Drops

7.3.6.1.1. Steps

7.3.6.2. Ointment

7.3.6.2.1. Steps

7.3.7. Otic Medication

7.3.7.1. Ear drops

7.3.7.1.1. Steps

7.3.8. Nasal Drops

7.3.8.1. Steps

7.3.8.1.1. Pt blow nose

7.3.8.1.2. Supine position

7.3.8.1.3. Hold dropper 1/2 in above nares

7.3.8.1.4. Remain supine for 5 min

7.3.9. Nasal Spray

7.3.9.1. Steps

7.3.9.1.1. Pt Blow Nose

7.3.9.1.2. Upright pt with head tilterd

7.3.9.1.3. Breathe out through mouth

7.3.9.1.4. 1/3 inch into nostril plug opposite nare

7.3.9.1.5. Administer spray as pt inhales through nose

7.3.9.1.6. Blot excess but no blow nose

7.3.10. Rectal suppository

7.3.10.1. Steps

7.3.10.1.1. Position?

7.3.10.1.2. Lubricate tip of suppostiory with water soluble lube

7.3.10.1.3. Have pt take slow deep breaths to relax anal sphincter

7.3.10.1.4. Spread buttocks and insert using one finger 3-4 inches in adults, 2 in child

7.3.10.1.5. Pt remain flat for 5 min

7.4. IV

7.4.1. IV Push, Fluid, Piggyback

7.4.1.1. Assess IV site for

7.4.1.1.1. Infiltration is outside of the vein

7.4.1.1.2. Swelling pain, discomrfort, cool to touch, wet from leakage

7.4.1.1.3. Phlebitis: Inflammation of vein

7.4.1.1.4. Redness, Warmth

7.4.2. Complications: Mechanical, Infiltration, Extravasation, Phlebitis

7.4.2.1. Infiltration

7.4.2.1.1. IV catheter slips out or through blood vessel resulting in IV fluids/meds leaking into surrounding tissues

7.4.2.1.2. Nursing consids

7.4.2.2. Phlebetitis or Thrombophlebitis

7.4.2.2.1. Phlebitis is inflammation of vein

7.4.2.2.2. Thrombophlebitis is development of a blood clot

7.4.2.2.3. Local swelling

7.4.2.2.4. Throbbling/pain/burning at IV site

7.4.2.2.5. increased skin temperature

7.4.2.2.6. Red line/erythema up the arm with palpable band

7.4.2.2.7. Consids

7.4.3. Primary/ Maintenance Fluids

7.4.3.1. Check six rights, are considered med orders, correct rate, correct amount

7.4.4. Piggyback- Maintenace fluid must always be lower than piggyback medication

7.4.4.1. If not piggyback it can run up into maintenace fluid so always keep piggyback higher

7.4.5. 6 Righ

8. Teaching

8.1. Key to safeguard

8.1.1. Improved adherence and compliance

8.1.2. Promotes therapeutic outcomes

8.2. Communicate clearly

8.2.1. Avoid medical jargon

8.2.2. What grade level?

8.2.3. Teach back method

8.2.4. Provide and REVIEW education

8.2.4.1. Written

8.2.4.2. Diagrams

8.2.5. KENNA

8.3. Assess their knowledge- What's the best way?

8.4. What should be included

9. H

10. Life Span

10.1. Infants/Children

10.1.1. Smaller Dose

10.1.2. Calibrated Dropper

10.1.2.1. How to administer with dropper

10.1.3. Based on weight

10.1.4. Liquid form of meds <5 years

10.2. Older Adults

10.2.1. Age related changes

10.2.2. Crushed and liquid

10.2.2.1. What meds can't we crush

10.2.2.2. New pill crusher and clear prior to crushing new meds

10.2.2.3. Liquid Meds

10.2.2.3.1. Draw liquid into syringe if less than 10ml

10.2.3. More time to administer

11. Dysphagia

11.1. Signs

11.1.1. Choking during or after eating

11.1.2. Frequent clearing of throat

11.1.3. Repeated swallowing of same bite

11.1.4. Drooling

11.1.5. Gagging

11.2. High risk for what if pt has dyphagia?

11.2.1. Aspiration

11.2.1.1. Food or medication moves into trachea/airway

11.2.1.2. Precautions

11.2.1.2.1. Thicken liquids/Crush meds

11.2.1.2.2. Sit patient up to 90 degrees

11.2.1.2.3. Administer small amounts at a given time