Академический Документы
Профессиональный Документы
Культура Документы
A. Right Client
Nurse must do:
verify client check ID bracelet & room number
have client state his name
distinguish bw 2 client’s with same last names
B. Right Drug
medication order may be prescribed by:
a. Physician
b. Dentist
c. Podiatrist
d. Advanced practice registered nurse (APRN)
3. PRN order
given at client’s request & nurse’s judgement for need & safety
4. STAT order
given once, immediately
C. Right Dose
Nurse must do:
• Calculate and check drug dose accurately.
• Check PDR, drug package insert or drug handbook for recommended range of
specific drugs.
• Check heparin, insulin and IV digitalis doses with another nurse.
D. Right Time
Nurse must do:
• Administer drugs at specified times.
• Administer drugs that are affected by foods, before meals.
• Administer drugs that can irritate stomach, with food.
• Drug administration may be adjusted to fit schedule of client’s lifestyle, &
activities. & diagnostic procedures.
• Check expiration date.
• Antibiotics shld be administered at even intervals.
E. Right Route
Nurse must do:
• assess ability to swallow before giving oral meds.
• Do not crush or mix meds in other substances before consultation with
physician or pharmacist
• Use aseptic technique when administering drugs.
• Administer drug at appropriate sites.
• Stay with client until oral drugs have been swallowed.
F. Right Assessment
get baseline data before drug administration.
G. Right Documentation
Immediately record appropriate info
• Name, dose, route,time & date, nurse’s initial or signature
Client’s response:
• narcotics
• analgesics
• antiemetics
• sedatives
• unexpected reactions to meds.
H. Right to Education
Client teaching :
• therapeutic purpose
• side-effects
• diet restrictions or requirements
• skill of administration
• laboratory monitoring
I. Right Evaluation
client’s response to meds.
o effectiveness
o extent of side-effects or any adverse reactions.
J. Right to Refuse
Nurse must do:
• determine, when possible, reason for refusal.
• facilitate px’s compliance.
• explain risk for refusing meds & reinforce the reason for medication.
• Refusal shld be documented immediately.
• Head nurse or health care provider shld be informed when omission pose
threat to px.
ALL MEDICATION ERRORS ARE SERIOUS OR POTENTIALLY SERIOUS!!!!!!!!
A. Preparation
1. Wash hands before preparing meds.
2. Check for allergies.
3. Check medication order with physician’s orders, medicine sheet, & medication card.
4. Check label on drug container 3 times.
5. Check expiration date on drug label.
6. Recheck drug calculation with another nurse.
7. Verify doses of drugs that are potentially toxic with another nurse or pharmacist.
8. With unit dose, open packet at bedside after verifying client identification.
9. Pour liquid at eye level.
10. Dilute drugs that irritate gastric mucosa or give with meals.
B. Administration
11. Administer only those drugs that you have prepared.
12. Identify the client by ID band or ID photo.
13. Offer ice chips when giving bad tasting medicine.
14. Assist client to appropriate position.
15. Provide only liquids allowed on the diet.
16. Stay with client until meds are taken.
17. Administer no more than 2.5 to 3 ml of solution by IM at one site.
18. Infants receive no more than 1 ml of solution by IM at 1 site & no more than 1 ml
subcutaneously. NEVER recap needles.
19. Give drugs last to client who need extra assistance.
20. Discard needles & syringes in appropriate containers.
21. Follow appropriate drug disposal based on institution policy.
22. Discard unused solutions from ampules.
23. Store appropriately unused solutions from open vials.
24. Write date & time opened & initials on label.
25. Keep narcotics in a double-locked drawer or closet. Med cart – locked at all times
when nurse is not around.
26. Keys to narcotics drawer must be kept by the nurse & not stored in drawer.
27. Avoid contamination of one’s own skin or inhalation to minimize chances of allergy.
C. Recording
28. Report drug error immediately to nurse manager & physician. Complete an incident
report.
29. Charting: record drug given, dose, time, route & your initials.
30. Record drugs promptly after given, esp STAT doses.
31. Record effectiveness & results of meds given, esp PRN meds.
32. Report to physician & record drugs that were refused with reason for refusal.
33. Record amount of fluid taken with medications on input & ouput chart.
B. Liquids
• Forms : elixir, emulsions, suspensions
• read label if dilution or shaking is required.
• read the MENISCUS.
• refrigerate once reconstituted.
C. Transdermal
• systemic effect
• more consistent blood levels & avoid GI absorption problems associated with oral
products.
• patches should NOT be cut.
D. Topical
• Applied to skin with a glove, tongue blade or cotton - tipped applicator.
• Apply to clean dry skin when possible.
• Do not contaminate the medication in a container.
• Do not “double dipped” .
• Observed sterile technique when skin is broken.
• Use firm strokes if medication is to be rubbed in.
E. Instillations
• Eyedrops
1. wash hands
2. lie or seat down and look up towards ceiling
3. remove any discharge by wiping out from inner canthus
4. rest hand holding the dropper against the client’s head.
5. gently draw skin down below affected eye to expose conjunctival sac
6. administer drops into center of the sac
7. gently press lacrimal duct with sterile cotton ball or tissue for 1 to 2
mins after instillation
8. keep eyes closed for 1 to 2 mins following application
• Eye Ointment
1, 2, 3, 4,- same as above
5 . squeeze strip of ointment (abt ¼ inch, unless stated otherwise).
5. keep eyes close for 2-3 mins.
6. instruct px for blurred vision for a short time.
7. apply at bedtime, if possible.
• Ear Drops
1. wash hands.
2. med shld be at room temp.
3. sit up with head tilted slightly toward unaffected side.
4. child: pull auricle down & back. (after 3yo ,same as adult)
adult: pull up & back.
5. instill prescribed drops.
6. do not contaminate dropper.
7. maintain position for 2-3 minutes.
F. Inhalations
• Semi-fowlers or high-fowler’s position.
• Teach correct use of nebulizer & metered-dose inhalers.
G. Parenteral
Action site
1. ID > local effect > ventral midforearm,
> small amt clavicular / scapular area
> for tuberculin / skin test
Remember!!!!
Ventrogluteal site – preferred for IM inj. in adults & infants >7 mos old.
DONOT use DORSOGLUTEAL site for IM inj in children.
Vastus lateralis - infants < 7 mos old
Developmental needs:
Stranger anxiety – infant
Hospitalization/ ilness viewed as punishment – 3-6 yo
Fear of mutilation – 3- 6 yo
Technological advances:
• Patient- Controlled Anesthesia (PCA) systems
• Eutectic mixture of local anesthetics (EMLA)