Medication Administration: You have been assigned to be the medication nurse in a long-term care facility to a group of 20 residents, of which 7 are there for short-term rehabilitation after total hip replacement. It is the first time you have worked with this group and therefore are unfamiliar with their medication routines and preferences.
1.The 1500-2330 shift nurse has completed his report and asks you if there are any questions. What information regarding the residents themselves would be beneficial for you to know in order to organize the administration of medications for this shift? (5 points)
Do they take med one at a time, take crush with apple source
Patient preference- before shower
2.For medications you are unfamiliar with, what resources could you use to learn about these medications prior to administration? Which one is the best source of nursing implications? (5 points)
Medication reference book such as David’s drug guide
Consumer websites medical journals or publications
Government agency Web sites
Nitroderpad- clean skin with water and place it
3. For each of the medications listed on the MAR:
a.What equipment will you need to prepare and administer the medications?
b.What key physical assessments and/or lab data are needed prior to administering these medications? (15 points)
Medication Route Equipment Patient/ Lab Data
Nitro-Dur Patch Transdermal injection
Injection needle Prevent chest pain in patient with heart conditions
NovoLog Subcutaneous injection
Disposable Insulin syringe needle Check Blood glucose before administering
Lanoxin IV push Check patient HR before administering if pulse under 60 hold medication and contact provider
Dose level
Caltrate
Oral
Pill water and medication cup
Dissolve pill in water Take by mouth with food. Check calcium level
Coumadin IV or Oral
Medication cup and water
Injection needle Anticoagulant blood (thinner) prevents blood clots. Before administering check PT and INR level
Lyrica
Oral
Medication cup
Water Used to treat pain by nerve damage related to diabetes.
Assess pain, numbness and tingling in hands or feet
Actonel
Oral
Medication cup
Water Take with full glass of water. Avoid laying down 30 minutes after taking medication. Check vitamin D level
Timoptic Eye
Used to treat high pretty inside eye.
Check Heart rate prior to administering
Combivent Respiratory (Inhalation)
Respimat inhaler ****Check for respiratory****
Cyanocobalamin IM or Subcutaneous
Syringe
Medication vial Used to prevent lack of vitamin V12. Before administering check Hematocrit, Vitamin B12
4. Describe the “Rights of Medication” and the “Three Checks.” How do these facilitate a culture of safety in medication administration? (10 points)
Rights Key Points
Drug Medication administered to treat, prevent or diagnose a disease
Patient
Needs 2 patient identifier. Check name, date of birth and MAR number
Dose The quantity ordered and to be given to a patient at a time
Route Location use to administer medication (orally, parenteral, topical IV injection, sublingual, rectal, inhalation)
Time A schedule determined when a medication should be administered
Documentation Complete a thorough written or electronic record of evidence regarding a patient’s care.
Reason Verify that the drug prescribed is the right one to treat the patient’s illness, monitor patient’s response to the drug administered.
To Know Know the 10 rights of medication administration, ensure safety delivery to patients.
To Refuse
A patient can refuse a medication but notify the provider and document the refusal
5. Describe the medication ‘three checks’ process (10 points)
First check is in the medication room when retrieving the medication (check expiration date on label, right patient, right medication
Second check is in the patient’s room
Third check is in the patients at the bedside, recheck the medication label against the MAR and do the 8 rights of medication.
6. Mrs. Lowery tells you, “I am not taking all those nine o’clock pills. I can’t swallow them— they get stuck in my throat.”
a.What information do you need about the ordered medications to address this problem? (5 points)
b.What alternatives are available to help with this swallowing issue? (5 points)
Medication Usual Dosage Form Can It Be Crushed? Alternatives
Caltrate with vitamin D
Lyrica Look for other forms that medication comes ex. IV, injection
7. The medication Lyrica is not available in the resident’s routine medication drawer. What could be some possible causes of this problem and how will you obtain the medication when needed? (5 points)
Make sure they can be crush
8. You go to place the Nitro-Dur patch on Mrs. Lowery and note that the patch from yesterday is still applied to her chest. The MAR indicates that it was removed the previous evening as ordered. What should be your first action? How will you address this occurrence? (10 points)
Remove the old patch, clean the… put new patch to new area and document it
9. Mrs. Lowery prefers to insert her own eye drops. As you observe her doing so, what key aspects of the administration procedure should she be doing to ensure correct technique? (5 points)
10. Mrs. Lowery refuses the extender or spacer for her Combivent inhaler, telling you, “It’s too much trouble.” How would you explain the benefits of its use to her? (10 points)
11. The cyanocobalamin solution is provided in a vial with a concentration of 1 mg/1 mL. (15 points)
a.Calculate the correct volume for the ordered dose. (6 points)
b.What type of syringe and needle gauge will you use for administration? Explain. (3 points)
1ml syringe
c.Where will you administer this injection? Give a rationale for your choice.
(3 points)
Deltoid or ventro gluteal
Use Z-trach method
d.How can you minimize the discomfort of the injection for Mrs. Lowery? (3 points)
Correct size needle
