Professional Documents
Culture Documents
I.
5 Additional Rights
1. right assessment
2. right documentation
3. clients right to education
4. right evaluation
5. clients right to refuse
A. Right Client
Nurse must do:
verify client check ID bracelet & room number
have client state his name
distinguish bw 2 clients 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)
Components of a drug order:
1. date & time the order is written
2. drug name (generic preferred)
3. drug dosage
4. frequency & duration of administration
5. any special instructions for withholding or adjusting dosage
6. physician or other health care providers signature or name if TO or VO
7. signature of licensed practitioner taking TO or VO
Nurse must do:
check med order is complete & legible.
know general purpose or action, dosage & route of drug
compare drug card with drug label three times.
1. at time of contact with drug bottle/ container
2. before pouring drug
3. after pouring drug
4 Categories of Drug Orders:
1. Standing Order / Routine Order
ongoing order
may have special instructions to base administration
include PRN orders
ex. digoxin 0.2 mg PO q.d., maintain blood level at 0.5 2.0 ng/ml
2. One-time (single) order
given only once, at a specific time
ex. Cefixime 2mg IM at 7 AM on 12-1-05
3. PRN order
given at clients request & nurses judgement for need & safety
ex Mefenamic Acid 500mg q 4h PRN for pain
4. STAT order
given once, immediately
ex. Morphine 2mg IV STAT
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.
Stock- method vs Unit-dose method
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 clients 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.
F. Right Assessment
get baseline data before drug administration.
G. Right Documentation
Immediately record appropriate info
Name, dose, route,time & date, nurses initial or signature
Clients response:
narcotics
analgesics
antiemetics
sedatives
unexpected reactions to meds.
Use correct abbreviations & symbols.
H. Right to Education
Client teaching :
therapeutic purpose
side-effects
diet restrictions or requirements
skill of administration
laboratory monitoring
Principle of Informed Consent
I. Right Evaluation
clients 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 pxs 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.
II.
III.
Do not mix with large amt of food or beverage or contraindicated food or infant formula
Enteric- coated & timed-release capsules must be swallowed whole.
Administer irritating drugs with food to lessen GI discomfort.
Administer drugs on empty stomach if food interferes with absorption.
Drugs given sublingually or bucally must remain in place until fully absorbed.
Encourage use of child-resistant caps.
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 clients 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 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-fowlers position.
Teach correct use of nebulizer & metered-dose inhalers.
G. Parenteral
Action
> local effect
> small amt
> for tuberculin / skin test
site
> ventral midforearm,
clavicular / scapular area
2. SC
3. IM
4. IV
1. ID
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)