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North Florida / South Georgia

Veterans Health System

Study Guide for NF/SG VHS
Medication Exam
Study Guide developed by
Mary Jane Zaborsky
Modified by Patti L. Paige,
Beverly A. Boyko and Dayle Ann McCary

Last Revision 5/22/2015

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Introduction
This study guide is much more than a simple way to prepare for your medication exam.
It’s a review of critical knowledge that you need to safely calculate and administer drug
dosages. No one purposely sets out to make a medication error but they do occur. Our
patients deserve to have medications administered correctly and safely. Our medication
exam is one way to ensure that nurses provide this care for our veterans.

Basic Review of Key Safety Points
 Do not try shortcuts.

 Avoid distractions while calculating and giving medications.

 Check for allergies / adverse reactions.

 Listen to the patient

 “That doesn’t look like my usual pill”
 “I’m supposed to have a different pill today.”
These are red flags which warrant further investigation. Do not assume that
the pill looks different because it is a generic form

Bar Code Medication Administration (BCMA) has a list of approved abbreviations & a
list of “do not use” abbreviations. Take care to follow those lists.

Take care when giving meds to know if they interact with foods (grapefruit & Procardia,
Lipitor) or if they react with other meds. Use med book, call your pharmacist, or check
http://www.nlm.nih.gov/medlineplus/sitemap.html when in doubt.

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Know the 5 rights

1. Right Medication
a. not contraindicated
b. what is ordered
c. listen to patient if he/she says that med “looks different” – check
d. don’t assume med is correct just because it came from pharmacy
e. don’t use virtual due list (VDL) of bar code med admin (BCMA) as
the current med administration record

2. Right Patient
a. ask the patient
b. scan the name band
c. keep up with “name alerts”

3. Right Dose
a. check the dose for appropriateness – look it up if questionable
b. don’t assume it is correct because pharmacy sent it
c. double check all of your calculations
d. have another nurse check if you are unsure or if med is high risk
e. take into account other factors (client age, other meds that may impact)

4. Right route (and correct administration for that route)

5. Right time

If drug is supplied in powder form & you are adding liquid, follow instructions carefully
as to type & amount of diluent to use, resulting mg per ml, & to ensure powder is
dissolved.

Report medication errors or “near misses” on a medication incident report. A report on a
“close call” may result in identification of problems that could save another patient’s life.
Never assume that the doctor or pharmacist “got it right.”

Know the major classifications of drugs.

For each drug you administer, you should know the uses & indications, major side
effects, nursing interventions & considerations, and normal dosage. If you are not sure,
look it up.

Know the reversal agents (antidotes) available for common meds.
1. Protamine sulfate reverses heparin overdose.
2. Vitamin K reverses coumadin overdose.
3. Narcan reverses opiod narcotic overdose.
4. Kayexalate reverses hyperkalemia (high K+) but works slowly.

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 Keep palm over label when pouring to keep label clean & easy to read.5 ml (most are 0.  Crushing a medication to give with liquid or food  Never crush an enteric coated (hard coat) tab. These are meant to dissolve in the alkaline medium of the intestines.  Use TB syringe with 5/8” needle (25. & right & left lower quadrants of abdomen (above iliac crest & at least 2 finger 4 . anterior thigh. insert needle (bevel up) at a 15 degree angle directly under the skin so that injected fluid raises a small bleb. Injections Intradermal Injections  Used to evaluate sensitivity to drugs & allergens.May be in pill or liquid form.  If patient has NG or is unable to swallow pills.01 to 0. upper back. Ecotrin (gastric irritation)  Safest to ask physician to substitute a liquid medication  Liquid medications  Shake if it is a precipitate.  Measure in a medicine cup at the lowest level of meniscus.  Never crush a sustained release tab or capsule  Never crush a SL tab  Avoid crushing E-mycin. 27 gauge)  Hold skin taut. Administration Techniques Oral Medications  Sublingual tablets – to be placed under tongue to dissolve  Other oral meds . 26. obtain it in liquid form if available.  Never inject more than 0. Heparin only given with TB syringe  23 – 25 gauge needle (no more than 5/8”) inserted at 45 – 90 degree angle  Never inject more than 1 ml of fluid into fatty tissue  Can grasp skin to create a 1” fold  See sections on Insulin & Heparin for further info  Common sites: lateral posterior aspect of upper arm. upper chest Subcutaneous Injections  Used most often for administration of Heparin and Insulin.  Insulin is only given with Insulin syringe.1 ml)  Common sites: forearm. Dulcolax.

Do NOT massage.  Straighten adult’s ear canal by pulling auricle up & out. Dextran. Intramuscular Injections  Used most often for immunizations. and analgesics. Release skin.  Use normal dart like injection technique & 90 degree angle. antibiotics.  Only regular insulin can be given by IV. breadths from umbilicus). the anterior & lateral aspect of thigh (vastus lateralis).  Used for Iron (ferrous sulfate).  Rapid response.  Used most often in emergencies  Look up injection times & instructions – follow carefully  Never give oil or aqueous suspensions by IV. Never use a bottle of regular insulin that may have been contaminated by other insulins or if it appears cloudy. 5 .  Common sites: deltoid. Abdomen is easiest site for patient to self- inject.  Needle gauge & length are determined by:  Size of patient  Viscosity of liquid  Never inject more than 3 ml of fluid. Ear Drops  Lie down with ear to receive drops pointed up. etc IV Injections  Most direct route & the most dangerous.  Med should be injected slowly & you should wait 10 seconds before removing the needle.  Potassium should NEVER be given IV push.  Pull skin to side (about 1.5 inches away from injection site). or the ventrogluteal site Z Track  A type of IM injection used for meds that can be irritating to sub-q tissue or may stain skin.  Dart like motion to insert needle at 90 degree angle to site.

Ideal to have separate bottle for each eye.described as going in the sac toward the inner aspect of lower lid.  Med is given to conjunctival sac toward the inner aspect of lower lid. eye spasm  Systemic reactions: N/V.  Best administered by patient.  Miotic (cholinomimetic) – reduces intraocular pressure in glaucoma  Example: Pilocarpine  Monitor for headache. blurred vision  Systemic reactions: facial flush.Albuterol or Isoproterenol  These meds relieve spasms of the bronchi 6 . pain. exudate. bradycardia. odor.  Cold ear drops may result in nausea or vertigo. * Avoid the nasolacrimal sac (corner next to nose) * **** Med goes here **** Med goes here – in the inner aspect of lower lid  Turn head to side so med does not flow to nasolacrimal sac. Ask patient to look up & pull down lower lid. burning.  Wear gloves. Drop goes into the sac you form .  Monitor for swelling.  Patient should remain in position for 2-3 minutes. med effectiveness. Inhaler Medications  Bronchodilators (anticholinergics) . dry mouth. Eye Medications Pull down lower lid. photophobia. bradycardia Nasal Medications  Instruct patient to clear nasal passages.  Monitor for: itching. diaphoresis  Mydriatic – dilates the pupil  Example: Atropine and Scopolamine  Monitor for dilation. pain. exudate. inflammation. blurred vision.  Avoid contamination of bottle/tube. itching. stinging.

Levels above therapeutic (above a level of 20 mcg/ml) are associated with symptoms such as N/V. etc (Inhaler meds cont’d)  Check for proper technique when patient uses:  Patient exhales normally  Presses down once to release dose & inhale slowly  Hold breath to allow aerosol to reach deeper airways  Then exhale. Oxygen Administration  Ordered in liters per minute (LPM) or percentage of oxygen concentration (%)  Oxygen toxicity may develop with 100% oxygen use over long period.  Remove old patch & clean skin before applying new patch  Never re-apply to same site from which old patch was just removed. Wait several minutes before using the steroid inhaler to enhance distribution of the steroid  Advise patient to rinse mouth with water after using inhaler Oral Bronchodilator Medications . Side effects include weight gain. Oral Corticosteroids – Used orally for asthma. Peak & trough theophylline levels are drawn. ulcerative colitis.   Steroids – beclomethasone. Transdermal Medications  Wear gloves. Drug is usually discontinued gradually to allow adrenal glands to resume function.  WARNING – Patients with chronic lung disease (COPD) may have hypercapnea if given 100% oxygen. Wait 20 to 30 seconds for 2nd metered dose of bronchodilator. Azmacort. hyperglycemia. headache. shock. 7 . etc. and high blood pressure. adrenal insufficiency. Use a low-flow system.  Used to prevent & also to treat.Oral medications include theophylline (Theo-dur). tachycardia. There is more than 1 type of patch.

ointment.  Insert slowly. & never force (perforation). less muscle. not every 24 hours. other health problems o May need to use liquid form of med o May need to crush meds (see that section) o Allow extra time for patient to take meds 8 . lubricate round end of suppository with water (or water soluble lubricant).  Insert tip of bottle or suppository toward patient’s umbilicus. Increase slowly.  Most patches are changed every 24 hours. Fleet enema . stroke. less water – retain fat-stored meds o Low serum albumin levels – impacts some drugs’ effectiveness  (digoxin) o Altered drug sensitivity – more sensitive to some. Never cut the patch to achieve appropriate dose.  Labeling o Use large type on labels o Color code for multiple medications o Have Braille labeling available for blind patients  Start with low dose. o Fentanyl (Duragesic) is replaced every 72 hours. Medications & the Elderly Patient The 65 and over age group is the largest user of both prescription drugs and over the counter medications. Rotate sites). For example. Rectal Medications Suppository. o (i.e. or enema (Fleet)  Sims (left lateral) or knee-chest position.  Wear gloves. Elderly have: o Decreased kidney & liver function – drug stays in body (Demerol) o More fat. carefully. Some meds are not.patient should hold until strong urge to defecate is felt. (2-5 min) Suppository should be in contact with rectal wall well past internal sphincter. less sensitive to  others  Ability to chew / swallow o Dental issues.

1 teaspoon (tsp) = 5 mL = 5 cc 4. 15 mL = _______ cc Answer is 15 cc 2. 1 kg = 2. 4 Liters (L) = ________ mL Answer is 4000 mL 4.2 lbs or 1000 grams 7. 1 Tbsp = _________ oz Answer is ½ oz 6. 2 Tbsp = 30 mL = 6 tsp = 1 oz 6. 1 Tbsp = ________ mL Answer 15 mL 7.  Administration issues – controlled release. 1 Gm = 1000 mg 2. Oxycontin. 2 Tbsp = _________tsp Answer 6 tsp Drug Categories Narcotic / Opiate Analgesics  Better pain relief if taken BEFORE pain becomes severe. Below are some example questions with answers: 1. etc – o Don’t crush or break in ½ o Crushing sustained release meds releases them immediately & can  Result in serious side effects  Drug used to treat opioid/narcotic overdose = Narcan 9 . MS Contin. Conversions Not on exam: grains & minims (1 grain = 60 mg & 1 mL = 16 minims) Need to know for exam: 1. 3 oz = ________ mL Answer is 90 mL 3. 1 Tablespoon (Tbsp) = 15 mL = 3 tsp = ½ oz 5. 1 L = 1000 mL There will be a section that is fill-in the blank on the test. 4 tsp = ________ mL Answer is 20 mL 5. 1 mg = 1000 mcg 3.

UA. cefazoline).  May result in hepatitis & liver failure (cephalosporins). gentamycin. etc). dizziness. call pharmacy or check med reference. hearing loss.  Common side effects: abdominal cramping. Levofloxin). Patients should be instructed about:  Importance of taking around the clock at scheduled times. monitor patients for:  Nephrotoxicity – some antibiotics (gentamycin. creatinine. tetracyclines.  Avoidance of sun while taking some (fluoroquinolones. liver function tests. nausea.  Side effects: o GI (constipation. aminoglycosides (ex. tinnitus. assess the patient to include the IV site (is it patent. 10 . Some antibiotic drugs:  Must be taken on empty stomach and without dairy (Tetracycline)  Cause oral contraceptives to fail (Tetracyclines)  Have frequent drug to drug interactions (Fluoquinolones).  Peak drawn at time of drug Peak after infusion complete  If IV infusion interrupted. anorexia. Anticoagulants Anticoagulant drugs prevent clot formation. and report findings to charge nurse & MD for further instructions. macrolides (E-mycin). vancomycin  Are ototoxic (ex gentamycin may cause hearing loss or ringing in ears). Peak and Trough levels may be ordered with antibiotics  Trough drawn 30 minutes prior to infusion. diarrhea. N/V. With antibiotic use. ampicillin). Antibiotics Multiple major classes of antibiotics exist. tetracyclines)  Special instructions as indicated. vancomycin) damage kidney  Liver function – some antibiotics may result in hepatitis or liver failure  Hearing – some (gentamycin) are ototoxic (hearing loss or ringing in ears)  Monitor BUN.  Taking the entire prescription – not stopping when they feel better  Hypersensitive reactions. specific gravity.  If question about Peak & Trough. They will not break up existing clots but will prevent existing clots from enlarging. Some of these are penicillins (ex. fluid status. fluoroquinolones (ex. cephalosporins (ex.  Should never be taken with alcohol (Flagyl). and lightheadedness  If patient on IV pain med is not obtaining relief. restart infusion when problem is resolved & set new Peak time. cramps) o Sedation. & peak/trough levels. etc).  Are nephrotoxic (kidney failure) – gentamycin.

nosebleeds.  Nursing Implications o Patient education as above. o The lab test for coumadin is PT. following a myocardial infarction (MI). red or brown urine or bloody stools. Thrombolytic agents are used to dissolve thrombi and are administered after a heart attack to prevent myocardial ischemia and are also used to treat pulmonary emboli and deep vein thrombosis. o Use a soft bristle toothbrush and shave with an electric razor. immobilization after certain surgeries.  The antidote for coumadin is Vitamin K (aquamephyton) Other Drug Categories Affecting Blood Coagulation Other drugs affecting blood coagulation include antiplatelets.  Protime (PT) and/or unfractionated heparin levels are monitored closely until the desired levels are achieved. hematomas or petechiae o Report bleeding gums.  Patient Education Issues: o Inspect skin for bruising. The most widely studied antiplatelet drug is aspirin (ASA) – used with patients with angina. Hemostatic drugs are systemic or local agents used to control excessive bleeding. o If giving subcutaneously: do not aspirate & do not rub site  Warning sign of overdose is black.  May be given orally (warfarin) or parenterally (heparin). o Inspect IV sites often for hematomas o Draw labs below IV site (preferably on arm opposite IV site) if IV heparin is o infusing. 11 .  Indicated in patients with recent thrombus. and hemostatic drugs. cardiac valve disease or replacement.  Heparin is administered IV or by deep subcutaneous injection. Check before each dose. ministroke). thrombolytics. o The lab test for heparin is unfractionated heparin. o Avoid over the counter medications containing ibuprofen and aspirin unless o ordered by your physician. or hemodialysis. tarry stools.  The antidote for heparin overdose is protamine sulfate. and with patients following a transient ischemic attack (TIA. It is NEVER given IM (painful hematomas).

which helps to regulate posture. Many are initially given via IV. Do not use with patients with glaucoma.  Benadryl is an antihistamine with anticholinergics activity used for nighttime sedation. premature ventricular contractions (PVCs). Side effects: o Hypotension . allergy symptoms.  Phenytoin (Dilantin) is not compatible with glucose in IV solution.  Anticholinergics also have anti-spasmodic effects and are used for irritable bowel syndrome and urinary bladder spasms. The safety margin for all antiarrhythmias is very narrow. atrial fibrillation and angina pectoris. and ataxia. mental confusion.  Common side effects associated with this category are constipation. Their use ranges from treatment of tachycardia. o Examples . Use cautiously with patients with tachycardia. dry mouth. patient is switched to oral medications. prostatic hypertrophy. Never confuse it with sodium pentothal which is a general anesthetic.  Antiarrhythmics Many of these drugs have more than one action on the heart.Pronestyl. GI symptoms. An example is Probanthine. gingival hyperplasia o CNS effects such as slurred speech. Once stable.frequent when anticonvulsants are given IV.  Phenobarbital is a long acting barbituate. Anticonvulsants  Anticonvulsants are used in the treatment of seizures. and voluntary movement. 12 . Do not mix in IV fluids. hypertension. muscle tone. and Norpace o Lidocaine is the treatment of choice for ventricular arrhythmias. and as an anti-Parkinsonism agent. Valium can cause respiratory depression.Anticholinergics The body requires a balance between dopamine and acetylcholine. o Hypersensitivity. tremors) may occur from Parkinson’s disease or from antipsychotic drugs such as phenothiazines. Scopolamine and Cogentin that block the effects of acetylcholine. Dilantin.  Valium (diazepam) is used to terminate status epilepticus. Manifestations of imbalance (rigidity. nystagmus. Lidocaine. or chronic kidney disease.  Anticholinergics are drugs like Atropine.  Sodium channel blockers. and urinary retention.

spots.Inderal and metoprolol (Lopressor). increase cardiac output. BP greater than 140/90 may require medication treatment if nonmedical interventions (diet/exercise) fail. double.  Adrenergic blocking agents include bretylium and amiodarone.  Receptor site antagonists – affect BP by working on sympathetic nervous system 13 .  Monitor EKG to determine effectiveness when receiving IV dosages  Use IV pump to regulate infusion rate.  Nursing implications – o Side effects vary widely among the drug classes. or hypertension. & atrial fibrillation o Digoxin Nursing Implications  Toxic digoxin level is greater than> 2 nanograms/ml Monitor for toxicity  HR less than 60 beats/min (take 1 minute apical pulse)  N/V. halos) . o Propranolol may precipitate severe bronchospasm.information on side effects and precautions.  worsened by low K+ or Mg+. Atropine is used to treat bradyarrhythmias.common in patients with reduced hepatic function  Symptoms: respiratory depression. Antihypertensives  Individualized for each patient. This o improves blood flow to kidneys & periphery with excretion of excess fluid.verapamil (Calan) and diltiazem (Cardizem).  Calcium channel blockers . and coma. o Digoxin is used to strengthen heart muscle.  Patient teaching .  Miscellaneous – adenosine and digoxin. high Ca+.  Full 1 minute apical pulse prior to giving. & hypothyroidism o Additional Nursing Implications for Antiarrythmics  Assess intake and output ratio  Look for dehydration or hypovolemia. In general. It may also cause urinary retention in the elderly.  Beta adrenergic blockers o Examples . hypotension. diarrhea. o Lidocaine toxicity . appetite loss  visual disturbances (seeing colors.  If < 60 beats/min hold dose & notify provider  Used to treat CHF. convulsions.  Assess blood pressure and/or heart rate prior to giving. tachycardia.

arrhythmias. shortness of breath o Bronchospasm o Irregular heart rate o Impotence in men (may stop med abruptly)  Nursing Implications of Antihypertensives Patient Teaching o Information about disease & medication o Reason to take med & not abruptly halt it o Additional BP interventions (weight loss. Adverse reactions may vary by class of diuretic. nifedipine (Procardia)  Ace Inhibitors (Angiotension Converting Enzyme Inhibitors) – include captopril (Capoten).  The classes of diuretics indicate the different ways they work. If not taken in the morning. asthma. decrease stress. nocturnal frequency may occur. 14 . diabetes. muscle cramps. o Signs of low K+ include weakness.  Vasodilators – decrease BP by relaxing smooth muscles of blood vessels. o Venous pooling occurs if stand for long period. o Dizziness. atenolol. o Orthostatic hypotension common side effect of antihypertensives. etc) o Postural hypotension & why to avoid abrupt standing up Diuretics  Diuretics are used to treat hypertension. lower extremity edema. fosinopril. Adverse effects are caused by the fluid & electrolyte imbalance that occur with use. enalopril (Vasotec). and the increased intraocular pressure that occurs with glaucoma.  Common precautions with all diuretics include electrolyte imbalances. verapamil. o It is especially important to monitor for a decrease in the potassium level. o Use with caution if peripheral vascular disease is present. lisinopril (Prinivil. o Beta blockers fall in this category o Includes metoprolol (Lopressor). and postural hypotension. o Do not abruptly halt med.  Side effects of antihypertensives. edema with CHF. Loop diuretics are the class used in emergencies when a fast loss of fluid is needed (Pulmonary edema). propranolol (Inderal) o Use with caution if patient has poor cardiac function. Zestril). dehydration. o Calcium Channel Blockers fall in this category o Includes diltiazem (Cardiazem).  Furosemide (Lasix) is the most commonly used loop diuretic. Loop diuretics produce the most fluid loss of all diuretic classes.

DO NOT RUB o Cover paper with plastic film  NTG transdermal o Remove old patch before applying a new one. remember that K+ can NEVER BE GIVEN IV PUSH.. trauma.  Some patients are at high risk for low potassium associated with diuretic use – patients taking digoxin.  Use with caution when patients have hypotension or volume depletion.  Carbonic anhydrase inhibitors are mild diuretics often used to treat glaucoma.  Common side effects of nitrates are: o Headache o Dizziness associated with hypotension o N/V o Agitation. and with patients experiencing heart failure after MI. Also used for acute renal failure secondary to drug overdose.  NTG ointment 2 % o Remove ointment from old site o Measure prescribed amount on application paper o Place paper on nonhairy area in new site & tape in place. These patients may be placed on potassium sparing diuretics like spironolactone (Aldactone). and increased heart rate. facial flushing. o If K+ level too low. An example is Diamox. Hydrochlorothiazide (HCTZ) falls in this class.  Thiazide & Thiazide-Like Diuretics are considered to be mild diuretics when compared to Loop diuretics. document in BCMA 15 . May increase the effect of hypotensive drugs so monitor BP.  NTG sublingual o 1 tab SL every 5 minutes for chest pain. o If removed at bedtime. Max of 3 tabs o Keep in original bottle o Replace bottle every 3 -6 months  NTG parental injection – the drug should be diluted in a glass bottle solution and used with special tubing from manufacturer (80% drug absorbed by regular IV tubing).  They are contraindicated with alcohol use and should be used in caution while administering calcium channel blockers and other antihypertensive medications. An example is Mannitol. or with cardiac arrhythmias. Alcohol use may increase hypotension so discourage patients from drinking. Nitrates  Used to reduce the pain of angina and/or prevent angina. shock.  Osmotic diuretics are treatment of choice for increased intracranial pressure. treat high BP.

H/A. glossitis (inflammed tongue). abdominal pain. insulin decreases blood sugar.  Patient teaching includes reporting signs of infection. anorexia. antibiotic antitumor drugs.  Insulin is a very dangerous drug – always double check dose with another nurse. fatigue. o GI side effects: N/V. Chemotherapeutic agents  Chemotherapeutic agents interfere with cell reproduction or replication at some point in the cell life cycle.  Symptoms of hypoglycemia (Insulin reaction) . Chemotherapeutic agents include: antimetabolites. or shortness of breath.is available in SL. dry & flushed skin  Never shake insulin – roll between palms of your hands. headache. Monitor liver function tests before and during therapy. chewable and oral forms. acetone breath (sweet). dry mouth. weakness  Symptoms of hyperglycemia (ketoacidosis) – Nausea. dizziness)  Isosorbide dinitrate . glyburide. o Patch is placed on an area of skin free from hair. o Alopecia (hair loss) common – distressing to patients. o Remove prior to defibrillation (aluminum back on patch may cause arcing / burns)  Patients should sit / lie down before taking med (postural hypotension. signs of anemia.  Epoetin Alfa (recombinant human erythropoietin) will stimulate the red blood cell production in the bone marrow. thirst. polyuria (excessive voiding). increased temperature. diarrhea. alkylating agents. 16 . If not clear. Site is rotated. Insulin / Oral Hypoglycemic Agents  Oral antidiabetic agents cause functioning beta cells in the pancreas to release insulin. Note signs of bleeding.  Monitor CBC for decreased WBCs and decreased platelets. fatigue. drowsiness.  Most common side effects – o Hematological side effects occur from bone marrow suppression. tremors.  Only use an Insulin syringe to draw up insulin. Obtain renal function tests before and during therapy and record I&O. (Diabinese. discard & get new vial.  Only REGULAR insulin can be given IV. etc)  Whether released by body or given to patient. and hormonal agents.

o Patient should carry source of fast glucose (soda. Remove needle without pulling up med. etc) to treat hypoglycemia. don’t contaminate Regular Insulin with the other form of insulin you need to draw up. See example below: 1) Inject air into the NPH vial as shown. 4) Now insert needle into NPH vial & withdraw NPH dose.  Nursing Implications o Assess blood glucose levels during treatment. Remove needle from vial. follow directions below. o For hyperglycemia. Once your needle goes into the Regular insulin vial to inject air.Drawing up regular & NPH insulin. When drawing up 2 types of insulin in same syringe. add snack. sugar. o Teach patient / family symptoms & treatment of low & high blood sugar. Regular insulin MUST be drawn up FIRST. keep it in vial until you have drawn up the regular insulin. 2. 1. use regular insulin for most rapid onset & peak. o If patient with Type 1 DM has low blood sugar everyday at same time. 2) Inject air into the Regular insulin vial as shown 3) Invert bottle & pull up Regular insulin dose 1st. Commonly used insulin Type Examples Insulin Peaks (Time to watch for insulin reaction) Rapid Acting Humalog (Lispro) 30-90 minutes Rapid Acting Novolog (Aspart) 1-3 hours Short Acting Regular (Humulin R) 2-4 hours 17 . In order to do this.

***Caution: Insulin Aspart and Lispro act more rapidly than other insulins. *** 18 . the patient is at the greatest risk for insulin reaction or low blood sugar from 2pm – 8 pm.Intermediate Acting NPH (Humulin N) 6-12 hours Intermediate Acting Lente (Humulin L) 8-12 hours Long Acting Ultralente 14-20 hours Glargine (Lantus) none Example: So if you give NPH at 8am. Lispro is clear but CANNOT be given IV.

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feet). cramping  Bulk laxatives (Metamucil) . Ex-Lax) o Increase peristalsis o Used to prepare for barium enemas or proctologic exams o Side effects – hypokalemia. Assess vital signs. famotidine (Pepcid). legs. Laxatives  Stimulant laxatives (Ducolax. occlusion. I&O. ulcers.  Check IV site for signs of phlebitis. & strengthen mucosal barrier. rate. Symptoms of fluid overload include edema. Rolaids.may be prescribed for patients with Gastroesophageal Reflux Disease (GERD). Amphojel. Check for correct fluids and IV rates. malabsorption. and check for dependent edema (sacral area. distended neck veins. infiltration of IV. weight. They include Tums. Septicemia is major concern with IV lines. heartburn. etc): o Assess the patient(s) involved o Notify charge nurse & MD (practitioner) o Fill out incident report (even if no patient harm occurred) o If the patient is receiving the IV solution of a different patient. caffeine. &/or rapid respirations. elevate gastric pH.least harmful type of laxative o Increases volume & bulk of intestinal contents. Tagamet. encouraging bowel activity o Must drink adequate daily fluid or won’t work o Used to treat irritable bowel syndrome & diverticular disease Intestinal Lubricants (mineral oil) o Lubricate feces o Used when straining must be reduced – after abdominal or rectal surgery Emollients or fecal softeners (Colace) o Lowers surface tension which allows water & fat to penetrate stools o Used when stools are dry or hard Bowel Evacuants (GoLYTELY) o Increase osmotic pressure in bowel o Prep for colonoscopies or radiologic exams 21 . Examples include ranitidine (Zantac).Intravenous Fluids / Electrolytes  Elderly and cardiac patients at higher risk for fluid overload. Some agents reduce total acid. Patients should be counseled to avoid other gastric irritants such as alcohol. protein loss. “noisy” breathing. and aspirin containing products. If you note an error (wrong fluid. also check the other patient’s status GI Agents Some agents inhibit gastric acid secretion .

delusions. obsessive compulsive disorders. worry (often used pre-op) o Benzodiazepines – Valium. feeling of “hangover” o Get out of bed with assistance o Do not use with alcohol –increases effect o Barbiturates may cause excitement & confusion in the elderly patient 22 .Haldol o Used for major psychotic problems (hallucinations. etc) o Side effects: extrapyramidal symptoms (muscle rigidity.Rectal Suppositories . nervousness. headache.Zoloft o Used for depressive disorders. panic attacks o MAO inhibitors (Nardil) may cause hypertensive crisis when tyramine – containing foods (ex – aged cheese. tremor. chianti wine. The use of alcohol should be avoided with any of these drugs.Lithium o Bipolar disorders o Contraindicated in patients with restricted sodium diets Sedatives & Hypnotics  Short acting barbiturates o Used for insomnia o Nembutal & secobarbital  Long acting barbiturates – peak over 10 – 12 hours o Used to treat epilepsy & chronic neurologic disorders o Used to sedate highly anxious patients o Phenobarbital  Benzodiazepines also used for this o For insomnia. Xanax o Patient safety – patient ask for assistance when getting out of bed o Librium used for alcohol withdrawal  Anti-Manic . high residue foods (Bran) & increased fluid intake Assess for laxative dependence / abuse Monitor electrolyte and fluid balance. dizziness. etc) are consumed  Anti-Anxiety meds o Decrease feelings of apprehension. Ativan. Ex – Dalmane & Restoril o For seizures Ex – Klonopin & Valium  Drowsiness. Psychotherapeutics These medications break down into major treatment categories.See Administration Techniques earlier in study guide Nursing Implications Encourage high fiber.  Antipsychotics . etc)  Antidepressants . loss of dexterity.

Drug dose is 16 mg / kg of body weight C. Convert first – convert 200 lbs to kg 2. Supply: Donnatol 2 mg per 1 mL c. you probably made a mistake 2. Never stop here. Use common sense. If 2.5 D. Calculate: 16 mg / kg x 91 kg = 1456 mg to give. you may have an error 2. I’ll definitely need a lot more than 1 mL Most can look & say – “I want 7. Drug dose by body weight: A. What is dose to give? 16 mg / kg = Patient weighs 200 lbs 1. THINK: Always look at the problem.5 mL” d. If your answer involves using 15 vials of a med. DRUG CALCULATIONS REVIEW How to calculate medication problems correctly: A. Then 200 lbs converted to kg will be a smaller number than 200 200 lbs divided by 2. Look at answer – 1456mg sounds reasonable. Order: Donnatol 15 mg PO b. C. Always proceed to next step. Example – a. 4. could be rounded to 1500 mg.9 or 91 kg ( a smaller number) 3. CONVERT: Always check to see if you need to convert first! The order and the drug on hand should both be in mg. THINK. B. Patient weight = 200 lbs B. If my answer were 7040 mg. 2mg/1ml = 15mg/x 15 x 1÷2 = 7. Think: If 2 mg is in 1 mL. Stop & think. or grams. etc. or mcg. 1. it sounds like too much for 16 mg / kg 23 .2 lbs = 1 kg. If your answer is to give 125 pills. LOOK at answer: 1.2 = 90. CALCULATE: Now ready to set up & calculate problem.

Simple IV rate calculations Order is for 1 Liter to infuse in 10 hours How many mL will infuse in 1 hour? 1.000 X = 500.000 units heparin Set infusion pump at _____ mL per hour 1000 units = 10.000 mL X = 50 mL/ hr 24 . 1000 mL divided by 10 hours = 100 mL / hour IV rate 3.000 units X 500 mL Cross multiply 10. Infused in 1 hour: 100 mL x 1 hr = 100 mL 4. Convert: 1 Liter IV bag = 1000 mL 2. Look at answer – I can add up 100 mL each hour to get 1000 mL in 10 hrs Complex IV rate calculations Order is for a 30 mL bag of medication to be given over 20 minutes What rate should you set the IV pump (flow rate) for? 30 mL bag over 20 minutes 30 mL = x mL Cross multiply 20 min 60 min 20 x = 1800 x = 90 mL per hour IV rate will infuse the 30 mL in 20 min Order: infuse 1000 units heparin each hour On hand: 500 mL bag containing 10.

Convert = formula wants time in minutes. Round up to 17 qtts / min Simple drug calculations Most Commonly Used Formula D x Vol (Desired is what I want) x (volume I have on hand) X= H (What I have on hand) Order: Donnatol 15 mg po Supply: Donnatol 2 mg per 1 mL Using First Formula 15 mg x 1 mL = 15 mL = 7.Drip factor formula (commit to memory): Drops / minute to set the drip to deliver in the drip chamber = Volume x Drop Factor (on box of IV tubing) Time in minutes Order reads to give 1000 mL IV over 10 hours IV set (box) says that it delivers 10 qtts / ml How many qtts/min should you set the drip to deliver? 1. 16. 1000 mL x 10 qtts/ min 600 min 4.5 mL 2 mg 2 25 . not time in hours 60 min per hr x 10 hrs = 600 minutes 2.66 qtts / min. Vol (1000 mL) x Drop Factor (10 qtts / mL) Time in minutes (600 min) 3. you can’t count fraction of a drop 5.

Calculate: 1500 mg x 1 tab 500 mg 4.Alternative Formula that can be used Dose on hand = Dosage desired Volume on hand X (volume to give) 2 mg = 15 mg 1 mL X vol (Set-up) 2 mg = 15 mg cross multiply 1 mL X vol & cancel mg 2X = 15 mL X= 15 = 7. Convert 1 gram = 1000 mg 1. Think: I want 1. 3 tabs Look at answer (3 tabs) .5 gram = 1.it makes sense 3 tabs x 500 mg each = dose I wanted (1500 mg) 26 .5 grams of drug PO On hand: 500 mg of drug per capsule 1.5 gm x 1000 = 1500 mg 2. I have 500 mg in 1 capsule I’ll need more than 1 pill 3.5 grams or 1500 mg.5 mL 2 Other drug calculations Involving Conversion: Order: Give 1.

72ml .000 units of heparin. not the number of units. The pharmacy sends up a 250 mL bag of D5W mixed with 25. The physician wants to give 12units/kg/hr and has ordered 720 units/hr per IV. 2.2 mL 27 . Example: A 60 kg patient needs to be started on a heparin drip.” Heparin Drip Orders You may have a question on a Heparin drip. An example question: Give 3600 units of heparin by IV bolus once. You also can see that the physician has already done the calculations to determine the number of units required per hour (60 kg patient x 12 units/kg/hr = 720 units / hr). Pharmacy sends up a vial of 5000 units per 1 mL. You need to note that the question asks you for mL. one time 5000 units Make sure that you put down both the mL and that it is given “one time. How many mL will be administered & how often will it be given.Involving distractors/extra information Order: Give 40 mg of Gentamycin IV every 12 hours On hand: Gentamycin 40 mg per mL Convert = no 40 mg x 1 mL = 1 mL 40 mg Involving Decimals  Use care when plugging into calculator & double check Heparin Bolus Orders A bolus of Heparin is given as a onetime order. 3600 units x 1 ml = 0. The drip will be administered at how many mL/hr? Suggestions: 1. 720 units x 250 ml = 7.

NEVER RECAP used syringes!! A.2 mL in 10 mL syringe 28 .Never use for insulin 1. Example shows 0. make sure that you write down 5. Tuberculin (TB) syringe . For example.000 units *** Make sure that you do not round the IV hourly rate when giving heparin!*** Take it out to the hundredth place. Example shows 58 units drawn up in a 100 unit insulin syringe (Each small line = 2 units) B. if your answer is 577 units of heparin per hour (5. Other Syringe 5.77 mL). Example shows 0.77 mL Syringe Review . 25. NEVER use for other meds 1. Insulin syringe – 50 unit & 100 unit syringes. Example shows 28 units drawn up in a 50 unit insulin syringe (Each small line of a 50 unit syringe = 1 unit 2.61 mL drawn up 2.05 mL of med drawn up A.

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