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MEDICAL CALCULATIONS
• 6 RIGHTS OF MEDICATION ADMINISTRATION:
o RIGHT PATIENT
• Check id bracelet
• Ask pt name and birthdate
• Check name on pts medication label
o RIGHT MEDICATION
• Make sure drug order is complete and legible
• Check drug label 3 times
• Check expiration date
• Know the drug action
o RIGHT DOSE
• Calculate drug dose
• Know recommended dose for the drug
• Recalculate dose with another nurse when in doubt
o RIGHT ROUTE
• Know proper route of administration
• Use aseptic techniques
• Document injection site on patients chart
o RIGHT TIME
• Administer drug at specified time
• Document any delay or omitted drug dose
• Administer with food if it irritates gastric mucosa
• Administer ATB in even intervals q6h, q8h
o DOCUMENTATION
• Place initials on MAR and eMAR
• Document that pt refused or drug was omitted by circling
initials
• Indicate on the MAR if drug was delayed and time it was
given
• TYPES OF DRUG ORDERS:
o Standing or Routine: Carried out until Dr cancels or prescribed
number of days has passed.
o PRN: Given at patient’s request or nurses’ discretion.
o Single (One Time): Given once at a specific time.
o STAT: Given immediately and given once.
o NOW: Client needs meds quickly but not right away, has 90 min.
to administer.
o Prescription: To be taken outside of hospital.
• TWO IDENTIFIERS:
o PT’S ID BAND
o HAVE PT STATE NAME AND DOB
o PT FAMILY MEMBER
o MARS
• PHARMACIST ROLE:
o Prepare and distribute
o Mixing solutions
o Fill RX accurately
o Dispensing correct medication, proper dosage and amount with
accurate labels.
• DISTRIBUTION SYSTEM:
o Pharmacy gets orders, prepares orders, and delivers.
o Medication rooms, pixys.
• NURSES ROLE:
o Admin medication to client
o Verify 6 rights
• MEDICATION ERROR:
o Notify supervisor, physician, patient
o Document on variance form
o Fill out incident report
1 GM = 15 GR 1 GR = 60 MG
1 IN = 0.0254 M 1 IN = 2.54 CM
1 L = 32 OZ 1 OZ = 30 ML
1 KG = 2.2 LBS
30 ML = 1 OZ = 8 DR = 2 T = 6t
STEPS IN DRAWING UP INSULIN, HUMULIN R & N:
• Cleanse stoppers with alcohol, roll between palm of hands to mix
the insulin
• Draw up air for amount of humulin n and inject into bottle, make
no contact with medication, pull needle out
• Draw up amount of air for humulin R, inject in bottle and
withdraw same amount of medication
• Inject needle in humulin n and withdraw medication
• Administer immediately.
• Always draw up insulin R before N!!!!!!!!
Z-TRAC INJECTION:
• Used to minimize local skin irritation by sealing meds in muscle
tissue.
• Select site and prepare with alcohol
• Pull overlying skin and subcutaneous muscle 1 to 1 ½ inches
laterally to side.
• Hold skin taut with non dominant hand, inject med deep into
muscle
• Needle stays in for 10 seconds to allow meds to disperse
• Release skin after withdrawing needle
HEPARIN
MORPHINE
USUAL DOSAGE: 4-10 mg every 3-4hours starting dose 50 years and older
MI 8-15 mg q3-4h, <50 years old .05-.2 mg/kg q3-4h
Neonates .05mg/kg q4-8 h
NITROGLYCERIN
ROUTE OF ADMINISTRATION:
Sublingual
Buccal
By mouth
IV
Transdermal
SPECIAL CONSIDERATIONS:
» Anemia, severe
» Cerebral hemorrhage or
» Head trauma, recent (nitrates may increase cerebrospinal fluid pressure)
» Glaucoma (nitrates may increase intraocular pressure)
Hepatic function impairment, severe (increased risk of methemoglobinemia)
» Hyperthyroidism
Hypertrophic cardiomyopathy (angina may be aggravated)
Hypotension, with low systolic pressure (may be aggravated, accompanied
by paradoxical bradycardia and increased angina pectoris)
» Myocardial infarction, recent (risk of hypotension and tachycardia, which
may aggravate ischemia)
• SUBCUTANEOUS INJECTIONS:
o Outer posterior aspect of the arm
o Abdomen below the costal margins to the iliac crest
o Anterior aspect of the thighs
• INTRAMUSCULAR INJECTIONS:
o Vastus Lateralis: anteral lateral aspect of the thigh
o Ventrogluteal: locate by placing heel of hand over greater
trochanter of hip using index finger and thumb to create triangle.
o Deltoid