Joshua Shared "N406 Exam III" - 49 Picmonics
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N406 Exam III
6 Rights of Medication Administration
- Right Patient
- Right Medication
- Right Dose
- Right Time
- Right Route
- Right Documentation
- Nursing Considerations
- Three Checks
- Check for Allergies
- Assess the Patient
- Education
2 mins
Peak and Trough
- Peak
- Highest Concentration
- Trough
- Lowest Level of Therapeutic Range
- Obtain Before Next Dose
- Half-Life
2 mins
Routes of Administration Part One
- Enteral Administration
- Oral
- Sublingual
- Buccal
- Rectal
- Tubes
- Topical or Mucous Membrane Administration
- Transdermal
- Drops/Spray
- Vaginal
- Inhalation Administration
- Inhalation
2 mins
Routes of Administration Part Two (Parenteral)
- Parenteral Administration
- Intradermal
- Subcutaneous
- Intramuscular (IM)
- Intravenous
- Epidural
- Intrathecal
- Intraosseous
- Intraperitoneal
2 mins
Eye Medication Administration
- Procedure
- Supine with Neck Hyperextended
- Wash Away Crusts
- Cotton Ball on Cheekbone
- For Ophthalmic Drops
- Instill Drops into Conjunctival Sac
- Repeat if Missed or Patient Blinks
- 5 Minutes Before 2nd Medication
- For Ophthalmic Ointment
- Thin Stream Along Inner Edge
- Inner Canthus to Outer Canthus
2 mins
Ear Drops Medication Administration
- Indications
- Earwax Buildup
- Ear Infections
- Pulling The Pinna
- Child - Back and Downward
- Adult - Back and Upward
- Procedure
- Side-Lying with Ear Up
- Instill Medication
- Stay for 2-3 Minutes
- Nursing Considerations
- Room Temperature
- May Massage Tragus
- Perforated Eardrum
2 mins
Intramuscular Medication (IM) Administration
- Risks
- Injury to Nerves, Bone, and Blood Vessels
- Sites
- Deltoid
- Vastus Lateralis
- Ventrogluteal
- Nursing Considerations
- Selection of Needle Length
- Aseptic Technique for Drawing Up
- Z-Track
- 90 Degree Angle
- Max Amount (2-5 mL Adult, 1 mL Child)
- Techniques to Reduce Pain
2 mins
Transdermal Medication Administration
- Application
- Patch or Disc
- Directly on Skin of Arms, Chest, Upper Back
- Benefits
- Avoids First Pass Metabolism
- Sustained Administration of Medication
- Nursing Considerations
- Clean Skin After Removal
- Rotate Sites of Patches
- Apply to Dry Skin
- Avoid Shaved Skin
- Avoid Heat
- Nitro Effects Lost After 24 Hours
2 mins
Total Parenteral Nutrition (TPN)
- Mechanism
- Nutrition Given Outside GI
- Side Effects
- Hyperglycemia
- Hyperlipidemia
- Refeeding Syndrome
- Nausea and Vomiting
- Considerations
- Slow IV Infusion
- Use Large Central Vein
- No Added Meds to TPN Line
2 mins
Needle Sizes and Uses
- Adjust Size Based on Height/Weight
- Subcutaneous Injections
- 3/8 or 5/8 inch
- Intramuscular (IM)
- 1-1.5 inches
1 min
Mixing NPH and Regular Insulin for Injection
- Verify Order
- Roll NPH Insulin
- Alcohol to Multiuse Vials
- Inject Air into NPH Insulin (Cloudy)
- Inject Air into Regular Insulin (Clear)
- Withdraw Regular Insulin Units
- Withdraw NPH Units
- Verify with 2nd Nurse
- Discard if Error
3 mins
Normal Electrolyte Lab Values
- Potassium (K+)
- 3.5 to 5.0 mEq/L
- Calcium (Ca2+)
- 8.5 to 10.5 mg/dL
- Phosphate (PO43–)
- 2.5 to 4.5 mg/dL
- Magnesium (Mg2+)
- 1.5 to 2.5 mEq/L
- Sodium (Na+)
- 135 to 145 mEq/L
- Chloride (Cl–)
- 95 to 105 mEq/L
2 mins
Hypokalemia
- Assessment
- < 3.5 mEq/L
- Muscle Weakness
- Arrhythmia
- U Wave
- Ileus
- Hyporeflexia
- Interventions
- IV K+ Infusion at 5-10 mEq/hr
- Give Orally with Food
- Nursing Considerations
- Monitor Respiratory Status
3 mins
Hyponatremia
- Assessment
- < 135 mEq Na+
- Nausea and Vomiting
- Decreased LOC
- Confusion / Lethargy
- Seizures
- Priority Interventions
- Assess Airway
- Reduce Diuretic Dosage
- Fluid Excess Hyponatremia
- Mannitol (Osmitrol)
- Fluid Restriction
- Fluid Deficit Hyponatremia
- Hypertonic Solution (3% or 5% NaCl)
2 mins
Hypernatremia
- Assessment
- > 145 mEq/L Na+
- Change in LOC
- Extreme Thirst
- Orthostatic Hypotension
- Dry Flushed Skin
- Muscle Twitching
- Seizures
- Priority Interventions
- Treat and Prevent Dehydration
- Hypotonic Solutions (0.225% or 0.45% NaCl)
- Sodium Restriction
- Diuretics
2 mins
Hypocalcemia
- Muscle Spasms
- Assessment
- < 8.5 mg/dL Ca2+
- Decreased Bone Density
- Tetany
- Chvostek's Sign
- Trousseau's Sign
- Increased DTR
- ECG Changes
- QT Prolongation
- Considerations
- Oral and IV Replacement of Ca2+
- Seizure Precautions
2 mins
How to Interpret Acid Base Disorders
- pH, pCO₂, HCO₃ (Bicarbonate)
- Step 1
- pH
- Acidosis
- Alkalosis
- Step 2
- pCO₂
- Opposite Direction as pH
- Respiratory Acidosis
- Respiratory Alkalosis
- Step 3
- HCO₃ (Bicarbonate)
- Same Direction as pH
- Metabolic Acidosis
- Metabolic Alkalosis
3 mins
Respiratory Acidosis Assessment
- Assessment
- Decreased pH < 7.35
- Increased PaCO2 > 45
- Reduced Respirations
- Anxiety
- Change in LOC
- Tachycardia
- Cyanosis
- Increased Electrolytes
- ECG Changes
- Muscle Weakness
- Hyporeflexia
2 mins
Potassium (K+) Lab Value
- 3.5 to 5.0 mEq/L
20 secs
Calcium (Ca2+) Lab Value
- 8.5 to 10.5 mg/dL
26 secs
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