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This section will review assessments to be performed prior to, during, and after a medication pass to ensure safe medication administration. Pre-AdministrationIn addition to verifying the rights of medication administration three times, the nurse should also perform focused assessments of the patient’s current status and anticipate actions of the medications and potential side effects. Here are some examples of pre-assessments before administering medication:
During AdministrationThe nurse continues to assess safety during administration of medication, such as sudden changes in condition or difficulty swallowing. For example, if a patient suddenly becomes dizzy, the administration of cardiac medication is postponed until further assessments are performed. If a patient starts to cough, choke, or speak in a gurgly voice during oral or tube administration of medication, the procedure should be stopped and further assessments performed. Table 15.1 Summary of Safe Medication Administration Guidelines
Post-Administration: Right ResponseIn addition to documenting the medication administration, the nurse evaluates the patient after medications have been administered to monitor the efficacy of the drug. For example, if a patient reported a pain level of “8” before PRN pain medication was administered, the nurse evaluates the patient’s pain level after administration to ensure the pain level is decreasing and the pain medication was effective. This evaluation data is documented in the patient’s chart. Additionally, the nurse continually monitors for adverse effects from all of a patient’s medications. For example, the first dose of an antibiotic was administered to a patient during a previous shift, but the nurse notices the patient has developed a rash. The nurse notifies the prescribing provider of the change in condition and anticipates new orders or changes in the existing orders. Which medication form is commonly prepared for administration by parenteral route?Parenteral Route of Medication
Intravenous injection is the most common parental route of medication administration and has the benefit of bypassing the first-pass metabolism by the liver.
Which adverse effect involves overreaction or Underreaction to a medication effect?Idiosyncratic Effects
When a patient has a reaction to a medication that is not desired, predicted, or expected, this is an idiosyncratic effect. In this situation, the patient will overreact, or underreact to the medication.
Which route of administration did the nurse use if the medication was administered in the subarachnoid space?Intrathecal. The intrathecal route uses a catheter place in the subarachnoid space or a ventricle of the brain to administer medication.
Which route of administration is beneficial in an emergency situation for an infant with poor access to intravascular space?For critically ill children, the intraosseous route is quick and safe because it involves non-collapsible vascular access - unlike the peripheral veins, which undergo vasoconstriction during clinical and traumatic situations, leading to shock that prevents puncture and maintenance of an appropriate route for treatment.
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